Abstract：
OBJECTIVE: Pain in children and adolescents with autism spectrum disorders remains underdiagnosed due to their inherent communication difficulties. The goal of this review is to identify the most suitable methods for assessing pain in this population and for evaluating the specific perceptions of, or behavioural reactions to, pain whilst considering disorder severity and specifiers (with or without accompanying intellectual impairment, with or without accompanying language impairment).
METHODS: A systematic review and analysis of the international literature was conducted.
RESULTS: Fourteen studies were selected. No difference was found in pain-related behaviours based on the age or gender of children or adolescents with autism. Three studies showed pain-related behaviours in autism spectrum disorders to be similar to control groups. Other studies showed specific behavioural responses in autism spectrum disorders with a longer physiological and behavioural recovery time associated with an episode of acute pain in this population. Similarly, the three studies that focused on sensory perceptions of pain all showed differences in the autism spectrum disorders population compared to control groups. In hospital or daily life contexts, studies essentially showed idiosyncratic expressions, hypervigilance, motor agitation, negative emotional reactions, or vocalizations. Regarding the association of autism severity with hyposensitivity to pain, the results remain unclear even when language disorders or intellectual disabilities are also present (in conjunction with autism). The Non-Communicative Children Pain Checklist and its translation into French and Italian showed good internal validity and was used by almost half of the studies in hetero-assessment, mostly by parents. Studies recommend the inclusion of parents in the assessment in order to optimise the evaluation process. Similarly, analysis of parent/child/caregiver interviews from the studies highlights the importance of personalizing pain assessment of children and adolescents, taking into account subject-specific characteristics, pathology, and context.
CONCLUSIONS: An integrative and personalized approach to pain assessment appears to be the most appropriate for enhancing the understanding and detection of pain in individuals with autism spectrum disorders. This approach aligns well with a care setting where a nominated professional with a good expertise in autism is responsible for pain assessment. Given the complexity of identifying pain in individuals with autism, further qualitative studies, in conjunction with new pain exploration technologies, are considered necessary as well as a more extensive categorization of the population studies.
METHODS: A systematic review and analysis of the international literature was conducted.
RESULTS: Fourteen studies were selected. No difference was found in pain-related behaviours based on the age or gender of children or adolescents with autism. Three studies showed pain-related behaviours in autism spectrum disorders to be similar to control groups. Other studies showed specific behavioural responses in autism spectrum disorders with a longer physiological and behavioural recovery time associated with an episode of acute pain in this population. Similarly, the three studies that focused on sensory perceptions of pain all showed differences in the autism spectrum disorders population compared to control groups. In hospital or daily life contexts, studies essentially showed idiosyncratic expressions, hypervigilance, motor agitation, negative emotional reactions, or vocalizations. Regarding the association of autism severity with hyposensitivity to pain, the results remain unclear even when language disorders or intellectual disabilities are also present (in conjunction with autism). The Non-Communicative Children Pain Checklist and its translation into French and Italian showed good internal validity and was used by almost half of the studies in hetero-assessment, mostly by parents. Studies recommend the inclusion of parents in the assessment in order to optimise the evaluation process. Similarly, analysis of parent/child/caregiver interviews from the studies highlights the importance of personalizing pain assessment of children and adolescents, taking into account subject-specific characteristics, pathology, and context.
CONCLUSIONS: An integrative and personalized approach to pain assessment appears to be the most appropriate for enhancing the understanding and detection of pain in individuals with autism spectrum disorders. This approach aligns well with a care setting where a nominated professional with a good expertise in autism is responsible for pain assessment. Given the complexity of identifying pain in individuals with autism, further qualitative studies, in conjunction with new pain exploration technologies, are considered necessary as well as a more extensive categorization of the population studies.
摘要：
目的：患有自闭症谱系障碍的儿童和青少年的疼痛由于其固有的沟通困难而仍未被诊断。这篇综述的目的是确定最适合的方法来评估这一人群的疼痛，并评估具体的看法，或行为反应，疼痛，同时考虑疾病的严重程度和说明（有或没有伴随的智力障碍，伴有或不伴有语言障碍)。
方法：对国际文献进行系统回顾和分析。
结果：选择了14项研究。根据自闭症儿童或青少年的年龄或性别，疼痛相关行为没有差异。三项研究表明，自闭症谱系障碍患者的疼痛相关行为与对照组相似。其他研究表明，自闭症谱系障碍的特定行为反应与该人群的急性疼痛发作相关的生理和行为恢复时间更长。同样，三项研究集中于疼痛的感觉知觉，均显示孤独症谱系障碍人群与对照组的差异。在医院或日常生活中，研究基本上显示了特殊的表达，高度警惕,电机搅拌，消极的情绪反应,或发声。关于自闭症严重程度与对疼痛不敏感的关联，即使存在语言障碍或智力障碍（与自闭症有关），结果仍不清楚。非交际儿童疼痛清单及其翻译成法语和意大利语显示出良好的内部有效性，几乎一半的研究都在异性恋评估中使用，主要是父母。研究建议将父母纳入评估中，以优化评估过程。同样，对来自研究的父母/儿童/照顾者访谈的分析强调了对儿童和青少年进行个性化疼痛评估的重要性，考虑到特定主题的特征，病理学,和背景。
结论：综合和个性化的疼痛评估方法似乎最适合增强自闭症谱系障碍患者对疼痛的理解和检测。这种方法与护理环境非常吻合，在这种护理环境中，具有自闭症专业知识的提名专业人员负责疼痛评估。鉴于识别自闭症患者疼痛的复杂性，进一步的定性研究，结合新的疼痛探索技术，被认为是必要的，也是对人口研究进行更广泛的分类。
方法：对国际文献进行系统回顾和分析。
结果：选择了14项研究。根据自闭症儿童或青少年的年龄或性别，疼痛相关行为没有差异。三项研究表明，自闭症谱系障碍患者的疼痛相关行为与对照组相似。其他研究表明，自闭症谱系障碍的特定行为反应与该人群的急性疼痛发作相关的生理和行为恢复时间更长。同样，三项研究集中于疼痛的感觉知觉，均显示孤独症谱系障碍人群与对照组的差异。在医院或日常生活中，研究基本上显示了特殊的表达，高度警惕,电机搅拌，消极的情绪反应,或发声。关于自闭症严重程度与对疼痛不敏感的关联，即使存在语言障碍或智力障碍（与自闭症有关），结果仍不清楚。非交际儿童疼痛清单及其翻译成法语和意大利语显示出良好的内部有效性，几乎一半的研究都在异性恋评估中使用，主要是父母。研究建议将父母纳入评估中，以优化评估过程。同样，对来自研究的父母/儿童/照顾者访谈的分析强调了对儿童和青少年进行个性化疼痛评估的重要性，考虑到特定主题的特征，病理学,和背景。
结论：综合和个性化的疼痛评估方法似乎最适合增强自闭症谱系障碍患者对疼痛的理解和检测。这种方法与护理环境非常吻合，在这种护理环境中，具有自闭症专业知识的提名专业人员负责疼痛评估。鉴于识别自闭症患者疼痛的复杂性，进一步的定性研究，结合新的疼痛探索技术，被认为是必要的，也是对人口研究进行更广泛的分类。
