Brief report: judging pain intensity in children with autism undergoing venepuncture: the influence of facial activity.
Watch facial activity, not the autism label, when you judge pain.
01Research in Context
What this study did
Doctors watched short clips of kids with autism getting blood drawn.
They rated how much pain each child felt.
The study told half the doctors that autistic kids feel less pain.
Then they checked if the tip changed scores.
What they found
Doctors used the child’s face to judge pain.
More face movement meant higher pain scores.
The autism label did not move the numbers at all.
How this fits with other research
Moore (2015) looked at many pain studies.
Parent reports say autistic kids feel less pain.
Lab and hospital tests show normal or more pain.
Matson et al. (2008) fits the lab side: faces told the truth, not the stereotype.
Mosalmannejad et al. (2025) moved the idea forward.
They found adults who can’t name feelings read pain faces poorly.
The two papers together say: watch the face, but check for alexithymia if ratings seem off.
Why it matters
During shots, dental work, or ABA sessions, look at the child’s face.
Do not lower your pain guess just because the client has autism.
If you know the learner has alexithymia, ask a second staff member to rate the face too.
This keeps you from under-medicating or pushing too hard in therapy.
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02At a glance
03Original abstract
The biasing effect of pain sensitivity information and the impact of facial activity on observers' judgements of pain intensity of children with autism were examined. Observers received information that pain experience in children with autism is either the same as, more intense than, or less intense than children without autism. After viewing six video clips of children with autism undergoing venepuncture, observers estimated pain intensity using a visual analogue scale. Facial activity as coded by Chambers et al. (Child Facial Action Coding System Revised Manual, 1996) had a significant impact on observers' estimates of pain intensity; pain sensitivity information did not. These results have important implications for the assessment and management of pain in children with autism.
Journal of autism and developmental disorders, 2008 · doi:10.1007/s10803-007-0511-0