Self-Injurious Behaviour in Young People with a Learning Disability
Self-injurious behaviour refers to behaviour that causes physical harm, which may include bruising, wounding and bleeding.
In very young children with severe learning disabilities or Autistic Spectrum Disorders, self-injurious behaviour may begin as a stereotypy (repetitive movement), such as tapping themselves on the head or as a self-stimulatory behaviour. It is important to consider that the reason why a behaviour started, may not be the reason why the young person continues to engage in the behaviour (for example, it may have started as self-stimulatory but the young person finds that it results in attention which is desirable).
There are a number of different possibilities why young people may self-injure:
An attempt to communicate anything from being thirsty to being bored, to wanting a hug (particularly where the young person has limited verbal skills).
Letting people know they are distressed.
A way of keeping people at a distance.
A form of self-stimulation (seeking sensations to stimulate their senses).
Examples of self-injurious behaviour
Using hands or objects to bang against the head. Banging the head on objects, e.g. walls, sinks, tables.
Biting limbs, hands, hard or sharp objects.
SCRATCHING / SKIN-PICKING
Legs and arms, excessive scratching or picking may cause bleeding.
On parts of their own body, or on walls and objects.
POKING / GOUGING
Eyes, ears, nose, and other soft tissue.
Sticking fingers or objects down their throat to encourage gag-reflex, or able to vomit purposefully.
What interventions are available?
It is important to acknowledge that the intervention(s) offered to young people who exhibit self-injurious behaviour are not a magic wand. Although some young people may respond well to specific interventions, they may still exhibit some self-injurious behaviour.
The first step is to observe and try to understand the reasons why a young person may be exhibiting self injurious behaviour. For example:
Are they trying to communicate? If so, what might they be trying to say?
Are they attempting to seek attention from someone?
Are they bored and engaging in self-injurious behaviour because it is stimulating?
Some young people may benefit from medication. A qualified psychiatrist would be able to provide you with more information.
These require a specialist to observe the child over a period of time within different situations to help identify possible causes. It is also important for the specialist to talk with people who are involved with the young person in order to develop a greater insight into their behaviours.
Possible interventions include:
Encouraging the young person to communicate their needs in other ways, such as verbally or signing (e.g. to ask for a drink, or have a coloured card to say “leave me alone”).
Teaching strategies to help the young person cope with stressful situations (e.g. relaxation, stress toys).
Encouraging the young person to express how they are feeling (e.g. point to symbols/pictures of facial expressions).
If the behaviour is to stimulate, think about other ways to stimulate the young person. (e.g. replace head banging with a head massage).
What you can do as a parent/carer
Observe the young person as much as possible. Think about the reasons why they may be engaging in self-injurious behaviour and try to replace it.
Teach communication skills. It is important that the young person can communicate using their preferred method and have people understand what he/she is trying to say.
Try not to react to the self-injurious behaviour, and try to remain calm for yourself and your child’s best interest.
Keep in mind that it is very difficult to completely eliminate self injurious behaviours, and that a young person may always exhibit some self-injurious behaviours.
When to consider asking for more specialist help
CONSIDER SEEKING HELP:
If you are unable to cope with your child’s self-injurious behaviour.
If your child is experiencing more self-injurious behaviour.
If your child’s self-injurious behaviour is affecting their quality of life.
Please talk to your Paediatrician, Social Worker, or School about a referral to the LD-CAMHS team.
Further support, advice and self-help
The National Autistic Society provides information and support for people with Autism and their families and for professionals. They are a very active organisation and offer some really useful information about strategies and approaches for supporting people with Autism.
The British Institute of Learning Disabilities also have some useful information and further advice about a variety of common issues.
Local Offer is a Derbyshire-specific site which allows you to search for lots of different services, including parenting support groups, in the local area.