What is Hyper or hyposensitivity? Do children with ASD suffer from hyper or hyposensitivity? How to detect it? How can we help them? The following article attempts to resolve these doubts.

Many parents and professionals who work with children and adolescents with Autism Spectrum Disorders (ASD) have observed the experience of irregular responses of a good part of children with ASD to painful stimuli, generally expressed as lower sensitivity (hyposensitivity) to pain. , although hypersensitivity is also possible. The DSM-5 includes within group B referring to restrictive and repetitive patterns of behavior a criterion that indicates:

Hyper- or hypo-reactivity to sensory stimuli or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse responses to specific sounds or textures, excessive sniffing or palpation of objects, visual fascination with lights or the environment). motion.

In this article it refers only to physical pain and hyposensitivity to pain, given the risks that not being able to express their painful experience entails for the child with non-verbal ASD.

WHAT IS PAIN?

Pain is the integration of a series of physical perceptions that warn the person of the risk of “physical harm” or that this “harm” has already occurred. Not all of us perceive pain in the same way, because in addition to the physical experience, this perception is accompanied by a series of emotional elements that can vary the response. That is to say, pain is an unpleasant sensitive and emotional experience associated with a present or possible injury (Kandel E et al, 2000). Here we can see the first point, because the definition refers to the “integration of a series of perceptions” and we know that sensory integration-perception presents its irregularities, problems or differences within the population with ASD.

This pain can be acute or chronic. Acute pain is a reflection of an injury that activates immediate protective mechanisms, it has that meaning: to protect us. Now, chronic pain is meaningless, it is simply the persistent experience over time of the result of an injury or of physiological mechanisms that have been altered as a result of that injury.

HOW DO WE PERCEIVE PAIN?

Pain is a complex perception. To simplify this complex mechanism we will resort to a scheme, without going into the complex neural mechanisms that provide the substrate for the sensation-perception of pain.

• Nociceptors receive information and trigger an immediate protective response that is reflex.
• Subsequently, the pain is localized and there is a general alert response in the individual who is already fully aware of the felt and perceived stimulus. Pain is a sensory and emotional experience at the same time.
• Behavioral changes then occur.
• Analgesia is sought and is achieved, to different degrees, through various mechanisms.

WHAT ALTERATIONS ARE OBSERVED IN CHILDREN WITH ASD IN RELATION TO PAIN?

The point of concern is hyposensitivity to pain and the consequent risk of suffering significant injuries without warnings that allow us to detect them. But another point is also important: hyposensitivity does not mean that it does not hurt, it literally means that it hurts less. The following graph seeks to consolidate information regarding changes related to the perception of pain in children with ASD:

To complete this point I want to note some general ideas for reflection:

• Children inevitably experience pain as part of their daily lives and often depend on their caregivers to relieve that pain. It is important, then, that caregivers are able to recognize expressions of pain and provide measures to alleviate it. In the case of children with communication difficulties this can be very difficult. Language limitations in this population may contribute to limitations in communicating “their pain” to others (Messmer RL, 2008).
• Facial activity or variations in facial expression are presented as the most important indicator for judging pain. Many of the mechanisms for dealing with pain are related to changes in behavior, among which changes in facial expression turn out to be frequent and very important.
• We found little written about pain in children with ASD in all the literature related to pain. Their difficulties in communication can lead to two problems: their pain not being recognized and their pain going untreated (Alley CS, 2013).

PRECAUTIONS WE SHOULD TAKE

Hyposensitivity to pain does not imply that it is not felt or that it is not harmful, as we have already mentioned in the previous apparatus. We all have to be alert:

1. The sensation of pain occurs in children with ASD, but its interpretation may be different. This implies the need to look for mechanisms to avoid, minimize and relieve pain.
2. Although they respond little to pain, the possibility of physical damage exists and must be prevented.
3. They may learn inappropriate mechanisms seeking to provoke pain as a form of internal regulation in the face of excessive or very demanding stimuli.

How much can it hurt them? Measuring the degree of pain perception is complex, especially in children with ASD who are non-verbal. A primary response that we should be aware of is crying, however, it does not always occur. Various scales have been developed whose validation has been achieved in a variety of groups (non-verbal children, with physical or intellectual disabilities, etc.) which can be used at a certain time.

Finally, it is recommended to be attentive to facial expressions because they may be our only indication of the perception of a painful stimulus.

BIBLIOGRAPHY:

1. Allely CS. Pain sensitivity and observer perception of pain in individuals with Autistic Spectrum Disorder. The scientific World Journal 2013.
2. Kandel ER, Schwarts JH, Jessel T. Principles of Neuroscience, IV edition. McGraw Hill Editorial Interamericana de España, SA, 2001.
3. Messmer RL, Nader R, Craig KD. Brief report: judging pain intensity in children with autism undergoing venipuncture. Journal of Autism and Developmental Disorders 2008; 38: 1391-1394.
4. Prkarchin KM. Assessin pain by facial expression: facial expression as nexus. Pain Red Management 2009; 14(1): 53-58.

Text edited by Mariona Alsedà Florensa from the Autismo Diario page and Carlos Orellana