UNDERSTANDING SELF-INJURIOUS BEHAVIOR

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Understanding Self-Injurious Behavior (SIB)

Looking beyond the behavior to understand the function and how we can help.

MAY 2025 • 15–18 MIN READ

Seeing your child hurt themselves can be scary, heartbreaking, and exhausting. You may wonder, “Why is this happening?” or “What can I do to stop it?”

Self-injurious behavior (SIB) is more common than many parents realize, especially in children with developmental differences. The good news is that when we understand the possible reasons and the purpose the behavior serves, we can respond with strategies that support safety, communication, and long-term healing.

This guide will help you understand what SIB may look like, why it can happen, and what you can start observing today.

1. What Is Self-Injurious Behavior?

Self-injurious behavior refers to any behavior in which a person intentionally causes harm to their own body. SIB is not about wanting attention or being “bad.” It is a form of communication or coping.

Examples of SIB may include:

  • Hitting or banging the head

  • Biting self

  • Scratching, pinching, or digging into skin

  • Hitting or punching self

  • Pulling hair

  • Rubbing skin raw

The behavior can vary in intensity and frequency. Understanding the “why” is the first step to helping.

2. Why Does SIB Happen?

SIB almost always serves a purpose for the child. The main functions (or reasons) include:

  • Automatic (Sensory): The behavior feels good or provides sensory input (e.g., deep pressure, pain, movement).

  • Escape/Avoidance: The behavior helps the child escape or avoid a difficult demand, task, or situation.

  • Attention: The behavior has been learned to gain attention from others.

  • Tangible/Access: The behavior helps the child obtain a desired item or activity.

A functional behavior assessment (FBA) by a behavior professional can help identify the function.

3. Common Triggers & Contributing Factors

SIB is usually triggered by a combination of factors, such as:

  • Sensory overload (loud noises, bright lights, busy environments)

  • Communication difficulties or inability to express needs

  • Transitions or changes in routine

  • Demands that feel too difficult

  • Pain, discomfort, or illness

  • Fatigue, hunger, or poor sleep

  • Anxiety, frustration, or being overwhelmed

Identifying patterns can help reduce the frequency and intensity of SIB.

4. What Happens in the Body and Brain?

When a child is overwhelmed, their nervous system shifts into “survival mode.” The brain’s alarm system (amygdala) becomes very active, while the thinking and problem-solving parts of the brain (prefrontal cortex) go offline.

This can lead to:

  • Strong fight, flight, or freeze responses

  • Increased cortisol and adrenaline

  • Reduced ability to think, communicate, or self-regulate

  • SIB becoming the only strategy available to cope

Understanding this helps us respond with compassion and regulation rather than punishment or frustration.

5. How to Respond in the Moment

During an episode of SIB, the goal is safety, calm, and connection.

  • Ensure safety first—remove dangerous objects and protect the child.

  • Stay calm and use a neutral, supportive tone.

  • Do not give lengthy instructions or ask a lot of questions.

  • Use simple, reassuring phrases: “I’m here.” “You’re safe.” “It’s okay.”

  • Allow time and space for the nervous system to settle.

  • Avoid trying to reason, negotiate, or solve the problem in the moment.

Once the child has calmed down, connection and co-regulation are key.

6. What Helps Over Time

Long-term support focuses on teaching new skills and meeting underlying needs.

  • Identify and address triggers.

  • Teach communication skills (e.g., requests, breaks, help).

  • Provide sensory input throughout the day (not just when upset).

  • Build predictable routines and clear expectations.

  • Reinforce replacement behaviors.

  • Ensure sleep, nutrition, hydration, and health needs are met.

  • Collaborate with professionals to create a personalized plan.

Consistency, patience, and small steps lead to big changes.

7. When to Seek Additional Support

Consider reaching out to a professional if:

  • SIB is frequent, intense, or causes injury

  • Interferes with daily life, learning, or safety

  • You are unsure what is causing it

  • You feel overwhelmed or need guidance

  • It begins suddenly or increases without clear reason

A BCBA, psychologist, occupational therapist, speech-language pathologist, or pediatrician can help determine underlying factors and create a plan.

8. What Can Parents Start Observing?

Observations help paint a clearer picture. Consider noting:

  • What happened right before the SIB?

  • What was your child doing?

  • Where was your child?

  • What demands or instructions were given?

  • What happened right after the SIB?

  • How long did it last?

  • What seems to help calm your child?

  • Are there patterns with time of day, day of week, environment, or activity?

These details are valuable to share with your behavior professional or care team.

9. Hope and Progress

SIB can feel overwhelming, but children can learn new ways to cope, communicate, and regulate. Change may be gradual, but every small step matters.

With the right support, understanding, and a plan that fits your child’s unique needs, progress is possible.

You are not alone in this.

10. Remember

  • SIB is a message, not a choice.

  • Every behavior has a purpose.

  • Understanding leads to connection.

  • Connection builds change.

  • You are your child’s biggest advocate.

  • Support makes a difference.

References

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  3. Durand, V. M., Boivin, M., & Bertrand, P. (2007). The prevalence of self-injurious behavior among persons with intellectual disabilities: A meta-analysis. American Journal on Intellectual and Developmental Disabilities, 112(1), 72–92.

  4. Matson, J. L., & Shoemaker, M. (2009). Intellectual disability and its relationship to autism spectrum disorders. Research in Developmental Disabilities, 30(6), 1107–1114.

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  6. Carr, E. G., Taylor, L. A., & LeBlanc, L. A. (1996). Sensory processing and attachment in children with self-injurious behavior. Journal of Autism and Developmental Disorders, 26(5), 539–554.

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  8. National Research Council. (2001). Educating children with autism. National Academies Press.

  9. Schreibman, L., & Dawson, G. (2015). The science of early intervention for autism. Journal of Autism and Developmental Disorders, 45(2), 544–560.

  10. National Institute of Mental Health. (n.d.). Helping children manage stress.https://www.nimh.nih.gov/health/publications/children-and-stress