My autistic child is self harming and is only 4 years old. He mostly slaps his face and bangs his head against the floor. What can I do to help my child? I’m not sure how to stop him.

Below are some simple benign interventions that I would use in order to make sure that the child is safe. These interventions are not a replacement for behavioural services (ABA) concentrating in the area of a functional assessment in order to determine those variables that influence the occurrence of the problem behaviour.

It’s all about safe and calm interventions.

Self injurious behaviour in the form of headbanging is very severe, therefore we need to come up with an action plan with or without ABA services. If he is manageable to a certain degree, I would hold him standing up and not let him get to the floor. If he is difficult to manage and I am in the home I would put him couch with soft pillow and deny him access off the couch until the headbanging and all problem behaviours were absent for a period of one minute and I had some compliance (simple one step commands that he would follow before I would let him off the couch). Next, direct him to a neutral activity (something that he does but he doesn’t find a lot of pleasure in doing) and praise him for engaging in the activity.

While doing this procedure, try to maintain a straight face and use as minimal communication as possible. I would try to control the environment and be proactive in trying to keep him from hurting himself.

What about when this happens while we are out?

If I was out and about what would I do to control his SIB. I would make sure that there would be two people when going on outings with him to make sure that you would be able to physically control the child to ensure he would not hurt himself. Possibly one adult holding one hand above the wrist and the other adult holding the other hand above the wrist and just begin walking forward and seeing if the child responds. If he complies, praise him for walking with you and continue with your daily routines.

I would also make sure that I would be able to transport him easily back home where I could manage the problem behaviour in a more controlled environment.

How can I protect my child from these outbursts?

In the past, for headbanging, I have used thick exercise mats in the corner of the child’s room so that the child would not be able to hurt himself and specialize helmets. However, this was mainly for adults. These are simple reactive strategies, however, if I  cannot gather more information about the child the strategies may not be effective and may actually strengthen their occurrence of the problem behaviour. The fact that he engages in the SIB (headbanging) I would also need to know if he engages in other problem behaviours to better detail and effective plan for the reduction of the SIB. If the strategies are not successful, please write to me again and I will try to guide you to a more structured plan for your child.

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