How can I stop ds hurting himself?

[macwoozy]

Can anyone offer any ideas as to how I can stop my ds (AS) hitting himself. It is now an everyday occurrence and he really hits his head hard. He does it when he's angry or frustrated.

I've tried ignoring it but that hasn't made any difference, I've threatened him with the removal of priviledges (but haven't done so yet as I don't know if punishment is the way to go).

He started banging his head against the table last night, I tried not to react but it's such a difficult thing to do.

Dp reckons he has now formed some kind of habit and I just don't know how to break it, any ideas how I can stop this?

Incidentally he has such a low pain threshold that I'm shocked that he keeps causing himself so much physical pain. I know he's unhappy at school but other than home educating him there's nothing I can do to help him.

Is there something else you can give him to distract him and vent his frustrations on? for example, my ds loves stomping over bubble wrap or sitting popping it. I also find that food or drink is the easiest way to distract ds when he is wound up.

I agree that I don't think punishments are goign to help, it will jsut make him more frustrated.

Thanks chopstheduck for advice, Ds loves bubblewrap too.

But the problem is, when ds is angry, my god he is angry, and nothing will distract him. He doesn't hit himself for long but it's how hard he hits himself that's worrying.

I hope you get some better advice!

ds is heading that way, has started slapping himself across the face when upset. He also has a v high pain threshold.

I've read that it can be a method of blocking out thoughts or other stimulation that is unwanted.

Does he have an OT? I wonder if it is worth asking them, as it is a kind of sensory thing.

Hi, i met a lady on a course (for AS) and her little boy had anger problems she found that running helped at home and at school, if he got angry she would send him for a run around the garden (luckily they have a large garden) or the teacher would send him to the top of the playing field and back.

My step son (possible AS or ADHD) used to hurt himself, he was at his worst in the last 2 years of primary school, he hit his head on a brick wall and went through a stage of pulling his hair out. This stopped once he got to high school and has never returned (he's 16 now).

Ds used to head butt the floor or wall, its out frustration of not being able to communicate. Obviously the long term solution is to try and help him communicate better (easier said than done!)

The quick fix solution was to physically try and stop him, i would stand between him and the wall or pick him up until he had calmed down(mind you he was about 3 at the time)How old is your ds?

There is a theory about a biochemical called endorphins, called happy hormones, which is released into the body by repeated self harm.

Thanks for the replies

I hadn't considered asking his OT about this, I just presumed that ds punching his head when angry was similar to young men who punch a door/wall out of rage.

Running is also something I hadn't thought about although our home and garden is tiny, we can barely swing a cat. I could always get him to run up and down the pavement but I just don't think he'd even agree to doing it in the first place, and when he's angry he just erupts.

He's 9 years old. I have wondered whether I should physically stop him from doing it, but I'm concerned that if I make a big deal out of it, it could encourage him to do it even more, I just don't know.

At 9 years old i imagine he is a bit big to be picked up then!

I suppose it depends on how much physical damage he causes to himself. I can remember everyone telling me to ignore it and that 'kids are not silly, they wont actually hurt themselves'. Ds would head butt repeatedly until he was badly bruised or bleeding.

There is also the proprioceptive sense, which OT explained to me was the input from the muscles and joints about body position, weight, pressure, stretch, movement. Although ds doesnt head butt anymore, he often runs and crashes into things, a sensory seeking thing.

I think if you are going to physically stop him you need an alternative to offer him at the same time. Maybe physically refrain him from headbutting the table, but let him headbutt a large pillow instead, or run around? I'd be a bit worried about trying to refrain him personally. My ds HATES being physically restrained, and jsut bolts as soon as I let go.

My ds does the running into things as well, I had no idea it was a sensory seeking thing!

Oh yeh, I recall the OT also talking about body position, pressure, joints etc. Ds also crashes in to things but I'm not so sure its sensory seeking with my ds because he howls with the slightest pain! (I think it's more to do with spatial awareness difficulties)

That's why I just can't understand how he puts up with the pain when hurting himself deliberately.

I will offer him a pillow, I know that's drawing attention to it, but I just can't ignore.

Macwoozy - Ds also has a very low pain threshold, the slightest graze and he thinks he will bleed to death! I also found it very conflicting that he cant stand to be touched, but yet would hug people.

OT explained to this to me as its about being in control, he controls the pain he inflicts upon himself by self harming or crashing into things. Falling over and grazing a knee, he has no control over.

Although as you quite rightly said in some cases if could possibly have something to do with spatial awareness. In ds's case i think its more to do with his proprioceptive sense, as he isnt clumsy, in fact he is quite agile, like a little monkey!

bloody complicated business isnt it

Far more complicated for my little brain to cope with!!

That's interesting when you say about controlling the level of pain, ds will over react to any slight pain if he's not expecting it, like he will bump into the table and hurt himself and will react OTT, but yet will hurt himself purposely far more and not react. Maybe he is aware of how much it will hurt and with the pain being expected he is able to deal with it. Hmmm...I will think about this.

Macwoozy, you have hit the nail on the head, its all about expected and unexpected, control and no control, predictable and unpredictable.

If you control you now exactly what will happen next, there is no unexpected or unpredictable, this is why AS kids are notorious bossy boots and like everything done their way!

According to so-called experts SIB is highly connected to communication (I have been to many conferences, talks, presentations etc on the subject over the years!). Even if he is verbal, does he have a way to easily express some sudden and/or overwhelming feelings? He may need to be rehearsed through phrases to use or visual strategies. Apart from that, other ideas on here are really good too. Physical exercise will help, can you get a small trampoline? Trampolining is the biggest reducer of anxiety according to one expert I saw? Sensory issues also seem to be a factor as already suggested. I have a friend who wraps her son up in a big duvet if he gets anxious, although I'm not sure this would be possible in your situation. The OT-related stuff sounds worth exploring although I don't know much about that and the whole issue of being able to predict events. Is it at transition times? DS is terrible with transitions, i.e. arriving or leaving somewhere, starting or finishing something, although he is otherwise very adaptable to change and not routine bound. That would be a case of trying to let him know what is happening next, what he is doing next or eating next etc (mind you, I am terrible at this scheduling stuff). The endorphin theory, as I understand it, is that people with ASD have a higher level of endorphins in the brain and therefore (usually) have higher pain threshhold so will tolerate more pain than typically, AND they enjoy the sensation caused by endorphins so cause pain to create more. Not sure how scientifically sound that is but I did hear it from one of the "experts" I've seen but it was quite some years ago so may have been proved or disproved since. HTH.

We have this with dd1, one suggestion we had was talk to dd1 about this and agree a plan. we have the plan that if she starts to feel angry that she might hurt herself she should take 2 slow beaths and find her Pig (obbessive toys atm). Its yet to work, but we will keep trying
HTH

Just giving you our experience. We have had this with DS for years and ignoring it is not an option as heavy and/or repeated blows to the head can do damage.

This type of SIB is one of the hardest challenging behaviours as if there is an attention/support seeking component, the behaviour still cant be ignored when its at a level that its risking damage to the child. (other SIB behaviours that were not very harmful were eradicated through ignoring)

Best way, so far, to deal with it in the meantime is to insert a hand or object (eg piece of dense foam) between his head and the table/wall etc. BUT this is done without talking, making eye contact or otherwise increasing attention in any way IYSWIM. This has worked well for us.

We combine this with prioritising trying to reduce the things that drive the behaviour -

-Sensory integration from OT helped, after a proper weekly program of input was in place.

-We are working hard on communication, and as that increases it definately helps as Davros says, but progress there obviously slow.

-Identifying and reducing sources of anxiety, especially in school day, helped.

I have found it very useful to keep a brief journal of each day, detail the incidents of SIB, what happened before and after (helps to identify any consequences of the behaviour you may not have noticed, in case the behaviour is being unintentionally reinforced). I noticed triggers I,d missed and got better at preventing DS getting wound up in the first place

Do you have access to a Clinical Psycholgist at the moment? This is very much their area. The sooner you can get on top of it the better chance you have of preventing it becoming a set habit. Most clinical psychologists would recognise the referral was urgent if it specifies that your child is hitting his head, with force, against hard objects

Very interesting thread.
I had the same trouble understanding why my ds puts up with wrapping elastic bands or any bits of string as tight as he can around his hands and arms to the point that it must hurt or go crashing into things as well.
Yet he is so OTT with pain generally, scream blue murder for a tiny graze, yells and cries 'it hurts' when i cut his nails....

Can't help with original question sorry, but i hope you can find a way to help your ds, it must be hard to see and try to ignore it...

Do you have DAN! dr's in the UK? Sometimes this type of stimming responds well to things like B12 injections or getting an overload of yeast out of the system. A DAN! dr has training in this type of thing. I also have a patient who decreased the incidence of hitting himself after we started vision therapy. This type of stimming can come from visual-spatial disorientation and a need for proprioceptive input to know where one is in space. You would need a behavioral/developmental optometrist to evaluate that.

Dear...must be tired. posted last phrase all wrong, didn't mean to say that the behaviour should be ignored, but the opposite.

Thanks for all the responses. I haven't been on here for a few days as ds has suspected swine flu, he got angry last night and went to hit his head then realised what a bad idea that was when already suffering with a headache!

I don't believe it's a form of stimming, as it is only when he is angry or very upset, but I do believe that if he could express his feelings better then he might not be so quick to hurt himself, it's the way he responds to anything that angers him, there doesn't seem to be any pattern.

I will re-read later everyone's suggestions as to how to help,(only had time to skim through with ds not being well). Thanks for all your help, I appreciate it

Macwoozy - Just had a thought i received some info from the NAS about managing anxiety for ds, i dont see why it couldnt be adapted to managing anger.

Understanding anxiety

Emotions are abstract. To understand emotion you need an imagination. One of the areas of difficulty for people with an ASD is not being to imagine things so understanding emotions can be difficult for them. People with high-functioning autism may understand some emotions and recognise the feelings that are associated with them. By helping someone to understand anxiety, you can help them to manage it better.

Strategies for managing anxiety

Once someone understands anxiety and has identified the things and situations that make them anxious, they can then take steps to cope with the anxiety. If you are looking after someone with an ASD, try and be aware of what makes them anxious and how best to help them manage certain behaviours.

Keep a diary

To help someone with an ASD understand anxiety, get them to understand the symptoms they display when they are anxious and to look at the causes of their anxiety. Keeping a diary in which they write about certain situations and how these make them feel may help them to understand their anxiety and manage it better.

Use the diary also to think about the physical changes linked to anxiety. Someone with an ASD often retreats into their particular interest if they are anxious about something ? use the diary to monitor this as well:

Time and date Situation How I felt at the time On a scale of one to ten, how anxious did I feel?

Meltdown prevention plan

Create an ?anxiety plan? when someone with an ASD is feeling positive about things. An anxiety plan is a list of things and situations that cause anxiety as well as solutions and strategies they can use to help them manage their anxiety levels. The plan can be adapted, depending upon how well someone understands anxiety:

Situation going on the bus, Symptoms of anxiety Hearts beats fast; sweat and feel sick. Solution Have stress ball in pocket.
Squeeze the ball and take deep breaths.
Listen to music.

Relaxation techniques

Someone with an ASD can find it very difficult to relax. Some people with an ASD have a particular interest or activity they like to do because it helps them relax. If they use these to relax, it may help to build them into their daily routine. However, this interest or activity can itself be the source of behavioural difficulties at times, especially if they?re unable to follow their interest or do the activity at a particular moment.
Some people may need to be left alone for short periods of the day to help them unwind.

Physical activity can also often help to manage anxiety and release tension. Using deep breathing exercises to relax can be helpful as can activities such as yoga and Pilates, which both focus on breathing to relax. Use a visual timetable or write a list to help remind the person when they need to practice relaxation.

Any other activities that are pleasant and calming ? such as taking a bath, listening to relaxing music, aromatherapy, playing on a computer ? may also help reduce anxiety. Some people may find lights particularly soothing, especially those of a repetitive nature, such as spinning lights or bubble tubes.

You may need to encourage adults who are less able to take part in these activities so that they can enjoy their benefits. You can do this by explaining when and where they will do the activity and what it will involve. You may have to go along with the person at first and do short periods of activity to begin with.

Talking about anxiety

Some people with an ASD find direct confrontation difficult. They may therefore be unable to say they don?t like certain things or situations, which will raise their anxiety levels. If they identify they are anxious, they could use a card system to let family or friends around them know how they are feeling. At first, you may need to tell them when to use the card and prompt them to use it when they do become anxious.

They could also carry a card around with them to remind themselves of what they need to do if they start getting anxious. You could also give them a ?stress scale? that they can use whenever they find something particularly stressful.

Hope some of it, might give you some ideas.

claw3 thank you for showing me all that info, anxiety is a big feature in his life.

With all the responses I've recieved on this, it encourages me to ask another question!!

My ds (AS) constantly says I'm evil, I accept he is angry with me as I take him to school, he hates it and I'm the one sending him there every morning, so I'm presuming I'm the evil one with regards to school.(I hope thats it anyway)

But lately he has been saying constantly- 'I'm going to kill myself', ds fears everything, I can't imagine for one moment that he would take any risks, but he says it so often now that it worries me. Should I take this seriously or is it the very sad part of aspergers?

Hi Macwoozy

It does sound like he is an anxious wee man. A stress ball might help - my ds2 hits himself and picks the skins on his fingers.

My gut feeling, given that he's 9 and the demands and expectations are greater on him in school, would be to go down the psychology route, particularly if he is verbalising that he is going to kill himself. He may not truly understand what he is really saying but it does perhaps put into perspective how things are for him atm.

Let us know what you decide and how you get on x

not sure if this will be helpful, but google 'retained reflexes' and see if any of the things mentioned are applicable to your son.

we found sensory trained OT and have been doing various exercises over last 6 months which have helped 10 yr old with aspergers. he seems happier, far less frustrated.

Just had another idea, look at www.challengingbehaviour.org.uk
They have an information sheet and a DVD on Self Injurious Behaviour.

Hi Macwoozy
I have ordered one of these here
for ds to take his anger out on, hug, jump on, kill, make friends with etc
It hasnt arrived yet so we shall see - ours will be a large one

My ds is 8 with AS