Pediatric Pain and Neurodevelopmental Disorders: Implications for Research and Practice in Behavior Analysis
Always screen for pain before treating new or escalating problem behavior in kids with developmental disabilities—it may be driving the behavior.
01Research in Context
What this study did
McKeown et al. (2022) wrote a position paper. They say pain in kids with developmental disabilities is often missed.
The authors urge every behavior analyst to screen for pain before treating new or worsening problem behavior.
What they found
The paper does not give new data. It argues that hidden pain can mimic or worsen behaviors we try to treat.
If pain is driving the behavior, our ABA plans may fail until the hurt is found and eased.
How this fits with other research
Lloveras et al. (2022) zooms in on biting. They agree that pain or other aversive body events may spark self-injury when classic functional analyses show no social payoff.
Tager-Flusberg et al. (2016) and Case-Smith et al. (2015) supply tools—desensitization, eye-tracking, ERP—that can help non-verbal kids signal pain, turning the pain-screen idea into something you can actually do.
Levy et al. (2022), Jackson-Perry et al. (2025), and McComas et al. (2025) also wave reform flags. They spotlight racism and ableism instead of pain, yet the shared message is the same: check the hidden variable or your intervention may miss the mark.
Why it matters
Next time a client slumps, hits, or bites more than usual, pause the program. Run a quick pain check—look for red gums, ear tugging, or new absences. Use the desensitization tips from Tager-Flusberg et al. (2016) so the child lets you peek. Treating the ache first can spare weeks of useless behavior plans and needless escalation.
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02At a glance
03Original abstract
Individuals diagnosed with a neurodevelopmental disorder also are commonly diagnosed with a medical comorbidity. Because of this, it is estimated that this population experiences nearly twice the incidence of pain or discomfort as their neurotypical peers. Although behavior analysts consider the effect of biological variables on a client’s behavior, considerations of pain appear to be underdiscussed and understudied. The purpose of this article is to discuss how pain may interact with the efficacy of behavior analytic assessments and treatments, provide potential solutions to the barriers associated with pain states, and describe avenues to promote clinical research to improve our behavior analysis of pediatric pain while developing treatments for behavior problems such as aggression.
Perspectives on Behavior Science, 2022 · doi:10.1007/s40614-022-00347-w