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Living with Autism


February 12, 2012

Self-Injurious Episodes in Non-Verbal Autistics

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                 10 Things to Consider When a Non-Verbal Autistic Person Has a Sudden Self-Injurious Episodes: 

1.              Environment. Auditory: Are loud noises (car alarms, dogs barking, others talking too loud, music or TV blasting) triggering behavior? Olfactory: Sudden onset of strong smells, such as fresh paint, perfume, popcorn in microwave? Tactile: Sits on chair with book on it. Visual: Sunlight in eyes. Scary show on TV. Frightening picture on wall? Scan area for everything possible that could startle or cause fear or discomfort. Re-direct autistic person to safe, quiet area, if needed.  

2.              Clothing. Is something like underwear or diaper pinching? Pants too tight? Sleeves wet? Clothing bunched? Itchy? Sweater tag scraping neck? Check for insects, as in Ants in pants (yes, this happened once on a field trip to park). Overdressed? Underdressed? Too hot? Too cold?

3.              Shoes. Rocks, pebbles or stickers in shoe. Shoes or socks too tight. Or wet. Or have holes. Also check toe-nails. Long nails can cut other toes. Check for blisters.

4.              Hunger or Thirst. ESPECIALLY if autistic person is on MEDICATIONS. Drug-induced hypoglycemia presents with low blood sugar and cause automatic behaviors, ataxia, anxiety, dilated pupils, confusion, myoclonus, tingly skin, shakiness, sweating and heart palpitations. Such symptoms lower self-injurious threshold in a behaviorally-fragile autistic person (BFAP). Check for de-hydration. Non-verbal autistics often can’t tell you they’re thirsty. Offer frequent sips of water or juice. Keep hydrated. Know when they last ate. Offer food.

5.              Sleep deprivation. Acute or chronic. If you suspect insomnia or other sleep issues, which are common among autistics, look for appetite changes, constant yawning, changes in vision (bumping into things), off-baseline [not normal for person] distractibility, bloodshot eyes, extreme agitation, elevated histamine levels in blood (request blood test if suspected as this can also be sign of gut bacteria), hand tremors, sensitivity to cold and/or unusual re-actions to noise.  

6.              Underlying, undetected medical issues: Infection. Allergies. Impaction. Constipation. Bladder infection. Sore throat. Ear infection. Adverse reactions to medications. Cavities (one of the hardest things to detect, since many severely- autistic persons with behavioral issues can’t tolerate dentist looking inside mouth, and so have to be put under general anesthesia just to have a check up).  Remember, they can't tell you if they're in pain. Watch for changes in behavior, eating, sleeping. That's called "off baseline" meaning your child isn't acting like he or she normally does. Be sure to tell doctor this, so they don't think it's part of the autism.  

7.              Acute Injury. Stubbed toe. Scraped knee. Bumped head. Treat (apply ice packs or Bactine spray for pain relief, as needed). Remember pain caused BY self-injury triggers MORE self-injury. Do all you can to STOP the pain. Remember: They may have paradoxical reaction to some medications.  Ie...Ativan or Benadryl used for calming may cause mania in autistic children and adults. 

8.              Defense Mechanism. Is autistic person being rushed, let’s say, to go to bus? Rushed to get into car? Rushed to change classrooms? Forced to board airplane? All these can be triggers to self-injury, as pressure and stress of situation becomes overwhelming. Slow down, if possible. Obviously, in an emergency, if you need to vacate a building, you have to move quickly, but if you can, prepare autistic person prone to self-injury by moving slowly and calmly from place to place. Provide extra time and space to process things.

9.              Boredom. Sitting in a classroom staring at wall for hours could be a trigger. Staying in one place too long could trigger self-abuse. Some autistics get “stuck.” They need re-direction. They need you to help them get unstuck. Introduce new assistive technology, toys and settings, as tolerated. Read to them. Try hand over hand assistance and prompting.

10.       Subnutrition. Chronic exposure to inadequate nutrition. State and private-run facilities and other programs serving autistic populations offer junk food because it’s cheap. Common foods served include crackers, bread, chips, cake, canned vegetables, French fries, hot dogs, pizza, puddings and TV dinners. Subnutrition can also occur when autistics with nutrient absorption issues don’t receive MINCE or PUREE foods to enhance digestion. Even great food can’t be digested if it’s being swallowed whole, which some autistics tend to do. In cases where autistic won’t chew slowly, ask doctor to order minced or pureed diet. Subnutrition affects mood and lowers self-injurious threshold. Every bite counts. It’s essential to evaluate and improve diet and nutritional status of self-injurious autistics. Remember: They may refuse to eat and drink several times before finally eating.  If you give up, they won’t receive proper nutrition and hydration. Keep trying. Move them to a different room. Come back. Try again. Food preferences may change. One week the autistic person may prefer crunchy, salty foods. The next, sweet and sour, the next warm foods only, the next cold foods only, and finally, they may refuse any food unless it’s minced or pureed foods.  It’s is critical to learn as much as you can about the autistic individual’s behaviors and preferences.

        Autistic people are smarter than they appear. Even if they’re sitting alone and appear in own world, they still need stimulation. Give them sensory toys to chew on or play with. Placing them in front of a TV for hours— in some cases— isn’t therapeutic. TV today is not like when I was young. Visual pictures move FAST. Commercials are annoying and loud. It can overexcite the brain and later trigger undesirable behaviors. Sitting in a garden, with a little sunshine, proper hydration, reading them a book and playing Mozart would be a good alternative.


Autism Mom said...

Great list that emphasizes being pro-active as well as checking all possible issues should an autistic child exhibit self-injury. It also makes us painfully aware that it could be almost anything that triggers such behavior.

Anonymous said...

The idea about the pureed diet sounds great. I am going to suggest it to my BIL--my SIL has early onset dementia and does not eat well. This might be just what they need, otherwise I think a feeding tube is going to be inserted and I know he is dreading it.
Thanks for the information.

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