Highlights
- •Anecdotal reports indicate that children with autism do not feel pain.
- •Children's thermal thresholds for warmth and cool detection and heat and cold pain were tested.
- •Children with autism had lower thresholds for cool and warmth detection.
- •Warmth, cool, and heat pain perceptions were related to intelligence.
- •Reduced thermal sensitivity may reflect lack of awareness or attention.
Abstract
Social communication deficits and repetitive behaviors are established characteristics
of autism spectrum disorder (ASD) and the focus of considerable study. Alterations
in pain sensitivity have been widely noted clinically but remain understudied and
poorly understood. The ASD population may be at greater risk for having their pain
undermanaged, especially in children with impaired cognitive ability and limited language
skills, which may affect their ability to express pain. Given that sensitivity to
noxious stimuli in adolescents with ASD has not been systematically assessed, here
we measured warm and cool detection thresholds and heat and cold pain thresholds in
20 high-functioning adolescents with ASD and 55 typically developing adolescents using
a method-of-limits quantitative sensory testing protocol. Adolescents with ASD had
a loss of sensory function for thermal detection (P < .001, both warm and cool detection thresholds) but not pain threshold (P > .05, both heat and cold pain thresholds) in comparison to controls, with no evidence
for significant age or sex effects (P > .05). Intelligence quotients and symptomatology were significantly correlated with
a loss of some types of thermal perception in the ASD population (ie, warm detection
threshold, cool detection threshold, and heat pain threshold; P < .05). Decreased thermal sensitivity in adolescents with ASD may be associated with
cognitive impairments relating to attentional deficits. Our findings are consistent
with previous literature indicating an association between thermal perception and
cortical thickness in brain regions involved in somatosensation, cognition, and salience
detection. Further brain-imaging research is needed to determine the neural mechanisms
underlying thermal perceptual deficits in adolescents with ASD.
Perspective
We report quantitative evidence for altered thermal thresholds in adolescents with
ASD. Reduced sensitivity to warmth, coolness, and heat pain was related to impaired
cognitive ability. Caregivers and clinicians should consider cognitive ability when
assessing and managing pain in adolescents with ASD.
Key words
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References
- Diagnostic and Statistical Manual of Mental Disorders.5th ed. American Psychiatric Publishing, Arlington, VA2013
- Autism during infancy: A retrospective video analysis of sensory-motor and social behaviors at 9-12 months of age.J Autism Dev Disord. 1999; 29: 213-224
- Sensory Experiences Questionnaire: Discriminating sensory features in young children with autism, developmental delays, and typical development.J Child Psychol Psychiatry. 2006; 47: 591-601
- Sensory clusters of toddlers with autism spectrum disorders: Differences in affective symptoms.J Child Psychol Psychiatry. 2008; 49: 817-825
- Tactile sensitivity in Asperger syndrome.Brain Cogn. 2006; 61: 5-13
- Tactile perception in adults with autism: A multidimensional psychophysical study.J Autism Dev Disord. 2008; 38: 127-137
- Autism: Processing of novel auditory information assessed by event-related brain potentials.Electroencephalogr Clin Neurophysiol. 1984; 59: 238-248
- The thermal grill illusion: Unmasking the burn of cold pain.Science. 1994; 265: 252-255
- Coding of incremental changes in skin temperature by single warm fibers in the monkey.J Neurophysiol. 1979; 42: 1316-1331
- Warm fibers innervating palmar and digital skin of the monkey: Responses to thermal stimuli.J Neurophysiol. 1979; 42: 1297-1315
- Cold-induced pain and prickle in the glabrous and hairy skin.Pain. 1998; 75: 47-57
- Reaction times and intelligence differences: A population-based cohort study.Intelligence. 2001; 29: 389-399
- Self-injurious behaviours are associated with alterations in the somatosensory system in children with autism spectrum disorder.Brain Struct Funct. 2014; 219: 1251-1261
- Neural underpinnings of behavioural strategies that prioritize either cognitive task performance or pain.Pain. 2013; 154: 2060-2071
- Children with cognitive impairment: Parent report of pain and coping.J Dev Behav Pediatr. 1999; 20: 228-234
- Thermal sensibility changes during ischemic nerve block.Pain. 1984; 20: 355-361
- Cortical thickness and pain sensitivity in zen meditators.Emotion. 2010; 10: 43-53
- Nociceptors and warm receptors innervated by C fibres in human skin.J Neurol Neurosurg Psychiatry. 1982; 45: 313-319
- Reproducibility and influence of test modality order on thermal perception and thermal pain thresholds in quantitative sensory testing.Clin Neurophysiol. 2010; 121: 1878-1885
- Quantitative sensory testing of thermal and vibratory perception in familial dysautonomia.Clin Auton Res. 2000; 10: 177-183
- Quantitative thermal perception testing in adults.J Clin Neurophysiol. 1999; 16: 462-471
- Development of somatosensory perception in children: A longitudinal QST-study.Neuropediatrics. 2012; 43: 10-16
- Coding of incremental changes in skin temperature by a population of warm fibers in the monkey: Correlation with intensity discrimination in man.J Neurophysiol. 1979; 42: 1332-1353
- Auditory event-related brain potentials in autistic-children and 3 different control-groups.Biol Psychiatry. 1995; 38: 150-165
- Sensory neuropathy and signs of central sensitization in patients with peripheral arterial disease.Pain. 2006; 124: 190-200
- The Diagnostic Interview for Social and Communication Disorders: Algorithms for ICD-10 childhood autism and Wing and Gould autistic spectrum disorder.J Child Psychol Psychiatry. 2002; 43: 327-342
- Describing the sensory abnormalities of children and adults with autism.J Autism Dev Disord. 2007; 37: 894-910
- Influence of aging on thermal and vibratory thresholds of quantitative sensory testing.J Peripher Nerv Syst. 2005; 10: 269-281
- Sensory and attention abnormalities in autistic spectrum disorders.Autism. 2006; 10: 155-172
- The Autism Diagnostic Observation Schedule–Generic: A standard measure of social and communication deficits associated with the spectrum of autism.J Autism Dev Disord. 2000; 30: 205-223
- Comparison of perception threshold testing and thermal-vibratory testing.Muscle Nerve. 2008; 37: 514-517
- Fibre function and perception during cutaneous nerve block.J Neurol Neurosurg Psychiatry. 1975; 38: 865-873
- Infant distress during immunization: A multimethod assessment.J Clin Psychol Med Settings. 2003; 10: 231-238
McGrath PA, Brown SC, Crawford EJ, Mincic A, Davis KD: Quantitative sensory testing in healthy adolescents reveals sex differences. World Congress on Pain, International Association for the Study of Pain. 2008
- Quantitative assessment of cutaneous thermal and vibration sensation and thermal pain detection thresholds in healthy children and adolescents.Muscle Nerve. 2001; 24: 1339-1345
- Repetitive behaviors in autistic disorder.Eur Child Adolesc Psychiatry. 2002; 11: 210-218
- Acute pain experience in individuals with autism spectrum disorders: A review.Autism. 2014;
- Expression of pain in children with autism.Clin J Pain. 2004; 20: 88-97
- CSF beta-endorphin levels in patients with infantile autism.J Autism Dev Disord. 1997; 27: 155-163
- Quantitative sensory testing in patients with polyneuropathy and healthy individuals.Acta Neurol Scand Suppl. 2008; 188: 56-61
- The modulation of sensory input and motor output in autistic children.J Autism Child Schizophr. 1974; 4: 197-215
- Thermal perception thresholds recorded using method of limits change over brief time intervals.Somatosens Mot Res. 2005; 22: 327-334
- Comparison of thermal threshold tests to assess small nerve fiber function: Limits vs. levels.Clin Neurophysiol. 2003; 114: 556-563
- Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Standardized protocol and reference values.Pain. 2006; 123: 231-243
- Quantitative sensory testing: A comprehensive protocol for clinical trials.Eur J Pain. 2006; 10: 77-88
- Paradoxical heat sensation in healthy subjects: Peripherally conducted by A delta or C fibres?.Brain. 1999; 122: 239-246
- Pain reactivity and plasma beta-endorphin in children and adolescents with autistic disorder.PLoS One. 2009; 4: e5289
- Parent and child anxiety sensitivity: Relationship to children's experimental pain responsivity.J Pain. 2006; 7: 319-326
- Quantitative somatosensory thermotest. A key method for functional evaluation of small calibre afferent channels.Brain. 1992; 115: 893-913
- Central suppression of cold-induced C fibre pain by myelinated fibre input.Pain. 1989; 38: 313-319
- The Diagnostic Interview for Social and Communication Disorders: Background, inter-rater reliability and clinical use.J Child Psychol Psychiatry. 2002; 43: 307-325
- Release of cold-induced burning pain by block of cold-specific afferent input.Brain. 1990; 113: 893-902
- Warm and cold specific somatosensory systems. Psychophysical thresholds, reaction times and peripheral conduction velocities.Brain. 1991; 114: 1819-1826
- Heat pain thresholds: Normative data and repeatability.Pain. 1995; 60: 329-332
- Quantitative sensory testing in children with migraine: Preliminary evidence for enhanced sensitivity to painful stimuli especially in girls.Pain. 2006; 123: 10-18
Article info
Publication history
Published online: February 20, 2015
Accepted:
February 4,
2015
Received in revised form:
January 21,
2015
Received:
August 29,
2014
Footnotes
Funding for this work was provided by the Hospital for Sick Children (EGD) and the Canadian Institutes of Health Research New Emerging Team Grant (CIHR; P.A.M. and K.D.D.). P.A.M. is the founder and an employee of Pain Innovations, Inc, London, Ontario. None of the other authors have any conflicts of interest to disclose.
Identification
Copyright
© 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
