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Salabura C, Sourty A, Bat-Pitault F, Regnery K, Mayen S, Colson S. [Pain assessment for children and adolescents with autism spectrum disorders (ASD): A systematic review]. L'ENCEPHALE 2024:S0013-7006(24)00116-7. [PMID: 38971646 DOI: 10.1016/j.encep.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/16/2024] [Indexed: 07/08/2024]
Abstract
OBJECTIVE Pain in children and adolescents with autism spectrum disorders remains underdiagnosed due to their inherent communication difficulties. The goal of this review is to identify the most suitable methods for assessing pain in this population and for evaluating the specific perceptions of, or behavioural reactions to, pain whilst considering disorder severity and specifiers (with or without accompanying intellectual impairment, with or without accompanying language impairment). METHOD A systematic review and analysis of the international literature was conducted. RESULTS Fourteen studies were selected. No difference was found in pain-related behaviours based on the age or gender of children or adolescents with autism. Three studies showed pain-related behaviours in autism spectrum disorders to be similar to control groups. Other studies showed specific behavioural responses in autism spectrum disorders with a longer physiological and behavioural recovery time associated with an episode of acute pain in this population. Similarly, the three studies that focused on sensory perceptions of pain all showed differences in the autism spectrum disorders population compared to control groups. In hospital or daily life contexts, studies essentially showed idiosyncratic expressions, hypervigilance, motor agitation, negative emotional reactions, or vocalizations. Regarding the association of autism severity with hyposensitivity to pain, the results remain unclear even when language disorders or intellectual disabilities are also present (in conjunction with autism). The Non-Communicative Children Pain Checklist and its translation into French and Italian showed good internal validity and was used by almost half of the studies in hetero-assessment, mostly by parents. Studies recommend the inclusion of parents in the assessment in order to optimise the evaluation process. Similarly, analysis of parent/child/caregiver interviews from the studies highlights the importance of personalizing pain assessment of children and adolescents, taking into account subject-specific characteristics, pathology, and context. CONCLUSION An integrative and personalized approach to pain assessment appears to be the most appropriate for enhancing the understanding and detection of pain in individuals with autism spectrum disorders. This approach aligns well with a care setting where a nominated professional with a good expertise in autism is responsible for pain assessment. Given the complexity of identifying pain in individuals with autism, further qualitative studies, in conjunction with new pain exploration technologies, are considered necessary as well as a more extensive categorization of the population studies.
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Affiliation(s)
- Christelle Salabura
- Centre médico-psychologique infanto-juvénile, centre hospitalier Sainte-Marie, 07000 Privas, France; Groupement hospitalier les Portes de Provence, 26200 Montélimar, France.
| | - Arnaud Sourty
- Centre ressource autisme du centre hospitalier le Vinatier, 69678 Bron, France; Service de neurologie du Centre hospitalier universitaire Lyon-Sud, 69495 Oullins-Pierre-Bénite, France; Centre hospitalier Saint-Jean-de-Dieu, 69008 Lyon, France.
| | - Flora Bat-Pitault
- Assistance publique-hôpitaux de Marseille, 13009 Marseille, France; Équipe CANO-P, institut de neurosciences de la Timone, Aix-Marseille université, 13385 Marseille, France
| | - Kirsty Regnery
- Centre médico-psychologique infanto-juvénile, centre hospitalier Sainte-Marie, 07000 Privas, France; Centre ressources autisme, 26000 Valence, France
| | - Sandrine Mayen
- Faculté des sciences médicales et paramédicales, Aix-Marseille université, 13385 Marseille, France; EA3279-CEReSs, centre hospitalier d'Aix-en-Provence, 13100 Aix-en-Provence, France
| | - Sébastien Colson
- Faculté des sciences médicales et paramédicales, Aix-Marseille université, 13385 Marseille, France; EA3279-CEReSs, centre hospitalier d'Aix-en-Provence, 13100 Aix-en-Provence, France
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Johnson E, van Zijl K, Kuyler A. Pain communication in children with autism spectrum disorder: A scoping review. PAEDIATRIC & NEONATAL PAIN 2023; 5:127-141. [PMID: 38149220 PMCID: PMC10749405 DOI: 10.1002/pne2.12115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/29/2023] [Accepted: 09/11/2023] [Indexed: 12/28/2023]
Abstract
Children with autism spectrum disorder (ASD) experience social interaction and communication challenges and often display repetitive, restricted patterns of behavior, activities, and interests. The concept of pain is regarded as one of the most complex human stressors due to its subjective and personal nature and the influences of multiple internal and external factors. Due to the complexity of this disorder, it remains concerning how children with ASD communicate their pain and how observers (i.e., parents, carers, and health care practitioners) respond to these children's pain communication. This scoping review aimed to identify how children with ASD communicate or express their pain. Ten studies met the inclusion criteria for further data extraction. Through reflexive thematic analysis, two main themes were identified: verbal and nonverbal responses used by children with ASD to communicate their pain that could influence pain assessment and management strategies. This review highlighted that children with ASD utilized various verbal and nonverbal methods to communicate their pain experiences and that these methods differed compared to children without disabilities. Furthermore, this review emphasizes the importance of holistic pain assessment strategies as well as additional pictorial support for children with ASD. This review recommends that future research should focus on understanding how the inclusion of different stakeholders in pain assessment for children with ASD, can contribute to holistic pain assessment.
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Affiliation(s)
- Ensa Johnson
- Department of Inclusive Education, College of EducationUniversity of South AfricaPretoriaSouth Africa
| | - Karen van Zijl
- School of the Arts: Visual ArtsUniversity of South AfricaPretoriaSouth Africa
| | - Ariné Kuyler
- Department of Inclusive Education, College of EducationUniversity of South AfricaPretoriaSouth Africa
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Nicolardi V, Fanizza I, Accogli G, Macchitella L, Scoditti S, Trabacca A. Pain assessment in autism: updating the ethical and methodological challenges through a state-of-the-art review. Neurol Sci 2023; 44:3853-3861. [PMID: 37436557 DOI: 10.1007/s10072-023-06942-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/03/2023] [Indexed: 07/13/2023]
Abstract
Sensory features of autism include hypo- or hyper-reactivity to pain; however, previous studies on pain in autism lead to conflicting results. Here, we present the state of the art and the methodological challenges concerning pain perception in autism, focusing on studies that used standardized protocol as Quantitative Sensory Testing (QST) to measure perception. Despite there are still scant evidences found with the use of QST, they have challenged the presumed hyposensitivity to pain in autisms, which emerged from parents' reports. Both, peripheral and central mechanisms, have been found involved in typical features of perception in autism. Nonetheless, evidences with controlled protocols are still scarce, and even scarcer are studies focused on children. Overall, complex ethical challenges have to be overcome in order to collect subjective and objective measures from autistic children. With heterogeneous neurodevelopmental features, or intellectual disability, novel or modified protocols are needed.
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Affiliation(s)
- Valentina Nicolardi
- Unit for Severe Disabilities in Developmental Age and Young Adults (Developmental Neurology and Neurorehabilitation), Scientific Institute IRCCS "E. Medea", Ex Complesso Ospedaliero "A. Di Summa" - Piazza "A. Di Summa", 72100, Brindisi, Italy
| | - Isabella Fanizza
- Unit for Severe Disabilities in Developmental Age and Young Adults (Developmental Neurology and Neurorehabilitation), Scientific Institute IRCCS "E. Medea", Ex Complesso Ospedaliero "A. Di Summa" - Piazza "A. Di Summa", 72100, Brindisi, Italy
| | - Giuseppe Accogli
- Unit for Severe Disabilities in Developmental Age and Young Adults (Developmental Neurology and Neurorehabilitation), Scientific Institute IRCCS "E. Medea", Ex Complesso Ospedaliero "A. Di Summa" - Piazza "A. Di Summa", 72100, Brindisi, Italy
| | - Luigi Macchitella
- Unit for Severe Disabilities in Developmental Age and Young Adults (Developmental Neurology and Neurorehabilitation), Scientific Institute IRCCS "E. Medea", Ex Complesso Ospedaliero "A. Di Summa" - Piazza "A. Di Summa", 72100, Brindisi, Italy
| | - Sara Scoditti
- Unit for Severe Disabilities in Developmental Age and Young Adults (Developmental Neurology and Neurorehabilitation), Scientific Institute IRCCS "E. Medea", Ex Complesso Ospedaliero "A. Di Summa" - Piazza "A. Di Summa", 72100, Brindisi, Italy
| | - Antonio Trabacca
- Unit for Severe Disabilities in Developmental Age and Young Adults (Developmental Neurology and Neurorehabilitation), Scientific Institute IRCCS "E. Medea", Ex Complesso Ospedaliero "A. Di Summa" - Piazza "A. Di Summa", 72100, Brindisi, Italy.
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Tavares M, de Lima A, Lia E. Validation of an instrument for dentists' perception of pain in patients with communication difficulties. Braz J Med Biol Res 2023; 56:e12996. [PMID: 37878889 PMCID: PMC10591483 DOI: 10.1590/1414-431x2023e12996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/01/2023] [Indexed: 10/27/2023] Open
Abstract
Pain is present in the dental clinic, whether due to oral problems such as dental caries and its complications or related to dental procedures. Pain evaluation in patients with communication difficulties (PCDs) is challenging for dentists, potentially compromising treatment. The aim of this study was to develop and validate an instrument to assess the perception of dentists about pain in PCDs. This study followed a quantitative methodological approach involving constructing and validating an instrument administered to 50 dentists. The initial instrument consisted of 29 items divided into four domains. Content and construct validity and internal consistency were confirmed. Content validation was performed by judges using the Content Validity Index. The instrument underwent construct validation and internal consistency assessments through exploratory factor analysis and confirmatory factor analysis using Cronbach's α, Kaiser-Meyer-Olkin, and Bartlett's sphericity tests. The final instrument consisted of 21 items divided into three domains, with a high Cronbach's α for one domain and moderate values for the others. The total variance accounted for was above 46.03%. Each factor retained at least three items, with factor loadings greater than 0.3, commonalities greater than 0.2, and eigenvalues >1. Despite the study's limitations, the instrument demonstrated its applicability and potential in evaluating the perception and management of pain in PCDs.
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Affiliation(s)
- M.G. Tavares
- Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, DF, Brasil
| | - A.A. de Lima
- Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, DF, Brasil
| | - E.N. Lia
- Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, DF, Brasil
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Trudel SM, Winter EL, Fitzmaurice B, Norman G, Bray CR. Integration of physical health and sensory processing assessment for children with autism spectrum disorder in schools. PSYCHOLOGY IN THE SCHOOLS 2022. [DOI: 10.1002/pits.22704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Sierra M. Trudel
- Department of School Psychology University of Connecticut Storrs Connecticut USA
| | - Emily L. Winter
- Department of School Psychology University of Connecticut Storrs Connecticut USA
| | - Brenna Fitzmaurice
- Department of School Psychology University of Connecticut Storrs Connecticut USA
| | - Gina Norman
- Department of School Psychology University of Connecticut Storrs Connecticut USA
| | - Clark R. Bray
- Department of Mechanical Engineering University of Connecticut Storrs Connecticut USA
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Pizzinato A, Liguoro I, Pusiol A, Cogo P, Palese A, Vidal E. Detection and assessment of postoperative pain in children with cognitive impairment: A systematic literature review and meta-analysis. Eur J Pain 2022; 26:965-979. [PMID: 35271756 PMCID: PMC9311729 DOI: 10.1002/ejp.1936] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background and Objective Children with cognitive impairment (CI) are at risk of experiencing pain. Several specific pain rating scales have been developed to date. Thus, the aim of this meta‐analysis was to estimate the degree of reliability of different pain assessment scales for the postoperative pain in children with CI. Databases and Data Treatment PubMed, Scopus and Web of Science databases were approached: all studies validating and/or using pain assessment tool in children (0–20 years) with CI published in English from the 1st of January 2000 to the 1st of January 2022 were included. Only studies reporting the interclass correlation coefficient (ICC) to evaluate the concordance between caregivers’ and external researchers’ scores were eligible. Results Twelve studies were included (586 children with CI, 60% males; weighted mean age 9.9 years – range 2–20). Five of them evaluated the Non‐Communicating Children's Pain Checklist‐Postoperative Version (NCCPC‐PV) scale whereas four the original and revised Face, Legs, Activity, Cry, Consolability (FLACC) scale. The analysis showed an overall ICC value of 0.76 (0.74–0.78) for the NCCPC‐PV scale, with a high heterogeneity index (I2 = 97%) and 0.87 (0.84–0.90) for the FLACC scale, with a discrete I2 index (59%). Conclusions The NCCPC‐PV and FLACC pain rating scales showed the strongest evidence for validity and reliability for assessing postoperative pain in children with CI. However, due to the high heterogeneity of the studies available, these results should not be considered conclusive. Significance This review is focused on the assessment of pain in children with CI in the postoperative period. Simplified observation‐based pain assessment tools that rely on evaluating non‐verbal expressions of pain should be recommended for children with difficulties to communicate their feelings. Even if there is a high degree of heterogeneity in clinical presentations among youth with CI, two tools (NCCPC‐PV and FLACC) have emerged as reliable and valid in this population.
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Affiliation(s)
- A Pizzinato
- Department of Medicine (DAME), School of Nursing, University of Udine, Udine, Italy
| | - I Liguoro
- Department of Medicine (DAME), Division of Pediatrics, University of Udine, Udine, Italy
| | - A Pusiol
- Department of Medicine (DAME), Division of Pediatrics, University of Udine, Udine, Italy
| | - P Cogo
- Department of Medicine (DAME), Division of Pediatrics, University of Udine, Udine, Italy
| | - A Palese
- Department of Medicine (DAME), School of Nursing, University of Udine, Udine, Italy
| | - E Vidal
- Department of Medicine (DAME), Division of Pediatrics, University of Udine, Udine, Italy
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