BRIEF REPORT Brief Report: Judging Pain Intensity in Children with Autism Undergoing Venepuncture: The Influence of Facial Activity Rosemary L. Messmer Æ Rami Nader Æ Kenneth D. Craig Ó Springer Science+Business Media, LLC 2007 Abstract The biasing effect of pain sensitivity informa- tion and the impact of facial activity on observers’ judgements of pain intensity of children with autism were examined. Observers received information that pain expe- rience in children with autism is either the same as, more intense than, or less intense than children without autism. After viewing six video clips of children with autism undergoing venepuncture, observers estimated pain inten- sity using a visual analogue scale. Facial activity as coded by Chambers et al. (Child Facial Action Coding System Revised Manual, 1996) had a significant impact on observers’ estimates of pain intensity; pain sensitivity information did not. These results have important impli- cations for the assessment and management of pain in children with autism. Keywords Autism Á Pain Á Facial expression Á Observer report Á Biasing information Children inevitably experience pain as part of their everyday lives (McGrath and McAlpine 1993), and they often must depend on caregivers for relief from pain. It is important, therefore, for caregivers to be able to accurately interpret children’s expression of pain in order to provide appropriate care. Unfortunately, accurate pain assessment can be a challenging task, especially in children with aut- ism. The language impairments that characterize this population pose a significant barrier to communicating their pain to others (Nader et al. 2004). As well, there is a belief that children with autism are less sensitive to pain than the average child, and this may bias observers’ interpretation of pain signals in these children. Caregivers may discount or deny signals of distress in children who cannot clearly express their pain (Walco et al. 1994), especially if it is believed that the child does not feel pain. It is important, therefore, to understand the behaviours observers can use to assess pain in children with autism, and to understand the potential bias of pain sensitivity information on judgements of pain in these children. The sociocommunicative model of pain was developed by Craig et al. (1996) to help explain how pain in children is experienced, expressed, and interpreted by others. According to the model, the communication of pain begins with the child’s experience of pain (1) this experience influences the encoding of pain expressions by the child, (2) these pain expressions are broadcast to observers, who then can decode the child’s pain, (3) and potentially take action to alleviate the child’s pain (4) this model can be used to help understand pain in children with autism. The model takes into account that there are many ways that a child can encode their pain experience. Because the sub- stantial impairment in verbal and nonverbal language functions in children with autism impose a significant barrier to pain communication, observers must rely on other modes of communication in order to decode the child’s pain. Facial activity has been found to be a major determinant of observers’ judgements of pain in infants (Hadjistavro- poulos et al. 1994), children (Breau et al. 2001), and adults with cognitive impairments (LaChapelle et al. 1999). Nader et al. (2004) examined the facial pain reactions of children with autism undergoing venepuncture and com- pared them to children without autism undergoing a similar procedure. As well, the researchers compared parents’ R. L. Messmer (&) Á R. Nader Á K. D. Craig Faculty of Education, The University of British Columbia, 2125 Main Mall, Vancouver, BC, Canada V6T 1Z4 e-mail: rmessmer@interchange.ubc.ca 123 J Autism Dev Disord DOI 10.1007/s10803-007-0511-0