Expression of pain in children with autism
Expression of pain in children with autism
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DOI：
10.1097/00002508-200403000-00005
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发表时间：
2004-03-01
影响因子：
2.9
通讯作者：
Craig, KD
中科院分区：
文献类型：
--
作者：
Nader, R;Oberlander, TF;Craig, KD
目的：据广泛报道，疼痛敏感性降低是自闭症儿童的一个共同特征，但这一结论往往是基于轶事观察和可疑的疼痛测量方法。该研究的目的是（1）使用疼痛和痛苦的客观观察测量来表征经历静脉穿刺的自闭症儿童的行为反应，（2）检查父母对自闭症儿童和非自闭症儿童疼痛行为的评估，包括比较父母报告与行为测量的关系，以及（3）比较接受静脉穿刺的自闭症儿童和非自闭症儿童的行为反应和父母评估。对 21 名自闭症儿童（3-7 岁）和 22 名正常儿童的静脉穿刺进行了录像、系统描述和比较，后者提供了按实际年龄和性别相当的对照组。家长提供疼痛的观察报告，面部活动被用作疼痛的客观行为测量。结果：自闭症儿童对静脉穿刺程序表现出明显的面部疼痛反应。父母对自闭症儿童疼痛的报告与观察到的疼痛反应之间缺乏一致性。自闭症儿童的行为反应总体上与对照组相似，但自闭症儿童静脉穿刺引起的明显面部疼痛反应超过了未受损的对照组儿童。自闭症组和对照组之间家长对疼痛严重程度的报告没有差异。对照组的家长报告和观察到的疼痛反应之间的一致性程度始终较好。讨论：研究结果表明，自闭症儿童对疼痛刺激表现出显着的行为反应，这些发现与迄今为止文献中描述的疼痛不敏感的普遍观点形成鲜明对比。研究结果还对家长全球报告作为自闭症儿童疼痛评估工具的适当性提出了质疑。
Objectives: Reduced pain sensitivity is widely reported to be a common feature of children with autism, yet this conclusion frequently has been based on anecdotal observations and questionable measures of pain. The aims of the study were to (1) characterize the behavioral response of children with autism experiencing a venepuncture using objective observational measures of pain and distress, (2) examine parents' assessments of pain behavior in children with and without autism, including comparison of the relationship of parental reports with behavioral measures, and (3) compare the behavioral reactions and parental assessments of children with autism with children without autism undergoing venepuncture.Methods: Pain reactions to the invasive procedure of venepuncture were videotaped, systematically described and compared in 21 children with autism (3-7 years old) and 22 nonimpaired children, the latter providing a chronological age and gender equivalent comparison group. Parents provided observer reports of pain, and facial activity was used as an objective behavioral measure of pain.Results: The children with autism displayed a significant facial pain reaction in response to the venepuncture procedure. There was a lack of concordance between parental reports of pain and observed pain responses for the children with autism. Behavioral responses of the children with autism were generally similar to the comparison group, except the substantial facial pain reactivity instigated by the venepuncture in the children with autism exceeded that displayed by the nonimpaired comparison children. Parent reports of pain severity did not differ between the autism and comparison groups. The degree of concordance between parental report and observed pain responses was consistently better for the comparison group.Discussion: The findings demonstrate that children with autism display a significant behavioral reaction in response to a painful stimulus, and these findings are in sharp contrast to the prevailing beliefs of pain insensitivity described in the literature to date. The findings also raise questions about the appropriateness of parental global report as an assessment tool for pain in children with autism.