Self Injurious Behaviour and Autism

Best Practice

We have identified a number of organisations that have published best practice guidance on challenging behaviours.

Social Care Institute for Excellence (SCIE)

The Social Care Institute for Excellence (SCIE) is an independent charity that promotes good practice in social care services for adults and children throughout the UK.  The following is a summary of some of the key points from its guidance on challenging behaviours in adults (2010).

• Challenging  behaviours can usually be prevented or reduced if the right kind of support is provided
• Support should be flexible and personalised to the needs and circumstances of individual families
• Support should be available from the behaviour support team or  equivalent service [such as the local autism team if it exists]
• A comprehensive behaviour assessment should include: a functional assessment of behaviour, a medical health check, a mental health check, a communication assessment, and an assessment of any social and environmental factors that may affect behaviour.
• A behaviour support plan should be developed, setting out what is likely to trigger the behaviour and how families and services should respond.

NICE Guidance

The National Institute for Health and Care Excellence (NICE) is a UK government body which supports healthcare professionals and others to make sure that the care they provide is of the best possible quality and offers the best value for money.

NICE has not published any specific recommendations on treating self injurious behaviours in people on the autism spectrum. However it has published recommendations on treating challenging behaviours – which includes self injurious behaviours – in people on the autism spectrum.

The following is a summary of the NICE guidance on challenging behaviours in people on the autism spectrum (2012, 2013).

Before initiating other interventions for challenging behaviour, you should address any identified factors that may trigger the behaviour by offering:

• the appropriate care for physical disorders
• treatment for any coexisting mental disorders
• Interventions aimed at changing the physical or social environment.

Once you have tried these, you may need to consider a psychosocial intervention.  When deciding on the nature and content of a psychosocial intervention, use a functional analysis. The functional analysis should facilitate the targeting of interventions that address the function(s) of problem behaviour(s).

In addition to the functional analysis, base the choice of intervention(s) on:

• the nature and severity of the behaviour
• the person’s physical needs and capabilities
• the physical and social environment
• the capacity of staff and families, partners or carers to provide support
• the preferences of the person with autism (and family, partner or carers)
• past history of care and support.

Psychosocial interventions for challenging behaviour

Psychosocial interventions for challenging behaviour should be based on behavioural principles and informed by a functional analysis of behaviour.

They should include:

• clearly identified target behaviour(s)
• a focus on outcomes that are linked to quality of life
• assessment and modification of environmental factors
• a clearly defined intervention strategy
• a clear schedule of reinforcement, and capacity to offer reinforcement promptly and contingently on demonstration of the desired behaviour
• a specified timescale to meet intervention goals
• a systematic measure of the target behaviour(s) taken before and after the intervention to ascertain whether the agreed outcomes are being met.

Combined interventions for challenging behaviour

Consider antipsychotic medication in conjunction with a psychosocial intervention for challenging behaviour when there has been no or limited response to other interventions.  Antipsychotic medication should be prescribed by a specialist and quality of life outcomes monitored carefully. Review the effects of the medication after 3–4 weeks and discontinue it if there is no indication of a clinically important response at 6 weeks.

Updated

02 Nov 2017