We asked the Respectfully Connected community to submit questions for our authors, and this is the fourth in our series of eight responses. (All of the ‘You Asked’ series of posts can be found here)
Our Autistic writers respond thoughtfully to Q.4 here, sharing their own experiences, parenting values & strategies for supporting children. Within the responses, we also link to posts by other Autistic people, which we encourage you to read.
Q4. How do you respond to and support children with ‘self-injurious stims’? eg. A child repeatedly putting their fingers down their throat, or a child picking at their skin? What about using unpleasant stimuli (like vinegar on fingers) to prevent self-injury?
Anonymous: I would strongly advise not to use aversives (unpleasant stimuli) in trying to stop a child from engaging in self-injurious behaviours. It’s really, really important to figure out why a child is doing this because there may actually be a medical reason for doing so.
Perhaps these blogposts will help:
Naomi: We’re big fans of bodily autonomy here, so usually when it comes to stims we’re accepting and supportive. Our only exception to that is if someone is getting hurt. When that happens we try to redirect the need for stimming to a different one that is not harmful, or distract from the harmful stim with a toy or activity. Sometimes what looks painful to me isn’t painful to the other person, so I try to be careful not to put my own sensory interpretation on something. We also know that behaviour is communication, always – which is really important when living with a non verbal person.
If someone is continuously returning to a harmful stim, and they weren’t able to talk about what need it is meeting for them (whether they were non verbal or just not able to put the words together), I’d try my best to figure that out through observation and see if there was a way to meet than need without the physical harm. If a child is making themselves vomit, I’d always want that to be checked out by a doctor. Using unpleasant stimuli to inhibit a stim is not something I would choose to do, because it doesn’t help you to understand the reasoning behind the self-injury. Whatever is leading to the harmful stim is going to remain unaddressed, and end up manifesting some other way.
Meg Murry: I don’t think that aversive stimuli are likely to do much good, as stims tend to be so necessary to the child that they will be quite creative in getting around them.
When this has come up for us, I try to talk to my child in a low-key, logical way about the damage that may be done by the stim – you are hurting your skin, for example, and if it gets much worse we may have to see the doctor for some medicine. I try to offer alternatives in the form of stim toys or other body movements. So far, I have always found that these things pass without doing any serious harm. I know that’s not true for everyone so I’ll have to leave it to others to give a better answer.
Leia: I’ve been known to do some self injurious stimming myself and I know that for me, the only thing that works is to replace the stim with something else. I try different things but basically anything that keeps my hands busy will stop them from picking at myself. For my child, we’ve tried explaining how bodies work and how some things can harm our bodies and we’ve tried giving him replacement items to stim with or covered
parts of his body that need healing with clothing. We would never do anything unpleasant to him to discourage his stims (strong smelling stuff on his hands to stop biting them etc) as this is abuse.
Michelle: We never prevent, or attempt to prevent in any way, stimming. When a stim causes injury, we encourage self care using strategies for self care and offering alternatives for the child to choose from if they wish.
Example: child licks their lips and the skin around their face until it is raw and bleeding. We encourage the use of a barrier cream, and have a prescription cream to use if needed. We offer gum and mints to chew/suck on when the skin is sore or becoming sore. We do not say “stop licking”, we do say “if your skin is sore you can put some cream on it if you want to” and “your gum/mints are here if you would like to have some”. If the child declines the alternatives offered that is the end of the conversation. The child needs control over how they self regulate, and we do not interfere.
On the broader topic of self care, which Q1 and Q4 touch on, I have this blog post: http://amazingadventuresautism.blogspot.com.au/2015/05/amazing-adventures-acceptance-love-and.html
Briannon: First up – Never ever, ever do we use aversives in this house. They are psychologically and physically harmful.99% of my own stims involve touching, picking or poking at my body in some way. I do this non-stop; often I hurt myself. It’s important for me for stress release, processing information, and feeling my mind is connected with my body.
Attempts to stop stimming are realllly stressful. All the fidgets and stimmy gadgets in the world are never quite as good, although they do protect my body from attack somewhat. Sometimes, if I am really hurting myself I will protect my body with a barrier (e.g. clothing, bandaids) or do something very distracting and positive.
Personal autonomy is very important for me, and I want my children to feel as much autonomy as possible too, including over their body. I trust that their stims serve a purpose, and unless they are having a serious health impact, I never prevent my children from stimming, nor shame them in any way.If a stim is causing a serious safety risk to myself or my children (as it has before), then I attempt to distract, divert, and offer alternatives.
Trusting that this behaviour is serving an important purpose, I then try to work through what that purpose is, e.g. anxiety, physical health conditions, response to a trauma, distress, not having the tools but wanting to communicate something. Sometimes, I need to ask people for help. I have a small circle of family, friends and health professionals that I can safely problem solve with.
Importantly, my children are actively involved in this process. I make sure their beliefs and self knowledge are valued by adults and they are leading the problem solving process with our support.
As well as the links listed by others, there is also a short video on self-injurious stims with a message of care and acceptance by Amythest Schaber at https://youtu.be/S4lhXidFPx8
* All of the ‘You Asked’ series of posts can be found here *