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Q&A Advice from an Expert…Help! My Autistic Nephew Bites his Brother

December 10, 2021

Q: I have two nonverbal autistic nephews whom I watch and, for what seems like no reason, one likes to bite the other. I would like some advice on how to handle this for me and my brother. Thank you.

Q&A Advice from an Expert… Help!My Autistic Nephew Bites his Brother

A: Hi, Jenny! Thank you for submitting your question on biting in children with autism spectrum disorder (ASD). Biting is a common trait that many families deal with on a daily basis and it can be very frustrating in addition to impacting the child’s ability to regulate their impulse control during social and play settings.  

From an Applied Behavior Analysis (ABA) perspective, biting can serve a couple of different functions. One of the functions biting serves is attention-seeking. I do not know the age of your nephews and I would love to know if the biting is happening only when they are with you, or if the biting is a regularly occurring problem at home as well. 

If the function is attention-seeking, we often look for things that have changed in their environments. If you are a new caregiver to them, or their daily schedule has recently changed, the biting could serve as a way to get your attention or to take attention away from the other brother.  

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Applying positive reinforcement 

In ABA therapy, we use positive reinforcements to alter or change negative behaviors into positive and more functional or appropriate behaviors. With attention-seeking behaviors, we are trained not to give attention to those behaviors, because even by saying “Don’t do that” or “That’s not nice”, the negative attention they receive serves the purpose for the behaviors—thus we are unknowingly rewarding those negative behaviors with attention.  

Of course, we don’t want his brother to get hurt, so behaviors have to be modified using positive reinforcement if the function is attention-seeking. 

Token boards

Token boards are effective in modifying behaviors when the reward they receive is a highly desired item. It doesn’t have to be an expensive reward either. It can be five minutes of iPad time, a favorite children’s song, or a small edible. 

If you are new to using a token board, be sure to start with very small increments of time and then gradually increase the duration.

  • In this example, if the boys can sit for one minute together without biting each other, they get a token. After they fill up their token board, they receive their reinforcer
  • Verbal prompting can be used to remind them “We are working for five minutes of iPad time!” to keep them on track. Time can gradually increase to two minutes, five minutes, etc., until the behaviors are extinct and/or replaced with a more positive and appropriate behavior

Oral sensory seeking behavior

Another function that biting serves is oral sensory-seeking behaviors. These behaviors are the ones that I see most often working with nonverbal clients as a behavior technician. They are biting without conscious awareness of doing so, trying to seek that sensory input. 

Are your nephews in occupational or physical therapy? Sensory seeking input behaviors are often addressed in OT and PT, but it definitely carries over into the ABA side of therapy as well. 

Oral stimulation ideas

When behaviors are sensory seeking, we have to use a different approach than attention-seeking behaviors. If children have the need for that sensory input and they are unable to get it (due to behaviors being blocked or items being taken away), the sensory seeking behavior will often be transferred to a different sensory seeking behavior. This may often be even worse than biting, such as head banging and other self-injurious behaviors. Older kids will often be okay with chewing gum to get that oral sensory input.  

  • Chewy tubes or chewing gum

For younger children, we have seen a lot of success with chewy tubes. Chewy tubes are easily found on the internet and serve as a more functional and appropriate item to bite as opposed to the brother or you

  • Weighted blankets

Weighted blankets, hugs, and compression squeezes (often used in physical therapy) are also healthy sensory-seeking options that work well with all ages. If your nephews use an iPad or PECS board to communicate, be sure to have pictures of those items available for them to ask for so they will learn to be more self-aware of how they are feeling and can learn independence in being able to ask for what they want. 

In closing

If your nephews are not currently in therapy, ABA therapy, occupational therapy, and physical therapy can all address the biting behaviors. These teams of experts should be able to collaborate to have continuity in administering therapeutic programs in both home and clinical environments. 

If the cost of therapy is preventing your nephews from receiving appropriate therapy to treat some of the behaviors associated with autism spectrum disorder, I suggest looking online for grants and programs that help cover expenses. 

There are a lot of nonprofits that serve the autism community as well. Social workers can also help connect you to services. If you are in the United States, Autism Speaks has a special emergency fund set aside to help families through these difficult and challenging times.  

I hope that information helps. Your nephews are so lucky to have you care for them!

This article was featured in Issue 123 – Autism in Girls

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