Autism Research Institute

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Understanding and Treating Self-Injurious Behavior

This website is designed to assist professionals and parents in identifying treatments that may reduce or eliminate self-injurious behaviors (SIB) in clients or children.

SIB is one of the most devastating behaviors exhibited by individuals on the autism spectrum. Examples of these behaviors include head- and ear-banging, eye-gouging, hand-biting, and excessive scratching and rubbing. These behaviors are associated with redness, bruises, open wounds, and/or bone fractures. Note: Tic-like and stereotypic behaviors (e.g., repetitive motor behaviors such as rocking and flapping) tyically do not lead to injury and are not addressed on this website.

Research has documented numerous reasons for SIB (see Durand, 1990; Edelson, 2020; Edelson & Johnson, 2016; Handen et al., 2018; Laverty et al. 2020). There are many effective interventions, and the selection of appropriate interventions often depends on identifying the underlying causes of the behaviors.

Responses to the questions below may provide insight into one or more possible reasons why an individual engages in SIB. Links to published studies on causes as well as appropriate interventions are also provided. Most of these articles will include references to related articles.

Notes:

1. It is recommended that a thorough medical assessment be conducted first to rule out SIB as a coping mechanism to deal with discomfort or pain, such as migraine headaches and irritable bowel syndrome (IBS). A functional behavior assessment at the same time or soon after is also recommended to reveal possible cause(s) as well as the context of the behavior (e.g., antecedents, consequences, surroundings).

2. In a few instances, possible reasons for SIB listed on this website are based primarily on reports by experienced clinicians, rather than on research. When trying to understand the reason(s) for such devastating behaviors, it is important to include all information as possible.

3. Medical interventions are sometimes prescribed to treat SIB. Since it is important to consult with a medical provider regarding drug treatments, such interventions are not discussed in this website. You can learn more about them from the following published review reports:

Please read the disclaimer notice prior to completing the questionnaire.

Stephen M. Edelson, Ph.D.
Executive Director
Autism Research Institute

Did you read and do you agree to the statements in the disclaimer notice?

Yes
No

Behavior directed toward a specific area of the body

1. Does the individual hit or bang his/her head and/or ears?

2. Does the individual hit or slap the face area and/or nose?

3. Does the individual press, rub, or poke his/her eye(s)?

4. Does the individual pull out his/her hair?

5. Does the individual hit or bang his/her mouth or chin?

6. Does the individual excessively scratch, pinch, or rub his/her skin on anywhere on the body?

Possible physiological reasons

7. Does the individual suffer from seizures?

8. Does the individual have limbic encephalitis or herpes simplex encephalitis?

9. Does SIB worsen after suffering from a viral syndrome?

10. Does the individual suffer from asthma, allergies (e.g., rhinitis, food allergy), and/or sinusitis?

11. Does the individual suffer from celiac or Crohn's disease, or from gastrointestinal problems,
such as bloating, constipation, diarrhea, flatulence (gas), foul smelling stools, reflux (GERD), and/or unhealthy looking-stools?

12. Does the individual engage in excessive air swallowing or aerophagia?

13. Does the individual have one or more food allergies or intolerances?

14. Is the individual a picky eater?

15. Does the individual appear to receive pleasure from the SIB and/or is the individual insensitive to pain, such as not feeling the SIB?

16. Does the SIB appear to be related to sensory issues (e.g., avoidance, calming, craving)?

17. Does the SIB often occur under anxiety and/or stress? (Examples: humming, acting "antsy,"
repeating/perseverating on words/phrases, breathing rapidly, sweating, trembling, pacing or
acting more active, agitated, and/or irritable)

18. Does the individual have sleep problems?

19. Does the SIB occur mostly prior to or during menstrual cycling?

Possible communication/social reasons

20. After the individual engages in SIB, do you try to comfort him/her? Or after the individual engages in SIB, do you tell him to stop or say something to him/her to get him/her to stop the behavior? Or does this behavior occur when you are talking to other people?

21. After the individual engages in SIB, does he/she receive some thing (such as food, toy or object) or some activity (such as watching TV or playing on the IPad or computer? Or does the SIB occur when an object or activity is taken away from him/her?

22. Could the SIB be interpreted as a form of communication to get his/her needs and wants met? (e.g., "I want to leave" or "Leave me alone")

23. After the individual engages in SIB, does he get to stop doing a task or activity? Or does the SIB stop occurring shortly after you stop working or making demands on him/her? Or does the SIB occur following a demand to perform a task?