Over the last two weeks, we've seen a big increase in head-banging frequency and severity from Alex. His compliance (without complaining) has gone down.
Dave and I have been talking about last year, when we saw similar behaviour after we reduced his medication. It was supposed to be the start of a gradual weaning but when reducing it by 1 ml daily produced such difficult behaviours, we never went past that threshold. We kept it down for a month, waiting to see if his behaviour would stabilize and it never did. And it took another 3 months to get back to our baseline after we went back to a full dose.
This year's behaviour has no such explanation and is casting doubt on our results. Perhaps his behaviour had nothing to do with the medication. His doctor reaffirmed his dosage within the last week, so it's not that he's outgrown the original dosage. Maybe something else happens at this time of year which triggers the difficulty.
If the pattern is consistent with difficult behaviour lasting until March or April, then we'll have to start suspecting that there's a seasonal trigger. If this is a short term burst (likely triggered by the changes in expectation and routine), then it should resolve itself much faster.
Meanwhile, we've had to institute a policy of removing toys when he headbangs. No attention, simply collecting a favoured toy and putting it out of reach. Once he's calmed down, he's warned what the next toy target will be if he headbangs again. If he's beginning to do the anticipatory whine which preceeds a headbang, then he gets a warning. He is definitely using the headbanging as an attention tool. He will look to make sure we're noticing how hard he's banging. My hope is that losing the toy will make it not worth it, particularly if he's not getting any attention for it.