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]

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

Self-Injury Awareness Day 2017

Raising awareness about self-injury is incredibly important. Awareness leads to understanding and empathy, banishing judgement and fear, and reducing the number of people who feel alone and suffer in silence.

Raising awareness is about educating people who do not self-injure, and reaching out to people who do.

What is Self-Harm?

Self-harming is when a person chooses to inflict pain on themselves in some way. If you are self-harming, you may be cutting or burning yourself, biting your nails excessively, developing an eating disorder or taking an overdose of tablets. It can also include taking drugs or excessive amounts of alcohol. It is usually a sign that something is wrong. Self-Harm is not always obvious and sometimes isn’t intentional (self harm can be done absently). A person may self-harm if they are feeling anxious, depressed or stressed or if they are being bullied and feel that they do not have a support network or way to deal with their problems. The issues then ‘build up’ to the point where they feel like they are going to explode. Young people who self-harm often talk about the ‘release’ that they feel after they have self-harmed, as they use it as a mechanism to cope with their problems. A person may self-harm to relieve tension, to try and gain control of the issues that may be concerning them or to punish themselves. Sometimes it is an attempt to commit suicide if the problems are very severe.

Prevalence of Self-Harm in Young People

It has been estimated that 1 in 12 young people in the UK have self-harmed at some point in their lives. And the latest figures show that in the last two years alone ChildLine has seen an increase in counselling sessions of 167% on the issue.

There is also evidence that self-harming is affecting children at a younger age than ever before.  In 2011/12, ChildLine reported that self-harm was in the top five concerns for fourteen year olds for the first time. However, in the first six months of 2012/13, this age dropped further appearing for the first time in the top five concerns for thirteen year olds.

Misconceptions and Facts

There are many misconceptions surrounding why young people self-harm. The reality is that:

  • Self-harm is not a mental illness, nor is it an attempt to commit suicide.
  • It doesn’t just affect girls. Boys self-harm too, but they are much less likely to tell anyone about it.
  • We know that young people from all walks of life self-harm, regardless of their social or ethnic background.
  • Self-harm is not a fashion fad, nor is it merely ‘attention seeking behaviour’.
  • Most importantly, it is not easy for a young person to stop self-harming behaviour.
  1. Self harm is a very common problem, much common than a lot of people think. Although it is common, a lot of people struggle to deal with it. Recent research shows that at least 1 in 15 young people in Britain have harmed themselves. This amounts to at least 2 young people in every school classroom self harming at the same time. The most common age for self harm is between the ages of 11 and 25. Most people start self harming at around 12 years old but it is increasing among those younger.
  2. Self harming is usually not for attention. Self harm is a way to release emotions, deal with stress and pressures and to replace mental pain with physical pain. Most people harm themselves because they don’t feel like they have any other options. Self harm provides a temporary relief and a sense of control. Most people self harm due to being bullied at school, stress and worry about work, feeling isolated, divorce, bereavement or pregnancy, experience of abuse, problems with their sexuality, low self-esteem, underlying mental health issues.
  3. Self harm is not closely linked to suicide. The majority of people who self harm are not trying to kill themselves, but rather trying to cope with difficult situations and feelings. Although many people who do go on to commit suicide have self-harmed in the past, self harming itself does not indicate that a person is attempting to take their own life.
  4. Self harm can become addicting. Chemicals are released in the body when it is injured. These chemicals make you less sensitive to pain. Self harm mostly becomes addicting as it grows to be a habit that the person begins to rely on in order to function.
  5. Self harm is not just a phase. In young people, self harm is often blamed as a ‘teenage phase’ that the person will grow out of. However, self harm does not just affect young people. It affects people from all ages and all walks of life. If someone is self harming, then someone is severely bothering them and if left untreated, it can become more aggressive and frequent over time.

siad

 

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

The truth about self harm (SIAD)

 

Tuesday March the 1st 2016 marks Self-Injury Awareness Day.

Raising awareness about self-injury is incredibly important. Awareness leads to understanding and empathy, banishing judgement and fear, and reducing the number of people who feel alone and suffer in silence.

Raising awareness is about educating people who do not self-injure, and reaching out to people who do.

Self-harming is when a person chooses to inflict pain on themselves in some way. If you are self-harming, you may be cutting or burning yourself, biting your nails excessively, developing an eating disorder or taking an overdose of tablets. It can also include taking drugs or excessive amounts of alcohol. It is usually a sign that something is wrong. Self-Harm is not always obvious and sometimes isn’t intentional (self harm can be done absently). A person may self-harm if they are feeling anxious, depressed or stressed or if they are being bullied and feel that they do not have a support network or way to deal with their problems. The issues then ‘build up’ to the point where they feel like they are going to explode. Young people who self-harm often talk about the ‘release’ that they feel after they have self-harmed, as they use it as a mechanism to cope with their problems. A person may self-harm to relieve tension, to try and gain control of the issues that may be concerning them or to punish themselves. Sometimes in severe cases it is an attempt to commit suicide if the problems are very severe.

I was 11 years old when self-harm introduced itself into my life and its been an ongoing battle since. I’ve therefore decided to put together 5 little truths I’ve personally come across in relation to self-harm.

  1. Self harm is a very common problem, much common than a lot of people think. Although it is common, a lot of people struggle to deal with it. Recent research shows that at least 1 in 15 young people in Britain have harmed themselves. This amounts to at least 2 young people in every school classroom self harming at the same time. The most common age for self harm is between the ages of 11 and 25. Most people start self harming at around 12 years old but it is increasing among those younger.
  2. Self harming is usually not for attention. Self harm is a way to release emotions, deal with stress and pressures and to replace mental pain with physical pain. Most people harm themselves because they don’t feel like they have any other options. Self harm provides a temporary relief and a sense of control. Most people self harm due to being bullied at school, stress and worry about work, feeling isolated, divorce, bereavement or pregnancy, experience of abuse, problems with their sexuality, low self-esteem, underlying mental health issues.
  3. Self harm is not closely linked to suicide. The majority of people who self harm are not trying to kill themselves, but rather trying to cope with difficult situations and feelings. Although many people who do go on to commit suicide have self-harmed in the past, self harming itself does not indicate that a person is attempting to take their own life.
  4. Self harm can become addicting. Chemicals are released in the body when it is injured. These chemicals make you less sensitive to pain. Self harm mostly becomes addicting as it grows to be a habit that the person begins to rely on in order to function.
  5. Self harm is not just a phase. In young people, self harm is often blamed as a ‘teenage phase’ that the person will grow out of. However, self harm does not just affect young people. It affects people from all ages and all walks of life. If someone is self harming, then someone is severely bothering them and if left untreated, it can become more aggressive and frequent over time.

hands-istock