Blog Posts

Being Mindful about Self-Injurious Behaviors

By Danielle Delorenzo, OTDS, OTR/L
Mornings with an OT Mom
Danielle Delorenzo Consulting Co
.
www.danielledelorenzo.com

Headbanging and self-injurious behaviors are topics that hold a stigma.  My goal is to shift the mindset of the masses when thinking about self-injurious behaviors towards a more mindful and positive one.  Most often, children engage in self-injurious behaviors when they are frustrated and unable to express their wants, needs, and emotions.  Some children will head bang or engage in other self-injurious behaviors as a way to meet their optimal sensory needs.  It is imperative to determine what is driving the self-injurious behaviors to identify which strategies will be the most effective to increase a self-regulated response1.

When you observe a child engage in SIBs (self-injurious behaviors), what is happening before? How did you react? Is there a pattern? Are they in pain – teething? Are they trying to communicate? Did they want something, and it was not available?  A simple way to help determine what could be the cause of a behavior is to ABC it! 1

What happened before? (A-Antecedent)The Behavior (B- Behavior)What did you do after? (C-Consequence)Comments
  Ex. Child asked for an item that was not there i.e. asked for goldfish but we were out so I offered something else and that is what triggered him to run towards the wall.   Ex. When told no, child ran to wall and banged head against the wall.  Assessed intensity of headbanging; planned ignoring; once child was calm – I said, “I know you are mad” paired with modeling taking deep breaths; offered any other snack choice as well as a highly preferred option to support success; then offered two preferred activities to prepare for transition.  Notes: If child asks for something that you can anticipate and know you do not have, get within close proximity of child before answering to block/redirect attempt to run to wall and bang head; quickly provide a highly preferred choice and/or sensory activity to redirect attention and focus
    
    
    
Simple ABC chart and example

Once you have begun to discover patterns or reasons behind the behavior, you can start to implement strategies to reduce and replace self-injurious behavior. Simple manipulations in the environment and non-contingent sensory options available as needed can provide the child with opportunities to stay regulated throughout the day.  This will create a foundation for accepting non-preferred directives and engaging in non-motivating tasks more easily. 

Each child has their own unique sensory preferences.  With that being said, heavy work activities are my go-to and have been shown to help children calm, organize, and support achieving optimal self-regulation.  But first heavy work, right! Seriously! Lifting, crawling, picking up weighted objects, pushing weighted objects, can greatly help the body calm and organize to support optimal self-regulation.  Provide multiple opportunities daily to engage in heavy work and organized movement activities.  We must nurture and support the child’s sensory system while providing guidance with helping them express and understanding their emotions and the emotions of others2

Remember, headbanging and other self-injurious behaviors are a way of communication.  The more we are mindful of the child’s unique needs, the better strategies and supports can be implemented to help them regulate in a better way3.  One way to do this is giving children the words when they are unable to verbally communicate.  This is such a powerful strategy to help children understand that you do in fact know they are upset. 

My son uses signs, word approximations, gestures, and PECs to communicate.  When my son is upset and trying to express himself, we often say “I know you are mad” or “insert whatever I think he is upset about”.   This has been a strategy that consistently works to help him calm and organize.  Also, we pair this with a simple breathing exercise – just modeling taking a deep breath in and then exhaling.  We have been using these strategies since my son was about 13 months old.  He also loves deep pressure input and hugs.  When he is upset, we will also ask him if he needs a hug and this typically calms him down enough for me to then offer him alternative choices. 

The one consistent thing I have noticed is that when I am at my most regulated, I have better success with helping my son calm and organize as oppose to when I am frazzled, angry, or upset.  You are your child’s anchor to regulate.  The strategy you use is only as good as how you execute it.  Be mindful of your emotions.  When you as the parent or therapist are calm and organized you are using yourself as a therapeutic agent through co-regulation4.  This will naturally create a calming environment and set the stage to transition to a new task or activity.  Most importantly, be kind to yourself.  This journey is far from easy and will feel like an emotional rollercoaster, from both a parent and therapist perspective.  Stay mindful and know you are doing the best you can.  You are amazing!

Next time you are out in the community and you see a parent working through a “behavior”, look at them and smile.  Ask them if they need any help?  Give them a thumbs up.   Tell them they are doing an amazing job. You have no idea how much that could mean to them in the moment.  It may just be enough to get them regulated to be that anchor their child needs, to calm, organize, and work through the situation as gracefully as possible.  Sending everyone good vibes for a mindful day!

Disclaimer: This is me sharing my story as a pediatric occupational therapist and now mother to a neurodiverse toddler that engages in self-injurious behaviors daily.  This is just my thoughts paired with my years of experience, that guided me down the journey of determining the supports and strategies to use with my son.  This is not providing occupational therapy services or medical advice.  If you have any concerns about your child’s development, please speak with your pediatrician or occupational therapist for further evaluation and treatment options.

References

1Wacker, D., Northup, J., & Lambert, L.K. (1997). Self-injury. In N.N. Singh (Ed.), Prevention & treatment of severe problems: models and methods in developmental disabilities. Pacific Grove: Brooks/Cole Publishing Company

2Dyer, K. & Larsson, E.V. (1997). Developing functional communication skills: alternatives to severe behavior problems. In N.N. Singh (Ed.), Prevention & treatment of severe problems: models and methods in developmental disabilities. Pacific Grove: Brooks/Cole Publishing Company.

3Edelson, S.M. (1984). Implications of sensory stimulation in self-destructive behavior. American Journal of Mental Deficiency, 89, 140-145.

4Gulsrud, A.C., Jahromi, L.B. & Kasari, C. (2010). The co-regulation of emotions between mothers and their children with Autism. Journal of Developmental Disorders. 40227–237. https://doi.org/10.1007/s10803-009-0861-x

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