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      Self-Injury in Autism Spectrum Disorder and Intellectual Disability: Exploring the Role of Reactivity to Pain and Sensory Input

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          Abstract

          This paper provides information about the prevalence and topography of self-injurious behavior in children and adults with autism spectrum disorder and intellectual disability. Dominant models regarding the etiology of self-injury in this population are reviewed, with a focus on the role of reactivity to pain and sensory input. Neuroimaging studies are presented and suggestions are offered for future research.

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          Most cited references77

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          The functions of deliberate self-injury: a review of the evidence.

          E Klonsky (2007)
          Deliberate self-injury is defined as the intentional, direct injuring of body tissue without suicidal intent. The present article reviews the empirical research on the functions of self-injury. This literature includes self-reports of reasons for self-injuring, descriptions of the phenomenology of self-injury, and laboratory studies examining the effects of self-injury proxies on affect and physiological arousal. Results from 18 studies provide converging evidence for an affect-regulation function. Research indicates that: (a) acute negative affect precedes self-injury, (b) decreased negative affect and relief are present after self-injury, (c) self-injury is most often performed with intent to alleviate negative affect, and (d) negative affect and arousal are reduced by the performance of self-injury proxies in laboratory settings. Studies also provide strong support for a self-punishment function, and modest evidence for anti-dissociation, interpersonal-influence, anti-suicide, sensation-seeking, and interpersonal boundaries functions. The conceptual and empirical relationships among the different functions remain unclear. Future research should address the measurement, co-variation, clinical correlates, and treatment implications of different functions.
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            Central modulation of pain.

            It has long been appreciated that the experience of pain is highly variable between individuals. Pain results from activation of sensory receptors specialized to detect actual or impending tissue damage (i.e., nociceptors). However, a direct correlation between activation of nociceptors and the sensory experience of pain is not always apparent. Even in cases in which the severity of injury appears similar, individual pain experiences may vary dramatically. Emotional state, degree of anxiety, attention and distraction, past experiences, memories, and many other factors can either enhance or diminish the pain experience. Here, we review evidence for "top-down" modulatory circuits that profoundly change the sensory experience of pain.
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              Toward a functional analysis of self-injury.

              This study describes the use of an operant methodology to assess functional relationships between self-injury and specific environmental events. The self-injurious behaviors of nine developmentally disabled subjects were observed during periods of brief, repeated exposure to a series of analogue conditions. Each condition differed along one or more of the following dimensions: (1) play materials (present vs absent), (2) experimenter demands (high vs low), and (3) social attention (absent vs noncontingent vs contingent). Results showed a great deal of both between and within-subject variability. However, in six of the nine subjects, higher levels of self-injury were consistently associated with a specific stimulus condition, suggesting that within-subject variability was a function of distinct features of the social and/or physical environment. These data are discussed in light of previously suggested hypotheses for the motivation of self-injury, with particular emphasis on their implications for the selection of suitable treatments.
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                Author and article information

                Journal
                Brain Sci
                Brain Sci
                brainsci
                Brain Sciences
                MDPI
                2076-3425
                26 October 2017
                November 2017
                : 7
                : 11
                : 140
                Affiliations
                [1 ]Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A1, Canada; yona.lunsky@ 123456camh.ca
                [2 ]Centre for Addiction and Mental Health, 1001 Queen Street W, Toronto, ON M6J 1H4, Canada; ali.shahrami@ 123456camh.ca (A.S.); stefanie.cali@ 123456camh.ca (S.C.); chantelle.dmello@ 123456camh.ca (C.D.); milena.kako@ 123456camh.ca (M.K.); andjelka.palikucinreljin@ 123456camh.ca (A.P.-R.); melissa.savage@ 123456camh.ca (M.S.); olivia.shaw@ 123456camh.ca (O.S.)
                Author notes
                [* ]Correspondence: jane.summers@ 123456camh.ca ; Tel.: +1-416-535-8501 (ext. 30833)
                Article
                brainsci-07-00140
                10.3390/brainsci7110140
                5704147
                29072583
                9de905a8-d318-43bf-a58e-c5970bb59bf5
                © 2017 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 18 September 2017
                : 23 October 2017
                Categories
                Review

                self-injury,autism spectrum disorder,intellectual disability,pain,sensory processing abnormalities

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