Headbanging. Sensory or communication? Part I

Anna who is an OT came to the supervision today to discuss about Archie who is almost 3, has diagnoses of hydrocephalus and autism (non-verbal), and every time he feels that something goes wrong, he bangs his forehead on various firm surfaces such as the table, the wall, the floor and sometimes also on soft ones, such as pillows or mats. This does not last long, for example he does not do it many times, but his mother is quite worried, firstly because her child is in pain and secondly she does not want this to become a habit/a repetitive behaviour

But why is he doing this?

Archie does not use words as yet and struggles to communicate with alternative types of communication.

Hypothesis 1. Archie tries to communicate the anger or frustration he feels following an unpleasant moment or a failure.

H2. Archie's CNS needs additional sensory-rich input (proprioceptive and tactile) and so he will seek hitting, pushing, pulling, or he will aim to cause pain to himself to self-regulate.

H3. All the above.

H4. Something else that I cannot think of right now :)

- And now, what do we do? Anna asks.

- What are you thinking? I ask her back.

- I'm thinking of observing him during the next session to find out what are the reasons of doing this and how often.

- Ok, I replied. Won't you try to do something with him on the meantime?

- What should I do?  Anna asks me.

- Deep pressure, maybe? I reply. Place your hand on his forehead and press it deeply and continuously, and check if he likes it. If so, use it every time he is repeating it. If this does not work, then offer something else. Maybe a heavy blanket, or pillows over his body to calm him down whilst using some simple/key words such as 'I know you didn't like this' or 'do you need help?' or 'I’m here for you'.

- ok says Anna, that’s what I’m going to do and I’ll let you know next week…