Scratching is a significant concern for many families supporting a child on the autism spectrum. While the act is not unique to autism, the underlying reasons are often related to how autistic individuals process and interact with their environment. Effective management requires moving beyond simply stopping the action and focusing on identifying the function the behavior serves for the child. This approach relies on immediate safety measures, careful behavior analysis, and teaching new, appropriate skills to promote healthier self-regulation.
Identifying Why the Scratching Occurs
All behavior occurs for a reason, and determining the function is the necessary first step toward an effective solution. This function can be categorized into four main areas: sensory input, escape from demands, access to attention, or access to tangible items. Scratching often falls under the sensory function, meaning the child engages in the behavior because of the physical sensation it provides. The pressure or sensation may serve as a means of self-regulation to cope with overwhelming sensory input or relieve internal discomfort.
The behavior may also function to gain attention from a caregiver, even if that reaction is scolding or redirection. The child learns that scratching reliably results in a parental reaction, reinforcing the behavior. Scratching can also be an escape mechanism used to avoid a non-preferred task or situation, such as a challenging lesson or a noisy environment. Parents can identify the function by systematically tracking the “ABC” data: the Antecedent, the Behavior, and the Consequence. Consistent patterns reveal the underlying function, which dictates the most appropriate intervention strategy.
Immediate Physical and Environmental Management
While the underlying function is being assessed, immediate measures must be implemented to reduce the risk of physical harm and infection. Keeping the child’s fingernails trimmed short and filed smooth is an effective physical barrier to deep skin injury. Moisturizing the skin regularly, especially if the child has dry patches or eczema, can help, as irritation increases the urge to scratch. Managing skin health is a preventative measure, as skin issues can sometimes be an antecedent to the behavior.
Protective clothing is another immediate strategy to prevent contact between fingernails and skin. This includes specialized garments or ensuring the child wears long sleeves and pants, particularly when scratching is more likely. For nighttime scratching, soft cotton scratch-mitts or thick socks placed over the hands can reduce injury during sleep. Caregivers should also identify and remove environmental triggers, such as scratchy fabrics, known sources of anxiety, or overly stimulating settings.
Teaching Alternative and Replacement Behaviors
Addressing the long-term behavior requires teaching a Functionally Equivalent Replacement Behavior (FERB)—a new, appropriate skill that fulfills the same function as the scratching. The replacement behavior must be easier and more effective for the child to use, ensuring they gain the desired outcome positively. Interventions are customized based on the function identified through the behavioral assessment process.
If the scratching is driven by a sensory need, the FERB should offer safer, alternative sensory input. This might involve providing a vibrating toy, a textured fidget item, or deep pressure input through a weighted blanket or vest. Teaching the child to rub a designated textured material instead of scratching their skin redirects the sensory input to an acceptable outlet. The goal is to compete with the sensation derived from scratching by offering a more appropriate and satisfying sensory experience.
When the scratching is an attempt to gain attention or escape a task, the intervention focuses on Functional Communication Training (FCT). This involves teaching the child a clear, simple way to communicate their need, such as using a picture card, a sign, or a phrase like, “Break, please,” or “Look at me.” When the child uses the FCT skill, the caregiver must immediately provide the requested item or attention. Consistency is paramount; the replacement behavior must reliably lead to the desired outcome, while the scratching behavior must no longer result in the same reinforcement.
Consulting Specialists for Intensive Support
If home-based strategies do not significantly reduce the scratching or if the behavior causes serious injury, professional consultation is necessary to ensure safety and develop an intervention plan. The first step is often a medical consultation with a pediatrician or dermatologist to rule out underlying biological factors, such as allergies, skin infections, or neurological conditions. Addressing medical issues can sometimes eliminate the trigger for the behavior entirely.
Comprehensive support for persistent behavior challenges comes from a Board Certified Behavior Analyst (BCBA). A BCBA conducts a formal Functional Behavior Assessment (FBA), which involves systematic observation and data collection to precisely determine the function of the scratching. Based on the FBA results, the BCBA develops a customized Behavior Intervention Plan (BIP) that outlines specific procedures for teaching the replacement behavior and modifying the environment. These plans utilize evidence-based strategies from Applied Behavior Analysis (ABA) and provide caregivers with structured support.