Self-injurious behavior, or SIB, is a common and serious issue in children struggling with a developmental disorder, such as autism spectrum disorder (ASD).
These behaviors are often referred to as non-suicidal self-injury (NSSI). They can include head banging, skin picking, biting, and other forms of intentional self-harm that can have devastating short-term and long-term consequences.
Self-harming behaviors in autistic children can begin in early childhood and often peak in adolescence. They can even continue through adulthood.
NSSI behaviors are often the result of poor impulse control, difficulty regulating emotions, an attempt to “feel” something, or used as a form of self-punishment.
To minimize self-harming behaviors in autistic children, it is important to understand the potential root causes of the behaviors. Once potential triggers are identified, treatment can be tailored to lower the incidence of these actions.
Self-Harm & Injury in Autistic Children
Self-harming behaviors in children with autism can look different from these types of behaviors in children without autism.
In neurotypical children, characteristic self-harming behaviors often include cutting and burning. For children with autism, the most common forms of self-harm include:
- Head banging.
- Head hitting.
- Scratching, rubbing, or picking at skin.
Hair pulling, vomiting, and pica (eating non-edible things such as dirt) are additional forms of self-harm that autistic children may engage in.
Self-harming behaviors are not intended to be lethal, which is why they are often classified as NSSI behaviors. Children who engage in these actions are not generally suicidal. Rather, they are seeking a type of release through these behaviors, using them as a form of communication, or using them to try and regulate their emotions.
At What Age Does Self-Harm Usually Begin?
Self-harming behaviors can occur at any age. Babies and toddlers may bang their head against the wall or hit their heads when frustrated. As communication skills improve, these behaviors are usually outgrown. Autistic children often struggle to communicate, and that’s one of the reasons these behaviors may persist. Some self-harming behaviors, such as head banging, can coincide with symptoms of autism. In autistic children, it is viewed as a need for release. It can also be a repetitive action, which is another sign of autism.
In a large study of autistic adults reporting NSSI behaviors, the average age that they began harming themselves was 15 years old. Another comprehensive study found that over 50% of autistic children between the ages of 2 and 7 reported SIB, while close to 40% of adolescents in the study engaged in these behaviors.
These studies show that self-harming behaviors are common over a range of ages in children with differing levels of autism severity.
Incidence of Self-Harm in Autistic Children
Between 20% and 30% of people who struggle with autism engage in self-harming behaviors. These behaviors can range from mild and infrequent to chronic and severe.
While self-harming behavior may start in adulthood, it most commonly begins in childhood and adolescence. In fact, one out of every four autistic children engages in some form of self-injury.
Risk Factors for SIB
Traits that present as risk factors for self-harming behaviors in autistic children can include:
- Aggression and belligerence.
- Hyperactivity and inability to sit still.
- Sleep issues.
- Mood problems or disorders.
Certain environmental issues can further increase the risk that a child will engage in self-harming behaviors. Children are at higher risk if:
- They come from a low-income family.
- Their mother lacks a college degree.
- They use public health insurance.
These factors may limit children’s access to treatment. Without targeted therapy to cope with ASD, they are more likely to engage in self-harm.
A Coping Mechanism
There are a variety of reasons that autistic children engage in self-harming behaviors. They may use it as:
- An attempt to regulate emotions.
- An attempt to break through numbness, or lack of feeling, and actually feel something.
- A form of self-punishment.
- A method of expression or social communication.
Self-harming behaviors are often the result of low self-esteem, an inability to communicate effectively, and poor coping skills. They can also be used as a way to affect outcomes, such as exerting control in a situation where the child feels they have no control.
Self-injurious behavior in autistic children is also linked to poor impulse control.
All of these underlying reasons can trigger SIB as a coping mechanism. If the root issues are addressed, the damaging behavior can be lessened and eventually stopped.
Addressing Injury & Self-Harm
Self-harming behaviors are often evident by physical evidence, such as bruising, bite marks, cuts and scratches, wounds that will not heal, and hair loss.
Parents of autistic children frequently witness the self-harming behaviors firsthand, which can be alarming. These behaviors go beyond typical hand flapping and repetitive behaviors that are consistent with autism. They are injurious and come with the potential for serious long-term consequences.
Parents can’t effectively curb the self-harming behaviors until they identify the causes. For example, self-harming behaviors in autistic children can be the result of a lack of stimulation. By keeping these children busy, they may see a decrease in SIB.
In other autistic children, self-harming behaviors may relate to an inability to communicate effectively and subsequent frustration. In applied behavior analysis (ABA) therapy and speech therapy, the child can learn to communicate their needs more effectively. As they improve with verbal and nonverbal communication, they feel less frustration. This translates to less self-harming behavior.
If self-harm is used as a way of escaping things that make the child uncomfortable or as a method of social communication, this can be addressed in therapy. For example, if a child does not want to do a particular thing, they may use self-harming behavior to be removed from the situation. This removal reinforces the idea that the SIB works as a method to get what they want.
The good news is that all of these issues are treatable. There is an underlying problem, often related to an unfulfilled need and a limitation the child currently has. By improving skills and teaching healthy coping mechanisms, the child can learn to have their needs met in a healthy manner.
Treatment involves helping an autistic child to better understand their emotions and their behavior. Therapy works to improve self-esteem and confidence while teaching children how to regulate their emotions and control their impulses.
All of this work builds their self-image, improves their communication skills, and boosts independence. These benefits usually coincide with a decline in self-harming behaviors.
Effective Self-Harm Management & Treatments
There are three main interventions when it comes to treating self-harming behaviors in autistic children: medications, psychological approaches, and complementary methods, such as diet changes and increased physical activity. Usually, more than one approach is used simultaneously to redirect these behaviors and teach coping skills to manage emotions.
Medications are used to treat specific symptoms or underlying medical or mental health conditions. Due to their potential side effects, they are either used as a last resort or in conjunction with other therapeutic methods.
Therapies and behavioral interventions are most helpful when addressing autism and SIB. Try these behavioral interventions to curb self-harming behaviors:
- Preempt the behaviors by changing the environment, increasing or decreasing stimulation, and rearranging schedules and routines.
- Reinforce positive behaviors while introducing new “replacement” skills or activities that can be used instead of the self-harming actions.
- Eliminate the reinforcement of the self-harming behaviors by ignoring them. Don’t give in to the demands of your child if they are seeking social attention with these actions.
- Use ABA therapy and occupational therapy to learn new coping skills, communication techniques, and ways for managing the emotions that lead to these outbursts.
- Boost your child’s self-esteem by encouraging independence and helping them acquire new skills.
In addition to difficulty managing their own emotions, autistic children often struggle to understand the emotions and actions of others. By learning to better process their own emotions, they can improve their ability to understand and relate to other people. This increases the potential to form satisfying relationships that greatly increase their overall quality of life.
ABA therapy can incorporate methods and mechanisms to limit self-harming behaviors as well. Parents and the treatment team work together to identify underlying causes and then implement approaches to decrease the hazardous actions.
Self-Harm & Potential Comorbidities
Self-harming behaviors in children with autism can also imply that other issues are present.
Self-injury in autistic children can be linked to sleep issues or disorders. Changing sleep habits and implementing strategies to help a child get more restful sleep can help in these instances.
Mood and anxiety disorders, including depression, are also common comorbidities with self-harm. In order to improve SIB, these disorders must be treated.
Depression is a common mood disorder that often co-occurs with autism, and self-harm can be an indicator of depression. People who struggle with comorbid depression and ASD are more likely to engage in self-harming behaviors than those who do not suffer from both disorders simultaneously.
If anxiety or depression is present in a child with ASD, medications are sometimes used to stabilize brain chemistry. Therapeutic and behavioral interventions are recommended as the primary method of treatment to improve communication, self-esteem, and coping strategies.
- Understanding and Treating Self-Injurious Behavior. (2019). Autism Research Institute (ARI).
- Q and A: Head Banging Solution. Autism Parenting Magazine.
- A ‘Choice,’ an ‘Addiction,’ a Way Out of the Lost’: Exploring Self Injury in Autistic People Without Intellectual Disability. (April 2019).Molecular Autism.
- Self-Injury in Autism Spectrum Disorder and Intellectual Disability: Exploring the Role of Pain and Reactivity to Sensory Input.Brain Sciences.
- Autism and Self-Harm. (2020). Selfharm.
- Large Study Shows Self-Injury Common Among Children With Autism. (July 2017). Spectrum News.
- Long-Term Study Tracks Persistence of Self-Harm in Autistic People. (February 2020). Spectrum News.
- Using Functional Communication Training to Reduce Self-Injurious Behavior. Indiana University Bloomington.
- Essential Guide to Self-Injurious Behavior and Autism. (March 2019). Research Autism.
- The Association Between Self-Injurious Behaviors and Autism Spectrum Disorders. (April 2014). Psychology Research and Behavior Management.
- Emotional Development in Children With Autism Spectrum Disorder. (March 2017). Raising Children Network.
- Understanding Depression and Thoughts of Self-Harm in Autism: A Potential Mechanism Involving Loneliness. (February 2018). Research in Autism Spectrum Disorders.
- What’s the Connection Between Autism and Depression? (September 2018). Autism Speaks.