Individuals with autism spectrum disorder (ASD) often exhibit differences in pain responsivity. This altered responsivity could be related to ASD-related social communication difficulties, sensory differences, or altered processing of pain stimuli.
People with autism have normal pain thresholds but increased sensitivity to painful stimuli, concludes a study in PAIN®, the official publication of the International Association for the Study of Pain (IASP).
Sensory considerations
For example, for someone who is over-sensitive to touch and sound, people brushing past them and a loud announcement at a train station could cause pain and sensory overload, leading to a meltdown.
Many autistic people experience hypersensitivity to bright lights or certain light wavelengths (e.g., LED or fluorescent lights). Certain sounds, smells, textures and tastes can also be overwhelming. This can result in sensory avoidance – trying to get away from stimuli that most people can easily tune out.
A recent National Autistic Society survey found 59% of autistic people said anxiety had a high impact on their ability to get on with life. Experiencing such high levels of anxiety can lead to exhaustion and meltdowns. It may also lead to autistic fatigue and burnout.
They may not respond to communication anymore, retreat to their room or lie down on the floor. They may also no longer be able to move from the situation they are in, no matter what it is (for example, a shopping centre or a classroom). Shutdowns tend to be more discreet than meltdowns, and may sometimes go unnoticed.
Autistic people in burnout describe feeling exhausted and depleted. As if all of their internal reserves have been used up. These symptoms are not better explained by being physically unwell, malnourished, or having engaged in excessive exercise.
People with autism spectrum disorder are sometimes said to lack empathy (the ability to feel along with others) and/or sympathy (the ability to feel for others). While this stereotype is often used to describe all people with autism, these challenges are not experienced by everyone on the spectrum.
While children with autism may experience sensory overload in relation to the five core senses (taste, touch, hearing, sight, and smell), they may also overreact or underreact to two additional senses: the proprioceptive and vestibular senses.
In children and teenagers with high-functioning autism, this can present as a limited social circle, difficulty completing group work, or problems sharing toys and materials. Many people with ASD have sensory difficulties. Certain tastes, noises, smells, or feelings can be intolerable.
Individuals with autism spectrum disorder (ASD) often exhibit differences in pain responsivity. This altered responsivity could be related to ASD-related social communication difficulties, sensory differences, or altered processing of pain stimuli.
Sensory overload is a common reason for a meltdown or shutdown. Kids with autism tend to experience lights, sounds, smells, and sensations differently than neurotypical children. Many struggle with hypersensitivity, which means they experience their senses more intensely, sometimes to the point of physical pain.
Among those with autism, common triggers include disturbing breaks in routine, lack of sleep, jarring “sensory stimuli” (noises, lights, or smells) or even undiagnosed mental health problems. Clearly, it's important to look beyond the behavior itself to identify the underlying cause.
Children with autism are about twice as likely as their typical peers to experience chronic or recurrent pain (9). Various co-morbidities in ASD, such as epilepsy (10, 11), joint hypermobility-related disorders (12), gastrointestinal disorders (13), anxiety (14), and sleep problems (15) may be additive sources of pain.
Cascio and others have found that autistic people are less susceptible to the rubber-hand illusion than neurotypical people are, suggesting their sense of self is somehow less flexible. That rigidity might explain the strong response many of them have to touch.
Difficulty reading non-verbal cues. This can be why autistics don't always understand riddles, jokes, or abstract figures of speech.
difficulties with high-level language skills such as verbal reasoning, problem solving, making inferences and predictions. problems with understanding another person's point of view. difficulties initiating social interactions and maintaining an interaction.
posturing – holding hands or fingers out at an angle or arching the back while sitting. visual stimulation – looking at something sideways, watching an object spin or fluttering fingers near the eyes. repetitive behaviour like opening and closing doors or flicking switches.
Adults diagnosed with autism spectrum disorder (ASD), including Asperger's and autism, are prone to anger outbursts. An 'on-off' quality during which individuals may be calm one second and then have an autism outburst in the next is common.
Better understanding of theory of mind was related to greater proneness to guilt and pride, but only for children with ASD. These findings are important because these complex emotions are linked with both positive and negative social behaviors towards others and oneself.
Facial expressions smooth social interactions: A smile may show interest, a frown empathy. People with autism have difficulty making appropriate facial expressions at the right times, according to an analysis of 39 studies1. Instead, they may remain expressionless or produce looks that are difficult to interpret.
Analytical Thinking: People with an autism spectrum disorder think in a logically consistent way that leads to quick decision making. These thinkers can make decisions without experiencing the framing effect that inhibits most neurotypicals from making decisions without bias.
While some people with autism merely yell or stamp, many really do become overwhelmed by their own emotions. 3 Bolting, hitting, self-abuse, crying, and screaming are all possibilities. These can be particularly frightening—and even dangerous—when the autistic individual is physically large.
Sensory overload, changes in routine, social isolation, co-occurring conditions, and lack of support can all exacerbate the symptoms of autism. However, with early intervention, therapy, and support, individuals with autism can manage these challenges and improve their quality of life.
During a meltdown, we found that most autistics described feeling overwhelmed by information, senses, and social and emotional stress. They often felt extreme emotions, such as anger, sadness, and fear, and had trouble with thinking and memory during the meltdown.