Self-Harming in Children with Autism: Behavior & Injury

Instructor: Lauren Scott

Lauren has a Master's degree in special education and has taught for more than 10 years.

This lesson describes self-injurious behaviors that educators may observe in students with autism, and discusses possible triggers and interventions for these behaviors.

Observing Self-Harm

It is an unsettling and heartbreaking sight for any educator. A student with autism starts injuring him or herself through biting, scratching, head-banging, or hitting, and seems impervious to the pain. It may be tempting to hold the student or give verbal commands, but these tactics could make things worse. Fortunately, with the proper training and resources, educators may stop or prevent these behaviors before the student gets hurt.

Triggers of Self-Harm

About 10%-15% of people with autism engage in self-injurious behaviors, which may stem from several different triggers. One may be frustration over the inability to communicate wants and needs. A child who is nonverbal cannot use words to communicate and may act out in response to emotional upsets or undesired tasks. Sensory triggers are also common. Sensitivity to textures, sounds, and visual stimulation can provoke an outburst of self-aggression. Conversely, a student may self-harm as a means of seeking sensory input.

Sensory sensitivities may trigger self-injury.
A distraught child covers his ears with his hands.

Behavioral Interventions

You cannot always prevent the self-injurious behavior, but you may be able to reduce its occurrence by identifying the triggers. Completing an Antecedent-Behavior-Consequence (ABC) chart for the student can help you determine the events that occurred immediately before the self-injury, and help you identify any reinforcement or reward gained from the behavior. For example, you may notice that a student always starts biting himself when presented with a math task and that the biting always results in a trip to the nurse. He escapes the unwanted math assignment by engaging in self-injury. Modifying the task or changing the reaction to the behavior might prevent the self-injurious behavior in the future.

Environmental Modifications

Changing the student's environment could also circumvent self-injury. Reduce harsh or flickering lighting by using table lamps instead of fluorescent lighting, or by covering lights with a thin cloth. Cover the ends of chair legs and desk legs to avoid sudden, harsh noises. Keep sensory objects like bean bags, stress balls, and weighted blankets on hand to calm anxious students. If you have a school psychologist or an occupational therapist in your building, consult with them to develop a sensory diet that adjusts sensory input for the student.

Educators may prevent self-injury in students with autism by adapting the learning environment to their needs.
A tidy and cheerful classroom.

Physical Interventions

Some students may require physical supports and interventions during behavior plan implementation. These should be implemented by a behavior specialist or physical therapist who is well-trained in preventing injuries due to self-harm. They may recommend braces to limit the range of motion for students who repeatedly bite or strike themselves. Helmets may be prescribed for students who hit their heads on hard surfaces.

In extreme cases, physical restraint may be required to keep the student safe. Restraint involves using a practitioner's hands or body to restrict a student's movement until the threat of imminent harm has passed. Controversy surrounds physical restraint due to the risk of injury or death when improperly implemented. Only trained, designated staff members in a school should perform restraints, and only when absolutely necessary to prevent serious injury.

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