Understanding Vocal Stimming in ADHD and Autism

“Stimming” or self-stimulation can be used to define any conscious or unconscious self-soothing behaviors a person does. These behaviors are usually in the form of repetitive sounds or movements. Vocal stimming (or auditory stimming) specifically, refers to any self-stimulation behavior that involves the use of the vocal cords, mouth, lips, and ears.

The reasons for stimming will vary from person to person; however, these behaviors usually serve to help an individual stimulate their senses, reduce anxiety, cope with sensory overload, express frustration, or relieve physical discomfort.

While stimming behaviors can be found and conducted by all people, it is commonly associated with individuals with autism (ASD), attention deficit hyperactivity disorder (ADHD), and other disorders.

There are also many different types of stimming behaviors; such as visual, touch (tactile), verbal, and vestibular (balance-based). However, this article will be exploring verbal stimming alone, as well as, the signs, examples, reasons why it is done, and how it is managed.

What is Vocal Stimming?

Vocal stimming (also known as auditory stimming) can be understood as any self-stimulating behavior that involves the use of the vocal cords, mouth, lips, and ears.

When we generally think of stimming, it is usually associated with autism due to it being a part of the autistic diagnostic criteria. However, these behaviors are common among individuals with varying neurodevelopmental differences, thus, individuals with ADHD will also exhibit stimming behaviors.

However, in these instances, the reasons for stimming will differentiate. For instance, people with ADHD will tend to stim as a means to improve impulse control and focus; whereas, autistic people will tend to do it to relieve anxiety or sensory overload.

The manifestation and type of stimming behavior may be different too. After all, ADHD and autism are neurological disorders that affect different parts of the brain. That said, there is yet to be more research on the experiences of individuals with both (AuDHD).

Additionally, while stimming behaviors have long been associated with children, more current research has begun to highlight the ways these behaviors present in adults too.

Signs and Examples

This type of stimming usually manifests in the form of giggling, singing, excessive throat clearing, the repetition of specific words, and the making of repetitive sounds (such as humming or murmuring).

“Signs to look out for include frequent repetition of certain sounds or words, a fixation on specific vocal patterns, and engaging in vocal stimming in various environments,” says Mike Iwinski, Lead Therapist at DreamLife Recovery. These behaviors may vary in intensity and form from person to person.

“In addition, this behavior can also include grunting, sighing, singing the same line from a song repeatedly, or even repeating lines from TV programs or movies,” says Hester Grainger, a certified ADHD coach and co-founder of Perfectly Autistic.

Grainger was personally diagnosed with ADHD in her forties and is wife and mum to her autistic/ADHD husband and autistic/ADHD/dyspraxic children — thus has a lot of lived experience when it comes to stimming.

“I often repeat specific words I like the sound of or phrases from TV programs. I find it comforting but also find it involuntary. It genuinely makes me happy repeating certain words that I like the sound of,” adds Grainger.

Why Do People With ADHD or Autism Stim?

“This behavior can serve various functions, including self-regulation, sensory stimulation, communication, and expression of emotions,” says Iwinski. Thus, vocal stimming can be said to occur due to sensory processing differences, emotional regulation challenges, and a need for self-soothing.

“It can provide a sense of predictability and control in an overwhelming world, or serve as a method to express inner feelings that may be difficult to communicate verbally,” he adds.

For example, a 2021 study on autistic and non-autistic adults found autistic adults (diagnosed and suspected/self-diagnosed) reported having greater sensory sensitivities and stimming than non-autistic adults.

They found that the sensory sensitivity of these individuals had negative emotional, physical, and cognitive effects on individuals. Therefore, stimming worked as a self-regulatory mechanism that allowed for positive and negative emotional expression, and cognitive distraction.

Additionally, this work highlighted that suppression of these behaviors had a negative effect on both emotions and cognition. Yet, due to social pressure individuals tended to suppress them regardless.

How Is Vocal Stimming Managed?

While vocal stimming shouldn’t be seen as a negative behavior, it can sometimes occur during inappropriate times, resulting in individuals feeling the need to suppress their behaviors. In moments such as these, different management strategies can be employed as a means to help. This could include behavioral modifications, therapy and in the case of people with ADHD, medication. 

Iwinski has listed the following management tools as a means to help the navigation of vocal stimming. He states, that a multi-faceted approach is best employed:

1. Environmental Modifications: Creating a supportive environment with sensory-friendly tools and resources can help individuals regulate their sensory experiences, reducing the need for stimming behaviors. Providing quiet spaces, fidget tools, and sensory objects can contribute to self-regulation.
2. Replacement Behaviors: Identifying alternative, socially acceptable behaviors that fulfill the same sensory needs can help redirect stimming tendencies.
3. Communication Skills: Developing communication skills through speech therapy, social skills training, or augmentative and alternative communication (AAC) systems can provide individuals with alternative ways to express themselves and reduce the need for vocal stimming.
4. Coping Strategies: Teaching coping strategies such as mindfulness, grounding techniques, and emotion regulation skills can help individuals manage overwhelming feelings without resorting to stimming.
5. Individualized Approaches: Tailoring interventions to the individual’s specific needs, preferences, and sensory sensitivities is essential. Collaborating with the individual, their caregivers, and a multidisciplinary team can yield effective strategies.
6. Social Support: Educating family members, peers, and educators about stimming behaviors can foster understanding and acceptance, creating a more inclusive environment.

Possible Replacement Behaviors

As mentioned above, replacement behaviors can be utilized as a means to fulfill the same sensory needs as stimming. Some examples of healthier alternatives to vocal stimming include using stress balls, soft fabrics, or engaging in deep breathing exercises. 

“Sucking can also help some individuals organize, increase their attention, and soothe or calm themselves,” says Grainger. She also points out “5,4,3,2,1 grounding techniques” as another exercise that can be of benefit. While this technique can be done in any different ways, she states the following as an example:

• List five things you can see
• Touch/feel four things
• Listen and share three things you can hear
• Name two things you can smell
• Find one thing you can taste or think about tasting

Clinical Interventions

Regarding the clinical management of stimming, medical practitioners may look to the use of a combination of therapeutic modalities. “These include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and sensory integration techniques,” says Iwiniski.

It is vital that individuals experiencing vocal stimming work towards finding a balance between self-expression and functional communication. Therefore, these modalities are often utilized alongside the implementation of adaptive behaviors. “With the goal of enhancing their overall well-being and quality of life,” Iwiniski finishes.

Navigating Stigma and Stimming

Once again, while it’s important to note that while the management of stimming behaviors can be beneficial for a person in terms of socialization, and relationships, stimming behaviors should not be seen as a negative trait needing to be “fixed” or “cured”.

After all, neurotypical people stim too and stimming is the body’s way of calming itself down. Therefore stimming shouldn’t be seen as something to be suppressed and in some instances, stimming can even be a lot of fun, too!

In the same regard, it’s important to also note that both ADHD and autism are highly stigmatized. As a result, some individuals may find that they (consciously or unconsciously) mask their stimming behaviors.

In these instances, individuals should research the topic as a means to uncover any “unknown” stims they have. After all, while stimming may be beneficial in the short term, it is an exhausting practice that can lead to burnout.

"I never knew I vocal stimmed until I was diagnosed with ADHD at 43. I have spent years repeating certain words over and over again — as I like how they sound but I didn’t know why I did this. For example, saying ‘Hamburger’ on repeat, like Steve Martin in the Pink Panther movie!" says Grainger.

"Now I understand my ADHD, I understand why I stim. When I work with my ADHD clients coaching them, I let them know it is okay to let the stim out. I always advise not to try and repress it if you are in a situation where you can be yourself."