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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\u2010profound 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\u2010profound ID. We highlight the key role of difficulties in emotion regulation (ER)\u00a0and co\u2010occurring internalizing symptoms in the manifestation of self\u2010harm 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\u2010profound 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\u2010occurring internalizing symptoms. Future directions and implications for longitudinal research, measurement development, and clinical treatments are discussed.<\/jats:p>","DOI":"10.1002\/aur.3289","type":"journal-article","created":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T11:02:47Z","timestamp":1734433367000},"page":"261-272","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Toward improved understanding and treatment of self\u2010injurious behaviors in autistic individuals with profound intellectual disability"],"prefix":"10.1002","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2771-6346","authenticated-orcid":false,"given":"Emily F.","family":"Ferguson","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaylin M.","family":"Russell","sequence":"additional","affiliation":[{"name":"Department of Counseling University of California  Santa Barbara California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarely J.","family":"Licona","sequence":"additional","affiliation":[{"name":"Department of Counseling University of California  Santa Barbara California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2954-0495","authenticated-orcid":false,"given":"Ru Ying","family":"Cai","sequence":"additional","affiliation":[{"name":"Aspect Research Centre for Autism Practice Autism Spectrum Australia  New South Wales Australia"},{"name":"Olga Tennison Autism Research Centre, School of Psychology and Public Health La Trobe University  Bundoora Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6951-2667","authenticated-orcid":false,"given":"Thomas W.","family":"Frazier","sequence":"additional","affiliation":[{"name":"Center for Autism Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4034-9157","authenticated-orcid":false,"given":"Giacomo","family":"Vivanti","sequence":"additional","affiliation":[{"name":"A.J. 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