Student with self-abusive behavior?

Question

I teach a mental impairment class in an elementary school. One of my students hits himself in the head with his hands when he is frustrated (sometimes for no reason I can tell). He is nonverbal, and functions on about a 9 month old level. We hold his arms and try to stop him from hitting himself, but then he will try to bite, bang his head, etc. He has been evaluated for medical causes for this, and they haven't found anything yet. We have tried applying gentle pressure to his head, distracting him with toys and music, and talking soothingly to him. All of these work at times. He does this up to 10 times during the school day. Does anyone have any advice or methods they have used or seen? We can secure his hands when we need to, but I don't like to do this all the time. Thanks for your help

Answer 1

I have no experience but I think there is a trigger factor that might be in his surrounding. If this situation happens in the classroom, I think you better recommend a home study for the child. I know this can be against the child's right to socialize but after all medical help has been done (with results) that the child can safely be allowed to stay in a classroom setting.

Answer 2

My daughter was also nonverbal, and self injurious. We decided that the ability to express frustration was important, and rather than trying to eliminate the behavior altogether, we watched for potential antecedents, and redirected to a less dangerous expression. With my daughter it was hitting the desk rather than herself.

We did this by utilizing her one-on-one aide. When she started to get angry, the aide would hit the table and verbalize, "I am mad. I hit the table...one, two, three" If dd tried to hit herself, aide would catch her hand, direct to the table and verbalize, "Bre is mad, she hits the table...one, two three" Then reward like crazy. Bre would get a bite of snack every time she was able to hit the table. At first she would hit five or six times, but as long as she was hitting the table instead of herself, reward reward reward. We weaned back on those rewards, then started working on lessening the number of times she hit the table. Mostly by counting the hits and then physically blocking after she hit about 50% of the time, so if she hit ten times, we'd cut back to five. We'd count the hits aloud, then place our right hand under hers so she couldn't hit, then reward. When that was mastered, we cut down to four, then three, then two. We stopped there because teacher and I both felt that she should have the right to express frustration, I mean, life sucks when you can't talk! The aid would say, "You're angry, one two! Thanks for sharing." Reward.

We also worked quite hard to figure out what the frustrating things were and provide ways for her to resolve. If the room was loud, she got to go for a walk. If she was out of the right snack, she could go play computer, just being really creative, finding those positives and reducing the negatives until the SIBs are under control.

The SIB has become a response he does without thinking, I'd bet. I'm sure what you are providing is helping with the overall problem, but weaning back to a more appropriate behavior will help. Securing his hands does not allow him to express his frustration, OR teach him a replacement behavior, so I'd definitely not do that unless blood was involved. Good luck.

Answer 3

If you are indeed a SPED teacher, why on earth are you asking that question here, when you certainly must have access to tons of experts through your school system?

Answer 4

Does the child have a behavior plan?.Is there a Behavior Specialist available to observe? Someone needs to come up with alternative behaviors that are rewarded immediately.Every 5 minutes or less, if need be.Maybe if the boy was given some cards with words or pictures(depending what he understands) that say break or a picture of a toilet,  whatever deemed appropriate, that he could use to help communicate.There may be sensory issues going on too. Have someone keep a log of when and where these behaviors are occurring.I know you said sometimes it seems to be for no reason but if you keep a log you might figure it out.Is he getting speech therapy. Learning to  communicate,should help  relieve some of his frustration.Good luck!

Answer 5

Yes, whoever mentioned conducting a funtional analysis or FBA in order to determine behavioral function would be correct. You need to find out WHY she is engaging in the behavior before you treat it. The worst thing you can do is assume why she is hitting her head... and frustration is not really measured in an FA because you can't measure it. You can observe behaviors, not frustration. Just conduct the FA or have the behavior analyst do it over a period of a couple days.

You'll find that her behavior is either maintained by access to tangible items, access to social attention, escape from task, or sensory/automatic... or a combination of. Once you figure out which is maintaining her SIB, you can then implement treatment. Extinction, blocking, differential reinforcement, replacement behaviors, and competing responses are typical treatments for SIB, but you then should test them out as well for reinforcement schedules, etc.

SIB is unique, in that, you can cause injury to yourself, so make sure you consult a nurse or doctor when implementing treatment... For example, you may have to block him from doing it even if data suggests that you shouldn't.

Also, be aware that holding kids arms is considered a restraint and is illegal without consent in the IEP and parents, and sometimes even behavior or human rights committees. You cannot simply restrain someone on your own... Blocking is different, but I would follow up or you can get in serious trouble...

There is a lot of research on Self-injury in JABA... you can go to the JABA website and search SIB.

Answer 6

Self-Injurious behavior is considered a "serious" behavior problem according to the law. This child is entitled to behavioral services such as a functional analysis which will determine the function of the behavior and then a behavior intervention plan which will target teaching replacement behaviors that serve the same function as the self-injurious behavior but are not self-injurious.

You can read more about rights for students with behavior problems here.

http://www.wrightslaw.com/howey/iep.spec...

Answer 7

hmmm.. A kid in my second grade class acting like that, but it was more when he got the answer wrong. I'm not really sure, but if i remember correctly, my teacher ignored it. Maybe if he doesn't do it all the time and just when he's frustrated try to help him and encourage him on the things he gets frustrated on so he doesn't get as frustrated. Let him know it's okay to be frustrated and confused sometimes.

Answer 8

I am also handling Special kids in a class here in school, however, this student of mine, already 8 but still bites his hand, wrist and fingers if he is frustrated. he is hungry most of the time too. When we started, i allowed him to eat when he wants but i also asked about this behavior with his parents. They give food instantly when my student whines coz if theu don't give in, he will bite himslef then bite others nearby.

I assigned his caregiver as a shadow teacher during the class. She would help me administer sit down activities and i try to talk to the child with a firm voice asking him if he wants food, he can have it aslong as he finishes his work. I do this daily and he seems to understand me but sometimes, would throw a tantrum and bite or scratch anyone, so we restrain his arms by holding them firmly. I make sure he looks at me when i say finish his work so he can eat and now, he does.

it took a lot of effort and time, but be firm with ur rules.

You must do this consistently and ask the parents to do the same. If the kid doesn't comply, deprive him of something he likes so much but if he follows, give a good reward.

Good luck, we need all the help we can get !

Answer 9

Self-injurious behavior is a difficult one to manage.  In the attempt to prevent injury to the child, you provide reinforcement of the behavior through intense physical attention.  If this behavior is socially-reinforced, the reinforcement must be withdrawn to decrease the incidence of the behavior.  All of your methods that you listed all give him attention in one form or another, rewarding him for this activity.  In the case of cranial self-injury, it may be possible for the child to wear a helmet, reducing the chance of injury, and allowing you to continue your work without the disruption of redirection/restraint.  Ask your school psychologist.