The behavior problems, including self-injurious behavior, can also be difficult to eliminate. Effective management of this problem requires three ingredients. The most important of these is prevention by physical restraint. All sharp and dangerous objects must be kept out of reach. The wheelchair should have all sharp edges within reach covered safely. Loose arm ties or elbow splints can be very helpful to control finger biting or hitting. Some children must have their teeth removed if they bite themselves.
The second most important ingredient for controlling self-injurious behaviors is behavior therapy. This can be done at home, but in most cases it is done by professionals who have been trained in behavior therapy. The goal is to focus attention on good behaviors while ignoring bad behaviors. Punishing bad behaviors by shouting or spanking does not work, and may even make the bad behaviors worse. It is also helpful to identify the situations that cause problem behaviors, and then try to avoid these situations.
The third ingredient for controlling self-injurious behaviors is medications. Many different medications have been used to control these behaviors, but they do not work all of the time. Several medications may also be useful in the management of self-injurious behaviors, but none has been evaluated in a controlled clinical trial. Promising possibilities include gabapentin, carbamazepine, diazepam, others. These medications can reduce the frequency of self-injurious behavior, but they rarely eliminate it entirely.
Some physicians also like to use risperdal for self-injurious behavior. Unfortunately, risperdal causes sleepiness and can sometimes make the neuromotor problems worse. If it is used, it is important to verify that improvements in self-injury are not being traded for sedation or worsening of neuromotor function.