“When I physically discipline my 6-year-old son [who has autism], he starts to hit himself. Should I use physical discipline? Do I just let him hit himself?”
Today’s “Got Questions?” answer is by psychologist Stephanie Weber, of the Kelly O’Leary Center for Autism Spectrum Disorders at Cincinnati Children’s Hospital Medical Center. The center is part of the Autism Speaks Autism Treatment Network.
Thank you for your question. You raise an important topic that many families deal with on a regular basis.
The short answer to your first question is “no,” physical discipline is not a good approach – particularly for a child on the autism spectrum. I’m glad to provide a longer answer to the question of why we don’t recommend physical discipline to address problem behaviors.
First, I understand why some families use physical discipline. After all, it often makes the behavior stop – and quickly. So physical discipline can feel like a quick fix. However, it isn’t a long-term solution to your concerns about your child’s behavior. Why?
To start, it doesn’t teach your child how you want him to behave. For example, if you want your child to stop running down the hallway at home, you could say, “Don’t run.” Unfortunately, your child still may not understand what you want. However, if you tell him, “walk in the house,” you are communicating what you expect. Along these lines, physical discipline quickly conveys the message “don’t,” but fails to help direct your child toward the right behavior.
The importance of modeling behavior
Another important way children learn behavior is through imitation. To put it another way, “modeling” is a powerful way to teach children how to behave. The danger, when you use physical discipline, is that you may be modeling that it’s okay for your child to physically discipline others – or himself.
You also ask how to handle your son’s reaction to physical discipline – hitting himself. Certainly, we don’t want him to hurt himself.
Whenever I talk about self-harm behaviors with families, my first priority is safety. If your child is leaving bruises or making himself bleed, it’s very important to discuss your concerns with physician or psychologist. If you feel that your child may seriously harm himself or someone else, don’t delay! Call 9-1-1 or take him for an evaluation at the nearest emergency department.
If there’s no danger of serious self-harm, I suggest working with a behavioral specialist to determine why your son is hitting himself.
All behaviors have underlying reasons. Just as we make dinner because we’re hungry, a child misbehaves for a reason. One common reason is to communicate. This motivation is particularly common among those who have trouble communicating with words – which is true of many individuals who have autism.
Five common issues with self-injury
Generally, we see five main motivations behind problem behaviors such as self-injury:
First, some children have painful medical issues such as a toothache or headache that cause them to hit themselves to mask or soothe the pain. I suggest you talk with your child’s doctor if you suspect this may be contributing to your child’s behavior.
Second, a child may be acting out to “escape” a distressing situation or avoid a task or chore.
Third, individuals with autism sometimes strike themselves as a way to get another person’s attention.
Fourth, an individual may use a distressing behavior to get something he or she wants – be it a food, toy or other item.
The behavior may be a broader attempt to self-stimulate or self-soothe. Rocking is a classic example of a self-soothing, repetitive behavior common among children and adults who have autism. Your son’s hitting himself may fall in this category of behaviors.
Finally, as mentioned above, your son may be imitating your physical discipline when he hits himself.
Once you and your child’s therapist understand why your child is hitting himself, you can work together to find solutions and more appropriate “replacement” behaviors.
For instance, if the underlying reason is "escape," then I recommend teaching him a better way to ask or signal his need for a break. If your son’s behavior is a way to get something tangible, I suggest teaching him waiting skills. We often do this with visual supports, like a "First/Then” picture board. The first picture shows the task he must complete before receiving what he wants – as shown in the second picture. (More on working with visual supports below.)
Building on positive behaviors
A more-positive approach can help you address both the challenging behaviors that led you to use physical discipline and your son’s subsequent habit of hitting himself. I suggest starting by building on the constructive behaviors your child shows. For example, praise him, give him a high-five or some other positive reinforcement when he “keeps nice hands” and doesn’t hit himself when frustrated.
Also look for more-positive ways to show your son what you want him to do. Visual supports can help you convey what you expect of him. The use of a visual schedule, for example, can be helpful to let your child know when things will happen in his day. The Autism Speaks ATN/AIR-P tool kit Visual Supports and ASD can help. Download it free of charge here.
Token boards are another example of a visual tool for communicating what your son needs to do to earn something he wants. A token board (photo below) includes a picture of the “reward” with tokens that can be earned for each task completed toward the goal. Once all tasks are completed, the child receives the item in the picture. I suggest customizing the rewards to your child’s interests. You can have fun with the tokens as well. I know one family that used pictures of their child’s favorite action hero as the tokens.
I also recommend the Autism Speaks Challenging Behaviors Tool Kit, available for free download here. This tool kit is full of practical strategies for encouraging positive behavior and teaching replacement behaviors.
By making the change from physical discipline to positive reinforcement, I think you will see many improvements in your child’s behavior. Please let us know how you’re doing with a note below or by emailing GotQuestions@autismspeaks.org.
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