Advertisement

Journal of Autism and Developmental Disorders

, Volume 49, Issue 1, pp 270–278 | Cite as

Internalizing Symptoms Mediate the Relation Between Acute Pain and Autism in Adults

  • D. Garcia-VillamisarEmail author
  • D. Moore
  • M. Garcia-Martínez
Original Paper

Abstract

Research on pain in autism spectrum disorder (ASD) is in its infancy, with almost nothing known about how individual differences may predicting pain response in ASD. In the present study, 45 adults (28 male, age 22–48 years) with diagnoses of autism and intellectual delay were observed during vaccination or dental cleaning and their pain behaviours coded and measures of autism symptom severity, anxiety, depression and obsessivity taken. Our findings showed that greater autism severity predicted greater pain response which was partially mediated by anxiety and depression. These data suggest that mental health symptoms are important when considering pain response in autism. Mood must therefore be considered in future research on pain in ASD as well as clinical pain management.

Keywords

Pain Autism ASD Clinical Mediation analysis 

Notes

Acknowledgments

This study was supported in part by The Royal Board on Disability (Ministry of Health and Social Policy, Spain) and The Social Policy Department (Regional Govern of Madrid, Spain). We especially appreciate the assistance of Carmen Muela and Marina Jodra with the administration and organization of the data set. Finally, we would like to thank the participants with autism spectrum disorder and their teachers who contributed to the development of the program and assisted with data collection.

Author Contributions

Dr. Garcia-Villamisar designed the study, conducted the statistical analysis, analyzed the data and participated in revising the manuscript and addressing the reviewers’ comments. Dr. Moore wrote the initial draft of the paper, assisted with manuscript development, provided guidance on statistical analysis, and participated in revising the manuscript and addressing the reviewers’ comments. Ms. Garcia-Martinez participated in the design of the study and addressing the reviewers’ comments.

Funding

Funding for this study was provided by The Royal Board On Disability. The Ministry of Health, Consumption and Social Welfare of Spain Grant #25. 2015.The funder had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th edn.). Arlington: American Psychiatric Publishing.Google Scholar
  2. Anderson, D. K., Lord, C., Risi, S., DiLavore, P. S., Shulman, C., Thurm, A., et al. (2007). Patterns of growth in verbal abilities among children with autism spectrum disorder. Journal of Consulting and Clinical Psychology, 75(4), 594.Google Scholar
  3. Bair, M. J., Poleshuck, E. L., Wu, J., Krebs, E. K., Damush, T. M., Tu, W., & Kroenke, K. (2013). Anxiety but not social stressors predict 12-month depression and pain severity. The Clinical Journal of Pain, 29(2), 95.Google Scholar
  4. Bakken, T. L., Helverschou, S. B., Eilertsen, D. E., Heggelund, T., Myrbakk, E., & Martinsen, H. (2010). Psychiatric disorders in adolescents and adults with autism and intellectual disability: A representative study in one county in Norway. Research in Developmental Disabilities, 31(6), 1669–1677.Google Scholar
  5. Bird, G., Silani, G., Brindley, R., White, S., Frith, U., & Singer, T. (2010). Empathic brain responses in insula are modulated by levels of alexithymia but not autism. Brain, 133(5), 1515–1525.  https://doi.org/10.1093/brain/awq060.Google Scholar
  6. Bottos, S., & Chambers, C. T. (2006). The epidemiology of pain in developmental disabilities. In F. Symons & T. Oberlander (Eds.), Pain in individuals with developmental disabilities (pp. 67–87). Baltimore: Paul H. Brookes.Google Scholar
  7. Buck, T. R., Viskochil, J., Farley, M., Coon, H., McMahon, W. M., Morgan, J., & Bilder, D. A. (2014). Psychiatric comorbidity and medication use in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44(12), 3063–3071.Google Scholar
  8. Cascio, C., McGlone, F., Folger, S., Tannan, V., Baranek, G., Pelphrey, K., & Essick, G. (2008). Tactile perception in adults with autism: A multidimensional psychophysical study. Journal of Autism and Developmental Disorders, 38(1), 127–137.  https://doi.org/10.1007/s10803-007-0370-8.Google Scholar
  9. Castillo, R. C., Wegener, S. T., Heins, S. E., Haythornthwaite, J. A., MacKenzie, E. J., Bosse, M. J., & Group, L. S. (2013). Longitudinal relationships between anxiety, depression, and pain: Results from a two-year cohort study of lower extremity trauma patients. PAIN, 154(12), 2860–2866.Google Scholar
  10. Charman, T., Pickles, A., Simonoff, E., Chandler, S., Loucas, T., & Baird, G. (2011). IQ in children with autism spectrum disorders: data from the special needs and autism project (SNAP). Psychological Medicine, 41(03), 619–627.Google Scholar
  11. Courtemanche, A. B., & Black, W. R. (2016). Everyday expressions of pain in children with and without autism spectrum disorder. Research in Autism Spectrum Disorders, 26, 65–70.Google Scholar
  12. Duerden, E. G., Card, D., Roberts, S. W., Mak-Fan, K. M., Chakravarty, M. M., Lerch, J. P., & Taylor, M. J. (2014). Self-injurious behaviours are associated with alterations in the somatosensory system in children with autism spectrum disorder. Brain Structure and Function, 219(4), 1251–1261.Google Scholar
  13. Duerden, E. G., Oatley, H. K., Mak-Fan, K. M., McGrath, P. A., Taylor, M. J., Szatmari, P., & Roberts, S. W. (2012). Risk factors associated with self-injurious behaviors in children and adolescents with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(11), 2460–2470.Google Scholar
  14. Duerden, E. G., Taylor, M. J., Lee, M., McGrath, P. A., Davis, K. D., & Roberts, S. W. (2015). Decreased sensitivity to thermal stimuli in adolescents with autism spectrum disorder: Relation to symptomatology and cognitive ability. The Journal of Pain, 16(5), 463–471.Google Scholar
  15. Fanurik, D., Koh, J. L., Schmitz, M. L., Harrison, D. E., & Conrad, T. M. (1999). Children with cognitive impairment: Parent report of pain and coping. Journal of Developmental & Behavioral Pediatrics, 20(4), 228–234.Google Scholar
  16. Fontenelle, I. S., Fontenelle, L. F., Borges, M. C., Prazeres, A. M., Rangé, B. P., Mendlowicz, M. V., & Versiani, M. (2010). Quality of life and symptom dimensions of patients with obsessive–compulsive disorder. Psychiatry Research, 179(2), 198–203.Google Scholar
  17. Gavaruzzi, T., Carnaghi, A., Lotto, L., Rumiati, R., Meggiato, T., Polato, F., & Lazzari, F. (2010). Recalling pain experienced during a colonoscopy: Pain expectation and variability. British Journal of Health Psychology, 15(2), 253–264.Google Scholar
  18. Gilbert-MacLeod, C. A., Craig, K. D., Rocha, E. M., & Mathias, M. D. (2000). Everyday pain responses in children with and without developmental delays. Journal of Pediatric Psychology, 25(5), 301–308.  https://doi.org/10.1093/jpepsy/25.5.301.Google Scholar
  19. Helverschou, S. B., Bakken, T. L., & Martinsen, H. (2009). The psychopathology in autism checklist (PAC): A pilot study. Research in Autism Spectrum Disorders, 3(1), 179–195.Google Scholar
  20. Jochum, T., Letzsch, A., Greiner, W., Wagner, G., Sauer, H., & Bär, K.-J. (2006). Influence of antipsychotic medication on pain perception in schizophrenia. Psychiatry Research, 142(2), 151–156.Google Scholar
  21. Joshi, G., Wozniak, J., Petty, C., Martelon, M. K., Fried, R., Bolfek, A., et al. (2013). Psychiatric comorbidity and functioning in a clinically referred population of adults with autism spectrum disorders: A comparative study. Journal of Autism and Developmental Disorders, 43(6), 1314–1325.Google Scholar
  22. Kemani, M. K., Olsson, G. L., Lekander, M., Hesser, H., Andersson, E., & Wicksell, R. K. (2015). Efficacy and cost-effectiveness of acceptance and commitment therapy and applied relaxation for longstanding pain: A randomized controlled trial. The Clinical Journal of Pain, 31(11), 1004–1016.Google Scholar
  23. Klintwall, L., Holm, A., Eriksson, M., Carlsson, L. H., Olsson, M. B., Hedvall, A., et al. (2011). Sensory abnormalities in autism: A brief report. Research in Developmental Disabilities, 32, 795–800.  https://doi.org/10.1016/j.ridd.2010.10.021.Google Scholar
  24. Koenen, L. R., Icenhour, A., Forkmann, K., Pasler, A., Theysohn, N., Forsting, M., et al. (2017). Greater fear of visceral pain contributes to differences between visceral and somatic pain in healthy women. PAIN, 158(8), 1599–1608.Google Scholar
  25. Lautenbacher, S., Bär, K.-J., Eisold, P., & Kunz, M. (2016). Understanding facial expressions of pain in patients with depression. The Journal of Pain, 18, 376–384.Google Scholar
  26. Lee, L.-C., Harrington, R. A., Chang, J. J., & Connors, S. L. (2008). Increased risk of injury in children with developmental disabilities. Research in Developmental Disabilities, 29(3), 247–255.  https://doi.org/10.1016/j.ridd.2007.05.002.Google Scholar
  27. Lotan, M., Ljunggren, E. A., Johnsen, T. B., Defrin, R., Pick, C. G., & Strand, L. I. (2009). A modified version of the Non-Communicating Children Pain Checklist-Revised, adapted to adults with intellectual and developmental disabilities: Sensitivity to pain and internal consistency. The Journal of Pain, 10(4), 398–407.Google Scholar
  28. Lotan, M., Moe-Nilssen, R., Ljunggren, A., & Strand, L. (2010). Measurement properties of the non-communicating adult pain checklist (NCAPC): A pain scale for adults with intellectual and developmental disabilities, scored in a clinical setting. Research in Developmental Disabilities, 31(2), 367–375.Google Scholar
  29. Matson, J. L., Boisjoli, J. A., Gonzalez, M. L., Smith, K. R., & Wilkins, J. (2007). Norms and cut off scores for the autism spectrum disorders diagnosis for adults (ASD-DA) with intellectual disability. Research in Autism Spectrum Disorders, 1(4), 330–338.Google Scholar
  30. Matson, J. L., Wilkins, J., Boisjoli, J. A., & Smith, K. R. (2008). The validity of the autism spectrum disorders-diagnosis for intellectually disabled adults (ASD-DA). Research in Developmental Disabilities, 29(6), 537–546.Google Scholar
  31. McGrath, P. J., Rosmus, C., Canfield, C., Campbell, M. A., & Hennigar, A. (1998). Behaviours caregivers use to determine pain in non-verbal, cognitively impaired individuals. Developmental Medicine and child Neurology, 40(5), 340–343.Google Scholar
  32. Militerni, R., Bravaccio, C., Falco, C., Puglisi-Allegra, S., Pascucci, T., & Fico, C. (2000). Pain reactivity in children with autistic disorder. The Journal of Headache and Pain, 1(1), 53–56.  https://doi.org/10.1007/s101940050011.Google Scholar
  33. Miller, M., & Pisani, E. (1999). The cost of unsafe injections. Bulletin of the World Health Organization, 77(10), 808.Google Scholar
  34. Minshew, N., & Hobson, J. (2008). Sensory sensitivities and performance on sensory perceptual tasks in high-functioning individuals with autism. Journal of Autism and Developmental Disorders, 38(8), 1485–1498.  https://doi.org/10.1007/s10803-007-0528-4.Google Scholar
  35. Moore, D. J. (2015). Acute pain experience in individuals with autism spectrum disorders: A review. Autism, 19(4), 387–399.Google Scholar
  36. Moss, P., Howlin, P., Savage, S., Bolton, P., & Rutter, M. (2015). Self and informant reports of mental health difficulties among adults with autism findings from a long-term follow-up study. Autism, 19(7), 832–841.Google Scholar
  37. Nader, R., Oberlander, T. F., Chambers, C. T., & Craig, K. D. (2004). Expression of pain in children with autism. The Clinical Journal of Pain, 20(2), 88–97.Google Scholar
  38. Oberlander, T. F., Gilbert, C. A., Chambers, C. T., O’donnell, M. E., & Craig, K. D. (1999). Biobehavioral responses to acute pain in adolescents with a significant neurologic impairment. The Clinical Journal of Pain, 15(3), 201–209.Google Scholar
  39. Rattaz, C., Dubois, A., Michelon, M., Viellard, M., Poinso, F., & Baghdadli, A. (2013). How do children with autism spectrum disorders express pain? A comparison with developmentally delayed and typically developing children. PAIN, 154(10), 2007–2013.Google Scholar
  40. Tordjman, S., Anderson, G. M., Botbol, M., Brailly-Tabard, S., Perez-Diaz, F., Graignic, R., et al. (2009). Pain reactivity and plasma β-endorphin in children and adolescents with autistic disorder. PloS ONE.  https://doi.org/10.1371/journal.pone.0005289.Google Scholar
  41. Wing, L. (1976). Diagnosis, clinical description and prognosis. In L. Wing (Ed.), Early childhood autism (2nd ed.). Oxford: Pergamon Press.Google Scholar
  42. Wing, L. (1996). Autistic spectrum disorders. British Medical Journal, 312(7027), 327–328.Google Scholar
  43. Wise, T. N., Fishbain, D. A., & Holder-Perkins, V. (2007). Painful physical symptoms in depression: A clinical challenge. Pain Medicine, 8(s2), S75–S82.Google Scholar
  44. Yasuda, Y., Hashimoto, R., Nakae, A., Kang, H., Ohi, K., Yamamori, H., et al. (2016). Sensory cognitive abnormalities of pain in autism spectrum disorder: A case–control study. Annals of General Psychiatry, 15(1), 8.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • D. Garcia-Villamisar
    • 1
    • 4
    Email author
  • D. Moore
    • 2
    • 3
  • M. Garcia-Martínez
    • 1
  1. 1.Unit of Psychopathology, Department of Personality and Clinical PsychologyComplutense University of MadridMadridSpain
  2. 2.Psychology Department, School of Natural Science and PsychologyLiverpool John Moores UniversityLiverpoolUK
  3. 3.Research Centre for Brain and BehaviourLiverpool John Moores UniversityLiverpoolUK
  4. 4.Asociación Nuevo HorizonteLas RozasSpain

Personalised recommendations