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In Children with Autism, Nonverbal Signs of Pain Predict Sleep Problems

Researchers urge more attention to signs of chronic pain; flag need to address underlying issues to improve sleep in children with ASD
February 06, 2014


Behavioral signs of pain are both extremely common and closely linked to disturbed sleep in children with autism, according to a new study published online in the journal Autism.

The investigators, from New York’s Stony Brook University, urge doctors and behavioral therapists to give more attention to assessing and treating pain and sleep problems in individuals with autism spectrum disorder (ASD).

The researchers used online postings to recruit 62 mothers of children with autism as study participants. Fourteen of the children were nonverbal, partially verbal or using assisted-communication devices. The rest were fully verbal.

All the mothers filled out a standard assessment of pain-related behaviors for populations with communication difficulties. This scored the frequency of behaviors such as seeking comfort, frowning, whining or holding a part of the body such as the stomach. More than 90 percent of the sample scored above the test level that flags a high possibility of chronic pain (7 or more on a scale of 49).

The mothers also completed a standard measure of their children’s sleep habits. Ninety-three percent scored above the level indicating chronic sleep problems (41 or higher on a scale of 99).

When comparing the results of the two questionnaires, the researchers found a direct relationship between higher scores for pain-related behavior and disrupted sleep.

“While it's no surprise to parents or astute clinicians that sleep problems may relate to underlying pain, this study helps demonstrate a strong connection in children with autism,” comments developmental pediatrician Paul Wang, Autism Speaks senior vice president for medical research. “It also helps point us in the direction that research needs to go.” Such research, he says, should evaluate how often painful underlying conditions occur. At the same time, autism specialists need to develop appropriate medical evaluations for identifying these conditions in children who can’t always describe their pain.

“Families and physicians who encounter these situations should look for ear infections, dental problems, GI conditions, skin conditions and other possible causes of pain or discomfort,” Dr. Wang adds.

The Stony Brook researchers noted a number of important limitations to their study. The information they gathered relied on parents’ recall of their children’s behavior. The study lacked a comparison group of children not affected by autism. Also, behavioral signs of pain and discomfort likely overlap with those of emotional distress and frustration, they acknowledge. The latter are also common among children who have difficulty communicating.