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Just call us on NHS 111 (select the mental health option)  if you need help 24/7. Livewell Southwest’s First Response Service is a 24/7 crisis line providing advice, support and signposting for people (adults and children) experiencing mental health difficulties.

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Livewell Southwest's First Response Service is a 24/7 helpline providing advice, support and signposting for people experience mental health difficulties.

If you feel worried about your mental health or that of a loved one or a friend, you can call the helpline on 0800 923 9323.

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Livewell Southwest's First Response Service is a 24/7 helpline providing advice, support and signposting for people experience mental health difficulties. If you feel worried about your mental health or that of a loved one or a friend, you can call the helpline on 0800 923 9323.

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If you find any broken links or want to feedback on anything else on this padlet. We'd be happy to have it please click on link above.

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How parents can support youth who self-injure

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How parents can support youth who self-injure

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How can parents support youth who self-injure

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Duration: 27 mins Publication Date: 24 Jul 2024 Next Review Date: 24 Jul 2027 DOI: 10.13056/acamh.13677

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Wellbeing, Health & Healing - The Black, African and Asian Therapy Network (baatn.org.uk)

A collection of wellbeing resources covering resonses to covid 19, the killing of George Floyd, police brutality, allyship, resources for children and young people and more.

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The Muslim Community Helpline is a national organisation for women, men, youth and children. It is a confidential, non-judgemental listening and emotional support service.

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The Muslim Community Helpline is a confidential, non-judgemental listening and emotional support service. Pleased to endorse the Apartheid-Free Communities campaign and the Commitment to Kindness.

COMING SOON! The Helpline is pleased to announce that there will be an Imam on board whose role will be to give emotional and psychological support. NOTE: Fiqh or Fatwa advice WILL NOT be available from the Imam.

The Muslim Community Helpline is a national organisation for women, men, youth and children which was launched in 2007. We began our work as the nationwide Muslim Women's Helpline (1987) but changed status to reflect the growing number of calls from all members of the community. We are here to help and support, whatever your needs, and have trained volunteers with many years of experience on hand, five days a week. We aim to provide a listening and emotional support service for members of the community in the United Kingdom

Service Hours: Monday to Friday: 10 am to 1 pm (core hours). Extended service: Mondays 1 pm to 3 pm, Fridays 1-4 pm NEW: Tues: 5-6 pm or Wed: 5-6+ pm, dedicated one to one with male counsellor (call a mobile; pre-booking required which is done by emailing) & Fridays (1 pm to 4 pm). CONTACT NUMBERS: 0208 908 6715 OR 0208 904 8193. Email: ess4m@btinternet.com PLEASE NOTE THAT ANY INFORMATION SENT TO US IS SEEN AND DELETED. WE DO NOT RETAIN PERSONAL INFORMATION PROVIDED BY CALLERS
Languages Spoken: Asian languages (Urdu, Punjabi, Gujrati) & English, Mon-Thurs English on Fridays. Arabic possible by appointment

"I didn't know who to turn to. I didn't feel that people had understood my mental health issues. I was having panic attacks, anxiety and was diagnosed by my GP and consultant psychiatrist as having Chronic Anxiety Disorder. I had little trust and faith in the Muslim community and struggled to find someone to talk to and felt it was easy to talk to a volunteer at the Helpline.

I was worried about the stigma and reaction to my problems if I told my family or someone in the community. I got a lot of emotional support and help to become more independent and manage my anxiety more effectively on a daily basis. I was able to trust more in people after to speaking to the Helpline volunteer.

I'm now feeling more happy, confident and positive just knowing the Helpline is there. Talking to the same people has really helped, especially when I had some really difficult dilemmas. I just want to say thank you to everyone for the tremendous support you gave me to move on positively in life. I managed to achieve my ultimate goal, which was to go to university. You played a really positive role in getting me to achieve my degree through some really difficult times."

- "Khalil" (not his real name)

PROUD TO BE AN APARTHEID-FREE ZONE (pending application)

The Apartheid Free Zones campaign promotes the creation of spaces of proactive solidarity with the Palestinian people. Inspired by the struggle against apartheid in South Africa, the Apartheid Free Zones (AFZ) campaign seeks to cut links of complicity in Israeli violations of Palestinian human rights, especially those related to the UN-defined crime of apartheid. Spaces can be conceptual or physical. MCH encourages others to join the movement for AFZs across the world. Information Toolkit here MCH is against discrimination and inequality.

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The Muslim Community Helpline is a confidential, non-judgemental listening and emotional support service. Pleased to endorse the Apartheid-Free Communities campaign and the Commitment to Kindness. COMING SOON! The Helpline is pleased to announce that there will be an Imam on board whose role will be to give emotional and psychological support.

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Black Minds matter (aimed at adults but suitable for older teens)

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Black Minds matter (aimed at adults but suitable for older teens)

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Services 4 — Black Minds Matter UK

(Use link directly above)

Black Minds Matter UK is a registered charity operating in the UK. Our purpose is to create and champion safe and accessible mental health support with and for Black community. Our vision is to see a community of Black people readily accessing Mental Health support, recovering fully from mental illness and thriving.

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Suicide prevention app created by Grassroots suicide prevention

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BlueIce is an app designed to support with reducing the urges to self-harm, and providing strategies for supporting mood.

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Skip to main content

BlueIce is a prescribed evidence-based app to help young people manage their emotions and to reduce urges to self-harm.

It includes a mood diary, toolbox of evidence based techniques to reduce distress and automatic routing to emergency numbers if urges to harm continue.

BlueIce was developed by Dr Paul Stallard, a Clinical Psychologist and Professor of Child and Family Mental Health at the University of Bath and co-produced by young people with a lived experience of self-harm.

Blue Ice is available for iOS and Android.

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BlueIce app | Oxford Health NHS Foundation Trust

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BlueIce is a prescribed evidence-based app to help young people manage their emotions and to reduce urges to self-harm. It includes a mood diary, toolbox of evidence based techniques to reduce...

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Helpful Responses to Self-harm | Self Injury Support

This webpage offers some ideas for helpful responses to self-injury, both in the short term and the long term.

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Show that you see and care about the person in pain behind the self-harm - ideas for short and long term support

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Our vision

That anyone who uses self-injury knows they are not alone;

that everyone understands that self-injury is a complex and important issue we should all care about;

and that together we tackle both the causes and stigma of self-injury.

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charity self-harm self-injury self harm distress trauma women girls

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Only UK-wide self-harm & self-injury charity offering direct support, reliable information, expert training and specialist consultancy

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Our vision

That anyone who uses self-injury knows they are not alone;

that everyone understands that self-injury is a complex and important issue we should all care about;

and that together we tackle both the causes and stigma of self-injury.

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charity self-harm self-injury self harm distress trauma women girls

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Only UK-wide self-harm & self-injury charity offering direct support, reliable information, expert training and specialist consultancy

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A self help resource with artwork, quotes and poems by young people who self-injure, the Rainbow Journal contains useful tips to gain insight and awareness.

The Rainbow Journal is a book aimed at helping young people move from self-harm to self-care. It has blank pages for writing about feelings and for drawing. It includes artwork, quotes and poems by young people who self-injure. From Self Injury support

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Useful resources around the issue of self harm that can either develop awareness and understanding, or act as a source of help and support for people

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By Lisa Williamson (Suicide Bereavement Service Lead) On Wednesday evening (1st November), I was invited to attend The Voluntary Sector Awards 2023 as I had

By Laura Hughes (Suicide Crisis Service Lead - Maternity Cover) The Tomorrow Project is currently inviting applications for an unpaid academic internship, which involves contributing

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Self Harm Doesn't DiscriminateNeither Do WeGet In TouchSelf Harm Doesn't DiscriminateNeither Do WeGet in TouchSelf Harm Doesn't DiscriminateNeither Do WeGet In TouchSelf Harm Doesn't DiscriminateNeither Do WeGet in Touch Previous Next Welcome to Harmless Harmless is a passionate organisation who works to address and overcome issues related to self-harm and suicide.

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This information provides information about keeping yourself safe while self-harming. Whilst we don’t encourage self-harm, we do understand that for some people self-harm is a way of coping with emotional distress. For those who are using self-harm as a coping mechanism, we encourage taking steps to keep yourself safe.

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Video co-created with young people about a parent's journey supporting their child with self-harm

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#NoHarmDone | A Parent's Journey | My Child Self-Harms | YoungMinds

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Free online 7 week Self-Harm Support for 11-19 year olds

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Free online 7 week Self-Harm Support for 11-19 year olds

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Alumina is a free, online 7 week course for young people struggling with self-harm. Each course has up to 14 young people, all accessing the sessions from their own phones, tablets or laptops across the UK. The courses take place on different evenings of the week and are run by friendly, trained counsellors and volunteer youth workers. You don’t need an adult to refer you or sign you up, and no-one will see or hear you during the sessions – you’ll just join in via the chatbox. We want to help you to find your next steps towards recovery, wherever you are on your journey.

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Warning: some information on this page may be difficult to read or may cause strong or upsetting feelings.

Please only carry on reading if you feel safe to do so.

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Warning: some information on this page may be difficult to read or may cause strong or upsetting feelings.

Please only carry on reading if you feel safe to do so.

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This information is provided by the Children's Psychological Health and Wellbeing Team at the University Hospital's Plymouth NHS Trust.

If you are worried about your child or young person please speak to your health or social care professional, child's school or crisis lines. Good communication and support are key and a risk assessment may be needed to keep your child safe. The advice on these pages is not a substitute for seeking out advice from someone who knows your child.

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If you are looking at this padlet then someone felt it may be helpful to you or a young person you care for. We have tried to group the information into sections (some have the same information in).

Scroll down to find the section relevant to you:

Crisis information

Information for Parents and Caregivers

Information for Young People

Neurodivergence

LGBTQIA+

Books and Apps

Then scroll left or right within each section (the bar will appear at the bottom of the section if you hover) to see the resources we have put together.

Clicking on a picture in the box will either take you to a word document, video or webpage.

When you have finished, click the X in the top left hand side to come back to the padlet to find more information.

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Who finds out about about any information I share?

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Who finds out about about any information I share?

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Sharing that you are self-harming, or are thinking about self-harm, can be upsetting.

Lots of young people feel worried about who this information might be shared with and why.

This graphic gives an overview of what might happen if you share something that cannot be kept confidential, or when someone is worried about your safety.

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Warning: some information on this page may be difficult to read or may cause strong or upsetting feelings.

Please only carry on reading if you feel safe to do so.

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Self-harm and being LGBTQIA+

Young people who are part of the LGBTQIA+ community, or are still working out what their gender or sexuality is, may experience:

Someone reacting badly when they come out, like being rejected

Being bullied, or experiencing stigma or discrimination

Feeling confused, uncomfortable, or negative about who they are

Dealing with sexuality or gender stereotypes, to act or be a certain way

A lack of support from people around them

Feeling unable to talk openly about how they feel

Supporting other friends who are also LGBTQIA+

If we don't know how else to cope, we may be more likely to self-harm. This is why young people who identify as LGBTQIA+ might need extra support.

For LGBTQIA+ support, you can visit Stonewall and Mermaids.

From Mind.org.uk

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Coping with self-harm – for 11-18 year olds - Mind

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Coping with self-harm – for 11-18 year olds - Mind

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Coping with self-harm – for 11-18 year olds

Information for young people on understanding self-harm, how to talk about it and where to go for support.

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‘No Harm Done’ is a film dealing with the topic of self harm. The films were co-produced with young people, parents and professionals to reassure those affected by self-harm that things can and do improve.

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#NoHarmDone Things Can Change | Self-Harm | YoungMinds

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Healthy coping strategies and alternatives to self-harm

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Healthy coping strategies and alternatives to self-harm

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Some of these ideas will feel like a perfect fit, whilst others will seem ridiculous to you; it’s just about seeing what works for you as we’re all different. These ideas have all been suggested by people who’ve self-harmed in the past, so they worked for someone! Collated by Pooky Knightsmith

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Healthy Coping Strategies and Alternatives To Self-Harm | PDF

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Some of these ideas will feel like a perfect fit, whilst others will seem ridiculous to you; it’s just about seeing what works for you as we’re all different. These ideas have all been suggested by people who’ve self-harmed in the past, so they worked for someone!

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The Trevor Project is the leading suicide prevention and crisis intervention charity organization for LGBTQ+ young people. They provide information & support to LGBTQ+  young people 24/7, all year round.

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The Trevor Project | For Young LGBTQ Lives

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The Trevor Project provides 24/7 crisis support services to LGBTQ young people. Text, chat, or call anytime to reach a trained counselor. Free and confidential.

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Supporting trans, non-binary and gender-diverse children, young people and their families.

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Self-harm is difficult to talk about, but support is available to help you recover. Charlotte, shares what helped her stop self-harming after eight years.

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I was only 14 when I started to self-harm. I didn't know what I was doing at the time, but it began as a kind of anxious habit to calm me down.

I was never intending to hurt myself. I was doing it for the sense of relief it provided. I felt like the only way I could function and leave my room was if I had that release. I was so ashamed that I did it, and at school I was worried I would be bullied for the scars on my skin. I didn't want to be known for that, so I hid under baggy clothing.

It impacted my relationships too. I didn't want a person I liked to see my skin, or to see my scars. Even at school I would find excuses not to do P.E. so I wouldn't have to get undressed. If I couldn't get out of it I would have to change in such a complicated way that I still managed to draw attention to myself. It was hell.

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My Story of Self-Harm Recovery | Young Person Blog

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Self-harm is difficult to talk about, but support is available. Our guest blogger, Charlotte, shares what helped her stop self-harming after eight years.

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Headstrong is a great place for talking, sharing and reading about all kinds of topics for Young People

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Real Life and Real Faith in the Real World

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Emotional wellbeing resources and advice to do real life and real faith in the real 21st century world.

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Provided by Young Minds includes information on:

What is self-harm?

Signs a young person is self-harming

Supporting your child with the urge to self-harm

Supporting your child with their feelings

Finding professional help

Keeping your child safe

Looking after yourself

Useful helplines and websites

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#NoHarmDone | A Parent's Journey | My Child Self-Harms | YoungMinds

If you're worried that your child is self-harming but they aren't talking to you about it or showing visible injuries, it can be difficult to know what's going on.

Ways that young people self-harm

Some ways that young people self-harm include:

cutting themselves

scratching skin with fingernails

burning skin

biting skin

hitting themselves, or banging their head or another part of their body on a wall

pulling hair out from their head, eyebrows or eyelashes

inserting objects into their body

Things to look out for

If you are worried your child may be self-harming, here are some things to look out for:

unexplained cuts, burns, bite marks, bruises or bald patches

keeping themselves covered, for example wearing long sleeves or trousers even during hot weather, not wanting to change clothes around others or avoiding activities like swimming

bloody tissues in waste bins

seeming low or depressed, for example withdrawing from friends and family

blaming themselves for problems or expressing feelings of failure, uselessness or hopelessness

outbursts of anger or argumentativeness

Self-harm is usually a way of trying to manage very difficult feelings. People often self-harm when life feels hard to cope with - when lots of distressing feelings have built up and it's become overwhelming. In the moment, the sensation of self-harming and experiencing some physical pain can feel easier than feeling out of control emotionally.

If a young person is self-harming, it's often a sign that something in their life isn't quite right or has become too much to deal with. It can be understood as an important message about how a young person is feeling - one that needs to be noticed with care by the adults around them.

Some myths you might hear about self-harm can make it harder to talk about as a parent - including that it's a 'phase' young people go through, or that it's an attention-seeking behaviour.

While it might feel hard to understand sometimes from the outside, self-harm can be a way for a young person to:

manage, reduce or express very strong and upsetting emotions - such as hurt, sadness, anger, fear or feeling bad about themselves

relieve tension and pressure, or reduce feelings of panic and anxiety and temporarily feel calmer

experience a feeling of physical pain to distract from emotional pain

gain a sense of control over feelings or problems - for example, by feeling there's something they can do when things feel too much

stop feeling numb or 'zoned-out' - which can be a protection mechanism our bodies use when we're experiencing overwhelming feelings

However, while it often feels like self-harm brings some relief in the moment, this is only temporary. As feelings build up again, so does the urge to self-harm. As this cycle continues over time, a young person may start to feel ashamed, confused or frightened about the fact that they're self-harming - increasing the load they're carrying on top of what they're already going through. This can become a cycle that's really hard to break, and a habit that's hard to stop.

Helping your child in the short term

When the urge to self-harm does build in the moment, having a list of other things they can do straight away can also help your child to 'ride the wave of' their intense feelings without self-harming.

Remember that different things will work for different people, and that what helps will usually depend on the feelings your child is trying to manage. Some young people will want to do something soothing like wrapping themselves up in a comfy space, while others might want to do something very active to burn off the energy in their body.

Talk to your child about different strategies they could try, while also giving them space to find their own ways of coping and figure out what works for them. Strategies could include:

Making and using a self soothe box

Writing down how they're feeling in a journal

Writing down difficult feelings on pieces of paper and then ripping them up

Ripping up a magazine or newspaper

Hitting a soft cushion, pillow or bean bag

Listening to loud music

Having a shower

Doing some exercise

Going for a walk outside, or taking the dog for a walk

Focusing on their breathing - how it feels in their body to breathe in and out

Wrapping up in a blanket or duvet

Talking to someone - a friend, family member or calling a helpline

Tidying or organising something

Doing a hobby they enjoy that helps them feel calm, such as painting, drawing, colouring-in, watching a favourite TV programme, playing video games, cooking or baking

Your child might want to use an app like Calm Harm so they have something on their phone that suggests different techniques they can try when they feel the urge to self-harm.

Helping your child over the longer term

Over the longer-term, becoming more aware of how they feel when they self-harm, what's making them feel this way and what kinds of things help, will empower your child to feel more in control. This will hopefully reduce the sense of being overwhelmed and the feeling that they need to self-harm. You can find more tips about this below.

It might help to start a conversation while walking outside or doing an activity, which can help your child to feel more relaxed and make it feel less like a 'big chat'. It can also help both of you to be in a neutral space, for example not in their bedroom. You can find our activity ideas for starting a conversation in our guide to talking to your child about mental health.

While you may understandably have lots of questions, it's important to remember your child is going through a tough time and may find this overwhelming. Focus on finding out how they're doing, without bombarding them for information.

Remember that your child may feel ashamed about self-harming and find it difficult to talk about. Let them come to you when they feel ready to talk, and reassure them that they can talk to you as often and for as long as they need to.

If your child is struggling to talk, they might find it easier to text you or write you a letter. This also gives you time to process what they've told you and think about how you'd like to respond.

When your child does open up, try to focus on listening, showing empathy and being curious about what it's like for them, rather than trying to 'fix' things straightaway. Sometimes they will just want you to listen and understand how they are feeling.

What kinds of thoughts are they having, and how do they feel in their bodies? For example, they might start to feel more zoned-out, or like they're full of panic. This can help them to recognise what feelings they're trying to cope with, and what they can do instead to express and manage these.

Keeping a mood diary might help them to understand this overtime - this could be as simple as a word, phrase or emoji that they note down each day.

Responding to self-harm - Roundup | YoungMinds Parents Lounge

There are different places where you can find help for your child. Speaking to your GP is often a good place to start, as they can discuss your concerns, speak to your child to find out how they're doing and let you know what support options are available. Depending on your child's situation, they can also refer them for an assessment by a mental health specialist or to Child and Adolescent Mental Health Services (CAMHS). You can speak to the GP yourself to explain the situation and ask for advice, even if your child doesn't want to talk to them.

Young people who are self-harming may find it particularly helpful to speak to a counsellor or therapist, who can help them to make sense of how they're feeling and work with them to find new ways of coping. Our guide to counselling services takes you through the process of finding a counsellor or therapist for your child.

You can find out more about speaking to GPs, finding a counsellor or therapist, accessing CAMHS, getting help from your child's school and finding local services on our guide to getting support from mental health services.

Trying to find the right help for your child and finding your way around different services can be really tiring at times - so keep reminding yourself that you're doing your best and that it's not easy.

Some young people who are self-harming will find it very difficult to speak to a professional, go to appointments or even acknowledge what's going on. If things are feeling stuck, you can call our Parents Helpline for information, advice and support.

Parents have found the following things helpful to keep in mind when seeking professional help:

If you're feeling under a lot of strain yourself, or that the situation is too much to manage as a parent, it's often a sign that more professional help is needed.

Try to speak to professionals early on, before things have escalated to a crisis situation.

Encourage your child to give themselves some time to get to know a professional and build trust, remembering that they might be starting from a very withdrawn place.

Ask if you can see the same professional each time, so that you and your child don't have to keep re-explaining the situation.

Be open minded about different types of treatment - remembering that what works for your child might not be the same as what would work for you.

It's important to take your child to hospital or to your GP if they have any injuries or wounds that require medical attention.

It can be helpful to understand as a parent that self-harm is often a coping mechanism to help someone manage, and isn't necessarily an expression of suicidal feelings or an attempt to take their own life. However, people who experience suicidal thoughts can be more likely to have self-harmed in the past. If you're worried that your child may be experiencing suicidal thoughts, read our guide to find out how you can access help.

If your child is having a mental health crisis and needs urgent help now, find out who to contact on our urgent help page.

If your child's life is at risk, or if it does not feel like they're safe, please call 999 for an ambulance or take them straight to A&E.

Find urgent help

Finding out that your child is self-harming can be an incredibly distressing, or even traumatic, experience as a parent. It's completely normal to struggle with feelings of anxiety, confusion, sadness, anger, frustration, guilt or shame.

Try to take time when you can to check in with yourself, and to think about ways you can take care of yourself as well as your child. Remember that it's okay to ask for help when you need it, and to share your worries with someone you trust.

Many parents who have been in this situation find it helpful to reach out to other parents so they can talk through how they have handled difficult situations and found support. You may also be able to find a local parent support group using the Charlie Waller Trust directory.

If you need more help, speaking to your GP is a good place to start, and they may be able to refer you to a local support service. Sometimes it helps just having someone there who can listen to what you're going through - and if you need someone to talk to, you can call the Samaritans anytime on 116 123.

Useful helplines and websites

While we take care to ensure that the organisations we signpost to provide high quality information and advice, we cannot take responsibility for any specific pieces of advice they may offer. We encourage parents and carers to always explore the website of a linked service or organisation to understand who they are and what support they offer before engaging with them.

This page was reviewed in July 2021. It was created with parents and carers with lived experience of supporting their child or young person with self-harm. We will next review the page in 2024. YoungMinds is a proud member of PIF TICK - the UK's quality mark for trusted health information.
Whether you love the page or think something is missing, we appreciate your feedback. It all helps us to support more young people with their mental health.

Please be aware that this form isn't a mental health support service. If your child is in crisis right now and you want to talk to someone urgently, find out who to contact on our urgent help page.

At YoungMinds we take your privacy seriously. If you'd like to read more about how we keep the information we collect safe, take a look at our privacy policy.

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Self-Harm & Mental Health | Guide For Parents

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Read our guide to self-harm to learn more about what self-harm is, what the signs of self-harm are in a young person, and where to get support.

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Provided by Young Minds.

Self-harm can be difficult to talk about but it’s a common problem and you can beat it. Find out what self-harm means and what to do if you think you’re affected by it.

This resource includes:

What is self-harm?

Why do I self-harm?

How can I stop self-harming?

Managing scars from self-harm

Supporting a friend or family member who is self-harming

Get help now

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If you need help right now

If you feel like you are about to self-harm now, there are things you can do to help keep your mind off it. Watch the video about the TIPP technique - a simple technique you can use to help you in the moment.
If you are in an emergency or worried for your life you should call 999.

Self-harm is when you intentionally cause harm to yourself as a way of dealing with difficult feelings, traumatic experiences or memories, neglect, or situations that you find overwhelming. People sometimes self-harm when life feels hard to cope with.

Self-harm can look different for different people. You might find yourself doing things which are harmful, but not think of them as 'self-harm'. But that doesn't make your experience any less valid.

Self-harm can look like:

cutting yourself

using drugs or alcohol to cope with your problems

not eating, over-eating, or forcing yourself to throw up

spending all your time on addictive behaviours like gaming, social media or gambling

over-exercising and/or exercising when you are injured

biting, hitting or burning yourself

hitting walls

getting into situations on purpose where you risk getting hurt, including fights or risky sexual behaviour

Often self-harming only brings temporary relief. You might also have negative feelings after self-harming, such as guilt, shame or fear. When difficult feelings start to build up again, you might feel like you have to harm again. It can be really hard to break out of this cycle. Self-harming can become a habit and it can be upsetting to think that this is your only way to cope. But there are things you can do to stop self-harming and get better. And with support, you can learn other ways of coping when things feel too much.

People self-harm for many different reasons. Some people find it hard to explain why they do it, but often it's a way for people to let out feelings that are hard to explain or control.

There are many reasons why you might self-harm and these reasons will be different for everyone. You might be dealing with lots of intense thoughts and feelings and hurting yourself might feel like the only way to let those feelings out. Or you might feel numb and want to hurt yourself so that you can feel something.

For some people, self-harm feels like a way to show the feelings they have inside on the outside. It can be a way of:

People often start self-harming due to something stressful or upsetting that is going on in their life that is difficult to deal with . This could be something like:

suffering abuse

experiencing a traumatic incident

family problems like a divorce

money worries

bullying

a sudden change in your life, like a death, a relationship ending or moving school

exam stress or extreme pressure or criticism from family, friends, teachers or at work

low self-esteem or issues with body image

difficult feelings like loneliness, anxiety, depression or anger

an illness or health problem

feelings of guilt, failure, or being unloved

experiencing discrimination against your race, religion, sexuality, gender or disability

These are just examples. Whatever the reason you started self-harming, your feelings matter and you can get through this.

You may not always know the reason why you are self-harming. If you're unsure why, or don't understand the reasons, you are not alone and you can still get help.

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Artwork credit: @the_mini_ADHD_coach

An illustration of a face with eyes closed. Text reads: 'It's ok to feel overwhelmed.'

Things can happen in life that can leave us feeling overwhelmed, angry and hurt. Instead of finding ways to express those feelings to the world, we might start to take this pain and anger out on ourselves.

We might self-harm because we have learnt that in order to be accepted or loved we have to be 'perfect'. When we don't live up to this 'perfect' image we can feel like a 'failure'. The constant guilt, or worry about disappointing people, can make us feel like we need to punish ourselves for not being 'good enough'. If this resonates with you, you're not alone. With the right support, you can stop feeling this way, and learn to love yourself for who you are.

Sometimes people make comments about self-harm being attention-seeking. Comments like this can be hurtful and make you feel judged, alone or misunderstood. Those who self-harm actually often keep this private. However, if you do self-harm as a way of bringing attention to yourself, remember that there is nothing wrong with wanting people to notice you more and wanting to have your feelings taken seriously. You deserve to feel loved by those around you and you deserve support.

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Artwork credit: @ohhappydani

An illustration of six arms all of different skin tones. On each arm reads the word 'worthy'.

Overall, the most important thing which I hope everyone knows is you don't have to go through this alone.

I was only 14 when I started to self-harm. I was never intending to hurt myself. I was doing it for the sense of relief it provided. I felt like the only way I could function and leave my room was if I had that release.

Ways to keep yourself safe now

It's really important to keep yourself as safe as possible and reduce your risk of serious self-injury. Even though you want to stop self-harming, you might not feel able to stop straight away. Sometimes it can take time to find new ways to cope, and that's normal.

If you are unable to stop self-harming right now, make sure you are at least doing it as safely as possible. This means using sterile equipment, keeping your wounds clean, and avoiding mixing drugs and alcohol with other forms of self-harm. You can also call Samaritans at any time - whether you're thinking about self-harm or have already harmed yourself.
If you are in an emergency or worried for your life you should call 999 or go to A&E.

Things you can do to help

There are also lots of things you can do in the moment to help you not self-harm.

When you feel the urge to self-harm building, you could try to:

go for a walk or do some gentle exercise

distract yourself by focusing on your breathing

text a friend and let them know you need them to help you take your mind off things

play music and sing or dance along

hold an ice cube

write down your thoughts

hit a cushion or pillow

tear up a magazine or newspaper

make a self-soothe box

go to a public place like a park or a cafe

You might find the TIPP technique helps to stop your urge to self-harm.

This video explains how to use the TIPP technique to help you feel calmer.

Ways to keep yourself safe in the long term

There are also a number of ways to help yourself in the long term and support your recovery journey.

Talking about self-harm can feel difficult. It is understandable that you might feel nervous to talk to someone, feel like you'll be judged or feel you won't be understood. But talking about how you're feeling with someone you trust can help you to get the right support.

Try talking to someone you feel comfortable and safe with, like a friend or family member. If you don't feel like you can talk to friends or family, you could talk to someone in your wider community, such as a teacher, a school counsellor/nurse, a faith leader or a youth worker. Think about who you would feel most comfortable communicating with and how, whether it's face to face, over the phone, by text or email.

In some communities it can feel more difficult to reach out for help because of certain stigmas around mental health. If you reach out for help and the person you talk to does not react the way you hoped, remember that this reaction is about them, not you. Don't let their reaction discourage you from reaching out again. If you don't feel like you can reach out to someone you know, remember that there are still lots of people who can help. You may prefer to get support from a professional, a helpline or through a charity. Take a look at our list of organisations that can help, and don't struggle on your own.

Speaking to a professional about self-harm can feel scary, but it's often an important step to recovery. You may be worried that you'll be misunderstood or judged, but there are lots of trained people that you can talk to who understand and really care. That's because they speak to lots of young people who are going through this too. They are there to listen and support you.

It is helpful to tell the GP exactly what you are doing and what your worries are. If you need medical treatment for injuries, do make sure you get it. Don't be afraid or embarrassed to go to your GP or hospital for this - they are there to help you get better and it is not their job to judge you.

Your GP will listen and discuss the best options to support you. They might offer you an assessment with a local community mental health team, or if you are under 18, they can refer you to Child and Adolescent Mental Health Services (CAMHS) for an assessment. These assessments are so they can help you to find the right treatment, such as counselling or talking therapy, where you can talk with a trained mental health professional about what you are feeling and ways you can cope.

The types of talking therapy you might be offered include:

cognitive behavioural therapy (CBT) - a type of therapy that focuses on how your thoughts, beliefs and attitudes affect your feelings and actions

dialectical behaviour therapy (DBT) - a type of CBT adapted specifically for people who experience emotions very intensely

mentalisation-based therapy (MBT) - a type of therapy that focuses on helping you to make sense of your own and other people's thoughts, feelings and actions

Find out more about counselling and therapy in our guide.

Sometimes the first person you speak to won't help, but that doesn't make your feelings invalid. If you are finding it hard to get the right support from your GP, you may find it helpful to turn to other support, such as your school nurse or a specialist organisation such as Samaritans. For more tips and advice getting the right support from your GP, including information about your rights as a patient, visit our guide on how to speak to your GP about mental health.

Journaling can be a helpful way to let out your emotions. It can also help you to recognise what is bothering you and any patterns in what triggers you or causes you to feel bad.

Take a few minutes every day to write down how you are feeling. If you don't like writing, try doodling, drawing or recording a voice note. Remember this is just a way to express yourself - there's no right or wrong way to do this and nobody has to see it but you.

If you want to, you could show your journal to any mental health professionals who are supporting you, to help them understand what you are going through.

Sometimes just making small changes to your daily routine can help improve your mood. Consider trying some of these changes:

Make sure you get enough sleep and stay hydrated - staying physically healthy can help you to feel happier.

Take time out when you need to - this could be going for a walk, doing some drawing or relaxing however you like to.

Think of three things you are proud of each day - you could do this when you first wake up or just before you go to sleep.

Be as kind to yourself as you would be to your best friend - think about the advice and support you would give someone else if you heard they were struggling.

The internet can be a helpful space for those who self-harm. It offers a lot of information, advice and support. You may also find that it's easier to speak openly about your feelings through social media, rather than face-to-face. However, there is also a lot of content about self-harm on the internet that can be distressing or make you feel worse. We also know that those who have peers that self-harm are more likely to self-harm themselves. Think about how your use of social media is affecting your mood and what content is best for you. Make sure to only follow accounts that make you feel positive and safe.

Some people find it really helpful to create a 'safety plan' that they can use when the urge to self-harm is really strong. This can include whatever you think would be helpful, but generally it includes ideas of what you can do to distract yourself, who you can speak to, and what else you can do to keep yourself safe. Papyrus have a useful guide to creating a safety plan, which might help if you'd like to create your own. Although the focus of their guide is for suicidal feelings, you can use it for self-harm as well.

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Artwork credit: @crazyheadcomics

An image of a bendy road titled 'the road to recovery'. Text along the road reads: 'start', 'progress', 'hope', 'relapse', 'second attempt', 'setback', 'growth', 'change', 'calm'.

If you have self-harmed by cutting or wounding yourself in some way, you are likely to have scars on your body from this. You may find that you have a number of emotions and feelings associated with these scars, such as guilt, regret or difficulties accepting your body image. This can be particularly difficult if you are experiencing stigma around your self-harm.

For advice on how to manage stigma around self-harm within your community, take a look at Louisa's blog.

If you're really struggling with the scars left on your body, you may be able to find treatment that can help. You can find information about scar treatments on the NHS website. Scars will look different for everyone depending on skin tone, where the scar is and the type of wound that caused the scar, and this will lead to different treatment options. Not everyone will want to do this and that is completely okay - it is your body and you should only do what feels comfortable for you.

It can be really difficult if you know a friend or loved one is self-harming. It's hard to see someone you love hurting themself in that way, and it can be difficult to know how best to support them.

Just being there and letting them know they're not alone can be very helpful, but it's also important to remember that you may not be able to help them on your own.

Remember there is always support available.

Recognising the signs and symptoms of self-harm

There are lots of different ways that someone might self-harm and this can make it difficult to spot the signs. Your loved one is likely to be in both physical and emotional pain during this time. Here are some signs to look out for.

If your loved one is self-harming by cutting or wounding themself, you may be able to notice some physical signs. This could include:

keeping their body fully covered all the time, even when it is hot, like wearing long sleeves to conceal scars (this is only a sign of self-harm if they do not normally wear long sleeves or clothes that cover the whole body)

having cuts, bruises or burn marks on their body that are unexplained

unexplained scarring on their skin

unexplained blood stains on clothing or tissues

any signs that they are pulling out their hair, for example hair loss or large clumps of hair lying around

Self-harm takes lots of different forms, not just physically hurting yourself. So it's important to also be aware of the emotional signs. These might include:

becoming very withdrawn and talking less than usual to others

unusual changes in mood, such as feeling low, teary or demotivated

making suicidal comments e.g. talking about not wanting to go on

expressing feelings of self-blame, hopelessness or failure

Supporting a loved one with self-harm now
If a friend or family member has self-harmed and has injuries that need medical attention, you should take them to A&E to seek medical help.
The most important thing you can do to support someone is be there to listen. Talking about self-harm is difficult, but having that conversation can help your loved one take the first step to recovery.

Take a look at our tips below for having a sensitive conversation.

Supporting a loved one with self-harm in the long term

Here are some tips on how you can give ongoing support to someone in your life who is self-harming.

Recovery can only happen when your loved one takes steps towards this for themself. You can't force someone to get better. It can be very difficult to see someone you love struggle with self-harm, but letting them be in control of their decisions will support their recovery in the long term. But remember you should always get them medical attention if needed.

You may find it helpful to develop a 'safety plan' with your loved one. This is a tool you can use to help communicate with each other and keep your loved one safe. Samaritans have advice on this as well as a safety plan template you can use.

Speaking to a GP about self-harm may be a scary thought for your loved one, but encouraging them to do this is important so they get the right support. If they really don't want to talk to a GP, there are also lots of charity services and helplines that can help.

This page was reviewed in June 2023. It was co-created by young people with lived experience of self-harm. We will next review the page in 2026. YoungMinds is a proud member of PIF TICK - the UK's quality mark for trusted health information.
Whether you love the page or think something is missing, we appreciate your feedback. It all helps us to support more young people with their mental health.

Please be aware that this form isn't a mental health support service. If you are in crisis right now and want to talk to someone urgently, find out who to contact on our urgent help page.

At YoungMinds we take your privacy seriously. If you'd like to read more about how we keep the information we collect safe, take a look at our privacy policy.

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Self-harm | Advice for young people | Get help

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Self-harm is when you intentionally harm yourself as a way of dealing with difficult feelings or experiences. Find out about self-harm and how to get help.

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Resources from crisis intervention charity The Trevor Project, specifically for supporting the wellbeing of BIPOC LGBTQ + youth

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Black LGBTQ+ youth are less likely to receive mental health counseling than other demographics. Learn more about the statistics.

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Free online course for parents/caregivers on self-harm provided by Youth Mental Health Foundation

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Jade has spoken to over 35,000 young people about mental health, visiting over 70 schools. She has been interviewed several times on the national TV news and radio about teen mental health. She was shortlisted for a National Diversity Award 2018 as a 'Positive Role Model For Young People'.

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Free online 7 week Self-Harm Support for 11-19 year olds

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Free online 7 week Self-Harm Support for 11-19 year olds

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Alumina is a free, online 7 week course for young people struggling with self-harm. Each course has up to 14 young people, all accessing the sessions from their own phones, tablets or laptops across the UK. The courses take place on different evenings of the week and are run by friendly, trained counsellors and volunteer youth workers. You don’t need an adult to refer you or sign you up, and no-one will see or hear you during the sessions – you’ll just join in via the chatbox. We want to help you to find your next steps towards recovery, wherever you are on your journey.

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Webinar aimed at parents including understanding why young people self harm and some coping strategies.

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Norfolk and Suffolk NHS Foundation Trust

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Information for individuals with Autism 

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Information for individuals with Autism 

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Information from the National Autistic Society on self-harm, including advice for parents of children who have autism and self-harm

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This section looks at autism and self-harm and what we can do to help people who might be affected.

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Webinar on Self Harm for parents and professionals

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Webinar on Self Harm for parents and professionals

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Webinar for supporting young people who self-harm. This webinar offers exploration of the reasons behind self-harm, helpful responses, and practical alternatives for professionals and family

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This information provides information about keeping yourself safe while self-harming. Whilst we don’t encourage self-harm, we do understand that for some people self-harm is a way of coping with emotional distress. For those who are using self-harm as a coping mechanism, we encourage taking steps to keep yourself safe.

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If you are caring for a young person with mental health needs, you can have a carer’s assessment. This which looks at the support you need to look after someone else.

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Carer's assessment

A carer is someone who gives regular care and support to someone else and isn't paid for it. If you're an unpaid carer, you can have a carer's assessment, which looks at the support you need to look after someone else.

You can have a carer's assessment even if the person you look after doesn't want to have their own needs assessment or isn't eligible for help from Plymouth City Council. The person you care for needs to live in Plymouth - if they don't get in touch with the council where they live.

How might a carer's assessment help me?

If you provide care and support to an adult friend or family member, you may be eligible for support, such as a personal budget to spend on the things that make caring easier; or practical support, like arranging for someone to step in when you need a short break. Or you may prefer to be put in touch with local support groups so you have people to talk to.

A carer's assessment will consider the impact the care and support you provide is having on your own wellbeing and important aspects of the rest of your life.

When can I request a carer's assessment?

You can ask for a carer's assessment at any time. You should contact the council covering the area where the person you care for lives, if it is not the same as your own. If you don't want a carer's assessment but you are looking for advice and information about local support, Plymouth City Council or Caring for Carer Plymouth will be able to help you.

How do I arrange a carer's assessment?

You can either arrange this by contacting Plymouth City Council on 01752 668000 or email customerservices@plymouth.gov.uk or by contacting Carers for Carers on 01752 201890 or email caringforcarers@improvinglivesplymouth.org.uk

What will be considered during the assessment?

A carer's assessment will look at the different ways caring affects your life and work out how you can carry on doing the things that are important to you and your family. It will cover your caring role, your feelings about caring, your physical, mental and emotional health, and how caring affects your work, leisure, education, wider family and relationships.

Your physical, mental and emotional wellbeing will be at the heart of this assessment. This means that you will be able to tell the person undertaking the assessment how caring for someone is affecting your life and what could make things better for you and the person you look after.

What happens after a carer's assessment?

If you're eligible for our help we'll agree with you what support you need and how your needs will be met. You might be able to get help with housework or gardening, with transport and getting around, such as taxi fares or driving lessons and support to improve your health and wellbeing, such as a gym membership

You might also be able to get financial support such as a direct payment to spend on things to make caring easier.

Personal Protective Equipment (PPE)

If you are an unpaid carer Caring for Carers may be able to provide PPE if you meet the criteria of need as laid out in this
Personal Protective Equipment Document

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CFC - Carers/Assessments - Improving Lives Plymouth

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Resources from crisis intervention charity The Trevor Project, specifically for supporting the wellbeing of BIPOC LGBTQ + youth

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Black LGBTQ+ youth are less likely to receive mental health counseling than other demographics. Learn more about the statistics.

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Provided by the Children's Psychological Health and Wellbeing Team

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Book resource for carers and family members

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Book resource for carers and family members

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This book is an essential resource for anyone who has a supporting role or relationship with someone who hurts themself, whether in a professional or informal context. It is also a useful resource for people who self-injure, to help them to explore their experiences and to keep themselves safe. Based...

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This book is an essential resource for anyone who has a supporting role or relationship with someone who hurts themself, whether in a professional or informal context. It is also a useful resource for people who self-injure, to help them to explore their experiences and to keep themselves safe. Based...

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Blog post exploring lived experience of identifying as queer and the way that this has interlinked with self-harming behaviours

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Queer Identities and Self-Harm: Conquering Shame

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Queer Identities and Self-Harm: Conquering Shame As an adult, reflecting on my adolescence, it is clear how parts of myself and my identity were not only intersecting, but were inextricably linked and weaved throughout one another. My queerness tied to my womanhood, and my mental health both an outcome and reflection of these identities. As a queer person, I was othered and ridiculed; for being ‘too gay’ and at the same time, ‘not gay enough’. As a woman, I was targeted, name-called, and forced into a box that would not fit. As a self-harmer, I was feared, whilst simultaneously subjected to patronising interactions and instructions. Whatever parts of myself were on show, I wasn’t what people wanted for me, and I felt nowhere near good enough. Now, as a young, proud, queer, peer support worker, I embrace and accept the parts of myself that made me different and ‘weird’. These parts of me are too important to hide away, just for someone else’s comfort. Hidden Identities I spent a long time hiding the parts of myself that others and, by influence, myself, believed were unacceptable. It took years to come out to school friends, let alone my family. I grew up around homophobic views, traditional ‘values’, and dramatised ‘vomiting’ at TV screens showing queer love. The more I squeezed my round peg into a square hole, the more I felt unusual, strange, and unlovable. My struggles with mental health were similarly hushed around loved ones; no one asked questions and I preferred it that way. I spent a long time not fitting in with others at my school, and turned to social media and online platforms to find a sense of belonging. That was, until an attempt at my life led to some unexplained time off school. I was welcomed back into my class with whispers and hushed tones. One of my few friends told me upon my return that she had heard a group of girls discuss my absence, stating “everyone knows she went to hospital, that’s why no one wants to be her friend”. The decision whether to come out about my mental ill health on my own terms was robbed from me; by pastoral staff who brazenly took me out of class to ‘ask me some questions’, by PE uniforms that took away my choice to cover my scars, by a school culture that spread rumors like wildfire. Shaming and Reclaiming Despite these experiences of shame and exposure, over time, I was able to seek out spaces for people like me. After I left school, I began gravitating towards a community of queer people who made me feel safe, and towards a place of acceptance for myself. I reclaim my weirdness, my eccentricities, and my less-than-ideal experiences, for just what they are; parts of myself. I cannot separate myself from them, and so I take them for what they are, and address them with pride. I was told, a long time ago, that I couldn’t achieve my dreams because of my scars. As if marks on my body took away my freedom, my choice, and my power. Everyday that I get to live out my dream as a mental health worker, I am demonstrating to my inner child that I get to live my dreams because of what I have been through, not in spite of it. The struggles I have overcome and healed from have enabled me to live the future I wanted for myself. So now, I thrive off my weird, amazing, queerness, and embody the role model I never had.

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Self Help for People with Learning Differences

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Self Help for People with Learning Differences

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The Hidden Pain? Self-injury and people with learning disabilities research project looked at the perspectives of people with learning disabilities who self-injure. This is the first time a study has actually asked people with learning disabilities throughout the UK about their own understandings of their self-injury and what would help them.

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We are working to make these resources available electronically as they are now out of print. Thank you for your patience and understanding.

The Hidden Pain? Self-injury and people with learning disabilities research project looked at the perspectives of people with learning disabilities who self-injure. This is the first time a study has actually asked people with learning disabilities throughout the UK about their own understandings of their self-injury and what would help them.

Resources produced by the project:

A DVD of people with learning disabilities talking about their experiences of self-injury

A workbook for people with learning disabilities who self-injure, to help them think through and address their self-injury -PDF only

An information booklet for family members/supporters or people with learning disabilities who self-injure

To ask for any of these resources for yourself when they are available in electronic form please click here.

If you would like to order any of these resources for people you work with when they become available electronically please contact us on [email protected]

If you experience any difficulties ordering a copy using the order form you can email our office or telephone 0117 927 9600 and we'll be happy to help.

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charity self-harm self-injury self harm distress trauma women girls

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Self Help Resources for People with Learning Disabilities

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We are working to make these resources available electronically as they are now out of print. Thank you for your patience and understanding. The Hidden Pain? Self-injury and people with learning disabilities research project looked at the perspectives of people with learning disabilities who self-injure.

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Many people with scars from self-harm can struggle in the summertime, as it becomes more common to wear shorter sleeves and clothing. This blog explores some of the challenges, and makes suggestions for how to feel comfortable during summer, whether you choose to cover scars or not

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Summer body image and self-harm - Mental Health UK

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Summer is typically a time for looser, more revealing clothing, but for someone who struggles with their body image — the way they think and feel about their appearance — summer may be a difficult time. For people who self-harm or who have scars from self-harm, it can be even more distressing.

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The difference between self-harm and self-injury in neurodivergence

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The difference between self-harm and self-injury in neurodivergence

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This podcast episode for parents of individuals with Autism talks about the differences between self-harm and self-injury.

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In this podcast, we are joined by Dr. Ann Ozsivadjian, independent clinical psychologist and visiting senior lecturer at King's College London, and Dr. Penny Williams, consultant speech and language therapist at the Evelina London Children's Hospital.

Ann and Penny set the scene by explaining the difference between self-harm and self-injurious behaviours in the context of autistic children, and provide insight into how common self-harm is in autistic people, as well as what is currently understood about why autistic children and young people self-harm.

In addition, Ann and Penny discuss whether there are certain situations that can act as triggers, how parents can help to reduce these stressors, where parents can get help for an autistic child who is harming themselves, and what support can they expect to receive. We also hear about nonverbal strategies that can help when it comes to self-injurious behaviour.

Furthermore, Ann and Penny also talk to us about whether there is a link between self-harm and suicidal ideation, what parents should do if they are worried about this, and what advice they have for autistic older children and young people who may be listening to this podcast.

We are delighted that this podcast series for parents is supported by the Autism Diagnostic Practice at Clinical Partners. Working nationwide with only the most experienced consultants, Clinical Partners ensures you get the best ASD diagnosis and help tailored specifically to your child, as fast as possible. Discover more.

Please subscribe and rate our podcast from your preferred streaming platform, including; SoundCloud, iTunes, Spotify, CastBox, Deezer, Google Podcasts and Radio.com (not available in the EU).

Other Episodes in The Series
Episode 6 'Food Sensitivities and Proclivities' with Dr. Vicki Ford Episode 7 'Tailoring Support CBT and Mindfulness' Episode 8 'Challenging Behaviour and Demand Avoidance'
Ann trained in clinical psychology at Oxford and is now an honorary principal clinical psychologist at the Evelina London Children's Hospital, honorary researcher at King's College London and is also an independent practitioner. Ann worked in the Complex Paediatric Neurodevelopmental Disability Service at the Children's Neurosciences Centre, Evelina London Children's Hospital (Guy's and St Thomas' NHS Foundation Trust) for 16 years. Her clinical and research interests include the assessment and treatment of mental health difficulties in ASD, cognitive pathways to anxiety in ASD, and also working with girls and women on the autism spectrum.

Penny works within a tertiary service for the assessment, diagnosis and management of children with neurodevelopmental disorders (affecting intellectual, motor, communication, behaviour and/or social development). Her clinical interests in ASD include challenging behaviour and the role of communication. Her research interests include exploring the parental role in speech & language interventions in young children. Nationally she co-developed and updated the NICE guideline on recognition, referral & diagnosis of ASD and is currently an expert adviser on autism for NICE. She contributed to the National Strategies Inclusion Development Programme for ASD and is a past chair of a regional specialist group in ASD for SLTs. (Bio and Image from learn.autism.org.uk)

Transcript

[00:00:30.750] - Jo Carlowe: Hello. Welcome to the latest instalment of the Special In Conversation podcast series for the Association for Child and Adolescent Mental Health, ACAMH, focusing on autism. Today we will focus on autistic children who harm themselves. The terms autistic spectrum disorder, ASD, and autism spectrum condition, ASC, are preferred by different people. In this talk we will use the term autism to encompass both. I'm Jo Carlowe, a freelance journalist with a specialism in psychology.

[00:01:01.290] Today I'm interviewing Dr. Ann Ozsivadjian, independent clinical psychologist and visiting senior lecturer at King's College London, and Dr. Penny Williams, consultant speech and language therapist at the Evelina London Children's Hospital. This podcast is supported by Clinical Partners. If you're a fan of our In Conversation series, please subscribe on iTunes or your preferred streaming platform. Let us know how we did with a rating or review and do share with friends and colleagues. Ann and Penny, thanks for joining me for another podcast in this important series. Can you start with a brief introduction?

[00:01:34.650] - Dr. Ann Ozsivadjian: Hi there. Yes, I'm Ann Ozsivadjian, clinical psychologist specialising in neurodevelopmental conditions, and I've got a particular interest in mental health conditions in autism, and for 16 years I worked at the Evelina London Children's Hospital, some of them with my colleague Penny here.

[00:01:49.830] - Dr. Penny Williams: Hi. Yes, I'm Penny. Speech and language therapist, as everyone said, at the Evelina, and I specialise in complex communication disorders and neurodevelopmental disorders, such as autism. My particular interests though are children who are minimally verbal and those who present with behaviour that challenges, including self-injury, working directly with parents to support change.

[00:02:10.890] - Jo Carlowe: I think of activities such as hand biting or head hitting. Can you explain the difference between self-harm and self-injurious behaviours in the context of autistic children?

[00:02:23.310] - Dr. Ann Ozsivadjian: Yes, you're right, Jo. Those two terms are typically used in those ways and in many ways contributes to a dichotomous way of thinking about autism, so high and low functioning, which have become terms that the autistic community are increasingly rejecting. And in this podcast we've deliberately chosen to include behaviours that involve a young person causing harm to themselves in one way or another across the whole spectrum to highlight that point, that any self-harm or behaviour causing injury is a communication or a response to something, so either within the child or within the environment, wherever the young person may be on a verbal or intellectual spectrum.

[00:03:01.530] So self-injury often refers to behaviours such as head banging, hair pulling and biting, as mentioned, and sometimes a distinction has been made between self-injury and self-harm in that self-injurious behaviours often don't necessarily have a wilful intent to cause harm to the self, unlike self-harm, which is sometimes seen as very much a wilful behaviour and choice. However, again, I'm not sure that this is a helpful distinction to make, as very few young people I've met want to be self-harming. So whether the behaviour involves a deliberate choice or not, it's really important to look at the drivers of harmful behaviours, which often involve some sort of distress.

[00:03:40.410] In fact, in one study published in 2016, where only about half the sample were considered to have an intellectual disability, rates of self-injurious behaviour were documented across the spectrum in about a quarter of the sample. So while it was recognised that intellectual disability is likely to increase the prevalence of traditional self-injurious behaviours, they were still seen in comparable rates in those that have average range intellectual ability. So in other words, it's not necessarily helpful to have this sort of dichotomous distinction between self-harm and self-injury, but rather to identify the drivers of the behaviour, and what skills an individual has to overcome the distress that they're feeling in more adaptive ways.

[00:04:21.510] - Dr. Penny Williams: I completely agree. When we look at the evidence base, it just seems that the difference is due perhaps to tradition rather than any particular scientific explanation, and hence may be arbitrary. Though it is important that if parents and others wish to find out what the research says, to seek information that perhaps speaks to them and their child, it may still help to share what is currently meant by the two terms. So in individuals who have minimal speech and/or an intellectual disability, self-injurious behaviour is the term that's traditionally used. This behaviour, as with self-harm, is any behaviour that results in someone causing physical harm to him or herself. Some of these have already been mentioned, such as hand biting and head butting. Another common behaviour we see in autism and intellectual disability is scratching.

[00:05:06.330] - Jo Carlowe: And today we're going to talk about both self-harm in verbally able young people with mental health issues and self-injurious behaviours in minimally verbal children. Starting with self-harm, how common is this in autistic people?

[00:05:21.330] - Dr. Ann Ozsivadjian: Self-harm is actually very common in autism. As with any area of investigation, there's often a wide range of prevalence statistics, but basically the studies that I've seen have suggested rates of about 40 to 50 percent and that's with a lifetime prevalence, i.e., that's happened at least once in someone's life, in autistic people and across the intellectual spectrum. So this is far higher than in the general population. However, interestingly, one study looked at self-harm in people with and without autism, and they actually found that there was very little difference in terms of types of self-harm, age of onset or reason for self-harm.

[00:05:57.570] - Dr. Penny Williams: Estimates in children with intellectual disability vary depending on how the behaviour is described and the degree of cognitive impairment. For example, in autistic children with severe intellectual disability and with severe and persistent self-injury, current estimates suggest that we might expect to see this behaviour in 4-5 percent of such children. In other words, a special school for this particular group of children with, say, 100 pupils, four or five of them will be displaying frequent and difficult to manage self-injurious behaviour, which are in most need of services and support. This estimate, of course, doesn't capture less severe behaviours or the occurrence in young people with less severe autism cognitive impairments.

[00:06:38.310] When we're looking at a broader definition of self-injury without the severity indicator, a large study in America found that almost 30 percent of children with autism, autistic children, were reported to engage in self-injurious behaviour. Research, however, does not appear to be capturing transient episodes of self-injury, perhaps in response to pain, or the behaviours that perhaps occur in specific contexts only. These are just as important to identify and provide intervention for, so estimates can only be a guide, regardless of how common it is. Understanding it and treating it is vital if we are to minimise the harm to young people and the impact on their families.

[00:07:15.810] - Jo Carlowe: Is it always obvious that a child or young person is self-harming and if not, what behaviours should parents look out for?

[00:07:24.210] - Dr. Penny Williams: With self-injury the behaviours are often obvious. However, albeit rarely, they can be misunderstood. People can assume the behaviour is just a part of his or her autism and may not see it as harmful. For example, a child who every time his class had what they call circle time would sit in his spot and repeatedly bang his head against the cupboard which he sat next to, but staff thought it's just what he does and because it wasn't causing any obvious physical damage to his head, it wasn't considered harmful. Some behaviours can also start out as light touch, and so not causing bruising or broken skin, or will be very rare, and people can perhaps be forgiven for missing early signs. However, the nature of self-injury in autism means that not understanding these behaviours and providing appropriate interventions early on can risk them escalating and persisting. As I said, this is not common. Parents do notice and are more likely to rate their self-injurious behaviour as more severe compared to teachers.

[00:08:19.110] - Dr. Ann Ozsivadjian: Yes, and in more intellectually able young people or verbally able young people, there is a risk that they will develop more sophisticated methods of keeping their behaviour covert, so perhaps, for example, due to feelings of shame or embarrassment or so as to not be prevented from doing the behaviour. So some behaviours might be obvious, such as visibly punching themselves, but other behaviours might be obvious after the event. So, for example, cuts to the arms or bald patches where hair should be, and some behaviours might not be obvious at all, such as cuts to places where people can't see or which take place in private. So parents could look out for signs such as covering up more than usual or secretive behaviour or a tendency to isolate for long periods at times of distress.

[00:09:03.750] - Jo Carlowe: That's very helpful. What is understood about why autistic children and young people self-harm?

[00:09:10.110] - Dr. Ann Ozsivadjian: This is a great question, which will lead us into how we can help those who self-harm. So what is incredibly important in trying to understand why anyone is self-harming is to start with a functional assessment in order to identify when it happens, in what context, who is around and what's happening at the time, etcetera, etcetera. Otherwise, there might be a tendency to jump to conclusions, so it must be happening because of A or B or it must be suppressed, and people link straight into helping. Sometimes it might be a post on social media or something, which elicits a feeling and then that leads to self-harming behaviour. And with those for whom communication is a challenge this might be done through carers and observation, the functional assessment that is, but for those who are able, it might involve diary recording of their own feelings or thoughts or what circumstances their self-harm tends to occur in, etcetera, etcetera. So even for very verbally able individuals, diary recording might be quite challenging, though there are ways of supporting people with this.

[00:10:09.870] But a useful starting point for understanding why self-harm occurs is always to think of it as a communication rather than a behavioural choice. The communication might be I'm unhappy or I can't stand this feeling or I need to punish myself. Self-harm might be an indicator for more enduring mental health problems such as anxiety or depression, and for some, it's a coping mechanism, even if not necessarily a very helpful one. Low mood or negative affect is a common cause of self-harm, as is low self-esteem. And more and more the concept of emotion dysregulation is of interest to researchers, and emotion regulation is trans diagnostic, meaning that it's a trait that might underlying a number of conditions, not just autism.

[00:10:50.790] And self-harm sometimes occurs in a response to a surge of emotions, which can feel overwhelming. So self-harm might be acting as a kind of pressure valve is what I read in one paper. So sometimes people feel that engaging in the behaviour releases that pressure. And it's also really important to mention that self-harm can itself be or become rewarding. For example, in young people with hyposensitivity or alexithymia, for example, they may say, Well, at least I'm feeling something when I self-harm. Or for hypersensitivity it can counteract that intensity of the sensory overstimulation of extreme emotions. And we also know that the endorphins released can be pleasurable and hence reinforcing also.

[00:11:31.110] - Dr. Penny Williams: In children and young people who are minimally verbal, understanding why they are engaging in self-injurious behaviours is much more difficult to ascertain. They don't have the language to tell you. And even for those with some words, their ability to understand themselves is limited by their autism and their learning disability. Instead, we rely on careful observations together with an understanding of what the research tells us. This can give us a working hypothesis, as you will, as to why this child is hurting themselves and provide an opportunity to intervene. Parents, carers, teachers who know the young person will already be desperately trying to work out why this child is hurting themselves. They'll probably have many ideas that come to conclusions, such as it seems to come from nowhere, or he does it all the time in so many different contexts that we just don't know, or it's different at home than at school, so we can't work it out. Sometimes those who are close to the child may have identified multiple different reasons, and that can make it hard to know where to start.

[00:12:29.910] Research tells us that the things that might increase the risk of an autistic person engaging in self-injury and it persisting, include experiencing anxiety, being impulsive, engaging in repetitive behaviours, and experiencing problems with sleep. If a child is in pain, this can also trigger self-injurious behaviour. These alone don't always explain the behaviour. This means, as Ann's already mentioned, we'll still need to carefully observe the behaviour to understand what might precipitate or trigger it, and also unintentionally maintain it or keep it going. We call this a functional analysis of behaviour. The process of observing the behaviour over a good period of time is it allows us to see patterns about why it's occurring and what might be maintaining it. It's like the process that those close to the child are already engaging in; only it's done systematically and includes interviews with those people. By gathering the evidence and testing our ideas the intervention we provide is completely individualised to that child and their family. This is at the core of what's called positive behaviour support, the recommended holistic, person-centred approach to managing any behaviour that challenges.

[00:13:36.210] - Dr. Ann Ozsivadjian: And one interesting study that I read looked at different aspects of autism as risk factors for self-injury. So again, across the intellectual spectrum, so only a third of people in this study had an intellectual disability. They found that sensory atypicalities was the greatest predictor of harmful behaviours. And interesting here, sensory processing difficulties can have two functions. So one is that self-harm might be a sensory seeking behaviour, so, for example, extreme skin picking. Or it might be a response to a sensory aversion, so, for example, head banging in response to a noise that the person can't stand or them resulting being removed from the situation.

[00:14:14.070] And other factors that were associated with self-harm included a need for sameness, so self-harm being a reaction to the anxiety caused by disruption to a routine, for example. And another factor is a tendency to [inaudible] behaviour and autism, as we know, doesn't just occur in isolation but also in conjunction with other conditions often, co-occurring conditions or aspects of other conditions, so like ADHD, impulsivity and also compromised executive function. So difficulty with inhibition might be a feature which makes self-harm an easy go-to solution, as it were, to alleviating pain, and therefore it's incumbent on us as professionals to identify an individual's profile of features which makes them more likely to engage in harmful behaviours to themselves, but then also to help them problem solve and to think of alternatives.

[00:15:00.870] - Jo Carlowe: You've already touched on this a bit, but I want to look at the triggers. Are there certain situations that will act as triggers? And if so, how can parents help to reduce these stressors?

[00:15:12.510] - Dr. Ann Ozsivadjian: So this can be very, very tricky for parents. So self-harm or self-injury is very distressing behaviour for parents to observe. And sometimes it happens to be such a degree when a young person is actually at serious risk to themselves, for example, causing themselves brain damage or brain injury or, as with an eating disorder, at risk of starvation even. And again, situations that trigger self-harm will be unique to an individual. But common triggers that I've come across include seeing something on social media, receiving a distressing text, having a fight with a friend or partner, or sometimes having memories, which are just really emotionally overwhelming.

[00:15:48.090] - Dr. Penny Williams: So for the child or young person with limited verbal communication the first thing to consider is pain, particularly if the self-injurious behaviour is new or is suddenly escalated. Parents already know that their children struggles to tell them when they're in pain and where it hurts, and finding that out isn't easy. When working on a child's functional communication, I often ask parents what they want their child to be able to communicate, and it's often to be able to tell them that they're in pain or ill, perhaps highlighting how difficult this area is. If pain is thought to be the reason, then parents could consider providing standard pain relief until they're able to seek out medical attention. Just as important, though, is ensuring regular health check-ups, both with the doctor and the dentist to try and reduce the risk occurring.

[00:16:33.210] When a young person is minimally verbal the other reasons that can underline the behaviour is communication difficulties. This could be because they don't understand what's being said, and this may be on top of not understanding the context that they're in. It might also be because they can't express themselves. They can't tell you they don't understand, that they need your help, your attention, or that they want to escape, or that they want to protest. Some children who are severely impaired self-injury can sometimes be self-stimulatory, a way in which they occupy themselves. Unfortunately, some of these behaviours can start off with an identifiable cause, then risk becoming a part of a person's repertoire of repetitive behaviour, due to their autism.

[00:17:11.910] So how can parents help? If you've identified that it's serving a communication function, then your child will need to be taught an alternative method of communicating this need. This is called functional communication training, essentially replacing the atypical communicative act that is self-injurious behaviour with something safe and meaningful. If it is self-stimulatory, then looking at ways of developing your child's ability to self-occupy and safely so. This is where the speech and language therapist and occupational therapist, respectively, can help.

[00:17:43.110] What should go without saying, though, is that this is good practise anyway, even if your child isn't harming themselves, ensuring that they understand what's going on around them with object or picture support, for example, and providing them with the ability to get their basic needs met through alternative ways of communicating is essential. Sometimes, however, even when these triggers have been reduced, anxiety, impulsivity and sleep problems can remain, and may warrant additional intervention, for example, using modified therapy where appropriate, or using medication approaches which can address features such as impulsivity, emotional dysregulation and rigidity.

[00:18:19.590] - Jo Carlowe: Ann and Penny, any other ideas about how parents can support a child who is intentionally damaging or injuring themselves?

[00:18:27.390] - Dr. Ann Ozsivadjian: The one really important thing that parents could not do is to get very emotional in response to the self-harm. Easier said than done, I know.

[00:18:35.250] - Jo Carlowe: Sure.

[00:18:35.250] - Dr. Ann Ozsivadjian: So often this can serve to increase feelings of shame or self-loathing, which the individual may already be struggling with, and be counterproductive. So the single most useful thing parents can do is talk to their child in as non-judgmental and calm way as possible. So make it clear that you want to support, not chastise your child. It may also be important, if possible, to subtly maintain a slightly higher level of supervision than you do normally, and also, of course, remove access to any items that a young person might use to harm themselves. Although people can be incredibly resourceful about how they access items, so it's really important for parents not to feel terrible if a young person does get hold of something. And sometimes young people may find it too difficult to talk to a parent. There might be a trusted adult that they can open up to, such as another family member or someone at school, and that would be really more facilitating dialogues to ensure that your child is talking to someone.

[00:19:31.230] - Dr. Penny Williams: I should mention that for some very severe cases, there may be a need to use some form of physical restraint, such as a splint, but this should only ever be a temporary solution and where possible to be part of the therapeutic intervention that includes fading out its use. If they are required, professionals may wish to check that it is actually in the best interest of your child. Otherwise, seek help, ensure regular health check-ups, including the dentist, work with school to ensure that communication and how your child can communicate are priorities for both home and school, but recognising that there may be differences in what they need to communicate in both settings. Also, please don't neglect your own wellbeing. The impact on families is significant, and not just sleep deprivation. Speaking to your GP if needed, and looking into respite opportunities, even if it's just within your own family. Taking a break and putting yourself first occasionally can give you the strength to keep going.

[00:20:28.050] - Jo Carlowe: Sounds really important. I'm wondering if an autistic child or young person finds talking hard or shies away from being asked questions, are there nonverbal strategies that can help when it comes to self-injurious behaviour?

[00:20:43.230] - Dr. Ann Ozsivadjian: Yes, certainly this can be a challenge, even when, or sometimes especially when, working with verbally able individuals. Sometimes this might be due to core communication difficulties or perhaps due to feelings of shame or embarrassment, or another thing which is increasingly gaining interest is alexithymia, which is difficulty recognising and labelling your own emotions. So, for example, how much were you feeling angry, sad, or whatever? That might be a really difficult question to answer for some people. So, as always, when working with young autistic people, mixing things up with visual supports for communication as well as verbal questioning can be useful.

[00:21:20.130] So, for example, some professionals are still delivering therapy via online platforms, which often have the facility to share a whiteboard or if in person it might be easier for individuals to express themselves through writing or drawing. And strategies such as social stories or comic strips can also be useful in thinking about facts and explanations, or understanding a sequence of events. Using a visual thermometer can be really helpful. A resource, which I use a lot, is something called the CAT‑Kit, which I've got electronically. It's a really handy collection of feelings, words, or faces for those who prefer, and lots of ideas for different ways to use them. So, for example, constructing a timeline or there's a visual thermometer to help people think about how much of something that they're feeling.

[00:22:03.210] - Dr. Penny Williams: And just to add for those who might be minimally verbal and if they're comfortably able to do so, a technique called Talking Mat may be worth trying. It's a structured and visual way of using pictures, of helping people to express opinions. There is a website for more information and we've included that information.

[00:22:21.330] - Jo Carlowe: Great. Thank you. Where can parents go to get help for an autistic child who is harming themselves and what support can they expect to receive?

[00:22:30.030] - Dr. Ann Ozsivadjian: So it's essential that a young person who is self-harming has a risk assessment by an appropriate qualified professional. If the behaviour is not yet entrenched, for example, if it's just happened once or twice and the young person indicates that they regret having done it, there's openness and a desire to stop, then it may be possible to manage this with a therapist, such as a counsellor or a clinical psychologist addressing the underlying feelings, who will have the appropriate training to know when to escalate intervention and also to adopt a multidisciplinary approach or refer on to specialist services.

[00:23:03.750] At the same time as monitoring risks, they'll be able to work on prevention of self-harm behaviours, and that involves usually helping a young person recognise the triggers, recognise the pathways, possibly using something called chain analysis, which involves analysing the chain of sequence of thoughts, behaviours and feelings, and then helping the young person to think about alternatives when they recognise those triggers happening. But if the behaviour is more entrenched and escalating, a referral to CAMHS should absolutely be made, usually via a GP. Many people find CAMHS quite difficult to access or there are long waiting lists, but nevertheless, it's really important to try because services vary a great deal regionally, and sometimes they're a very good alternative to Tier 3 CAMHS, which CAMHS teams themselves may signpost to.

[00:23:50.790] In an emergency situation, parents should always contact their GP, and if out of hours, accident and emergency where there'll be access to an on-duty psychiatrist.

[00:24:00.150] - Dr Penny Williams: Some areas have a CAMHS service, especially for children with intellectual disability, and who have specialist skills in managing any kind of behaviour that challenges. They're also often multidisciplinary and increasingly have speech and language therapy involved. If you find out if your GP, local paediatrician or other professionals involved don't know, then I'd probably suggest The Challenging Behaviour Foundation. They have a list of what's available across the country and also have named champions for specific areas. That would be my go-to.

[00:24:29.970] - Jo Carlowe: This is a difficult question, but parents may worry that there is a link between self-harm and suicidal ideation. Is that the case and what should parents do if they are worried about this?

[00:24:43.110] - Dr. Ann Ozsivadjian: This is indeed a difficult question. And here it's really important to have a balanced view between not minimising the risk, but also not alarming parents. As I said before, self-harm is actually very common, but this doesn't mean that every person who self-harms will attempt suicide. There is a link, which can cause people to become very, very alarmed indeed when self-harming behaviour comes to light, and indeed self-harm is a strong risk factor for suicidal behaviour. But this doesn't mean that all people who self-harm will go on to attempt suicide, but rather it means that of those who do attempt suicide, many will have a history of self-harm. Let's not forget, though, that suicide has also become a leading cause of death in under 25s, and therefore it's important to address the underlying feelings of unhappiness as early as possible.

[00:25:28.590] So people might have feelings that life is not worth living and they might engage in self-harm to manage emotional dysregulation, but the two might not necessarily be associated. However, as I said, self-harm is a risk for suicidal behaviours, and that's why it's really important to seek out professional support in good time, and therefore it's very, very important as well to address the underlying distress. As mentioned already, think about what is this young person communicating either to other people or to themselves. How can we alleviate their distress and give them better tools to manage their emotions? Do they need a break from social media or at least change the way they use it? Do they need a specialist school setting because they're not coping? Do they need a psychiatric consultation because the emotional dysregulation warrants medical intervention? So these are all things that we need to consider.

[00:26:18.930] - Jo Carlowe: Do you have any advice for autistic older children and young people who may be listening to this podcast? If the urge to self-harm arises, what might they do to alleviate this?

[00:26:30.930] - Dr. Ann Ozsivadjian: I think the main thing that I would say is talk to someone, so either a trusted adult at home or school or a trusted friend. But don't think that you're alone and you've got nowhere to go. Or maybe call one of the advice helplines that we detail below. Another thing that we would consider is for young people to consider their uses of social media. So cyberbullying we know can be a huge problem and leads to feelings of low mood. And it's also a risk factors for self-harm, even though other aspects of social media, such as seeing people at parties, etcetera, that they may not have been invited to, can also be quite distressing and overwhelming.

[00:27:06.390] Secondly, avoiding unhelpful web materials such as how to self-harm. There has been a concern that levels of self-harm have risen because of the attention it's received on social media, so I would avoid anything that appears to promote self-harm and only look at websites which help you manage your feelings and overcome the urge to self-harm. And thirdly, I'd recommend some useful literature in helping you recognise your feelings, recognising that overwhelming feelings will pass. There's a nice phrase called 'surf the urge', which I've come across, which essentially means sitting with the uncomfortable feeling, but knowing that it will go away.

[00:27:41.310] - Jo Carlowe: Where else can listeners go for more information or to find helpful resources on the issues we've talked about today?

[00:27:47.910] - Dr Ann Ozsivadjian: We've made some suggestions, which will be at the end of the transcript alongside this podcast. So there's information on the NSPCC website, the Childline website and Penny, you've got some recommendations?

[00:27:59.310] - Dr.Penny Williams: Yes. As I mentioned, The Challenging Behaviour Foundation, Cerebra, The Positive Behavioural Support Academy, the British Institute of Learning Disabilities, and the Council for Disabled Children, National Autistic Society, and also the National Institute for Clinical Excellence. They have some clinical guidelines with some helpful recommendations and guidance.

[00:28:21.630] - Jo Carlowe: Excellent. Penny, that's been so helpful. Finally, what are your takeaway messages for those listening to our conversation today?

[00:28:29.850] - Dr. Penny Williams: For the children who are minimally verbal, it may seem obvious, but to their parents, tell someone, tell a professional it's happening and that you're worried. Don't wait. The younger the child and the sooner the intervention is provided, the better chance of a good outcome. For a child who can't communicate in typical ways, this behaviour is telling you something. Don't wait for the right professional. A speech and language therapist can help with communication, an occupational therapist with how your child occupies themselves. Mental health awareness in schools has improved greatly. Your SENCO or school counsellor may be valuable. Anxiety may play a huge part in this, and this might make you think that only CAMHS has the answer, but helping a child understand, communicate, and be meaningfully occupied may go a long way in reducing the anxiety. I guess don't just tell someone, tell everybody, and encourage them to talk to each other. Working with a team, yourselves included, is what is needed. Lastly, we may have made this sound simplistic. We recognise it's not, particularly if the behaviour has been going on for some time, but we hope it will help.

[00:29:31.890] - Jo Carlowe: Ann, have you got anything to add?

[00:29:33.270] - Dr. Ann Ozsivadjian: Yes, I think just for people across the spectrum, again, the key message is to talk to someone. And again, as I said, just be careful about what information you access for help. Obviously, it's really good to know that you're not alone, and online forums, etcetera, can be really helpful for that, but equally, any sort of information which reinforces the behaviour is not necessarily helpful. So really it's about seeking help and thinking of how to address the underlying causes.

[00:29:57.510] - Jo Carlowe: Ann and Penny, thank you so much. It's been hugely helpful and so informative. For more information on autism and the issues covered in today's podcast, please visit www.acamh.org or Twitter . For more information on Clinical Partners, visit www.clinical-partners.co.uk. And let us know if you enjoyed the podcast with a rating or review, and do share with friends and colleagues.

External Resources

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Self-harm & Self-Injury - Episode. 9 'Autism a parents guide'

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For this podcast, focusing on autistic children who harm themselves, we are joined by Dr. Ann Ozsivadjian, and Dr. Penny Williams.

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by Jane Smith “The first book on self-harm written for parents by parents. Are you concerned that your child may be self-harming? Are you wondering what to do for the best? Do you need more information and help? If so, this is the book for you. An ever-increasing number of young people are turning to self-harm in order to cope with the pressures of modern living, and this poses a huge problem for parents and others who care for them. This book provides the answers you need to questions such as: how do I know for sure whether my child is self-harming?; how should I approach my child?; what help and treatment is available to us?; what can I do to help my child?; how have other parents coped? Full of the real-life experiences of other parents who have been there, this is a practical book that will both inform and equip you to help your child and yourself through this difficult time.”

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The difference between self-harm and self-injury in neurodivergence

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The difference between self-harm and self-injury in neurodivergence

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This podcast episode for parents of individuals with Autism talks about the differences between self-harm and self-injury.

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In this podcast, we are joined by Dr. Ann Ozsivadjian, independent clinical psychologist and visiting senior lecturer at King's College London, and Dr. Penny Williams, consultant speech and language therapist at the Evelina London Children's Hospital.

Ann and Penny set the scene by explaining the difference between self-harm and self-injurious behaviours in the context of autistic children, and provide insight into how common self-harm is in autistic people, as well as what is currently understood about why autistic children and young people self-harm.

In addition, Ann and Penny discuss whether there are certain situations that can act as triggers, how parents can help to reduce these stressors, where parents can get help for an autistic child who is harming themselves, and what support can they expect to receive. We also hear about nonverbal strategies that can help when it comes to self-injurious behaviour.

Furthermore, Ann and Penny also talk to us about whether there is a link between self-harm and suicidal ideation, what parents should do if they are worried about this, and what advice they have for autistic older children and young people who may be listening to this podcast.

We are delighted that this podcast series for parents is supported by the Autism Diagnostic Practice at Clinical Partners. Working nationwide with only the most experienced consultants, Clinical Partners ensures you get the best ASD diagnosis and help tailored specifically to your child, as fast as possible. Discover more.

Please subscribe and rate our podcast from your preferred streaming platform, including; SoundCloud, iTunes, Spotify, CastBox, Deezer, Google Podcasts and Radio.com (not available in the EU).

Other Episodes in The Series
Episode 6 'Food Sensitivities and Proclivities' with Dr. Vicki Ford Episode 7 'Tailoring Support CBT and Mindfulness' Episode 8 'Challenging Behaviour and Demand Avoidance'
Ann trained in clinical psychology at Oxford and is now an honorary principal clinical psychologist at the Evelina London Children's Hospital, honorary researcher at King's College London and is also an independent practitioner. Ann worked in the Complex Paediatric Neurodevelopmental Disability Service at the Children's Neurosciences Centre, Evelina London Children's Hospital (Guy's and St Thomas' NHS Foundation Trust) for 16 years. Her clinical and research interests include the assessment and treatment of mental health difficulties in ASD, cognitive pathways to anxiety in ASD, and also working with girls and women on the autism spectrum.

Penny works within a tertiary service for the assessment, diagnosis and management of children with neurodevelopmental disorders (affecting intellectual, motor, communication, behaviour and/or social development). Her clinical interests in ASD include challenging behaviour and the role of communication. Her research interests include exploring the parental role in speech & language interventions in young children. Nationally she co-developed and updated the NICE guideline on recognition, referral & diagnosis of ASD and is currently an expert adviser on autism for NICE. She contributed to the National Strategies Inclusion Development Programme for ASD and is a past chair of a regional specialist group in ASD for SLTs. (Bio and Image from learn.autism.org.uk)

Transcript

[00:00:30.750] - Jo Carlowe: Hello. Welcome to the latest instalment of the Special In Conversation podcast series for the Association for Child and Adolescent Mental Health, ACAMH, focusing on autism. Today we will focus on autistic children who harm themselves. The terms autistic spectrum disorder, ASD, and autism spectrum condition, ASC, are preferred by different people. In this talk we will use the term autism to encompass both. I'm Jo Carlowe, a freelance journalist with a specialism in psychology.

[00:01:01.290] Today I'm interviewing Dr. Ann Ozsivadjian, independent clinical psychologist and visiting senior lecturer at King's College London, and Dr. Penny Williams, consultant speech and language therapist at the Evelina London Children's Hospital. This podcast is supported by Clinical Partners. If you're a fan of our In Conversation series, please subscribe on iTunes or your preferred streaming platform. Let us know how we did with a rating or review and do share with friends and colleagues. Ann and Penny, thanks for joining me for another podcast in this important series. Can you start with a brief introduction?

[00:01:34.650] - Dr. Ann Ozsivadjian: Hi there. Yes, I'm Ann Ozsivadjian, clinical psychologist specialising in neurodevelopmental conditions, and I've got a particular interest in mental health conditions in autism, and for 16 years I worked at the Evelina London Children's Hospital, some of them with my colleague Penny here.

[00:01:49.830] - Dr. Penny Williams: Hi. Yes, I'm Penny. Speech and language therapist, as everyone said, at the Evelina, and I specialise in complex communication disorders and neurodevelopmental disorders, such as autism. My particular interests though are children who are minimally verbal and those who present with behaviour that challenges, including self-injury, working directly with parents to support change.

[00:02:10.890] - Jo Carlowe: I think of activities such as hand biting or head hitting. Can you explain the difference between self-harm and self-injurious behaviours in the context of autistic children?

[00:02:23.310] - Dr. Ann Ozsivadjian: Yes, you're right, Jo. Those two terms are typically used in those ways and in many ways contributes to a dichotomous way of thinking about autism, so high and low functioning, which have become terms that the autistic community are increasingly rejecting. And in this podcast we've deliberately chosen to include behaviours that involve a young person causing harm to themselves in one way or another across the whole spectrum to highlight that point, that any self-harm or behaviour causing injury is a communication or a response to something, so either within the child or within the environment, wherever the young person may be on a verbal or intellectual spectrum.

[00:03:01.530] So self-injury often refers to behaviours such as head banging, hair pulling and biting, as mentioned, and sometimes a distinction has been made between self-injury and self-harm in that self-injurious behaviours often don't necessarily have a wilful intent to cause harm to the self, unlike self-harm, which is sometimes seen as very much a wilful behaviour and choice. However, again, I'm not sure that this is a helpful distinction to make, as very few young people I've met want to be self-harming. So whether the behaviour involves a deliberate choice or not, it's really important to look at the drivers of harmful behaviours, which often involve some sort of distress.

[00:03:40.410] In fact, in one study published in 2016, where only about half the sample were considered to have an intellectual disability, rates of self-injurious behaviour were documented across the spectrum in about a quarter of the sample. So while it was recognised that intellectual disability is likely to increase the prevalence of traditional self-injurious behaviours, they were still seen in comparable rates in those that have average range intellectual ability. So in other words, it's not necessarily helpful to have this sort of dichotomous distinction between self-harm and self-injury, but rather to identify the drivers of the behaviour, and what skills an individual has to overcome the distress that they're feeling in more adaptive ways.

[00:04:21.510] - Dr. Penny Williams: I completely agree. When we look at the evidence base, it just seems that the difference is due perhaps to tradition rather than any particular scientific explanation, and hence may be arbitrary. Though it is important that if parents and others wish to find out what the research says, to seek information that perhaps speaks to them and their child, it may still help to share what is currently meant by the two terms. So in individuals who have minimal speech and/or an intellectual disability, self-injurious behaviour is the term that's traditionally used. This behaviour, as with self-harm, is any behaviour that results in someone causing physical harm to him or herself. Some of these have already been mentioned, such as hand biting and head butting. Another common behaviour we see in autism and intellectual disability is scratching.

[00:05:06.330] - Jo Carlowe: And today we're going to talk about both self-harm in verbally able young people with mental health issues and self-injurious behaviours in minimally verbal children. Starting with self-harm, how common is this in autistic people?

[00:05:21.330] - Dr. Ann Ozsivadjian: Self-harm is actually very common in autism. As with any area of investigation, there's often a wide range of prevalence statistics, but basically the studies that I've seen have suggested rates of about 40 to 50 percent and that's with a lifetime prevalence, i.e., that's happened at least once in someone's life, in autistic people and across the intellectual spectrum. So this is far higher than in the general population. However, interestingly, one study looked at self-harm in people with and without autism, and they actually found that there was very little difference in terms of types of self-harm, age of onset or reason for self-harm.

[00:05:57.570] - Dr. Penny Williams: Estimates in children with intellectual disability vary depending on how the behaviour is described and the degree of cognitive impairment. For example, in autistic children with severe intellectual disability and with severe and persistent self-injury, current estimates suggest that we might expect to see this behaviour in 4-5 percent of such children. In other words, a special school for this particular group of children with, say, 100 pupils, four or five of them will be displaying frequent and difficult to manage self-injurious behaviour, which are in most need of services and support. This estimate, of course, doesn't capture less severe behaviours or the occurrence in young people with less severe autism cognitive impairments.

[00:06:38.310] When we're looking at a broader definition of self-injury without the severity indicator, a large study in America found that almost 30 percent of children with autism, autistic children, were reported to engage in self-injurious behaviour. Research, however, does not appear to be capturing transient episodes of self-injury, perhaps in response to pain, or the behaviours that perhaps occur in specific contexts only. These are just as important to identify and provide intervention for, so estimates can only be a guide, regardless of how common it is. Understanding it and treating it is vital if we are to minimise the harm to young people and the impact on their families.

[00:07:15.810] - Jo Carlowe: Is it always obvious that a child or young person is self-harming and if not, what behaviours should parents look out for?

[00:07:24.210] - Dr. Penny Williams: With self-injury the behaviours are often obvious. However, albeit rarely, they can be misunderstood. People can assume the behaviour is just a part of his or her autism and may not see it as harmful. For example, a child who every time his class had what they call circle time would sit in his spot and repeatedly bang his head against the cupboard which he sat next to, but staff thought it's just what he does and because it wasn't causing any obvious physical damage to his head, it wasn't considered harmful. Some behaviours can also start out as light touch, and so not causing bruising or broken skin, or will be very rare, and people can perhaps be forgiven for missing early signs. However, the nature of self-injury in autism means that not understanding these behaviours and providing appropriate interventions early on can risk them escalating and persisting. As I said, this is not common. Parents do notice and are more likely to rate their self-injurious behaviour as more severe compared to teachers.

[00:08:19.110] - Dr. Ann Ozsivadjian: Yes, and in more intellectually able young people or verbally able young people, there is a risk that they will develop more sophisticated methods of keeping their behaviour covert, so perhaps, for example, due to feelings of shame or embarrassment or so as to not be prevented from doing the behaviour. So some behaviours might be obvious, such as visibly punching themselves, but other behaviours might be obvious after the event. So, for example, cuts to the arms or bald patches where hair should be, and some behaviours might not be obvious at all, such as cuts to places where people can't see or which take place in private. So parents could look out for signs such as covering up more than usual or secretive behaviour or a tendency to isolate for long periods at times of distress.

[00:09:03.750] - Jo Carlowe: That's very helpful. What is understood about why autistic children and young people self-harm?

[00:09:10.110] - Dr. Ann Ozsivadjian: This is a great question, which will lead us into how we can help those who self-harm. So what is incredibly important in trying to understand why anyone is self-harming is to start with a functional assessment in order to identify when it happens, in what context, who is around and what's happening at the time, etcetera, etcetera. Otherwise, there might be a tendency to jump to conclusions, so it must be happening because of A or B or it must be suppressed, and people link straight into helping. Sometimes it might be a post on social media or something, which elicits a feeling and then that leads to self-harming behaviour. And with those for whom communication is a challenge this might be done through carers and observation, the functional assessment that is, but for those who are able, it might involve diary recording of their own feelings or thoughts or what circumstances their self-harm tends to occur in, etcetera, etcetera. So even for very verbally able individuals, diary recording might be quite challenging, though there are ways of supporting people with this.

[00:10:09.870] But a useful starting point for understanding why self-harm occurs is always to think of it as a communication rather than a behavioural choice. The communication might be I'm unhappy or I can't stand this feeling or I need to punish myself. Self-harm might be an indicator for more enduring mental health problems such as anxiety or depression, and for some, it's a coping mechanism, even if not necessarily a very helpful one. Low mood or negative affect is a common cause of self-harm, as is low self-esteem. And more and more the concept of emotion dysregulation is of interest to researchers, and emotion regulation is trans diagnostic, meaning that it's a trait that might underlying a number of conditions, not just autism.

[00:10:50.790] And self-harm sometimes occurs in a response to a surge of emotions, which can feel overwhelming. So self-harm might be acting as a kind of pressure valve is what I read in one paper. So sometimes people feel that engaging in the behaviour releases that pressure. And it's also really important to mention that self-harm can itself be or become rewarding. For example, in young people with hyposensitivity or alexithymia, for example, they may say, Well, at least I'm feeling something when I self-harm. Or for hypersensitivity it can counteract that intensity of the sensory overstimulation of extreme emotions. And we also know that the endorphins released can be pleasurable and hence reinforcing also.

[00:11:31.110] - Dr. Penny Williams: In children and young people who are minimally verbal, understanding why they are engaging in self-injurious behaviours is much more difficult to ascertain. They don't have the language to tell you. And even for those with some words, their ability to understand themselves is limited by their autism and their learning disability. Instead, we rely on careful observations together with an understanding of what the research tells us. This can give us a working hypothesis, as you will, as to why this child is hurting themselves and provide an opportunity to intervene. Parents, carers, teachers who know the young person will already be desperately trying to work out why this child is hurting themselves. They'll probably have many ideas that come to conclusions, such as it seems to come from nowhere, or he does it all the time in so many different contexts that we just don't know, or it's different at home than at school, so we can't work it out. Sometimes those who are close to the child may have identified multiple different reasons, and that can make it hard to know where to start.

[00:12:29.910] Research tells us that the things that might increase the risk of an autistic person engaging in self-injury and it persisting, include experiencing anxiety, being impulsive, engaging in repetitive behaviours, and experiencing problems with sleep. If a child is in pain, this can also trigger self-injurious behaviour. These alone don't always explain the behaviour. This means, as Ann's already mentioned, we'll still need to carefully observe the behaviour to understand what might precipitate or trigger it, and also unintentionally maintain it or keep it going. We call this a functional analysis of behaviour. The process of observing the behaviour over a good period of time is it allows us to see patterns about why it's occurring and what might be maintaining it. It's like the process that those close to the child are already engaging in; only it's done systematically and includes interviews with those people. By gathering the evidence and testing our ideas the intervention we provide is completely individualised to that child and their family. This is at the core of what's called positive behaviour support, the recommended holistic, person-centred approach to managing any behaviour that challenges.

[00:13:36.210] - Dr. Ann Ozsivadjian: And one interesting study that I read looked at different aspects of autism as risk factors for self-injury. So again, across the intellectual spectrum, so only a third of people in this study had an intellectual disability. They found that sensory atypicalities was the greatest predictor of harmful behaviours. And interesting here, sensory processing difficulties can have two functions. So one is that self-harm might be a sensory seeking behaviour, so, for example, extreme skin picking. Or it might be a response to a sensory aversion, so, for example, head banging in response to a noise that the person can't stand or them resulting being removed from the situation.

[00:14:14.070] And other factors that were associated with self-harm included a need for sameness, so self-harm being a reaction to the anxiety caused by disruption to a routine, for example. And another factor is a tendency to [inaudible] behaviour and autism, as we know, doesn't just occur in isolation but also in conjunction with other conditions often, co-occurring conditions or aspects of other conditions, so like ADHD, impulsivity and also compromised executive function. So difficulty with inhibition might be a feature which makes self-harm an easy go-to solution, as it were, to alleviating pain, and therefore it's incumbent on us as professionals to identify an individual's profile of features which makes them more likely to engage in harmful behaviours to themselves, but then also to help them problem solve and to think of alternatives.

[00:15:00.870] - Jo Carlowe: You've already touched on this a bit, but I want to look at the triggers. Are there certain situations that will act as triggers? And if so, how can parents help to reduce these stressors?

[00:15:12.510] - Dr. Ann Ozsivadjian: So this can be very, very tricky for parents. So self-harm or self-injury is very distressing behaviour for parents to observe. And sometimes it happens to be such a degree when a young person is actually at serious risk to themselves, for example, causing themselves brain damage or brain injury or, as with an eating disorder, at risk of starvation even. And again, situations that trigger self-harm will be unique to an individual. But common triggers that I've come across include seeing something on social media, receiving a distressing text, having a fight with a friend or partner, or sometimes having memories, which are just really emotionally overwhelming.

[00:15:48.090] - Dr. Penny Williams: So for the child or young person with limited verbal communication the first thing to consider is pain, particularly if the self-injurious behaviour is new or is suddenly escalated. Parents already know that their children struggles to tell them when they're in pain and where it hurts, and finding that out isn't easy. When working on a child's functional communication, I often ask parents what they want their child to be able to communicate, and it's often to be able to tell them that they're in pain or ill, perhaps highlighting how difficult this area is. If pain is thought to be the reason, then parents could consider providing standard pain relief until they're able to seek out medical attention. Just as important, though, is ensuring regular health check-ups, both with the doctor and the dentist to try and reduce the risk occurring.

[00:16:33.210] When a young person is minimally verbal the other reasons that can underline the behaviour is communication difficulties. This could be because they don't understand what's being said, and this may be on top of not understanding the context that they're in. It might also be because they can't express themselves. They can't tell you they don't understand, that they need your help, your attention, or that they want to escape, or that they want to protest. Some children who are severely impaired self-injury can sometimes be self-stimulatory, a way in which they occupy themselves. Unfortunately, some of these behaviours can start off with an identifiable cause, then risk becoming a part of a person's repertoire of repetitive behaviour, due to their autism.

[00:17:11.910] So how can parents help? If you've identified that it's serving a communication function, then your child will need to be taught an alternative method of communicating this need. This is called functional communication training, essentially replacing the atypical communicative act that is self-injurious behaviour with something safe and meaningful. If it is self-stimulatory, then looking at ways of developing your child's ability to self-occupy and safely so. This is where the speech and language therapist and occupational therapist, respectively, can help.

[00:17:43.110] What should go without saying, though, is that this is good practise anyway, even if your child isn't harming themselves, ensuring that they understand what's going on around them with object or picture support, for example, and providing them with the ability to get their basic needs met through alternative ways of communicating is essential. Sometimes, however, even when these triggers have been reduced, anxiety, impulsivity and sleep problems can remain, and may warrant additional intervention, for example, using modified therapy where appropriate, or using medication approaches which can address features such as impulsivity, emotional dysregulation and rigidity.

[00:18:19.590] - Jo Carlowe: Ann and Penny, any other ideas about how parents can support a child who is intentionally damaging or injuring themselves?

[00:18:27.390] - Dr. Ann Ozsivadjian: The one really important thing that parents could not do is to get very emotional in response to the self-harm. Easier said than done, I know.

[00:18:35.250] - Jo Carlowe: Sure.

[00:18:35.250] - Dr. Ann Ozsivadjian: So often this can serve to increase feelings of shame or self-loathing, which the individual may already be struggling with, and be counterproductive. So the single most useful thing parents can do is talk to their child in as non-judgmental and calm way as possible. So make it clear that you want to support, not chastise your child. It may also be important, if possible, to subtly maintain a slightly higher level of supervision than you do normally, and also, of course, remove access to any items that a young person might use to harm themselves. Although people can be incredibly resourceful about how they access items, so it's really important for parents not to feel terrible if a young person does get hold of something. And sometimes young people may find it too difficult to talk to a parent. There might be a trusted adult that they can open up to, such as another family member or someone at school, and that would be really more facilitating dialogues to ensure that your child is talking to someone.

[00:19:31.230] - Dr. Penny Williams: I should mention that for some very severe cases, there may be a need to use some form of physical restraint, such as a splint, but this should only ever be a temporary solution and where possible to be part of the therapeutic intervention that includes fading out its use. If they are required, professionals may wish to check that it is actually in the best interest of your child. Otherwise, seek help, ensure regular health check-ups, including the dentist, work with school to ensure that communication and how your child can communicate are priorities for both home and school, but recognising that there may be differences in what they need to communicate in both settings. Also, please don't neglect your own wellbeing. The impact on families is significant, and not just sleep deprivation. Speaking to your GP if needed, and looking into respite opportunities, even if it's just within your own family. Taking a break and putting yourself first occasionally can give you the strength to keep going.

[00:20:28.050] - Jo Carlowe: Sounds really important. I'm wondering if an autistic child or young person finds talking hard or shies away from being asked questions, are there nonverbal strategies that can help when it comes to self-injurious behaviour?

[00:20:43.230] - Dr. Ann Ozsivadjian: Yes, certainly this can be a challenge, even when, or sometimes especially when, working with verbally able individuals. Sometimes this might be due to core communication difficulties or perhaps due to feelings of shame or embarrassment, or another thing which is increasingly gaining interest is alexithymia, which is difficulty recognising and labelling your own emotions. So, for example, how much were you feeling angry, sad, or whatever? That might be a really difficult question to answer for some people. So, as always, when working with young autistic people, mixing things up with visual supports for communication as well as verbal questioning can be useful.

[00:21:20.130] So, for example, some professionals are still delivering therapy via online platforms, which often have the facility to share a whiteboard or if in person it might be easier for individuals to express themselves through writing or drawing. And strategies such as social stories or comic strips can also be useful in thinking about facts and explanations, or understanding a sequence of events. Using a visual thermometer can be really helpful. A resource, which I use a lot, is something called the CAT‑Kit, which I've got electronically. It's a really handy collection of feelings, words, or faces for those who prefer, and lots of ideas for different ways to use them. So, for example, constructing a timeline or there's a visual thermometer to help people think about how much of something that they're feeling.

[00:22:03.210] - Dr. Penny Williams: And just to add for those who might be minimally verbal and if they're comfortably able to do so, a technique called Talking Mat may be worth trying. It's a structured and visual way of using pictures, of helping people to express opinions. There is a website for more information and we've included that information.

[00:22:21.330] - Jo Carlowe: Great. Thank you. Where can parents go to get help for an autistic child who is harming themselves and what support can they expect to receive?

[00:22:30.030] - Dr. Ann Ozsivadjian: So it's essential that a young person who is self-harming has a risk assessment by an appropriate qualified professional. If the behaviour is not yet entrenched, for example, if it's just happened once or twice and the young person indicates that they regret having done it, there's openness and a desire to stop, then it may be possible to manage this with a therapist, such as a counsellor or a clinical psychologist addressing the underlying feelings, who will have the appropriate training to know when to escalate intervention and also to adopt a multidisciplinary approach or refer on to specialist services.

[00:23:03.750] At the same time as monitoring risks, they'll be able to work on prevention of self-harm behaviours, and that involves usually helping a young person recognise the triggers, recognise the pathways, possibly using something called chain analysis, which involves analysing the chain of sequence of thoughts, behaviours and feelings, and then helping the young person to think about alternatives when they recognise those triggers happening. But if the behaviour is more entrenched and escalating, a referral to CAMHS should absolutely be made, usually via a GP. Many people find CAMHS quite difficult to access or there are long waiting lists, but nevertheless, it's really important to try because services vary a great deal regionally, and sometimes they're a very good alternative to Tier 3 CAMHS, which CAMHS teams themselves may signpost to.

[00:23:50.790] In an emergency situation, parents should always contact their GP, and if out of hours, accident and emergency where there'll be access to an on-duty psychiatrist.

[00:24:00.150] - Dr Penny Williams: Some areas have a CAMHS service, especially for children with intellectual disability, and who have specialist skills in managing any kind of behaviour that challenges. They're also often multidisciplinary and increasingly have speech and language therapy involved. If you find out if your GP, local paediatrician or other professionals involved don't know, then I'd probably suggest The Challenging Behaviour Foundation. They have a list of what's available across the country and also have named champions for specific areas. That would be my go-to.

[00:24:29.970] - Jo Carlowe: This is a difficult question, but parents may worry that there is a link between self-harm and suicidal ideation. Is that the case and what should parents do if they are worried about this?

[00:24:43.110] - Dr. Ann Ozsivadjian: This is indeed a difficult question. And here it's really important to have a balanced view between not minimising the risk, but also not alarming parents. As I said before, self-harm is actually very common, but this doesn't mean that every person who self-harms will attempt suicide. There is a link, which can cause people to become very, very alarmed indeed when self-harming behaviour comes to light, and indeed self-harm is a strong risk factor for suicidal behaviour. But this doesn't mean that all people who self-harm will go on to attempt suicide, but rather it means that of those who do attempt suicide, many will have a history of self-harm. Let's not forget, though, that suicide has also become a leading cause of death in under 25s, and therefore it's important to address the underlying feelings of unhappiness as early as possible.

[00:25:28.590] So people might have feelings that life is not worth living and they might engage in self-harm to manage emotional dysregulation, but the two might not necessarily be associated. However, as I said, self-harm is a risk for suicidal behaviours, and that's why it's really important to seek out professional support in good time, and therefore it's very, very important as well to address the underlying distress. As mentioned already, think about what is this young person communicating either to other people or to themselves. How can we alleviate their distress and give them better tools to manage their emotions? Do they need a break from social media or at least change the way they use it? Do they need a specialist school setting because they're not coping? Do they need a psychiatric consultation because the emotional dysregulation warrants medical intervention? So these are all things that we need to consider.

[00:26:18.930] - Jo Carlowe: Do you have any advice for autistic older children and young people who may be listening to this podcast? If the urge to self-harm arises, what might they do to alleviate this?

[00:26:30.930] - Dr. Ann Ozsivadjian: I think the main thing that I would say is talk to someone, so either a trusted adult at home or school or a trusted friend. But don't think that you're alone and you've got nowhere to go. Or maybe call one of the advice helplines that we detail below. Another thing that we would consider is for young people to consider their uses of social media. So cyberbullying we know can be a huge problem and leads to feelings of low mood. And it's also a risk factors for self-harm, even though other aspects of social media, such as seeing people at parties, etcetera, that they may not have been invited to, can also be quite distressing and overwhelming.

[00:27:06.390] Secondly, avoiding unhelpful web materials such as how to self-harm. There has been a concern that levels of self-harm have risen because of the attention it's received on social media, so I would avoid anything that appears to promote self-harm and only look at websites which help you manage your feelings and overcome the urge to self-harm. And thirdly, I'd recommend some useful literature in helping you recognise your feelings, recognising that overwhelming feelings will pass. There's a nice phrase called 'surf the urge', which I've come across, which essentially means sitting with the uncomfortable feeling, but knowing that it will go away.

[00:27:41.310] - Jo Carlowe: Where else can listeners go for more information or to find helpful resources on the issues we've talked about today?

[00:27:47.910] - Dr Ann Ozsivadjian: We've made some suggestions, which will be at the end of the transcript alongside this podcast. So there's information on the NSPCC website, the Childline website and Penny, you've got some recommendations?

[00:27:59.310] - Dr.Penny Williams: Yes. As I mentioned, The Challenging Behaviour Foundation, Cerebra, The Positive Behavioural Support Academy, the British Institute of Learning Disabilities, and the Council for Disabled Children, National Autistic Society, and also the National Institute for Clinical Excellence. They have some clinical guidelines with some helpful recommendations and guidance.

[00:28:21.630] - Jo Carlowe: Excellent. Penny, that's been so helpful. Finally, what are your takeaway messages for those listening to our conversation today?

[00:28:29.850] - Dr. Penny Williams: For the children who are minimally verbal, it may seem obvious, but to their parents, tell someone, tell a professional it's happening and that you're worried. Don't wait. The younger the child and the sooner the intervention is provided, the better chance of a good outcome. For a child who can't communicate in typical ways, this behaviour is telling you something. Don't wait for the right professional. A speech and language therapist can help with communication, an occupational therapist with how your child occupies themselves. Mental health awareness in schools has improved greatly. Your SENCO or school counsellor may be valuable. Anxiety may play a huge part in this, and this might make you think that only CAMHS has the answer, but helping a child understand, communicate, and be meaningfully occupied may go a long way in reducing the anxiety. I guess don't just tell someone, tell everybody, and encourage them to talk to each other. Working with a team, yourselves included, is what is needed. Lastly, we may have made this sound simplistic. We recognise it's not, particularly if the behaviour has been going on for some time, but we hope it will help.

[00:29:31.890] - Jo Carlowe: Ann, have you got anything to add?

[00:29:33.270] - Dr. Ann Ozsivadjian: Yes, I think just for people across the spectrum, again, the key message is to talk to someone. And again, as I said, just be careful about what information you access for help. Obviously, it's really good to know that you're not alone, and online forums, etcetera, can be really helpful for that, but equally, any sort of information which reinforces the behaviour is not necessarily helpful. So really it's about seeking help and thinking of how to address the underlying causes.

[00:29:57.510] - Jo Carlowe: Ann and Penny, thank you so much. It's been hugely helpful and so informative. For more information on autism and the issues covered in today's podcast, please visit www.acamh.org or Twitter . For more information on Clinical Partners, visit www.clinical-partners.co.uk. And let us know if you enjoyed the podcast with a rating or review, and do share with friends and colleagues.

External Resources

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Self-harm & Self-Injury - Episode. 9 'Autism a parents guide'

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For this podcast, focusing on autistic children who harm themselves, we are joined by Dr. Ann Ozsivadjian, and Dr. Penny Williams.

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NHS advice on caring for scars, and improving healing

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A scar is a mark on the skin after a wound or injury has healed. You cannot get rid of a scar, but most will fade over time. This can take up to 2 years or more, but there are some things you can do to help it heal or improve how it looks.

Things you can do if you have a scar

There are some things you can do to help most scars heal and improve how they look.

Do

massage your scar with a water-based cream (such as aqueous cream or E45 cream) a few times a day for up to 10 minutes each time - only massage your scar if the wound is fully healed

try to keep your scar covered when you're in the sun for at least 1 year - wear clothing that covers it, or put a dressing over it

use sunscreen with a sun protection factor (SPF) of 30 or more on your scar

A pharmacist can help with scars

A pharmacist can recommend some things for scars such as:

silicon dressings or gels to help improve the appearance of your scar

creams you can use to massage your scar

Skin camouflage

There are special creams and powders (called skin camouflage) that you can apply to your skin to cover your scar so it's less noticeable.

A GP can refer you for an appointment to get skin camouflage products, or you can refer yourself online.

At your appointment, a trained professional will colour match the creams and powders to your skin and show you how to apply them.

You can get the products on a prescription or buy them.

Video: scars - skin camouflage

In this video, an expert explains how skin camouflage is used to cover marks and scars.

you have a scar and it's painful or bothering you

Your GP may be able to recommend treatments that can help.

Ask for an urgent GP appointment or get help from NHS 111 if:

a scar is swollen or painful

a scar feels warm to the touch

a scar has pus coming out of it

You can call 111 or get help from 111 online.

Treatment for scars

You cannot get rid of a scar, but most scars fade over time without any treatment.

If a scar is more severe or bothering you, a GP may be able to recommend treatments or refer you to a specialist. The aim of treatment is to help improve how the scar looks.

Depending on the type of scar you have, treatments may include:

silicone dressings or gels

steroid injections or cream

cryotherapy (a treatment to freeze the scar)

laser therapy

skin camouflage (creams and powders you use to cover your scar)

A GP can refer you for talking therapy if a scar is affecting your mental health.

Types of scars

Scars can be many colours such as pink, red, purple, white, brown, skin-coloured or darker than the skin around it.

They can also be itchy, painful or uncomfortable.

Fine-line scar

Can be slightly raised to start, but usually flattens and fades over time without treatment

Atrophic scar

Can be a deep, small hole in the skin that looks like a deep pore, or it can be a larger and slightly sunken mark; usually happens after acne or chickenpox

Usually raised, hard and smooth, it grows to be bigger than the original wound, and the area where the scar is may be uncomfortable or difficult to move; it does not usually flatten or fade without treatment

Hypertrophic scar

Usually raised and firm, it does not grow to be bigger than the original wound; the area where the scar is may be uncomfortable or difficult to move; it usually fades and flattens over time

Contracture scar

Feels tight and the area where the scar is may be difficult or painful to move; it usually happens after a burn

Page last reviewed: 18 September 2023
Next review due: 18 September 2026

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Find out about scars, including types of scars, things you can do to improve how a scar looks, and treatments that may be recommended if a scar is severe.

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