Autism and Self Injury  
There is little research administered on children with autism and self injurious behaviors. However, in a
study on challenging behaviors in individuals with intellectual disabilities, self injury has been found to be
connected to both receptive and expressive communication. Among individuals with autism, incidence
estimates range from 20% to 71% depending, relatively, on the IQ and age range of the child. In young
children with autism (4-5 years old), the frequency rate of self injurious behavior may be as high as 52%,
based on parental reports. A number of studies have reported that individuals with autism who are also
mentally retarded have higher levels of self injury than individuals without mental retardation. In children
with autism, lower levels of expressive meaningful language and more severe levels of communication,
socialization and daily living skills domains are all associated with increased self injurious behaviors.

Studies on autism have concluded that characteristics of self injurious behaviors in children with autism and
individuals with developmental disabilities without autism to be notably similar. Self injurious behaviors can
be seen as a class of behaviors, often highly repetitive and frequent, that result in physical harm to the
individual displaying the behavior. Furthermore, such behaviors occur without an obvious purpose or
intentional self harm. It is important to distinguish between behaviors, such as suicide, that are associated
with deliberate wishes of self harm, and self injurious behavior found in individuals with developmental
disabilities, which may occur in connection with biological causes or are more a result of environmental
factors.

Intentionally self harming behaviors are also often referred to as self mutilation, self destructive, or
masochistic behaviors (gratification gained from physical pain). Self injurious behaviors are often placed on
a category of repetitive stereotypes, and have been proposed to only differ in severity at the moment of
injury. In fact, recent reviews of repetitive behaviors in autism place self injurious behavior within a wide
range. Self injurious behaviors can range from severe, life threatening injuries to less directly damaging cases.

Types of Self Injurious Behaviors

•        Head rubbing
•        Occasional impact with surface when rocking or head-banging.
•        Finger or arm sucking
•        Frequent arm biting or self-biting
•        Nail picking
•        Mouthing such as putting things in mouth or suck on an object.
•        Bringing up partially digested food and re-chews before swallowing or spitting out.
•        Thigh slapping
•        Poking external openings in the body like eyes, nostrils, mouth, and ears.
•        Stuffing external openings of the body.
•        Hair pulling
•        Self-scratching
•        Self-pinching
•        Ingestion of air
•        Ingestion of feces or playing with feces
•        Excessive fluid intake

Frequency and severity may vary in children with self injurious behaviors depending on individual
circumstances and environmental demands. Therefore, a behavior that may be considered stereotyped may
also appear as self injurious in a different situation. Social self injury seems to occur more often in a social
setting, is directly self aggressive, and associated with stereotyped behaviors and other behavior problems.


To date no study has compared self injury in individuals with autism across the lifespan. Although it’s
unpredictable, as the child matures in age certain fixations depending on adaptive behavior skills, settings,
symptoms of severity, and ability level self injurious behaviors may decrease.

Unpleasant Forms of Communication

Given the communication impairments that individuals with autism experience, it is not surprising that
another cause has been proposed that self injury is a display of an abnormal and impaired need to
communicate. Problematic behavior used as unpleasant forms of communication is developed to replace
their lack of socially acceptable forms of verbal and nonverbal communication. Challenging uncontrolled
verbal behavior is minor compared to serious self injuries.

Instead of just attempting to decrease the challenging behavior through direct punishment or prescription
treatment, attempts to teach socially appropriate forms of communication become crucial. Teaching
communicative positive ways for escaping punishment can replace the challenging verbal behaviors used as
a substitute for self injurious behaviors.

Causes and Theories of Self Injurious Behavior

There are numerous causes and theories trying to explain self injury in autism and mental retardation. While
most theories are a little more than untested assumptions, behavioral and neuro-chemical theories have been
researched and validated. It is important to mention that attempts to explain the cause of self injurious
behavior in autism has been strongly influenced by the helpful use of treatments. Determining whether a self
injury is replacing a form of communication depends on careful analysis of the individual and consequences
of the behavior. As well, the cause and persistence of the injury are seen more as provocation rather than
environmental possibilities.

Self-Stimulation Theory

The self-stimulation theory is often proposed as a trigger to self injury which seems to occur without
apparent environmental possibilities. In this case self injury is understood as being sustained by self induced
stimulation of the senses, and helps strengthen both sensory and social development. Case studies and
neuropsychological models have long supported the notion that individuals with autism are characterized by
a sensory impairment in adjustment, resulting in either under or oversensitivity to stimulation.

Self-injury as a form of self stimulation corresponds with the idea that repetitive, stereotyped movements (e.
g. body-rocking, hand-flapping, spinning etc.) provide under aroused individuals with stimulation. One study
shows that allowing individuals to replace the stimulating effects of self injury with more suitable behaviors
decreases the problem behaviors. The limited studies suggest that among children with mental retardation, a
diagnosis of autism is associated with a higher incidence of tantrums, aggression, and destruction of
property. Most case studies attribute violence to impairment in theory of mind (a lack of understanding and
inability to appreciate the victim’s point of view), although this interpretation is controversial.

Treatment for Self Injurious Behavior

Among the many methods available for treatment and education of people with autism, applied behavior
analysis (ABA) has become widely accepted as an effective treatment. Thirty years of research
demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing
communication, learning, and appropriate social. ABA therapy created as a behavioral intensive management
of one-on-one child-teacher interaction for 40 hours a week to help reinforce desirable behaviors and reduce
undesirable ones.

The U.S. Food and Drug Administration (FDA) approved a new use of one of the leading prescription
antipsychotic medications, Risperdal (risperidone), for the treatment of irritability associated with autistic
disorder, including symptoms of aggression, deliberate self-injury, temper tantrums, and quickly changing
moods, in children and adolescents aged 5 to 16 years. This is the first time the FDA has approved any
medication for use in children and adolescents with autism. The dosage of Risperdal should be individualized
for children and adolescents based on weight. The safety and effectiveness of Risperdal in pediatric patients
with autistic disorder less than 5 years of age have not been established.

The most effective treatment of self injurious behavior in autism is most often a combination of medication,
cognitive/behavioral therapy, and other treatment services as needed. Medication is often useful in the
management of aggression, and thoughts of self injury. Behavioral therapy helps individuals control and
decreases their injurious behaviors.
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