Self-harm is an extremely difficult, emotive topic, that is very distressing for parents. It is also a topic that is unfortunately quite common working with autistic young people. Autistica estimate that up to 50% of autistic people have self-harmed. (https://www.autistica.org.uk/what-is-autism/anxiety-and-autism-hub/self-harm-and-autism) No-one wants to find that their child is self-harming, and as a parent it is incredibly difficult to know what to do, how to respond, what to say – you want to stop it, but do not know how. Our own responses can be difficult to manage, our emotions can spill out and be hard to control, and support is not always available for us. This is a very painful, difficult, frightening situation and one that is hard to understand. There is no right or wrong response, there is only your response. We are all human, and I think that the emotional pain and shock at discovering your child is self-harming makes it difficult for anyone to have a calm, measured response. Do not beat yourself up if you think you did not handle it well, I doubt any parent congratulates themselves on how they handle this situation.
Research has identified a range of reasons why autistic young people self-harm, including the following:
- To manage overwhelming emotions, which are extremely unpleasant and hard to bear.
- To shock themselves out of intolerably strong emotions.
- To feel something when they are cut off from their emotions and feel numb.
- Many autistic people have difficulties recognising how they are feeling and using language to describe and tell people how they feel. Self-harm can be a way to communicate that they are suffering when it is difficult to use other means.
- To reduce stress and pressure. Every-day life can be extremely stressful for many autistic people. We live in a predominantly neurotypical world that does not always accommodate different neurotypes, e.g., Attention Deficit Hyperactive Disorder, Tourette’s, Autism, Dyslexia, Dyspraxia. Neurodivergent people often have to continually adapt to accommodate differences in many areas of their life, which is exhausting and can be overwhelming. For example, they have to work hard to filter out background noises so that they can focus on what someone is saying, to manage difficult sensory experiences, to respond in expected ways which might not be as instinctive as they are for other neurotypes. Managing uncertainty, unplanned events and experiences, transitions and changes can be extremely stressful, and many people do not have sufficient time to recover from stressful, tiring experiences and to rebuild their energy reserves. This can result in becoming completely overwhelmed and losing control. Self-harm is sometimes used as a way to stop and control meltdowns.
- To punish themselves. Self-hatred and perfectionism can result very negative self-perceptions that are a factor in self-harming behaviours.
How can I stop my child self-harming?
Self-harm can be very dangerous, especially when young people do this in a state of high emotions and extreme agitation and distress. Although this is difficult for parents to see and hear about, it is better to know that your child is self-harming than not know. If you find evidence of self-harm, it will be very difficult for you to manage your response as this is so upsetting. However, it is very important that you do not acknowledge what is happening, or talk about this with your child until you can control what you say and how you say it as strong emotional responses might agitate and distress your child even more and make them feel even worse about themselves and what they are doing. It might lead to more secretive behaviours, and this makes it more risky.
- Timing: Wait for a time when you feel that you can manage your emotions and when you can see that your child is calm and not stressed, use this time to tell them that you love them, and you know that they are finding life very difficult at the moment.
Say this at time that you are alone together, and you are both relaxed and calm. Try to use this time to talk to your child as a regular time so that it becomes a special time that you share together.
- Expectation: Do not expect a response, do not expect them to say anything back to you. If they do not reply to anything you say, accept this, do not try to make them say anything. This is a difficult situation, and you want to reduce as much pressure as possible.
- Language: avoid asking lots of questions and trying to find out more information about self-harming. Questions can put pressure on young people, and they can make it harder for your child to stay calm and share thoughts and feelings with you.
Comment and share information to normalise and reduce pressure. For example, “I am really sorry things are so hard. I wish I could make it better so that you would be happier” instead of “What’s wrong? Why are things so hard? What can I do to help?”
Pause before you say more so that you do not overwhelm your child with language. This is an emotional time and we do not want to increase anxiety and trigger loss of control.
- Observation: notice your child’s body language, facial expressions, tone of voice, etc. so that you can match what you say and do to what they can manage. For example, if you see that they tense up, look and sound upset, change what you are doing to try to reduce stress.
- Window of Tolerance: Notice their window of tolerance (what they can cope with) and be careful not to take them out of this, match what you do to what they can tolerate.
Do not say more than your child can manage, you probably won’t be able to have a long conversation about self-harm straight away. Acknowledge your child is finding life hard, that you love them, that you want to help them. That might be enough to start with.
- Use this time when you are together to share experiences that you had as a child/teenager which were very difficult to manage to normalise this. Always watch for your child’s response to help you see if they are getting stressed, etc, and to see if you need to stop or adapt what you are saying.
- Think about what might be increasing stress for your child and try to make adaptations at home to reduce these, e.g., be mindful of placing demands on your child, expecting more than they can do, putting pressure on them to do things that are outside their window of tolerance at the moment. Make sure that the sensory environment is manageable for them, e.g., reduce noise, bright lights, etc.
Emotions: Many autistic people have difficulty recognising how they feel, and using language to name, describe and communicate emotions (as described above).
- Asking them how they feel can put pressure on them and increase stress as they might not know.
- They might not recognise how they feel until their emotions are very strong and hard to manage – this can be a trigger for self-harming behaviour, especially if they are in a situation where they cannot lose control, e.g., at school.
- Notice what might be increasing stress at home, e.g., noise, uncertainty, unplanned events, and experiences, too much language and too much information, sensory experiences, expectations, demands – spend time noticing and then think about what you can change to reduce pressure.
For example, change the language you use so that instead of asking them to do things, such as go on a walk with you, say you are going for a walk at 2, if they want to come, they can, but no problem if they don’t want to. There is some great information on changing language we use to reduce demands here: https://www.pdasociety.org.uk/life-with-pda-menu/family-life-intro/helpful-approaches-children/