autism · journey to recovery · mental health · mental health blogger · mental illness · personal journey · Uncategorized

Autism and Self-Injurious Behaviours

Self-injury can be one of the most distressing and difficult behaviours that parents, carers, family members and people with autism themselves may face.

Sometimes referred to as self-harm, self-injurious behaviour is any activity in which a person inflicts harm or injury on themselves. About half of people with autism engage self-injurious behaviour at some point in their life. It can take many different forms, including:

  • head banging (on floors, walls or other surfaces)
  • hand or arm biting
  • hair pulling
  • eye gouging
  • face or head slapping
  • skin picking, scratching or pinching
  • forceful head shaking.

People across the spectrum and of all ages may engage in self-injurious behaviours at some point. People who engaged in self-injurious behaviours as children may return to these as adults during times of stress, illness or change.

Usual behavioural intervention approaches are not always appropriate. Seek professional guidance for any self-injurious behaviour which is difficult to manage or resistant to intervention, or for any behaviour which places the person at risk of harm.

Causes

The reasons a person engages in self-injurious behaviours can be wide and varied, and will often involve a complex interaction between multiple factors. People with learning disabilities told Self-Injury Support that they self-injure when:

  • they feel they are not listened to
  • they have been told off
  • they have little or no choice about things
  • they have been bullied
  • they are involved in arguments, or hear other people arguing
  • they are feeling unwell
  • they have memories of a bereavement
  • they have memories of abuse.

MEDICAL OR DENTAL PROBLEMS

People with autism may have difficulty communicating to others that something is wrong physically and particular self-injurious behaviours (such as ear slapping or head banging) may be their way of coping with pain or communicating discomfort.

MENTAL HEALTH ISSUES

Some self-injurious behaviour may indicate underlying mental health issues such as depression or anxiety.

REPETITIVE BEHAVIOUR

Repetitive behaviours, obsessions and routines are common in people with autism, and some forms of self-injury may be expressions of this feature.

DEVELOPMENTAL STAGES

Some self-injurious behaviour may be persisting remnants of earlier motor behaviours which occur during particular developmental periods (eg hand mouthing which may continue beyond infancy).

COMMUNICATION

Sudden self-injurious behaviour can get a very quick response from other people, and many such behaviours occur in people who have no other functional way of communicating their needs, wants and feelings.

  • Head slapping, or banging the head on a hard surface, may be a way of communicating frustration, getting a preferred object of activity, or reducing demands.
  • Hand biting may help someone cope with anxiety or excitement.
  • Skin picking or eye gouging may be a response to lack of stimulation or boredom.

LEARNED BEHAVIOUR

The person may learn that self-injurious behaviour can be a very powerful way of controlling the environment. A behaviour (eg head slapping) which was initially a response to physical pain or discomfort could eventually become a way of avoiding or ending an undesired situation (eg turning the television off, interrupting an argument taking place nearby).

Reactive strategies

Appropriate responses will vary according to the behaviour, but here are some pointers on what to do when the behaviour is happening. It is important when using any of these strategies that the person is also provided with opportunities to develop skills to communicate their needs more appropriately and to self-regulate stress and anxiety levels.

RESPOND QUICKLY

Intervene early, and respond quickly and consistently to incidents of self-injury. Even if the behaviour serves the function of gaining attention from others, it is never appropriate to ignore severe self-injurious behaviour.

KEEP RESPONSES LOW KEY

Limit verbal comments, facial expressions and other displays of emotion, as these may inadvertently reinforce the behaviour. Try to speak calmly and clearly, in a neutral and steady tone of voice.

REDUCE DEMANDS

The person may be finding a task too difficult or that they are unable to complete the activity at that time. Come back to the activity again later when the person is feeling calmer.

REMOVE PHYSICAL AND SENSORY DISCOMFORTS

Remove unpleasant sensory input. Provide relief for physical discomfort (eg pain killers) if a medical professional has advised this after seeing the person.

REDIRECT

Tell the person what they need to do instead of the self-injurious behaviour, eg “David, hands down”. Use visual cues such as picture symbols to back up instructions. Redirect to another activity that is incompatible with the self-injury (eg an activity that requires both hands) and provide praise and reinforcement for the first occurrence of appropriate behaviour, eg “David, that’s excellent playing with your train”.

PROVIDE LIGHT PHYSICAL GUIDANCE

If the person is having difficulty stopping the behaviour, provide light physical guidance, eg gently guide their hand away from their head, using as little force as possible. Immediately try to redirect attention to another activity and be prepared to provide physical guidance again if the person attempts to re-commence self-injurious behaviour. This approach must be used with extreme caution as it may escalate the behaviour or cause the person to target others.

USE BARRIERS

Place a barrier between the person and the object that is causing harm. For head slapping, place a pillow or cushion between the person’s head and their hand. For hand or arm biting, provide an alternative object to bite down on. For head banging on a hard surface, place a cushion or pillow between the surface and the person’s head. You can get removable padding that is placed temporarily on the floors or walls to minimise injury.

CONSIDER PHYSICAL RESTRAINTS

Some self-injurious behaviour can place the person at serious risk of harm. In these instances, it may be appropriate to explore the use of physical restraints such as arm restraints, gloves or helmets. These may also reduce the sensory experience and frequency of the behaviour.

However, physical restraints are very restrictive and should always be used under the guidance of a specialist to ensure they are used safely and appropriately, and with a plan to fade out their use over time.

Physical restraints do not address the cause of the behaviour, so they must never be used in isolation without teaching the person new skills which address the function of the behaviour.

CALL FOR HELP

In extreme circumstances or emergencies, call 999 for assistance.

Preventative strategies

Here are some ideas about how to prevent self-injurious behaviours.

RULE OUT MEDICAL AND DENTAL CAUSES

Visit the GP or dentist and seek a referral to a specialist if needed. Bring along notes about when the behaviour happens (ie what time of day and in which situations), how often it happens, when it first started, and how long it lasts.

THINK ABOUT THE FUNCTION OF THE BEHAVIOUR

Complete a behaviour diary, which records what is occurring before, during and after the behaviour, or a functional analysis questionnaire, to help you to understand the purpose of the behaviour. Make notes on the environment, including who was there, any change in the environment and how the person was feeling.

INCREASE STRUCTURE AND ROUTINE

Establish a clear daily routine to increase predictability and thereby reduce anxiety. Try to build a range of activities into the person’s routine to minimise boredom and restrict opportunities for the person to engage in self-injurious behaviour. Make plans for difficult times of the day. Increase structure and provide additional supervision and support to the person during these periods or activities. People with Pathological Demand Avoidance may need a less directive and more flexible approach than others on the autism spectrum.

PROVIDE SENSORY OPPORTUNITIES

Find alternative activities that provide a similar sensory experience and build these into the daily routine. Jumping on a trampoline or swinging on a swing may provide needed stimulation to the vestibular system (that head shaking or slapping may have previously provided). Providing the person with a bum bag of edible or safe objects to chew on that provide different sensory experiences such as gum, carrots, raw pasta or sultanas may reduce the need for hand or arm biting.

INTRODUCE COMMUNICATION TOOLS

Support the person to use other ways of communicating their wants, needs and physical pain or discomfort, eg by using visual supports such as pictures of body parts, symbols for symptoms, or pain scales, pain charts or apps.

REWARD APPROPRIATE BEHAVIOURS

Provide frequent encouragement to the person for engaging in appropriate behaviour and for periods in which they did not engage in the self-injurious behaviour. This will help the person learn that other, more appropriate behaviours bring positive outcomes.

Rewards can take the form of verbal praise and attention, preferred activities, toys, tokens or sometimes small amounts of favourite foods or drinks. Ensure that you clearly name the behaviour that you are rewarding, eg “Jane, that’s good waiting!” and ensure that rewards are provided immediately after the behaviour that you wish to encourage eg “You can spend 10 minutes on the computer now”.

It should be noted that some people with autism do not enjoy social attention. In these circumstances, verbal praise can cause distress and actually stop the person engaging in the desired behaviour in the future.

MEDICATION

Medication may help to reduce the frequency of self-injurious behaviour for some people. As with physical restraints, medication should be seen as a last resort approach to management and again, should never be used without teaching new skills and consulting a medical specialist.

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[Source: National Autistic Society]

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eating disorder · journey to recovery · mental health · mental health blogger · mental illness · personal journey · Uncategorized

Do YOU have an eating disorder?

There are various different types of eating disorders and it can be difficult to spot whether a person’s food habits signify those of someone with an eating disorder. This blog post asks questions about your eating habits to determine if you may be struggling with food. It is not a diagnosis. Answering yes to the questions could indicate you have an eating disorder and you should seek advice from a doctor.

  1. Do you spend a significant amount of time worrying about your body, weight or shape?

  2. Would you say that food, or thinking about food, dominates your life?

  3. Do you worry you have lost control over how much you eat?

  4. Do you make yourself sick when you feel uncomfortably full?

  5. Do you believe that you are fat when others say you are too thin?

  6. Do you avoid food or eating? – OR – Have you experienced a lack of interest in food or eating?

    If you suspect that you or someone you know has an eating disorder, it is important to seek help immediately. The earlier you seek help the closer you are to recovery. While your GP may not be formally trained in detecting the presence of an eating disorder, he/she is a good ‘first base.’ A GP can refer you on to a practitioner with specialised knowledge in eating disorders.

    find your local eating disorder service here

    https://www.b-eat.co.uk/

    https://eatingdisorder.org/eating-disorder-information/

    http://eating-disorders.org.uk/

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mental health · mental health blogger · mental illness · personal journey · Uncategorized

I’ve been nominated for a National Diversity Award

I’ve been recently nominated for a national diversity award in the Positive Role Model category for Disability.

The National Diversity Awards – a prestigious black tie event, which celebrates the excellent achievements of grass- root communities that tackle the issues in today’s society, giving them recognition for their dedication and hard work.

Charities, role models and community heroes will be honoured at the ceremony showcasing their outstanding devotion to enhancing equality, diversity and inclusion; thus embracing the excellence of all our citizens irrespective of race, faith, religion, gender, gender identity, sexual orientation, age, disability and culture.

In order to be shortlisted for the awards, the judges will look at nominations that the person as received.

I will really appreciate it if you can head over to my profile and vote for me. It would mean the world to be shortlisted and possibly win this award so I can gain more recognition to help a wider audience.

To vote head over to:

https://nominate.nationaldiversityawards.co.uk/Nominate/Endorse/30610?name=savannah%20lloyd

Thank you.

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journey to recovery · mental health · mental health blogger · mental illness · personal journey · Uncategorized

The lack of mental health care available…

It’s an obvious fact that mental health treatment is underfunded in the UK, but the true extent of this under funding has only become more apparent to me in the last couple of weeks.

My mental health has turned downhill gradually over the year and more so in the last few months that I’ve needed to go and seek help for it again. The hardest thing in the world is to go to a doctor and tell them you’re there because your mental health is poor. It’s one of the hardest things to do, especially if you have anxiety and hate the thought of going there. The even harder thing is going and knowing that you possibly may not even get the help you need because of stigma, misunderstanding, the area you’re in and the lack of funding.

Mental health care is a like a lottery. If you live in the right area, you may have access to the help you need. Other areas have less funding and less mental health services available. It makes me feel really sad.

It’s so frustrating. It’s agonising when you’re sat through a suicide crisis at 2:30am in the morning and theres no help at all. The helplines shut at midnight, your GP is closed and you’re too afraid to call out of hours. You feel like your mental health problem is not serious enough for A&E and think the staff there will assume you’re wasting their time. Anyone whose been in this position will know how frightening this situation is…

I’m really hoping one day this will change. I want to make that change. I want to advocate. I want to educate. I want to raise awareness. I want to offer support. I don’t want people to feel like they’re ever alone. I want people to know that someone, somewhere, loves them and cares about their safety.

For help and support visit my mental health support page or email me.

When “I” is replaced by “We” even Illness becomes Wellness.

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journey to recovery · mental health · mental health blogger · mental illness · personal journey · Uncategorized

I was REALLY sick…

I was on instagram last night when I went onto my instagram profile. I decided to just stroll through my pictures and found some from 2014/2015. For those who know me, you’ll understand that during this time I was in the depths of my eating disorder. At the time, I didn’t really know this. I thought I was okay. I thought I was better than I’d ever been. How wrong I was though. June 2014 consisted of doctors appointments, hospital appointments, blood tests, scans, meetings with college, intervention from community mental health teams and social services. My weight was drastically dropping by each day. The calories kept getting lower and lower.

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Whilst going through those pictures last night; I had the realisation that I was actually really sick back then. How I had managed to feel so healthy I have no idea. How did I survive on no calories for a week? How did I manage to exercise every waking hour of the day?

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I knew that I was sick, I just don’t think I realised how sick I was. I thought I was getting healthy and stronger, not unhealthy and weaker. I remember getting every single illness going; my immune system was very weak. I was always cold yet I still took freezing showers. My muscles always ached and bruised but I would walk for hours on end.

All I wanted to do was sleep and food plagued every single thought.

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Anorexia is such a wretched disease.

It stops its victims even noticing theres something wrong. It refuses to let them see their true self or feel any sort of happiness.

Anorexia is strong, but Savannah is stronger.

journey to recovery · mental health · mental health blogger · mental illness · personal journey · Uncategorized

What Anorexia Taught Me

When I was 12 years old, I remember thinking to myself, “you’ll never get an eating disorder; you’re too overweight”, after hearing about eating disorders on the news. I remember telling myself that was one less mental illness to worry about because I certainly wouldn’t get that. I already had Anxiety and Depression; I’d never get an eating disorder too.

Funny enough, 3 years later…you can kind of guess what happened. I – the person who told myself I’d never get one – developed Anorexia Nervosa. I didn’t actually realise I had an eating disorder until a long while in. I thought I was on a diet – simply cutting out ‘bad’ foods in order to lose weight. I thought exercising was making me stronger, fitter, thinner. The exercise boosted my self-esteem. Saying ‘no’ to a piece of food made me proud. A few months in, I finally realised I may have had a problem. I’d cut out all types of food. Any food that led to possible weight gain. Pizza, chips, ice cream, bread, carbohydrates, takeaway, crisps, pasta, rice. The list mounted and soon the only food I felt truly comfortable eating was fruit, vegetables and water. I realised I was developing something abnormal, but I refused to admit it or tell anybody. I began purging. Throwing up the small amounts of food I’d consumed because those calories just weren’t worth it. Using pills to lose weight.

Oh I knew by now that this was Anorexia Nervosa. I knew what she was doing to my body; abnormal blood counts, fatigue, lack of oxygen in the skin, intolerance to cold, abnormal heart rhythms, dizziness and fainting, low blood pressure, dehydration, osteoporosis, irritability, depression and increased anxiety, hatred and fear of food, thoughts and attempts of suicide, social withdrawal, self harm, constipation, constant hunger, brittle nails and thin hair, low potassium and chloride… the list is endless, but I was lacking one important symptom; an extremely low body weight (which I eventually gained after a doctor told me I was ‘too fat’ after losing 31% of my body weight).

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You see, I never thought I would get a disease known as Anorexia Nervosa. I never expected to have a life-long condition that can be managed but won’t truly go away. But the thing is, as an 8 year old I wrote a poem about a girl named ‘Ana’ who told me I was fat and not to eat. It happens that 7 years after that poem, it came true. Maybe I was predisposed to Anorexia  from a early age and there was nothing anybody could do to stop it.

Anorexia Nervosa is completely destructive and the most lethal psychiatric disorder to date, but its taught me things I never thought it would.

Because of Anorexia; I learned to look deeper into the way people act, behave and think. I have learned to be compassionate, to not judge but to be accepting. I have learned who my real friends are (to those of you who stuck around; I love ya) and who is there for me in the darkest of times. I have learned about a range of illnesses I knew nothing about before. I have learned to advocate for change and grow a passion for changing the world and the people in it. I have learned to stand up for those who have mental illness and befriend those who struggle. I have learned so, so much…

but most of all,  I have learned about me.

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autism · journey to recovery · mental health · mental health blogger · mental illness · personal journey · Uncategorized

Overcoming Perfection

I’ve been a perfectionist my entire life; I know that. I’ve always set extremely high goals and aimed to achieve them. I’ve always been extremely critical about anything and everything. I do set unrealistic standards of myself, and I do focus on the results. I have a huge fear of failure, procrastinate, defend and have a low self-esteem. I know this. But days like today make me realise how much being a perfectionist truly affects your life. Your emotions. Your thoughts. Your behaviours towards others.

I set myself a goal – a grade – a task…and if this goal isn’t met in the way I’ve planned, I meltdown. I cry and scream and punch and hit. It’s not the silent tears that roll down a cheek; its a full blown messy, screaming cry; the sort that makes you extremely tired and distraught. Today was that day…

That day to cry, to scream, to hit the wall; and in its consequence, feel like an utter failure.

But, being a perfectionist is not always a bad thing. Setting unrealistic goals allows you to work hard to try and reach that goal. You have motivation, determination and persistence to get things done. You become amazing at correcting errors and faults. You repeat something over and over again until you get it right.

You never accept failure from yourself, and that is utterly okay.

I am a perfectionist, and on days like today its really hard to get past that, but after calming down, I realised its okay to be a perfectionist..

it’s how I make things work. It’s how I focus and push myself to do work. It’s how I organise and succeed in aspects of life.

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