Thursday, February 2, 2012

Handling Self-Injurious Behavior in Children With Autism

I have read recently and understand that some parents are desperately seeking advice for handling their child's self-injurious behavior. Self-injurious behavior, also known as SIBs, are classified as any aggression towards oneself. The most common forms of self-injurious aggression is hitting or biting but some older children may also be involved with cutting. Other forms of SIBs may also include head butting, body slamming, picking or scratching, and using other objects to hit. Before talking about strategies that help to replace these SIBs and decrease the severity of the injury, let's discuss how critical SIBs are.
If your child is demonstrating SIB, then it is time to get a behavior consultant involved if there is not one already. The reason for this is because it is crucial to get to the root of the problem and find out exactly why your child is acting out in an aggressive way. He may be desperate with communicating his needs and incredibly frustrated. She may be seeking out deep sensory input. He may be trying to gain access to some tangible that he can't have. Unless a functional behavior assessment is done, you will not be able to truly address the SIB because you won't know exactly what is causing it. I will focus another few posts on functions of behavior but it is important to note that when you know the function of the behavior, you can act proactively to help prevent and/or at least decrease the behavior that is inappropriate. So seeking out the help of a professional behavior consultant may be your first step. Now, this may take some time to get set up. In fact, just getting an agency, evaluation, behavior consultant, and/or services in place, (if you do not have already) can take a tremendous amount of time. So, here are some tips that you can try now to handle the everyday occurrences until you have more help in place.
I know it must be SO incredibly frustrating and disheartening to see your child hurting himself. You're willing to try anything because you know your child may end up causing himself severe injury, if not hospitalization. You also may be very puzzled as to why your child is acting this way. Some children will casually bite their hand and stop biting because it hurts. This is a natural consequence. They will stop biting because they feel pain. However, many children with Autism Spectrum Disorders do not feel pain like typical children do. Many of them have an extremely high tolerance for pain and may not even cry when they get hurt. Many of them also seek out deep sensory input. They crave, not only deep pressure, but some kind of impact to their bodies in order to help feel more regulated. These are children with sensory processing disorders known as the "sensory seekers." Biting can be due to an oral fixation, the need for sensory input to the mouth. As odd as it may sound, children who are orally fixed and may be biting, may continue to bite because it brings them a sense of joy and regulation, NOT pain. Don't forget that most SIBS are caused by some level of frustration in the child, not just sensory needs. A biter may be seeking input but may also be acting out of frustration for another need or want. That is why a behavior assessment needs to be done to truly understand the cause.
Let' also discuss the issue of restraint. When a child is acting out against himself or someone else, retraining him/her can be an option. HOWEVER, it is very important to note 3 things. 1. Restraining a child should only be done to help prevent further injury to the child or someone else, especially in extreme measures. 2. There is a protocol, a heirarchy, and training involved with restraining a child appropriately so that you and the child do not continue to get hurt in the process. If you are not trained properly, nor understand the protocol, then I would not recommend restraint in any way. 3. If restraining the child makes matters worse, i.e. causes your child to completely lose control, fight back, and increase rage, frustration, SIBS, and/or aggression, then restraint should not be used. I will discuss the methodology of restraint in other posts but please keep these tips in mind if considering it as a reactive measure to SIBs.
Biting can be very harmful as bite marks and bruises can occur without too much force. If you have a child that bites, you should invest in some kind of a chew object. There are companies that sell chew tubes that help children who need to chew or bite due to lower oral motor function or who may need sensory input to the mouth because of a sensory disorder. Chew tubes also work great for children who bite because you may be able to replace the biting of one's arm to biting this rubbery object and still give your child the oral input that they may be craving. If the biting is done out of frustration, it is still done in a safer way. One company, The Sensory University, offers a pack of chew toys called CHEWY RETRACTABLE BITE BUDDIES that can be attached and retractable to a belt loop so they are on hand immediately whenever they are needed. There are also CHEWY TUBES as well as a TRI CHEW toy that looks like a triangle.
Hitting can be a little trickier, depending on where the child is hitting himself. Some times, hitting can be prevented by holding down the child's arms. You want to do this only with enough force to prevent the child from lifting his arms to hit. You can also place your hand between your child's hand and the place your child is hitting. For example, if your child is hitting his forehead, you may be able to place your hand on the child's forehead to block the hit. This has worked with some children. I had a student who stopped hitting once he felt another hand there, blocking his face. He may hit one to two more times but then stopped. Another idea is to have the child wear a helmet if he engages in repetitive and severe hits or blows to his head. The best type of helmet to use is a soft foam helmet that is easy to put on and does not harm the head further if pounded on. It simply creates a soft space between the hand and the head to protect the head. One such helmet would be Playmaker Headgear. Be sure to get a helmet that fits your child's head properly. The helmet should only be put on while head hitting is occurring and then it can be removed.
Remember that these are measures that can be taken to help reduce the severity and/or harm that can happen as a result of SIBs. They are only tips that can be tried as a reactive strategy. They are not to be considered solutions. The best way to handle SIBS is to assess what is causing the SIB and address the specific function of the behavior. In this way, you can learn to be proactive and help prevent SIBs from happening at all.

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