Dealing with Head Banging Behavior in Children: Expert Guidance

Head banging caselet Expert advisor : Parul Gupta Varun is 8 years old and recently started having trouble going to bed. He has recently started banging his head and being self-injurious and does it several times a day. Mom and dad try to read him books and calm him down, but nothing is working. How should a parent handle this situation?

Head banging caselet Expert advisor : Parul Gupta To address this issue let us start with a few questions to the parents/caregivers. A thorough analysis of the factors that might play a role in Varun's self injurious behaviour, will help us understand and address the same. Careful observation of the child s behaviour When is this behaviour observed? Does it happen at a specific time? What is the frequency of the incident (how many times during the day?) How long does it last? During the episodes is the child mindful of the happening? If the child is aware of his doing, does he choose a surface to bang on? Does he bend forward or bangs his head from behind? If he bangs his head behind, is he aware of the happenings, does he responds to his parents' calls? Do you observe any changes in his facial expressions? If yes, what do the expressions look like? How does it usually end? Why do these observations matter? They matter in order to understand the root cause of his expression through this behaviour

Head banging caselet Expert advisor : Parul Gupta Possible scenarios that may cause Varun to react by banging his head Notice a preference for a SURFACEthat Varun chooses to bang his head on? Is the surface hard? He maybe doing it to fulfill his proprioceptive/sensory needs SENSORYNATUREOFTHESELF-INFLICTINGBEHAVIOUR

Head banging caselet Expert advisor : Parul Gupta Now that you have identified the sensory nature of Varun s behaviour, what do you do? Short term Go to a Psychologist to understand if the child has sensory processing challenges and whether this behaviour is indeed an outcome of seeking sensory input (here proprioception) Go to an Occupational therapist (OTist) and learn some home tips to fulfil the sensory need in an appropriate manner for the immediate short term. Practice at home - A few safer alternatives can be : Using a soft cloth, stretchy band and or an elastic band that can be used to provide the pressure needed. Look for safety precautions to minimise injury Long Term Visit an OTist Understand the child s sensory needs Teach the child to understand his sensory needs Teach the child to ask for help to achieve his sensory needs Teach the child how to seek the necessary sensory input without self inflicting injury. Note : Please refrain from putting your child on a so called sensory diet plan. Treat behavior modification through behavior intervention only.

Head banging caselet Expert advisor : Parul Gupta Possible scenarios that may cause Varun to react by banging his head Notice that Varun is FULLYAWAREof his behavior and closely observes his parents when engaging in self harm. While head banging Varun is OBSERVING the reaction of people He is aware of the behaviour, and hence chooses a soft surface to bang his head on Engages in head banging as a means to a chosen outcome going out, getting icecream, get hugs COMMUNICATIONCHALLENGES DESIRESEXPRESSEDTHROUGHSELF-INFLICTINGBEHAVIOUR

Head banging caselet Expert advisor : Parul Gupta Now that you have identified the communication challenges as the root cause of Varun s behaviour, what do you do? Short term Go to a Speech/communication therapist for immediate guidance Explain to the child that communicating his/her displeasure with anything must be communicated (verbal) or pointed to using a communication board (non-verbal child) Long term Under the coaching of a Behaviour therapist, the child can be taught to better convey/communicate his feelings. This would help in minimising such attention seeking behaviour. Once effective communication is established, the Behaviour therapist can work on emotional regulation and task compliance skills.

Head banging caselet Expert advisor : Parul Gupta Possible scenarios that may cause Varun to react by banging his head Varun has trouble regulating his emotions and becomes angry and has a meltdown. While he may seek attention by engaging in the behaviour, at the same time he is unable to regulate the outcome of his emotions. Refuses any help handed out to him and expresses his emotions by inflicting harm Appears very frustrated EMOTIONALREGULATIONISIMPAIRED : EXPRESSEDTHROUGHSELF-INFLICTINGBEHAVIOUR

Head banging caselet Expert advisor : Parul Gupta Now that you have identified emotional regulatory issues as the root cause of Varun s behaviour, what do you do? SHORT TERM: Go to a Psychologist Bridge the communication gap This can be achieved through speech sign gestures picture exchange. LONG TERM: Teach the child to ask for alternatives to such behaviour Improvement in communication skills will help in regulating the child s emotions, as emotional regulatory issues are closely linked to communication challenges.

Head banging caselet Expert advisor : Parul Gupta Possible scenarios that is causing Varun to react by banging his head Varun appears frustrated and helpless Lashes out for no apparent reason has a meltdown To drive his caregiver s attention towards his bodily discomfort Discomfort due to medical reasons - Allergies, toothache, ear ache, stomach issues or heavy sinuses MEDICAL PROBLEMS COMPOUNDED BY LACK OF ABILITY TO COMMUNICATE EXPRESSEDTHROUGHSELF-INFLICTINGBEHAVIOUR

Head banging caselet Expert advisor : Parul Gupta Now that you have identified medical issues as the root cause of Varun s behaviour, what do you do? SHORT TERM: Go to a Pediatrician/General physician Teach the child to ask for help when having bodily discomfort This can be achieved through speech sign gestures picture exchange. LONG TERM: Improvement in communication skills will help communicating bodily discomfort without resorting to behaviour outbursts.