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What’s The Deal With Perseveration?

What’s The Deal With Perseveration?

Image: Gadi

What is it?

Perseveration means to respond in the same way repetitively, and can include behaviours like echolalia, stimming, stereotypies, obsessions and routines.

But repetition is only half the story when it comes to perseveration. It’s not just about doing the same thing over and over - it’s continuing to do that thing past the point where it’s reasonable to stop (because the conditions have changed or the behaviour no longer serves a purpose) or being unable to stop. And that’s the key idea about perseveration, the ‘being stuck’ part.

Perseveration can involve actions, thoughts, words, phrases and emotions. For example:

  • Continuing to talk on a topic after the conversation has moved on
  • Anxiety about an event which has passed or no longer a threat
  • Asking the same question over and over despite receiving an answer
  • Not being able to move on from feeling angry
  • Constantly talking about something that happened weeks ago
  • Banging a box on the table to get it to open even though it’s clearly not working
  • Giving the same answer to a different set of questions
  • Looking for a toy in the place where it used to be hidden
  • Texting a new friend over and over even when they don’t reply
  • Repeatedly going over previous conversations in your mind
  • Calling the new teacher by the old teacher’s name
  • Walking around with a towel in your hand long after your shower is over

 

Why does it happen?

Perseveration isn’t a single behaviour but rather a way of thinking and behaving. It can be:

  • A response to stress, exhaustion or overload
  • A way to self-soothe and relax the mind or body
  • A way of processing thoughts and experiences 
  • A learning style where information is parsed in more detail
  • A neurological inability to shift attention or inhibit certain responses

Let’s take a closer look at this last one, because there’s a big difference between wanting to do things in the same order because it provides a sense of calm and needing to do those things because you’re stuck and can’t move on.

Cognitive flexibility is part of executive functioning, and it means being able to cope with changes in environment or demands by adjusting your thought processes. People who have difficulty shifting their attention, thinking about different things at once or thinking about different angles of the same thing at the same time (e.g. seeing all the possible solutions) are said to be cognitively inflexible, or rigid thinkers.

These people can have trouble adapting to new information or situations which require different ways of thinking and solving problems. When it’s difficult to override older thought processes and responses that have become really ingrained or habitual, behaviours start to perseverate.

Another executive function involved with perseveration is being able to curb or interrupt what are called prepotent responses. These are responses that have become so ingrained that our reactions become impulsive - like grabbing for your phone when you hear the text message alert.

Sometimes we have to control that impulsive reaction so we can respond to a different situation in the right way, like refraining from reading text messages at the dinner table. That kind of control can be difficult for some people, and without it they continue to respond in the same way even when the context or environment around them changes.

A side effect of this kind of repetition is that the more you repeat an activity that you feel strongly about, the more your emotions become aroused. This emotional dysregulation then in turn makes it even harder to disengage and shift focus.

 

Let’s look at an example

Your son is excited and nervous about starting school, so he asks you when the first day will be. You reply “Next Tuesday” and the answer eases his anxiety. The next time he feels nervous, he responds in the same way - to ask you again when the first day will be, despite the fact that he already knows the answer. There are a few different reasons why he might be doing this:

  • The repetitive and predictable response is soothing
  • It’s giving him time to process the information and/or how he feels about it
  • His lack of cognitive flexibility is preventing him from adjusting his reaction based on the changes in the situation (getting the answer to his question or you getting increasingly annoyed at having to give it so many times) 
  • He’s having trouble suppressing his impulse to ask the question
  • He’s having trouble stopping himself once he starts
  • The more he asks, the more emotionally invested he becomes which is making it even harder to switch his attention to something else

The answer could be one or all or none of these. But the upshot is that perseveration isn’t always voluntary or controllable, so people who perseverate aren’t just being stubborn or defiant or noncompliant... and the solution isn’t going to be as easy as saying “just stop thinking about or doing that thing”.

 

Is it a bad thing?

The term perseveration is most often used when talking about dysfunctional behaviour - acting beyond a point which has been deemed ‘reasonable’. But that point isn’t clearly defined and is in fact highly subjective - who decides how long you can talk about a single topic before it becomes boring?

And is it more of a problem if that topic isn’t an interest that most people share? Is the guy at work who talks about sports every day more dysfunctional than the woman who wants to tell you about Ancient Roman aqueducts?

In fact, although perseveration is one of the defining features of autism (and is also said to be characteristic of other conditions such as Fragile X, Down Syndrome, Alzheimer’s, ADHD and brain injury), almost everybody behaves perseveratively at some point... but then it tends to be called by other names, like ruminating or worry or tenacity or diligence.

There are times when thinking or behaving repetitively can be extremely useful. It can help you to:

  • Work through thoughts and gain greater understanding
  • Categorize experiences and ideas
  • Process intense emotions and trauma
  • Gain expertise in an area or skill
  • Turn short-term memories into long-term ones
  • Continue until you find a solution
  • See things in greater detail
  • Consider all the angles and possibilities

In short, it can be a wonderful tool for learning.

But this repetitive way of responding starts to become a problem when the perseverating isn’t productive or stops you from reaching a goal. For example, when:

  • You can’t make a choice or take too long pondering the options that they become unavailable
  • You can’t learn or get other things done because your mind is stuck on one topic
  • It interferes with communication
  • It hampers your social connections because other people become annoyed or bored or frustrated with you
  • It keeps you from experiencing positive emotions
  • It stops you being active or eating a diverse range of healthy foods
  • You can't stop it even though you want to

In these kinds of situations perseveration is indeed problematic.

And while repetitive actions can at times be enjoyable and soothing, being fixated and unable to move on can also be an incredibly frustrating thing to experience - like being stuck in a loop without making any progress, or walking down a path even though you know it doesn’t lead where you wanted to go.

So repetitive behaviour is in itself neither good nor bad - it’s the outcome of that behaviour for a particular person in a particular situation that determines whether or not it’s a problem.

 

What can you do about it?

As we’ve already seen, perseveration doesn’t automatically cause problems... but here are some ideas for how to help when it does.

Talk about it

It’s important for kids to understand how their own brains and bodies work. Talk about their tendency to act repetitively - why it happens, what it means, how it can be a positive thing and how to avoid it becoming a problem.

Assess the problem

Is there one? Who is it a problem for? Is the behaviour always a problem or only in some situations? Does the person have control over when and whether they stop doing it?

Identify the ‘reasonable’ stopping point

Remember how perseveration is about doing a behaviour past the point at which you should stop? Well you need to know what that point looks like, to identify the line between ‘okay’ and ‘problem’.

Encourage self-awareness

Being aware that you’re perseverating is an important tool for developing self-regulation and control over your own behaviour. This includes not just noticing that you’re acting repetitively, but knowing when you’re stuck and deciding whether or not that’s a problem. You might want to compile some questions that can help, like:

  • Is this action helping you?

  • Are you getting anywhere?

  • It is time to stop?
  • 
Is this behaviour still appropriate?
  • Is this stopping you from doing other things?
  • Is this causing a problem for other people?
  • What can you do about it?

Be patient

It can be really frustrating when someone asks you the same question over and over, only talks about one topic or keeps trying a solution that obviously isn’t working. But they’re not deliberately trying to make your life hard - they may be stressed, thinking things through, or stuck and need help to move on... and having someone yell at them or be visibly annoyed isn’t helpful. So figure out how to manage your own reaction.

Be flexible

The ability to overcome perseverations differs greatly depending on the task and whatever other demands are coming in at the same time - so remember that controlling the behaviours isn’t always a sign of how hard someone is trying or how compliant they’re being.

Be careful with setting limits

Curbing the impulse to perseverate requires a degree of self-regulation that can take a while to develop. Giving someone a limit for how long or how often they can perseverate isn’t always helpful because no matter how much they may want to comply with a request to stop or move on, they might not be able to.

Make it visual

When the perseveration is a thought, you can sometimes feel more control over it when it’s turned it into something external and physical that can be touched and seen and manipulated e.g. drawing a picture of it and then screwing up the paper into a ball.

Distraction and redirection

Sometimes throwing in another stimulus or prompt to respond to is enough to disengage attention - changing the topic, moving to another room, swapping to another preferred food or activity.

Build a bridge

If moving on from repetitive behaviours is proving difficult, try to make a smoother connection to the next thing so the transition is less huge and jarring. For example, someone who is perseverating on dinosaurs might like to talk about what plants the dinosaurs ate, which might allow the conversation to move on to other topics like gardens or insects.

Avoid triggers

If you can identify the stimulus for the repetitive behaviour you can try to avoid setting up a situation which starts the ball rolling, like driving a different route to school that bypasses the ice cream shop that acts as a cue for your son to ask when his next birthday will be.

Exaggerate environmental cues

Sometimes the problem is that they’ve missed the signs that things have changed and the behaviour needs to as well. Making these changes obvious or using reminders of the new behaviour conditions can help trigger the shift to the correct response, such as pointing to the new teacher’s name on the board when it’s time to say good morning.

Reduce anxiety

Perseveration is often a response to situations which are frightening or worrying, so providing reassurance, stability, consistency and protection can help ease those concerns and hence the need to engage in repetitive behaviours.

Cognitive exercises

Practice activities which promote flexible thinking, and develop mental strategies for breaking free of repetitive thoughts (like visualizing putting the thought in a room and closing the door).

Make it productive

Channel the behaviour into a more positive outcome e.g. use intense interests to start conversations or teach math skills.

 

The bottom line

There are times when perseveration can be a useful strategy for learning, processing or coping with the world around us, and some of us are hardwired to do this more readily than others.

But sometimes these repetitive behaviours can become unproductive or problematic, or affect our ability to adjust to new situations. At those times perseveration becomes dysfunctional, and learning how to spot where that line is can be just as important as knowing what you can do to help.

This article was first published on 15 December 2013

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