Ask a health professional for help with any self-injurious behaviour which is difficult to manage or which places the person at risk of harm.
Visit the GP or dentist. Bring along notes about the behaviour - what time of day it happens, in which situations, how often it happens, when it first started and how long it lasts.
Complete a behaviour diary, which records what is occurring before, during and after the behaviour. This could to help you to understand the purpose of the behaviour. Make notes on the environment, including who was there, any change in the environment and how you think the person was feeling.
Create a clear daily routine. This will make things more predictable and could reduce anxiety. Put a range of activities into the routine. This will reduce boredom and leave fewer opportunities for the person to engage in self-injurious behaviour. Make plans for difficult times of the day, providing more supervision and support at these times. People with a demand avoidant profile might need a more flexible approach than other autistic people. More about routine and transition times.
Build alternative sensory experiences into the daily routine. Jumping on a trampoline or swinging on a swing might provide a similar sensory experience to head shaking or slapping. Providing the person with bag of safe objects to chew on - gum, carrots, raw pasta or sultanas - might reduce the need for hand or arm biting.
Support the person to use other ways of communicating their wants, needs and physical pain or discomfort. You could try visual supports, pictures of body parts or symbols for symptoms.
Give encouragement to the person for appropriate behaviour and for periods when they didn't engage in self-injurious behaviour. This will help them learn that other behaviours bring positive outcomes. Rewards can be verbal praise and attention, a favourite activity, toys, tokens or sometimes small amounts of favourite foods or drinks. Say clearly what it is that you are rewarding, and give the reward straight away.
Note that some autistic people don't enjoy social attention. Verbal praise could cause distress and have the opposite effect to the one you wanted.
Medication is sometimes used where the behavior is very severe or lasts a long time.
Md Gulzar Ahmad
(Clinical Psychologist)
Mainstream Foundation, Patna, Bihar
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