Jemma Swales has developed this workshop organised by SHINE for Autism with the intention of educating parents/carers about Violence and Self-injurious behaviour.

 

Individuals with autism spectrum disorder (ASD) can behave aggressively towards themselves or other people. There are lots of strategies you can use to help prevent and manage their self-injurious or aggressive behaviour.

 

Violence, self-injurious behaviour and autism spectrum disorder

 

Individuals with autism spectrum disorder (ASD) don’t necessarily express anger, fear, anxiety or frustration in the same way as other people.  They can sometimes express these feelings through aggressive behaviour towards other people.  Sometimes they’re aggressive towards themselves, which is called self-injurious behaviour.  They might hit, kick, throw objects or hurt themselves – for example, by head-banging.

 

Individuals with ASD might behave aggressively or hurt themselves because they:

 

   •     have trouble understanding what’s happening around them – for example, what other people                  are saying or communicating non-verbally

   •     can’t communicate their own wants and needs – for example, they can’t express that they don’t              want to do an activity or that they want a particular object

   •     are very anxious and tense

   •     have sensory sensitivities, like an over sensitivity to noise or a need for stimulation

   •     want to escape from stressful situations or activities.

 

Understanding aggressive behaviour in individuals with autism spectrum disorder

 

Understanding what causes an individual’s self-injurious and aggressive behaviour can help you to change or reduce the behaviour.  You can do this by looking at the aggressive behaviour as an ABC sandwich:

 

   •     Antecedents: these are ‘triggers’ for the aggressive or self-injurious behaviour

   •     Behaviour: this is the way they respond to the trigger

   •     Consequences or ‘rewards’: this is what they get out of behaving aggressively, like being allowed            to go on with a favourite activity, or to leave a stressful situation.

 

You can work on the individual’s aggressive behaviour by changing either the triggers or the rewards that they get from behaving aggressively or self-injuring.

Understanding how well they can communicate is also a key step in finding out what’s causing the aggressive behaviour.  When individuals can’t express feelings or ask for what they need, they might use aggressive behaviour to communicate.

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It can be helpful to ask yourself, ‘Are they trying to tell me something?’. For example, if they don’t like corn flakes but can’t tell you, they may hit you as a way of saying ‘Take it away, I don’t want it!’.

 

Managing an aggressive outburst from an individual with autism spectrum disorder

 

You probably can’t prevent every outburst, but you can try to manage the aggressive behaviour when it happens.  Here are some tips.

 

The first and most important thing is to stay calm.  Most aggressive outbursts or tantrums happen because their feelings are building up and they can’t communicate them.  By managing your own feelings and staying calm and quiet, you won’t add your emotions to the mix.

 

During an outburst they will be feeling very stressed.  It’s hard to process what someone else is saying when you’re feeling stressed, and this is especially true for individuals with ASD, who can have trouble understanding language.

 

It can help if you limit what you say to short phrases or even just a couple of words.

 

You might need to move the individual to a safer place, away from anything that could hurt them – for example, shelves that could fall over or glass objects.  A quiet enclosed space outside might be an option.  You might also need to get other people to move out of the way for safety.  Visual cues can also help in these situations

 

If you find you have to use physical restraint when the individual has an aggressive outburst, speak with your child’s paediatrician, doctor or a behavioural therapist.

Physical restraint can be dangerous to both you and them, and can often increase your their anxiety and make the situation worse.  Positive behaviour support is always preferable to physical options.

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Managing self-injurious behaviour in an individual with autism spectrum disorder

 

Working out what the individual with autism spectrum disorder (ASD) is trying to tell you with self-injurious behaviour can help you decide how to manage it.

For example, they might find it hard to switch from one activity to another.  They might bang his head on the floor when you tell them that it’s time to put away the train set before dinner.  You could try warning them five minutes before you need them to pack away by showing them a photo of washing hands and sitting at the table for dinner.  This will give a warning, plus time to finish what they’re doing.

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If they have been doing a puzzle for 10 minutes and they start to pull their hair, they might be trying to let you know that they want to do something else. Offering a new activity might stop the hair-pulling. 

They may hit themselves because they want you to look at them and talk to them.  Going over and giving them attention will stop them hitting themselves.  The next step is teaching them to get your attention in another way – for example, by saying ‘Mum’ or coming to you and showing you a help card.

 

The individual might be feeling frustrated and need help.   For example, they have been playing with a doll but the leg comes off, so they start to scream and scratch themselves.  If you help fix the doll, it will stop them hurting themselves.  The next step is teaching them how to show their frustration in another way – for example, to say, sign or show a picture to tell you when they need help.

 

A note about responding to self-injurious behaviour by giving them what they want can strengthen the behaviour and make it more likely that they will behave in the same way in a similar situation in the future.

 

A better long term strategy is to:

 

   •     prevent the behaviour by avoiding situations that trigger it

   •     teach them to express their needs in a more positive way

   •     ignore self-injurious behaviour and reward when they express themselves in a more positive                  way.

 

This can be hard to do without professional help to work out why they are behaving aggressively or self-injuring.

 

Getting professional help

 

An experienced professional can help you understand and manage you’re the individuals aggressive or self-injurious behaviour.  This might be particularly helpful if you’ve already tried other strategies without success.

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For example, the professional might use functional analysis to work out why they are behaving aggressively or is self-injuring.  Then the professional might create a positive behaviour support plan that includes strategies to reduce the behaviour and teach new behaviour.