Addressing self-injurious behavior in your child

Patients with autism spectrum disorder (ASD) may exhibit self-injurious behavior (SIB). A holistic approach to diagnosis and treatment may help address this behavior.

It is estimated that 43% of patients with ASD will engage in some type of SIB, with hand-hitting being the most common. A recent case study published in the Journal of Developmental-Behavioral Pediatrics addressed SIB in a medically complex patient. A summary of its findings is addressed below.


Gillian is a seven-year-old nonverbal, internationally adopted girl with autism spectrum disorder, significant visual impairment, moderate-severe hearing loss, profound intellectual disability, and a seizure disorder. She was referred to a multi-disciplinary team in developmental-behavioral pediatrics for evaluation and management of injurious behavior that occurred before bowel movements.

Self-Injurious Behavior

Gillian would hit her head with her palm and poke her eyes repetitively. This behavior resulted in her having bruises consistently on her forehead. Her SIB would occur an hour before stooling and also involved screaming. The teachers at school and her parents at home would block Gillian from poking her eyes and redirect her to the toilet. Gillian’s adoptive mother even attempted to have her wear goggles but this only resulted in increased aggressive behaviors.

Evaluating for Triggers

The initial assessment involved evaluating the possible sources of pain that could be the trigger for the behavior. Using validated pain scales such as the Non-Communicating Children’s Pain Checklist-Revised (NCCPC-R) can help rate the frequency and severity of the SIB. The parents noticed the patient would arch her back and tense her muscles when sitting on the toilet. Her eye poking and head hitting behaviors decreased dramatically after defecating. These clues identified constipation as a trigger for her SIB.

Developing a Plan

In this case, treatment for the SIB involved preventing the trigger, which was pain related to severe constipation. Gillian’s gastroenterologist initiated a treatment for constipation involving senna, which is a laxative and increases gut motility. This treatment is often more effective for constipation compared to stool softeners and will produce a bowel movement. After two weeks on this treatment plan, Gillian’s SIB decreased and stopped within one month. A constipation action plan was created to prevent relapses. This is an excellent example of how to address SIB by looking holistically at the patient to identify the cause and not focusing on the SIB itself.

Pharmacological Treatments

In this case the parents and patient’s health team were able to identify a painful stimulus that triggered SIB in the patient. Once the trigger was identified, an appropriate treatment plan was developed to address this trigger and extinguish the SIB. This is the ideal treatment plan for SIB. Unfortunately, this isn’t always possible, and therapy as well as pain action plans are not able to reduce SIB in certain patients. In these situations parents can consider pharmacologic treatments such as risperidone, which is FDA-approved to treat irritability in patients with ASD. Studies on risperidone have demonstrated a significant improvement in symptoms compared to placebo. However, this intervention is not without side effects and requires regular blood testing as well as monitoring for increased weight gain. Risperidone is also not appropriate in young patients and is FDA approved for use in children 5-16 years old. This is why taking a holistic approach towards SIB is ideal.

What Can You Do For Your Child?

The first step is to discuss your child’s behavior with someone experienced in addressing SIB. The behavior should be evaluated in depth, and providers should work with parents on identifying possible triggers. If there are triggers for the SIB, then a plan should be developed to address these triggers. There should also be a plan developed to address the SIB that involves prevention and treatment during an episode. Pharmacologic options are available but should be managed by a medical professional familiar with monitoring for various adverse side effects. For more information about what may be best for your child feel free to set up a free consultation with one of our specialists.