WHY IS MY CHILD ENGAGING IN SELF-INJURY?

By Fady Beshara, MSc, BCBA

MANY CHILDREN WITH AUTISM ENGAGE IN SELF-INJURIOUS BEHAVIORS (SIBS). AS A PARENT, YOU MIGHT SEE THIS AND IMMEDIATELY REACT, WHICH MAY BE THE RIGHT DECISION AT THE TIME. HOWEVER, IT IS CRUCIAL AS A PARENT TO UNDERSTAND WHY YOUR CHILD IS ENGAGING IN THIS DANGEROUS BEHAVIOR. THIS ARTICLE WILL EXPLORE THE FOUR DIFFERENT FUNCTIONS OF BEHAVIOR RELATED TO SIBS AND DISCUSS THE IMPORTANCE OF A TREATMENT PLAN DEVELOPED BY A BOARD-CERTIFIED BEHAVIOR ANALYST (BCBA).

The first function we will explore is attention. As humans, we have an intrinsic need for attention; a child with autism is no different. An attention-maintained behavior is one that is dependent on another individual. For example, Jesse begins to bite his arm. Mom runs at him and starts to hug him while also asking if he’s okay. In this situation, Jesse learned if he bites himself, he will receive attention from his mom. Each time he wants attention, he may now begin to bite his arm. Each time Mom runs to him, it increases the likelihood he will do it again.

The second function is escape. Behaviors can be maintained by escape from demands, situations, activities, environments, etc. For example, Mom asks Jesse to put his cars away, so he begins to bite his arm. Mom responds right away and says, “It’s okay, you can play for a few more minutes.” As you can see in this example, Mom gave Jesse what he wanted: escape from the demand she placed (putting away his cars). Once again, each time Mom lets Jesse escape, he is more likely to bite his hand to do so.

The third function is access. Behaviors can be maintained by wanting to access things such as items, actions, activities, etc. For example, Jesse is sitting in the kitchen, and he starts to bite his arm. Mom once again runs to him and gives him a bar of chocolate. In this situation, Jesse is learning if he bites his arm, he will get what he wants.

Finally, the fourth function is automatic reinforcement. Behaviors can be maintained internally. Meaning, the behavior itself serves as its own reinforcer as it is internally rewarding.

Jesse bites his arm because it feels good to him. These behaviors can be the most challenging to identify as they are happening with no clear indication. One characteristic of this function is that it seems to occur at any time and maybe even at all times. Behaviors maintained by an automatic function (the feeling of biting his arm) are often the most dangerous as they can increase rapidly due to how quickly the reinforcement is delivered.

Now we understand the function; let’s explore the steps you need to take to decrease and eliminate this behavior before the child gets hurt. The answer to this might be surprising, but don’t change anything you are doing until you contact a BCBA. This is important as it makes sure the BCBA can address the SIB function as it was established. However, you can help the BCBA by being prepared with some important information and data they may need. Prepare for the BCBA some antecedent, behavior, and consequence data (ABC data).

ABC data is composed of what was happening before the behavior began (antecedent), what the behavior looks like (behavior), and what happened after the behavior occurred (consequence). It is important to note each section has specific information the BCBA will need to understand the behavior. For an antecedent, you want to include where and what the child was doing, who was there, and what were the others around them were doing. For example, at 3:30 pm, Jesse was sitting in front of the television in the living room on the main floor, watching Dora The Explorer. Mom was in the kitchen, cooking his favorite meal, lasagna. When describing the behavior, we must identify what the behavior looked like, where the SIB was, how long (if you have this information), and the observable intensity. For example, Jesse bit the middle top of his left palm with force, leading to teeth marks. No blood was drawn. The consequence must include what the individuals in the environment did and what happened to the environment (if anything). In this case, Mom ran over to Jesse with a food table and his lasagna, then set it up in front of the television.

As you can see, taking ABC data can yield a lot of valuable information. Jesse was watching TV while his mom was cooking his favorite meal. The moment he bit himself, she gave him food. Based on what we learned about functions, this seems like access. However, by collecting multiple days’ worth of data, the BCBA might find that the behavior has multiple functions or that it is happening all the time.

What is important to remember is that being prepared for the BCBA can help them speed up the process. This does not mean they will not need to do their own assessments; this simply means they have more information to help them create a treatment plan. Also, keep an open mind. Even if you think it may be a specific function, the BCBA might find something different. Ask them why and how they got to those results. This will allow you and the BCBA to get on the same page and express all your worries and concerns.

REFERENCES

Cipani, E., & Schock, K. M. (2011). Functional behavioral assessment, diagnosis, and treatment: A complete system for education and mental health settings. New York, NY: Springer Publishing Company, LLC.

Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.). Upper Saddle River, NJ: Pearson.

Fady Beshara, MSc, BCBA, is the co-founder and Chief Clinical Officer of Endless Abilities, Inc. He is a passionate behavior therapist with experience working with children and youth with autism and other developmental disabilities. He received his master’s degree in Applied Behavior Analysis and Autism from The Sage Colleges. Fady currently works on developing programs to increase various skills for children with autism. In addition, he specializes in working on aggressive and self-injurious behaviors. Fady has spent his career working in many different environments, such as homes, centers, group homes, schools, and hospitals. His passion for working in this field has developed into a mission: ensuring all children with developmental disabilities receive the best treatment possible. Fady supports a collaborative approach. He believes it is important to work with all individuals involved in the child’s life, including parents, siblings, teachers, childcare workers, and beyond.