Guide to self-injurious behaviour
Posted on July 27, 2019 by Ann
Story of Rose
Rose is an 18-year-old female with intellectual disability. She usually scratches her face and arms repeatedly. She does not appear to suffer from any apparent skin problems or allergies and the trigger of her behaviour is not known. How do we manage her behaviour?
What is self-injurious behaviour?
Self-injurious behaviour (SIB) is a form of behaviour that results in the child injuring himself or herself. Common forms of SIB include:
- hitting or biting himself or herself,
- scratching or rubbing himself or herself repeatedly,
- picking at skin or sores, and
- head banging.
SIB is a form of self- stimulation as it is repetitive and provides sensory stimulation to the child.
Frequent and intense occurences of SIB may cause tissue damage such as bruises, redness, open wounds, and even serious injuries.
SIB is more prevalent in individuals with severe and profound levels of intellectual disability.
Why is my child doing this?
It is important to understand why your child engages in SIB so that you can intervene appropriately.
Some reasons could be:
1. To avoid/escape undesirable tasks
Your child may engage in SIB to avoid a negative or unfavourable event.
For example, if your child dislikes washing dishes, he or she may bite his or her hand to the extent of bleeding so that he or she can avoid washing the dishes. Every successful attempt to avoid an unwanted event (washing dishes) reinforces the SIB (hand-biting).
2. To get attention from the caregiver
SIB may be used to attract attention. Your reaction to your child’s self-injurious behaviour may inadvertently reinforce it.
3. Underlying medical or dental problems
Your child may be experiencing pain from a medical problem. SIB, such as slapping or head banging, may be a coping mechanism to help him or her cope with the pain of an earache or a headache.
The child may be unable to communicate his or her needs and feelings to others due to speech and language difficulties. Therefore the child may engage in SIB as a means of communicating frustration, anxiety or excitement.
SIB may also occur as a response to excessive stimulation or arousal (e.g. loud noises or bright lights), boredom, or a lack of stimulation or arousal.
5. History of abuse
Research has suggested that childhood abuse may be a risk factor that contributes to SIB. SIB is a form of self-directed abuse that is learnt through repeated abuse or criticisms by others.
We need to analyse the physiological, social, and emotional needs of each child as each child has a different background.
How do I manage my child who has SIB?
1. Ignore problematic behaviour and reward good behaviour
In Rose’s case, her problematic behaviour is scratching her face and arms. If your child does the same, do not pay attention to the behaviour. However, this method should only be used for SIB that is not potentially harmful to the child.
Each time your child does not exhibit the behaviour, reward him or her with tokens that he or she can use to exchange for access to watching TV, snacks, video games or other activities that are of interest to him or her.
2. Introduce an alternative behaviour
If the SIB is due to under-arousal, exercise can be used to increase arousal.
If the SIB is due to over-arousal, relaxation or deep pressure techniques may be introduced to reduce arousal.
In Roses case, she can be directed to an alternative form of physical stimulation like rubbing textured objects such as fur-like or Velcro-like cloth/gloves on the skin. She can even be provided with a brush that lets her stroke it against the skin to reduce the incidence of scratching.
3. Consistency of management
If your child engages in SIB to obtain an object or seek attention, use positive reinforcement consistently to encourage positive behaviour. Provide rewards and pay attention to your child only when he or she does not engage in SIB.
For example, give your child a selection of desirable objects at specific times of the day to encourage good behaviour or pay attention to your child only after he or she has displayed no self -injurious behaviour after a specified period of time.
4. Reduce/stop problem behaviour and follow through with your original demands
When your child is displaying SIB to avoid a task, direct attention to him or her to stop the behaviour and persist with the task you have assigned.
In situations where the SIB is severe and cannot be reduced after various attempts, research shows that negative reinforcement in the form of punishment is effective. The use of punishment should be given together with another reinforcement that encourages an appropriate non-SIB.
If you are considering punishment, ensure that it is meted out properly. Consult a psychologist for assistance if necessary.
5. Consider using medication as treatment.
The use of medication should be considered as a last resort and in consultation with a medical doctor/psychiatrist.
MINDS is an All In Preferred Partner.
Movement for the Intellectually Disabled of Singapore (MINDS) is one of the largest Voluntary Welfare Organisations in Singapore, serving some 2,400 clients from past the age of six to their ripe old age. MINDS’ services include four special schools, three employment development centres, three day training and development centres, and one multi-service residential home.
This guide was originally published by MINDS’ Allied Health Professionals unit and republished with minor editorial amendments by All In.