ASD and Self Injury

From LoveToKnow Autism

ASD and self-injury problems are very troublesome for parents, caretakers and those diagnosed on the autism spectrum. The self-injurious behaviors can stem from a number of factors, and in some cases, they can be prevented with the right interventions.

Defining Self-Injury

People in general often engage in self-injurious behaviors on a regular basis. Self-destructive behavior comes in a number of different forms, some are more difficult to detect because they are quite subtle.

Consider some of the ways a neurotypical person can cause himself harm, emotionally and physically. Entering unhealthy relationships, subconscious sabotage and poor self-esteem are among the damaging behaviors. Those who smoke, overeat, or bite their nails are engaging in self-injurious behaviors. The effects of the behaviors are not immediately apparent, as they are with those often displayed by individuals on the spectrum.

When physicians discuss ASD and self-injury, they typically refer to physical harm that can cause cuts and bruises. Behaviors may include:

  • Head banging
  • Biting
  • Scratching
  • Rubbing the skin raw
  • Grinding teeth excessively
  • Pressing on eyes
  • Hitting

The behaviors are very upsetting to those who care for the individual who engages in them and the drive to extinguish the behaviors is great. The process begins with considering the possible causes of self-injury.

Possible Causes

The possible causes of the behaviors may stem from a couple realms: physical and social. The individual may have physical sensations that drive him to engage in the damaging behaviors. In some cases, the behavior stems from problems with social interaction and communication.

Social Realm

It is said that all behavior is communication on some level. ASD and self-injury may coincide because the individual has difficulty communicating effectively using language, as part of autism symptoms. A person on the spectrum may literally bang her head against the wall out of sheer frustration.

  • Attention can be the goal as well. The individual may learn that she receives a strong reaction from others when she engages in self-injury. The can reinforce the behavior, causing it to reoccur.
  • Avoidance is another issue that can come into play, especially in children. The individual wants to avoid a completing task, and has learned that hurting himself provides a diversion.

Physical Realm

  • Sensory dysfunction in cases of autism can be extremely uncomfortable. In some cases, the individual may be so overwhelmed with sensory input that she engages in behaviors to block it out. On the other hand, the individual may not be receiving enough sensory input, so he seeks it through the harmful behaviors.
  • Self-stimulatory behaviors can be self-harming in some cases. Just as nail-biting causes damage to the nails, some ASD stims can be damaging to other parts of the body.
  • Endorphins can play a role in the behaviors because the pain releases beta-endorphins in the brain. Endorphins are the brain's natural painkillers that have an opiate-like effect.
  • Pain elsewhere in the body can lead to self-injurious behaviors as well. A child may pull out her hair because she can't deal with the pain caused by a urinary tract infection, for example.

Treatment

Functional Analysis

Treatment approaches vary from one individual to the next, but the beginning of the process usually begins with functional analysis, an approach closely associated with applied behavioral analysis. The strategy helps the treatment team to identify the source of the behaviors, moving the focus away from the response to the behavior and toward the cause, more precisely, how the specific function of the behavior. An example of functional analysis is the ABC chart, in which the person working with the individual records details about the episode:

  • Antecedent is what happens immediately before the behavior.
  • Behavior is the specific action carried out by the individual.
  • Consequence is what happens immediately after the behavior.

It is important to note that the person recording the data should remain objective, focusing on the occurrence without drawing conclusions. For example, she would write, "A loud truck traveled past the house," rather than "He wanted to see a truck and got mad," or "The loud truck scared him." All information should be observable and concrete. Functional analysis is time consuming and it requires a series of tests. There are three types of functional assessments from which to choose, each is quite involved but worth the effort. More information about functional analysis is available through Polyxo.

Planned Ignoring

Planned ignoring may be used in some cases in which it is determined that the behaviors are attention seeking. However, any actions that can cause harm to the individual are non-negotiable. Ignoring some attention-seeking behaviors can help to extinguish them, but self-injury is a serious matter that requires intervention. Planned ignoring is difficult to practice because natural responses to some behaviors are automatic. It may be nearly impossible to avoid showing reactions of surprise, fear, and anxiety that result from the behaviors.

Sensory Integration

Sensory integration therapy for autism is a fantastic approach that is effective if the individual is having difficulty processing sensory information. Creating a program that addresses specific sensory needs can reduce self-injurious behaviors that stem from processing problems. The activities can help to calm and organize behavior.

Make sure to discuss the behaviors with the individual's physician. In some cases, an EEG may be necessary to detect subclinical seizures. Other underlying physical problems may lead to the extreme behaviors as well.

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