Biting is a common behavior in young children, but it can persist as a concerning behavior into older childhood and adulthood for some individuals with autism spectrum disorder (ASD). Parents of children with autism often report their child going through a “biting phase” or biting consistently as a behavioral issue. But why might biting be associated with autism, and is it truly a trait of autism itself?
Is biting more common in autism?
Multiple studies have suggested that biting and other self-injurious behaviors may be more prevalent among individuals with ASD compared to the general population.
For example, a 2020 study published in the Journal of Autism and Developmental Disorders examined self-injurious behaviors in children with autism compared to non-autistic children with intellectual disability. The study found that 68% of children with autism engaged in some form of self-injurious behavior compared to 49% of children with intellectual disability but no autism. Biting oneself was specifically engaged in by 51% of the autism group.
Additionally, a meta-analysis published in 2014 looked at studies comparing rates of challenging behaviors like aggression, self-injury, and destruction of property among those with developmental disabilities. The analysis found higher rates of all challenging behaviors among individuals with ASD compared to those with intellectual disability but no ASD.
So research indicates biting and other self-injurious behaviors do seem to be more prevalent among those with ASD than in the general population or even among those with intellectual disability alone. But why might this be the case?
Possible reasons for increased biting in autism
There are a few possible explanations for why biting may be more common among those with ASD:
Communication difficulties
Many individuals with autism have difficulty communicating through speech and language. Biting or mouthing objects may serve as an alternative nonverbal means of communication out of frustration with not being able to express wants and needs through words.
Sensory seeking
Some believe biting provides sensory input for those with autism who may be sensory seeking. Biting can provide pressure and oral stimulation for those seeking extra sensory experience.
Self-regulation
Biting may also serve a self-regulatory function for some with ASD. Those overwhelmed by stimuli may bite themselves to calm down by providing an intense competing sensory experience.
Executive functioning deficits
Autism involves difficulties with executive functions like planning, impulse control, and self-monitoring. Those with autism may thus be more prone to impulsive behaviors like biting without self-monitoring to inhibit the urge.
Repetitive behaviors
Some believe biting when autistic stems from repetitive behavior tendencies. The behavior may start as stimulation seeking and then become a habit.
So in summary, biting in autism may serve communication, sensory, self-regulation, executive functioning, and habitual functions. But it is still unclear if it is an innate behavior directly associated with autism itself.
Is biting an inherent trait of autism?
Despite the higher prevalence of biting among those with autism, there is disagreement among experts as to whether biting is an inherent characteristic of autism itself.
Some experts theorize biting is directly tied to the biological differences underlying ASD. For example, some hypothesize that differences in pain perception, oral sensitivity, and dopamine levels among those with autism predispose them to biting behaviors.
But others argue biting likely stems from autism only indirectly. They propose that biting emerges in response to autism-related difficulties like communicating needs, regulating emotions, controlling impulses, and coping with sensory overload. But the biting itself is not a core feature of autism biologically.
More research is still needed to uncover if biting stems from the neurobiological features of autism itself or develops secondarily from the associated cognitive and behavioral features of ASD. But regardless of the origins, biting remains a troubling symptom for many living with autism and their caregivers.
How common is biting in autism?
While biting appears more common in ASD than the general public based on research, estimates on actual rates vary:
– A 2012 study found 48% of children with autism engaged in biting others at some point.
– A 2014 study found 70% of autistic children had bitten someone in their lifetime and 57% did so repeatedly over time.
– But other estimates are more conservative, like a 2011 study finding only around 18% of children with ASD bite others frequently.
So while not all individuals with autism bite, estimates generally suggest around 50% may bite at some point and 10-20% likely do so persistently.
Biting others seems more common than self-biting, though some individuals do both. Most studies focus on rates of biting others rather than self-injury through biting. More research could clarify self-biting rates in ASD.
There is also limited research on when and how long biting persists across the lifespan for those with autism. Anecdotally, biting appears most problematic between ages 3-5 years but may continue into adulthood for some.
Who is at risk of biting with autism?
Biting in autism does not seem to discriminate by gender, with similar rates among girls and boys. Nonverbal children and those with more severe autism also appear more prone to biting.
Additionally, those with the following conditions seem most likely to bite:
– Intellectual disability
– Impulse control problems
– Difficulty sensing pain
– Heightened oral sensitivity
– Obsessive compulsive disorder
– Anxiety
– Attention deficits
So autistic individuals with co-occurring conditions like these may be most prone to engaging in biting of themselves or others.
When does biting with autism occur?
Biting in ASD seems most likely to occur in the following situations:
– Transitioning between activities
– During sensory overload
– When needs aren’t being met
– When demands and expectations are placed
– When bored or lacking stimulation
– When tired or ill
So biting often arises as a reaction to environmental conditions like changes, sensory input, communication breakdowns, demands, or discomfort. Paying attention to trigger situations can help parents anticipate and prevent biting.
Is autism biting premeditated?
Most experts believe biting among those with autism is not typically premeditated or done with intent to harm. More often it is an impulsive reaction during periods of distress. Some key indicators biting is not meant aggressively include:
– The bite itself is often not forceful enough to break skin or cause bruising.
– Biting may be followed by displays of affection like hugs.
– The individual may appear remorseful or upset after biting someone.
– Biting often occurs alongside other self-injurious behaviors like head banging.
– Agitation and emotional escalation often precedes biting episodes.
So while the bite itself can certainly be painful and upsetting, parents can find some comfort in knowing it likely arose from stress, not spite. That said, sometimes those with autism can bite intentionally if taught it gains them attention. Differentiating the intent is helpful in choosing how to respond.
Should autism biting be ignored?
Parents are often torn on how to respond when their autistic child bites. Some resources recommend ignoring biting to avoid reinforcing the behavior. However, others argue ignoring biting risks allowing it to escalate into a dangerous behavior.
Most experts recommend not ignoring biting entirely but responding minimally without giving too much attention. Strategies include:
– Using a firm, neutral voice to state “No biting” without too much emotion
– Avoiding excessive verbal reprimands, negotiation, and rationale
– Briefly separating the child from the biting situation
– Not allowing the bite to achieve its intended outcome
– Withholding reinforcement like toys or food for a brief period after biting
So while biting in autism should not be completely ignored, the response should be measured to avoid escalation. Excessive attention can inadvertently reinforce the behavior.
Strategies to curb biting in autism
While concerning, biting in autism can often be reduced through targeted intervention. Some evidence-based strategies include:
Replace the behavior
Teach the child an alternate behavior like pressing a “help” button when feeling overwhelmed. Reward them for engaging in the replacement behavior instead of biting.
Reinforce incompatible behavior
Provide frequent reinforcement when they engage in behaviors incompatible with biting, like keeping hands down and asking for breaks appropriately.
Alter the environment
Modify the child’s environment and routine to minimize biting triggers like transitions, sensory overload, and communication frustration. Prevent escalation to biting through early intervention.
Improve communication
Expand the child’s communication skills through aids like picture exchange systems. Enable them to express needs in alternate ways.
Provide sensory supports
Provide oral sensory supports like chewy necklaces to fulfill needs in safer ways.
Teach emotional regulation
Use behavioral strategies to teach self-regulation skills as an alternative to biting for emotional release.
Use reinforcement systems
Utilize token economy systems with rewards to reinforce desired behavior and consequences like brief time-outs for biting.
Consider medication
In severe cases, medication targeting aggression or impulsivity could be considered under a doctor’s direction.
With consistent intervention over time using strategies like these tailored the child’s needs, improvement in biting often occurs. But the process requires diligence and patience.
What if biting persists?
If biting continues despite intensive intervention, further evaluation and support may be needed. Some next steps include:
– Medical assessment to check for underlying illness causing aggression
– Testing for co-occurring conditions exacerbating biting
– Referral to a specialist like a behavior analyst for additional support
– Change in school supports and IEP goals if biting occurs at school
– Trial of alternate communication systems if biting is communicative
– Testing different sensory and oral supports
– Update of behavioral intervention plan and reinforcement systems
– Consideration of special restraint equipment if biting is severe and dangerous
While difficult to eliminate entirely in some severe cases, bringing in additional professional support and trying alternate interventions can still often reduce biting to more manageable levels. But this process requires significant time and resources.
Is autism biting grounds for removal?
When biting occurs at school, parents often fear their child may be expelled. But legislation protects students with disabilities from disciplinary removal in most cases.
Specifically, the Individuals with Disabilities Education Act states schools can only remove students for more than 10 days if:
– The behavior is deemed not a manifestation of their disability.
– Removal is necessary due to likelihood of injury to others.
But in most cases, biting arising from an autism diagnosis like emotional dysregulation would be considered a manifestation of disability.
Schools cannot usually expel autistic students for behaviors like biting without providing alternate setting arrangements. However, they can remove the student briefly for biting if needed for safety.
So instead of expulsion, a functional behavior assessment, updated behavioral intervention plan, and additional supports should be provided. Biting alone rarely warrants complete classroom removal.
Conclusion
In summary, biting does appear more prevalent in autism than the general public. But the jury is still out on whether biting is an inherent characteristic of autism itself, or stems from associated features like communication, sensory, emotional, and impulse control challenges. Regardless of cause, targeted behavioral intervention can help curb biting in many cases. But significant time, resources, and professional support are often needed to manage severe biting behavior arising from autism. While highly concerning for parents and educators, biting alone is not grounds for expulsion or removal according to disability legislation. With compassion, consistency, and expertise, improvement in biting is possible for most children on the spectrum.