A functional assessment of handmouthing among persons with severe and profound intellectual disability

Swender, Stephen L.; Matson, Johnny L.; Mayville, Stephen B.; Gonzalez, Michael A.; McDowell, D. M.

doi:10.1080/13668250600710880

Cited by 16 publications

(7 citation statements)

References 18 publications

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“…(1992) found indications that rumination and meal‐time challenging behaviours may be caused by dysphagia, GORD or aspiration. Adults who engaged in hand mouthing were diagnosed with GORD more often (Swender et al . 2006).…”

Section: Resultsmentioning

confidence: 99%

Physical conditions and challenging behaviour in people with intellectual disability: a systematic review

Winter¹,

Jansen²,

Evenhuis

2011

J intellect Disabil Res

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Medical conditions can play a role in challenging behaviour, and this should be evaluated in the clinical setting. So far, the level of evidence is generally low, and longitudinal studies are completely lacking. We recommend a systematic approach to research examining the role of physical conditions in challenging behaviour, the ultimate aim being to establish a basis for the development of clinical guidelines.

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Section: Resultsmentioning

confidence: 99%

Physical conditions and challenging behaviour in people with intellectual disability: a systematic review

Winter¹,

Jansen²,

Evenhuis

2011

J intellect Disabil Res

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“…Swender et al were among the first to specifically test the a priori hypothesis that GERD may be causally related to handmouthing in Rett patients. This group also identified a correlation between GERD and SIB in ID children; however, they found that GERD treatment did not alter behaviour and concluded that SIB may take on secondary functions in this population (Swender et al 2006). Nevertheless, pharmacological intervention to alleviate pain due to GERD may be an important component of treatment of SIB, and GERD status should be assessed in susceptible patients.…”

Section: Gastroesophageal Reflux Diseasementioning

confidence: 96%

“…were among the first to specifically test the a priori hypothesis that GERD may be causally related to handmouthing in Rett patients. This group also identified a correlation between GERD and SIB in ID children; however, they found that GERD treatment did not alter behaviour and concluded that SIB may take on secondary functions in this population (Swender et al . 2006).…”

Section: Self‐injury As a Coping Mechanism For Pain In Patients With mentioning

confidence: 99%

Self‐injurious behaviour in intellectual disability syndromes: evidence for aberrant pain signalling as a contributing factor

Peebles

Price

2011

J intellect Disabil Res

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Background In most individuals, injury results in activation of peripheral nociceptors (pain-sensing neurons of the peripheral nervous system) and amplification of central nervous system (CNS) pain pathways that serve as a disincentive to continue harmful behaviour; however, this may not be the case in some developmental disorders that cause intellectual disability (ID). Moreover, individuals affected by ID disorders may initiate self-injurious behaviour to address irritating or painful sensations. In normal individuals, a negative feedback loop decreases sensation of pain, which involves descending inhibitory neurons in the CNS that attenuate spinal nociceptive processing. If spinal nociceptive signalling is impaired in these developmental disorders, an exaggerated painful stimulus may be required in order to engage descending anti-nociceptive signals. Methods Using electronic databases, we conducted a review of publications regarding the incidence of chronic pain or altered pain sensation in ID patients or corresponding preclinical models. Results There is a body of evidence indicating that individuals with fragile X mental retardation and/or Rett syndrome have altered pain sensation. These findings in humans are supported by mechanistic studies using genetically modified mice harbouring mutations consistent with the human disease. Thus, once self-injurious behaviour is initiated, the signal to stop may be missing. Several developmental disorders that cause ID are associated with increased incidence of gastroesophageal reflux disease (GERD), which can cause severe visceral pain. Individuals affected by these disorders who also have GERD may self-injure as a mechanism to engage descending inhibitory circuits to quell visceral pain. In keeping with this hypothesis, pharmacological treatment of GERD has been shown to be effective for reducing self-injurious behaviour in some patients. Hence, multiple lines of evidence suggest aberrant nociceptive processing in developmental disorders that cause ID. Conclusions There is evidence that pain pathways and pain amplification mechanisms are altered in several preclinical models of developmental disorders that cause ID. We present hypotheses regarding how impaired pain pathways or chronic pain might contribute to self-injurious behaviour. Studies evaluating the relationship between pain and self-injurious behaviour will provide better understanding of the mechanisms underlying self-injurious behaviour in the ID population and may lead to more effective treatments.

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“…Recurrent vomiting is common, but not always associated with GERD . Clinical case reviews suggest that many individuals, who engage in hand mouthing, have also been diagnosed with GERD …”

Section: Gerd In Developmentaly Disabled Individualsmentioning

confidence: 99%

Dental erosion due to GERD in patients with developmental disabilities: case theory

Rada

2013

Special Care in Dentistry

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Gastroesophageal reflux disease (GERD) is a common finding among individuals in our society. Unfortunately, the condition is even more prevalent in individuals with developmental disabilities. There are significant comorbidities that can affect the upper gastrointestinal tract. Erosion of tooth surfaces may be the first comorbidity that is detected in individuals unable to express physical discomfort associated with GERD. The dentist should be aware of these findings and able to refer the patient for medical management. In addition, an awareness of preventive regimens and restorative options is essential in maintaining a healthy dentition for these individuals.

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A functional assessment of handmouthing among persons with severe and profound intellectual disability

Cited by 16 publications

References 18 publications

Physical conditions and challenging behaviour in people with intellectual disability: a systematic review

Physical conditions and challenging behaviour in people with intellectual disability: a systematic review

Self‐injurious behaviour in intellectual disability syndromes: evidence for aberrant pain signalling as a contributing factor

Dental erosion due to GERD in patients with developmental disabilities: case theory

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