When children hurt themselves
What to do in the moment; how to address the deeper pain
Some children with autism and developmental disabilities harm themselves — banging their heads or biting or hitting themselves.
Felicia Jervis is an educator and social worker who encourages parents to trust their instincts and soothe, comfort and reassure their children during these episodes. BLOOM interviewed Felicia — who began searching for answers while raising her son with autism — to learn about compassionate practices that can be used with children who self-injure.
What causes self-injury?
One thing parents can be certain about is the child is communicating about pain — physical or emotional pain. It could be physical discomfort that the child can’t verbalize — such as a headache, earache or uncomfortable clothing — or discomfort with sounds and smells. More importantly, it could be emotional pain that comes from living in a world where you’re not always welcome, often misunderstood and excessively controlled. Children with developmental disabilities are often denied an ordinary life of playing and learning alongside other children. The impact of that exclusion — the pain of isolation, boredom and rejection — is underestimated.
How has self-injury been handled traditionally?
By trying to control and eliminate it, and often that is done with intrusive and controlling methods such as physical and chemical restraints, reprimands, consequences, threats, punishment and isolation in time-out rooms.
How would you describe your approach?
We begin with the understanding that self-injury is an expression of pain, so the aim is to comfort, soothe and reassure the child. We must help children not only to be physically safe, but to feel safe emotionally. This involves connecting with the child rather than controlling, and learning the specific practices of peaceful presence, deep listening, taking care of our anger, patience, companionship, gratitude and — most of all — maintaining a joyful mind.
What are helpful responses?
To comfort and reassure the child we need to become calm and get in touch with the joy in our hearts. The louder the child is, the quieter we are. The more intense the child is, the softer we are. We need to smile, to reassure, to use our hands to soothe, comfort and embrace, rather than control. Offer good things to eat and drink, and speak in reassuring words. “I love you. You are such a wonderful boy. I’m sorry you’re not feeling well. I want to help you feel better. Could I sit with you? Would you like a hug? I love being with you.” Think of something you know your child would find very comforting and give it unconditionally.
What doesn’t help?
Reprimands, threats, consequences, punishments and restraints. Words like “no,” “don’t,” “stop it,” and “that’s inappropriate” are experienced as painful rejection and can provoke further self-injury or aggression. One simple suggestion I share with parents is to stop using the words “no” and “don’t” and replace them with loving and encouraging words.
Why do consequences not work?
Consequences hurt. These children already pay dearly for living in a world that doesn’t welcome or understand them. Why would we want to add to their pain?
If a child can’t speak, how do parents figure out what the physical pain is?
Most moms and dads are experts at reading their children. If a child is smashing his head and you have a sense he has a headache, you might offer pain medication approved by your doctor. If the child is anxious, often the hands and feet become cold and clammy and warming them up — with a cozy blanket, heating pad, or by running a warm bath — can make a big difference. Being upset and agitated is draining and the child may be hungry. Sometimes a little snack works wonders. The simple act of paying attention and being available in a loving and joyful way calms both parent and child.
What changes can parents expect?
Parents tell me their homes become a lot more calm, peaceful and joyful. Usually the child will relax and settle within minutes of being calmed. But it’s misleading to imply there’s a quick fix to this problem.
Staying calm sounds difficult. Is it?
It is in the sense that it takes daily discipline and practice. Becoming calm takes awareness that we may be agitated, fearful and angry, and it takes the intention to practise being peaceful instead. But I find that parents get it really fast. And that’s for two reasons: one, the need is desperate, and two, they love their child so profoundly. Being calm and peaceful is not something we have to learn but something we have to practice and allow to surface. Often our capacity to be calm is buried under the weight of very difficult daily challenges. Most important, parents need to take it easy on themselves and not judge themselves when they don’t stay calm. It’s very difficult to stay calm consistently under these circumstances. Parents are not to blame!
How do we address the emotional pain behind self-injury?
We need to look deeply at all the ways that our children are hurting because they are left out and deprived of opportunities to participate in ordinary life. Just because children have developmental disabilities doesn’t mean they don’t have a profound desire to exercise personal autonomy and to belong with others. In spite of serious communication challenges, our children have important things to say — often without words. All children have the need to be heard and to feel welcome and included. Hope lies in our capacity to understand that children are much more than their pain and suffering and that we can help them find the joy within their hearts. To do this we need to practise peacefulness, help children feel safe and loved, and ensure all children enjoy a full life where they can play and learn alongside other children.
More on compassionate practices
Felicia Jervis’s teachings are informed by a number of mentors, including Pema Chodron, Thich Nhat Hanh, John McGee, Jean Vanier and Wolf Wolfensberger.
‘The impact of
exclusion — the
pain of isolation,
rejection — is