Q: When my 16-month old son gets upset he hits himself on the head or bangs his head against the wall until he's hurt and starts crying. Is this a normal reaction to frustration? We do not spank or hit at home and I'm worried it's a sign of autism.

A: It seems that your son is engaging in what is commonly called ‘self injurious’ behavior. The literature shows that self injurious behavior is due to a neurochemical imbalance and results in a release of endorphins in the body which can lead to a euphoric like response.  Often times, a frustrated child with a limited vocabulary to express himself will bite or hit another child or person with whom he is frustrated.

Although self-injurious behavior is associated with Autism, it is also a sign of seizure activity. Self injurious behaviors associated with seizure activity are head banging, slapping ears and/or head, hand-biting, chin hitting, scratching face or arms, and, in some cases, knee-to-face contact. This type of behavior is involuntary and requires restraint from another adult to stop it.

Self injurious behavior is also associated with pain, often due to an ear infection or allergies.  You can begin to assess if this is the source of the behavior you are seeing by keeping a journal documenting when you see an increase or decrease in your son’s behavior.

Overall, self harm is not a typical toddler trait. Instead, a child who is frustrated or angry would likely hit or bite another person and not himself.  In and of itself, this is not a sign of Autism, but think about other areas of development and where you son is or is not lagging. Autism is a disorder that affects language and communication, social interaction, and behavior (repetitive or restrictive). If you are only seeing self-injurious behavior, your son may be highly frustrated due to an inability to communicate his needs clearly through words or gesture with you and other family members.

I would strongly recommend that you ask your pediatrician to assess your child’s hearing in the case that poor hearing is impeding his ability to acquire language.  If this is not the case at all, I would sit down with your son in the moment when he is becoming angry and help him to problem solve. In essence, you are teaching him to cope so that he does not resort to banging his head on the wall.

Good luck and keep me posted!

Answered by Dr. Elizabeth Matheis