Kids with autism or special needs may show a wide range of challenging behaviors such as property destruction, physical aggression towards others and, quite often too, self-injurious behavior. One of the most worrying self-injurious behaviors (SIB) for parents is head banging.
Head banging, hitting the head with a fist, banging the head on the wall or floor are all different manifestations of the same behavior. For us parents it is an extremely overwhelming situation:
- fears of brain damage and for their general health and safety
- frustration over our inability at times to understand what is going on
- helplessness over our failed attempts to help them
- doubts about whether our actions help fix the problem or make it worse.
Today, I will try to put together a comprehensive document to help parents or caregivers that are facing this type of situation. Hopefully, by the end of this read, you will know a bit more about the following topics:
- most common reasons why kids engage in headbanging behavior
- tips and ideas to prevent it or mitigate the consequences
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What is Head Banging?
We can find two very different head banging definitions when we look at this behavior in kids:
- Behavior that appears in up to 20% of normal children in the latter half of the first year of life and ends spontaneously by about 4 years of age; more common in boys.
Source: Medical Dictionary for the Health Professions and Nursing. © Farlex 2012
- A type of stereotyped self-injurious behavior, often present in those with ASD, intellectual disability, or other developmental disabilities that may be described as:
- highly repetitive behavior
- episodic under highly specific stimulus contexts, or
- in bursts after long periods without problematic behavior
Source: Self-Injury in Autism Spectrum Disorder and Intellectual Disability: Exploring the Role of Reactivity to Pain and Sensory Input.)
In this post, I´m going to focus on the latter.
The first head banging behavior that I´ve mentioned does not typically result in physical injury. It is still a worrying situation for a parent and you will need to consult your doctor. But it doesn´t mean there is a developmental problem behind.
Head Banging and Autism
Self-injurious behavior is frequent is kids and adults with ASD (up to 50% occurrence). And head banging is its most common form.
Why do Kids Engage in Head Banging Behavior or Other Self-Injurious Behaviors
There are lots of theories about the origins of SIB (developmental, biological, environmental), but most research shows that SIB is a learned behavior maintained by its consequences.
From the perspective of applied behavior analysis, there are four functions of self-injurious behavior:
- social positive reinforcement (either attention or access to food and materials)
- social negative reinforcement (escape from demands or sources of aversive stimulation)
- automatic positive reinforcement (sensory reinforcement )
- automatic negative reinforcement (the SIB assists to stop an aversive stimulation-like pain)
Source: Functions of Self-Injurious Behavior: An Experimental Epidemiological Analysis (Iwata, B)
As parents, we don´t usually use these academic/behavioral labels when we talk about the causes for head banging. The most common reasons for head banging that I will address below are:
- Sensory processing issues
- Escaping from demands
- Communication Issues / Frustration
It soon becomes obvious that there cannot be a one-size fits all solution. Understanding the function of this behavior is key to ensuring that the strategies you put in place are going to be successful.
What can we do to Prevent Head Banging
General Tips, Ideas and Recommendations
There are some tips that could apply to SIB in general and specifically to head banging, no matter what the function of this behavior is.
1. Always look for advice from your health professionals.
2. A Functional Analysis by a behavior therapist will help produce a good behavior intervention plan.
3. Watch out for precursor behaviors (things that may be happening even before the actual behavior is present):
- mood changes
- verbal escalation
If you can act on those behaviors you may be able to avoid the SIB situation altogether.
A tip for those situations may be to redirect him into another task or distract her with a question (Response interruption and redirection): What was your favorite toy? What was your favorite food?
4. Track behaviors to understand their function (you can read my post on how to track behaviors)
5. Understand triggers
6. Act upon those triggers
7. Medication may be required for severe or long-lasting cases.
Tips to minimize physical harm:
8. Get a protective helmet
9. Secure problematic areas with some padding (e.g. padding on the walls around the bed)
10. Learn how to do safe holds to prevent harm / Block attempts to bang head
Specific Tips for Head Banging Depending on its Function.
Sensory Processing: Sensory Strategies for Head Banging
Senses are often acutely affected in people with ASD. Kids with autism may have increased or decreased sensory sensitivity (over-responsiveness or under-responsiveness). An individual can even present both reactions to a different range of stimuli.
Tips to Prevent Self-Harm due to Sensory Overload:
11. Remove stimuli that are causing the sensory discomfort:
- Ensure he wears comfortable clothes
- Remove a smell that may be overpowering
- Remove noise with noise-cancelling headphones. A couple of examples:
- Take your child to a quieter room
Tips to Prevent Self-Harm due to Under-Stimulation
12. Provide sensory alternatives that provide a similar experience to head banging:
- Jumping on a trampoline (This is a review of Best Trampolines)
13. Provide other sensory inputs that they may find stimulating (examples in the links below)
As a parent, you may feel that you are giving your full attention to your kid, but triggers may be as subtle as:
- Mom and Dad talking to each other for more than one minute
- Leaving your child alone watching t.v. (even a favorite cartoon) and not making enough interaction for a certain period of time
- Talking to another sibling
14. “Non-Contingent Attention” Program
There will always be situations in which we know we are going to be busy or we need to engage in a discussion with some other people. If aggressive behaviors are triggered by attention-seeking you may need to start a “non-contingent attention” program.
Non-contingent means you give attention for no special reason (“just because”). Your kid will get the attention that he/she is craving for without the need to engage in self-injurious behavior. This approach will need to be implemented over a period of time:
- Acknowledging your kid before you start an interaction with another person
- Providing attention at very high rates of attention (every 1-2 minutes) while engaging with another person
- Slowly extending the amount of time that elapses between attention moments (e.g.2 minutes – 3 minutes- 5 minutes).
The final objective is for your kid to learn to regulate himself. During the weeks that you are implementing this non-contingent attention program, you will need to train your kid to ask for attention in appropriate ways
Escaping from Demands
Some kids with autism or special needs have learned that they can escape from activities that they find too difficult (or just boring) with disruptive behavior.If we have identified escape as a trigger, these are some tips that may be useful:
15. Redirect into the task, so that your kid does not associate engaging in that behavior with escaping from that demand, BUT
16. Assess the task difficulty to ensure that it is achievable
17. Assess if it can be made more fun /easier
18. Try using a token economy, so that there is an extra motivation
Frustration / Communication
Behavior is a form of communication. In the case of kids with ASD or special needs, when communication may be affected, head banging may be a way to express frustration, anxiety or discomfort.
19. Use visual support to help your kid communicate his/her needs.
20. Prompt your kid to demonstrate what he/she wants “show me what you want”
21. When giving instruction, ensure that they are clear and concise.
22.Explain rules and ask your kid to repeat them back (if he/she is verbal)
Example: If you throw a toy, it goes away. When you throw a toy, what happens? (Expect him to fill in the blank). Repeat this 3-4 times before he has time to have an item or do an activity.
23. If you identify transitions as a problem, there are different ways to address it, depending of your specific situation. You can check “Helping Children with Autism Spectrum Conditions through Everyday Transitions. Small Changes- Big Challenges”
It is important to rule out any medical condition that may be causing pain. A kid may use head banging (or other SIB) as a way to mitigate or mask pain and discomfort. So the tips here may be a bit obvious:
24. Get your doctor to rule out a medical condition that may be causing pain or discomfort
25. Provide alternative pain relief solutions
I really hope you have found these strategies to prevent head banging useful. Let me know if there are other suggestions that we could add to this list.
And if you are parenting a kid with special needs, you may find the reading in the Special Needs section of this blog interesting.
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