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The expression of acute pain reactions in children with autism : a comparative analysis Nader, Rami

Abstract

The present study examined acute pain expressions of children with autism. It has been widely reported that reduced pain sensitivity is a common feature of children with autism. However, the evidence supporting this conclusion is based on anecdotal observations and studies using questionable measures of pain. Assessment of pain in children with autism is difficult due to self-report and nonverbal expression communication impairments. Caregivers often must provide proxy reports. The current study used objective behavioral measures of pain (facial activity and distress responses). Twenty-one children with autism were videotaped while receiving a venepuncture, with parental assessments of pain collected before and after the procedure. Twenty-two children without autism served as an age and gender matched control group. The results showed that children with autism display a significant behavioral response to the venepuncture procedure, with the response comparable to that observed in the control children. The concordance between parental reports of pain and observed pain responses of the child was consistently greater for the control group over the autism group. The results put into question the validity of parental global report as an assessment tool for pain in children with autism. The findings are explained using the sociocommunicative model of pain which views pain as not solely an internal experience, but as an interpersonal phenomenon and takes into account the encoding and decoding processes involved in the communication of pain.

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