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Self-Injurious Behavior

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Self-injurious behavior, or SIB, is described as any occurrence of behavior in which an individual physically injures his or her own body. Common forms of SIB include head-hitting, head-banging, or hand-biting. Most severe cases of SIB may cause bleeding, broken bones, blindness, retinal detachment, and sometimes death. Between ten and fifteen percent of those with autism will self-harm in some way. SIB can occur more often among individuals living in an institution, or those with serious cognitive deficits. Parents who observe any form of self-injurious behavior should seek medical advice immediately, before the behavior becomes worse.

Types of Self-Injurious Behavior

The types of self-injurious behavior parents may see in a child with autism include any one or combination of the following:

  • Head hitting
  • Head banging
  • Biting themselves
  • Picking at their skin, or sores
  • Repeatedly rubbing or scratching themselves

image008All of the above behaviors are serious and need to be treated once noticed. Gary J. Heffner at Autism Help Org notes that parents should not only be watching for the obvious and consistent behaviors, but also for the seemingly harmless self-injurious behaviors that quickly become repetitive. For example, a child rubbing their arm every once in a while may not be considered a self-injurious behavior, but over time it could cause significant tissue damage and scarring if left untreated – and it could have been caught at an earlier stage. The dangers are worse when the head is involved, as consistent head banging, even if done softy, can result in brain damage. Overall, any form of self-injurious behavior should be treated soon after it is first noticed.

For the more noticeable and obvious self-injurious behaviors, parents often seek immediate medical attention for their children. Even then, parents should remember that once the behavior has been allowed to become repetitive, it may continue despite their many efforts to prevent the behavior from occurring. This is why seeking medical advice as soon as the behavior is noticed is vital for helping the child to recover from the self-injurious behavior.

Assessing Self-Injurious Behavior

An individual assessment will be required for each individual child or adult engaging in self-injurious behavior to determine both cause and motivation. Should your child be harming himself or herself, discuss the matter with a professional, such as their physician or a psychologist. Sometimes a self-injurious behavior is the result of a medical problem that a physician may be able to help treat. Other times the behavior occurs if the child wants sensory stimulation, in which case you could find a replacement behavior that recreates the desirable stimuli, in a safer and socially acceptable manner. For example, a child who once sought pressure by pounding her hands on a hard surface may be able to replace this behavior with a deep massage.

The reasons for self-injurious behavior are many, which is why parents should accurately record all details of any behavior observed. Every child is unique and may engage in different behaviors for different reasons. As such, the functional analysis data is essential to the overall well-being of the child, and especially important to helping the child stop engaging in any type of self-injurious behavior.

Causes and Intervention for SIB

Currently, it is believed that Self-Injurious behaviors are a phenomenon which is both highly complex and heterogeneous while also attributable to a wide variety and combination of factors. The physiological and social causes outlined below may provide an answer for your child. Use the following as a guide along with consulting a doctor or other medical professional for the proper diagnosis and treatment.

Physiological Reasons

The following are believed to be some of the main physiological causes for self-injury:

Biochemical Reasons

When self-injurious behaviors are caused by biochemical irregularities inside the body, then external elements in the person’s life have no effect on these behaviors. This means that the self-injurious behaviors can occur at any time and in any place, regardless of who is present and other stimuli (such as noises and lights). Furthermore, due to the high level of neurotransmitters in the system caused by abnormal biochemical reactions the child may not experience any pain while engaging in the SIB. This abnormality, along with an endorphin release, may cause the child to perceive the SIB as pleasurable rather than painful.

Normalizing the person’s biochemistry should help reduce or eliminate the self-injurious behaviors, and can be accomplished through both nutritional and medical interventions. Parents associated with the Autism Research Institute in San Diego have sent thousands of reports stating they have seen significant improvements in general mental state after giving their children vitamin B6, calcium, and/or DMG. In addition, these parents often observed dramatic reductions in, or elimination of, self-injurious behavior. Furthermore, parents who have their children consume a restricted diet (removing gluten, casein, or other potential allergens) also observed positive results in reducing problematic behaviors.

Seizures

When self-injurious behaviors are accompanied by seizures, there are often involuntary. As such, parents may not see any environmental connection between the two either. However, many believe there is a connection between environmental stressors and self-injury since stress is a known trigger for seizures. Sources of stress can be any of the following: physical stimulation from lighting or noise, social stimulation from demands, certain foods, and even puberty. When seizures are the suspected cause of SIB, drugs will be needed to help control seizure activity. Unfortunately, negative side effects often accompany these medications. Current evidence suggests that DMG may be a milder and safer treatment option for seizures.

Genetic

Lesh-Nyhan Syndrome, Carnelia de Lange Syndrome, and Fragile X Syndrome are genetic disorders that cause structural and biochemical dysfunction. When these dysfunctions occur they can lead to a child engaging in SIB. Self-biting and self-hitting are the two most common behaviors observed in children with these disorder. The best treatment option for these individuals, according to current research, is biochemical interventions involving a variety of nutritional supplements and drugs.

Arousal

Arousal levels in an individual may be a cause of self-injurious behaviors, which are presented as under-arousal or over-arousal. When a child is under-aroused, they will use an extreme form of self-stimulation in order to increase their arousal level or reach active wakefulness. Over-arousal can result from an external stimulation (e.g. strong lights, loud noises, and overwhelmingly social setting) or internal dysfunction (e.g. anxiety, tension). The child then turns to an SIB in hopes to reduce their arousal level.

According to the arousal motivation theory, when the arousal levels are below our optimal levels, we seek out stimulation.  For children who are under-aroused, an additional physical activity may help increase alertness, such as an exercise program with a stationary bike. If the child is over-aroused, parents and guardians should remove them from highly stimulating environments and create an exercise or relaxation program that reduces the arousal level.

Pain

When a child with autism is in pain, they may resort to self-injurious behavior simply to lessen the pain already being experienced. Head banging may occur if the child is suffering from an ear infection or headache, and wishes to reduce that pain. Additionally, other pains can lead children with autism to SIB, such as the high pitched sounds of a vacuum cleaner, or the pain from any gastrointestinal disorders.

Sensory

Some children with autism do not have the same levels of sensory information as others, which can lead to excessive self-rubbing or scratching. This can occur if the child continues to scratch one area until the optimal level of arousal or stimulation has been reached, but the behavior has also damaged skin or tissue. Typically, when this is the reason for self-injurious behavior, the child will not engage in it when they are occupied with other tasks that direct them away from his/her body. As such, the interventions employed for this cause will involve helping them learn safe forms of stimulation.

2015-03-18_1235Social Environmental Reasons

Frustration is actually believed to be one of the more common causes of self-injurious behaviors, as many children with autism can become easily frustrated when they are unable to communicate due to limited language skills, or did not receive what they wanted. The reasons are discussed further below:

Communication

Depending on where a child is on the autism spectrum, they may or may not be able to communicate effectively. When there are consistent misunderstandings, the child often becomes easily frustrated and intensifies into self-injurious behavior. The difficulties in communication may relate to either poor receptive or expressive language skills. The latter can be improved and taught through functional communication. Receptive communications skills, however, can be developed through auditory integration training (AIT), which emphasizes long-term memory information retrieval.

Obtain Tangible/Escape

One study reported that nearly 33% of patients whom engaged in a self-injurious behavior because they want something. If this is not the situation, the child may use self-injury as a method of avoiding social interactions or requests. When an individual wants to obtain an object, his or her caretakers must be careful not to provide them with anything during and immediately after the individual has engaged in a self-injurious behavior. Caretakers should be both consistent and firm, making sure the child only gets what they want when the request is made in peaceful and controlled manner. On the other hand, in the event that an individual is using the behavior for avoidance, caretakers need to ensure they are following through with any requests until the individual complies.

Conclusion

Self-injurious behaviors are a serious issue that must be addressed immediately, at which time caretakers should seek advice from medical professionals. Fortunately, Vitamin B6, magnesium, and DMG have all been noted as remarkably beneficial supplements that can potentially reduce self-injurious behaviors in children with autism. Behavior modifications, medications, and nutritional supplements may help further decrease or eliminate these potential behaviors in addition to following treatment plans made by an individual’s doctor.

References

Stephen M. Edelson, Ph.D. (2015). “Understanding and Treating Self-Injurious Behavior”.

Gary J. Heffner (2015). “Introduction to Self-Injurious Behavior”.

Kennedy Kreiger Institute (2012). “Behavioral Disorders/Self Injurious Behavior”.