The assessment of pain and discomfort in individuals with mental retardation.
A one-page facial checklist called PADS spikes during dental cleaning, proving it spots pain in adults who can’t say ouch.
01Research in Context
What this study did
The team watched adults with intellectual disability during a dental cleaning.
They used the PADS scale, a short checklist of face, voice, and body cues.
Scores were tracked while the hygienist scraped teeth, a known painful moment.
What they found
PADS numbers jumped when the scaling began and dropped when it stopped.
The quick rise shows the tool senses real-time pain in nonverbal clients.
How this fits with other research
Matson et al. (2008) saw the same pattern in autistic kids getting blood draws.
Observers again trusted facial cues, not myths about autism and pain.
Moore (2015) later pooled many studies and found no proof that ASD blunts pain.
Together these papers warn: don’t assume anyone with DD feels less pain.
Sabater-Gárriz et al. (2025) now want to automate this idea with an AI phone app that reads faces for clients with cerebral palsy.
Why it matters
You can add PADS, or any quick facial-voice checklist, to your intake kit.
Use it before, during, and after any procedure—dental, shot, or wound care.
If the score climbs, pause and give comfort or pain meds.
One page, one minute, and your nonverbal client finally has a voice.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Print the PADS items, watch your client’s face during the next procedure, and stop if the score jumps.
02At a glance
03Original abstract
This research was conducted to replicate and expanded the work of Bodfish et al. [Bodfish, J. W., Harper, V. N., Deacon, J. R., & Symons, F. J. (2001, May). Identifying and measuring pain in persons with developmental disabilities: A manual for the Pain and Discomfort Scale (PADS). Western Carolina Center Research Reports] by assessing the functional sensitivity of the Pain and Discomfort Scale (PADS) in patients with MR. We used the PADS to detect pain and discomfort during a dental scaling and polishing procedure. Subjects (N=28) with cognitive and communication deficits were assessed at multiple baselines, during and after the procedure. The results indicated that scores on the PADS were significantly higher during the scaling procedure than during all other observations quantified by the PADS. We conclude that the PADS is a functionally sensitive measure that may lack specificity, but that may also represent the state of the psychometric art of assessing pain in patients who have MR.
Research in developmental disabilities, 2005 · doi:10.1016/j.ridd.2004.10.001