Autism and Chronic Pain: How Can I Help My Child?

For a long time professionals and parents alike have wondered about the possible connection between autism and chronic pain. 

In the past, it was assumed by some that individuals diagnosed with autism spectrum disorders (ASD) didn’t really feel pain. That the pain intensity was different for them somehow. This is a misconception and thankfully there is now more understanding of the spectrum. 

The article, Autism and Amplified Musculoskeletal Pain Syndrome (AMPS): The role of sensory factors and anxiety in Psychology Today states that a presumed lack of pain came from people observing self injurious behaviors. It was thought by professionals that there was decreased sensitivity to pain in individuals with ASD.

That preconceived notion has now been debunked, with the article stating: “Research has carefully examined pain responses in controlled experimental settings. These studies show that it’s not that kids on the spectrum don’t have pain. Instead, they express pain in ways that may not be immediately recognizable by others.

“Indeed, there is a growing body of research indicating that not only do autistic persons have pain but that they experience it to a greater degree than others; particularly in debilitating chronic pain conditions.”

So, how does autism affect pain responses?

Another study I found interesting was, Prevalence of autism traits and attention-deficit hyperactivity disorder symptoms in a clinical sample of children and adolescents with chronic pain, which contains research linking individuals with autism spectrum disorder (ASD) and/or Attention Deficit Hyperactivity Disorder (ADHD) and chronic pain. 

The article states: “Children with debilitating chronic pain, particularly girls, may present with an elevated risk of having a comorbid, possibly high-functioning, neurodevelopmental disorder. Results suggest that clinical assessment of pediatric chronic pain should include screening for neurodevelopmental disorders.”

Is chronic pain a symptom of autism?

There are different views on whether chronic pain is a known symptom of ASD. The fact is that autism is a spectrum disorder and there are multiple symptoms that are dependent on the individual.

Going back to the above article, Prevalence of autism traits and attention-deficit hyperactivity disorder symptoms in a clinical sample of children and adolescents with chronic pain, research is discussed that links chronic pain patients with having lower executive function skills. It also states that psychiatric disorders, like depression and anxiety, can be typical in relation to pediatric chronic pain, and functional impairments can be a higher risk factor.

Some neuropsychological function studies have linked chronic pain symptoms like stomach and/or abdominal pain and migraines to ASD and ADHD. However, due to the possibilities that these conditions could go undetected among pediatric patients, the results of a link are unclear until there’s a definitive and consistent way of taking pain measurements.

If my child feels pain differently, how can I know they are in pain?

So, with the above research and information in mind, how do you know if your autistic child is in pain?

It is important to observe the following and take action accordingly:

• Any changes in behavior and/or mood, as that can be an indicator the individual is experiencing pain
• If visuals are available, use them and consider how the person with autism is describing what they are feeling
• Use other modifications that are available for communication (if needed) for the individual to use to describe how they are feeling
• Talk to your child’s doctor and maintain open conversation about any concerns you may have if you fear your child is experiencing pain

In the Psychology Today article, Amplified Musculoskeletal Pain Syndrome (AMPS) is also highlighted. This is a condition defined by the American College of Rheumatology as an umbrella term that covers different noninflammatory musculoskeletal pains.

Symptoms and characteristics of AMPS are:

• Extreme pain that progressively gets worse
• The pain can be experienced in one area or spread over the body
• Due to poor sleep there is fatigue and hazy cognitive functioning
• Light sensitivity that makes pain worse (Allodynia)

The American Psychiatric Association notes that depression and anxiety can cause pain to increase, depending on the individual’s sensitivity. As many people on the spectrum struggle with anxiety, this is something to be aware of.

What do you do if your child is in pain?

If you fear your child is experiencing any type of pain, it is highly recommended to talk to their doctor and have the child evaluated.

If a medical professional assures you there is no pain, then you will still feel good about having had your child checked out. If you are not convinced by the diagnosis though, it is always worth getting a second opinion. If there is pain of any type, whether it is a chronic pain or not, your child’s doctor can set up treatments to help them feel more comfortable.

Keeping open communication with your child’s doctor could lead to your child being on a pain management program which might include medication. The clinician could also open access to therapies like occupational therapy, physical therapy, or others that could support the pain management further, or refer them to a professional such as a chiropractor.

The light at the end of the tunnel

Each person has a different pain threshold. With autistic children, it can be more difficult to gauge what they are feeling and how they experience pain.

Whether children with autism have acute pain that comes and goes, or are suffering from a disorder like the AMPS syndrome, it is important to get a diagnosis to move forward and form a treatment plan. 

All good parents want their children to have a high quality of life. If they are able to put a pain management plan in place for a child who is suffering, that is a great step in the right direction.

References:

American Psychiatric Association. (2020). Chronic Pain and Mental Health Often Interconnected. https://www.psychiatry.org/News-room/APA-Blogs/Chronic-Pain-and-Mental-Health-Interconnected

Bolte, S., Hirvikoski, T., Holmstrom, L., Lekander, M., Lipsker, C.W., & Wicksell, R.K. (2018). Prevalence of autism traits and attention-deficit hyperactivity disorder symptoms in a clinical sample of children and adolescents with chronic pain. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6235327/

Lynch, C. (2020). Autism and Amplified Musculoskeletal Pain Syndrome (AMPS): The role of sensory factors and anxiety. Psychology Today. https://www.psychologytoday.com/us/blog/autism-and-anxiety/202008/autism-and-amplified-musculoskeletal-pain-syndrome-amps