By Raising Children Network
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image of sad and angry boy with his arms crossed credit RCN
Children with autism spectrum disorder (ASD) can behave aggressively to themselves or other people. There are lots of strategies you can use to help prevent and manage your child’s aggressive behaviour or self-injurious behaviour.

Aggressive behaviour, self-injury and autism spectrum disorder

Children with autism spectrum disorder (ASD) don’t necessarily express anger, fear, anxiety or frustration in the same way as other children.

They can sometimes express these feelings through aggressive behaviour towards other children. Sometimes they’re aggressive towards themselves, which is called self-injurious behaviour. They might hit, kick, throw objects or hurt themselves – for example, by head-banging.

Children with ASD can behave aggressively or hurt themselves because they might:

  • have trouble understanding what’s happening around them – for example, what other people are saying or communicating through facial expressions and body language
  • not have effective ways of communicating their own wants and needs – for example, they can’t express that they don’t want to do an activity or that they want a particular object
  • be very anxious and tense
  • have sensory sensitivities, such as an oversensitivity to noise or a need for stimulation
  • want to escape from stressful situations or activities.
If your child is ever in immediate or life-threatening danger, call emergency services on 000 straight away.

Understanding aggressive behaviour and self-injurious behaviour

Understanding what causes your child’s aggressive behaviour and self-injurious behaviour can help you to change or reduce the behaviour.

You can do this by looking at the aggressive behaviour as an ABC sandwich:

  • Antecedents: the ‘triggers’ for the aggressive or self-injurious behaviour
  • Behaviour: the way your child responds to the trigger
  • Consequences or ‘rewards’: what your child gets out of behaving aggressively, such as being allowed to go on with a favourite activity, or to leave a stressful situation.

You can work on your child’s aggressive behaviour by changing either the triggers or the rewards your child gets from behaving aggressively or self-injuring. Our article on managing challenging behaviour in children with ASD explains how to do this.

Understanding how well your child can communicate is also a key step in finding out what’s causing the aggressive behaviour. When children can’t express feelings or ask for what they need, they might use aggressive behaviour to communicate.

It can be helpful to ask yourself, ‘Is she trying to tell me something?’ For example, if your child doesn’t like corn flakes but can’t tell you, she might hit you as a way of saying ‘Take it away, I don’t want it!’

Behaviour-based interventions such as Applied Behaviour Analysis (ABA) can help with your child’s aggressive behaviour and self-injurious behaviour. These interventions focus on teaching children new behaviour and skills by using specialised, structured techniques.

Managing an aggressive outburst

You probably can’t prevent all your child’s outbursts. These tips can help you manage the aggressive behaviour when it happens.

The first and most important thing is to stay calm. Most aggressive outbursts or tantrums happen because your child has feelings building up and he can’t communicate them. By managing your own feelings and staying calm and quiet, you won’t add your emotions to the mix.

During an outburst your child will be feeling very stressed. It’s hard to process what someone else is saying when you’re feeling stressed, and this is especially true for children with autism spectrum disorder (ASD), who can have trouble understanding language.

It can help if you limit what you say to short phrases or even just a couple of words – for example, ‘Sit down’ rather than ‘Lachlan, come over here and sit down’.

You might need to move your child to a safer place, away from anything that could hurt her – for example, shelves that could fall over or glass objects. A quiet enclosed space outside might be an option. You might also need to get other people to move out of the way to keep them safe.

Visual cues can also help in these situations – for example, you might have a picture of a quiet place in your home that your child can go to.

Physical restraint
If you find you have to use physical restraint when your child has an aggressive outburst, speak with your child’s paediatrician or a behavioural therapist about other options.

Physical restraint can be dangerous to both you and your child, and can often increase your child’s anxiety and make the situation worse. Positive behaviour support is always preferable to physical options.

Managing self-injurious behaviour

Working out what your child is trying to tell you with self-injurious behaviour can help you decide how to manage it. Here are some reasons children with autism spectrum disorder (ASD) hurt themselves and some ways to respond.

Your child might find switching from one activity to another difficult. For example, he might bang his head on the floor when you tell him that it’s time to put away his train set for dinner. You could try warning him five minutes before you need him to pack away by showing him a photo of washing hands and sitting at the table for dinner. This will give him a warning, plus time to finish what he’s doing.

If your child has been doing a puzzle for 10 minutes and starts to pull her hair, she might be trying to let you know that she wants to do something else. Offering her a new activity might stop the hair pulling. 

Your child might hit himself because he wants you to look at him and talk to him. Going over to him and giving him attention will stop him hitting himself. The next step is teaching him to get your attention in another way – for example, by saying ‘Mum’ or coming to you and showing you a help card.

Your child might be feeling frustrated and need help. For example, your child has been playing with a doll but the leg comes off, so she starts to scream and scratch herself. If you help her fix the doll, it will stop her hurting herself. The next step might be teaching her to say, sign or show a picture to tell you when she needs help.

Getting professional help

Your child’s paediatrician can refer you to a behavioural therapist. A behavioural therapist can help you understand and manage your child’s aggressive behaviour or self-injurious behaviour. This might be particularly helpful if you’ve already tried other strategies without success.

For example, the therapist might use functional assessment to work out why your child is behaving aggressively or is self-injuring, then use strategies to reduce the behaviour and teach new behaviour.

Your paediatrician might suggest medication to reduce your child’s aggressive behaviour. Before deciding whether medication is right for your child, it’s important to understand what the medication does and what its side effects are.

Medications include:

Looking after yourself, especially your physical and emotional wellbeing, can help you stay calm and consistent when things get tough. Friends and family can be a great source of support, as can other parents. You might like to connect with other parents like yourself in our online forum for parents of children with ASD.
  • Last updated or reviewed 02-12-2014
  • Acknowledgements This article was developed with help from Cherie Green, University of Melbourne and Avril Brereton, Monash University.