3. SIRS-ACTIVITY, a. Sensory Interests, continued –
(a.1.) Self-Injurious Behavior
In the DSM-5, part of, and listed under Sensory Interests, is Self-Injurious Behavior (SIB). Thompson (2012) states that the most common emergent forms of self-injury are finger, hand, and wrist biting and hitting head with fists or against hard surfaces. Once self-injury becomes entrenched behavior, it is often difficult to eliminate.
A parent reports that there were periods that her son struck his head so hard and so often, it caused severe bruising on the back of his head. His only form of communication, as soon as she gave him what he wanted he stopped.
Often SIBS are found to be included in ‘Challenging Behavior’, or ‘Behavioral Disturbances’ instead of a stand-alone sensory issue. Soke et al. (2017) the reasons may be that studies find both environmental and biological factors have been implicated in studies of SIBs since 1977.
These authors say that generally SIBs are difficult to manage and may result in hospitalizations, exclusion from educational or vocational activities, admission to residential facilities, and even in death. They believe that previous studies are lacking and SIBs have been associated with everything from maternal smoking, sensory issues, gastrointestinal problems, aggression, insomnia, age and gender, severity of co-morbid behaviors; and everything in between.
Chezan et al. (2017) claim that SIBs is a relatively common problem behavior among children with Autism Spectrum Disorder (ASD). This review covers a broad category of problem behaviors, including verbal and physical aggression, property destruction, and tantrums. Severe SIBs require an intervention that is both effective and efficient.
Without effective interventions, they say, it can have a negative impact on children’s quality of life, limiting development and even leading to health-related problems. Interventions have the potential to prevent or reduce the frequency and severity of SIB, but if allowed to persist across time may continue until adolescence and adulthood.
Sicile-Kira (2014) thinks that some children with autism participate in self-aggressive behavior because they could be in pain and don’t have any other way of communication this. She also has seen ASD persons self-injuring in the throes of a PTSD flashback.
She defines SIBs as hitting, biting, head banging, flicking fingers, or slapping oneself as a possible method of sensory seeking stimulation to relieve anxiety, pain, or frustration. Others believe that there is something missing in their diet or something they are getting in their diet that they should avoid.
Those lacking stimulation from their environment may seek it through self-abuse. Some self-abuse is in response to smells, being touched, auditory and visual overstimulation or under-stimulation. Still others believe medication can be found to counteract symptoms.
< My Thoughts > “Others believe medication can be found to counteract symptoms.”
Some of the things that Sonny does, as a result of his autism, is self-injurious behavior (SIBs). With him, this seems to be compulsive, ritualistic, and some sort of stimulation or communication. This was before finding a method of communication and a therapeutic dosage of medication to help him, too. He would strike out to bite or hit himself and others. He would stick a finger in his eye, poking and poking until restrained. When Sonny is under medicated, stressed, and/or can’t get what he wants he will tantrum and bite himself until his needs are satisfied.
He has other undesirable and even dangerous behaviors, which I will not go into here. I’m sure you get the idea of how frightening this can be. The caveat with Sonny is that as well as sad or mad, he can and will often do this self-injurious behavior as a result of being happy and excited about something he’s thinking about or doing. So first, we must stop the risky behavior and then try to find out why. Smiles.
Bogdashina & Casanova (2016) believe self-stimulating behaviors can occur when autistic children are seeking control of their Autonomic Nervous System. One intervention can be a desensitization intervention of the affected areas performed by a qualified and experienced therapist. Another intervention can be exploring deep pressure, squeezing by cushions, or a weighted blanket may help.
They say that when excessive aggression, anxiety meltdowns and panic attacks occur, physical exercise like swinging, climbing, or pushing heavy objects relieve some people. Self-monitoring behavior and other coping mechanisms can be taught for less severe cases of SIBs, to help your child feel safe, trusting their environment.
Sarris (2012) tells parents that early symptoms of autism may be among the most puzzling. Some are barely noticeable, such as response to lights, heat, cold, or physical discomfort. Using their hands or body to manipulate things is not always seen as problematic behaviors.
< My Thoughts > “Some are barely noticeable…”
Sometimes the sensory response causing the self-injurious behavior is an attempt to fix what’s wrong. But often, they don’t know what is wrong or how to fix it. A child who bites themselves because they are too hot or too cold, doesn’t know that putting on or taking off a sweater can make them more comfortable. Of course, trying to get a sweater on or off, may be a challenge of its own! Sonny just reacts as if there is some sort of task assignment taking place. Smiles.
Sarris (2015) cautions that self-injury can persist into adolescence. Violent episodes of challenging repetitive behavior can lead to cuts, bruises, dental problems, and even broken bones, concussions, and detached retinas. She tells how frightening this is because it seems to violate our basic instinct of self-preservation. Those parents are deeply challenged to protect their offspring. They childproof their homes, buckle their seat belts, walk them to school, shielding them from outside harm. But she questions how they can protect them from themselves?
Wright (2018) believes that a behavior consultant is able to offer new insight for the entire family to digest and begin to shift the perspective needed to track and record behavior. An example would be – The family is concerned that Johnny seems to be an aggressive child, frequently hitting those in his environment. Through BEHCA data collection the behavior consultant is able to find that Johnny is NOT doing this on purpose but as a sensory response to his environment. He is also NOT aware of how hard he is hitting.
Taking this further, she says that perhaps Johnny’s behavior is due to his NOT knowing what his body is doing. He is lacking spatial awareness. Or, by slamming his body/arms into things or people, he is seeking sensory input. But, he is NOT intentionally trying to hurt anyone.
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