Repetitive behaviour and special interests

What the guideline was about

The guideline dealt with them under one shared target symptom, “repetitive behaviour, disruptive special interests and sensory hyper- or hyporeactivity”. ^{[1, Rec. 23]} The word “disruptive” is important: the guideline did not say that repetitive behaviour or special interests in themselves needed to be treated. What “disruptive” means in an individual case depends on the situation and the person. This article does not explain why people with autism repeat certain actions or what function special interests have, because the sources we read contain no statements on this.

Recommendations for young children

For toddlers and preschool children, the guideline (recommendation grade A) says that the same therapy approaches used to promote social interaction and communication should be applied. They should also improve disruptive repetitive behaviour and sensory differences. Approaches that foster parental synchrony and responsiveness are recommended in particular. These include child-led play, including symbolic play, and targeted practice in widening the child’s interests. ^{[1, Rec. 23]} More on this: Autism-specific therapy and support.

In addition, parents should be guided individually and systematically by trained behavioural therapists. The basis is behaviour analyses of specific situations in which disruptive behaviour occurs repeatedly; the techniques include structuring everyday life to avoid disruptive stimuli, extinction by ignoring, building up alternative behaviours, and child- and development-appropriate exposure methods (recommendation grade B). ^{[1, Rec. 23]} Where sensory differences are pronounced, guided exposure to different sensory stimuli can be added (recommendation grade 0). ^{[1, Rec. 23]}

School-age children, adolescents and adults

• School-age children and adolescents: The therapy approaches for promoting social interaction can also be used here; parents and also integration assistants or special educators in schools should be additionally guided after behaviour analyses (consensus-based). ^{[1, Rec. 24]}
• Adults with intellectual disability: Parents, carers, trainers and other people close to the person should be guided after behaviour analyses so that they can use specific techniques in everyday life, work or a residential group. ^{[1, Rec. 25]}
• Adults without intellectual disability: Group-based approaches for promoting social interaction can also be used for improvement. ^{[1, Rec. 26]}
• Medication: For strongly pronounced repetitive behaviour, children and adolescents may be offered certain antipsychotics for a limited time in addition to psychosocial measures; this is decided by physicians, weighing desired and undesired effects. ^{[1, Rec. 28]} More: Medication in autism.

What should not be used

According to the guideline, no therapies beyond the psychosocial and medication approaches mentioned can currently be recommended. Procedures involving direct punishment or coercive measures must not be used under any circumstances to treat stereotyped behaviours, special interests or sensory hypo- or hyperreactivity (strong consensus). ^{[1, Rec. 30]}

Critical remarks in the guideline

• Undesired effects: For psychosocial interventions, no undesired effects are known so far when they are carried out correctly, but they have rarely been studied systematically. From the perspective of a self-advocacy organisation (Aspies e. V.), which the guideline reproduced, there are situations in which exposure does not lead to desensitisation but to mere habituation to endurance, which costs strength and resources. ^{[1, Rec. 27]}
• Dissenting opinions: For the recommendation for adults without intellectual disability there were dissenting opinions from professional associations of behavioural therapy and from Autismus Deutschland: individualised methods should be used, and group therapy can be a component alongside individual therapy. ^{[1, Rec. 26]}

What else you should know

• Not everything repetitive is a problem. The guideline referred to disruptive behaviour. When support makes sense is something to discuss with professionals who take your view seriously.
• Stimuli and structure in everyday life: Sensory processing and perception and Routines and structure in everyday life.
• Leisure and interests: Leisure and special interests.
• On stimming (self-stimulation) in detail, the sources we read contain no separate account; the article on it remains open.

Sources and literature

1. DGKJP, DGPPN et al. Autismus-Spektrum-Störungen im Kindes-, Jugend- und Erwachsenenalter. Teil 2: Therapie. S3-Leitlinie, AWMF-Reg.-Nr. 028-047, Stand Text 02.05.2021 (Kap. C.1; Empf. 23–28, 30). – Guideline (in German); expired on 23 March 2026 (see no. 2)
2. DGKJP. Aktuelle Leitlinien (Eintrag 028-047: „Gültig bis 23.03.2026“). https://www.dgkjp.de/wissen/aktuelle-leitlinien/ – Professional society (website in German)