What Happened to Paul? Manifestation of Abnormal Pain Response for Individuals With Autism Spectrum Disorder
Abstract
During the progression of a pilot nutrition intervention designed to teach cooking skills to young adults with autism spectrum disorder (ASD), one participant—Paul—fell in the parking lot. Prior to the accident, Paul had been making significant gains in the program and had communicated in a number of ways his enthusiasm. After his accident, which resulted in broken and dislocated bones in his ankle, his demeanor was dramatically altered, program gains were lost, and staff noted the appearance of many new challenging behaviors. This article analyzes Paul’s behavior in reference to the pain response in autism. For some time, it was believed that many individuals with ASD did not experience pain based on anecdotal reports of how individuals responded to injury with seeming indifference. This view has given way of late to a more nuanced understanding of how atypical sensory processing and stimulus over-selectivity spill over into pain pathways and pain amplification mechanisms. The consequence is not a reduction in pain sensation, but a different expression of pain, determined by that individual’s particular communicative, cognitive, or physiological challenges. From this perspective, many of the disruptive and harmful behaviors that emerged after Paul’s accident can be seen as a delayed response to the incident. This article concludes by arguing that professionals across all domains of health care need to begin to see behavior as communicative for those with ASD. This is particularly true of changes in behavior, which can be significant indicators of health care problems rather than something to be dismissed as another manifestation of the condition.
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Studies found a lack of awareness by healthcare providers about the range of communication issues faced by people with intellectual disabilities and/or autism when accessing and attending primary and acute healthcare settings.
“Studies found a lack of awareness by healthcare providers about the range of communication issues faced by people with intellectual disabilities and/or autism when accessing and attending primary and acute healthcare settings.23,45–47”
From Barriers and facilitators to primary health care for people with intellectual disabilities and/or autism: an integrative review (2020) · cites this paper as [45]
Healthcare practitioners may rely on communicating with a carer, family member, or support worker rather than with the service user directly.
“Healthcare practitioners may rely on communicating with a carer, family member, or support worker rather than with the service user directly.23,25,36,45,47”
From Barriers and facilitators to primary health care for people with intellectual disabilities and/or autism: an integrative review (2020) · cites this paper as [45]
Long waiting times are a major cause of anxiety and stress.
“Long waiting times are a major cause of anxiety and stress.25,32,45,78,79”
From Barriers and facilitators to primary health care for people with intellectual disabilities and/or autism: an integrative review (2020) · cites this paper as [45]
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Doherty, A. J., Atherton, H., Boland, P., Hastings, R., Hives, L., Hood, K., James-Jenkinson, L., Leavey, R., Randell, E., Reed, J., et al. (2020) · BJGP Open · doi:10.3399/bjgpopen20x101030 · Cited by 244 · see citing works
- Authors
- Goldschmidt, J.
- Affiliations
- Community Support Services, Gaithersburg, Maryland, USA
- Corresponding author
- Goldschmidt, Janice
- ORCID
- Goldschmidt, Janice
- Venue
- Qualitative Health Research
- Publisher
- SAGE Publications
- Published
- 2016-04-26
- Volume
- 27
- Issue
- 8
- Pages
- 1133-1145
- ISSN
- 1049-7323 (ISSN-L)
- 1552-7557
- OpenAlex
- W2343215358
- Cited by
- 18
- References
- 67
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 2 · 2022: 4 · 2021: 2 · 2020: 3 · 2019: 1 · 2018: 3 · 2017: 1
- FWCI
- 1.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Qualitative Health Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Kaiser Permanente
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- autism spectrum disorder, pain response, pain perception, sensory processing, pain amplification, behavioral problems, young adults with autism, nutrition interventions, cooking skills, injuries, ankle fractures
- MeSH terms
- Autism Spectrum Disorder, Behavior, Communication, Humans, Pain
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