UF Pediatric Pain copy
The commentary by McKeown, Vollmer, Cameron, Kinsella, and Shaibani examines the pervasive yet under‑addressed issue of pediatric pain in children with neurodevelopmental disorders (NDs), especially autism spectrum disorder (ASD). Drawing on epidemiological data, the authors argue that children with NDs experience roughly twice the rate of acute and chronic pain compared with neurotypical peers, and that this pain often goes undetected due to communication deficits, atypical sensory reactivity, and misconceptions among caregivers and clinicians. Five principal barriers are identified: (1) deficits in social communication that limit pain reporting; (2) diagnostic criteria that may mask pain sensitivity; (3) pain‑induced problem behavior; (4) interference of pain with accurate functional and skills assessments; and (5) pain’s interaction with treatment efficacy. The article details how pain can masquerade as automatically reinforced behavior, distort preference and skill assessments, and render standard interventions (e.g., escape extinction) ethically problematic when pain is the underlying maintaining variable. To mitigate these barriers, the authors propose a suite of practice recommendations: systematic medical clearance, interdisciplinary collaboration with physicians and allied health professionals, caregiver interviewing and training, selection and validation of pain‑measurement tools (e.g., NCCPC‑R, PADS, physiological indices), incorporation of conditional probability analyses, and the development of verbal behavior curricula to teach children to tact pain and mand for relief. The commentary concludes with a research agenda emphasizing (a) systematic assessment of pain as a private event, (b) validation of measurement systems for diverse ND populations, (c) experimental evaluation of pain‑focused interventions, and (d) broader dissemination of interdisciplinary guidelines. Throughout, the authors stress ethical responsibility, compassionate care, and the unique methodological strengths behavior analysts bring to the study and treatment of pediatric pain.
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Elevated Incidence of Pain in Children with Neurodevelopmental Disorders
Presents epidemiological evidence that children with NDs, particularly ASD, experience higher rates of acute and chronic pain than neurotypical peers, and outlines common medical comorbidities that contribute to pain.