Hand or wrist banging!

Jaime, one of our members has a problem that is common with some children on the spectrum.

Jaime

My daughter "Bangs" She uses the inside of her wrist to bang whatever she can. She has broken windows, walls, doors, tvs, vcrs. You name it, she's banged it till it broke or her hand went through it. We have targeted this "behavior/stim" over the last 5 or 6 years a million times, but it's usually replaced with high pitched screaming which I guess gives her the same sound satisfaction and attention seeking satisfaction or it's replaced by something worse (if you can imagine). But the "banging" always comes back. We've tried to get her to only hit pillows, but it doesn't provide the same function. She likes the feeling and the noise. It's so hard to live with. And her wrists are calloused over. I'm shocked her wrists aren't broken. The rest of the house is. She does it for a myriad of reasons: attention, dissatisfaction, lack of verbal communications and also for no reason we can discern while completely alone. Any suggestions?

My Response:

Jaime, you first need to identify what function the behavior serves for your daughter. I have known many kids in the past that need to bang their wrist, or ankles on objects around them. Yes, they do like the sound, as well as the strong proprioception (jarring to the joints and tendons). However, there are often other functions involved.

1. Usually these children have poor registration of proprioceptive stimulation (need high intense input into their joints). Their nervous system needs a higher intensity of stimulation for the brain to register it. So the behavior usually needs to be stronger to feel the stimulation. They tend to be sensory seekers to arouse their nervous system. Now, they will use the same behavior to calm themselves when overwhelmed, and also to alert themselves when underaroused. In these cases we give the child a sensory diet of strong proprioception (jumping, pushing, pulling, carrying, lifting, strong resistance to the joints and muscles). Frequently throughout the day we are giving them activities to feed their nervous system proprioceptive stimulation to keep their nervous system regulated. This is discuss in the "sensory world 2" presentation in the photo album (will give you more ideas).

2. If your child has an underaroused nervous system, she needs to be feeding her nervous system this intense proprioception to stay alert and connected to her body. When the proprioception doesn't register well, she will often feel disconnected from her body. Providing the strong banging wakes up her nervous system and she feels briefly reconnected to her body again. If she doesn't do it she starts to lose focus and awareness of her body which makes her feel anxious, which resets the banging. For these children for a while it can help to place ankle or wrist weights on them to increase the proprioception in those areas. We also give activities that provide strong input into their wrists, like playing with clay, rolling dough, squeezing something, etc. Bouncing a basketball, and hitting a large exercise ball around with a bat provides good input into the wrists. Next, we give them an alternative hand banging behavior, which is reinforcing them to slap the back of their hand into the palm of their other hand. This gives the strong jarring into the joints, plus added stimulation into the other hand. We have practice sessions were both the child and adult practice doing the hand banging, then when the child starts banging we redirect him to smacking his hand into his palm. Then we teach them to gradually lighten the slaps to make it more subtle.

3. If the child has an anxious, disorganized nervous system, then strong proprioception will release stress chemicals from the nervous system. For these children, since their nervous system is continually developing stress chemicals (anxious), they will feed their nervous system strong jarring/banging to their joints to release the stress chemicals. For them we provide them a strong sensory diet (see sensory world #2 photo presentation) of proprioception (gross motor activity) throughout the day to release build up of stress chemicals.

When the behavior (banging) occurs a lot it releases strong endorphins if the system that feels good. This can become addicting, resulting in the child continually engaging in the behavior to release the endorphins. This can make it very resistant to change. Also, the power the child feels from the cause and effect from the strong sound, breaking things, and getting strong reactions from the people (attention) around them can be very reinforcing. At that time then the behavior is being maintained (reinforced) by many variable (sound, feel, sight of things breaking, the reaction of others, proprioception, etc.) This becomes hard to substitute with other behavior that could provide the same function.

Now, when the behavior injures the child, injures others, or damages property, regardless of the function, it needs to be stopped, or modified. The child has to (1) feel that we recognized the need she has, (2) try to substitute other behavior to serve the same function, but (3) but place strong boundaries on not accepting the damaging behavior. We block, interrupt, and redirect the behavior immediately. Autism can explain why a behavior may be occurring, but it doesn't excuse a behavior that is destructive.


 http://www.facebook.com/autismdiscussionpage