Self-injurious behavior (SIB) is one of the most devastating types of behavior exhibited by children with autism. Ranging from head-banging, biting, to extreme hand-rubbing or scratching these types of actions can be detrimental to a child and to their parents. At Steinberg Behavior Solutions, we understand how hard it can be to witness any kind of SIB your child might exhibit. That’s why we have a wide-range of techniques we use to decrease and even stop self-injurious behavior. We understand that the key to curbing this type of behavior is to understand its cause or the reason behind it.
Frustration
Parents often report seeing their child exhibit self-injurious behavior as a result of frustration. Usually this is the result of the child’s lack of communication abilities. They may be unsuccessfully trying to explain something, or the child might not understand what is being asked of them by their therapist or parent. Whatever the reason, the inability to communicate leads to frustration and then self-injury.
The solution is to teach a child functional communication skills such as sign language, Picture Exchange Communication System (PECS), or to use a communication board. It’s important to remember to stick with one communication medium across all settings to reduce the frustration levels. That means parents, caregivers, therapists and doctors use the same system of communication when interacting with the child. It is also important the child have access to this communication system wherever he or she goes.
In cases where the child does not understand what is being asked, there may be a physical problem (i.e. headache, stomach illness) or they may have a physical impairment such as having problems hearing. In that case, it’s important the child be evaluated by their doctor.
Avoidance
At Steinberg Behavior Solutions, we’ve witnessed children engage in self-injurious behavior to avoid or escape an uncomfortable social encounter or instruction. The child may start to injure themselves before they are set to meet a certain person or during a specific activity. Either way, the goal of this type of behavior is to avoid something or someone. As an example, a therapist might ask a child to do something (e.g., to leave the play area). If he or she does not want to, they may then engage in self-injurious behavior. The result is the therapist’s initial request is dismissed because now they’re focused on stopping the destructive behavior. In this example, it’s crucial that the therapist follows through with their request. If the child begins to injure themselves, the trained professional must intercede and block the behavior for safety reasons, but then they should continue to follow through with the request so the child does not learn that SIB gets them out of an activity.
Attention
In the case where the self-injurious behavior is thought to be the result of the child wanting attention, it’s important he or she receives positive attention when the SIB is not occurring. At Steinberg, we understand that for the safety of the child you cannot ignore any self-injurious behavior and that it requires your immediate attention. If possible, intervene in the situation as neutrally as possible, for example, block the behavior from occurring but do not say anything (e.g., remove your verbal attention). Also, positively reinforcing any behavior that makes SIB impossible (i.e. asking them to use their hands in an activity which prevents them from slapping) is a great way of taking away the attention from the negative and focusing on the positive.
Sometimes, despite everyone’s best efforts, SIBs continue to occur for what seems to be no reason. As a parent or for us as therapists, our first priority is always to keep the child safe. Some families resort to the use of restraints or protective headgear. Additionally, some parents give access to other forms of stimulation. This can be a team approach in determining the best method between the family and therapists at Steinberg.
Conclusion
The reasons and techniques to stop self-injurious behavior mentioned above are only a fraction of what is available to a child who exhibits SIB. Despite the fear and frustration many parents express when dealing with self-injurious behavior, learning the reason why it happens and implementing a function-based treatment will help the situation tremendously. In our experience, not only will this decrease the undesired behavior, but it will increase other appropriate behaviors in your child.