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Self-Injury in a 5yr Old. DO NOT WANT.
May 24, 2010 10:35 AM   Subscribe

Starting self-destruction young: What methods are best to re-direct problem behavior in a self-harming five year old?

(The parents know that I'm asking this, so please, don't suggest that I consult with them. They're just as stumped as I am and we would all, collectively, like more help/information. Yes, we're working with his teachers and pediatrician.)

I nanny for a five year old who has some social learning disabilities. He has a lot of trouble "connecting" with the outside world and a fair amount of anxiety - beyond the normal kid stuff of not liking strange foods or loud noises, he really loses it when one of his triggers sets him off.

Lately, this has gone to a whole new and really scary level. When he gets upset, he's totally hell-bent on hurting himself. Many times, I've had to hold him in my lap with his legs in one hand and his arms in another to keep him from seriously injuring himself. He tells us point blank "I want to hurt myself!" and he really does mean this. It's very difficult to try and find a way to acknowledge his feelings while simultaneously keeping him safe.

Which is where my question comes in: How do we (his caretakers) do this? He doesn't exhibit this behavior at his preschool, and his teachers don't really have any easy ideas. The parents and I have tried everything we can think of to try and redirect him without feeding into his anxiety, but his tantrums keep escalating to this point where he truly intends to hurt himself. (And will seriously do so if not physically prevented.)

He's very much focused right now on everything in his life being "bad" and wanting to "ruin" and "destroy" things - this could be an extension in his feelings on himself, it's really hard to tell. In any case, we all want to do the right thing and help him control his anxiety in a way where no one gets hurt. Any advice - specifically for books/resources that cover self-harming in young children - is greatly appreciated.
posted by grapefruitmoon to Human Relations (25 answers total)
 
I don't have an answer, but wow do you know he really means to hurt himself? Has he severely hurt himself already?
posted by pjaust at 10:39 AM on May 24, 2010


If left alone, he DOES harm himself, yes. He's not kidding/exaggerating.
posted by grapefruitmoon at 10:39 AM on May 24, 2010


There are therapists for children, please get him to one. And/or family therapy.
posted by brainmouse at 10:44 AM on May 24, 2010 [1 favorite]


He has been to therapy and it is on the table. What we need is IN THE MOMENT solutions.
posted by grapefruitmoon at 10:45 AM on May 24, 2010


(Trying not to overmoderate my own thread, but also trying to head off the "Therapy!" brigade. It's already a possibility and one that is being strongly looked into. The advice I'm looking for is twofold: "What literature exists on this phenomenon?" and "What can we do *at the moment* he's throwing a tantrum to keep him safe?" I will now shut up for a bit and let the hive mind do its thing.)
posted by grapefruitmoon at 10:46 AM on May 24, 2010


You have MeMail.
posted by dorque at 10:48 AM on May 24, 2010


I dunno what you're asking, exactly. I'm certified Mandt/CPI/TCI, but I don't think it's best to teach you restraint holds over the internet. It's trickier than it sounds, positional asphyxia is not a joke, those might be something for you to look into. Restraint is pretty un-fun, but it can be pretty required.
posted by TomMelee at 10:56 AM on May 24, 2010


This might strike you as obvious, but have you looked at resources for parents of autistic kids?

I am not suggesting this kid is autistic. That's not for me to determine, and it's not really germane to the thread in any case. But just from a practical point of view, a decent number of autistic kids do self-injure, often in a temper-tantrum sort of way — and parents and caretakers of autistic kids are very well organized, so there's lots of information out there that's written by or aimed at them. Some of it may be helpful for you, even if you're not precisely the target audience for it.
posted by nebulawindphone at 10:58 AM on May 24, 2010 [3 favorites]


Until a therapist is involved and can provide situation specific advice, if he won't accept any redirection while he's intending to self harm, I don't think you have any option but physically restraining him.
posted by crankylex at 11:00 AM on May 24, 2010


I dunno what you're asking, exactly

Help for what to do/say for the kiddo when he's having a tantrum. I know restraint holds, what I'm looking for is what I/we can do to diffuse his anger before we get to that point.

And also: any resources that exist about/for kids in this situation. A few have been offered to me already by MeMail, which is really, REALLY helpful.
posted by grapefruitmoon at 11:01 AM on May 24, 2010


Why does he want to hurt himself? How does feeling physical pain help him feel better? Can he promise to tell you before he hurts himself? Can he do something creative instead of hurt himself? Can we get an angry dance which everybody does together, set moves, set music, effectively work to ritualize the dangerous behavior into something easily identifiable and refocusing the signals?

(Upset -> Pain -> Anger Dance -> Calm Dance -> Cookie Time -> Talk over how we feel)
posted by Nanukthedog at 11:05 AM on May 24, 2010 [1 favorite]


Rhetorical questions btw - not for you to answer here.
posted by Nanukthedog at 11:05 AM on May 24, 2010


a long shot, but please consider removing wheat and sugar from his diet. i believe there's some new research on treating 'spectrum' children this way.
posted by kimyo at 11:11 AM on May 24, 2010


Why does he want to hurt himself? How does feeling physical pain help him feel better? Can he promise to tell you before he hurts himself? Can he do something creative instead of hurt himself? Can we get an angry dance which everybody does together, set moves, set music, effectively work to ritualize the dangerous behavior into something easily identifiable and refocusing the signals?

Not sure why you're asking rhetorical questions you DON'T want answered, but I'm going to give it a shot anyway:

1) He can't communicate that information. We ask him, and the only answer is "That's why I want to hurt myself." That's his communication style - everything is "that's why" or "because" even if it doesn't make sense. He's very conditional in his responses: "I should be hungry" instead of "I AM hungry" - and this often leads to circular conversations when trying to get an actual answer from him. There may BE one, but he can't communicate it in a way that we understand.

2) Again, he can't communicate this.

3) He's not at a point developmentally where he can promise much of anything, but he does do a fairly good job of using his words MORE, but it's still not entirely consistent. That's not really even necessarily a thing with HIM so much as he's five years old. Five year olds don't always use their words when they're upset.

4) No, when he's at the point of being angry, he can not do ANYTHING without hurting himself. He can't be left alone or he'll bang his head into whatever is available - a wall, the floor, anything. If that doesn't work, he'll pinch and scratch his face. Hence why he has to be held so that he can not move his hands when he's throwing a tantrum.

5) This would undoubtedly make it worse. When I've tried to redirect in the past, his response is "I DON'T WANT TO DO [WHATEVER I SUGGESTED] - I WANT TO HURT MYSELF." He's very, very clear on this and attempts at redirection just make him MORE adamant.
posted by grapefruitmoon at 11:16 AM on May 24, 2010


3) He's not at a point developmentally where he can promise much of anything, but he does do a fairly good job of using his words MORE, but it's still not entirely consistent. That's not really even necessarily a thing with HIM so much as he's five years old. Five year olds don't always use their words when they're upset.

Can you try something non-verbal, a way for him to indicate escalating emotion? Like maybe flags of different colors -- like puts up a pink one when he's a little upset, then a redder one, and then maybe a fire engine red, as he's upset, to get him used to thinking in terms of nuance?

The process needs to get slowed down early on, which sounds like what you're aiming for. Maybe if the flags aren't any good, three different stuffed animals or symbols he can use to indicate where he is emotionally early on, without having to fight for the language to do it.
posted by A Terrible Llama at 11:21 AM on May 24, 2010 [1 favorite]


Have you read a book called "The Explosive Child?" If you have, I won't go further. We've used this to good effect with my daughter's occasionally self-harming tantrums. I can't actually FIND the book at the moment, but I know it is aimed at parents and caregivers of really edge-case kids, which my daughter isn't.
posted by KathrynT at 11:22 AM on May 24, 2010 [1 favorite]


The flags is a great idea. He does color coding for behavior at school, so perhaps telling me "I feel red!" will be useful. And yes, trying to get it slowed down is exactly what I'm aiming for. And thanks for the book suggestion, I'll check it out.

(And I really do promise to stop moderating now. Quiet time, which has gone very smoothly today, is over and it's back outside!)
posted by grapefruitmoon at 11:24 AM on May 24, 2010


I wish I had some advice for you.

Browse Inside: The Explosive Child

You may also consider asking this question over at the Conduct Disorders Forum. They talk about Dr. Greene's techniques over there frequently.

Good luck.
posted by zarq at 12:26 PM on May 24, 2010


How Does Your Engine Run?
The Incredible Five Point Scale
2nding The Explosive Child
posted by Daily Alice at 12:44 PM on May 24, 2010


We also had great success with a less-extreme situation with our son using the ideas in The Explosive Child, which focuses on cutting down on tantrums by reducing stressors and learning to recognize and avoid triggers. This was really helpful for us because once our son was in it, he was in it--he could not be redirected once he got "stuck" so the only way to cut down on rough times was to keep him from getting stuck.

I was going to do a quick run-down to maybe tide you over until you got the book, but was reminded that I wrote about it on my blog a little while ago, so I'll just give you the link. I don't know how applicable it will be to your charge, but there might be something useful.
posted by not that girl at 12:44 PM on May 24, 2010


IANAD or therapist. I work with children with disabilities (a lot of whom are on the spectrum and present with a wide range of behaviour issues), and we recently had a really good presentation during staff inservice on behaviour management. Here are some key ideas in the handout/ppt that we got:

- Behaviour does not occur in a vacuum - there is always a reason or motivator or function
- Four primary motivators: escape/avoidance, sensory seeking/avoidance, attention, something tangible (i.e. toy, food)
- ABCs: Antecedenct (what happened immediately prior to the behaviour?), Behaviour, Consequences (what happened immediately following the behaviour?)
- Our "job" is to be detectives and figure out the function of the behaviour for that person
- The "emotion/arousal" curve - there are certain points along the curve in which it is possible to redirect effectively (this is where the detective skills come in again - being really careful observers to figure out the sometimes subtle warning signs that a behaviour is going to occur), and after which you just need to ride it out, and give space and time before refocusing and processing
- Visual cues for behaviour are key! (I think that the idea of the flags is a great one)

Feel free to memail me if you would like a copy of the handout/more information.
posted by purlgurly at 12:55 PM on May 24, 2010 [2 favorites]


A few more thoughts...

When you notice behaviours that indicate that a tantrum may be coming, some things you can do to redirect/calm him (and teach him to do so) include:
- Counting down from 10
- Holding your fingers up (like "birthday candles") and have him "blow out" each one
- Hold your hands wide apart, and then slowly bring them together as you exhale
- Work on taking some deep breaths in and let them out
- Give him a "break" card - he can show you this card, and it means he gets a time out from whatever situation he is in (particularly useful if you figure out that he is tantruming as a way to avoid a particular situation/stimulus)

Just to reiterate (because I don't think I was very clear in my first "summary" answer) - when he gets to the actual tantrum/self-harming behaviour, it is too late to deploy these strategies - just keep him safe as he comes down (which it sounds like you're doing).

Also, I would give him a *ton* of positive praise/reinforcement every time you are able to redirect (using the flags, breathing techniques above, or something else). Maybe you and his parents can work out a reward system, and have the rewards "scale" appropriately (i.e. he gets a reward if you are able to avert the tantrum together, he gets a bigger reward if he is able to calm himself down).

Memail offer still stands. :)
posted by purlgurly at 2:16 PM on May 24, 2010


One more thought... (as ever, I wish I could edit)

I do think it is very relevant that he doesn't tantrum like this at school, only at home (sorry to keep using the detective analogy, but this is an important "clue" when you are trying to figure out the function of this behaviour).
posted by purlgurly at 2:26 PM on May 24, 2010


What do they do at preschool that keeps the tantrums from happening?

Any way you can observe/meet with the teacher to get information about exactly what strategies they use, the structures they have in place, how they handle him?

Variation in behavior is not always about one strategy being "better" (kids act different around different people) but at this point I think it would be worth looking into very precise and specific things that his teacher does differently.
posted by internet fraud detective squad, station number 9 at 7:36 PM on May 24, 2010


Help Me, I'm Sad: Recognizing, Treating, and Preventing Childhood and Adolescent Depression
posted by MsMolly at 6:50 PM on May 26, 2010


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