Lipsker Camilla Wiwe, Bölte Sven, Hirvikoski Tatja, Lekander Mats, Holmström Linda, Wicksell Rikard K
Functional Area Medical Psychology/Functional Unit Behavior Medicine, Karolinska University Hospital, Stockholm, Sweden,
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,
J Pain Res. 2018 Nov 8;11:2827-2836. doi: 10.2147/JPR.S177534. eCollection 2018.
Recent research has suggested that autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) may be comorbid to pediatric chronic pain, but the empirical support is yet scarce. Therefore, the current study aimed to investigate the occurrence of traits and symptoms consistent with clinically significant ASD and ADHD in a group of children and adolescents with chronic debilitating pain and examine potential differences in pain and demographic variables between children with and without clinically significant traits and symptoms of ASD and ADHD.
This cross-sectional study included 146 parent-child dyads (102 girls, 111 mothers, children 8-17 years) consecutively referred to a tertiary pain clinic. Parents completed the Social Responsiveness Scale to assess autistic traits, and Conners-3 to measure symptoms of ADHD in their children. Children completed the Lübeck Pain Questionnaire to evaluate experienced pain.
Among children, 20 (13.7%) received scores consistent with clinically significant ASD and 29 (19.9%) received scores consistent with clinically significant ADHD, with a combined prevalence of clinically significant ASD/ADHD traits and symptoms of 26% of the total sample. Only 4.8% of children were previously diagnosed with either disorder. Among children with clinically significant ASD traits, girls were more prevalent, parents reported lower health, and the pain was more likely triggered by being in school. Among children with clinically significant ADHD symptoms, there were no gender differences and pain was more likely triggered by the family situation and new situations. No differences regarding pain intensity, duration, or frequency were found between children with and without clinically significant ASD traits or ADHD symptoms.
Children with debilitating chronic pain, particularly girls, may present with an elevated risk of having a comorbid, possibly high-functioning, neurodevelopmental disorder. Results suggest that clinical assessment of pediatric chronic pain should include screening for neurodevelopmental disorders.
近期研究表明，自闭症谱系障碍（ASD）和注意力缺陷多动障碍（ADHD）可能与小儿慢性疼痛共病，但实证支持尚少。因此，本研究旨在调查一组患有慢性衰弱性疼痛的儿童和青少年中与具有临床意义的ASD和ADHD一致的特质和症状的发生率，并检查有和没有具有临床意义的ASD和ADHD特质及症状的儿童在疼痛和人口统计学变量方面的潜在差异。
这项横断面研究纳入了连续转诊至三级疼痛诊所的146对亲子（102名女孩，111名母亲，儿童年龄8至17岁）。父母完成社会反应量表以评估自闭症特质，完成康纳斯儿童行为量表第三版以测量其子女的ADHD症状。儿童完成吕贝克疼痛问卷以评估所经历的疼痛。
在儿童中，20名（13.7%）的得分与具有临床意义的ASD一致，29名（19.9%）的得分与具有临床意义的ADHD一致，具有临床意义的ASD/ADHD特质和症状的合并患病率占总样本的26%。只有4.8%的儿童先前被诊断患有这两种疾病中的任何一种。在具有临床意义的ASD特质的儿童中，女孩更为普遍，父母报告的健康状况较差，疼痛更有可能由上学引发。在具有临床意义的ADHD症状的儿童中，没有性别差异，疼痛更有可能由家庭情况和新情况引发。有和没有具有临床意义的ASD特质或ADHD症状的儿童在疼痛强度、持续时间或频率方面没有差异。
患有衰弱性慢性疼痛的儿童，尤其是女孩，可能存在共病可能是高功能神经发育障碍的风险升高。结果表明，小儿慢性疼痛的临床评估应包括对神经发育障碍的筛查。
