Understanding why some Autistic children use potentially harmful behaviours

Overview

This practice guide summarises the research evidence about the use of potentially harmful behaviours (PHB) by Autistic children. It also draws on practice wisdom and expertise to highlight examples of situations where Autistic children may use PHB to communicate unmet needs related to common types of neurodevelopmental differences.

This resource covers:

• what autism is and the prevalence of autism in Australia
• what PHB are
• information about the use and impacts of PHB by Autistic children
• identifying, understanding and addressing PHB used by Autistic children.

This practice guide has been developed for, and in consultation with, practitioners working in Family Mental Health Support Services (FMHSS). FMHSS provide early intervention and non-clinical community mental health support for children and young people aged up to 18 years who are showing signs of, or are at risk of, developing mental illness.

Practitioners working in early intervention support services told us that the use of PHB by Autistic children is an area where more information and resources would be useful to help service providers build on the existing supports they provide to children and families.

This practice guide will also be useful to other practitioners working with children and young people, parents and families. The content has been developed specifically for practitioners who have less than 5 years of experience in the child and family services sector, including those who are not trained to work in specialist services supporting Autistic children and families.

Introduction

Practitioners working in early intervention family mental health services frequently support families who have concerns about children's behaviours that have the potential to harm others (hereafter referred to as 'potentially harmful behaviours' or PHB). These behaviours include physical and verbal behaviours (e.g. hitting, shouting, throwing things) that children may use in a range of contexts including home, school or other public spaces (Holt, 2024; Kirst et al., 2022; Quetsch et al., 2023; Swaab et al., 2021).

Children's use of PHB is rarely pre-planned, vindictive or intended to cause harm. However, these behaviours can have physical, emotional and relational impacts on parents, siblings, peers, teachers and others, including the children themselves (Brown et al., 2024; Holt, 2024; Piro-Gambeti et al., 2023; Quetsch et al., 2023). For parents with children who use PHB, this can be a particularly challenging aspect of parenting. Parents report challenges with identifying and understanding why their child may be using these behaviours and how best to support them during and after use of PHB (Holt, 2023; Holt, 2024; Swaab et al., 2021).

This resource focuses on PHB used by Autistic children (toddler to early adolescence). While all children, especially young children, are likely to use PHB from time to time, research indicates that Autistic children use PHB more frequently than non-Autistic children and that the reasons for, or functions of, PHB may differ between Autistic and non-Autistic children (Quetsch et al., 2023; Sivathasan et al., 2024).

This resource synthesises the empirical research and practice wisdom and information from autism advocacy organisations to examine the use of PHB by Autistic children. It also outlines ways that supports for children and families can be strengthened. This resource covers:

• what autism is
• what PHB looks like
• what the research evidence says about the relationship between PHB and autism
• the impacts of PHB use by Autistic children
• PHB as a way of communicating unmet needs relating to autism
• neuro-affirming ways of supporting Autistic children using PHB, including case studies.

This resource primarily focuses on the use of PHB by Autistic children due to the greater availability of research evidence - however, the information may also be useful to practitioners working with neurodivergent children more broadly. Practice strategies based on neuro-affirming and trauma-informed approaches are beneficial for work with all children.

Why it is important to increase our understanding about PHB

Concerns about a child's use of potentially harmful behaviours (PHB) are commonly raised by the important adults in a child's life, and children and their family may access or be referred to early intervention support services. For example:¹

• Parents may feel their child is using PHB frequently or in situations where, in the parents' view, it feels like a disproportionate response.
• Early childhood educators or teachers may identify a child having conflicts in social situations with peers or with environmental stimuli, leading to the use of PHB.

When Autistic children use PHB, adults sometimes misinterpret the behaviours as a child 'acting out' or 'trying to get their own way' and therefore miss an opportunity to recognise that the child may be struggling to cope with their environment or to communicate what they need. It can be difficult for parents (and other adults) to understand what is happening for the child or to know how to respond appropriately.

By increasing awareness and understanding how and when Autistic children use PHB, early intervention practitioners can play an important role in supporting parents to identify, understand and address what is happening for the child, to adapt environments to better suit a child's individual needs and to support the child to develop skills and non-harmful strategies to use in challenging situations (Kirst et al., 2022; Neuhaus et al., 2022). Early intervention support can reduce the likelihood of PHB continuing into adolescence and adulthood (Gohari et al., 2024).

What is autism?

Autism is a lifelong neurodevelopmental condition where people experience differences to non-Autistic people in how they process information and interact with their environment (Aspect Autism Spectrum Australia [Aspect], 2025; Department of Social Services [DSS], 2024). Autistic people often share common traits but each person's experiences, strengths and challenges are unique.

These shared characteristics include:²

• different communication preferences, styles and skills to non-Autistic people
• different social interaction preferences and needs to non-Autistic people
• different sensory processing, sensitivity and preferences (e.g. to what they see, hear, smell, touch or taste) to non-Autistic people
• preferences for routines, predictability and structure
• potential difficulty with change and transitions
• special interests
• repetitive behaviours, including stimming.

In Australia, children can be diagnosed with autism through a comprehensive needs assessment conducted by a team of medical professionals (Raising Children Network, 2025). However, not all families of children with autism characteristics will want or be able to access a clinical diagnosis. This can be due to personal choice, long waiting lists for appointments and services, or constraints on time and finances (DSS, 2024; May et al., 2017; May et al., 2020). This means that early intervention mental health practitioners often work with Autistic children who have not yet been diagnosed.

Autistic people may have low support needs, complex support needs or anything in-between. Support needs vary between individuals but also change throughout an individual's lifetime due to a variety of factors including different developmental stages, life experiences and changing social and environmental contexts (DSS, 2024).

For more information about autism and how is it diagnosed, refer to Further reading and resources.

The prevalence of autism in Australia

The Australian Bureau of Statistics (ABS; 2022) Survey of Disability, Ageing and Carers reports that around 1 in 100 Australians have a diagnosis of autism, with a higher reported prevalence (more than 3.8%) amongst school-aged children. The Longitudinal Study of Australian Children (LSAC), using parent and teacher reports, shows an increase over time in the number of children diagnosed as Autistic (May et al., 2017; May et al., 2020).

Patterns of prevalence, such as higher rates for school-aged children or increases in diagnosis over time, may be the result of increased awareness of autism and better understanding of autism characteristics (ABS, 2022; May et al., 2017; May et al., 2020). Increasing rates of autism diagnosis may also be attributed to the fact that accessing some disability supports can be contingent on having a formal diagnosis.

In addition, early intervention mental health practitioners often work with children who have autistic characteristics but whose family has not yet sought clinical assessment. It can be hard to assess exactly how common autism is because the number of people who could meet the diagnostic threshold is likely to be larger than the number of people who have actually had a clinical assessment of support needs and/or diagnosis. For example, Aspect (2025) estimate that 1 in every 40 people in Australia may be Autistic.

What are potentially harmful behaviours?

In this resource, we use the term potentially harmful behaviours (PHB) to refer to physical or verbal behaviours used by children that have the potential to cause physical, psychological or emotional harm to others.³ Examples of these behaviours include:⁴

• physical behaviours directed towards other people (e.g. biting, hitting, kicking, pinching, pulling hair, punching, slapping, spitting)
• verbal behaviours directed towards other people (e.g. shouting or yelling at someone, using offensive language or name-calling)
• physical and verbal behaviours not directed towards other people (e.g. damaging property, throwing or breaking objects, kicking or punching walls, screaming or vocal outbursts not directed at anyone in particular).

PHB can be reactive or proactive. Reactive PHBs are impulsive (e.g. an immediate response to a real or perceived threat) or retaliatory (e.g. a response to someone else's behaviour that is, or appears, unfair or harmful). They can be thought of as 'hot' emotions or a body stress response. They often arise out of fear, frustration or feeling overwhelmed. Although a child might direct reactive PHB toward someone else, they are typically not actively intending to harm anybody.

Proactive PHB differ in that they are not a response to an immediate threat or situation. They can be unprovoked (e.g. bullying behaviour), goal-directed (e.g. a child wanting to do something their parent has said 'no' to) or a planned or delayed reactive response (e.g. a child pinching a classmate because they called you a mean name the day before) (Centre for Excellence in Child and Family Welfare (2025, Sept 3).).

Fundamentally, all behaviour, including PHB, is a form of communication (Strawa & Lancaster, 2024). Autistic and non-Autistic children may use PHB not because they want to harm anyone but to communicate unmet needs and strong emotions (Raising Children Network, 2025; Strawa & Lancaster, 2024).

Adults may interpret or describe PHB as violent or aggressive (Raising Children Network, 2025) and these terms are commonly used in the research literature. However, 'violence' and 'aggression' are often understood as being motivated by an intent to harm, which is typically absent when children use PHB.

In Australia, the National Disability Insurance Scheme (NDIS) has adopted the use of 'behaviours of concern' and national and international literature often uses 'challenging behaviours' (Strawa & Lancaster, 2024). These terms intend to avoid the negative connotations typically associated with 'violence' or 'aggression', such as implied intent to harm, and to separate the behaviour from the child (Sutherland et al., 2022). In this resource, we use PHB because we are focused on physical or verbal behaviour directed at others, rather than challenging behaviour more broadly.

Use of potentially harmful behaviours by Autistic children

The use of potentially harmful behaviours (PHB) by Autistic children often emerges during toddlerhood (1-3 years) (Holt, 2023; Holt, 2024; Quetsch et al., 2023; Sivathasan et al., 2024). This is not surprising, as many PHB (e.g. kicking, screaming, pinching or breaking things) are common toddler behaviours that reflect early childhood social, emotional and language developmental stages.

However, research suggests that Autistic children are more likely to continue using PHB as they grow older (e.g. at primary school-age and adolescence) and to use PHB more frequently and with higher intensity than non-Autistic children (Gohari et al., 2024; Holt, 2023; Holt, 2024; Quetsch et al., 2023).

Some research shows an increase in the use of physical PHB as Autistic children grow older (Holt, 2023; Holt, 2024). However, other studies suggest that physical PHBs decrease (Gohari et al., 2022; Quetsch et al., 2023) but that verbal PHBs may increase (Quetsch et al., 2023).

It is much more common for Autistic children to use PHB reactively rather than proactively. For example, as an immediate or spontaneous response to the behaviour of another child or to environmental stimuli that is overwhelming for them (Kirst et al., 2022; Quetsch et al., 2023). Use of PHB by Autistic children is not usually goal-oriented or retaliatory, although it is common for parents, teachers and other adults to misinterpret or assume PHB used by Autistic children is 'acting out' or a 'tantrum' (Holt, 2023; Holt, 2024).

The use of PHB can occur anywhere - in the home, at school or in other community settings (Brown et al., 2024; Holt, 2024; Quetsch et al., 2023). When Autistic children use PHB in the home, this is often directed toward, or in the presence of, their mother (Holt, 2023). This is thought to be because mothers are often the primary caregivers and tend to spend more time with their children compared to other family members and is not indicative of patterns of gender-based violence (Holt, 2023).

Regardless of the frequency of PHB, whether it is verbal or physical or where it occurs, parents of Autistic children report that their child's use of PHB becomes more challenging and stressful as the child grows older. This does not imply the emergence of intent to threaten or harm but instead reflects increasing physical size and strength and increasing societal judgements or 'norms' about age-appropriate behaviours as children become adolescents and young adults (Quetsch et al., 2023; Swaab et al., 2021).

Impacts of the use of potentially harmful behaviours by Autistic children

Although Autistic children typically do not use PHB with the intent to harm others, there are physical, psychological and emotional impacts experienced by the children, their families and others around them (e.g. teachers and peers). These impacts include:⁵

• physical injuries to the child or others sharing the physical space when PHB are used
• poor mental health and wellbeing for children and other family members
• shame and stigma:
  • Children can be labelled as 'naughty', 'violent', or 'dangerous' by others (e.g. family members, teachers, people in the community) who misunderstand what is happening for the child when they use PHB.
  • Parents, especially mothers, report feeling judged as 'incompetent' or 'bad' parents, particularly when their child uses PHB in a public space.
• social isolation - for example:
  • parents staying at home with their children because they feel judged in community spaces or by other family members
  • social rejection and/or bullying by peers
• lower academic performance and school attendance rates
• emotional and administrative labour for parents, especially mothers:
  • Mothers often see themselves as their child's 'safe space' and may be reluctant to reach out for help due to concerns about their child being judged.
  • Mothers tend to prioritise their child's needs above their own during and following the use of PHB and do not have time or space for self-care.
  • Parents report feeling high levels of stress and poor mental health and wellbeing.
• family conflict and stress on relationships, including:
  • increased marital conflict
  • siblings feeling as though their needs are secondary and they have to 'walk on eggshells' and compromise their own self-expression and wellbeing
  • strain on parent-child relationships.

Identifying, understanding and addressing potentially harmful behaviours used by Autistic children

Underlying the use of potentially harmful behaviours (PHB) is a child communicating or signalling that their needs are not being met in the current environment (Strawa & Lancaster, 2024; Swaab et al., 2021). As adults supporting children, practitioners should not assume that a child using these behaviours is being purposeful, calculated or intending to harm someone (Sutherland et al., 2022). Instead, practitioners can work with families to help them understand that this behaviour is a way for children to communicate to others.

Understanding that PHBs are a communication of need is particularly important when working with Autistic children. Neurodevelopmental differences associated with autism mean that Autistic children perceive and process the world differently. Although a parent, carer, teacher or other adult may view a situation as safe, ordinary or admissible, an Autistic child may perceive and process the same situation as unsafe, unexpected or unmanageable. The use of PHB by Autistic children can be a way of signalling to adults these differences in perception and the need for additional support.

In the following sections, we use case studies to describe how Autistic children may use PHB to communicate need related to 3 common types of neurodevelopmental differences:

• sensory processing, needs and preferences
• social interactions
• routines and managing change.

The case studies give examples of how early-career mental health practitioners who are not specifically trained in supporting Autistic children can work with families to identify, understand and address Autistic children's needs using trauma-informed, neurodiversity-affirming approaches. The case studies intend to support practitioners' professional development by raising awareness and understanding about the relationship between communicating need and the use of PHB by Autistic children.

Each case study draws attention to one type of neurodevelopmental difference. The case studies focus on various relationships and contexts that are common when supporting families (e.g. the needs of the Autistic child, sibling relationships and partnering with parents and schools). In practice, the challenges experienced by families when children use PHB are complex. Autistic children can experience overlapping and interacting needs related to sensory, social and change-related differences.

By using simple case studies, we invite practitioners to think about some of the challenges families of children who use PHB might experience. We invite practitioners to also consider the varied situations in which PHB might be used to communicate need and how to begin working with children and families in a neurodiversity-affirming way. Program managers can use these case studies in discussions with their team to think about appropriate ways to respond to similar situations. This resource aims to provide insights for practitioners working with families regardless of whether a child has an autism diagnosis.

We have adopted a neurodiversity-affirming approach in these case studies. This is a way of delivering supports that recognises and accepts that everyone has a unique way of thinking, feeling and functioning (Dallman et al, 2022; DSS, 2024). In practice, this means shifting the focus from a desire to change behaviour to understanding and addressing the support needs of the Autistic child and their family.

Sensory processing, needs and preferences

Every individual has different ways of filtering, processing and perceiving sensory information. When professionals work with children and their families to diagnose autism, one characteristic they look for is significant sensory processing differences. Autism assessments often frame these differences as difficulties, with children being seen as either over-sensitive or under-sensitive to certain sensory stimuli (Raising Children Network, 2024b). However, neurodiversity-affirming approaches encourage practitioners and those supporting Autistic children to view this characteristic as sensory differences (Autism Awareness Australia, n.d.).

Sensory differences can relate to (National Autistic Society, 2020):

• sight, smell, sound, touch and taste
• balance and bodily awareness.

Autistic children's sensory needs are not met when they are under- or over-exposed to sensory stimuli. This can lead to stress, distress and feelings of being overwhelmed, which can lead to or exacerbate the use of PHB (Quetsch et al., 2023). Autistic children may use these behaviours to signal that they are struggling to identify, accommodate or articulate their sensory needs.

The following case study illustrates one way that a practitioner can support an Autistic child using PHB in response to their sensory processing differences, and support their family.

Social interactions

People's social preferences and needs evolve throughout their entire lives. Children rapidly develop social skills and learn about their own and others' social preferences. When professionals work with children and their families to diagnose autism, one neurodevelopmental characteristic they look for is differences in how children process and respond to social situations (Raising Children Network, 2024b). This can include differences in some of the following:⁶

• use of eye contact
• using and interpreting facial expressions
• understanding of non-literal language (e.g. metaphors and idioms)
• perceptions of personal space and tolerance for other people being in their personal space.

It is important to note that not all Autistic children will display the same differences in the above characteristics or behaviours.

Autism assessments often define these differences as Autistic children having difficulty with social interactions (Raising Children Network, 2024c). However, some in the Autistic community have critiqued this categorisation because the norms of social interactions tend to be defined by the majority - that is, neuro-typical people (National Autistic Society, n.d.). Some people in the Autistic community argue that the difficulty Autistic children have with social interactions may be less to do with innate deficits in social skills and more to do with the social expectations of non-Autistic people.

This perspective is exemplified by the 'double empathy problem'. Differences in styles and preferences of communication, social interactions and expressing emotions between Autistic and non-Autistic people can make it difficult for Autistic people and non-Autistic people to understand and empathise with each other.

This is called a 'double empathy problem' because both Autistic and non-Autistic people experience difficulty understanding the other group (Reframing Autism, n.d.). Because non-Autistic social expectations are usually assumed to be 'correct', Autistic people have been disproportionately burdened with navigating this lack of understanding, empathy and acceptance (Milton, 2012).

Neurodiversity-affirming approaches encourage practitioners and those supporting Autistic children to identify, understand and address differences in social interactions while recognising there is no 'correct' way to interact. In practice, this means working with families to find strategies that reduce the barriers for socialisation experienced by Autistic children and supporting them to safely socialise with others (National Autistic Society, n.d.). The goal is to:

1. accept and value social interaction differences
2. make socialisation safe for Autistic children in the environments we can control
3. help them build the skills they need to navigate social worlds that are not designed for them and are not within the control of families and support services.

The following case study provides an example of how a practitioner can support an Autistic child using PHB in response to social interaction differences, and their family.

Routines and managing change

Everyone has preferences for how structured, predictable and consistent their everyday life is. This means that everyone manages change differently. When professionals work with children and their families to diagnose autism, one neurodevelopmental difference they look for is a strong preference for routine and apparent difficulty managing change (Raising Children Network, 2024a).

Changes that Autistic children may experience differently to non-Autistic children include:

• changes to everyday routines, such as irregular appointments or school excursions
• bigger life changes and transitions, such as starting school or moving house
• everyday transitions such as transitions between activities, tasks or locations.

Autistic children may respond to change with feelings of anxiety, distress or resistance. Autistic children may use PHB to signal they are having difficulty processing and responding to change or view that change as threatening.

The following case study provides an example of how a practitioner can support an Autistic child using PHB in response to a change in their routine, and their family.

Further reading and resources

The resources in the sections below will be useful for practitioners working with Autistic children and young people and neurodivergent children more broadly.

Resources from AIFS

• Understanding behaviours of concern for children with disability
  This practice guide draws on research evidence and practitioner knowledge to provide an overview of approaches to understanding the behaviours of children with disability and the concept of 'behaviours of concern'. It includes some practical principles for working with children with disability and their families.
• Supporting neurodivergent children and young people
  These information sheets define key terms associated with neurodivergence and provide guidance on understanding and accommodating 2 common areas of difference for neurodivergent children and young people: neurocognitive development and sensory processing. They aim to enhance readers basic neurodivergence literacy and to lay the groundwork for further learning and more informed discussions about neurodiversity.
• How to use neurodivergent-affirming strategies to support child mental health
  This webinar, co-produced by CFCA and Emerging Minds, explores neurodivergent-affirming mental health service approaches to supporting Autistic and/or ADHDer children and their families. Service providers and a carer advocate draw on their practice wisdom and lived experience to present neurodivergent-affirming care as a better way to support the mental health of Autistic and ADHDer children.

Resources from Emerging Minds

• A neurodivergent-affirming approach to children's mental health
  This podcast explores how neurodivergent-affirming service approaches benefit the mental health of Autistic and ADHDer children and their families. Service providers and parent advocates draw on their practice wisdom and lived experience to discuss language and the relevance of trauma-informed care.
• Working with families in neuro-affirming ways
  This podcast explores how practitioners can implement neurodivergent-affirming practice when supporting Autistic and ADHDer children and their families. Service providers and parent advocates draw on their practice wisdom and lived experience of validating, supporting and advocating for children's and families' needs.
• Understanding autistic and ADHDer children's mental health
  This free, online course introduces practitioners working with Autistic and ADHDer children to neurodivergent-affirming approaches. It provides insight on autism and ADHD, explores the role of practitioners and presents practice advice for taking a neurodivergent-affirming approach to delivering support services.

Other resources

What is autism and how is it diagnosed?

• Learning about autism
  This set of resources from the Raising Children Network presents fundamental information about what autism is and how it is diagnosed in Australia. It includes short written articles, videos from parents, insights from experts and links to additional resources.
• What is autism?
  This information sheet from Aspect presents some of the differences that are associated with autism, from the perspective of Autistic people.

Use of PHB by Autistic children

• Aggressive behaviour and autism: 3-18 years
  This article from the Raising Children Network discusses aggressive and self-injurious behaviour used by Autistic children and teenagers, why it happens and how to respond while looking after yourself.
• Distressed behaviour: A guide for all audiences
  This article from the National Autistic Society UK provides a list of practice strategies to try when Autistic people are displaying distressed behaviour that would normally be considered as physically aggressive.
• Autism and developmental disability: Management of distress/agitation
  These clinical practice guidelines from the Royal Children's Hospital Melbourne advise on how staff can assess and manage Autistic children with distress and agitation and their parents/carers in clinical settings.
• These 2 articles from Autism Awareness Australia (linked below) discuss behavioural challenges for young and school-aged Autistic children. They provide guidance on supporting Autistic children who abscond/wander or experience autistic meltdowns. 
  • Behavioural challenges for young children 
  • Behavioural challenges for school aged children

Other relevant websites

• Reframing Autism is a charity organisation that combines lived experience with research evidence to promote respectful, affirming approaches to autism. Their website hosts a mix of publicly accessible and paid resources for autistic people, as well as parents and professionals supporting autistic people.
• Yellow Ladybugs is a charity organisation that aims to support inclusivity for autistic girls, women and gender-diverse folks. Their website hosts resources and supports that may be of interest to people who support neurodivergent children.
• Autism CRC is a cooperative research organisation that aims to produce collaborative research and best practice guidance to benefit all autistic people. Their website hosts resources, tools and publications, including their best-practice guides.
• Neurodivergent Insights is a blog by Dr Megan Anna Neff, sharing accessible articles, infographics, podcasts and factsheets relating to neurodivergence, mental health and wellness.

Nature of the evidence

The research team conducted a rapid literature review to inform the content of this practice guide. We also drew on insight from consultations with practitioners and team leaders working in early intervention mental health services and information from autism advocacy organisations. Insights from previous AIFS consultation with neurodivergent researchers and frontline staff delivering mental health supports to children and young people influenced and guided the creation of this resource.

The research evidence includes national and international studies, published between 2017 and 2025, that explored one or more aspects of the use of potentially harmful behaviours (PHB) by children, including Autistic children.

The limitations of the research evidence include variations in specific research aims, different aged cohorts (from toddler to adolescents), different sample sizes and variations in behaviours measured and data collection tools (e.g. surveys and scales, parent or teacher reports). Most of the included studies focused on Autistic children with a clinical diagnosis. Most studies focused on the use of PHB in the home and/or at school and not other public or community settings. We acknowledge that much of the research on PHB and autism uses medicalised models and ways of understanding neurodevelopmental differences. We respect the critique of these medicalised models expressed by some Autistic people and the wider neurodivergent community.

Although in this resource we highlight the importance of using neurodiversity-affirming and trauma-informed practice when working with children using PHB, a further limitation of the research evidence is that it is mostly drawn from studies that do not specifically adopt neurodiversity-affirming or trauma-informed practices in their study design. Furthermore, although the research is about children, data collection mostly relies on parent or teacher reports and children's voices are not amplified.

Despite these limitations, the research evidence provides useful information for determining the patterns of PHB use by Autistic children, the impacts on children and families and the reasons why Autistic children may use PHB. This information was supported by practice experience, lived expertise and information from autism advocacy organisations. The research evidence did not cover support strategies, and we drew on information from practice experience and autism advocacy organisations to develop these sections.

We acknowledge that the use of potentially harmful behaviours by Autistic children, and research on autism more broadly, is an evolving space and includes diverse perspectives informed by research, practice experience and lived expertise.

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1 Holt, 2023; Quetsch et al., 2023

2 Aspect, 2025; DSS, 2024; Raising Children Network, 2025

3 This resource does not examine children's use of behaviours that have the potential to cause physical harm to themselves (sometimes referred to as 'self-injurious behaviours'). The authors acknowledge that this is a critical and distinct need for many children and families but that it is not within the scope of this resource.

4 Holt, 2023; Holt, 2024; Kirst et al., 2022; Quetsch et al., 2023; Swaab et al., 2021

5 Brown et al., 2019; Holt, 2023; Holt, 2024; Neuhaus et al., 2022; Piro-Gambetti et al., 2021; Quetsch et al., 2023

6 Raising Children Network, 2024b; The Spectrum, n.d.