Autistic Children Are Twice As Likely To Experience Chronic Pain As Neurotypical Children

Children with autism may experience pain more profoundly and more often than neurotypical children, found a study published in JAMA Pediatrics in October of 2019. For children with comorbid conditions like epilepsy or intellectual disability, their chances of feeling chronic pain are even more likely.

About 70% of children with autism experience sensory sensitivities, and pain can be exacerbated in children with autism due to these sensory sensitivities. Gut issues, lack of sleep, fixating on the pain, and anxiety are other issues frequently associated with ASD that can worsen the experience of pain.

And while physical pain is “not typically thought of as a core feature of [autism],” it seems to affect a significant number of children with the condition.

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“Children with autism spectrum disorder… have sensory sensitivities, meaning that physical sensations may be experienced differently or bother them more,” said the study’s author, Dr. Danielle Shapiro, PhD, who is an assistant professor of physical medicine and rehabilitation at the University of Michigan. “Painful experiences may, therefore, cause them more distress.”

Shapiro and her colleague, Dr. Daniel G. Whitney, PhD, analyzed data from the 2016-2017 U.S. National Survey of Children’s Health. They looked at a total of 50,063 children — 1,472 of whom had autism — who were ages 6 to 17 years old.

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The survey asked parents questions about their children’s medical diagnoses and their experience with pain over the previous year. Because the data relies on parental feedback rather than the patient’s, the data should be taken with a grain of salt — especially since children with autism can struggle with communicating to their parents that they are in pain.

“Children who have difficulty with communication may show that they are in pain behaviorally, which may take the form of increased irritability or behavioral problems,” Shapiro said. “A sudden, otherwise unexplained change in behavior is a good clue that something physical, like pain, may be a factor,”

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Shapiro and Whitney found that roughly 16% of the autistic children in the study experienced chronic or repeated pain during the previous year. That number was higher for children with comorbid disorders, coming in at slightly less than 20%.

“Pain is a common but under-recognized experience for children with autism,” Shapiro said.

About 8% of the non-autistic children experienced chronic pain. In this group of 49,000 non-autistic children, around 800 had epilepsy, intellectual disability or cerebral palsy.

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Shapiro says that one way children with autism who struggle with communication can indicate they are in pain is through the use of pictures. Using images of a body can make it easier for a child to show their parents where their pain is, and a scale of happy to sad faces can give a rough idea of how intense that pain is.

More work needs to be done in this area, including determining potential sources of pain in autistic children.

“That would serve as a pathway to help us think about how to address pain in kids with autism,” Shapiro said.

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