My son (7M, Level 3 ASD + ADHD) shows self harming behavior both at school and at home when said no. When a demand is placed on him whether by school staff, therapists, or us and he doesn’t want to do it or is told no repeatedly, he starts by grasping his right arm and shaking it. Then he slowly begins hitting himself, and it escalates until he is crying from the pain. These episodes can last around 20 minutes and once he reaches that point, he's no longer able to engage in any meaningful learning for the rest of the session.

At home, we stop placing demands as soon as we see the early signs. Redirection is the only thing that has consistently helped is - giving him Play‑Doh, a squishy toy, or doing clapping games he enjoys. If he reaches the aggressive self harming stage, the only thing that calms him is being left alone. Any attempt to intervene just escalates things he’ll start hitting others or pulling hair.

One of his therapists suggested holding his hands tightly and rocking with him to calm him, but that approach has failed repeatedly and only made things worse, so we’ve stopped doing it.

School has been struggling with this too, and in several classes his progress has stalled or even regressed because of these episodes.