Understanding Self-Injury Among Autistic Individuals

A young boy in a blue shirt sits against a blue wall, covering his ears with both hands.Head-banging, face-slapping, scratching, and other self-injurious behaviors (SIB) are common among children who become frustrated. According to United Cerebral Palsy, up to 20% of all young children bang their heads in frustration. The behavior is common and considered developmentally typical until a child is about four years old. Among autistic people, self-injury is even more common, and it may persist later into childhood and even adulthood. A 2016 analysis found 27.7% of autistic eight-year-olds engaged in head-banging or similar actions.

Self-injurious behavior can be alarming to parents and caregivers. It can also lead to frustrating and painful judgment from bystanders. In most cases, self-harm does not cause severe damage such as concussions or life-threatening wounds, though some autistic people do seriously injure themselves.

SIB is a symptom of an underlying problem. Parents, spouses, friends, and others invested in the well-being of autistic people must look to the underlying motivation. Understanding the emotions and frustrations that trigger self-harm is the fastest route to ending it.

Common Causes of Self-Injurious Behavior in Autism

People on the autism spectrum process information, emotions, and sensory input differently from neurotypical individuals. While the experience of every autistic person is slightly different, some characteristics of autism that increase the risk of self-injury include:

Sensory overload

Autism can make a person highly sensitive to sensory input. They may feel overwhelmed by loud noises, find certain textures intolerable, or be unable to concentrate in certain environments. A small change in an autistic person’s sensory environment can feel like torture. Some autistic people engage in self-injury out of frustration when sensory stimuli become overwhelming. Others self-injure as a physical counterweight to painful sensory input.

Lack of control

Both autistic and neurotypical children may self-harm in frustration when they have little control over their environments. For instance, a child forced to play with the toys their parents choose instead of the toys they desire might bang their head. Outdated notions about how to support children with autism sometimes advocate restraint or punishment. This may trigger self-harm in some kids.

Reinforcement

Parents and bystanders may inadvertently reinforce SIB by giving the child more attention while trying to stop the behavior. They might also reward a child immediately after they stop self-injuring. This tactic can backfire and reinforce the action itself rather than the act of stopping.

Pain

Autism is linked to a number of other conditions and symptoms. For example, autistic children are more likely to have gastrointestinal problems. For some children, self-injury is a way of coping with or distracting from pain. A 2017 study argues that some physical symptoms of autism, such as stomach discomfort, are likely due to stress instead of an underlying medical condition. This suggests stressful experiences and chronic stress may play a role in SIB.

Chemical changes

Research suggests SIB and other forms of self-harm may cause the body to release feel-good chemicals called endogenous opioids. This means self-injury can be a source of pleasure. For a person experiencing stress or pain, the pleasurable chemical rush associated with self-injury can be appealing. (This theory applies to both autistic and neurotypical people.)

Environmental changes

Autism often causes a person to crave routine, order, and control. So when their environment changes, their schedule is chaotic, or they can’t go about their usual routine, they may self-harm to cope.

How to Help an Autistic Person Who Self-Injures

A generation ago, much advice about managing autism-related challenges focused on rewards and punishments. Now, with the advent of autism self-advocacy communities, autistic individuals are able to weigh in on various strategies. The overwhelming majority of autistic people and autism advocates strongly oppose punishments. Many also have expressed concerns about rewards, especially when the person giving the reward does nothing to address the underlying cause of the behavior.

Parents and others who care for an autistic person should view SIB as communication. Some strategies that may help include:

  • A change in parenting strategy. Autistic individuals often thrive on order and routine. Parenting strategies that support this need can minimize SIB. A 2006 study found that a mindfulness-based parenting intervention improved parenting skills, helped parents feel more competent, and reduced aggression and self-harm.
  • Offering more control over the environment. A number of studies have shown that giving autistic people more choices and more agency can reduce self-injury. For example, rather than telling a child what they will eat for dinner, offer them two or three options.
  • Addressing underlying sensory issues. Sensory overload can be intense and painful. Parents and other caregivers should work to identify and understand their child’s sensory triggers. Advocates recommend removing or reducing these triggers as soon as possible. Many autistic people cannot function or concentrate until their triggers are gone. Something as simple as buying seamless socks could make a meaningful difference.
  • Avoiding inadvertently reinforcing the behavior. Don’t yell, punish, or immediately divert your attention to an autistic child engaged in self-harm. Some autistic children feel chronically unheard and have learned that self-harm is the only way to get a caregiver’s attention. Reverse this cycle by listening attentively when an autistic child attempts to communicate but minimizing attention during moments of self-harm.

Self-Help for Autistic People Who Engage in Self-Injurious Behavior

Some autistic people feel an overwhelming impulse to self-harm, even when doing so causes them difficulties at home, work, school, and in friendships or romantic relationships.

The right therapist can help an autistic person advocate for themself, building an environment that feels safe and healthy.Correcting SIB begins with understanding what causes it. Try asking yourself which triggers are most likely to bring about SIB? Then explore how you feel while self-injuring. Does it cause feelings of relief? Pleasure? Distraction? Identifying what you get out of SIB can help you begin cultivating healthy alternatives. For example, meditation might help with feeling calm in response to stress, while exercise might help with feeling jittery or frustrated.

Autistic people often find support and help from autistic self-help and advocacy groups. These groups view autism as an identity rather than a disability or illness. They say autism is a unique lens through which to view the world. Participation in such a group can help an autistic person cultivate new strengths and find healthy alternatives for managing challenging feelings.

Medication for Autistic Self-Injury

No specific medication is approved by the U.S. Food and Drug Administration (FDA) to prevent SIB. A number of drugs, however, may help treat the underlying causes of SIB:

  • Antipsychotics: The FDA has approved antipsychotics such as risperidone to treat autism-related irritability. Lowering anger may reduce one’s need to use SIB as an outlet. However, antipsychotics often make anxiety worse. Because many autistic people already struggle with anxiety, it’s often better to try other drugs first.
  • Antidepressants: Some antidepressants can help with anxiety, depression, irritability, and aggression.
  • Opioid agonists: Medications such as naltrexone counter the effects of opioids in the brain. Research suggests naltrexone can reduce the pleasure an autistic person experiences when self-injuring, potentially stopping the behavior.

Therapy for Self-Injury in People on the Spectrum

Therapy can help autistic people who self-injure, as well as their spouses, parents, and other loved ones. A therapist may work with an individual to identify triggers for SIB and cultivate healthier alternatives. The right therapist can help an autistic person advocate for themself, building an environment that feels safe and healthy.

Family counseling helps families better understand autism while dispelling myths about the spectrum. This can help parents better support their children, foster communication between autistic and neurotypical siblings, and offer a safe space for every family member to strategize and share concerns.

Couples counseling can help autistic people and their partners understand one another’s emotions. This fosters better communication, reduces frustration, and offers greater intimacy.

If you or a loved one would like support, you can find a therapist here.

References:

  1. About autism. (n.d.). Retrieved from http://autisticadvocacy.org/about-asan/about-autism
  2. ASAN Letter to FDA on banning electric shock devices. (2018, April 23). Retrieved from http://autisticadvocacy.org/2018/04/asan-letter-to-fda-on-banning-electric-shock-devices
  3. Humenik, A. L., Curran, J., Luiselli, J. K., & Child, S. N. (2008). Intervention for self-injury in a child with autism: Effects of choice and continuous access to preferred stimuli. Behavioral Development Bulletin, 14(1), 17-22. doi:10.1037/h0100503
  4. Living with children: Head-banging [PDF]. (n.d.). United Cerebral Palsy. Retrieved from http://ucphuntsville.org/wp-content/uploads/2015/06/Head-Banging.pdf
  5. LeClerc, S., & Easley, D. (2015). Pharmacological therapies for autism spectrum disorder: A review. Pharmacy and Therapeutics, 40(6), 389-397. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450669
  6. Minshawi, N., Hurwitz, S., Fodstad, J., Biebl, S., Morriss, D., & McDougle, C. (2014). The association between self-injurious behaviors and autism spectrum disorders. Psychology Research and Behavior Management, 7(1), 125-136. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990505
  7. Singh, N. N., Lancioni, G. E., Winton, A. S., Fisher, B. C., Wahler, R. G., Mcaleavey, K., . . . Sabaawi, M. (2006). Mindful parenting decreases aggression, noncompliance, and self-injury in children with autism. Journal of Emotional and Behavioral Disorders, 14(3), 169-177. Retrieved from http://journals.sagepub.com/doi/abs/10.1177/10634266060140030401
  8. Soke, G. N., Rosenberg, S. A., Hamman, R. F., Fingerlin, T., Robinson, C., Carpenter, L., . . . DiGuiseppi, C. (2016). Brief report: Prevalence of self-injurious behaviors among children with autism spectrum disorder—A population-based study. Journal of Autism and Developmental Disorders, 46(11), 3607-3614. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5392775
  9. Stress, not diet, likely source of GI problems in children with autism. (2017, July 14). Retrieved from https://www.healio.com/gastroenterology/stomach-duodenum/news/online/%7B6c9e6171-0a63-4f1e-9dcb-c7f0dd8e0b59%7D/stress-not-diet-likely-source-of-gi-problems-in-children-with-autism
  10. Walters, A. S., Barrett, R. P., Feinstein, C., Mercurio, A., & Hole, W. T. (1990). A case report of naltrexone treatment of self-injury and social withdrawal in autism. Journal of Autism and Developmental Disorders, 20(2), 169-176. Retrieved from https://link.springer.com/article/10.1007/BF02284716

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