The Relationship Between Pain, Self-Injury, and Other Problem Behaviors in Young Children With Autism and Other Developmental Disabilities.

The team watched 3- to young learners during normal preschool routines like snack and circle time.

Half of the kids had autism and self-injury; the other half had autism but no self-injury.

They counted pain signs: face grimaces, body guarding, rubbing a spot, or pulling away.

Children who hit or bit themselves showed three times more pain cues during the same ten-minute span.

The pain signs popped up right before or during the self-hit, not after.

Frank-Crawford et al. (2026) later showed that self-injury can run on automatic reinforcement, but they never checked if pain was the trigger.

Sullivan et al. (2020) saw new problem forms pop up when a treated behavior resurges; B et al. hint that pain may be one hidden driver of those new forms.

Sivberg (2002) and Whaling et al. (2025) tracked parent stress in autism families; higher pain loads in kids could be one reason those parents stay strained.

Before you write a behavior plan for self-injury, rule out pain. Look for tiny grimaces, rubbing, or pulling back during tasks. A quick nurse check or schedule change might drop the behavior without any extinction procedure.