Children with autism spectrum disorder (ASD) often exhibit aggressive and/or self-injurious behaviors that can frighten parents, caregivers, and playmates. While not at all uncommon, these types of behaviors, including biting, can be frustrating and difficult to manage without proper guidance and support. Fortunately, there are several resources and proven strategies that can help families deal with self-injurious and aggressive behaviors like biting.
Step One: Determine the Cause of Biting
While biting behavior is quite often a result of an environmental or internal physiological stressor, there are many medical conditions that can elicit these and other undesirable behaviors that a general practitioner may not be attuned to. It is essential to first rule out any underlying medical or biochemical conditions to be sure a child is not responding adversely to pain or other physical distress. A medical professional who is familiar with ASD children is usually the best source of information and support.
Step Two: Gather ABC Data
If a medical issue has been ruled out, then techniques derived from Applied Behavior Analysis (ABA) are generally the most effective way to pinpoint why biting is occurring and can be used to develop an intervention plan. A functional analysis is a tool that provides therapists and/or physicians with a comprehensive look at the behavior so strategies can be developed to eliminate it. Parents, teachers, and other caregivers can help with this analysis by using an ABC chart (ABC stands for antecedent-behavior-consequences) to document when and where the behavior occurs and under what circumstances. The goal at this point in the process is to document only what is observed, not to make inferences about the cause. Once enough data has been collected, then some determinations regarding the cause of the behavior can be made.
Step Three: Implement Strategies for Managing Biting Based on Cause
Gathering ABC information for a few weeks may actually give parents and caregivers the answers they are seeking as to why their child is biting without the need for professional intervention (other than to rule out a medical issue). Causes for biting can be as unique as the child, but some of the most common are:
- Inability to communicate
- Sensory deprivation
- Normal developmental stage (mouthing objects)
Even while collecting data, it is important to attempt to curb the behavior, so during the observation process, use these immediate interventions to keep everyone safe and to let your child know biting is never acceptable.
Don't Overreact to the Behavior
Whatever the cause of the biting behavior (or any other undesirable behavior), it is important not to overreact to it. Any attention given the behavior is only likely to increase its occurrence.
- It is best to say little and simply remove the child from the situation.
- Give the attention to the person who has been bitten, show sympathy, and treat the bite as needed.
- It is appropriate to say no, or that biting is not allowed, but try not to show anger or frustration and state the rules (no biting) only once. Use a firm, serious voice, but try not to yell.
If the biting is self-injurious, the bite will need to be attended to, but it is best not to fret or show dismay when that occurs. Long explanations about why biting isn't appropriate probably won't help, particularly for young children. Simply state it is not allowed and move on. Return attention to them when they are calm and behaving appropriately.
Redirect the Behavior
Whether the biting is aggressive or self-injurious, if the behavior seems to be occurring due to a lack of sensory experience, try forestalling the biting by having appropriate objects on hand the child can mouth or chew. It is much easier to redirect a behavior than to stop it cold, so having an appropriate item on hand in stressful situations can help, as well.
Offer an Alternative Solution
If the biting seems to stem from frustration or anger, offer an alternative solution to manage the anger. A stress gel ball may work for this. Tell the child they may squeeze the ball when they are angry, but they are not allowed to bite. This strategy can also be used for both aggression and self-injury.
Develop Communication Strategies
For nonverbal children, biting and other aggressive acts are often an attempt to communicate. Try using pictures and/or symbols to help the child communicate their feelings so they have a more appropriate outlet for their frustrations.
Reward Appropriate Behaviors
Remembering to tell a child when they are doing things the right way is as important as intervening when they aren't. Comments about their appropriate behaviors, like playing nicely or sitting quietly when asked, go a long way in helping them know what to do in various situations they encounter. Using a chart or other visual aid may help the child understand how and when they earn tangible rewards, but remember praise is a very powerful motivator as well, particularly when it comes from a parent or other authority figure.
Manage Avoidance and Escape Biting
It is much easier and more reinforcing to reward appropriate behaviors than it is to change and/or redirect inappropriate ones. It is particularly difficult to manage challenging behaviors that are the result of a desire to escape or avoid a task or situation. If the child is allowed to forego the task because of the biting, then they learn biting is a great way to get out of doing what they are supposed to do. This particular problem may require professional help, but if possible, insist the child complete the task once they have calmed down and are safe. Also examine whether the task is too difficult or is being requested at a bad time for the child. Again, try not to overreact. Use a firm and serious voice.
Offer Limited Choices
Sometimes, aggression and self-injury result from being too restricted in an environment. When children are given a limited amount of choices, they feel more in control and responsible. This may work better for school-age children, but may also work with pre-schoolers, as well. For younger children, limit the options to two so they are not overwhelmed. As children age, the number of choices can be expanded, but don't overdo it.
The Importance of Consistency
Whatever strategies or interventions are used, it is incredibly important to be consistent in implementing them. All people involved with the child must use the agreed-upon strategies each and every time the biting behavior occurs in order for them to work. Several strategies may need to be combined to achieve the desired outcome, but with patience and persistence, biting behaviors can usually be eliminated by using these techniques.
When to Seek Professional Help
Biting of any kind is distressing, but when it occurs frequently across a number of different settings, is severe, causes the child distress, or is causing serious injury, contact a professional right away. Behavior modification techniques such as those listed above are often effective, but there are other avenues of treatment. Some, however, are aversive techniques that should be discussed fully with a professional before being implemented. Other strategies may include dietary changes or prescribing medications, which would also require professional intervention and supervision.