Self-injury isn’t a defining characteristic of autism spectrum disorder. Though many people with ASD engage in some form of self-injury behavior as a co-morbidity of the condition.
Being able to identify the underlying disorder(s) contributing to the risk for self-injury behavior is a critical step in treatment and prevention. This often includes helping the individual to learn better communication and coping skills.
What Is Self-Injury Behavior?
There are actually many reasons for self-injury behavior in individuals with an autism spectrum disorder. These incidents can vary in type and severity with the most common being
- Excessive Scratching
- Headbanging Walls & Objects
- Biting the Extremities
To help curtail these self-injury behaviors caregivers need to also understand the underlying issues causing them.
Why Do Some Autistic Engage in Self-Injury?
Parents and clinicians should start by investigating triggers that lead to self-injury behavior. While some incidents are accidental, it’s also possible for them to be inadvertently reinforced, if they aren’t addressed promptly.
It’s also possible for self-injury behavior to serve as a form of communication. A child with ASD might be trying to convey a feeling or idea that they can’t express in words. Suddenly they resort to biting, headbanging, or other self-injurious behaviors as a form of acting out or expressing their frustration.
What Causes Self-Injury Behavior?
Sometimes self-injury behavior is a form of sensory stimulation. Individuals with autism might self-injure as a way to increase or decrease their level of stimulation.
Unfortunately, there are many cases where self-injury becomes a learned behavior that is accidentally ingrained. Parents and other caregivers might unintentionally reinforce the behaviors.
Once a child with ASD engages in self-injury and the parent or teacher might give them a preferred toy as a means of distraction or redirection. Only the child might take this as a sign that self-injury leads to their favorite toy.
In the same vein, it might be that the child is engaging in self-injury, and their parent or caregiver immediately removes them from an overstimulating environment. This accidentally sends the message that self-injury is a way to deal with overstimulation.
With both of these theoretical examples, the child with ASD might be attempting to communicate what they want or need. When self-injury provides the results they wanted, they learn to associate self-injury with a positive result.
Other factors can lead to self-injury that goes beyond learned behavior. It’s possible for things like biochemistry in the brain, a history of seizures, genetic factors, or a pain response can be the root cause of the self-injury behavior.
How to Identify the Root Cause of Self-Injury Behavior
Identifying the root causes of self-injury behavior starts with asking yourself what the child with ASD needs or wants. Also, consider any communication barriers that might lead them to initiate the self-injury behavior.
By identifying potential triggers, you can start eliminating specific stimuli. If you suspect that bright light is causing an overstimulation response that leads to headbanging, try lowering the light level when they aren’t engaging in self-injury behavior. If it doesn’t occur in low light conditions, you may have just found the reason.
This sort of systematic approach can be applied to stimuli and other external factors to either rule them out or help you better understand the root cause.
If necessary, you might need to track instances of self-injury, in a journal. Be sure to include key information such as where it occurred, what was happening, who was present, what occurred immediately before, and what occurred immediately after. This might help you identify triggers and stimuli that you might be able to eliminate as part of a self-injury prevention strategy.
Functional Behavioral Assessments to Determine the Cause of Self-Injury
If you’re still struggling to find the root cause of the self-injury behavior, your child’s clinical/therapeutic support team might be able to help you interpret the behavior. The science-based approach of ABA therapy often employs a functional behavioral assessment (FBA) to help identify the function of self-injurious behavior for the individual. This includes evaluating several factors such as:
- Gathering and analyzing information
- Defining the stimuli present when the behavior occurred
- Exploring when, where, and how the behavior is occurring
- Factoring in the consequences of the behavior
- Identifying potential reasons or causes
- Postulating what the child is trying to communicate
Interventions to Help Prevent Self-Injury Behavior
The first step in implementing a self-injury behavior prevention strategy is to communicate with your child. The more you understand why they are doing what they’re doing the easier it will be for you and your child’s clinician to make a plan to address it.
In a case where the self-injury behavior is related to anxiety or some form of discomfort, social stories and priming might help ease transitions. These are carefully crafted stories designed to help children practice before an anxiety-inducing situation occurs in real life. Then priming provides the child with the necessary information about how to reduce their anxiety. This therapist-guided process can help redirect the behavior in triggering situations.
Introducing an alternative behavior to essentially replace the self-injury behavior might also help the child to feel that their wants and needs are being met in another way is crucial. This might be something as simple as leaving them alone when they bite their hand to demonstrate that the behavior leads to disengagement.
You also need to remove or alter the primary triggers that encourage self-injury behavior. Here again, social stories and priming can help make the experience predictable and might uncover secondary stimuli that are afoot.
It’s also important to provide positive reinforcement anytime the child displays healthy communication instead of self-injury. This keeps the lines of communication open between the two of you, and allows you to present more options in the future.
Behavior Therapy For Self-Injury Behavior
If the self-injury behavior has escalated to the point where it is a learned habit, behavioral therapy is one of the best methods for helping the child replace old self-injurious patterns with new skills. Behavior therapy also has a long track record of success in helping children with ASD to improve their communication skills. This further opens the door to understanding why, and how to help them prevent self-injury behaviors in the future.