Highlights
- ADHD, stimming, and tics can be connected; however, these are distinct conditions.
- Stimming is not necessarily a symptom of a mental health condition even though it can be associated with ADHD. Neurotypical people can also stim sometimes.
- People with ADHD are prone to have comorbid conditions that cause tics.
- Stimming and tics may affect daily life and require professional help if the impact is significant.
Attention deficit hyperactivity disorder (ADHD), stimming, and tics are distinct conditions but they often co-exist. People with ADHD may display self-soothing behaviors such as certain sounds or movements. Also, there is a known probability of ADHD being comorbid with Tourette syndrome which causes tics.
Some people may confuse specific kinds of fidgeting — one of the official diagnostic criteria for ADHD — with stimming or tics, although they are different from each other in nature. So, let’s learn more about how they may overlap and interconnect to dispel the misconceptions and better understand the features of these conditions.
Stimming: What Is It, and Why Do People Do It?
Types of Stimming Behaviors
Stimming behaviors can range from subtle to highly noticeable; from twisting hair to nail-biting and hair-pulling. These behaviors fall into the following
- Auditory Stims: This is related to making sounds or having repetitive responses to sounds.
- Humming, grunting, whistling, or shrieking
- Covering and uncovering ears
- Finger-snapping, tapping on objects, or tapping on ears
- Repetitive speech (song lyrics, movie lines, and book sentences)
- Visual Stims: This involves visual stimulation when there is the need to self-soothe or cope with visual sensory overload.
- Staring at objects for a long time (ceiling fans, lights, etc.)
- Peering at things from the corners of the eyes (eye-tracking)
- Lining things up (object placement)
- Repetitive blinking
- Turning lights on and off
- Olfactory Stims: Stimming activities that involve taste and smell.
- Placing objects in the mouth to taste them
- Sniffing random objects
- Licking
- Vestibular Stims: Behaviors that involve moving the whole body.
- Pacing
- Jumping
- Rocking back and forth
- Spinning
- Tactile Stims: Involve the sense of touch.
- Rubbing or scratching the skin with hands or objects
- Hand flapping (when happy, anxious, excited, etc.)
- Tapping the hands and/or feet on hard surfaces
- Repetitive clenching and unclenching of hands
These can be also classified into typical and atypical stims. Typical ones are non-disruptive behaviors that everyone experiences at some point in time; for example, foot tapping, cracking knuckles, and playing with hair. Atypical stims, on the other hand, are disruptive and happen because of an underlying disorder. For example, walking on tiptoes, jumping repeatedly, and chewing non-edible items like clothes or hair.
All of these behaviors are purely sensation-seeking. When stims turn dangerous and can cause physical harm, then they are termed self-injurious behavior (SIB).
While these behaviors can be difficult to simply discontinue, they can oftentimes be redirected and minimized through effective treatment. Early intervention is key. "
Why Does Stimming Happen?
Stimming is a subconscious coping mechanism people may develop to deal with very strong emotions, boredom, frustration, or
Sometimes, when stimming repeatedly helps a person reduce pain, anxiety, or communication issues, it can get habitual. Even neurotypical people sometimes stim, however, they are more likely to stop it over time or switch to more meaningful activities.
Fidgeting vs. Stimming — Are They the Same Thing?
|
Fidgeting |
Stimming |
|
|
Form |
Simple repetitive movements |
Complex movements |
|
Nature |
Subconscious |
Deliberate, intentional |
|
Purpose |
Maintaining focus during periods of inattention, boredom, or stress |
Soothing oneself through sensory regulation during sensory overload |
|
Effects on daily life |
Minimum |
Significant |
|
Associated conditions |
Most commonly associated with ADHD |
More commonly associated with autism spectrum disorder |
The Link Between Stimming and ADHD
So, is stimming a sign of ADHD? Stimming is not included in its official diagnostic criteria, such as the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). However, stimming can be observed in people with ADHD — the reason lies in the
People with ADHD have variable levels of dopamine and norepinephrine; stimming provides a needed sense of stability and sensory feedback to offset this neurobiological imbalance. This is like the constant urge to move that causes trouble staying still or sitting quietly, that is why those with the hyperactive form of ADHD are most prone to fidgeting and stimming.
However, inattention may also happen as an attempt to overcome mental fog associated with inattentive ADHD. If a person needs some kind of stimulation to process information faster or more efficiently, concentrate, and inhibit impulses, they may stim, and such behaviors might transform into habits. Finally, for a few, stimming could be a way of disposing of unused energy or remaining alert mentally when they feel bored or engaged elsewhere.
Why Stimming Can Be Misdiagnosed as ADHD?
Stimming in people with ADHD is only one sign, which could indicate another condition. During the diagnostic process, a healthcare provider assesses the primary presentation of inattention, impulsivity, and hyperactivity, reviewing the health status and ADHD signs comprehensively. Some stimming behaviors can manifest with similarity to ADHD symptoms, which may be the cause for misdiagnosis, so it’s important to see a qualified clinician to get properly assessed and receive an accurate diagnosis. Before your appointment, you can take our free online ADHD test to prepare for a more informed discussion.
Understanding Tics
Like stimming, tics can occur in adults, adolescents, and even children. However, they are not intentional, are harder to control, and can be transient or chronic in nature.
Types of Tics
- Simple Motor Tics: Involve the movement of a single muscle or a limited number of muscles. They may go unnoticed, as they are quick.
- Lip biting
- Eye blinking
- Wrinkling the nose
- Head twitching
- Complex Motor Tics: The movement of more than one muscle group. They can appear very intentional, but are still involuntary and therefore, uncontrollable by a means of willpower.
- Facial grimacing
- Jumping
- Skipping
- Kicking
- Sniffing objects
- Mimicking others’ body movements
- Simple Vocal Tics: Involves basic sounds.
- Grunting
- Hissing
- Throat clearing
- Barking
- Coughing
- Complex Vocal Tics: These can seem quite intentional even though they are beyond the person’s control.
- Animal sounds
- Yelling
- Calling out
- Repeating words and phrases
Types of Tic Disorders
Tics may be normal if they are occasional or only during moments of stress. However, should they persist over time and worsen, they may turn out to be symptoms of a disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, there are three major forms of tic disorders:
- Provisional Tic Disorders: These are the most common type of tic disorder that begins before the age of 18 years and lasts less than a year. This can involve simple or complex motor tics.
- Persistent (Chronic) Tic Disorders: This is more severe, often with co-occurring sets of both motor and vocal tics, but typically not simultaneously. This disorder is present for more than 1 year, before the age of 18. They do not spontaneously remit, but the severity can vary over time.
- Tourette Syndrome: A complex tic disorder in which more than one motor and at least one vocal tic persist for longer than one year, thereby causing interference with normal social interaction or daily activities. The severity and frequency of tics can have periods of exacerbation and remission.
What Causes Tic Disorders
Biological and environmental factors are the largest contributing factors of tic disorders. Research shows evidence of
Environmental causes related to tic disorders involve chronic stress, traumatic experience(s), anxiety, and exposure to certain medications. Tension from the dislocation of a joint in the upper cervical vertebrae can affect the sensory stimulation via the spinal cord and brainstem, which can also cause tics.
Stimming vs Tics: How to Differentiate?
Although stims and tics share some characteristics, they are also differentiated in many ways. Imagine someone sitting in an office who is waiting to be interviewed for a job. Due to nervousness and anxiety, they may begin stimming, perhaps by tapping their feet, but they can stop, calm themselves (through alternate coping), and regain control over their movements. With tics, this is impossible despite best efforts.
How Stimming and Tics May Co-Exist?
Sometimes, tics and stimming may occur together, where voluntary and involuntary behaviors are mixed. Overlapping symptoms can complicate the diagnostic process and treatment, therefore a professional understanding is critical. If stimming and tics co-occur, it is important to identify the underlying disorder in order to create an effective plan of care for management.
Can ADHD Stimming Lead to Tics?
There is no direct evidence that stimming associated with ADHD will lead to tics. However, combined with a predisposed neurological state of people with ADHD, this can contribute to an increased risk for tic activation. There is also a significant degree of comorbidity between ADHD and tics:
If you suspect you have ADHD, consulting an online specialist for ADHD can provide clarity with a thorough evaluation and help you take the next steps toward effective management.
Impact on Daily Life and Social Interactions
The occurrence of stimming and tics may disrupt daily life or social interactions. Tics, especially vocal ones, can hinder effective communication resulting in frustration and misunderstandings. They can be distracting and affect one’s ability to focus at work, school, or during other activities.
In addition to potentially distracting behaviors themselves, people with tics or stimming may have a higher level of stress and anxiety caused by these symptoms. Consequently, a person may experience extreme vulnerability in certain social situations, face issues with self-esteem, and emotional distress.
Take control of your symptoms
Managing Stims
If stimming is prolonged, interferes with your life, or attracts negative attention, this may indicate the right time to seek professional help. In addition to diagnosis and treatment, there are also self-help techniques that can be very beneficial:
- Start managing your stims by learning what triggers them. Keep a log of the situations and factors that potentially trigger stims and analyze this information later.
- Use a fidget spinner, stress ball, or other textured objects to fill the need for sensory input when you are not able to stim without drawing negative attention in social situations.
- Reward yourself when you remember to use an alternative coping mechanism instead of stimming.
- Use non-aromatic products that will not cause sensory overload; neutral smells are best in these cases.
- Take warm baths with Epsom salts: they relax the muscles and decrease inflammation and tension.
- Create open dialogue when talking to family or friends about your experience to ensure they understand your behaviors. This dialogue can also provide a strong source of support.
Treatment Options for Tics and Stimming in ADHD
It is important to consult a medical professional about formulating a treatment plan based on the underlying cause and severity of your symptoms. The most common treatment options for the management of tics and stimming as part of ADHD include:
- Psychotherapy: Occupational and behavioral therapy have been proven to be effective in helping develop healthy self-regulating behaviors.
CBT [12*] can help individuals develop coping strategies and skills to manage their anxiety.Habit reversal training [13*] helps one replace stims with more socially accepted behaviors. Sensory integration therapy can help regulate sensory input load so the body feels a reduced need for stimming. - Medication:ADHD medications such as stimulants and non-stimulants may help with suppressing stimming as they regulate attention, hyperactivity, and impulse control.
- Other Techniques: Deep breathing exercises, mindfulness practices, meditation, yoga, muscle relaxation techniques, and other stress-management strategies can reduce stimming by providing alternative ways to self-soothe.
Conclusion
According to Health Sciences, stimming, tics, and ADHD can co-occur; however, one can not define the development of the other. Stimming is not a symptom specific to ADHD, but in some cases, people with ADHD may experience stimming. Tics, on the other hand, may indicate the presence of another condition, comorbid with ADHD. If you want to have a detailed assessment, book an online appointment with a licensed medical provider at MEDvidi.
