AUTISM AND PAIN IN CHILDREN

Autism and Pain in Children

Katiana Hogarth
Professor. Amiel
Orion College
11/28/2015

AUTISM AND PAIN IN CHILDREN

2

Abstract
Autism Spectrum Disorder (ASD) is a disorder that affects 1 out of every 68 children in the
U.S. (Autism Spectrum Disorder, 2015). Each individual diagnosed to be within the autistic
spectrum has a unique set of symptoms, characteristics and challenges that he or she faces on a
day-to-day basis. Among some of these challenges is interpreting pain. Many parents and
healthcare providers of autistic children must decipher their childs nonverbal signals and/or
behaviors to determine if pain management is necessary and when given, is done so adequately.
This can undoubtedly be a very daunting task. The purpose of this essay is to determine which
pain scale is more conducive towards rating the pain of an autistic child who has just undergone
major surgery, what to consider when giving medications for pain, and lastly to discuss the
probability of the autistic child becoming addicted or dependent on pain medications as he gets
older.

AUTISM AND PAIN IN CHILDREN

3

Autism and Pain

Pain within itself is a subjective experience, so achieving proper pain management for
any patient may be difficult for a nurse, but it is even more challenging when assessing and
managing the pain in a developmentally disabled child. Pain can be challenging to evaluate in
developmentally disabled children because their self-report of pain can be difficult to interpret
and obtain. The nurse has to take into account when providing medication for pain that an
autistic child may experience pain differently than a typical child. This means that he or she may
appear to have a reduced sensitivity to pain, but this in no way means that the patient is pain-free.
In fact, autism patients may display pain by unusual pain responses that include laughter,
humming, singing and removing of clothing (ASDF Autism 101 for Paramedics/EMS, 2012).
Therefore, when in situations where pain is expected, like post-surgery, it is best to administer
pain medicine as prescribed.
When administering pain medication, the nurses main objective should be to safely
relieve his/her patient from postoperative pain. This is because there are many dangerous effects
like chronic pain syndrome and delayed recovery that can happen to the child when pain is
prolonged or insufficiently controlled (Care of People with Pain). Furthermore, the nurse needs
to take into consideration that it is very common for children with ASD to be taking several
different medications including psychotropic, medications for anxiety or medications for
irritability associated with autism. Therefore, any pain medications given to the patient should be
ones that do not negatively interact with other drugs which the child may currently be receiving.
Due to the fact that the patient has autism, he may have difficulty with expressive and
receptive communication. The patient may not be able to accurately express pain level or
intensity in a verbal manner. Additionally, he may struggle to choose between the facial
expressions of pain on the FACES scale or describe the level of discomfort that he may be

AUTISM AND PAIN IN CHILDREN

4

feeling using the standard numerical pain scale. Therefore, his nurse should attempt to utilize an
alternative method of pain measurement.

The Pain Indicator for Communicatively Impaired Children (PICIC) distinguishes

between pain and non-pain in communicatively impaired children with life-threatening
illness. The PICIC has six core pain cues: crying with or without tears, screaming yelling
groaning or moaning, Screwed or distressed-looking face, body appearing stiff for tense,
difficulty in comforting or consoling, flinching or moving away if touched (Hockenberry
& Wilson, 2013, pp.156).

The Pediatric Pain Profile (PPP) uses history of pain provided by the parent(s) so that the
nurse and/or physician know what behaviors to look for which correlate with pain
(Eveleth, 2015).
The best method that the nurse can use is a combination of The Pain Indicator for

Communicatively Impaired Children and The Pediatric Pain Profile because utilizing both of
these in combination with each other allows the nurse to use observed behaviors and detailed
pain report given by the childs parent(s) or caregiver(s) as a means to properly assess and rate
pain level. Additionally, it is also helpful during pain management for the nurse to utilize a pain
relief scale or periodic ratings of pain intensity for evaluation of effectiveness of pain regimens.

In the event that the childs parent is concerned about the probability of her child facing
issues with addiction and substance abuse as he gets older, the nurse should inform the patient's
mother that after surgery it is normal for her son to experience higher than normal pain. This may
require high doses of pain medication; however as the road to recovery progresses, he may no
longer require such high doses for managing pain. Furthermore, the nurse should inform the
patients mother that nevertheless, like any individual taking large doses of pain medication for
long periods of time, there is a risk for dependency and addiction. Additionally, when
accompanied with the symptoms and challenges that autistic individuals face on a day-to-day
basis, these risks are known to increase. Therefore, it is imperative that all medications both
prescribed and over-the counter are used correctly and within the proper dosage range.
Moreover, the nurse should encourage the patients mother to express her concerns to the
physician so that overtime a lower dose or different medication such as a non-opioid, suitable for

AUTISM AND PAIN IN CHILDREN

5

mild to moderate pain; can be used or prescribed. Finally, it is important that the nurse express to
the patients mother the significance of remaining vigilant to any signs or behaviors that would
indicate drug abuse in the future.
In conclusion, I found this scenario to be both intriguing and informative. Being that I
have never had the opportunity to assess or manage the pain of a child with autism spectrum
disorder or any other complex disorders of brain development, I greatly enjoyed doing research
on this topic and found the information to be immensely valuable. Now that I have a greater
understanding of pain management in children with developmental disorders, I will be sure to
use my newly acquired knowledge of how developmentally disabled individuals process and
express pain, what to take into account when administering pain medication, what pain scale to
use, and finally information concerning drug dependency and/or addiction during my pediatric
rotation at Kids Comprehensive and throughout my nursing career.

AUTISM AND PAIN IN CHILDREN

6

References
ASDF Autism 101 for Paramedics/EMS (Emergency Medical Service). (2012,
July 30). Retrieved November 28, 2015, from
http://www.myasdf.org/site/about-autism/autism-information-foremergency-personnel/autism-101-for-paramedicsems-emergencymedical-service/
Autism Spectrum Disorder (ASD). (2015, August 12). Retrieved November 28,
2015, from http://www.cdc.gov/ncbddd/autism/data.html
Care of People with Pain. (n.d.). Retrieved November 28, 2015, from
http://www.ncbi.nlm.nih.gov/books/NBK92517/
Eveleth, R. (2015, January 7). Beyond the Smiley-Face Pain Scale. Retrieved
November 28, 2015, from
http://www.theatlantic.com/health/archive/2015/01/beyond-the-smileyface-pain-scale/384049/
Hockenberry, M., & Wilson, D. (2013). Pain Assessment and Management in
Children. In Wong's essentials of pediatric nursing (9th ed., p. 156). St.
Louis, Missouri: Elsevier/Mosby.