Little is known about the sensory and neurobiological basis of chronic self-injurious behavior (SIB) among individuals with intellectual and developmental disabilities (IDD). In behavioral models of SIB, sensory mechanisms function as putative positive or negative automatic reinforcers but there is little evidence directly linking behavioral and biological mechanisms. Evidence from both clinical and animal studies of chronic pain and its behavioral sequelae supports the hypothesis that some forms of SIB may be regulated by altered pain mechanisms. From our work and that of others, we know that pain can lead to SIB in this population but we know almost nothing about whether chronic SIB leads to pain and the resulting neuro-immune cascade of effects. An established body of preclinical and clinical literature and the investigator's preliminary data provide initial support for a working sensory dysfunction and neuropathic-pain like hypothesis of chronic SIB and point to an important role for the peripheral and central mechanisms of pain and inflammatory/immune activity. The purpose of this project is to begin testing a novel model of SIB in relation to chronic neuropathic-like pain due to inflammatory and immune system activation. We hypothesize that there will be a subgroup of individuals with chronic SIB that have significantly (a) altered peripheral sensory innveration, (b) increased inflammatory and immune activity, and (c) increased immune-mediated 'sickness'like behavior. A case-control design will be used to compare matched (age, gender, IQ) groups of children with IDD with (n = 40) and without SIB (n = 40). The groups will be compared on measures of (a) peripheral innervation (Aim 1), (b) inflammatory/immune cytokines and related peptides (Aim 2), and (c) functional indicators of 'sickness'-like behavior including adaptive/social behavior, sleeping/eating, and sensory reactivity and pain signs/symptoms as well as within SIB group comparisons of functional and structural variables (Aim 3). Our preliminary results suggest that, at least in the periphery, ongoing neuro-immune interactions may, in part, be related to the as of yet poorly understood pathophysiology of chronic self-injury. This study will provide the first opportunity to systematically investigate neuro-immune variables in relation to SIB among children with IDD.

Public Health Relevance

Self-injurious behavior (SIB) among individuals with intellectual and developmental disabilities (IDD) is a significant public health problem. For a considerable subgroup of individuals, treatment options may be limited by a lack of understanding about the basic sensory neurobiology related to chronic pain. The purpose of this study is to discover whether there are basic differences in sensory and pain neurobiology between children with IDD with and without SIB.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Special Emphasis Panel (ZRG1-BBBP-C (02))
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Oster-Granite, Mary Lou
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University of Minnesota Twin Cities
Schools of Education
United States
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Symons, Frank J; Gilles, Elizabeth; Tervo, Raymond et al. (2014) Skin and self-injury: a possible link between peripheral innervation and immune function? Dev Med Child Neurol :
Symons, Frank J; Byiers, Breanne; Tervo, Raymond C et al. (2013) Parent-reported pain in Rett syndrome. Clin J Pain 29:744-6
Selim, M M; Wendelschafer-Crabb, G; Redmon, J B et al. (2010) Gastric mucosal nerve density: a biomarker for diabetic autonomic neuropathy? Neurology 75:973-81
Symons, Frank J; Harper, Vicki; Shinde, Satomi K et al. (2010) Evaluating a sham-controlled sensory-testing protocol for nonverbal adults with neurodevelopmental disorders: self-injury and gender effects. J Pain 11:773-81
Hoch, John; Moore, Tim; McComas, Jennifer et al. (2010) Arousal and activity choice in autism: A single case assessment integrating autonomic and behavioral analysis. J Appl Biobehav Res 15:119-133
Rivard, Patrick F; Nugent, Andrea C; Symons, Frank J (2009) Parent-proxy ratings of pain before and after botulinum toxin type A treatment for children with spasticity and cerebral palsy. Clin J Pain 25:413-7
Symons, Frank J; Wendelschafer-Crabb, Gwen; Kennedy, William et al. (2008) Evidence of altered epidermal nerve fiber morphology in adults with self-injurious behavior and neurodevelopmental disorders. Pain 134:232-7
Symons, Frank J; Danov, Stacy E (2005) A prospective clinical analysis of pain behavior and self-injurious behavior. Pain 117:473-7