Dear Families,

Self-Injurious Behaviors, or aggression towards oneself, can be one of the most devastating and exhausting parts of caring for a neurodivergent child- especially those with more significant delays and support needs. You may often feel that no one else can understand- the sleepless nights, the injuries to parents/caregivers and siblings, the necessary safety equipment required, and endless trials of medications and supplements.

This month, The Neuropsychlopedia is focusing on helping families better understand self-injurious behaviors, what they are, why they are difficult to extinguish, and how to support both children and their families when a child is engaging in SIBs. What we are leaning about the differences in how some children’s brains respond to sensory input, the extreme frustration of communication barriers, and the struggling to be “heard” and validated has helped us to understand, even when it cannot be communicated verbally. Moreover, there are new technologies, nutritional supplements, and psychotic therapies and interventions coming down the pipeline.

Please know that if your family is navigating this, you are not alone, and while incredibly challenging and exhausting, there may be more resources and supports available then you may be aware of. As always, my hope is that this month’s resources offer you the clarity and compassion needed to advocate for your child’s needs.

Warmly,
Rebecca A. Fontanetta, PsyD, ABPdN
Board-Certified Pediatric Neuropsychologist
Founder, The Neuropsychlopedia

Why Does My Child Hurt Themself?

What do we think the reasons are behind self-injurious behaviors?

Well, it’s hard to really say for sure because there are so many potential components to SIBs including, cognitive, behavioral, sensory/emotional, social, and medical factors.

From what we know, SIBs may serve to indicate pain, a need/desire, frustration, self-punishment, or self-stimulatory needs. In fact, 67% of those with autism had atypical pain sensations, in which an injury to their body can release endorphins, causing feelings of euphoria. As such, it is suspected that for some, SIBs release these endogenous opiates and dopamine in the context of pain or high physical stimulation, and so the child is essentially chasing a high.

Newer views of motivations of SIBs understand that many engage in SIBs secondary to “barrage of sensations from the environment.” We know olfactory, tactile, auditory, visual thresholds can be much lower (also misophonia) in those with autism and other neurodevelopmental disorders, which cause sympathetic nervous system activation.

Some children described it as a release of frustration, anger, guilt, or shame, sometimes due to feeling stuck or trapped, feeling rejected or ignored, or a combination of both internal and external factors. Sometimes SIBs occur in response to trauma, and children with autism are generally hyper-vigilant and very sensitive if feel unsafe. Older children have reported engaging in SIBs in response to praise, as they may feel guilt or pressure. Additionally, increased instances of masking/camouflaging or autistic burnout, which can lead to SIBs.

How Can I Support My Child (and myself)?

Not surprisingly, early intervention is key for the best outcomes; however, as noted when discussing potential underlying causes and assessment, the intervention appropriate for any given child can vary quite significantly.

For some children, they may benefit from medical intervention to reduce pain or discomfort. Abilify or Risperdal can improve SIBs in some children, though often with some side effects.

There has been a number of studies regarding Naltrexone, an opioid antagonist, as it has been suspected that it can reduce euphoric sensation and increase feelings of pain/aversive sensory experiences; however, it is not currently FDA approved for SIBs and there are limited RCTs, despite some case studies showing significant reductions in severe SIBs with limited adverse effects.

There are also some supplements that may be effective as well, like NAC or magnesium.

Typically with ABA or other behavioral modification, differential reinforcement of other behaviors can be useful in providing another behavior that can serve a purpose (self-stim, coping, avoidance) without being detrimental.

Some may benefit from sensory integration therapy from an OT if there is a larger sensory role, while others may benefit from speech/language therapy and/or access to AAC device.

Therapy can also be helpful to assist children in differentiating between real and perceived threats. For those within limited access, Telehealth behavioral services may be an effective option for caregiver support and doing real-time assessments, and teaching brief or time-sensitive interventions.

Hope and Support

A Closing Thought

It is important for caregivers to remain calm and minimally reactive when SIBs are occurring and most important attempt to protect the child. Parental involvement and consistency in behavioral management plans is crucial for reduction in SIBs. Lastly, it is important to note that SIBs often change over time, so need constant awareness and modifications to any behavior plan or supports.

My hope is that this month’s newsletter helps replace some of the fear and uncertainty surrounding SIBs with clarity, confidence, and compassion both for your child and for yourself as a parent.

Parenting is certainly not about doing everything perfectly. It is about listening, observing, pacing, and supporting children as they grow and develop, and find their “voice, whatever that may look like.

As always, thank you for being here and for allowing The Neuropsychlopedia to be part of your parenting journey. I’m grateful to continue sharing evidence-informed guidance that supports not just children, but the families who care for them every day.

Wishing your family a safe, joyful, and restorative summer.

With gratitude,
Rebecca A. Fontanetta, PsyD, ABPdN