Treating Self Injurious Behavior

1. Treating self injurious behavior usually starts with doing a “functional behavior assessment” to identify the “functions” that the behavior serves (communication, stress release, escaping unwanted events, self stimulation, etc.) Functional behavior assessments involve tracking and identifying the situations under which the behavior occurs (when, where, with whom) and observing the immediate effects that the behavior produces. By identifying what triggers the behavior, and what occurs immediately after the behavior, we begin to get an idea of which function it provides.

2. Treatment the usually proceeds with changing the conditions (lowering demands, reducing stimulation, increasing support, etc.) that trigger the behavior, and teaching another, more appropriate, “replacement” behavior that meets the same need (function).

3. First we look at what environment demands are overwhelming, or lacking, for the person. This may require modifying the environmental demands, building in accommodations to lessen their impact, or providing greater assistant to support the person when faced with these conditions. If the person has too many demands placed on them, we look at providing less demands, lowering how hard the demands are, or providing added support in face of the demands. We want to better match the demands of the situation to the skill level of the person.

4. If the function of self abuse is to communicate needs and wants, then we focus on teaching the child communication skills. If person is nonverbal then we teach an alternative means of communication, such as pictures, gestures, signing, etc. We identify what the person is trying to communicate and then try and teach another, more appropriate way of communicating.

5. If the behavior is occurring to escape or avoid unwanted situations, we often need to look at “why” the person is trying to escape or avoid the situation in the first place. Then we build in added supports, or lessen the demands. In addition, we need to teach another way to communicate “stop” or “help”. Teach them another behavior to appropriately escape the situation. Then we prompt the child to use the replacement way of escape, and immediately allow them to escape. It is important that the new, more appropriate way of “escaping” is immediately reinforced with successful avoidance.

6. If the self abuse occurs for proprioception to release stress chemicals, than we look at (a) developing a sensory diet that gives frequent physical activity and other forms of proprioceptive stimulation (chewing gum, squish balls, weighted vest, etc.) that provides proprioception to release stress chemicals throughout the day, and (2) alternative replacement behavior to substitute for the self abuse. For example, if the child bites their wrist, we might provide a chewy tube to bite on. This would provide an appropriate form of biting/chewing. Substituting one form of proprioceptive tool for another.

7. If the person is engaging in self abuse to mask pain, than we identify the source of pain and treat it. We also try and teach the person a method of communicating to others that they feel pain.

8. If the person is self abusing to get strong reactions from others, we (a) lower the intensity of our reactions, and (2) provide stronger attention for other more appropriate behavior.

9. If the person is engaging in self abuse for self stimulation then we try and increase the stimulation the person Is receiving (keep them busier, provide an environment rich in stimulation) and teach other forms of self stimulation that either calms or alerts the nervous system. We also build in a sensory diet to provide the person frequent stimulation.

10. . If the behavior is the result of high anxiety, and the above doesn’t help, then medications are often used to calm the nervous system.

11. In rare occasions when the self injurious behavior may be maintained by endorphins then we give naltrexone to block the release of endorphins.