Could Autism Self Injury Be Due to Pain? With Dr. Timothy Vollmer

Autism self injury (otherwise known as self injurious behavior or SIB) as well as other problem behaviors may be caused by pain or medical issues that lead to behavioral treatments not being effective on their own. For children with autism who have little to no language, it can be really challenging to determine whether pain or medical issues are a root cause for their problem behaviors. In today’s vlog, we have an excerpt from podcast 46 with Dr. Timothy Vollmer about why pain and medical issues may have you stuck when it comes to eliminating problem behaviors in your child or clients.

Integrated Autism Service

As a BCBA I usually begin by looking at the 4 functions of behaviors, and what could potentially be the cause, in order to help decrease the problem behaviors. I talk about my behavioral approach to hitting and biting in some of my free materials. 

But, sometimes behavioral treatments alone won’t solve problem behaviors. As Autism Speaks outlines common medical conditions associated with autism that can certainly have an impact, but small things like headaches can trigger problem behavior too.  It is very important to rule out medical issues when looking at treating autism self injury, but it is very hard when an individual has little to no language. 

I asked Dr. Vollmer what physicians can do to help families and behavioral professionals. First, he says, is to remember that most severe problem behavior likely has a medical component. Professionals like BCBAs, must consult with a physician so they can medically evaluate the individual before trying to treat these behaviors. 

Hand Biting and Autism

One problem behavior that I see a lot is hand biting so I was amazed when I heard Dr. Vollmer discuss this topic at the Penn State autism conference.  What he said was that there is research that shows, as he says; 

Animals and all kinds of different species showing that, in response to some kind of averse of stimulation, so a painful stimulus or a loud noise, humans and other animals will bite down and they’ll bite down on whatever is available.

It might be (for a bird) if there’s a bar in front of them, they’ll bite on the bar. (In humans), if there’s nothing, maybe they’ll bite their hand. Before the days of anesthesiology, people would literally bite on a towel or bite on some object during surgical procedures.

So biting down is a natural human response. So what I’m wondering, and some of my doctoral students are starting to wonder is why we’ve ignored that literature for over 40 years now.”

This research suggests that when dealing with self injury, like hand biting, we want to first look at anything that could be causing possible pain, especially when working with a child or adult who has limited language ability and/or if you are dealing with autism self injury that has been resistant to other behavioral intervention. 

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I actually have first hand experience with this because my son, Lucas,  began having aggression and self injury with both hand-biting and hitting his head with his hand when he was startled by loud noises or when he would get headaches. Aggression and SIB was resolved when Dr. Micheal Murray  prescribed a beta blocker to calm Lucas’ autonomic nervous system. 

Lucas is also diagnosed with PANS which I talk about here and can also trigger sudden onset problem behavior.  

But as I tell Dr. Vollmer, it is all really complicated and although we agree that this should be researched, it is clear that parents noticing and tracking these problem behaviors and how they may be associated with pain is a really helpful step. I talk about how you can track these problem behaviors with a calendar here.

Frequently Asked Questions About Problem Behaviors

How to stop self injurious behavior autism? 

Self injurious behavior (SIB) is usually very complex and needs medical and behavioral assessments.  Using the 4 steps of the Turn Autism Around® approach; assessment, planning, teaching and using easy data will help you with preventative strategies you can put in place.  My online courses will help you learn how to complete these 4 steps to help problem behavior. Sign up for a free workshop.

Can medication help with problem behavior?

It depends on your individual child, but in many cases the right medication can help.  I discussed medications and autism with psychiatrist, Dr. Michael Murray here.

Can nutrition help with problem behaviors?

Potentially, especially if an individual’s diet is causing them digestive pain. Check out this podcast with a functional medicine nutritionist on common nutrition interventions.

You can make a difference for your child or client with autism or signs of autism through free training!
Attend a FREE Workshop!