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Q&A Help from an Expert… Help! My Son is Self-Harming


Q: I am from India (Bangalore city). My son is nearly eight years old. He is autistic and for the last eight months, he has developed the aggressive behaviors of biting himself, hitting his head, banging his head, and hurting his sister.

My son is nearly eight years old. He is autistic and for the last eight months, he has developed the aggressive behaviors of biting himself, hitting his head, banging his head, and hurting his sister.

I completed a year-long diploma in autism just because I wanted to learn how to help my son. I have tried a lot to understand his behavior. He was a nonverbal child. He has started to communicate, but he is unable to express the reason for his aggression.

I introduced both exercise and quiet time for him. I sit with him and play with him and give him private time, but even while doing that he suddenly gets aggressive and starts hurting himself. A few times in the past I realized he does it to seek attention, but this has reduced. Now I notice that he does it randomly.

I am taking care of his diet, too. I need advice about other methods or ways to help my child express his distress—or any possible way I can work with him to understand him better.

I do lose my patience as I am a single parent taking care of two kids of the same age. I am also a working mother and currently undergoing a separation. So there are a lot of things going on, and sometimes I feel my son can sense all of this too.

Thank you in advance.

Prathibha

A: Dear Prathibha,

Thank you for your question and for voicing your concerns regarding your son. Firstly, I want to commend you on what you have done for your son already. Not only are you reaching out for additional support (which some of us struggle with), but you have also completed a course in autism and put the strategies and suggestions into practice. 

You’re doing all this during a difficult time in your personal life. I often feel awestruck by the amount of support parents provide their children and families with and how little they expect to receive in return in terms of respite or assistance from family or friends. 

Now, let’s see if I can provide more suggestions that might support you and your son. You mentioned that you started exercise time and quiet time, which is great! Kids on the spectrum (all kids, really) require frequent movement breaks. 

It is recommended that kids diagnosed with ASD receive the opportunity for a movement break every 15-20 minutes. It is crucial to keep these movement breaks interest-based as we want this time to serve as a “reinforcer” for being able to manage different sensory input throughout the day. Ideally, we want our children to choose their own activity as a movement or sensory break, and thus I would recommend including a “visual choice board”. 

Please follow this link to watch a free video on how to create your own visual choice boards at home. It would be great if you can introduce visual choice boards to your son, one at a time, and then increase the amount you have around your home. This visual strategy has been proven to help children with limited speech express their needs more consistently and appropriately. 

You also mentioned he engages in various challenging and concerning behaviors, such as harming himself and others. The main focus here should be to decrease his anxiety and frustration levels, as I agree it does not seem to be “attention-seeking” behaviors. I know from experience that kids usually engage in aggressive or self-harming behaviors when they feel misunderstood, unheard, or if they are forced to complete activities or tasks that do not make sense to them. 


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I’m assuming that your son is feeling frustrated as he is able to communicate, but possibly not in the detailed way that facilitates understanding. It reminds me of a person moving to a new country and desperately needing to find the train station to get to their destination, but the people in their new country speak another language and Google Translate is not available in this scenario. 

This person might become upset or anxious; perhaps he/she will become angry with no-one understanding their needs and he/she might lash out. This seemingly aggressive behavior might feel unjustified until you place yourself in their shoes and feel the frustration he/she has to deal with for that short amount of time. Now, I can see from your question that you’re an extremely proactive mother and you show empathy for your son’s way of interacting with his sister and the people in his life. 

Let’s look at some ways to provide structure and support for him and your family:

  1. Visual schedules

Try and include a daily schedule where you include the movement breaks (include some sensory play here, too). It’s important to remember not to place any demands on your son during his “free time” (i.e. his movement and sensory breaks). These breaks can be short, but they need to be included throughout his day on a consistent basis for him to receive the amount of sensory and movement input he might be craving. 

  1. Sibling time

I would suggest you include “special sibling time” on your visual schedule for 5-10 minutes every day, where you initiate a game they both enjoy and facilitate turn-taking. Remember to include a highly motivating activity once they are done with their interactive game, as this will show your son that there is a reason to complete sibling time appropriately. 

  1. Use sincere social praise throughout the day

Our kids are acutely aware of our emotions. You stated this when you mentioned that you feel he is aware of the separation process and the feelings that are associated with this process. If you mention to him that you’re proud of him or that he is doing such a great job during tasks and activities throughout the day, you will show appreciation of all the times he is interacting appropriately. 

I believe you are doing this already, but it is always important to be reminded that our kids are suppressing many anxieties throughout the day if they are sensory seekers or sensory sensitive. 

  1. Visual choice boards

As mentioned earlier, I would suggest implementing visual choice boards throughout your day. As one extremely intelligent friend of mine, who has been diagnosed with ASD, mentioned: “I can speak if I feel 100% comfortable, the problem is that I never completely feel comfortable in the world. So I revert to writing my needs down on a small piece of paper and avoid the meltdown that might happen if I force myself to communicate in ‘your’ (neurotypical) way.” 

There are more strategies that I can suggest, but I believe these will make a positive difference in your family’s life. Please feel free to write to us again and let us know if you have noticed any small changes or if you require any other support or advice. Thank you for everything you are doing for your son, Prathibha.

Best,

Karla

This article was featured in Issue 124 – Autism Around the World

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