Self-Injurious Behavior

Hitting self, head-banging, biting self, scratching, or skin-picking. Always communicates something — pain, overload, frustration, or unmet need.

Expert guidance

Safety first

This behavior can involve risk to the person or others. Prioritize safety: create space, reduce demands, and use any pre-agreed safety plan. Work with a qualified professional to build a written plan before the next incident.

In crisis in the US, call or text 988. For medical emergencies, 911.

Behavior serves a function — it is not simply "good" or "bad." Stay curious about what it might be communicating.

Action panel

What can I do today?

Small, doable steps for right now, this week, and when to bring in a professional. Educational only — not individualized medical or behavioral advice.

Step 1

In the next 10 minutes

Pause and take three slow breaths together — regulate yourself first.
Reduce sensory load: lower lights, turn off background noise, offer quiet space.
Drop non-essential demands for the next few minutes. Safety and connection first.
Offer a preferred item or activity, or a familiar comfort routine.
Use fewer words. Try a visual, gesture, or written cue instead of talking through it.

Step 2

This week

Track what happens before, during, and after for 3–5 days (ABC notes).
Look for patterns in sleep, hunger, sensory input, and transitions.
Test one small environmental change (lighting, timing, warning before switches).
Introduce or review a visual schedule for the parts of day that are hardest.
Plan a 15-minute connection time daily, without demands, to fill the tank.

Step 3

Questions to ask a professional

Pediatrician or physician

Could a medical issue (pain, reflux, constipation, sleep apnea, allergies) be contributing?
Are there any recent changes in health, medication, or growth we should investigate?
What screenings or referrals would you recommend at this stage?

BCBA or behavior specialist

What might this behavior be communicating, and what function does the data suggest?
What antecedent changes and replacement skills would you prioritize first?
How will we measure progress, and how often will we review the plan together?

Speech-language pathologist

What communication modes (spoken, AAC, gestures) fit best right now?
How can we model language during real routines at home?
What signs of progress should we look for over the next month?

Step 4

Helpful printables

Step 5

When to seek urgent help

Any injury to the person or others, or damage that puts safety at risk.
New or worsening self-injury, especially to head, eyes, or with objects.
Signs of dehydration, fainting, extreme lethargy, or a very high fever.
Sudden loss of skills, seizures, or a large change in alertness.
Suicidal statements, plans, or intent — or a mental health crisis.
You feel unsafe or unable to keep the person safe by yourself.

In the US, call or text 988 for mental health crisis, 911 for medical emergencies, or Poison Control at 1-800-222-1222. Outside the US, use your local emergency number. This page is educational — it is not a diagnosis or a treatment plan.

What it looks like

Hand-biting, head-hitting or banging, slapping self, scratching, hair-pulling, picking at skin. May happen during overload or quietly throughout the day.

Possible reasons

Communicating pain (especially head-banging with ear/tooth infections, migraines)
Sensory overload
Communication frustration
Sensory seeking (deep proprioceptive input)
Emotional overwhelm
Trauma response

Communication

Investigate what the behavior is communicating before trying to stop it. Suppression without addressing the cause shifts it elsewhere.

Sensory

Some self-injury provides intense proprioceptive input. An OT can help find safer ways to meet that need.

Medical

PRIORITY: rule out medical causes — ear infections, dental pain, headaches, GI pain, constipation, menstrual pain. Sudden onset always warrants medical review.

Prevention strategies

Medical workup FIRST for any new or worsening self-injury
Provide reliable communication (AAC if needed)
Meet sensory needs proactively (deep pressure, chewables, heavy work)
Reduce overload triggers
Protective equipment only as bridge, not solution

During the behavior

Block harm gently without restraint when possible
Stay calm
Reduce input
Offer alternative deep-pressure input (squeeze, weighted blanket)
Don't scold or punish

After

Document antecedents carefully
Investigate medical causes
Adjust sensory and communication supports

Common mistakes

Treating it as attention-seeking
Punishment
Restraint as first response
Skipping medical investigation
Suppressing without addressing the cause

Questions to discuss with a qualified professional

Has a full medical workup been done (ears, teeth, GI, head)?
Could this be communicating pain?
Would an autism-affirming OT and SLP assessment help?
Is communication access adequate?

Educational content only. Always work with a qualified professional for individualized assessment and planning.