CHRU Montpellier, Centre de Ressources Autisme, Département Universitaire de Pédopsychiatrie, Montpellier, France Université Montpellier, Laboratoire Epsylon EA 4556, Montpellier, France Université de Brest Occidentale, EPS EA 4686, Brest, France Hôpital Ste Marguerite, Centre de Ressources Autisme, Service de Pédopsychiatrie, Marseille, France.
Pain. 2013 Oct;154(10):2007-2013. doi: 10.1016/j.pain.2013.06.011.
There is a lack of knowledge about pain reactions in children with autism spectrum disorders (ASD), who have often been considered as insensitive to pain. The objective of this study was to describe the facial, behavioral and physiological reactions of children with ASD during venipuncture and to compare them to the reactions of children with an intellectual disability and nonimpaired control children. We also examined the relation between developmental age and pain reactions. The sample included 35 children with ASD, 32 children with an intellectual disability, and 36 nonimpaired children. The children were videotaped during venipuncture and their heart rate was recorded. Facial reactions were assessed using the Child Facial Coding System (CFCS) and behavioral reactions were scored using the Noncommunicating Children's Pain Checklist (NCCPC). A linear mixed-effects model showed that children's reactions increased between baseline and venipuncture and decreased between the end of venipuncture and the recovery period. There was no significant difference between groups regarding the amount of facial, behavioral and physiological reactions. However, behavioral reactions seemed to remain high in children with ASD after the end of the venipuncture, in contrast with children in the 2 other groups. Moreover, we observed a significant decrease in pain expression with age in nonimpaired children, but no such effect was found regarding children with ASD. The data reveal that children with ASD displayed a significant pain reaction in this situation and tend to recover more slowly after the painful experience. Improvement in pain assessment and management in this population is necessary.
自闭症谱系障碍（ASD）儿童对疼痛的反应存在知识匮乏的情况，他们通常被认为对疼痛不敏感。本研究的目的是描述 ASD 儿童在静脉穿刺过程中的面部、行为和生理反应，并将其与智力障碍儿童和非损伤对照儿童的反应进行比较。我们还研究了发育年龄与疼痛反应之间的关系。样本包括 35 名 ASD 儿童、32 名智力障碍儿童和 36 名非损伤对照儿童。在静脉穿刺过程中对儿童进行录像，并记录其心率。使用儿童面部编码系统（CFCS）评估面部反应，使用非交流儿童疼痛检查表（NCCPC）对行为反应进行评分。线性混合效应模型显示，儿童的反应在基线和静脉穿刺之间增加，在静脉穿刺结束和恢复期间减少。在面部、行为和生理反应方面，各组之间没有显著差异。然而，与其他两组儿童相比，ASD 儿童在静脉穿刺结束后，行为反应似乎仍然很高。此外，我们观察到非损伤儿童的疼痛表达随年龄显著下降，但在 ASD 儿童中未发现这种影响。数据显示，在这种情况下，ASD 儿童表现出明显的疼痛反应，并且在疼痛经历后恢复得更慢。需要改善该人群的疼痛评估和管理。
