Kids on the Autism Spectrum and Their Reaction to Pain

As parents of kids with Aspergers (AS) and High-Functioning Autism (HFA), we are all familiar with the enigma of their unequal reaction to pain and injury. A stubbed toe or paper cut may set off a pain response (e.g., crying, screaming, and sobbing) such as is equaled by the loss of a limb, yet a burst ear drum or broken limb may go seemingly unnoticed.

Parents of children on the autism spectrum are often bewildered by this unequal response to pain stimuli. Anecdotal evidence from clients worldwide is full of reports on this topic. So, what's the answer to this confusing puzzle? The questions surrounding these kid's unequal response to pain can be explained scientifically.

The assumption that, physiologically, humans are equipped to limit the amount of stimuli entering our brains thereby preventing the brain from becoming overloaded, has led to the establishment of a 'normal' range of feeling. However, those with an autistic spectrum disorder are recognized as having a hyper/hypo sensitivity to stimuli (i.e., above average range of feeling or super-sensitivity).

Accounts written by people with AS and HFA state that their disability is directly linked to their senses and their sensory processing. So let's look at the biochemical processes that occur when our senses are stimulated:

Stimulation from the environment enters our brain through our eyes, ears, skin, nose and mouths. Our nervous system passes this information around our brain and body by the use of biochemical neurotransmitters. The amount of stimulation felt is determined by the amount of neurotransmitter processed in each neuron. The enzyme dopamine beta hydroxylase is released from nerve endings during stimulation.

Dopamine beta hydroxylase (DBH) is essential for cell communication and regulating neurons in the central and peripheral nervous systems. An increase in stimulation results in an increase in the level of this enzyme. Scientific studies have shown that children on the autism spectrum have much higher levels of dopamine beta hydroxylase in their systems than in ordinary children. The presence of this enzyme is also linked to behaviors such as repetition, agitation and aggression.

Repetitious activity, such as rocking, flapping or pacing, results in the release of endorphins through the system. Endorphins reduce the sensation of pain and have the ability to block pain. In other words, when endorphins are present, the amount of sensory reaction is reduced or stopped completely. Kids on the spectrum have the ability to purposely, but unknowingly, overload their sensory system in order to shut it down completely (i.e., by rocking, flapping or pacing etc.).

Blocking out all sensation by the production of endorphins might seem like a simple and easy way of coping with sensory over-stimulation; however, in caring for kids on the spectrum, we must realize that reaction to ALL sensation becomes limited. They won't recognize hunger, tiredness, body temperature (risk of overheating), full bladder/bowel or pain. Kids on the spectrum display agitation through use of repetitious behaviors such as rocking, flapping, pacing, head-banging, staring, screaming, spinning, chanting or humming.

Our job as parents is to recognize these signals of agitation. These behaviors are used to block out: (a) over-stimulation from their environment, (b) their emotions, and (c) their response to pain. These repetitive behaviors also serve to calm them, if their use is monitored rather than unlimited.

For young people with AS and HFA, the build-up or cumulative effect of these endorphins throughout the day also needs to be taken into consideration. This is why those who suffer accidents in the afternoon or evening may not show pain or seem to feel it.

All physical exercise causes the release of natural endorphins into the system that can help to protect the youngster without switching off the sensory response. So, exercise such as walking, running, and swimming is extremely beneficial in the youngster's daily routine as a preventative measure. It may be used during periods of agitation to help calm him or her. In this way exercise is used to develop appropriate social responses (e.g., it is more acceptable to jump on a trampoline rather than on the furniture).

With this information revealed, it becomes obvious that we must monitor our youngster's production of endorphins, because the presence of excess endorphins causes him or her to lose the ability to respond to any stimulation. This means that kids on the autism spectrum miss much of what they are meant to be learning.

Also, we must realize that these stereotyped/repetitive behaviors have social consequences; they are a visual reminder that they are different from their peers. We must take into account the youngster's socializing skills and ability when monitoring and setting limits on the use of repetitive behaviors. (i.e., tell him or her the times and places when flapping, rocking or head-banging are acceptable, for controlled periods of time.

We should not attempt to eliminate sensory stimulation in order to protect children on the autism spectrum. Without stimulation, our world becomes meaningless to them. Rather we should attempt to provide them with a safe sensory environment (e.g., dim lights, softer noises/voices, reduced odors, etc.), giving them the opportunity to learn and respond appropriately.

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•    Anonymous said… As a little guy my son never complained about ear infections, they only bothered him when it got to the point of a ruptured eardrum. Now I know why!
•    Anonymous said… Had to really push to get X-ray and taken seriously when daughter was 7 as she just 'wasn't crying enough'. Wrist was broken. A&E doctors need to be made aware of this.
•    Anonymous said… i have always wondered about this interesting read my son when little would smash his head off a wall ove and over almost like he liked pain but then a little trip and a bumped knee would send him crazy i never know when hes really ill he dont say its like he dont understand what pain is i struggle to manage this side of his autism
•    Anonymous said… If involves any blood... Simple scrapes, paper cuts, lost a loose tooth...Screaming... Also if he's about to get "sick"... He starts screaming... But ear infections, headaches, bad falls... He may or may not really mention it. I don't know what to make of it...
•    Anonymous said… Interesting. My son has a high thresh hold for pain and does not seem to worry too much about small injuries either. He was once bitten by a bunch of stinging ants and barely said more than ow. Another child also stung by one ant screamed for an hour. I always know to check in with him when he has an accident because chances are he is worse off than he let's on. He saves his meltdowns for irritations such as hairbrushing (which he says is unbearably painful), and he can't stand to be asked what he deems to be stupid questions smile emoticon
•    Anonymous said… My boy never complains rarely eats or sleeps
•    Anonymous said… My son also has a very high pain threshold. He has to be really hurt to cry and really sick to tell us. Other things like itches, though, he cannot deal with.
•    Anonymous said… So true! My daughter went 11 days with an arm broken in two places and we had no idea. I felt like the worst mom ever, but she never complained.
•    Anonymous said… Story of my life! Glad my son isn't the only one!
•    Anonymous said… This is one of the hardest parts of all of this for us. Our son has been badly injured twice and both times had no response to the pain at all. This last time (at 17) he was burned at work. He tried to refuse treatment but thankfully, they called me anyway. He had a 2nd degree burn larger than the size of my hand on his back!! Never even asked for a Tylenol. But if he has a headache...LOOK OUT!!!
•    Anonymous said… Very informative. My son is 10 and just turning the corner on his anger tantrums. It's such a nice feeling to have weathered the "poker face" phase. Anyway, my husband are trying to prep for the teen years. Good to hear your advice. Thanks Mark.
•    Anonymous said… Yes the tiniest cut on my daughters finger is like it's been cut off!
•    Anonymous said... It is nice to finally have an explanation for why my son cries over the smallest bump, but wasn't worried when he sliced his hand open and needed stitches. Thank you!
•    Anonymous said... This is an amazing article...thank you so very much for posting it...:)
•    Anonymous said... My son broke his foot at 4 yrs old by knocking over a concrete block on it, barefoot!.. of coarse it broke n he didn't shed a tear, he was suppose to wear a hard cast 6 weeks n by the 3 rd week he had literally run it off.. it never healed properly n he is now 6 n the top of his foot is still red to this day...knowing if he's sick or hurting is always a question ...
•    Anonymous said... My oldest daughter fell and broke her front tooth down to the nerve and was acting like nothing happened... but yet she freaks out over shots and stubbing her toes. :/ I always wonder at every injury if she hasn't done more damage than she can express or even knows about.
•    Anonymous said... My Aspie (7), doesn't usually ever feel the pain unless he can see the injury like blood. Once he sees it, he freaks out, even if it is a simple paper cut. He had a bursted ear drum once and we never knew it because he never complains of pain.
•    Anonymous said... This is a great article. 20 years ago my son broke his arm at the elbow, he was so calm, didn't cry. The nurses in the emergency room were telling him he should be the one crying like the other kids in the other rooms. He has always taken that kind of pain so well, yet his back pain he is always obsessing about. Of course when he was 4 we didn't know he was an Aspie. This article made it so clear.
•    Anonymous said... When my son was 6 he almost died. He had a blood infection and internal bleeding. He never said a word.He never notices the pain from Ear infections and strep throat. If I ever even suspect an illness we go straight to the doctor. Nice to know I'm not alone.
•    Anonymous said... I am an adult aspie and I have been told that when I had my jabs as a baby I was the only one that did not cry lol. Apparently I just glared at the nurse.
•    Anonymous said... Can I please just tell you how much I love and appreciate what you do for us as parents of a newly diagnosed 11-year old with Asperger's? This is something our son exhibits all the time, but we didn't know it was related to the Asperger's. Thank you for helping us be patient and understanding.
•    Anonymous said... when i took my son to the doc he had a hole in his ear drum the doc. could not believe it kept asking are ya sure that does not hurt?!! but the smallest scratch and its tears and panic..
•    Unknown said... My 8 year old just started complaining of pain in her feet. She says it hurts so much that she doesnt want to stand up or walk. Im unsure of it could be and its helped to read this article. To be on the safe side, should I have her seen by her physician? Thanks Sienna's mom
•    Nicole said... My daughter is only 18 months. She has never reacted to pain or fear. This article opened my eyes to why she does alot of what she does. She is almost identical to my nephew who has this type of autism. They both have received 3rd degree burns on their hands and never even flinched. Shes seeing her doctor on Monday.

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