{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T20:32:53Z","timestamp":1784925173160,"version":"3.55.0"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T00:00:00Z","timestamp":1718323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T00:00:00Z","timestamp":1718323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Br Dent J"],"published-print":{"date-parts":[[2024,6,14]]},"DOI":"10.1038\/s41415-024-7449-x","type":"journal-article","created":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T09:21:39Z","timestamp":1718356899000},"page":"876-880","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Diagnostic overshadowing: self-injurious behaviour as a manifestation of pain in the head and neck"],"prefix":"10.1038","volume":"236","author":[{"given":"Mona","family":"Yekezare","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Handley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey","family":"Clough","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,6,14]]},"reference":[{"key":"7449_CR5376","unstructured":"Reiss S, Levitan G W, Szyszko J. Emotional disturbance and mental retardation: diagnostic overshadowing. Am J Ment Defic 1982; 86: 567-574."},{"key":"7449_CR5378","unstructured":"Emerson E, Baines S. Health inequalities and people with learning disabilities in the UK: 2010. 2020. Available at https:\/\/pureportal.strath.ac.uk\/files-asset\/7402206\/vid_7479_IHaL2010_3HealthInequality2010.pdf (accessed May 2024)."},{"key":"7449_CR5381","doi-asserted-by":"crossref","unstructured":"Clough S, Handley P. Diagnostic overshadowing in dentistry. Br Dent J 2019; 227: 311-315.","DOI":"10.1038\/s41415-019-0623-x"},{"key":"7449_CR5384","unstructured":"General Medical Council. Learning Disabilities. 2024. Available at https:\/\/www.gmc-uk.org\/ethical-guidance\/ethical-hub\/learning-disabilities (accessed May 2024)."},{"key":"7449_CR5387","unstructured":"Public Health England. How social care staff can recognise and manage pain in people with learning disabilities. 2017. Available at https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/656269\/Social_care_staff_supporting_pain_management_in_learning_disabilities.pdf (accessed May 2024)."},{"key":"7449_CR5390","unstructured":"British Institute of Learning Disabilities. Factsheet: Communication. Available at https:\/\/www.imagineinclusion.co.uk\/media\/files\/Communication%2002.pdf (accessed May 2024)."},{"key":"7449_CR5393","doi-asserted-by":"crossref","unstructured":"Kankkunen P, J\u00e4nis P, Vehvil\u00e4inen-Julkunen K. Pain assessment among non-communicating intellectually disabled people described by nursing staff. Open Nurs J 2010; 4: 55-59.","DOI":"10.2174\/1874434601004010055"},{"key":"7449_CR5395","doi-asserted-by":"crossref","unstructured":"Regnard C, Reynolds J, Watson B, Matthews D, Gibson L, Clarke C. Understanding distress in people with severe communication difficulties: developing and assessing the Disability Distress Assessment Tool (DisDAT). J Intellect Disabil Res 2007; 51: 277-292.","DOI":"10.1111\/j.1365-2788.2006.00875.x"},{"key":"7449_CR5397","doi-asserted-by":"crossref","unstructured":"Wiens S. Interoception in emotional experience. Curr Opin Neurol 2005; 18: 442-447.","DOI":"10.1097\/01.wco.0000168079.92106.99"},{"key":"7449_CR5400","doi-asserted-by":"crossref","unstructured":"F\u00fcst\u00f6s J, Gramann K, Herbert B M, Pollatos O. On the embodiment of emotion regulation: interoceptive awareness facilitates reappraisal. Soc Cogn Affect Neurosci 2013; 8: 911-917.","DOI":"10.1093\/scan\/nss089"},{"key":"7449_CR5402","unstructured":"NHS Information Centre. Estimating the Prevalence of Autism Spectrum Conditions in Adults. 2012. Available at https:\/\/files.digital.nhs.uk\/publicationimport\/pub05xxx\/pub05061\/esti-prev-auti-ext-07-psyc-morb-surv-qual.pdf (accessed May 2024)."},{"key":"7449_CR5405","unstructured":"Battle D E. Diagnostic and Statistical Manual of Mental Disorders (DSM).Codas 2013; 25: 191-192."},{"key":"7449_CR5407","doi-asserted-by":"crossref","unstructured":"Di Martino A, Yan C-G, Li Q et al. The autism brain imaging data exchange: towards a large-scale evaluation of the intrinsic brain architecture in autism. Mol Psychiatry 2014; 19: 659-667.","DOI":"10.1038\/mp.2013.78"},{"key":"7449_CR5409","doi-asserted-by":"crossref","unstructured":"Fiene L, Ireland M J, Brownlow C. The Interoception Sensory Questionnaire (ISQ): A Scale to Measure Interoceptive Challenges in Adults. J Autism Dev Disord 2018; 48:3354-3366.","DOI":"10.1007\/s10803-018-3600-3"},{"key":"7449_CR5412","unstructured":"Goodall E. Facilitating interoceptive awareness as a self-management and self-regulation tool to increase engagement in learning and education. Queensland: University of Southern Queensland, 2021. Master's Thesis."},{"key":"7449_CR5414","doi-asserted-by":"crossref","unstructured":"Matson J L, Turygin N C. How do researchers define self-injurious behavior? Res Dev Disabil 2012; 33: 1021-1026.","DOI":"10.1016\/j.ridd.2012.01.009"},{"key":"7449_CR5416","doi-asserted-by":"crossref","unstructured":"Summers J, Shahrami A, Cali S et al. Self-Injury in Autism Spectrum Disorder and Intellectual Disability: Exploring the Role of Reactivity to Pain and Sensory Input. Brain Sci 2017; 26: 140.","DOI":"10.3390\/brainsci7110140"},{"key":"7449_CR5418","doi-asserted-by":"crossref","unstructured":"Cooper S-A, Smiley E, Allan L M et al. Adults with intellectual disabilities: prevalence, incidence and remission of self-injurious behaviour, and related factors. J Intellect Disabil Res 2009; 53: 200-216.","DOI":"10.1111\/j.1365-2788.2008.01060.x"},{"key":"7449_CR5421","doi-asserted-by":"crossref","unstructured":"Emerson E, Kiernan C, Alborz A et al. The prevalence of challenging behaviors: a total population study. Res Dev Disabil 2001; 22: 77-93.","DOI":"10.1016\/S0891-4222(00)00061-5"},{"key":"7449_CR5423","doi-asserted-by":"crossref","unstructured":"Deb S, Thomas M, Bright C. Mental disorder in adults with intellectual disability. 2: The rate of behaviour disorders among a community-based population aged between 16 and 64 years. J Intellect Disabil Res 2001; 45: 506-514.","DOI":"10.1046\/j.1365-2788.2001.00373.x"},{"key":"7449_CR5426","unstructured":"Weiss J. Self-injurious behaviours in autism: A literature review. J Dev Disabil 2003; 9: 129-143."},{"key":"7449_CR5428","doi-asserted-by":"crossref","unstructured":"Baghdadli A, Pascal C, Grisi S, Aussilloux C. Risk factors for self-injurious behaviours among 222 young children with autistic disorders. J Intellect Disabil Res 2003; 47: 622-627.","DOI":"10.1046\/j.1365-2788.2003.00507.x"},{"key":"7449_CR5431","doi-asserted-by":"crossref","unstructured":"Richards C, Oliver C, Nelson L, Moss J. Self-injurious behaviour in individuals with autism spectrum disorder and intellectual disability. J Intellect Disabil Res 2012; 56: 476-489.","DOI":"10.1111\/j.1365-2788.2012.01537.x"},{"key":"7449_CR5433","doi-asserted-by":"crossref","unstructured":"Rattaz C, Michelon C, Baghdadli A. Symptom severity as a risk factor for self-injurious behaviours in adolescents with autism spectrum disorders. J Intellect Disabil Res 2015; 59: 730-740.","DOI":"10.1111\/jir.12177"},{"key":"7449_CR5435","doi-asserted-by":"crossref","unstructured":"Duerden E G, Oatley H K, Mak-Fan K M et al. Risk factors associated with self-injurious behaviors in children and adolescents with autism spectrum disorders. J Autism Dev Disord 2012; 42: 2460-2470.","DOI":"10.1007\/s10803-012-1497-9"},{"key":"7449_CR5437","doi-asserted-by":"crossref","unstructured":"Hyman S L, Fisher W, Mercugliano M, Cataldo M F. Children with self-injurious behavior. Pediatrics 1990; 85: 437-441.","DOI":"10.1542\/peds.85.3.437"},{"key":"7449_CR5440","doi-asserted-by":"crossref","unstructured":"Nissen J M, Haveman M J. Mortality and avoidable death in people with severe self-injurious behaviour: results of a Dutch study. J Intellect Disabil Res 1997; 41: 252-257.","DOI":"10.1046\/j.1365-2788.1997.04545.x"},{"key":"7449_CR5442","doi-asserted-by":"crossref","unstructured":"Sandman C A. The opiate hypothesis in autism and self-injury. J Child Adolesc Psychopharmacol 1990; 1: 237-248.","DOI":"10.1089\/cap.1990.1.237"},{"key":"7449_CR5444","doi-asserted-by":"crossref","unstructured":"Allely C S. Pain sensitivity and observer perception of pain in individuals with autistic spectrum disorder. Scientificworldjournal 2013; 2013: 916178.","DOI":"10.1155\/2013\/916178"},{"key":"7449_CR5446","doi-asserted-by":"crossref","unstructured":"Symons F J, Harper V N, McGrath P J, Breau L M, Bodfish J W. Evidence of increased non-verbal behavioral signs of pain in adults with neurodevelopmental disorders and chronic self-injury. Res Dev Disabil 2009; 30: 521-528.","DOI":"10.1016\/j.ridd.2008.07.012"},{"key":"7449_CR5449","doi-asserted-by":"crossref","unstructured":"Courtemanche A B, Black W R, Reese R M. The Relationship Between Pain, Self-Injury, and Other Problem Behaviors in Young Children With Autism and Other Developmental Disabilities. Am J Intellect Dev Disabil 2016; 121: 194-203.","DOI":"10.1352\/1944-7558-121.3.194"},{"key":"7449_CR5453","doi-asserted-by":"crossref","unstructured":"Geddis-Regan A R, Gray D, Buckingham S, Misra U, Boyle C. The use of general anaesthesia in special care dentistry: A clinical guideline from the British Society for Disability and Oral Health. Spec Care Dent 2022; 42: 3-32.","DOI":"10.1111\/scd.12652"},{"key":"7449_CR5455","unstructured":"King's College London. Learning from lives and deaths - People with a learning disability and autistic people (LeDeR) report for 2021 (LeDeR 2021). 2021. Available at https:\/\/www.kcl.ac.uk\/ioppn\/assets\/fans-dept\/leder-main-report-hyperlinked.pdf (accessed May 2024)."},{"key":"7449_CR5458","unstructured":"UK Government. Health and Care Act 2022. Available at https:\/\/www.legislation.gov.uk\/ukpga\/2022\/31\/section\/181\/enacted (accessed May 2024)."},{"key":"7449_CR5461","unstructured":"Oliver's Campaign. About Us. Available at https:\/\/www.olivermcgowan.org\/about_us (accessed May 2024)."},{"key":"7449_CR5464","doi-asserted-by":"crossref","unstructured":"Breau L M, Camfield C S, McGrath P J, Finley G A. The incidence of pain in children with severe cognitive impairments. Arch Pediatr Adolesc Med 2003; 157: 1219-1226.","DOI":"10.1001\/archpedi.157.12.1219"},{"key":"7449_CR5466","doi-asserted-by":"crossref","unstructured":"Breau L M, Finley G A, McGrath P J, Camfield C S. Validation of the Non-communicating Children's Pain Checklist-Postoperative Version. Anesthesiology 2002; 96: 528-535.","DOI":"10.1097\/00000542-200203000-00004"},{"key":"7449_CR5469","doi-asserted-by":"crossref","unstructured":"Lotan M, Moe-Nilssen R, Ljunggren A E, Strand L I. Reliability of the Non-Communicating Adult Pain Checklist (NCAPC), assessed by different groups of health workers. Res Dev Disabil 2009; 30: 735-745.","DOI":"10.1016\/j.ridd.2008.10.005"},{"key":"7449_CR5471","doi-asserted-by":"crossref","unstructured":"Voepel-Lewis T, Malviya S, Tait A R et al. A comparison of the clinical utility of pain assessment tools for children with cognitive impairment. Anesth Analg 2008; 106: 72-78.","DOI":"10.1213\/01.ane.0000287680.21212.d0"}],"container-title":["British Dental Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41415-024-7449-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41415-024-7449-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41415-024-7449-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T09:23:25Z","timestamp":1718357005000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41415-024-7449-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,14]]},"references-count":39,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2024,6,14]]}},"alternative-id":["7449"],"URL":"https:\/\/doi.org\/10.1038\/s41415-024-7449-x","relation":{},"ISSN":["0007-0610","1476-5373"],"issn-type":[{"value":"0007-0610","type":"print"},{"value":"1476-5373","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,14]]},"assertion":[{"value":"20 November 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 February 2024","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 February 2024","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 June 2024","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no conflicts of interest.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics declaration"}},{"value":"Consent to publish has been obtained for cases and Figure 3.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics declaration"}}]}}