National Prevalence of Pain Among Children and Adolescents With Autism Spectrum Disorders | Adolescent Medicine | JAMA Pediatrics | JAMA Network
[Skip to Navigation]
Table 1.  Characteristics of Participants With and Without Autism Spectrum Disorders (ASDs)
Characteristics of Participants With and Without Autism Spectrum Disorders (ASDs)
Table 2.  Odds of Pain Among Participants With and Without Autism Spectrum Disorders (ASDs)
Odds of Pain Among Participants With and Without Autism Spectrum Disorders (ASDs)
1.
Global Burden of Disease Study 2013 Collaborators.  Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.  Lancet. 2015;386(9995):743-800. doi:10.1016/S0140-6736(15)60692-4PubMedGoogle ScholarCrossref
2.
Noel  M, Groenewald  CB, Beals-Erickson  SE, Gebert  JT, Palermo  TM.  Chronic pain in adolescence and internalizing mental health disorders: a nationally representative study.  Pain. 2016;157(6):1333-1338. doi:10.1097/j.pain.0000000000000522PubMedGoogle ScholarCrossref
3.
Allely  CS.  Pain sensitivity and observer perception of pain in individuals with autistic spectrum disorder.  ScientificWorldJournal. 2013;2013:916178. doi:10.1155/2013/916178PubMedGoogle Scholar
4.
Yasuda  Y, Hashimoto  R, Nakae  A,  et al.  Sensory cognitive abnormalities of pain in autism spectrum disorder: a case-control study.  Ann Gen Psychiatry. 2016;15:8. doi:10.1186/s12991-016-0095-1PubMedGoogle ScholarCrossref
5.
Tudor  ME, Walsh  CE, Mulder  EC, Lerner  MD.  Pain as a predictor of sleep problems in youth with autism spectrum disorders.  Autism. 2015;19(3):292-300. doi:10.1177/1362361313518994PubMedGoogle ScholarCrossref
6.
National Survey of Children’s Health (2016-2017). Data Resource Center for Child & Adolescent Health. https://www.childhealthdata.org/browse/survey. Accessed September 17, 2019.
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    Research Letter
    October 28, 2019

    National Prevalence of Pain Among Children and Adolescents With Autism Spectrum Disorders

    Author Affiliations
    • 1Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor
    JAMA Pediatr. 2019;173(12):1203-1205. doi:10.1001/jamapediatrics.2019.3826

    Pain is a leading contributor to the global morbidity and disability burden.1 Pediatric pain is especially problematic, as it may impede healthful development into and throughout adulthood.2 For children with autism spectrum disorders (ASD), pain is a highly understudied area, perhaps owing to the misguided historical impression that children with ASD have lower pain sensitivity.3 However, recent evidence has contradicted this perspective4 and indicates that pain may be implicated in pathogenesis of poor health outcomes in children with ASD.5 Therefore, this study sought to provide recent national estimates of the prevalence of pain among children and adolescents with ASD.

    Methods

    Data came from the 2016-2017 National Survey of Children’s Health, a nationally representative, parent-proxy survey of US children.6 The overall weighted response rate was 40.7% for 2016 and 37.4% for 2017. Institutional review board approval for this study was waived because data are publicly available and deidentified.

    Respondents answered the prompts, “Has a doctor or other health care provider EVER told you that this child has…” and “Has a doctor, other health care provider, or educator EVER told you that this child has…” ASD or a developmental comorbidity? If yes, respondents answered the prompt, “If yes, does this child CURRENTLY have the condition?” Autism spectrum disorder was considered if the respondent reported yes to the second prompt. A developmental comorbidity was considered if the respondent reported yes to the second prompt for cerebral palsy, epilepsy or seizure disorder, or intellectual disability. Respondents answered the prompt, “During the past 12 months, has this child had FREQUENT or CHRONIC difficulty with any of the following? Repeated or chronic physical pain, including headaches or other back or body pain.” Pain was considered if the respondent reported yes.

    Weighted prevalence estimates for children (aged 6-17 years) without ASD, with ASD, and with ASD and at least 1 developmental comorbidity were calculated using SAS, version 9.4 (SAS Institute). Logistic regression models were developed with pain as the outcome and group as the primary exposure. All P values were 2-tailed, and statistical significance was set at a P value less than .05.

    Results

    Data were missing on ASD, comorbidities, or pain for 1093 of 51 156 children (2.1%) and were excluded from analysis. Characteristics of children without ASD (48 591 [97.1%]), with ASD (1158 [2.3%]), and with ASD and at least 1 developmental comorbidity (314 [0.6%]) are presented in Table 1.

    The prevalence (weighted estimates) of pain was 8.2% for children without ASD, 15.6% for children with ASD, and 19.9% for children with ASD and at least 1 developmental comorbidity. Compared with children without ASD, the unadjusted odds of pain were higher for children with ASD (odds ratio [OR], 2.08; 95% CI, 1.11-3.90) and ASD and at least 1 developmental comorbidity (OR, 2.80; 95% CI, 1.55-5.07). After adjusting for age, sex, race, and household poverty status, the odds of pain increased for children with ASD (OR, 2.19; 95% CI, 1.19-4.03) and ASD and at least 1 developmental comorbidity (OR, 2.96; 95% CI, 1.65-5.32) (Table 2).

    Discussion

    The principal finding was that in a nationally representative sample from the United States, children with ASD had an elevated prevalence of pain compared with children without ASD. This disparity was more pronounced among children with ASD who had developmental comorbidities. These findings may be due to several factors, including underlying sensory sensitivities, comorbidity of conditions associated with pain (eg, cerebral palsy, genetic syndromes impacting gastrointestinal and other systems), and, by extension, a higher frequency of medical procedures that can lead to short-term or long-term pain. Study findings suggest the need for improved awareness and modalities for pain assessment as well as incorporating pain management as part of regular therapy for children with ASD. Future studies are needed to determine pain characteristics (eg, location) and if pain is implicated in short-term (eg, activity interference) or long-term (eg, noncommunicable diseases) adverse health outcomes for this population.

    Back to top
    Article Information

    Corresponding Author: Daniel G. Whitney, PhD, Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, 325 E Eisenhower Pkwy, Ann Arbor, MI 48108 (dgwhit@umich.edu).

    Accepted for Publication: April 25, 2019.

    Published Online: October 28, 2019. doi:10.1001/jamapediatrics.2019.3826

    Correction: This article was corrected on December 30, 2019, to fix an error in the Results section.

    Author Contributions: Dr Whitney had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Both authors.

    Acquisition, analysis, or interpretation of data: Both authors.

    Drafting of the manuscript: Whitney.

    Critical revision of the manuscript for important intellectual content: Both authors.

    Statistical analysis: Whitney.

    Supervision: Shapiro.

    Conflict of Interest Disclosures: Dr Whitney was supported by the University of Michigan Advanced Rehabilitation Research Training Program in Community Living and Participation from the National Institute on Disability, Independent Living, and Rehabilitation Research (grant 90AR5020-0200). No other disclosures were reported.

    References
    1.
    Global Burden of Disease Study 2013 Collaborators.  Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.  Lancet. 2015;386(9995):743-800. doi:10.1016/S0140-6736(15)60692-4PubMedGoogle ScholarCrossref
    2.
    Noel  M, Groenewald  CB, Beals-Erickson  SE, Gebert  JT, Palermo  TM.  Chronic pain in adolescence and internalizing mental health disorders: a nationally representative study.  Pain. 2016;157(6):1333-1338. doi:10.1097/j.pain.0000000000000522PubMedGoogle ScholarCrossref
    3.
    Allely  CS.  Pain sensitivity and observer perception of pain in individuals with autistic spectrum disorder.  ScientificWorldJournal. 2013;2013:916178. doi:10.1155/2013/916178PubMedGoogle Scholar
    4.
    Yasuda  Y, Hashimoto  R, Nakae  A,  et al.  Sensory cognitive abnormalities of pain in autism spectrum disorder: a case-control study.  Ann Gen Psychiatry. 2016;15:8. doi:10.1186/s12991-016-0095-1PubMedGoogle ScholarCrossref
    5.
    Tudor  ME, Walsh  CE, Mulder  EC, Lerner  MD.  Pain as a predictor of sleep problems in youth with autism spectrum disorders.  Autism. 2015;19(3):292-300. doi:10.1177/1362361313518994PubMedGoogle ScholarCrossref
    6.
    National Survey of Children’s Health (2016-2017). Data Resource Center for Child & Adolescent Health. https://www.childhealthdata.org/browse/survey. Accessed September 17, 2019.
    ×