Man overwhelmed due to perseveration. He is struggling with obsessive and repetitive thoughts.

What is the difference between obsessing and perseveration? Perseveration refers to the repetition of a particular behaviour, thought, or activity. How it becomes visible may look to others as out of place for the situation at hand or social interaction occurring and lasting longer than one might expect. Specifically, perseveration in Autism might involve repetitive movements, fixations, or specific interests, whereas, in ADHD, it can show up as persistent thoughts or excessive focus on singular tasks. Perseveration serves various purposes like managing stress, providing stimulating sensory experiences, or acting as a coping mechanism in response to anxiety.

Obsessing involves intrusive, unwanted, and distressing thoughts, images, or urges that repeatedly enter an individual’s mind. The thoughts are difficult to control and may lead to heightened anxiety, compulsive rituals, and repetitive actions for the purpose of relieving the anxiety associated with the obsessive thoughts.

Both perseveration and obsessing share the element of repetitive patterns, but the underlying motivations and context differ. Think of the difference between the two like this. Where obsessions are unwanted and associated with anxiety disorders, preservation meets a need born out of a neurodevelopmental condition. The neurodevelopmental issues connected to Autism and ADHD meet a need for things to be predictable or stay the same, to make for a more interesting, stimulating experience, or to make a lane where coping with stress is more possible.

For example, Alex experiences intrusive, unwanted thoughts when exposed to germs in his environment, whether perceived or real, that he feels compromises his health. To reduce a spike in anxiety, he has an urge to wash his hands each time the intrusive thought is ignited. The handwashing is a repetitive routine intended to reduce a spike of anxiety. It also doesn’t serve him well in that his hands become chaffed, causing a breakdown with his skin. Alex doesn’t want the thoughts because of the mental strain and emotional heaviness he feels and he laments about the difficulty with controlling the urge to wash his hands.

On the other hand, Jimmy, a young adult, has enjoyed his fascination with animals since childhood. It’s an endearing quality he possesses among people who support his interest. He thinks about it and talks about it repetitively. You may even observe Jimmy pacing while talking to himself out loud about it. Now, step outside of his supportive network and into a context where Jimmy has a desire to be social and an opportunity to make new friends, his repetitive discussion on animals is out of place. It serves him well initially meeting others, but after that, he discusses it repeatedly with each person he meets and each time he engages them and at every social engagement. Consequently,  Jimmy stops being included. Jimmy’s repetitive conversation topic is based on a need and desire to be social. He enjoys it! But it simultaneously hinders him from connecting in other interesting ways as others lose interest with his perseverating conversation topic and he is not included in future social opportunities.

Both obsessing and perseverating disrupt daily function, but while obsessing is unwanted perseverating comes from a place of need. That’s why it’s important to understand when observing a visible behaviour that is repetitive and appearing out of place to ask the question, is the repetitive nature of the behaviour distressing or fulfilling a need? This is a crucial question because asking the question shifts the mindsight of a person off the tendency to assume the behaviour to be negative and onto a more compassionate and supportive response. Let’s talk about what a supportive response looks like for both issues.

Addressing intrusive and unwanted thought patterns with a young adult starts with acknowledging that it occurs, it’s hard, and you are here for him. It also includes helping him acknowledge that the thoughts don’t represent what is real and are produced in his mind. Because the intrusive thoughts are inside his mind, the key is to create an external focus outside of his mind. This is done in many ways through the use of visual support, a positive auditory sound, or other productive fidget strategy all of which are designed to bring him out of his head and into the present moment, which creates a pattern disruption of the negative and intrusive thought. It’s important that the strategy used is meaningful and interesting to him, so he may practise the strategy repetitively, feeling soothed. Doing this is practising the skill of coping by staying in the present moment where he is reminding himself that he is safe.

Addressing repetitive physical movements, fixations or specific interests that come along with Autism starts by understanding the need behind the repetitive behaviour. For example, Jimmy needs to be social, but support requires predictability and structure. This means front-loading his social opportunities with social skills training that is experienced through role plays, interactive technology, visual social stories, or actual social interactions designated for practising the specific skill needed to be taught before engaging the social opportunity. In the case of ADHD, addressing perseveration means working with the young adult on shifting attention away from singular repetitive thought patterns like persistent worries, repetitive questioning, or dwelling excessively on a particular topic, task, or activity that keeps him stuck. Addressing the issue means shifting attention to what the young adult intends that is meaningful and achieves a positive outcome. Young adults with ADHD will talk about what they want to do but struggle to do what they intend when they are stuck perseverating on a non-related thought, task, or activity. Establishing clear and explicit goals, using external visual cues, consistent practice, and positive reinforcement is the key to developing more effective attention-shifting skills.

Perseveration and obsessing add a layer of complexity to an already intricate tapestry of neurodevelopmental conditions like Autism and ADHD. Recognizing the interplay between symptoms and repetitive behaviours is crucial for tailoring effective interventions and supportive strategies. Part of that supportive network may include a physician who can provide support through medication with the intent of reducing the symptoms, so a skill may be realistically taught, retained, and the medications reduced or discontinued.  By fostering understanding, patience, and an individualized approach, young adults living with Autism and ADHD can work with their supportive networks to navigate the challenges posed by obsessing and perseverating, allowing for improved daily functioning and increased quality of life.

For those looking to empower young adults with Autism and ADHD through dedicated coaching and support, explore our Autism Coaching services and ADHD Coaching services to learn how we can assist. Click the connect button below to schedule a call with Steve Gundy today.

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