A multifaceted psychophysical approach to assessment of sensory sensitivity and pain in adolescents with autism Open Access

Abstract

Autism spectrum disorder (ASD) encompasses a spectrum of conditions that are fairly common and heterogeneous in presentation. One core symptom of ASD as defined in the DSM-5 is altered sensory sensitivity, which can include hyper- or hyposensitivity to various environmental stimuli as well as diminished or heightened responses to pain. Previous studies have reported unusual sensory responses in 42-88% of older children with ASD that can greatly interfere in their abilities to participate in everyday activities; however, few clinical measures exist to adequately characterize sensory sensitivity and pain perception in ASD, especially in adolescent and adult populations. Few studies have employed quantitative sensory testing (QST) to assess neurophysiological underpinnings of sensory sensitivity in ASD, but these have yielded mixed results across age groups. The aim of this study was to utilize QST to better understand how ASD affects adolescents’ sensitivity to both noxious and innocuous thermal, pressure, mechanical, and auditory stimuli. We compared pain and detection thresholds measured in adolescents with ASD (n = 10) to published reference data collected from 13-16-year-old neurotypical adolescents (n = 64). Additionally, we utilized devices and methods that have yet to be tested in ASD populations, including the thermal grill illusion (TGI) and a hedonic rating scale, to provide a richer characterization of sensory sensitivity in ASD. Our findings indicate overall hypersensitivity specifically to noxious stimuli in ASD, and hyposensitivity to innocuous stimuli. Further comparison of individual threshold values to the reference data as well as exploratory examination of TGI and hedonic ratings revealed inter- and intra-individual variability of sensory responses in ASD, which may be reflective of heterogeneity inherent in the symptoms of the disorder. These findings indicate the value of QST as a tool for providing a detailed assessment of sensory sensitivity in ASD across numerous modalities.

Table of Contents

Introduction …………………………………………………………………………………….................................................. 1

Autism Spectrum Disorder (ASD) and Sensory Sensitivity ……………………………............................................. 1

    Quantitative Sensory Testing (QST) in ASD Populations ………………………………............................................ 5

Hypotheses …………………………………………………………………………………….................................................. 14

Methods ………………………………………………………………………………………................................................... 14

           Participants …………………………………………………………………………….................................................. 14

           Screening Measures ……………………………………………………………………............................................... 15

           ASD Diagnosis Confirmation ………………………………………………………….............................................. 15

           Sensory Sensitivity Self-Report Questionnaire ……………………………………............................................. 17

           QST Procedures ……………………………………………………………………….................................................. 18

           Data Analysis ………………………………………………………………………….................................................. 28

Results ………………………………………………………………………………………….................................................. 30

           Core QST Measures ……………………………………………………………………................................................ 30

           Exploratory Measures …………………………………………………………………............................................... 40

Discussion ……………………………………………………………………………………................................................... 45

           Contextualizing Current Findings with Those of Previous Studies ……………............................................ 46

           Mechanisms for Increased Pain Sensitivity in ASD ………………………………............................................. 49

           Mechanisms for Social Touch Aversion in ASD ……………………………………............................................. 52

           Mechanisms for Hyposensitivity to Innocuous Stimuli in ASD …………………............................................ 54

           Considerations of Heterogeneity Within the ASD Population …………………............................................. 55

Conclusions ……………………………………………………………………………………................................................. 58

References ……………………………………………………………………………………................................................... 61

 

 

Tables and Figures

           Table 1. Participant demographics and questionnaire scores …………………………..................................... 18

Table 2. Summary of QST procedures adopted from the German Research Network on Neuropathic Pain

(DFNS) and the peripheral sensory fiber function that they assess ........................................................... 27

Table 3. Summary of exploratory QST procedures and their associated sensory processing mechanisms ..... 28

Table 4. Summary of QST results from parameters with published reference values available for adolescents

ages 13-16 ...............................................................................…………………………………………………… 31

Figure 1. Mean pressure pain thresholds (kPa) of ASD and reference groups …………................................. 32

Figure 2. Mean thermal pain thresholds of ASD and reference groups ……………….................................... 33

Figure 3. Raw mechanical pain sensitivity of ASD and reference groups ...………….................................... 34

Figure 4. Raw mechanical pain thresholds of ASD and reference groups …………….................................... 35

Figure 5. ASD group mean pain ratings for tactile (brush, cotton wisp, Q-tip) and mechanical pain (pinprick)

stimuli at thenar eminence and hand dorsum sites ………........................................................................ 36

Figure 6. Mean thermal detection thresholds of ASD and reference groups …………................................... 37

Figure 7. Raw mechanical detection thresholds of ASD and reference groups ………................................... 38

Figure 8. Z-scores of individual ASD participants for core QST parameters …………................................... 40

Figure 9. Auditory sensitivity of ASD group and neurotypical control participant ……............................... 41

Figure 10. Mean suprathreshold pain ratings of ASD group and neurotypical control participant ............... 42

Figure 11. Mean thermal grill pain ratings of ASD group and neurotypical control participant ................... 43

Figure 12. Individual hedonic ratings of ASD group and neurotypical control participant .......................... 44

About this Honors Thesis

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School	Emory College
Department	Neuroscience and Behavioral Biology
Degree	B.S.
Submission	Honors Thesis
Language	English
Research Field	Psychology, Clinical Biology, Neuroscience Biology, Physiology
Keyword	Autism spectrum disorder Sensory sensitivity Pain
Committee Chair / Thesis Advisor	Ousley, Opal, Emory University Harper, Daniel, Emory University
Committee Members	Hamann, Stephan, Emory University Walker, Elaine, Emory University Roesch, Leah, Emory University

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