Pain Assessment of Children with Autism Spectrum Disorders.

OBJECTIVE Pain assessment of individuals with autism spectrum disorder (ASD) is largely unexplored. The core deficits of ASD may interfere with this population's ability to effectively use traditional pain assessment tools. Accurate pain assessment is essential to providing quality care. The objective was to illuminate barriers to pain assessment in children with an ASD, describe novel methods to communicate about their pain experience, and identify vocabularies that hold meaning with respect to pain to better understand pain from their context. METHODS Qualitative descriptive study using semistructured interviews including interactive electronic technology to enhance communication. Subjects included children aged 6 to 17 years with ASD experiencing acute pain after a surgical procedure at a large urban tertiary children's hospital. RESULTS Based on the analysis of 40 interviews, participants consisted of 34 (85%) male, 29 (72.5%) non-Hispanic white with mean age 11.75 ± 3.36 years (range: 6-17). All subjects were able to describe and locate their pain but required a variety of approaches. Assessment preferences included minimal time spent focusing on pain and simplistic language and actions using terms familiar to each subject. Notably, subjects were able to reliably demonstrate understanding of graded response and seriation. Parent involvement was essential, both in helping interpret the child's needs and providing trusted support. CONCLUSIONS Some children with ASD require an alternate interactive approach to pain assessment. Individualized consideration and estimation of pain assessment methods for use in this population may provide more meaningful interactions, ultimately guiding better pain management interventions.