Decreasing Self-Injurious Behaviors

Self-injurious behavior can be a common occurrence exhibited by children with Autism Spectrum and other disorders. To determine interventions or ways to decrease this behavior, it is imperative that the function or reason for the behavior can be determined.

Literature notes that common reasons include communication issues, frustration, escape/avoidance, an effort to obtain tangibles, pain, sensory issues, or medical issues. Often these functions or reasons may overlap.

Examples of interventions or ways to decrease this behavior include:

• Inability to communicate: work with your child’s speech therapist to identify the best mode of communication. It may be using American Sign Language or an adapted communication device.
• Frustration with a task or subject: if the behavior occurs during certain routines or demands, consider that the individual may not have the skills to meet that demand. Instead, break down the task, teach each component skill, consider decreasing the demands, and pair difficult tasks with reinforcers.
• Sensory: if you suspect a sensory need, consider working with related service providers (Occupational Therapist) to try to provide replacement tools for the child to bite or chew if they need sensory input; also ensure your child has a schedule that will keep them engaged and therefore less likely to exhibit self-injurious behaviors
• Medical: whenever a child has aggressive behaviors, especially self-harm, please rule out any medical issues. Speak with your child’s pediatrician and any specialists before attempting other interventions.

Be sure to reinforce when your child is engaged in appropriate behaviors- prevention is key! If the self-injurious behaviors are occurring at a high rate and/or intensity, enlist the help of a behavior specialist.

An example of each of these strategies follows with resources to access more information as well.

Some common forms of self-injurious behaviors can include head-banging, hand-biting, and scratching. As noted above, always check with your child’s medical team prior to beginning any other intervention. 

Methods to decrease the behavior will depend on the function (or reason). Assessing the reasons is called a Functional Behavior Assessment/Analysis. Caregivers or professionals typically note the type of behavior being exhibited, when and where it occurs, what happened right before (antecedent) and what happened during or after the behavior (consequence).

Noted interventions or strategies to decrease the behavior include reinforcement of alternative behaviors or reinforcement of incompatible behaviors which means reinforcing a behavior that is an alternative for the problem behavior or one that ‘interferes’ with the self – injurious behavior.

For example, providing a favorite food before the behavior occurs will interfere with or be incompatible with the self-injurious behavior. Alternate behaviors can be designed with alternate tools that serve the same function the student is seeking with the self-injurious behavior.

Determining the function and providing alternate behaviors may decrease the targeted self-injurious behavior. Strategies based on prevention once the functions are determined are presented in the Process section.

• Child's Age: 6-10, 11-13, 14-17, 18+
• Planning Effort: Moderate
• Difficulty Level: Moderate

Completion of an FBA or noting when, where, and what occurs before or after the behavior to determine the reason.

1. Begin the process by completing a form often called an ABC chart that will tell you information about the behavior. Note when and where it occurred and who was present. Describe the type of self-injurious behavior (head-banging, scratching, biting). Note what was happening right before and what happened during and after. This refers to responses by others around the child. If the behaviors occur at home and school, parents and teachers should work together to determine the reasons.
2. With this information, attempt to determine if the child needs assistance with communication, if they: want to gain access to something, is frustrated or in pain, is trying to escape an activity or a person, is gaining sensory input, or is seeking peer or adult attention. Also, note if it is not apparent what may have caused the behavior.
3. Remember – sometimes a behavior may start for one reason and then turn into another. For example, a child may be seeking sensory input, but when adults or peers react and attend to the child it may turn into an attention-seeking behavior.
4. Once you feel confident in the function or reason for the behavior begin to decide on an appropriate intervention or strategy that will decrease the behavior. A few examples follow.
   • If the reason appears to be due to an inability to communicate, work with the child’s speech and language therapist to determine the best mode of communication for the child.  This may include the use of pictures or an augmentative device. Coupled with communication, if the child appears to want access to an item, prompt use of the communication system to request the desired item.
   • If the behavior occurs in school when academic demands are placed on the child, consider decreasing the demands, teaching prerequisite skills, and provide reinforcers for all attempts. Pair this strategy with child choices regarding the work. Slowly increase the demands over time.
   • If it is surmised that the reason is sensory, consider an Occupational Therapist consult. The Occupational Therapist can identify if there are alternatives and activities to meet sensory needs. Try to provide replacement tools. 
5. Whenever the child is engaged in an appropriate behavior reinforce, reinforce, reinforce. Prevention is the key.
6. It is also possible self-injurious behaviors may have a biological base. Always check with your doctor and service providers to rule out other possible functions.
7. Working to assess the function of self-injurious behaviors can often be difficult. Even when a Functional Behavior Assessment identifies the function (s) of such behavior, it may be difficult to turn things around prior to harm occurring to the child.
8. Enlist the support of a Behavior Specialist if self-injurious behaviors are at high rates/intensity or if behaviors continue despite programming changes.