INTRODUCTION TO SELF-INJURIOUS BEHAVIOR

On a "good" day Bobby (not his real name) hits his head with his fist 500 times an hour. On a bad day the count may go up to 1,800 hits per hour. The short-term results of this self-abuse are absolutely sickening. The long-term results are much worse. Bobby has autism and engages in self-injurious behavior. That explains things for the professionals but how about for Mom and Dad? For a while they were even suspected of inflicting the injuries on Bobby themselves. But now that everyone knows what is going on, how do you make this self-injury behavior stop?

types of self-injury an autistic child may engage in

Children and adults with autism may engage in self-injurious behaviors, also known as self-harm. Self-injurious behaviors are actions that the child performs that result in physical injury to the child’s own body. Typical forms of self-injury behavior include:

• hitting oneself with hands or other body parts

• head-banging

• biting oneself

• picking at skin or sores

• scratching or rubbing oneself repeatedly.

The cause of self-harming behaviors remains as much a mystery as the cause of autism. It is thought that the behaviors may be caused by a chemical imbalance, sinus problems, headaches, attention-seeking, seizures, ear infection, frustration, seeking sensory stimulation/input, sound sensitivity, or to escape or avoid a task. There many different ways to treat self-injurious behaviors. The method chosen may depend upon the perceived cause of the self-injury and/or the bias of the professionals involved.

why less noticeable self-harm may be serious

Self-injurious behavior that results in bleeding and serious tissue damage is easy to notice and usually leads to frantic efforts to stop it. However, some repetitive behaviors that seem harmless (e.g., rubbing the skin, lightly tapping the forehead) can have serious, even life-threatening consequences over time. To see why, I will have to take you back to my high school physics class. I was taught that a 1,000 pound ball suspended on a chain would start to move back and forth from the steady, rhythmic motion of a ping-pong ball hitting up against it for thousands of repetitions. It is not the overwhelming force or the weight of the ping-pong ball that causes the movement but the repetitive nature of the motion. The danger of repetitive rubbing or tapping can also cause tissue damage over time and, if the head is involved, may even cause brain damage over many years. The point is, all forms of self-injurious behavior should be treated as soon as it is noticed.

assessment of self-injurious behavior

Each child or adult engaging in self-injurious behavior will require an individual assessment to try to determine the cause and motivation for the self-injurious behavior. If your child is hurting himself or herself in any way, make this an issue with the child's physician, psychologist, and/or any other professional who treats your child. If a medical problem is discovered, the medical problem can be treated. If the child is seeking sensory stimulation/input, you may be able to find a replacement behavior that will meet this need in a more socially acceptable and safe way (e.g., the child who seeks pressure from pounding his hands on the floor may prefer a vigorous hand massage).

different strategies for different causes of self-harming

If the self-injurious behavior is driven by attention, then tactical ignoring of the self-injurious behavior may extinguish the behavior. This would have to be accompanied by giving the child attention for appropriate behavior when it occurs, known as positive reinforcement. Of course, if the child is seriously hurting himself or herself, this may not be an option. Reinforcing other behavior that makes the self-injurious behavior impossible to perform may also be recommended (e.g., reinforcing the child for manipulating toys, which keeps the hands occupied and prevents face-slapping).

If the self-injurious behavior is caused by frustration, it may be that teaching the child a way to cope or communicate will prevent the self-injury. Simply giving the child constructive things to do may prevent boredom, which could lead to self-injury.

Some children are treated with medication. If the problem is a chemical imbalance, then treating the child with appropriate medications may be a perfect answer. There is a theory that children who injure themselves do so to release opiate-like chemicals in the brain. Naltrexone is a medication that inhibits the release of these opiate-like chemicals in the brain and the belief is that this will remove the reason for the self-injury. As a last resort, some parents and professionals have resurrected aversive procedures to treat the most serious self-injurious behavior. Aversives are behavior modification techniques that provide a negative stimulus to the child whenever the self-injurious behavior occurs (e.g., the child is spanked, yelled at, sprayed with water, or receives a mild electrical shock). It seems strange that a punishment would actually stop a child from harming themselves but many studies have proven the effectiveness of aversives in stopping serious self-injury.

debate over aversive strategies for self-injurious behavior

It would make sense that the seriousness of the self-injury should direct the choice of treatment. A child's whose life is in danger should receive the most aggressive treatment. The choice of treatment needs to be up to the parent, of course. In some countries or states, there may be laws that limit the type of treatment a child may receive, however. These laws may require treating self-injurious behavior with positive behavioral programs and outlaw the use of aversives, even when the self-injury is life-threatening. Read how one parent described this approach:

"Currently, there are 100's of autistic people being tortured by ineffective, tedious and ridiculous "positive behavioral programs" - Worse, even when these autistic people have repeatedly failed to respond to these conventional methods, several state laws have prohibited the use of mild aversive therapy, which - ironically is one of the most safe, effective and humane therapies used to protect a compulsive self-injurious autistic person-who has otherwise NOT responded to a plethora of conventional interventions. It's a crime to allow a person to continue injuring themselves...and the worst is the on-going practice of behavioral psychologists taking data - yes data - counting the number of times the autistic person smashes their skull with their fists, or rips their hair out... it's called a "functional analysis" - and this practice should be illegal.

I never want any family or child to suffer the unbelievable hell we experienced dealing with uncontrollable self-injurious behavior. Families should know what the alternatives are to help their child. Skin-stimulus therapy is very effective in that small population of self-injurious children, who have otherwise NOT responded to other therapies. Many people do not realize that it's extremely complex to treat a profoundly-autistic or profoundly-disabled person's self-injurious behaviors - as they have limited cognitive abilities; hence don't respond favorably to ignoring, re-direction or pharmaceutical interventions. The skin-shock works best for compulsive self-abuse, as it acts like a nudge on a record player that keeps playing. It's like it "startles' the otherwise very distant autistic child into reality. It actually teaches them self-control. Some of these types of autistic children are on a very primitive level - and it's hard for others to accept that they simply don't respond to conventional therapies." (An anonymous parent).

Try the non-aversive procedures first, but for those children whose seriously self-injurious behavior has not responded to these procedures, it may pay to look at aversive strategies as well.

by Gary J. Heffner, creator of The Autism Home Page at MSN Groups.

Go to Self-injurious behavior & autism for a detailed approach to handling self-injurious behaviors

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Visit http://groups.msn.com/TheAutismHomePage/environmental.msnw which is the autism home page of Gary Heffner, the author of this article. This fact sheet remains under his copyright and is used with his permission. You are encouraged to visit his site as it is one of the few autism websites offering free comprehensive information.