Acute pain experience in individuals with autism spectrum disorders: a review.
Autistic people are not pain-proof—lab and hospital data show normal or heightened pain even when parents report under-reaction.
01Research in Context
What this study did
The author gathered every paper that had looked at pain in people with autism. The search pulled in parent reports, doctor notes, lab tests, and hospital charts.
No new kids were tested. Instead, the team compared what different studies said about how autistic people feel pain.
What they found
Parents often said their child did not seem to feel pain. Yet lab studies and hospital records showed normal or even stronger pain reactions.
No clear pattern of high or low pain sensitivity appeared across all studies. The review says we cannot assume autistic people are pain-insensitive.
How this fits with other research
Cascio et al. (2008) ran a lab test and found autistic adults felt heat pain sooner than controls. This matches the review’s point that lab data show normal or heightened pain.
Matson et al. (2008) watched kids during blood draws. Observers rated pain higher when kids showed more face grimaces, not when they knew the child had autism. This supports the review’s warning that stereotypes can mislead.
Fründt et al. (2017) used standardized touch tests and found no broad threshold differences, echoing the review’s conclusion that pain sense is not globally altered.
Kovačič et al. (2020) found autistic teens with appendicitis had twice the perforation rate, showing that missed pain signals can hurt real outcomes. This clinical study backs the review’s call to treat pain reports seriously.
Why it matters
When a child with autism bumps his head and stays quiet, do not assume he is fine. Ask, watch, and scan like you would for any kid. Use face scales, check vital signs, and believe parent concerns even if the child looks calm. Teaching this rule to staff can catch injuries early and avoid the serious delays seen in appendicitis cases.
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02At a glance
03Original abstract
In addition to the diagnostic criteria for autism spectrum disorder, a number of clinically important comorbid complaints, including sensory abnormalities, are also discussed. One difference often noted in these accounts is hyposensitivity to pain; however, evidence for this is limited. The purpose of the current review therefore was to examine sensitivity to pain of individuals with autism spectrum disorder. This review is interested in reports which consider differences in subjective experience of pain (i.e. different pain thresholds) and differences in behavioural response to pain (i.e. signs of pain-related distress). Studies were included if they were conducted with human subjects, included a clearly diagnosed autism spectrum disorder population and reported data pertaining to pain experience relative to the neurotypical population. Studies were classified as being self/parent report, clinical observations, observations of response to medical procedures or experimental examination of pain. Both self/parent report and clinical observations appeared to report hyposensitivity to pain, whereas observations of medical procedures and experimental manipulation suggested normal or hypersensitive responses to pain. This review suggests that contrary to classical reports, individuals with autism spectrum disorder do not appear to have systematically altered pain responses or thresholds. More systematic experimental examination of this area is needed to understand responses to pain of individuals with autism spectrum disorder.
Autism : the international journal of research and practice, 2015 · doi:10.1177/1362361314527839