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What is Perseveration?

Perseveration is a behavior in which a person repeats a particular word or phrase, action or behavior, or emotion. Typically, the behavior persists long after it is either useful or meaningful, and the person has no conscious control over it. A common example of perseveration is when a person asks the same question repeatedly during the course of an hour, or a day, much to the frustration of those who have provided an answer time after time. However, it is important to remember that we all display perseverative behaviors from time to time. They only become a problem when they disrupt the lives of the individual who exhibits them, or those who are around him, or else is injurious to his health in some way. (3)

The term perseveration is used to describe a wide range of behaviors that result from the brain’s failure to inhibit certain responses, in particular to situations where the behavior has already produced the desired effect, or to be able to transition between one behavior and another. It indicates a lack of cognitive flexibility for set shifting (the ability of the brain to adjust one’s thinking ar attention from one situation to the next, much like a remote control changes channels on a television), or task shifting (when one step in a process has been completed and it’s time to move on to the next). One hypothesis is that a person’s lack of memory inhibition abilities caues him to repeat an answer because he has not been able to forget a past question, although this has not been proven. (1) The three most common forms are “stuck-in-set” (such as changes i the topic of conversation), recurrent (occuring over and over again), or continuous. (3)

Conditions associated with perseverative behaviors include:
1. Physical brain injury, trauma, or damage — especially in the case of frontal lobe lesions, dysfunction or dysregulation. Perseverative speech is often seen in persons with aphasia.
2. Autism spectrum disorders (especially Asperger sydrome) — these persons can be subject to obsessive and highly selective interests, as well as repetitive and ritualistic behaviors
3. Attention Deficit Hyperactivity Disorder (ADHD) — Individuals can exhibit “hyperfocus,” where resistance to transition between tasks may actually serve as a coping mechanism to compensate for the brain’s lack of ability to regulate attention
4. People who are either intellectually gifted or learning disabled (1)

Other disorders may produce symtoms similar to perseveration. It may be confused with other forms of habitual behaviors, such as those found in Obsessive-Compulsive Disorder (OCD), Post-traumatic Stress DIsorder (PTSD), body dysmorphic disorder, trichotillomania (hair pulling disorder), and habit problems. (1)

Management of perseveration requires that something be done to “break the circuit,” or interrupt the abmormal electrical stimulation in the brain that is causing the person to continue the behavior. This often necessitates a change in either the environment, the behavior of the care partner, or a change in the brain pathways with medications. (Usually a combination of all three is required.) Determine if the behavior accomplishes some kind of meaningful purpose, such as persisting in the efforts to solve a problem that is especially important to the individual, or if it is instead an inability to discontinue the behavior such that it is producing distress. This often means that a care partner or someone else needs to step in and help find a solution to the problem, or distract the person from it. But, remember that not all perseverative behaviors are negative. Try to figure out what is causing the behavior, and step in only if it is causing distress in the person who is exhibiting the behavior or those around him. Is it injurious to his health or others? Or is it merely annoying, and would attempting to stop it cause undue anxiety. (For example, is it keeping him from getting into trouble in some way?) (2)

During this stage of the disease process (whatever the causative condition might be) where a care partner will often need to have some respite time, or a short break in her duties. Living with a person who is going through this stage can take a great deal of time and energy, both mental and physical, and it would be very helpful if someone else can step in and help relieve some of the burden.

When considering medical management of perseverative behaviors, it is important not to eliminate the behavior altogether, but instead to decrease it to a level that the care partner can assist the individual by means of redirection or other strategies. A physician can be of help here. (2)

If the individual’s behavior seems to be increasing, or getting worse, it could be a way for the person to communicate that something is wrong or is upsetting him. Some triggers for perseverative behaviors can include fatigue or pain, hunger or dehydration, a change in routine illness, medical issues, holidays or special events that cause a disruption in the person’s routine, or other changes in the lives of important family members. (2) The behavior could also be caused by over-stimulation due to excessive light, noise, etc. (3)

Often a care partner needs to step back and try to analyze what might be triggering the behavior, and to change that, or remove the person from the situation, rather than to try and change the person who is displaying the behavior. Then, later, if the person is able, set aside a time to discuss the problem and what his perception of the causes/results might be, and then devise a plan for preventing them in the future. Other strategies that can be helpful for someone who perseverates include cognitive-behavioral therapy (CBT), supportive group therapy, and self-management strategies. It may be, too, that a time needs to be set aside during the person’s daily routine, to allow him to indulge in perseverative behaviors, if they are not harmful.(3)

In a sitution such as this, if the individual is able, it might be important to remember the six R’s:
1. Recognize — help the person to be able to identify his triggers and ask for help
2. Reduce — remove triggers, if possible
3. Retreat — stop and back off when the behavior starts
4. Relax — use various tools to calm down
5. Rethink — write out thoughts about the situatio, and plan for the future
6. Return — go back to what the person was doing when the behavior started (3)

Www.wikipedia.com (2/17/15)
Www.hdreach.org (2/17/15)
Northern Brain Injury Association/ http://www.nbia.ca (2/17/15)

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