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Addressing Self-Harm Behaviors in Children on the Autism Spectrum

"When my daughter (high functioning autistic) gets really upset, she pulls her hair (YANKS IT BY THE HANDFULL!). How can we stop this? Why does she do this? Is this something other parents deal with who have a child on the spectrum?"

Many children on the autism spectrum don’t know how to adequately verbalize their emotions. As a result, they may “act-out” their uncomfortable feelings by self-injuring. To make matters worse, research has found that self-injury is an addictive behavior. When a youngster self-injures, “feel-good” endorphins flood his bloodstream. In many cases, the rush is so pleasing that he learns to view self-injury as soothing instead of destructive.

Self-harm is one of the most devastating behaviors exhibited by children on the autism spectrum. The most common forms of these behaviors include: hand-biting, head-banging, and excessive self-rubbing and scratching. 

There are many possible reasons why a child may engage in self-harm, including the following:

1. Communication problems in children on the autism spectrum have often been associated with self-harm. If the child has poor receptive and/or expressive language skills, this can lead to frustration and escalate to self-harm.

2. Low levels of calcium have been associated with eye-poking behavior. When these “special needs” children are given calcium supplements, eye-poking decreases substantially, and language functioning improves.

3. Moms and dads often report that their youngster's self-harm is a result of frustration (e.g., a child with poor social skills becomes frustrated because of his lack of understanding of group play).

4. Positive attention can increase the frequency of self-harm (i.e., positive reinforcement), whereas ignoring the behavior can decrease the frequency (i.e., extinction).

5. Research on administering drugs to human subjects have indicated that low levels of serotonin or high levels of dopamine are associated with self-harm.

6. Researchers have suggested that the levels of certain neurotransmitters are associated with self-harm. Beta-endorphins are opiate-like substances in the brain, and self-harm may increase the production or the release of endorphins. Thus, the child experiences an anesthesia-like effect and, apparently, he doesn’t feel any pain while engaging in the behavior. In addition, the release of endorphins may provide the child with a euphoric-like feeling.

7. Self-harm has also been associated with seizure activity in the frontal and temporal lobes. Behaviors often associated with seizure activity include: slapping ears or head, scratching face or arms, knee-to-face contact, head-banging, hand-biting, and chin-hitting.

8. Self-harm is also common among several genetic disorders (e.g., Lesch-Nyhan Syndrome, Fragile X Syndrome, Cornelia de Lange Syndrome). Since these disorders are associated with some form of structural damage or biochemical dysfunction, these defects may cause the child to self-injure.

9. Some children engage in head-banging to reduce pain (e.g., middle ear infection, migraine headache, acid reflux and gas, etc.). Also, some children on the spectrum report that certain sounds (e.g., baby crying, vacuum cleaner, etc.) cause pain. In these cases, self-harm releases beta-endorphins that dampen the pain. On the other hand, these children may be “gating” the pain (i.e., stimulating one area of the body via self-injury to reduce the pain located in another area of the body).

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

10. Some children on the autism spectrum engage in self-harm to obtain privileges (e.g., the child may request something, not receive it, and then engage in self-harm). In addition, the behavior may be reinforced if the child should, on occasion, receive the desired privilege.

11. Some children on the spectrum function at a low level of arousal and engage in self-harm to increase their arousal level. In this case, self-harm is an extreme form of self-stimulation. On the other hand, some children on the spectrum function at a very high level of arousal (e.g., anxiety, tension, etc.) and engage in self-harm to reduce their arousal level (i.e., the behavior acts as a release of anxiety).

12. Some children on the spectrum engage in self-harm to avoid an undesirable social encounter (i.e., they engage in self-harm just prior to the social interaction, and as a result, may avoid the social interaction before it begins). Conversely, the child may engage in self-harm to escape a social encounter that has already begun (e.g., the parent may ask her child to leave the play area, but if the child doesn’t want to comply, he may then engage in self-harm, and as a result the parent’s initial request is dropped and attention is then directed at stopping the self-injurious behavior).

So, what can parents and teachers do to address the issue of self-harm in children on the autism spectrum? 

Below are some important considerations and strategies that may mitigate or eliminate these behaviors:

1. Biochemical interventions (e.g., nutritional supplements and drugs) appear to be the treatment of choice for these “special needs” children.

2. Following an episode of self-harm, make note how you attend to your child. Your attention may be positive (e.g., “How can I help you?"), or negative ("Stop that!"). Understand that your child may interpret a negative comment in a positive manner; thus, the behavior will be positively reinforced. In other words, he may continue the unwanted behavior.

3. If the child engages in self-harm because he doesn’t want to meet a parental request or demand, it’s important that parents “follow-through” with their request or demand anyway. If the child should engage in self-harm, parents can continue to make the request during the behavior, or they may direct the child’s attention to stop the behavior – but then present the request again until he complies.

4. If the child engages in self-harm due to “not getting his way,” parents should not give anything to the child during - or following - an episode of self-harm. Consistency is crucial here, because the self-harm behavior will continue even if the child gets what he wants on only some occasions.

5. Put positive and uplifting items in a box that your youngster can use when he gets the urge to self-injure (e.g., a journal, art supplies, upbeat music, photos of friends or his heroes –  anything your youngster finds calming).

6. With respect to over-arousal, self-harm may be observed in arousal-inducing situations (e.g., noisy or brightly lighted rooms).  Also, social interaction may be perceived by the child as very stimulating. If the child is over-aroused, steps should be taken before the self-harm behavior begins to reduce arousal level (e.g., relaxation techniques, deep pressure, vestibular stimulation, removing the child from the stimulating situation, etc.). 

7. With respect to under-arousal, self-harm may be observed when the child is bored or isn’t involved in stimulating tasks. If the child is under-aroused, an increase in activity level can be helpful. In this case, an exercise program can be implemented.

8. Visualizing a serene place is a great way to reduce painful emotions. When you practice positive imagery in front of your youngster, you help him strengthen these skills. For example, talk aloud as you describe a soothing landscape or reflect on positive memories of a place you’ve been to. Use graphic details in your descriptions. 

9. If your child has poor expressive skills, self-harm may occur after he tries to communicate with another person (e.g., by gesture) and the person doesn’t understand or doesn’t respond appropriately. With respect to expressive language, these children should be taught functional communication skills.

10. If your child has poor receptive skills, communication may be the problem if self-harm occurs after someone says something to him. With respect to receptive communication skills, the child may be chronically ill (e.g., headache, nausea, etc.) and may not be able to focus his attention to what was said.  This may be due to food sensitivities. Also, there is evidence that auditory integration training may improve receptive language skills due to better retrieval of information from long-term memory.

11. Help your youngster better understand the types of situations that trigger his negative feelings. For example, if it’s a test coming up at school, a social event, or a doctor’s appointment, talk about how the days leading up to it can feel stressful. This helps your youngster be prepared and have the necessary skills at his disposal. Also, talk about your personal triggers and the healthy strategies YOU use to cope.

12. If your child tends to receive a lot of attention following self-harm behavior, then you should do your best to ignore the behavior. If this isn’t possible because he may seriously injure himself, then minimize contact with him while displaying little facial expression – and don’t approve or disapprove of the behavior. Consistency is crucial here, because self-harm will continue if your child receives intermittent reinforcement (i.e., attention) for the behavior. Having said this, your child should receive attention – but it should not be contingent on self-harm. Instead, give him attention when he doesn’t engage in self-harm.

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

13. Many moms and dads of children on the autism spectrum have reported that vitamin B6, calcium, and/or DMG have resulted in dramatic reductions in self-harm behavior. Many parents have also reported reductions in self-harm soon after placing their youngster on a restricted diet (e.g., gluten/casein-free).

14. Nutritional and medical interventions can be implemented to regulate the child’s biochemistry, which in turn may reduce the self-harm behavior.

15. Self-harm behavior may occur sporadically. The child may show signs of illness or appear to be in pain (e.g., from a migraine or middle ear infection) on those days he exhibits self-harm. In this case, check your family history to see if migraines run in the family. Also, your child should have his ears examined and body temperature measured to check for a middle ear infection.

16. Since seizure-induced self-harm is involuntary, parents and teachers may not observe a relationship between the child’s behavior and his environment. But, since stress can trigger a seizure, there may be a relationship between self-harm and stressors in the environment (e.g., too much physical stimulation such as lighting and noise, too much social stimulation such as reprimands and demands).

17. The child can be encouraged to apply safe forms of physical stimulation to those parts of the body he rubs or scratches excessively (e.g., applying a massaging vibrator, rubbing textured objects against the skin, etc.). There is also evidence that placing a topical anesthetic on the injured area reduces self-harm behavior.

18. When self-harm is associated with a biochemical abnormality, there may be little or no relationship between the child’s environment and self-harm. Therefore, the behavior may occur in various settings and around different people. But, self-harm may occur less frequently in situations in which the child’s behavior is incompatible with self-harm (e.g., playing, eating, working on a task, etc.).

19. As you work with your child to address self-harm, know that setbacks are “normal.” Stopping self-harming behavior isn’t easy, and it’ll take time. Your youngster will experience some obstacles along the way that will slow the process down. The best approach if a setback does occur is to offer nonjudgmental support. Shame, criticism, or over-reaction when moms and dads see a wound usually causes children to withdraw back into self-harming behaviors.

20. If after working with your child, you still notice signs of self-harm, take him to a professional for an assessment. The professional will determine whether self-harm is suicidal or non-suicidal by administering a suicide assessment. He or she will also ascertain if other concerns are present.

Self-harm can usually be controlled in most situations. But, it’s important to understand that there are many different reasons why children on the autism spectrum engage in this behavior. It’s also possible that one form of self-harm may serve more than one function (e.g., the child may engage in head-banging when he is unable to communicate his needs – AND when he doesn’t get what he wants).

Based on observational data collected by the parent or teacher, the possible reasons for the behavior should be ranked-ordered, from most likely to least likely. This rank-ordering can then determine the order in which different interventions are implemented. By carefully examining the child’s behavior, parents and teachers can make a reasonable deduction regarding the appropriate intervention.

More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism

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