Beyond Misconceptions: Assessing Pain in Children with Mild to Moderate Intellectual Disability

Zabalia, Marc

doi:10.3389/fpubh.2013.00023

Cited by 13 publications

(13 citation statements)

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“…Expressing pain can be challenging for children, especially those with ILD, who may have a lack of verbal ability and intellectual immaturity . Pain underestimation presents more often in children with ILD than in their peers without disabilities .…”

Section: Discussionmentioning

confidence: 99%

“…Expressing pain can be challenging for children, especially those with ILD, who may have a lack of verbal ability and intellectual immaturity. 23,24 Pain underestimation presents more often in children with ILD than in their peers without disabilities. 25 Moreover, children with ILD have interaction T A B L E 6 Dental therapy needs and parents' ability to identify dental pain in their children challenges and commonly rely on their parents to express and verbalise their pain experiences.…”

Section: Discussionmentioning

confidence: 99%

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Parent perspectives on perceived dental pain and dental caries in Saudi schoolchildren with intellectual disability

Robinson

2019

Special Care in Dentistry

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Aims To assess dental pain among male Saudi schoolchildren with intellectual learning disabilities (ILD) compared with controls and evaluate parents’ perceptions of their children's dental pain and dental status. Methods and Results A mixed‐method cross‐sectional study of 92 male schoolchildren aged 12‐16 years was conducted at schools in Albaha, Saudi Arabia between March and May 2018. Participants were clinically examined for dental caries. Parents’ perspectives on their children's dental pain were explored using interviews and a questionnaire. Chi‐square, Mann‐Whitney, Kendall's tau‐b, and t‐test analyses were run using SPSS® version 20.0. Children with and without ILD had a high prevalence of dental caries (77% and 86%, respectively). Participants with ILD had significantly higher Dental Discomfort Questionnaire (DDQ) scores than healthy controls (0.75 ± 0.27 and 0.59 ± 0.11, respectively), and their decayed teeth (DT) scores were higher. Parents’ ability to determine the complexity of dental treatment needed was significantly related to oral pain in both groups. Conclusion Children with ILD had more dental caries and pain than children without disabilities. Future research may use longitudinal studies to examine dental pain and caries in younger children with ILD and assess their parental perspectives. Implementation of oral educational programmes targeting parents of those children may be recommended.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Parent perspectives on perceived dental pain and dental caries in Saudi schoolchildren with intellectual disability

Robinson

2019

Special Care in Dentistry

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“…Other effective coping strategies involve imagery or autobiographical memory tasks. One study showed that adolescents with mild to moderate intellectual disabilities can benefit from these pain coping strategies based on hypno‐analgesia . The stories used for these mental imagery tasks should be simple and without ambiguity or unrealistic events …”

Section: Discussionmentioning

confidence: 99%

“…One study showed that adolescents with mild to moderate intellectual disabilities can benefit from these pain coping strategies based on hypno-analgesia. 28 The stories used for these mental imagery tasks should be simple and without ambiguity or unrealistic events. 28 LaChapelle et al 29 found that 65% of adults with an intellectual disability were able to self-report pain.…”

Section: Discussionmentioning

confidence: 99%

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Pain sensitivity of children with Down syndrome and their siblings: quantitative sensory testing versus parental reports

Valkenburg

Tibboel

Dijk

2015

Develop Med Child Neuro

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AIM The aim of this study was to compare thermal detection and pain thresholds in children with Down syndrome with those of their siblings.METHOD Sensory detection and pain thresholds were assessed in children with Down syndrome and their siblings using quantitative testing methods. Parental questionnaires addressing developmental age, pain coping, pain behaviour, and chronic pain were also utilized.RESULTS Forty-two children with Down syndrome (mean age 12y 10mo) and 24 siblings (mean age 15y) participated in this observational study. The different sensory tests proved feasible in 13 to 29 (33-88%) of the children with Down syndrome. These children were less sensitive to cold and warmth than their siblings, but only when measured with a reaction time-dependent method, and not with a reaction time-independent method. Children with Down syndrome were more sensitive to heat pain, and only 6 (14%) of them were able to adequately self-report pain, compared with 22 (92%) of siblings (p<0.001).INTERPRETATION Children with Down syndrome will remain dependent on pain assessment by proxy, since self-reporting is not adequate. Parents believe that their children with Down syndrome are less sensitive to pain than their siblings, but this was not confirmed by quantitative sensory testing.As early as 1887, John L Down made the following observation about persons with what we now call Down syndrome: 'common sensation is generally less acute than in ordinary persons. Pain is borne with wonderful callousness.' 1 More than a century later, a study reported that around 30% of parents of children with Down syndrome have difficulty perceiving whether or not their child is in pain, and that 70% of parents have difficulty identifying the location of their child's pain. 2 These results were confirmed in a prospective study among a group of individuals with Down syndrome and a comparison group. The individuals with Down syndrome had more problems locating a painful stimulus and also reacted to the painful stimulus later than did the individuals in the comparison group. 3 Defrin et al. 4 applied quantitative sensory testing to assess the heat pain sensitivity of 11 adults with Down syndrome and 14 adults without Down syndrome, and concluded that those with Down syndrome were more sensitive to heat pain than those without (p=0.06). The ultimate goal of quantitative sensory testing is to better understand the mechanisms involved in pain transduction, transmission, and perception under normal and pathophysiological conditions. 5 Different techniques have been developed to assess mechanical, thermal, current perception, and pain thresholds. 5 Using these techniques, particularly low pain thresholds were found in children with functional abdominal (visceral) pain or with musculoskeletal pain, 6 and sensory deficits were identified in individuals with neuropathic pain, 7 to name a few examples. Down syndrome is the primary cause of congenital intellectual disability worldwide. More than 80 different associated anomalies have been identified i...

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Detection and assessment of postoperative pain in children with cognitive impairment: A systematic literature review and meta‐analysis

Pizzinato

Liguoro

Pusiol

et al. 2022

European Journal of Pain

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Background and Objective: Children with cognitive impairment (CI) are at risk of experiencing pain. Several specific pain rating scales have been developed to date. Thus, the aim of this meta-analysis was to estimate the degree of reliability of different pain assessment scales for the postoperative pain in children with CI. Databases and DataTreatment: PubMed, Scopus and Web of Science databases were approached: all studies validating and/or using pain assessment tool in children (0-20 years) with CI published in English from the 1st of January 2000 to the 1st of January 2022 were included. Only studies reporting the interclass correlation coefficient (ICC) to evaluate the concordance between caregivers' and external researchers' scores were eligible. Results: Twelve studies were included (586 children with CI, 60% males; weighted mean age 9.9 years -range 2-20). Five of them evaluated the Non-Communicating Children's Pain Checklist-Postoperative Version (NCCPC-PV)scale whereas four the original and revised Face, Legs, Activity, Cry, Consolability (FLACC) scale. The analysis showed an overall ICC value of 0.76 (0.74-0.78) for the NCCPC-PV scale, with a high heterogeneity index (I 2 = 97%) and 0.87 (0.84-0.90) for the FLACC scale, with a discrete I 2 index (59%). Conclusions:The NCCPC-PV and FLACC pain rating scales showed the strongest evidence for validity and reliability for assessing postoperative pain in children with CI. However, due to the high heterogeneity of the studies available, these results should not be considered conclusive.Significance: This review is focused on the assessment of pain in children with CI in the postoperative period. Simplified observation-based pain assessment tools that rely on evaluating non-verbal expressions of pain should be recommended for children with difficulties to communicate their feelings. Even if there is a high degree of heterogeneity in clinical presentations among youth with CI,

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Beyond Misconceptions: Assessing Pain in Children with Mild to Moderate Intellectual Disability

Cited by 13 publications

References 51 publications

Parent perspectives on perceived dental pain and dental caries in Saudi schoolchildren with intellectual disability

Parent perspectives on perceived dental pain and dental caries in Saudi schoolchildren with intellectual disability

Pain sensitivity of children with Down syndrome and their siblings: quantitative sensory testing versus parental reports

Detection and assessment of postoperative pain in children with cognitive impairment: A systematic literature review and meta‐analysis

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