Scratching is a challenging behavior sometimes seen in autistic children, often classified as self-injurious behavior (SIB) when it causes tissue damage. This behavior is typically a complex form of communication or self-regulation, not an act of defiance. Understanding the function of the scratching is the first step toward finding effective strategies for reducing the behavior. This guide offers practical methods for parents and caregivers to protect their child and teach them safer, alternative ways to meet their needs.
Identifying the Function and Triggers
All behavior serves a purpose, and scratching signals that your child is trying to communicate a need or cope with an internal state. Identifying the specific function the behavior serves is necessary to address it accurately. A common method for this is collecting ABC data, which involves observing the Antecedent (what happens immediately before the scratching), the Behavior (the scratching itself), and the Consequence (what happens immediately after).
Scratching may function as a way to seek or regulate Sensory Input. This can be a form of stimming, where the repetitive tactile sensation provides proprioceptive feedback or creates a distracting sensation. This behavior helps the child regulate their internal feelings by increasing an under-aroused nervous system or decreasing an over-aroused state.
Another function is Communicative or Environmental, meaning the behavior is a learned way to interact with the world to get a desired result. Scratching may be used to gain attention from a caregiver or to escape an undesired demand, task, or social interaction. If scratching leads to the removal of a non-preferred activity, the child learns the behavior is an effective communication tool.
Scratching can also be a reaction to Internal or Physical Discomfort that the child cannot verbalize. This includes seeking relief from pain, such as an earache, or intense itching from a dermatological condition like eczema. If the scratching is new or constant, consulting a medical professional to rule out an underlying physical cause is a priority.
Immediate Protective and Skin Management Strategies
Immediate steps must be taken to minimize the risk of injury and manage existing skin damage while working to understand the behavior’s function. The first step is to keep fingernails filed short and smooth. Clipping nails is helpful, but smoothing the edges with a nail file is an important measure to reduce the sharpness that causes skin breaks.
Frequent moisturizing is an effective strategy, especially if dry skin or eczema contributes to the urge to scratch. Applying a thick, hypoallergenic moisturizer or topical cream can soothe irritation and reduce the physical trigger. For actively irritated areas, a cool compress offers immediate, temporary relief and a safe sensory alternative.
Physical barriers prevent hands from reaching the skin, especially during sleep or high-risk times. Protective clothing, such as long-sleeved shirts and pants, provides a layer of defense against skin damage. Specialized garments or mild scratch mittens can serve as a temporary barrier to allow existing wounds to heal.
Environmental adjustments also contribute to immediate safety by reducing the risk of accidental injury. Quickly remove any sharp, rough, or abrasive objects from the child’s immediate surroundings. Ensuring the child’s play and rest areas are free of sharp edges or rough textures helps create a safer space.
Teaching and Reinforcing Alternative Behaviors
Addressing the long-term behavior requires teaching the child a new, safer skill that serves the same function as the scratching, using positive reinforcement. This process begins with Functional Communication Training (FCT), which replaces the challenging behavior with an appropriate way to communicate the need. If scratching is used to escape a task, the child is taught to use a “break card” or a simple verbal request like “all done.”
The replacement behavior must be easier and more efficient for the child than scratching, ensuring their need is met more quickly. If the function is attention, the child can be taught to tap an adult gently or say “look at me,” which the caregiver immediately reinforces. Consistently responding to the new communication makes the new skill the preferred method.
Replacement Behaviors for Sensory Needs
Providing replacement behaviors for sensory needs offers a safer way to receive the same type of input. If the child seeks deep pressure from scratching, alternatives like a weighted blanket, a tight hug, or a textured fidget toy provide similar proprioceptive input. Rough or textured sensory pads can also satisfy the tactile urge in a non-injurious manner.
Positive Reinforcement
Positive reinforcement is the foundation for establishing these new skills, meaning the desired replacement behavior is rewarded immediately and consistently. Rewards can be anything the child highly values, such as praise, access to a favorite toy, or a preferred activity. The goal is to make the experience of using the alternative behavior so positive that the child chooses it over scratching.
Consulting Specialists for Intensive Support
If the scratching is severe, causes significant injury, or persists despite consistent home interventions, seek professional support. A pediatrician or dermatologist should be the first point of contact, especially if there is suspicion of an underlying medical condition, chronic allergy, or skin infection. Treating physical ailments can sometimes resolve the behavior completely if it was a reaction to discomfort.
For behavioral support, a Board Certified Behavior Analyst (BCBA) provides specialized, evidence-based intervention. A BCBA conducts a formal Functional Behavior Assessment (FBA), which involves systematic data collection and analysis to determine the function of the scratching. This assessment ensures the intervention plan is tailored to your child’s specific needs.
The BCBA then develops a Behavior Intervention Plan (BIP) focused on safety, teaching appropriate replacement behaviors, and modifying the environment. Professional intervention is a cooperative process designed to build skills and improve the child’s long-term quality of life. The goal is to empower the child with functional, safe ways to communicate and self-regulate.