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Study into self-injurious behaviour in children with autism

In this article Phil Evans, Ask autism consultant for the National Autistic Society, writes about a study into self-injurious behaviour in children with autism. The study looked into possible triggers including pre-existing physical pain, and possible interventions.

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A study reveals half of all children with Autism Spectrum Conditions are self-injuring themselves

Almost 50% of all children with Autism Spectrum Conditions (ASC's) are showing signs of self-injury as compared with up to 10% of children with a wide range of intellectual disabilities are showing signs of self-injurious behaviour, a study by Professor Chris Oliver has revealed.

Working with Dr Debbie Allen, Effie Pearson, Dr Caroline Richards and Daisy Twigger as his team of post-doctoral research fellows, Professor Oliver, a Professor of Neurodevelopmental Disorders at the University of Birmingham and the Director of the Cerebra Centre for Neurodevelopmental Disorders has conducted research to establish the extent of how widespread self-injurious behaviour is in young people on the autism spectrum.

Professor Oliver and his team believe “self-injurious behaviour can have a serious impact on a person’s quality of life” and by conducting a study that works with children “because self-injurious behaviour tends to emerge during the childhood years”, “we are in a better position to create effective and appropriate interventions that reduce self-injury”.

Supported by The National Autistic Society, the study also found 49% of 216 adults with ASC engaged in self-injurious behaviour. A second study showed approximately 80% of children with ASC continued to self-injure over a three-year period, suggesting the behaviour can persist into adulthood if it isn’t worked with.

Effects of self-harm and self-injury

“Self-injurious behaviours may be precipitated by frustration during unsuccessful communication attempts, transitions, anxiety in new environments, boredom, depression, fatigue, sleep deprivation or pain”1.

“The presence of self-injurious behaviours, aggression, and other extreme behaviours may prevent the child from participating in integrated activities in the community with typically developing peers and cause significant family stress”1.

Prior to conducting a study that revealed the extent of how many children with ASC are harming themselves, Professor Oliver and his team knew “self-injurious behaviour is more likely when individuals have a greater degree of intellectual disability”. They believed this would equate to a higher level of self-injury in people with ASC who are “less able to care for themselves, communicate or learn new skills”.

The team’s thoughts were backed up in their findings as they found “self-injury occurs in up to 25% of more able individuals with ASC”. They found “individuals with physical health problems are up to two and a half times more likely to show self-injury” and that “when people with ASC are more impulsive and struggle to stop their own behaviours once they get going, they are also more likely to show self-injury”.

In children who live with low-functioning forms of ASC, a related study is currently taking place to look at a relationship between factors that influence self-injury and being non-verbal. The team believe “pain and discomfort may be contributing to the presence of self-injury in these children through undertreated or unknown health conditions” and hope if they can develop knowledge and understanding, it will “help with the development of early screening for self-injury and early intervention strategies to help prevent severe self-injury”.

Along with support from The National Autistic Society, the team has achieved linking between self-injurious behaviour and physical pain as they’ve noticed self-injury can often reduce when problems such as middle ear infections, gastroesophageal reflux disease and dental issues are managed.

Connor’s story

Professor Oliver and his team have worked with a number of children with ASC. One particular example of success they experienced through their research came with Connor, a 13-year-old who has had his name changed in this feature for anonymity.

Connor would resort to self-injury whilst at secondary school. As a non-verbal child who felt discomfort when having to cross a threshold, he would stop where two different types of flooring materials joined or if lines or shadows were visible on carpet. Two members of staff at the school, Martha and Abbie, helped him to deal with his anxiety that manifested in self-injurious behaviour by guiding him across thresholds while offering intense social attention and reward as transitions were successfully made.

Initially, the intervention proved successful. Regular occurrences of head and face slapping as forms of self-injury decreased but then begun to increase again. A transition between the lunch hall and playground could take between 30 and 40 minutes to complete.

Before Professor Oliver’s team could intervene and offer assistance to Martha and Abbie, they asked them to monitor Connor’s behaviour for two weeks. The team then identified high and low-risk times for self-injury that were noticeably around a transition from the hall to the playground.

The team noted “Martha constantly interacted with Connor and often engaged in ‘high five’ type games to reinforce good eating behaviour”. A handover would then take place from Martha to Abbie but Professor Oliver’s team noticed Connor didn’t respond entirely positively to change.

The team saw “a physical tussle” took place as Connor preferred to hold the hands of both members of staff at the same time. A further amendment was then made where Abbie would arrive five minutes earlier and as a result, Martha would no longer assist in transition. The handover eliminated stress for the staff and Connor.

Conclusion

Through working with Connor and conducting a study on self-harm and self-injurious behaviour, the team believe children with ASC can be helped. They feel there are no instant results but feel intervention “can certainly help to reduce or prevent self-injury”.

They feel Connor’s example confirms “the frequency and severity of behaviour often gets worse before it improves”, “the most effective interventions typically including teaching a more socially appropriate functionally equivalent behaviour to replace self-injurious behaviour” and that success “usually involves an element of staff and/or parent training in order to deliver interventions consistently”.

Appendices

1. The American Academy of Paediatrics, 2007. Identification and Rvaluation of Children with Autism Spectrum Disorders.

Author: Phil Evans

Date added: 18 December 2014