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Wednesday, October 26, 2016

Arm Biting

One of Janey's most consistent challenging behaviors is her biting of her own arm.  It's always her right upper arm.  She raises it to her month and bites the same spot.  It happens any time she is upset, and many times when she's not really upset, but overexcited or wound up in other ways.  The bite varies a lot in strength.  It can range from almost more like sign language with no real biting at all to actually biting down very hard on her skin.  She almost never breaks the skin, but she bites hard enough so she has a permanent hard area of callus where the teeth hit her arm.

The biting started quite suddenly when Janey was around eight.  One Friday, she came home from school with a bruised area on her upper right arm.  We had no idea what it was from until she got upset that weekend and started biting herself right where the bruise was.  From that point on, it's happened at least once a week, sometimes once a day, or hour, or in the worst times, a minute.

I think the biting is sometimes a release, a way to let off tension, and it's sometimes a way to communicate anger or annoyance at us.  When it's mild, I can see just ignoring it or using it as a starting point for discussion---"You are biting your arm.  Do you feel angry?"  However, when it's more severe, it truly hurts her.  This past weekend, when she was crying, I asked her if something hurt, and she said "Does your arm hurt?"  When I asked her to point at the hurty place, she pointed right at the biting area.  It made me feel a huge wave of sadness, thinking about her causing herself pain.

I have very few ideas for stopping the biting.  We've tried a lot of things---an ace bandage over that part of her arm, calling her attention to the biting and asking her to stop each time we see it, behavior plans here and at school, any number of millions of different bite toys, chewable jewelry, fidget toys, even bite-able toys meant for dogs.  Nothing stops the biting.  It seems like part of the whole routine for her is feeling the teeth on her skin.

Why does Janey bite her arm?  I have some theories.  One is that she learned she couldn't bite other people.  It's sad to think she then turned to herself.  If she feels angry enough to bite, and she knows biting other people will cause a big huge scene she wants to avoid, she bites herself.  In thinking about that, I've tried a few times making a big scene when she bites herself, but that hasn't seem to work at all.  Another theory is that the biting has become a habit, like nail biting or hair twirling or something.  But it doesn't happen when she's just bored or doing nothing else.  I've never seen her bite when she wasn't at least a little upset.

Searching the good old internet for ideas about biting is as often not that useful.  It so often seems everyone giving advice goes to their own corner and gives advice based on their own theories.  And often, the "expert" advice seems to assume that the parents have never tried a thing.  Ignoring her?  Figuring out the cause of the biting?  Giving her something else to bite?  Gee---neither her school or us have ever thought of anything like THAT!  It's very frustrating.

A problem with the biting beyond it hurting Janey is that it seems like self-injurious behavior is where a lot of programs draw the line at working with kids.  It's one of the most common questions I've seen on screening-out type applications.  And I can understand that.  It's a scary, awful thing to see at its worse, and I am sure sometimes there's also a worry that we as parents will think that Janey was somehow hurt by someone other than herself.  But it leads to more isolation.

Like with so many other areas of autism, we just keep doing what we can do about the arm biting.  We cobble together various ideas.  We try to keep her happy, which is the best way to keep her from biting.  We talk to her about it, and hope she understands some of what we are saying.  We work hard to calm her when she's upset or overexcited.  And we offer our ears, ideas and thoughts to anyone else dealing with seeing a child they so love hurt themselves.


emvelez said...

It's self stimulation. I had a young autistic client who has to wear a helmet because of hitting his head, rubbing the back of his neck raw. He also has a plastic chew thing in his mouth all the time.

emvelez said...

Btw, he lives at Crystal Springs in assonet, MA which does amazing things with the kids and adults in their programs.

Kirsty said...

I know I'm late here, but as a young autistic woman, I can tell you why I bite my arms sometimes. I agree with a lot of the ones you posted, and I doubt I can say anything you haven't heard, plus I have a lower level of impairment compared to Janey, but you never know! Sometimes it's just self stimulation like emvelez said, because to be honest, biting feels good to me! I like the feeling of biting the flesh on my arm, and the "pain" of the bite doesn't feel like typical pain to me. It feels GOOD and it feels like a RELEASE. When I'm agitated, I feel like I absolutely HAVE to RELEASE some kind of anger or energy in the form of moving or screaming or biting etc. Sometimes when I want to scream, I can get a similar kind of release by biting down on my arm really hard. I think I've read that Janey may not have huge problems with sensory stuff, or maybe I've gotten that completely wrong, if so - sorry! I have sensory problems, and when I am in a very stimulating, *painful* environment, sometimes I will bite my arms because the "pain" of the bite makes the pain in the room less intense, a bit like if you have a papercut and then intentionally break your wrist... the wrist pain will probably drown out the papercut pain. Again in a stimulating environment, biting my arm 1-3 times or so sometimes has the effect of "snapping me back" into reality, a bit like a pinch or being under cold water would. But, like most other stims, if I repeatedly do it, I will end up being more zoned out/in my own world. It feels good to stim and get into that zone, because everything around me suddenly seems to fade out a bit and I feel calmer. So, basically... that thing you're doing, guessing all these different reasons? I bet that lots of them could be correct, at different times! Personally, I have never done it as a form of communication, but, I also have the ability to communicate quite effectively. Maybe if I were non-verbal like Janey, I'd also use it for that purpose. Another thing, is that sometimes when I'm agitated, I will *automatically* bite my arm without thinking about it or intending to, meaning, it's kind of like a compulsion or some kind of reflex in response to my emotions.

Kirsty said...

Oh also, you're probably spot on with why your attempts haven't worked. I have also tried chewy necklaces, bracelets, toys. They are fun to chew sometimes but when I am biting out of frustration/agitation etc, they are useless because they don't give me the "pain" on my arm! And they're still not as good as my arm, ever. A counselor once suggested I use an elastic band but that was useless.

The only thing that's helped me indirectly is an inflatable deep pressure vest, one of those Squeez ones. Sounds random and again, I'm sure you've heard/tried it all by this point! But it helped reduce my biting, personally, so maybe someone else reading could benefit. They describe it as like getting a "hug" but I think I also kind of experience it as I'm getting a firm body "bite" or something!