Related Experiment Videos
Relation between pain and self-injurious behavior in nonverbal children with severe cognitive impairments
Lynn M Breau1, Carol S Camfield, Frank J Symons
1Pediatric Pain Research Laboratory, Division of Child Neurology, Pediatric Pain Management Service, Halifax, Nova Scotia, Canada. lbreau@ns.sympatico.ca
Insights
Self-injurious behavior (SIB) in children with severe cognitive impairments does not reduce pain expression. Chronic pain may influence the frequency and location of self-injurious behavior.
Area of Science:
- Pediatric Psychology
- Neurodevelopmental Disorders
- Pain Management
Background:
- Self-injurious behavior (SIB) is a concern in children with severe cognitive impairments.
- The relationship between SIB and pain expression in this population is not well understood.
- Chronic pain may influence the manifestation of SIB.
Purpose of the Study:
- To investigate if self-injurious behavior (SIB) affects pain expression in children with severe cognitive impairments.
- To explore the association between SIB and chronic pain in this vulnerable group.
Main Methods:
- Caregivers of 101 nonverbal children (3-18 years) completed the Non-Communicating Children's Pain Checklist-Revised (NCCPC-R).
- Data on SIB, behavior problems, and pain were collected using validated questionnaires.
- Multivariate analysis of variance and t tests were used to analyze the data.
Main Results:
- Pain expression, measured by NCCPC-R scores, did not differ between children with and without SIB.
- Children with chronic pain self-injured less body surface and fewer body sites.
- Two forms of SIB were identified: high frequency SIB to head/hand without chronic pain, and less frequent SIB near pain sites.
Conclusions:
- SIB in children with severe cognitive impairments is not associated with reduced pain expression.
- Chronic pain appears to influence the frequency and location of SIB.
- Further research is needed to guide the management of SIB and pain in these children.
Objectives:
To explore whether self-injurious behavior (SIB) alters pain expression in children with severe cognitive impairments and the relation between SIB and chronic pain.
Study Design:
Caregivers of 101 nonverbal children 3 to 18 years of age (55% boys) completed the Non-Communicating Children's Pain Checklist-Revised (NCCPC-R) retrospectively and for an observed pain episode. Caregivers of children with SIB (n = 44) completed the Behavior Problems Inventory, the Self-Injury Grid, and the Self-Injury and Self-Restraint Checklist.
Results:
Multivariate analysis of variance indicated that NCCPC-R scores did not differ between children with and those without SIB. However, t tests indicated that children with chronic pain (n = 13) self-injured less body surface (P =.01) and fewer body sites (P =.04) than did children without (n = 31). Multiple Correspondence Analysis generated 2 dimensions (49% variance), suggesting a distinction between two SIB forms: (1) high frequency of SIB to the head/hand and absence of chronic pain and (2) less frequent SIB near the site of pain.
Conclusions:
Children with severe cognitive impairments who display SIB do not have reduced pain expression, and chronic pain may influence the frequency and location of SIB. Further research should examine the usefulness of these findings for management of SIB and pain.