Repetitive Behaviour in Lowe Syndrome
Repetitive behaviours are frequently reported in individuals with intellectual disabilities, with differences in the type of repetitive behaviours noted for certain syndromes.
‘Repetitive behaviour’ is an umbrella term encompassing a range of behaviours including adherence to routines, insistence on sameness, stereotyped behaviours (e.g. a repetitive or ritualistic body movement, posture, or utterance) and restricted preferences. To read some introductory information about repetitive behaviours, please visit our key topics area and select 'repetitive behaviours' from the drop down menu.
Previous research has suggested that around 8-9 out of 10 individuals with Lowe Syndrome show stereotyped behaviour, while 8 out of 10 showed repetitive hand movements, mannerisms and habits. Research comparing individuals with Lowe syndrome to individuals with other genetic syndromes, has found that individuals with Lowe syndrome show higher rates of lining up behaviours and repetitive hand movements, including repeatedly waving their fingers or hands in front of the eyes. It has been suggested that waving fingers in front of their eyes may be related to the visual impairments that are common in individuals with Lowe Syndrome; to read more about these visual impairments, visit the Lowe syndrome health page.
Further common repetitive behaviours include sudden or rapid motor movements or vocalisations, repetitive language, flapping hands, twirling or repetitively moving objects or body parts, a strong fascination or attachment to specific objects and an intense fear of seemingly neutral objects or noises.
You can download original research here:
Moss et al. (2009). Repetitive Behaviour in Genetic Syndromes.
Research indicates that those who score higher on measures of repetitive behaviours were more likely to engage in behaviours that challenge, such as self-injury.
The Executive Function Theory (EF Theory) argues that repetitive behaviours may occur because of a deficit in executive functions. These are a set of brain based processes involved with putting the brakes on behaviour (inhibitory control), holding information in mind (working memory), and being able to respond flexibly to changes (cognitive flexibility). EF Theory suggests that specific types of repetitive behaviour are linked to specific deficits in EF. For example, inhibition difficulties could underpin repetitive questioning and object stereotypy, while difficulties set-shifting (task-switching or cognitive flexibility) may underpin adherence to routines.
Obsessional Behaviour
The Lowe Syndrome Association found that 4 out of 10 of their participants reported obsessive/compulsive behaviours.
Around half of individuals presenting obsessive behaviours also experienced issues regarding emotional control. These issues with emotional control may be linked to challenging behaviours, such as temper outbursts.
Also, 6 out of 10 individuals with Lowe syndrome had experienced a need for sameness, particularly having restricted interests and maintaining rigid routines.
There was also evidence of individuals with Lowe syndrome showing hypervigilance to correctness, such as repeatedly asking for reassurance that something they said/did was correct, and feeling a need to “confess”.
Sometimes, these types of repetitive behaviour may have a link to anxiety.
Interventions for Repetitive Behaviours
It is important to bear in mind that repetitive behaviours are not always problematic to either the person carrying them out or the people around them. Sometimes, though, they can occur very frequently or be very intense; at this point, the behaviour may start to interfere with the person’s day to day activities and well-being, and it is then important to look at methods of reducing or stopping the behaviour in question, while replacing it with more adaptive behaviour.
It is important to remember that behaviours often occur for a reason and serve a purpose, and before trying to reduce behaviour, you must first know the function of the behaviour. When reducing the repetitive behaviour, you must make sure that the alternative behaviour meets the same needs the old one did.
Please bear in mind that some of the following methods may work for some individuals and not others, and to seek psychological support if you are concerned.
There are a number of interventions that may help you manage your child’s repetitive behaviours. These will be listed below, categorised by the type of behaviour:
Managing Repetitive Movements
Prompts to stop the behaviour, combined with a reward system where the individual is rewarded if they can spend increasing periods of time without displaying the behaviour in question.
Depending on the function and type of behaviour, introducing fidget toys or stress balls in order to allow the same level of sensory stimulation or distraction.
Remember– you must first determine the function of behaviour, and then put a more acceptable alternative behaviour in place that fulfils the same need.
Managing restrictive adherence to routines
Rewarding the individual for gradually tolerating more changes in their routine. For example, creating a visual aid, such as a chart, where their weekly routine is laid out using pictures or symbols, and introducing a ‘?’ time slot which is unplanned, and gradually increasing this.
Managing insistence on sameness
Rewarding the individual for gradually tolerating an increasing number of changes to their environment. For example, if the furniture must stay in the same place all the time, you can start by taping around the furniture and stating it now needs to stay within the taped outline, then gradually making the taped space larger and moving the furniture within this space, until the taped area is large enough to move the furniture freely around the room.
Managing repetitive speech or questioning
Bear in mind that for these strategies to be effective the individual with Lowe syndrome will need to be provided with social attention for engaging in speech/questions that are not repetitive.
Explaining to the individual with Lowe syndrome that their questions will only be answered once, and that further questions on the same topic will not be responded to.
If the person can read, write the answer to the repetitive question on a piece of paper when it’s first asked, then redirect the individual to that when the question is asked again. A memory aid like this could also use pictures.
Insisting that once the individual’s question has been answered once, they then answer their own repetitive questions.
If the repetitive questioning continues, explain that you’ve already answered that question but are willing to discuss their choice of one of a few topics with them.
Allocating a special time of the day during which they are allowed to talk about their special interests or ask their repetitive questions.
Use a scripted format to introduce better conversational strategies and practice these across various topics and situations.
Teach self-control skills by encouraging the person to play simple games where they have to wait for their turn.