Toward improved understanding and treatment of self-injurious behaviors in autistic individuals with profound intellectual disability.
Treat emotion regulation as a main driver when self-injury shows up in autistic clients with profound ID.
01Research in Context
What this study did
Ferguson et al. (2025) wrote a narrative review about self-injury in autistic people with profound intellectual disability.
They pulled together past papers and built a new idea: emotion-regulation problems may drive the self-injury.
The paper does not test a new treatment; it gives clinicians a fresh lens for assessment.
What they found
The team argues that inner mood signs, like anxiety or sadness, often hide inside profound ID.
When these feelings build up, the person may use self-injury to cope or to signal distress.
The review links this idea to both biological stress and learned behavior chains.
How this fits with other research
Northrup et al. (2022) watched autistic youth in real time and saw self-injury often came BEFORE visible upset, not after. This seems to clash with the new emotion-first view, but the youth in B et al. had milder ID and were in a hospital ward. The setting and IQ gap may explain the flip in order.
Sáez-Suanes et al. (2023) backs the emotion link: in autistic people with mild ID, poor emotion regulation predicted later depression. Ferguson et al. (2025) widens this lens to the profound-ID subgroup and swaps depression for self-injury as the outcome.
Older reviews such as Matson et al. (2008) and Foti et al. (2015) pushed function-based behavior plans and bio-behavioral checklists. The 2025 paper keeps those tools but adds "teach emotion regulation" as a core step, updating the roadmap.
Why it matters
If you assess self-injury in clients with profound ID, add quick mood screens and caregiver interviews about anxiety or sleep. Pair your functional analysis with simple regulation supports like choice, sensory breaks, or deep-pressure routines. The paper reminds us that internal pain can hide behind severe self-injury, and treating that pain may cut the behavior faster than punishment alone.
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02At a glance
03Original abstract
Self-injurious behaviors (SIB) commonly occur in autism spectrum disorder (ASD) and span diverse topographies of self-inflicted behaviors ranging from head banging to hitting oneself against hard objects. Despite the high rates of SIB in autistic individuals, relatively little research has focused on psychological factors associated with the development and maintenance of SIB in individuals with autism and moderate-profound intellectual disability (ID). This commentary synthesizes existing literature on SIB and highlights the need for more research focused on psychological correlates and mechanisms in autistic individuals with moderate-profound ID. We highlight the key role of difficulties in emotion regulation (ER) and co-occurring internalizing symptoms in the manifestation of self-harm behaviors in clinical samples and autism. Furthermore, this commentary proposes a framework for understanding the interplay between poor ER and internalizing symptoms in the development and maintenance of SIB in autistic individuals with moderate-profound ID. Specifically, we explore the emergence of SIB in the context of precipitating cues that trigger strong emotions, ER processes and strategy deployment, and co-occurring internalizing symptoms. Future directions and implications for longitudinal research, measurement development, and clinical treatments are discussed.
Autism research : official journal of the International Society for Autism Research, 2025 · doi:10.1002/aur.3289