Does format matter for comprehension of a facial affective scale and a numeric scale for pain by adults with Down syndrome?
Face pain scales beat number scales for adults with Down syndrome, and asking them to order numbers drops their accuracy to near-guess levels.
01Research in Context
What this study did
The team asked adults with Down syndrome to use two pain scales. One scale showed faces from smile to grimace. The other used numbers 0-10.
Each adult tried both scales. Then they answered extra tasks about putting numbers in order and picking the bigger number.
What they found
The face scale was much easier. When adults had to order or judge number size, correct answers on the number scale dropped to about one in three. Face-scale scores stayed steady.
Adding math steps hurt number-scale use but did not hurt face-scale use.
How this fits with other research
Brankaer et al. (2011) saw the same math trouble in kids with mild ID. They also found that linking digits to quantities is hard for people with ID.
Sasson et al. (2018) showed that teens with Down syndrome struggle to read angry faces. Together these studies say: faces can work, but both number sense and some emotion reading are weak spots.
Hippolyte et al. (2009) found sad-face recognition is hard for adults with Down syndrome. The new study flips the picture: even if reading emotions is tough, reading pain-faces is still easier than reading numbers.
Why it matters
Pick face-based pain tools for adults with Down syndrome. Skip the 0-10 numbers unless you have time to teach size and order. A simple row of faces gives quicker, more reliable pain reports in clinics or day programs.
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02At a glance
03Original abstract
People with intellectual disabilities are at high risk for pain and have communication difficulties. Facial and numeric scales for self-report may aid pain identification. It was examined whether the comprehension of a facial affective scale and a numeric scale for pain in adults with Down syndrome (DS) varies with presentation format. Adults with DS were included (N=106, mild to severe ID, mean age 37 years), both with (N=57) and without (N=49) physical conditions that may cause pain or discomfort. The Facial Affect Scale (FAS) and a numeric rating scale (NRS) were compared. One subgroup of participants (N=50) had to choose the two items within each format to indicate 'least pain' and 'most pain'. The other subgroup of participants (N=56) had to order three faces of the FAS from 'least pain' to 'most pain', and to answer questions about the magnitude of numbers for the NRS. Comprehension percentages were compared between two subgroups. More participants understood the FAS than the NRS, irrespective of the presentation format. The comprehension percentage for the FAS did not differ between the least-most extremities format and the ordering/magnitude format. In contrast, comprehension percentages for the NRS differed significantly between the least-most extremities format (61%) and the ordering/magnitude format (32%). The inclusion of ordering and magnitude in a presentation format is essential to assess thorough comprehension of facial and numeric scales for self-reported pain. The use of this format does not influence the number of adults with DS who pass the comprehension test for the FAS, but reduces the number of adults with DS who pass the comprehension test for the NRS.
Research in developmental disabilities, 2013 · doi:10.1016/j.ridd.2013.07.016