Self-Injurious Behavior
What is Self-Injurious Behavior?
Self-injurious behavior (SIB) or self harm is when those with autism engage in behaviors such as head banging, hair pulling, self cutting, hand biting or hitting, excessive rubbing or scratching. [1, 2]
It is believed that people with autism use self-injurious behavior for a number of reasons including, when they are in pain, tired or frustrated, in an attempt to communicate, when they are seeking attention or when they are experiencing sensory overwhelm or sensory deficits. [4] All of these symptoms can be related. For example, a child may head bang to distract from other pain they are feeling. Or perhaps a child is non-verbal and trying to get a caregiver’s attention and communicate that they are in pain. If a child is experiencing sensory overload which they cannot control, they may self harm to focus their attention on something else, something they can control. [4]
It has also been suggested that self-injurious behavior may cause a release of endorphins, providing an anesthesia-like effect whereby the person does not feel any pain from the behavior. The release of endorphins may provide a euphoric-like feeling. [1]
Self-Injurious Behavior & Autism
Self harm is not something unique to autism but it can be a symptom. A recent study found that self harm is 3x more likely among children and adults with autism, than those without. [2] 20% of those with ASD have anxiety disorders and 11% have depressive disorders and these conditions are associated with a higher risk of suicide and increased prevalence of self-harm. [2]
SIB is often diagnosed as “stereotyped SIB” because it is habitual and repetitive in nature. [3] It often occurs under very specific conditions or can occur after a long period without any incidents. [3] It is believed that about 50% of those with autism engage in SIB at some point in their lives. Self harm carries obvious health risks to the person and can greatly limit a person’s work, education and social opportunities. There may be increased costs for medical care and protective equipment and loss of personal property.[3] Those who engage in SIB may be more likely to have aggressive or destructive behaviors. The presence of self harm predicts poorer long-term outcomes for the person. [3]
BOTTOM LINE:
Self-injurious behavior can be both dangerous and frightening but there are many ways to prevent or reduce the frequency. The first step is to try to understand why the behaviors are occurring and then you can help your child overcome them.
Next Steps
Diet
GI distress is often missed in people with ASD who are nonverbal because discomfort from multiple causes may all be expressed with self-injurious behaviors. Treating GERD (reflux) and constipation can dramatically reduce harmful behaviors and lead to improved nutrition as the GI system heals. [5]
Determining if your child has a food sensitivity which may be contributing to pain (GI pain, ear or sinus infections etc) is one way to address SIB with diet.
There are blood tests to determine food sensitivities, such as the MRT test.
If anxiety or depression are related to self-injurious behavior, assessing protein intake and micronutrients may be beneficial. Amino acids and many vitamins and minerals are essential for neurotransmitter production which regulates mood and brain function. It is important to assess whether the person has the nutrients needed to allow their brain to function optimally.
Supplements
One study suggested that calcium deficiency may have been an underlying cause of causing eye poking behavior because when calcium was supplemented, eye poking decreased significantly. [1]
The Autism Research Institute has received many anecdotal reports of parents who have supplemented vitamin B6, calcium and/or dimethylglycine (DMG) and have observed reductions in self-injurious behavior. [1]
Magnesium deficiency is associated with an increase in sound sensitivity. Magnesium supplementation may reduce sound sensitivity in some individuals. [1]
Lifestyle
Teaching the child to communicate (either verbally, with sign language, with pictures or with a device) is one of the most powerful tools for reducing self -injurious behavior.[7] Once you know the reason for the behavior, you can address it. Behavior therapy can help to establish coping skills and alternative behaviors. [7]
Examples of commonly used behavioral interventions include removing the trigger that had been prompting the behavior, reinforcing a more appropriate behavior via positive attention, or extinguishing the SIB by deliberately ignoring it. Self-injurious behaviors that are internally reinforced because it feels good to the person are the most challenging to change but can often be helped by replacing the inappropriate behavior with a behavior that may provide a similar sensory experience.[3]
One study demonstrated that the use of a strictly regimented sensory “diet”, which provided sensory activities every 45 minutes to one hour throughout the course of the school day to be the most effective intervention to decrease aggressive and self-injurious behavior. [8]
If a child is under-aroused and sensory seeking, it may be beneficial to increase their sensory stimulation with exercise such as jumping on a trampoline or bouncing on an exercise ball, climbing on a jungle gym, deep pressure with a body sock or a weighted blanket, using a vibrating pillow, playing on a scooter board or playing in a sensory bin.
If a child is overstimulated and overwhelmed, it may be helpful to use noise canceling headphones, work on breathing and relaxation techniques, use a weighted blanket or apply deep pressure, play relaxing music, use a cocoon type sensory swing or if possible, remove the person from the overwhelming situation.
In some situations, manual restraint by other people may be required to keep a person from seriously injuring themselves.
