In a recent study it was found that as many as 30% of children on the autism spectrum engage in self-injurious behaviour like head banging or skin picking. This an alarming issue for families with children on the autism spectrum.

In this guide we discuss the causes and strategies to help your child reduce self-injurious behavior.

Why do autistic children hit themselves?

For children with autism, headbanging is a way to self-soothe and communicate needs as a result of some form of anxiety. Babies and toddlers soothe themselves and want to feel the same as they did in their mother’s womb. This is known as vestibular stimulation. Other habits that feed a child’s vestibular stimulation include head rolling, body rocking, biting, and thumb sucking.

The desire to self soothe in this way can be for any of the following reasons

Physical Pain

Seeking attention

Sensory processing issues

Attempting to communicate

According to Dr. Harvey Karp, MD, rhythmic habits trigger the calming reflex in infants and toddlers. Many babies with autism headbang around six months of age, but their neurotypical peers stop doing so by three years of age.

Noha F. Minshawi, Ph.D., assistant professor of clinical psychology in at Riley Hospital for Children, says children with autism spectrum disorders show self-injurious behaviors at high rates.

What triggers headbanging?

Minshawi also makes the distinction that self-injurious behaviors, such as headbanging in those with autism, is usually classified as a “highly repetitive behavior (occurring at frequencies up to dozens of instances per minute).”

She also notes that headbanging can be episodic and triggered by the same stimuli or appear to start of nowhere. Monitoring your child and taking note of what happened right before headbanging can help identify triggers.

When a child diagnosed with autism headbangs past the age of two and a half or three, there is likely one of four things happening:

The child is in pain The child is attempting to communicate The child is attention seeking, or The child is experiencing sensory overload or a sensory deficit.

Self-harming behavior as a response to pain

Many parents are confused about why a child would inflict more pain via headbanging if a child is already experiencing discomfort. They fail to understand the significance of autism and self-harm. It’s important that parents recognize headbanging as a distraction from pain.

If you discover that your child regularly uses headbanging to manage pain, a pediatrician can suggest ways to ease your child’s discomfort. This may include checking your child’s body for cuts, bruises, redness, swelling, or other physical signs of injury. Working with a communication specialist to help your child develop new ways to show you where he/she is experiencing pain could be helpful as well. Some children are able to point to where they are feeling pain, draw a picture of what hurts, or communicate verbally using short phrases. Verbal children may need prompting to tell you where they are experiencing pain, as headbanging may be their first instinct.

Headbanging in an attempt to communicate

In some cases, autism and headbanging go together so a child can feel in control. A secondary reason may be that the child is trying to communicate. Nonverbal children will seek ways to communicate, often through movement. If a child knows headbanging will cause a caregiver to rush over and intervene, he/she is likely to use this to his/her advantage to help get needs met. This goes hand-in-hand with attention seeking.

Headbanging to seek attention

Children who headbang for attention may be experiencing sensory overload or deficit. In the moment, they may be unable to otherwise communicate their needs.

When children with autism experience sensory overload, their neurotransmitters cannot process the sensation. Noise, visuals, smells, and tastes can be uncomfortable and overwhelming for children with autism. The sensation of headbanging is one they can control and on which they can place their focus.

Self-harm due to sensory processing issues (overload or deficit)

Children that are overloaded due to sensory processing issues often self stimulate, a term that is commonly referred to as stimming. Children who are understimulated, lonely, or bored might headbang to stimulate their vestibular systems. They stimulate themselves in a way the feels good to them. Understimulated children may often seek attention from headbanging, even if they know they will not receive positive reinforcement.

Parents can provide a distraction from headbanging. A vibrating pillow, weighted blanket, gentle touch, or a well-secured bouncing chair, yoga ball chair, or rocking chair are some examples. Providing your child with attention including positive reinforcement, appropriate activities, and options on how to spend his/her time, may help redirect a child who is headbanging.

Additionally, some children headbang as a part of a routine they have developed to prepare for sleep. Autistic children often find the repetitive movements tire and soothe them. Using bedtime social stories or establishing a routine with your child that includes some form of exercise or kinesthetic movements may help prepare him/her for sleep. Stretching, yoga poses, leg flutters, or balancing on alternating legs are popular options.





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Physiological reasons for headbanging in autistic children

There are also some physiological aspects of autism and self-harm. Stephen M. Edelson, PhD, has some theories regarding autism and headbanging. He suggested physiological reasons autistic children headbang including biochemical and genetic factors. He says that research has found that neurotransmitter levels may have a link to headbanging and other self-injurious behaviors.

Edelson writes, “Beta-endorphins are endogenous opiate-like substances in the brain, and self-injury may increase the production and/or the release of endorphins. As a result, the individual experiences an anesthesia-like effect and, ostensibly, he/she does not feel any pain while engaging in the behavior (Sandman et al., 1983). Furthermore, the release of endorphins may provide the individual with a euphoric-like feeling.

“Nutritional and medical interventions can be implemented to normalize the person’s biochemistry; this, in turn, may reduce severe behavior. Although drugs are often used to increase serotonin levels or to decrease dopamine levels, the Autism Research Institute in San Diego has received reports from thousands of parents who have given their son/daughter vitamin B6, calcium and/or DMG. These parents often observed rather dramatic reductions in, and, in some cases, elimination of self-injurious behavior. Parents have also reported reductions in severe behavior problems soon after placing their child on a restricted diet, such as a gluten/casein-free diet, or removing specific foods to which their child showed signs of an allergic reaction.”

While Edelson admits that researchers and medical professionals have not reached a clear consensus on whether dietary or even pharmaceutical interventions can address autism and headbanging, he recommends exploring these options with your child’s pediatrician.

Can headbanging cause brain damage?

For parents of children with autism, brain damage is a common concern if a child starts headbanging. Children under three years old will rarely cause long-term damage by headbanging. Their heads are designed to handle impact from learning to walk, and headbanging will rarely cause more trauma than a slip and fall accident at this age. However, as children get older, they are at a higher risk of causing lasting damage.

Children who are strong enough to cause injury should receive a functional behavioral intervention to come up with a plan to replace headbanging with healthy coping and communication strategies.

“[Self-injurious] behaviors can be physically dangerous for the individual who is head-banging…; and self-injurious behavior is very concerning for their caregivers who want to keep these children safe. In order to implement a behavioral treatment plan for self-injurious behaviors, a functional behavioral assessment should be performed to help determine the environmental and/or internal factors that are maintaining the behaviors. This information is then used to inform behavioral interventions in order to preempt the causes or replace the unwanted behaviors with ones that are more acceptable,” writes Minshawi.

How to stop an autistic child from hitting themself?

It’s important to determine why a child with special needs is engaging in hitting before you can remedy it. First, you need to make sure your child does not have any other medical issues that would lead to him/her inflicting harm. Ear infections, stomach ailments, and other pains in the body might also be the culprit.

It’s also possible that the child uses this behavior as a way to communicate. Anxiety and hyperactivity are two other factors to consider.

You can work with a doctor or applied behaviour analysis specialist for the right response once the reason is clear. You can then work on sensory strategies for headbanging that makes sense for your child.

How can I protect my child from self-harm?

It can be terrifying to witness when a toddler hits himself or herself in the head, but protective measures can be taken to remedy autism and self-harm. Some children respond well to resistance exercises including chin-ups or lifting light weights. Tracking when your child headbangs and to what extent will help determine what level of pain he/she might experience after the episode.

Your pediatrician should be your primary source of information on how to best help a headbanging child. He/she will be able to assess the likelihood of self-harm, help you identify why your child headbangs, and offer solutions and alternatives.

The Cleveland Clinic recommends consulting a doctor immediately if your child hurts him/herself, leaves bumps or bruises, or if you think that the child is having seizures.

If you are unsure if your child is headbanging due to a diagnosis of autism or if it is developmentally normal at this point, partner with your pediatrician. He/she can refer you to other professionals and treatments that can help. This includes occupational therapy for autism, behavior interventionists, or autism support groups for parents.

Can an autism helmet protect my child?

Providing your child with an autism helmet as prescribed by the pediatrician should help prevent injury. You can also add padding to areas of your home that your child typically headbangs, especially any corners or uneven surfaces.

Self-injurious behavior treatment strategies

Treatment for self-injurious behavior in autism can take many forms and will most likely be a process of trial and error. In-home accommodations can be made to help an overstimulated child. Some examples are:

It is vital for a parent or caregiver to seek professional help to correctly resolve autism and head banging. An occupational therapist (OT) can help you and your child learn alternatives for headbanging. Many children find sensory therapy with an OT to be helpful. For children with autism, headbanging strategies might also include yoga and rhythmic therapy in conjunction with routine sensory input under the guidance of an OT.

Your pediatrician or insurance company can help you identify an Occupational therapist in your area.

References:

Prevalence of Self-injurious Behaviors among Children with Autism https://link.springer.com/article/10.1007/s10803-016-2879-1