Self-Injury in Autism: Causes, Safety and Support for Parents

Self-injury in autism is common, and it is not your fault. When an autistic child bangs their head, bites or scratches, the behaviour is usually telling you something, such as pain, overload or frustration. A medical check, careful detective work and the right support can help make it less frequent and less severe.

What is self-injurious behaviour?

Self-injurious behaviour (SIB) means actions that can cause harm to a person’s own body. Examples include head banging, hand biting, hitting, scratching, hair pulling and skin picking. It is different from the self-harm some teenagers do to cope with painful feelings, covered below.

How common is self-injury in autism?

A 2020 meta-analysis pooled 37 studies with 14,379 autistic people. It estimated that 42% had shown self-injury [1]. Hitting with the hand was the most common form (23%). Self-cutting was the least common (3%). Girls and women had higher rates than boys and men [1].

A large US study of records for 8,065 autistic children found SIB noted in 27.7% [2]. The authors say clinicians should ask about self-injurious behavior in autism during assessments [2].

Who is more likely to self-injure?

Caroline Richards, Chris Oliver and colleagues at the University of Birmingham have studied this closely. In one study of 149 autistic people, half had self-injured in the past month [3]. Self-injury was linked with:

• Lower everyday living skills[3].
• Less spoken language[3].
• Impulsivity and overactivity, though these links were weak [3].
• Low mood[3].

The study recruited through parent groups, so it may not represent everyone [3]. The same group followed 67 people for 3 years. Self-injury had continued in 77.8%, and impulsivity and social difficulties predicted it lasting [4]. Over 10 years, it lasted throughout in 44%, which the authors say supports early help [5]. A US study also linked SIB with sleep problems, gut problems and sensory differences [6].

Why autistic children self-injure: rule out pain first

Many autistic children cannot easily tell you where it hurts, so pain may come out as behaviour. A UK parent guide on pain lists common hidden causes in children with intellectual disability [7]:

• Reflux. Signs can include bad breath and tooth grinding [7].
• Constipation. This is easy to miss.
• Middle ear infections.
• Tooth decay and dental pain.

The guide notes that self-injury and aggression go up when children are ill with a fever or upset stomach [7]. A US expert panel warned that problem behaviour may be the main or only sign of a medical problem, including gut problems [8]. NICE says to assess pain and gut problems in autistic children whose behaviour challenges [9]. So if your autistic child’s head banging suddenly increases, see a doctor first.

Other common reasons

Once pain is ruled out, the behaviour usually meets a need. The Challenging Behaviour Foundation lists these common purposes [10]:

• Sensory needs. The feeling itself may be rewarding. See our guide to sensory processing.
• Communication. Getting attention, an object or an activity.
• Escape or demand avoidance. Getting out of a task or place.
• Frustration. For example, when needs are not met quickly enough.

One behaviour can mean different things at different times [10]. An autistic child biting themselves at school may be escaping a task, while at home it may mean tooth pain.

Functional assessment and positive behaviour support

A functional assessment describes the behaviour, finds when it does and does not happen, and works out what keeps it going [9][11]. NICE CG170 says support based on this assessment should be first-line treatment when no medical or environmental trigger is found [9].

This leads to a written behaviour support plan, part of positive behaviour support (PBS). NICE NG11, written for people with a learning disability, says a plan should include [11]:

• Prevention. For example, less noise and a more predictable day.
• New skills. A different way to meet the same need.
• Early calming. Relaxation and favourite activities at the first signs of distress.
• A safety plan. Using the least restrictive option first.

NICE also says not to offer sensory programmes before a functional assessment of your child’s sensory profile [11]. The Challenging Behaviour Foundation says PBS has the best evidence base for self-injury [10].

Teaching another way: functional communication training

Functional communication training (FCT) teaches your child an easy way to get what the behaviour was getting, such as a “break” card or a button on a communication device. In a study of 30 children aged 10 months to almost 5 years, head banging was the most common form of SIB, and it began at 17 months on average [12]. Assessment found what kept the SIB going in 62.1% of children, and FCT was the treatment chosen most often (70.8% of treated cases) [12].

A 2025 meta-analysis of 34 studies with 79 autistic children aged 2 to 8 found large reductions in challenging behaviour with FCT [13]. But be aware of the limits. These were small single-case studies, and only 29.4% met strict quality standards [13]. Ask a trained professional to design it and coach you.

Medication for self-injury in autism

In the US, risperidone and aripiprazole are FDA approved for irritability linked with autism. The risperidone label describes irritability as including aggression, deliberate self-injury, temper tantrums and quickly changing moods. It was tested in children aged 5 to 16 [14]. Aripiprazole is approved for ages 6 to 17 [15]. See our medication guide.

Evidence for self-injury itself is thin. A 2023 Cochrane review found that this group of medicines (atypical antipsychotics) probably reduces irritability. For self-injury, only one small study of 30 people could be used, and the evidence was low certainty [16]. The review also found more sleepiness, dizziness, tremor and increased appetite [16]. NICE advises that a specialist starts the medicine, reviews it after 3 to 4 weeks and stops it if there is no clear benefit at 6 weeks [9]. NICE also says antipsychotics should only be used together with psychological or other support [11].

New in 2026: a pilot trial of deep brain stimulation in 6 children with profound autism and severe, treatment-resistant SIB reported lasting reductions, but one child had a device infection [17]. A blinded trial of 25 children is planned [18]. This is experimental, not a routine option.

Keeping your child safe in the moment

• Stay calm. Use few words and a soft voice.
• Make the space safer. Move hard objects and offer a cushion.
• Reduce triggers. Pause demands and lower noise and light.
• Offer the replacement. Hold up the break card your child is learning.

Use helmets, padding or splints only with professional advice. They do not address the reason for the behaviour, may not prevent injury, and a child may start hurting a different body part [10]. Our guide to meltdowns has more calming ideas.

Keep an ABC chart

An ABC chart helps find patterns, which is what NICE asks a functional assessment to do [11]. Each time, note:

• A for Antecedent. What happened just before? Time, place, noise, a request?
• B for Behaviour. What did your child do, and for how long?
• C for Consequence. What happened next? A break, attention, comfort?
• Extras. Sleep, meals, bowels, illness and new medicine.

Take the chart to every appointment.

Looking after yourself

Watching your child hurt themselves is deeply upsetting, and parents describe long-term stress and exhaustion [10]. You deserve support too. NICE says families should be offered an assessment of their own needs, plus information, training and short breaks [9]. In the UK you have a right to a carer’s assessment, and NICE suggests parent-training programmes for children under 12 with a learning disability [11]. See our guide to parent burnout and siblings.

When self-injury in autism needs urgent help

Self-injury can cause wounds that do not heal, head injuries and eye damage [10]. In the UK, the NHS says to call 999 after a head injury if your child [19]:

• Loss of consciousness. Was knocked out, or cannot stay awake.
• Seizure. Has a fit.
• New problems. With vision, hearing, walking, balance or speaking.
• Fluid or bleeding. Clear fluid from ears or nose, or bleeding from ears.
• Behaviour change. More irritable or distracted than usual.

Call NHS 111 for vomiting or dizziness after a head injury [19]. In the US, call 911 or your pediatrician. Also get prompt help for eye injuries, infected wounds or a sudden big rise in self-injury.

Self-injury versus self-harm in autistic teens

Repetitive SIB such as head banging is usually different from self-harm, such as cutting [10]. A 2021 review of 31 studies found autistic people had higher odds of both self-injury and suicidal thoughts or attempts than non-autistic people [20]. If your teen says they want to die, or you find signs of hidden self-harm, take it seriously and get help the same day.

If you are worried about your child’s or your own safety right now, in the US you can call or text 988, any time [21]. In the UK, call NHS 111 and select the mental health option, or call Samaritans free on 116 123. Call 999 if a life is at risk [22].

When to talk to a professional

Seek help early, as early support may stop things getting worse [10]. Questions to ask:

• Medical. “Can we check for ear, dental, gut, reflux or sleep problems?”
• Assessment. “Can we have a functional assessment and a written behaviour support plan?”
• Communication. “Can a speech therapist help my child ask for breaks?”
• Safety. “What is our plan if it gets worse?”
• Medicine. “What are the side effects, and when will we review it?”

See also our guide to aggression.

Frequently asked questions

Why does my autistic child bang their head?

Head banging usually serves a purpose. It may signal pain, like an ear infection or toothache. It may also give sensory input, block out overload, get help or a break, or show frustration when words are hard. A doctor’s check comes first. A professional can then do a functional assessment to find out what the behaviour does for your child and teach a safer way to meet that need.

How can I stop self harm in my autistic child?

Start with a medical check to rule out pain. Keep an ABC chart to spot patterns, and reduce known triggers such as noise, hunger, tiredness or sudden changes. Ask for a functional assessment and a behaviour support plan. Teach a quick way to ask for help or a break. Stay calm during episodes. Change takes time, so look for steady progress rather than overnight results.

Should my child wear a helmet?

A helmet or other protective equipment is sometimes needed when self-injury is severe and the risk of injury is high. It should only be used with professional advice and as part of a wider plan. Equipment does not fix the reason for the behaviour, and your child may start hurting a different part of their body. Ask your team how and when to use it and how to reduce it over time.

Will my child grow out of self-injury?

Some children do improve, especially with early, well-planned support. For others it can last for years, and research shows it can be persistent. That is why it is worth getting help early rather than waiting. Treating pain, building communication and adjusting the environment can all make a real difference. Small, steady steps forward are real progress.

Is self-injury in autism the same as self-harm?

Usually not. Repetitive self-injury, such as head banging or hand biting, often links to pain, sensory needs, communication or distress. Self-harm in teenagers is usually done in private to cope with painful feelings, and it can be linked with suicidal thoughts. Both need care and support. If your child talks about wanting to die, treat it as urgent and get help the same day.

References

1. Steenfeldt-Kristensen C, Jones CA, Richards C. The prevalence of self-injurious behaviour in autism: a meta-analytic study. J Autism Dev Disord. 2020;50(11):3857-3873. doi:10.1007/s10803-020-04443-1 Link
2. Soke GN, Rosenberg SA, Hamman RF, et al. Brief report: prevalence of self-injurious behaviors among children with autism spectrum disorder: a population-based study. J Autism Dev Disord. 2016;46(11):3607-3614. doi:10.1007/s10803-016-2879-1 Link
3. Richards C, Oliver C, Nelson L, Moss J. Self-injurious behaviour in individuals with autism spectrum disorder and intellectual disability. J Intellect Disabil Res. 2012;56(5):476-489. doi:10.1111/j.1365-2788.2012.01537.x Link
4. Richards C, Moss J, Nelson L, Oliver C. Persistence of self-injurious behaviour in autism spectrum disorder over 3 years: a prospective cohort study of risk markers. J Neurodev Disord. 2016;8:21. doi:10.1186/s11689-016-9153-x Link
5. Laverty C, Oliver C, Moss J, Nelson L, Richards C. Persistence and predictors of self-injurious behaviour in autism: a ten-year prospective cohort study. Mol Autism. 2020;11:8. doi:10.1186/s13229-019-0307-z Link
6. Soke GN, Rosenberg SA, Rosenberg CR, Vasa RA, Lee LC, DiGuiseppi C. Self-injurious behaviors in children with autism spectrum disorder enrolled in the Study to Explore Early Development. Autism. 2018;22(5):625-635. doi:10.1177/1362361316689330 Link
7. Cerebra. Pain: a guide for parents. Cerebra and the Cerebra Centre for Neurodevelopmental Disorders, University of Birmingham; 2019. Link
8. Buie T, Campbell DB, Fuchs GJ, et al. Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: a consensus report. Pediatrics. 2010;125(Suppl 1):S1-S18. doi:10.1542/peds.2009-1878C Link
9. National Institute for Health and Care Excellence. Autism spectrum disorder in under 19s: support and management (CG170). 2013, updated 2021. Link
10. The Challenging Behaviour Foundation. Self-injurious behaviour (information sheet). Reviewed January 2023. Link
11. National Institute for Health and Care Excellence. Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges (NG11). 2015. Link
12. Kurtz PF, Chin MD, Huete JM, et al. Functional analysis and treatment of self-injurious behavior in young children: a summary of 30 cases. J Appl Behav Anal. 2003;36(2):205-219. doi:10.1901/jaba.2003.36-205 Link
13. Blair KC, Park EY, Risse MR. A meta-analysis of functional communication training for young children with ASD and challenging behavior in natural settings. Behav Sci (Basel). 2025;15(12):1688. doi:10.3390/bs15121688 Link
14. Janssen Pharmaceuticals. RISPERDAL (risperidone) prescribing information. DailyMed, US National Library of Medicine; label revised 2026. Link
15. Otsuka America Pharmaceutical. ABILIFY (aripiprazole) prescribing information. DailyMed, US National Library of Medicine; label revised 2025. Link
16. Iffland M, Livingstone N, Jorgensen M, Hazell P, Gillies D. Pharmacological intervention for irritability, aggression, and self-injury in autism spectrum disorder (ASD). Cochrane Database Syst Rev. 2023;10:CD011769. doi:10.1002/14651858.CD011769.pub2 Link
17. Mithani K, Breitbart S, Dinger T, et al. Deep brain stimulation of the nucleus accumbens for severe self-injurious behaviour in children: long-term outcomes from a first-in-human pilot trial. Mol Psychiatry. 2026;31(11):6413-6421. doi:10.1038/s41380-026-03710-4 Link
18. Mithani K, Sauter S, Hagopian LP, et al. Electrical stimulation of the nucleus accumbens for severe, refractory self-injurious behaviour in children (EASE-SIB): protocol for a randomised double-blinded crossover trial. BMJ Open. 2026;16(4):e110222. doi:10.1136/bmjopen-2025-110222 Link
19. NHS. Head injury and concussion. NHS website. Link
20. Blanchard A, Chihuri S, DiGuiseppi CG, Li G. Risk of self-harm in children and adults with autism spectrum disorder: a systematic review and meta-analysis. JAMA Netw Open. 2021;4(10):e2130272. doi:10.1001/jamanetworkopen.2021.30272 Link
21. 988 Suicide and Crisis Lifeline. 988lifeline.org. Link
22. NHS. Where to get urgent help for mental health. NHS website. Link

Professional review: this guide is waiting for review by a qualified clinician. It was written and checked against the published sources listed above. How we check our guides.

This guide is general education, not medical advice. Always talk to your child’s doctor or care team. Last checked: October 2026.