That looks like it hurts! Self-Injurious Behavior..

Written by Christie Cacioppo, M.A., BCaBA

Many children with autism and other developmental disabilities engage in behaviors that might seem unexplainable or irrational.  Some of these behaviors might be hitting their head against the wall, biting or scratching themselves, or even hitting their own head with their hand.  These behaviors are called self-injurious behavior (or SIB) and, to the one engaging in the behavior, it makes perfect sense.

There is always a reason (i.e. function) for every behavior, and SIB is no exception.  Self-injurious behaviors can be a response to something from within.  For example, let’s consider a headache.  Individuals who are able to vocalize that their head hurts can then receive relief either through medication or a scalp massage.  An individual who does not have the capability to tell someone that their head hurts might hit their head instead.  Hitting their head could lead to someone giving them medication which would reinforce their behavior.  Hitting their head could also make their head feel better because of the pressure that it produces.  In contrast, the SIB might be a response to something in their environment, such as someone takes something that they want and they don’t know how to ask for it back.  Some of the common reasons for self-injurious behaviors in general are:

1)      It feels good/decreases pain from a medical issue

2)      They do or do not have access to something that they want

3)      They are trying to escape from something or someone

4)      They want attention

5)      Inability to communicate any of the above reasons

It is very important to decrease these behaviors because they can have serious health risks to the individual.  If a child is poking their eyes as an SIB they might end up poking their eye to a point where they make themselves blind.  If a child is biting their hand on a regular basis, tissue damage might form on the spot where they are biting.  Many children have caused permanent damage to different parts of their body as a result of engaging in self-injurious behaviors.  These behaviors can result in serious risks and should be taken very seriously and handled with the utmost care.

So what can be done about these behaviors?  This is a very important area due to the fact these behavior pose a health risk.

1. The first thing that we recommend at Behavioral Consulting is a thorough medical exam to rule out any medical issues.  If you eliminate any underlying medical issues then the behavior may decrease or be eliminated on its own.
2. If the behavior persists after medical issues have been addressed or there are no medical issues, careful observations should be done to help determine what happens before (antecedent) and what is the result of the behavior (consequence).  A functional analysis (observing what happens in different situations) should also be done by a trained Behavior Analyst in order to determine the function of the problem behavior (i.e. why it is occurring) 
3. Once the reason, or function, for the behavior has been discovered then a treatment plan can be put in place based on the function.  The ultimate goal should be to eliminate the injurious behavior permanently.

The method for decreasing and eliminating the SIB should be based on the topography and function of the behavior.  If the child is skin picking for a toy, putting a helmet on them and not giving them attention is not going to be as effective as blocking them from skin picking and removing access to the desired toy.  One common treatment for SIB is teaching the child more effective forms of communication.  For the child, asking for what they want should require a lot less effort than engaging in self-injury.  Different communication methods can be used to ensure this, however the most common are vocal, sign, and Picture Exchange Communication Systems (PECs).  No matter which method is used, it should be used consistently across all settings so that the child will generalize the use of the communication to all settings which should also result in the decrease in SIB across all settings, as well. 

Self-injurious behaviors can be very scary to observe, especially if it is your child that is engaging in them.  No one wants to see their child hurting themselves.  Never fear!  The good news is that these types of behaviors can be decreased and eliminated all-together if effective assessment and intervention procedures are put in place.  There are many ways to decrease these types of behaviors although it is a matter of finding the function of the behavior and then developing a plan that addresses that function.  For more information about our assessment and intervention procedures at Behavioral Consulting of Tampa Bay, Inc., please visit our website at www.bcotb.com or contact us at 813-814-2000.