Perseveration becomes a problem when it interferes with normal life activities. Especially it becomes a problem when someone gets “caught in a loop,” and it involves escalating emotions. The target of the perseveration may be about a past emotional injury such as bullying, teasing, or an injustice, or a fear about the future, “What if…,” or it may be about something the person wants to do or have that is not possible or reasonable to obtain at that particular moment. The person may believe that they must do or have this thing, and emotionally escalate and even become aggressive in the attempt to get or do something they want in order to satisfy their anxiety about getting/not getting.
There are several ways to help someone overcome a perseverative behavior or verbalization.
One is to abruptly interrupt, or redirect, by quickly substituting a safer topic to think about or activity/object as a distraction.
A second would be to gently redirect by joining in and mirroring the perseverative behavior and modify it slightly to make it a socially relevant conversation or game.
You could also try a cognitive-behavioral technique, exploring the logical problem with thinking you must or you have to, reviewing what are the things you really must have to survive, like air and water. Point out the difference between wanting and needing.
Remind them to “Catch the thought,” and “Use your brain filter.” State that not all thoughts need to be spoken and to consider what others want and need to hear from you.
Make a T-chart of good things to think about and not-so good things to think about.
Explain the process and problem of “getting stuck in a loop” and generate a catch phrase to cue the person to make an effort to think and talk about one of their good things to think about. You could also use a gesture such as placing your hand over your mouth and saying “Oops! Catch yourself!”
Explore with your subject how they feel when they get stuck. Do they like this feeling? How do they know when they are getting stuck? How do people around you think and feel when you repeat the same thing over and over? Do other people like you better when you pay attention to what they are talking about?
Behaviorally you could ignore and move away when the perseveration presents, and offer rewards when the person successfully catches themselves and stops or switches to something else.
If the perseveration has an obsessive-compulsive component, you could practice Exposure and Response Prevention (ERP). For example, your subject gets stuck thinking they must get up and open and close the door seven times. You would spend several minutes a day asking them to think really hard for several minutes about having to do this behavior, and then don’t allow them to do it. Continue this for two to four weeks. If one disruptive behavior stops and there are others or another appears, you can switch to another obsession/compulsion.
Finally, you could make a “Perseveration Station,” a place to go when stuck with highly desired activities that are incompatible with the perseveration, and hopefully interesting enough to engage and distract. Or, you could direct them to this place at a regularly scheduled time of day, and instruct them to spend 15 minutes perseverating, hoping that they will get tired of it and say, “But I don’t want to do this anymore, or, I don’t want to worry.” This would be practicing paradoxical intention.
I hope this helps you stop an autistic child from perseverating at least sometimes and ease both your and their suffering.
If you have more ideas, email them to me and I will add them to this list.
You can find this document in pdf along with many more forms, templates, and free courses I have set up to help you help children who struggle here.
Taken from my book Diagnosis Autism or Aspergers: Now What?
Thank you to Brad Mason of Intensive Care for You for your kind permission to use this article