May Self-injure/Self harm.

 

1. Respond to the behaviour straight away; do not ignore self-injurious behaviour.

2. With self-injurious behaviour, check with your GP that there are no medical issues that may be affecting their behaviour such as digestive issues, allergies, biochemical imbalances etc.

3. Check that there are no medicines that they may be taking that are affecting their behaviour.

4. Keep a diary of their behaviours including who, what, where, when.  Understanding the purpose of the behaviour may help you to change or reduce it.

5. Identify any triggers for the behaviour i.e. if the trigger is transitions, you can use strategies to reduce their anxiety and therefore reduce the behaviour.

6. The behaviour may be to gain sensory feedback – such as biting self, banging head, hitting their head.  Over time this may become more dangerous as they may need to do it harder to get the same feedback and this may lead to injury.  Substitute the behaviour with another that gives the same level of feedback.

7. The behaviour might be part of their self-stimulatory behaviours – See Self-stimulatory Behaviour section for advice.

8. The behaviour may be to reduce anxiety – such as self-harming.  See Calming Techniques for other ways to reduce anxiety levels.

9. The behaviour may be to communicate – such as hitting themselves when they want to stop doing an activity.  See Communication sections for ways to help them communicate their needs.

10. Reduce demands and verbal communication.

11. Reduce any physical or sensory discomfort.

12. Please see a doctor for further advice on these issues if they do not reduce or the individual is at serious risk of harm.  Your GP may carry out a medical assessment and give appropriate treatment if necessary.  This may include medications or they may refer to a qualified mental-health professional.

 

May bite/spit/pinch/hair pull other people.

 

1. The behaviour may be due to pain.  Check with your GP that there are no medical issues that may be affecting their behaviour such as digestive issues, allergies, biochemical imbalances etc.

2. Check with your Dentist that there are no dental issues that may be affecting their behaviour or causing pain.

3. Check that there are no medicines that they may be taking that are affecting their behaviour.

4. Keep a diary of their behaviours including who, what, where, when.  Understanding the purpose of the behaviour may help you to change or reduce it.

5. Identify any triggers for the behaviour i.e. if the trigger is transitions, you can use strategies to reduce their anxiety and therefore reduce the behaviour.

6. Reduce any physical or sensory discomfort.

7. The behaviour may be sensory.  They may enjoy the feel of saliva etc or the reaction of others.  Substitute the behaviour with another that gives the same level of feedback.  See Sensory section for advice.

8. The behaviour may be to communicate their needs/frustration – such as biting when they want to stop doing an activity.  See Communication sections for ways to help them communicate their needs.

9. Biting may be due to a late mouthing stage or tooth development.  Chewellery such as chewigems enable them to chew without damaging clothing etc.  There are various types including necklaces, bangles and chubes (that can be attached to the strings of a hoody).  Oral stimulation such as chewing gum (if appropriate), blowing bubbles, drinking through a straw may help.

10. Try not to react and act as calmly as possible.  Redirect to another more appropriate activity.

11. Use positive reinforcements and rewards if appropriate.

 

May be Aggressive/Violent/Destructive.

 

1. Check with your GP that there are no medical issues that may be affecting their behaviour such as digestive issues, allergies, biochemical imbalances etc.

2. Check that there are no medicines that they may be taking that are affecting their behaviour.

3. Keep a diary of their behaviours including who, what, where, when.  Understanding the purpose of the behaviour may help you to change or reduce it.

4. Identify any triggers for the behaviour i.e. if the trigger is transitions, you can use strategies to reduce their anxiety and therefore reduce the behaviour.

5. Use the ABC method.  A- Antecedents (Triggers), B – Behaviour (what are they doing?), C – Consequence (what are they gaining from the behaviour). 

6. Remain calm to avoid escalating the situation further with your own emotions.

7. Reduce demands and verbal communication.

8. Reduce any physical or sensory discomfort.

9. If appropriate, move the individual to a quiet and safe place.

10. If you find you have to use physical restraint when the individual has an aggressive outburst, speak with your GP or a Behavioural Therapist.  Physical restraint can be dangerous to both you and them, and can often increase anxiety and make the situation worse.  Positive behaviour support is always preferable to physical options.

11. Use praise or rewards when they have remained calm. 

12. See Calming Techniques for ways to reduce anxiety.

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May have meltdowns (intense response to an overwhelming situation).

 

1. Keep a diary of their behaviours including who, what, where, when.  Understanding the purpose of the behaviour may help you to change or reduce it.

2. Identify any triggers for the behaviour i.e. if the trigger is transitions, you can use strategies to reduce their anxiety and therefore reduce the behaviour.

3. Reduce triggers if appropriate or gradually increase exposure to desensitise them to the trigger.

4. Use the ABC method.  A- Antecedents (Triggers), B – Behaviour (what are they doing?), C – Consequence (what are they gaining from the behaviour). 

5. Identify any signs of stress that they display before a meltdown i.e. if they begin to stim etc.  If you can identify signs of stress you may be able to distract or re-direct before a meltdown occurs.

6. Remain calm to avoid escalating the situation further with your own emotions.

7. Reduce demands and verbal communication.

8. Reduce any physical or sensory discomfort.

9. A bag of familiar items to touch or smell may help them remain calm.

10. If appropriate, move the individual to a quiet and safe place.

11. If you find you have to use physical restraint when the individual has a meltdown, speak with your GP or a Behavioural Therapist.  Physical restraint can be dangerous to both you and them, and can often increase anxiety and make the situation worse.  Positive behaviour support is always preferable to physical options.

12. Give them time; it can take a while to recover from a meltdown.

13. See Calming Techniques for ways to reduce anxiety.

 

May have shutdowns (partially or completely withdrawing).

 

1. Identify any triggers and use strategies to help reduce their anxiety.

2. Reduce triggers if appropriate or gradually increase exposure to desensitise them to the trigger.

3. Identify any signs of stress that they display before a shutdown.  If you can identify signs of stress you may be able to distract or re-direct before a shutdown occurs.

4. Remain calm.

5. Reduce demands and verbal communication.

6. Reduce any physical or sensory discomfort.

7. A bag of familiar items to touch or smell may help them remain calm.

8. Allow them to withdraw, if appropriate help move the individual to a quiet and safe place.

9. Give them time; it can take a while to recover from a shutdown.

10. See Calming Techniques for ways to reduce anxiety.

 

May avoid demands.

 

1. Visual Schedules may help by making demands less personal.

2. Use indirect language i.e. ‘We’re going to have breakfast, would you like toast or cereal?’ instead of ‘You need to eat your breakfast’.

3. Offer choice, but limit to two i.e. ‘would you like toast or cereal?’ or use ‘when’ and ‘then’ i.e. ‘when you are ready, then we can go to the park’.

4. Use their preferred interests to make demands less personal i.e. ‘Thomas the Tank Engine said we should....’

5. Do not take demand avoidance personally.  Remain calm to avoid escalating the situation further with your own emotions.

6. Use humour (if appropriate), laughter may lessen their anxiety.

7. Use distraction when needed to reduce anxiety.

8. Choose your battles.  Focus on which boundaries are important (i.e. safety) and re-enforce these.  Be flexible with demands that aren’t important.

9. If a boundary is important (non-negotiable) be clear why it is important.  Explain the reasons in general terms and don’t make it personal to them i.e. ‘It is illegal to steal and people that do will get in trouble with the police’.

10. Identify any triggers for the behaviour i.e. if the trigger is transitions, you can use strategies to reduce their anxiety and therefore reduce the behaviour.  See Transitions section for advice.

11. Reduce triggers if appropriate or gradually increase exposure to desensitise them to the trigger.

12. If the triggers are sensory, carry out an environmental profile – Take notes to figure out what sensory input may be causing them issues and modify the physical environment if appropriate.

13. Monitor their stress levels and reduce demands according to their tolerance.  If they are less stressed they may be able to cope with more demands.

14. Some individuals that struggle with demands may find rewards just as difficult as this may only add to the demand or may be seen as a bribe.

15. Plan ahead, but be prepared to be flexible.  If they are struggling, offer reassurance and try again the next day if possible.  This will reduce the demand.

16. If the demand avoidance is extreme, speak with your GP or Paediatrician who may refer them for further assessments.