Expresión del dolor en niños con Trastorno del Espectro Autista Severo: Estudio piloto con la escala NCCP-C

María Dolores Cárcel López; Mercedes Ferrando Prieto

doi:10.14198/DCN.2020.7.1.05

Autores/as

María Dolores Cárcel López Colegio Concertado Gabriel Pérez Cárcel. Murcia, España https://orcid.org/0000-0002-0173-1070
Mercedes Ferrando Prieto Departamento de Psicología Evolutiva y de la Educación. Universidad de Murcia, España https://orcid.org/0000-0001-9198-1390

DOI:

https://doi.org/10.14198/DCN.2020.7.1.05

Palabras clave:

Autismo, Sensibilidad al dolor, Discapacidad Intelectual, Expresión del dolor, Indicadores del dolor

Resumen

El perfil neurobiológico asociado a las personas con autismo dificulta su forma de identificar y expresar el dolor, lo que se traduce en una merma de su calidad de vida. El objetivo fundamental de este trabajo es conocer la idiosincrasia que rodea la expresión del dolor en las personas con autismo y discapacidad intelectual. Diez niños de 7 a 12 años con autismo severo (edad M= 14.4 años, DT= 3.50; todos ellos hombres). Participaron en este estudio. Se recogió información sobre los episodios de dolor utilizando la escala NCCP-C. Sus puntuaciones fueron comparadas con las de la muestra normativa para niños con discapacidad intelectual obtenida por Breau et al. (1) (edad M =10; DT = 4.4; 40.07% mujeres).Los resultados mostraron diferencias estadísticamente significativas en las áreas social (el alumno TEA evita la interacción social y rechaza el consuelo; mientras que otras discapacidades buscan más el consuelo del adulto), actividad (se dan más fluctuaciones en su actividad física) y psicofisiológica (alteraciones más notables en el sueño).

Citas

Breau LM, Finley GA, McGrath PJ, Camfield CS. Validation of the non-communicating children's pain checklist - Postoperative version. Anesthesiology. 2002;96(3):528-35. doi: https://doi.org/10.1097/00000542-200203000-00004

Gu X, Zhou TJ, Anagnostou E, Soorya L, Kolevzon A, Hof PR, et al. Heightened brain response to pain anticipation in high-functioning adults with autism spectrum disorder. Eur J Neurosci 2018 Mar;47(6):592-601. doi: https://doi.org/10.1111/ejn.13598

Merskey H, Bogduk N, Merskey H BN. Classification of Chronic Pain. IASP Pain Terminology. 1994. 240p.

López Timoneda F. Definición y Clasificación del dolor. Clínicas Urológicas de la Complutense. 1996;4:49-55.

Dubois A, Rattaz C, Pry R, Baghdadli A. Autisme et Douleur - Analyse Bibliographique. Pain Res Manag. 010;15(4):245-53. doi: https://doi.org/10.1155/2010/749275

APA. American Psychiatric Association, 2013. Diagnostic and statistical manual of mental disorders (5th ed.). Am J Psychiatry. 2013. doi: https://doi.org/10.1176/appi.books.9780890425596

Failla MD, Moana-Filho EJ, Essick GK, Baranek GT, Rogers BP, Cascio CJ. Initially intact neural responses to pain in autism are diminished during sustained pain. Autism. 2018; 22(6):669-83. doi: https://doi.org/10.1177/1362361317696043

Garcia-Villamisar D, Moore D, Garcia-Martínez M. Internalizing Symptoms Mediate the Relation Between Acute Pain and Autism in Adults. J Autism Dev Disord. 2019; 49(1):270-8. doi: https://doi.org/10.1007/s10803-018-3765-9

Ghanizadeh A. Is thermal regulation processing involved in the etiology of self injury of skin in autism? Iran J Pediatr. 2009;19(1):84-5.

Courtemanche AB, Black WR. Everyday expressions of pain in children with and without autism spectrum disorder. Res Autism Spectr Disord [Internet]. 2016;26:65-70. doi: https://doi.org/10.1016/j.rasd.2016.02.010

Paula-Pérez I, Artigas-Pallarés J. Vulnerabilidad a la autolesión en el autismo. Rev Neurol. 2016;62(supl 1):27-32. doi: https://doi.org/10.33588/rn.62S01.2015529

Tudor ME, Walsh CE, Mulder EC, Lerner MD. Pain as a predictor of sleep problems in youth with autism spectrum disorders. Autism. 2015;19(3):292-300. doi: https://doi.org/10.1177/1362361313518994

Quinn BL, Serna RW. Challenges and Barriers to Identifying Pain in the Special Education Classroom: A Review. Rev J Autism Dev Disord Disorders. 2017;4(4):328-38. doi: https://doi.org/10.1007/s40489-017-0117-1

Bandstra NF, Johnson SA, Filliter JH, Chambers CT. Self-reported and Parent-reported Pain for Common Painful Events in High-functioning Children and Adolescents With Autism Spectrum Disorder. Clin J Pain. 2012;28(8):715-21. doi: https://doi.org/10.1097/AJP.0b013e318243ecf6

Nader R, Oberlander TF, Chambers CT, Craig KD. Expression of Pain in Children with Autism. Clin J Pain 2004;20(2):88-97. doi: https://doi.org/10.1097/00002508-200403000-00005

Allely CS. Pain Sensitivity and Observer Perception of Pain in Individuals with Autistic Spectrum Disorder. Scientific World Journal. 2013;2013:1-20. doi: https://doi.org/10.1155/2013/916178

Moore DJ. Acute pain experience in individuals with autism spectrum disorders: A review. Autism. 2015;19(4):387-99. doi: https://doi.org/10.1177/1362361314527839

Messmer RL, Nader R, Craig KD. Brief report: Judging pain intensity in children with autism undergoing venepuncture: The influence of facial activity. J Autism Dev Disord 2008; 38(7):1391-4. doi: https://doi.org/10.1007/s10803-007-0511-0

Cascio C, Folger S. Tactile Perception in Adults with Autism: A Multidimensional Psychophysical Study. J Autism Dev Disord 2008;38(1):127-37. doi: https://doi.org/10.1007/s10803-007-0370-8

Fan YT, Chen C, Chen SC, Decety J, Cheng Y. Empathic arousal and social understanding in individuals with autism: Evidence from fMRI and ERP measurements.. Soc Cogn Affect Neurosci 2014;9(8):1203-13. doi: https://doi.org/10.1093/scan/nst101

Tordjman S, Anderson GM, Botbol M, Brailly-Tabard S, Perez-Diaz F, Graignic R, et al. Pain reactivity and plasma β-endorphin in children and adolescents with autistic disorder. PLoS ONE. 2009;4(8). doi: https://doi.org/10.1371/journal.pone.0005289

Bird G, Silani G, Brindley R, White S, Frith U, Singer T. Empathic brain responses in insula are modulated by levels of alexithymia but not autism. Brain. 2010;133(5):1515-25. doi: https://doi.org/10.1093/brain/awq060

Fiene L, Ireland MJ, Brownlow C. The Interoception Sensory Questionnaire (ISQ): A Scale to Measure Interoceptive Challenges in Adults. J Autism Dev Disord. 2018; 48(10):3354-66. doi: https://doi.org/10.1007/s10803-018-3600-3

Riquelme I, Hatem SM, Montoya P. Abnormal Pressure Pain, Touch Sensitivity, Proprioception, and Manual Dexterity in Children with Autism Spectrum Disorders. Neural Plast. 2016;2016:1-9. doi: https://doi.org/10.1155/2016/1723401

Baum SH, Stevenson RA, Wallace MT, Sciences S. HHS Public Access. 2016;140-60. doi: https://doi.org/10.1016/j.pneurobio.2015.09.007

Leekam SR, Nieto C, Libby SJ, Wing L, Gould J. Describing the sensory abnormalities of children and adults with autism. J Autism Dev Disord 2007;37(5):894-910. doi: https://doi.org/10.1007/s10803-006-0218-7

García-Villamisar D. Dolor en personas adultas con un trastorno del espectro del autismo (TEA) y comorbilidad: un análisis mediacional. Revista Española De Discapacidad. 2017;5(2):73-86. doi: https://doi.org/10.5569/2340-5104.05.02.04

Rattaz, Cécile; Dubois, Amandine; Michelon, Cecile; Viellard, Marine; Poinso, FranÇois; Baghdadli A. How do children with autism spectrum disorders express pain? A comparison with developmentally delayed and typically developing children. Pain. 2013;154(10):2007-13. doi: https://doi.org/10.1016/j.pain.2013.06.011

Koenen LR, Icenhour A, Forkmann K, Pasler A, Theysohn N, Forsting M, et al. Greater fear of visceral pain contributes to differences between visceral and somatic pain in healthy women. Pain. 2017;158(8):1599-608. doi: https://doi.org/10.1097/j.pain.0000000000000924

Hadjistavropoulos T, Craig KD. A theoretical framework for understanding self-report and observational measures of pain: A communications model. Behav Res Ther [Internet]. 2002;40(5):551-70. doi: https://doi.org/10.1016/S0005-7967(01)00072-9

Oberlander TF, Zeltzer LK. Pain in children with autism. In: Mental health and pain. Springer; 2014. p. 191-209. doi: https://doi.org/10.1007/978-2-8178-0414-9_12

Breau LM, Burkitt C. Assessing pain in children with intellectual disabilities. Pain Res Manag. 2009;14(2):116-20. doi: https://doi.org/10.1155/2009/642352

Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Paediatr Nurs [Internet]. 1996;23(3):293-7.

Ekman P, Friesen W v. Measuring Facial Movement. J Nonverbal Behav 1976;1(1):56-75. doi: https://doi.org/10.1007/BF01115465

Courtemanche AB, Black WR, Reese RM. The relationship between pain, self-injury, and other problem behaviors in young children with autism and other developmental disabilities. Am J Intellect Dev Disabil. 2016;121(3):194-203. doi: https://doi.org/10.1352/1944-7558-121.3.194

Garcia-Villamisar D, Moore D, Garcia-Martínez M. Internalizing Symptoms Mediate the Relation Between Acute Pain and Autism in Adults. J Autism Dev Disord [Internet]. 2019;49(1):270-8. doi: https://doi.org/10.1007/s10803-018-3765-9

Altman DG. Practical statistics for medical research. CRC press; 1990. doi: https://doi.org/10.1201/9780429258589

Breau LM. Non-communicating children's pain checklist: Better pain assessment for severely disabled children. Expert Rev Pharmacoecon Outcomes Res 2003;3(3):327-39. doi: https://doi.org/10.1586/14737167.3.3.327

Gilbert-Macleod CA, Craig KD, Rocha EM, Mathias MD. Everyday pain responses in children with and without developmental delays. J Pediatr Psychol 2000;25(5):301-8. doi: https://doi.org/10.1093/jpepsy/25.5.301