Autism and Pain Tolerance: What You Need to Know

My son bangs his head. It’s a stim he’s had since he was a toddler. We try to stop him from hitting his head too hard by placing a pillow between him and hard surfaces, but sometimes we are too late.

He’ll come away with a bump on his head but act like nothing is wrong. It raises questions about autism and pain tolerance.

Many people believe children with autism spectrum disorder have a higher pain tolerance than neurotypical kids. However, it may not be pain tolerance but pain perception that is at play in these scenarios.

It’s important for caregivers to recognize the difference in pain perception and tolerance so our loved ones don’t end up accidentally hurting themselves.

What is pain tolerance and pain perception?

In its simplest terms, pain tolerance is the maximum amount of pain a person can endure before taking action to relieve it.

When I was a child, my friends and I would each hang by our hands from the monkey bars. We would see how long we could tolerate the pain in our arms before letting go of the bar to fall to the ground.

In contrast, pain perception is each person’s experience with unpleasant sensory responses to pain. It tends to be a complex process that involves biological, psychological, and social factors.

Both pain perception and pain tolerance tend to be measured through self-reporting. At the doctor’s office, you might be shown a chart displaying pain levels and asked to show the one that matches your discomfort. Maybe you’ve asked your own child, “On a scale of one to ten, how bad is the pain?”

Caregivers and medical professionals use these self-reporting scales to know how bad an ailment is and what may need to be done to treat it. But do people with autism spectrum disorder have higher or lower levels of pain perception and tolerance?

Autism and pain tolerance: What the research says

For years, it was believed that children with autism spectrum disorder tended to have a higher pain tolerance than neurotypical people.

This altered pain perception appears to be connected to hyposensitivity, as many children with autism appeared to be less sensitive to pain than their neurotypical peers. However, that perception has been changing in recent years.

Studies on pain perception in individuals with autism spectrum disorder reveal intriguing findings. Many on the spectrum have lower pain tolerance and may experience intense pain more frequently than neurotypical individuals, depending on the type of stimuli.

Research shows that people with autism and neurotypical individuals often feel pain from sensory or heat stimuli at similar levels. However, after the pain starts, those with autism usually feel it more intensely and are more likely to develop chronic pain.

High pain tolerance in autism

Some children with autism may still demonstrate a higher pain tolerance than their peers, both neurotypical and on the autism spectrum.

Researchers found some people with autism may have less pain sensitivity due to sensory processing issues. They may need more intense pain stimuli before they begin pain processing, leading to a delayed response.

On top of the lower pain sensitivity, some people with autism spectrum disorder have reduced empathy for pain in others. This may contribute to their high pain threshold. 

People with autism may find it hard to express their pain clearly, even when they feel it. This can make them seem like they have a high pain tolerance because they underestimate their pain.

Low pain tolerance in autism

While some autistic children may appear to have a high pain tolerance, that doesn’t mean everyone on the autism spectrum does. Many children with autism also have a lower pain tolerance and are more sensitive to painful stimuli.

They may experience intense pain at a higher level than their peers and even demonstrate heightened pain responses to minor discomfort.

People with autism may feel pain more intensely and experience it differently from others. This is because their brain’s pain network may respond uniquely, and they might find it hard to explain how much they are hurting.

Signs autistic people may be in pain

Autistic children may struggle to properly communicate when they are in pain, especially if they are nonverbal. It’s up to parents and caregivers to keep a close eye on signs they may present. They can either be behavioral or physiological.

Behavioral signs of pain

Pain sensitivity can lead to increased behavioral reactions in people with autism spectrum disorder. These can include increased stimming, increased aggression, anxiety, withdrawal, and sleep changes.

From a personal perspective, I have experienced almost all of these with my children when they are in pain. My younger son will increase stimming and aggression when he’s in pain, especially stims like head banging.

Meanwhile, my older son demonstrated increased aggression, withdrawal, and anxiety. Both of them may struggle to fall asleep whenever they are in pain.

Physiological signs of pain

Besides behavioral responses, pain sensation can lead to physiological signs in children with autism spectrum disorder. These can include breathing fast, increased heart rate, and gastrointestinal disorders.

Tips for managing pain in autistic people

If people with autism are experiencing pain, it’s important to assist them with pain management. It’s also vital to discuss their pain with a licensed healthcare professional for the best way to treat it.

However, there are some important aspects to remember so the person understands how their caregiver is trying to help them.

Prioritize open communication

Use simple language and visual aids to help the person express pain levels. Be patient and allow them to communicate their pain thresholds to you.

Sensory considerations

It’s important to remember people with autism may have heightened sensory sensitivities. These can impact pain processing for them. It’s a good idea to utilize tools that can help address these sensitivities.

These can include deep pressure therapy or weighted blankets to help provide a calming presence.

If the painful stimuli require medical procedures, parents and caregivers can work with medical professionals to ensure the procedure is conducted in a sensory-friendly environment.

Distraction techniques

Depending on what may be causing people with autism to feel pain, distraction techniques may be necessary. Preferred activities or sensory items may divert their attention away from the pain.

Deep breathing exercises or listening to music are calming strategies that can help divert their attention. They may no longer feel pain or, at least, feel less pain.

Building a better understanding of autism and pain perception

Pain thresholds and sensitivities are different for each individual, whether they are on the autism spectrum or are neurotypical. However, people with autism experience pain processing differently, which can make it seem like they have either higher or lower pain thresholds. Autistic people may struggle with proper ways to communicate how much pain they are experiencing.

Parents and caregivers can work with our loved ones and medical professionals to understand what may be causing them pain and how much pain they can tolerate. It takes a village to keep our loved ones safe, but there’s always a way to work together to address when they feel pain.

FAQs

Q: How does an autistic person react to pain?

A: People with autism can react to pain in many different ways depending on their pain thresholds. They can experience intense pain sensitivity, difficulty communicating the source of the pain, or pain-related anxiety. They may also tolerate extreme heat or cold or even self-harm.

Q: Do neurodivergent individuals feel pain more?

A: While it’s not always the case, researchers found neurodivergent people are more likely to feel pain than the general population. This could be due to several factors, including hypermobility, anxiety related to pain processing, or differences in how the brain responds to pain.

Q: How do autistic people act when they are sad?

A: When feeling sad, autistic children may start exhibiting behaviors that include increased stimming, social withdrawal, changes in routine, irritability, difficulty communicating, and hyperfixation.

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