Self-harm

[daisy5678]

J is senlf-harming a lot at the moment. It doesn't seem to be linked with anything particularly stressful as school is going OK, but it has 2 forms: 1) to get my attention, when he will follow me and say 'look, I'm biting myself and 2) when he is out-of-control and it's not for show, iyswim.

Getting conflicting advice from 2 different professionals who are both expert in autism and in J, as they know him well. One is saying ignore and the other is saying distract and intervene.

What has worked best for you?

self

Morning, ds self harms, he pulls out his eyelashes and scratches and picks the skin off of his face.

I have been told it could be a sensory seeking thing or lack of sensory input or anxiety. Either way it seems to become a 'habit' that you have to break.

OT/CAMHS have told me to ignore and distract. So you do both if that makes sense.

For example everytime i see him pulling his eyelashes or picking, we do 10 star jumps or push the wall over (this can be every 2 minutes). If it gets really frequent I give him a hand held PSP or play ps2 with him for as long as possible.

OT has also given me a 10 minute exercise program to do with him twice a day (which involves lots of sensory input)

He is also having weekly session with CAMHS to try and get him to 'open up' about his worries.

Thanks guys. Both of your messages make a lot of sense and I will talk to his OT and psych too.

I know this isn't necessarily helpful, but please don't call it Self Harm unless it really is. ASD is more associated with Self Injurious Behaviour, Self Harm is related to mental health problems. They are not the same thing and it might make a difference with professionals which expressions you use, although they should know the difference of course. People with ASD do Self Harm of course, but it is usually if they develop Mental Health problems.

Davros, I have found the problem is even professionals have difficulties identifying the 'root' of the problem.

It is often a way of coping with feelings and distress. Someone may harm themselves because they feel overwhelmed and don't know how else to deal with things.

or it may be caused by not enough or too much sensory input.

or a combination of the two.

They appear to have reached the term self injurious in ASD, because it is so difficult to find the exact cause.

With ds he seems to injury himself when he feels anxious. Would this be self-harm or self injurious?

I used to call it a nervous tic and professionals were just not interested. Then ds ended up in hospital on IV antibiotics to prevent septicemia and almost had to have a finger amputated. The minute i mentioned self-harm professionals were tripping over themselves to help him.

Personally whether you call it self harm or self injurious, is unimportant. Call it whatever will get you some help.

Hmm just an aside, ds licks and chews his hands ands wrists (and chews/sucks his cloths). The school paed (who seems very knowledgable about ASD/ADHD/LD combinations) says this is a compulsion ie ticks. I stop it and where possible redirect it. I tolerate/ignore non injurous 'ticks' (well except the undies one!). He chews more when anxious or uncertain, but often it looks very defiant in that he looks at me very directly. I was shocked at the tick suggestion but actually it makes sense.

It does tend to vary depending on which professional you speak to.

For example from an OT point of view they feel it is caused by seeking sensory input or having too much sensory input and trying to block out sensory input.

From an ASD specialist's point of view is caused by anxiety and its used as a way of coping or comfort.

From CAHMS point of view is caused by anxiety and not being able to express yourself.

Like so many other things with ASD, the exact cause is unknown. I have given up with the 'why' and im focussing on the 'what are you going to do about it'. Using the word 'self harm' is very alarmist and dramatic, but as always you have shout and alarm to make yourself heard.

I have tried a lot of different methods over the years for my ASD boy's self-harming, and different things have worked at different times. At one stage, when his head-banging was clearly just attention-seeking, I would put him out in the hallway, shut the living room door and say calmly "do your banging head out there". It stopped amazingly quickly when there was no audience. At other stages though, when I think the headbanging has been more about just an expression of sheer rage, I have gone absolutely angry at him - "how dare you headbang, do you want a hairwash" and acted like he has committed an immortal sin. That also worked for a while, as he was shocked into stopping it by the hugeness of my reaction iyswim. It has gone in phases and I know the behavioural wisdom is that you should always ignore attention-seeking, but I find that doesn't always work. The one where I have gone nuclear at him is when he starts flailing about and headbanging in the car (dangerous for all). I have been known to stop the car and scream in his face with all the fires of hell for that one, but I make no apologies as he HAS to know that is a complete no-no. Don't know if any of this rambling helps, but he's not headbanging at the moment (touch wood) so I think some combination of these tactics has worked. Good luck!

I would personally call it self-harm and link it to mental health problems when accompanied by statements proclaiming his wish to die and repeated requests for knives so that he can kill himself. Also, it apparently makes him feel better. I don't see how this is any different from 'self-harming' as I understand it and certainly my sister, who has mental health problems (BPD and depression) as well as Aspergers, and who has self-harmed for years, calls what J does self-harm.

I see it as a description of what he is doing - harming himself deliberately - I didn't know there was some political dimension to this

Am going to keep a diary of triggers etc and come back to this.

Giveme, its very distressing and upsetting for all concerned, i hope you manage to find something that helps.

is there any medicine he is taking that may be causing these feelings? I think you may have mentioned in the past that J takes strattera. There have been reports of side effects
www.msnbc.msn.com/id/9529101/

Its not a political thing or a PC terminology thing. There is a technical difference, as I've been told on the many Challenging Behaviour sessions I've attended (lucky me!). But its hard to define for a non-professional. Its just that it could make a difference to the way it is treated/responded to and whether that is appropriate, e.g. you might get someone suggesting medication before using other approaches, not that medication isn't necessarily the right choice, it just may be there are more other things to try first iyswim. But I'm sure many professionals don't know the difference, its just that Self Harm may well be much more associated with mental health problems rather than sensory etc. I'm really not meaning to lecture, honestly! I just think its worth being aware of.

DS1 sometimes bits himself or, more often, picks at his skin until he bleeds. I use a combination of ignoring and re-directing, to be honest. I don't make a big deal out of it, but, since stress is his usual trigger, I try (not always successfully) to keep his hands occupied. If he has picked himself raw and keeps going at it, regardless, I tell him that if he keeps on making himself bleed I'll have to use the elastoplast spray on him. That works wonders, since he hates the stuff!