Managing Self-Injurious Behaviors in Your Child with Special Needs

Watching your child hurt themselves can be devastating, especially if you’re not sure what’s causing it or how to stop the behavior. Self-injurious behaviors are relatively common in kids with autism or other neurological disorders. Head banging, hand biting, pinching, scratching, hair pulling, or other repetitive and sometimes dangerous behaviors are the most common, however, there’s a wide range in the severity of the behavior. We don’t always know what causes self-harm, especially in non-speaking (or non-verbal) children, but it’s prevalent in kids who have difficulty communicating their emotions and in those who have sensory processing issues.

For the first six years of Sienna Bernal’s life, her family didn’t realize that she was hard of hearing. Her mother, Chrissy, says that as a young child, Sienna started banging her head on the ground. The behavior was highly distressing to witness as a parent. “After much trial and error, we figured out she was doing it because she was frustrated because she couldn’t communicate what she wanted to communicate,” Bernal explains.

Baby picture of Sienna waiting for her heart surgery
Credit: Chrissy Bernal | Sienna waiting for her heart surgery

Sienna was born with a very rare condition known as primordial dwarfism. She also had a hole in her heart “that had to be repaired, as well as Dandy-Walker Syndrome, where she’s missing parts of her brain,” says her mother, Chrissy Bernal, of Houston, Texas.

In some children, stopping these behaviors completely may be unrealistic, but parents can take a number of steps to reduce their frequency—starting with identifying the underlying reason for self-harm. With a better understanding of what triggers these behaviors, parents can help their kids to find better tools for coping.

What Is Self-Injurious Behavior?

Self-injurious behavior is when your child acts in a way that could hurt themselves. Also referred to as self-harm, it can result in minor cuts and bruises, or, in more severe cases, serious injury.

Examples of self-harm include:

  • Head-banging
  • Hitting
  • Hair pulling
  • Scratching
  • Biting hands and fingers
  • Punching or kicking a wall
  • Pinching
  • Slapping

Who It Affects

Self-harm behaviors are most common among children with neurological disorders, which may or may not have a genetic cause.

As many as half of kids with autism may self-harm, especially those who are non-verbal. Autism isn’t caused by a single gene, so the condition has been linked to a range of behaviors.

Research has shown that as many as 70% of kids with Fragile X syndrome self-harm, which frequently includes hand-biting. In general, about 10-15% of kids with neurological disorders may display similar behaviors.

Certain genetic diseases may cause more serious specific forms of self-harm, including eye-poking. Lesch-Nyhan syndrome and Smith-Magenis syndrome, for example, are associated with very severe self-harm behaviors, including biting of the lips, cheeks, and tongue, as well as eye poking that may result in hospitalization.

Why Kids Self-Harm and How to Manage It

Self-harm in children with special needs is a result of physiological and biological consequences that scientists don’t fully understand. But certain environmental or emotional factors—some of which you might be able to control—may trigger these behaviors.

Understanding your child’s self-harm triggers can help you to both reduce the behavior and better relate to your child. One of the most common is frustration with the inability to communicate their emotions. As a result, your child may feel overwhelmed and act out accordingly. For example, if your child wants to be left alone but can’t convey it, they may bite or hit themselves out of frustration.

In other cases, self-injuring behavior might be due to sensory overload. Some children who are sensitive to loud noises, bright lights, or certain smells, textures, and tastes may react by harming themselves.

“Some kids are feeling too much physiological arousal, and then they self-injure, and it appears they feel some sort of relief,” says Lauren Moskowitz, Ph.D., a psychologist at St. John’s University who specializes in treating children with autism and other intellectual and developmental disabilities. In fact, research has shown that non-verbal children who engage in these behaviors experience a reduction in their heart rate after they self-harm, suggesting that it may act as a release to help them calm down.

The next time your child self-harms, write down what happened right before it occurred. If you do this for a while, eventually, you should be able to identify a pattern. “Sometimes it might feel like it comes out of nowhere, in the moment, but there’s often something that happens right before the behavior occurs,” says Moskowitz.

Pinpointing triggers might be difficult on your own. Most of the time, parents living with kids who self-injure need the help of a professional child psychologist who specializes in kids with neurological disabilities, behavioral analysis, or a speech therapist, depending on your child’s underlying disorder.

For many kids, unpredictability is a trigger. Advance warnings can help: If you’re leaving the house in five minutes, set a timer so that your child isn’t caught off guard. Other kids are triggered by large groups of people, in which case you may try to plan grocery trips when you know the store is less crowded.

After addressing potential triggers, you’ll want to teach your child replacement skills. These are healthy substitutes for self-harm when triggers are unavoidable.

Of course, every child is different. Observe your child throughout the day and note any little things that seem calming to them. For example, if your child has a sensory issue, you may find that playing music, dancing, chewing on an ice cube, or taking a bath is soothing. Jewelry created specifically for kids with special needs, which gives a child something to chew on when they feel distressed, might also reduce the frequency of self-harm.

It’s also helpful to reinforce your child’s communication skills so they can tell you their needs without relying on self-harm. If your verbal child bites her hand when she wants you to go away, ask her to say, “Please leave me alone,” for example.

If your child is non-verbal, speech therapy can be especially beneficial. A speech therapist can find an appropriate augmentative and alternative communication (AAC) device that helps your child tell you what they want. The options vary based on your child’s needs, such as a board with symbols they can point to, sign language, or a high-tech communication app or device.

Other treatments depend on the child and their disorder. “I wish we had taught Sienna sign language from a younger age, but we didn’t realize she was hard of hearing until age 6,” says Bernal.

Sienna has a special type of hearing loss related to dwarfism, where the anatomy of her ear is too small. As a result, it took a certain type of specialist to diagnose it. Bernal says figuring out “the why” helped them to provide options for Sienna that prevented the head banging. “Once we started the sign language, it was like the synapses in her brain started firing off.”

Will It Get Better with Age?

In some kids, self-harm behaviors can be controlled—but they likely won’t go away completely. In most kids with Fragile X Syndrome, finger-biting persists into adulthood. In kids with autism, persistent and repetitive behaviors may lessen but never disappear completely.

Giving your child alternative tools to cope with emotions without hurting themselves can make things a lot easier on your child and on you as a parent. Identifying triggers, finding replacement behaviors, and helping your child to communicate their needs can all go a long way.

Sienna posing and smiling
Credit: Chrissy Bernal | Sienna posing and smiling

Today, Sienna is 25 years old, and her mom says she’s doing great. “For dexterity therapy, she started beading, and it turns out she was really good at it. Now she has her own jewelry line that she sells online and at markets,” Bernal says. “Today she can actually identify when she needs a moment, and she’ll go and do a type of yoga that helps her to get her anger out in a healthy way.”

Bernal says that in the end, being inquisitive as a parent helped her to effectively identify the cause for and address Sienna’s self-harm behaviors. “You have to dig deeper to figure out the why.”

References and Further Reading

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