What’s The Deal With Perseveration?

All about perseveration – what it means, why it happens, how it’s sometimes a good thing and what you can do to help when it isn’t.
Rows and rows of wood shaving spirals

What is perseveration?

In simple terms, perseveration means to respond in the same way repetitively – but it’s not just doing the same thing over and over, it’s continuing to do that thing past the point where it’s reasonable to stop.

How do we know where that stopping point is?

Most of the time, the signal for stopping a behaviour is when the reason for doing it changes or disappears, so the behaviour becomes pointless and no longer serves a purpose. Social rules also tell us when we should stop a behaviour, as well as changes in the environment which make the behaviour unsafe.

Take running in a marathon as an example. The finish line is a very clear signal for when to stop running, but it’s also appropriate to stop running when there’s a thunderstorm or if the race is over because the time limit is up.

Getting stuck and not being able to identify these reasonable stopping points, or to stop doing a behaviour despite reaching a stopping point, is the key to perseveration.

Perseveration isn’t a single behaviour, it’s a way of thinking and behaving. It can involve thoughts, words and feelings as well as physical actions:

  • Continuing to talk about a topic after the conversation has moved on
  • Anxiety about an event after it has  passed or is no longer a threat
  • Asking the same question over and over despite receiving an answer
  • Being unable to let it go and move on after a mistake or argument
  • Banging a box over and over to get it to open even though it’s not working
  • Continuing to give the same answer to a different set of questions
  • Looking for objects where they used to be after they have been moved
  • Being unable to stop thinking about a certain topic or phrase
  • Wanting to continue using an object even though it is clearly broken
  • Continuing to call the new teacher by the old teacher’s name

Why does it happen?

Perseveration 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 tool for parsing information in detail
  • An inability to shift attention or inhibit responses

Let’s take a closer look at the last one on that list, the inability to shift attention or curb responses. There’s a big difference between doing things in the same order because it feels calming, and needing to do it because you’re stuck and can’t move on.

Cognitive flexibility is part of executive functioning. It’s a thinking skill which helps us to cope with changes in demands or the environment by adjusting our thought processes. People who have difficulty doing this – who find it hard to shift their attention, see all the possible solutions or think about multiple things at once – are said to be cognitively inflexible, or rigid thinkers.

This inflexibility in thinking makes it hard to adapt to new information, to think outside of the box and cope with situations which require different ways of solving problems. Responses, answers and solutions stay the same despite the problem or environment changing.

Another cognitive function involved with perseveration is control over 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 a text message alert.

Sometimes we need to control impulsive reactions so we can respond in an appropriate way, like refraining from reading text messages at the dinner table. That kind of control can be really difficult for some people, and without it they continue to respond in the same impulsive 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 perseveration 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 stopping point is usually subjective and not clearly defined.

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?

Perseveration is one of the defining features of autism but it also occurs in other conditions such as ADHD, Fragile X, Down Syndrome, dementia and some types of brain injury. But in fact, nearly everybody behaves perseveratively at some point (except we tend to call that by other names like worry, tenacity or diligence).

There are lots of times in your life when thinking or behaving in a repetitive way can be extremely useful, especially when learning a new skill. It can help you to:

  • Process and understand your thoughts
  • 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

Although perseverative behaviour can be considered an asset in some situations, it starts to become a problem when the repetitive way of responding isn’t productive or stops the person 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.

How can you help?

Assess the problem

  • Is the behaviour interfering with learning?
  • Is it always a problem or only in some situations?
  • Is it affecting others?
  • Does the person have control over when and whether they stop doing it?

Identify the stopping point

Help them to understand and recognize when an action should stop. This might be a clearly worded rule that helps them remember when they need to change their behaviour e.g. when my pencil is broken I put it down and get another one.

Exaggerate environmental cues

Sometimes the person might miss the signs around them that it’s time for their behaviour to change (like everyone packing up to go to the next class). If you make these changes more obvious, it will help trigger them to 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).

Build a bridge

If the person is getting stuck and finding it difficult to move on from repetitive behaviours, try smoothing the connection to the next action, activity or response so the transition is smaller and less jarring. For example, a child who is perseverating on dinosaurs might be able to expand a little to talk about what plants the dinosaurs ate, which might allow the conversation to branch out to other topics like gardens or insects.

Make it visual

When the person is perseverating on a thought, they might feel more control over it if it they can turn it into something external and physical that can be touched and seen and manipulated. Try drawing a picture of it and then screwing up the paper into a ball and tossing it away, for example.

Make it productive

Think about whether there’s a way for you to help the person channel the repetitive behaviour into a more positive outcome. For example, you might be able to use their perseverating about video games as a prompt to have a conversation with them about what they like to do on the weekend.

Cognitive exercises

Add games or activities which encourage them to develop flexible thinking e.g. inventing new uses for objects, or strategy games where the conditions are often changing like Tetris. Practice mental strategies they can use to help break free of repetitive thoughts, like visualizing themselves putting their thoughts in a room and closing the door.

Distraction and redirection

Sometimes throwing in a new prompt to respond to is enough to disengage the student’s attention from the thing that they’re stuck on. Try a quick movement break, changing the topic, moving to another room or swapping to a different activity.

Talk about it

For someone to play an active role in managing their own behaviour and success, they need to understand where the behaviour comes from and how their brains and bodies work. Talk with the person about their tendency to act repetitively – why it happens, what it means, how it can be a positive thing and the things they can learn to do to avoid it becoming a problem.

Encourage self-awareness

Being aware that they’re perseverating is an important step in the person developing control over their own behaviour. This includes not just noticing that they’re acting repetitively, but knowing when they’re stuck and deciding whether or not that’s a problem.

Questions like these can help:

  • 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 careful with setting limits

Curbing the impulse to perseverate requires a degree of self-regulation that can take a long time to develop. Giving someone a limit for how long or how often they can perseverate usually isn’t 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.

Reduce anxiety

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

Avoid triggers

If you identify an event that’s acting as a prompt for the repetitive behaviour, you can try to avoid setting up a situation which starts the ball rolling. For example, you might need to walk a different route back to class to bypass the playground which acts as a trigger for them to repeatedly talk about basketball.

Be patient

A person’s ability to manage their perseveration will differ greatly depending on the task and the other demands they’re dealing with at the same time. So remember that their success at being able to control the behaviour isn’t always a sign of how hard they’re trying or how compliant they’re being.

It can definitely be super frustrating to have someone ask you the same question many times or keep trying a solution that obviously isn’t working. But remember that they might be feeling stressed or stuck, be busy thinking things through or need help to move on, and having someone speak loudly or be visibly annoyed won’t make any of that easier. So a big part of helping someone when they perseverate is simply figuring out how to manage your own natural reaction to their behaviour.

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.

Last updated 22 Nov, 2017 by Bec Oakley

Bec Oakley is an autistic writer and proud parent, with an intense passion for 80s text adventures, Twizzlers and making the world a better place for autistic people and their families.