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Published on: June 10, 2013
Children's Behavioral Pain Cues: Implicit Automaticity and Control Dimensions in Observational Measures
Kamal Kaur Sekhon1, Samantha R Fashler2, Judith Versloot3
1School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA.
Insights
This study found that children's pain behaviors can be categorized as automatic, controlled, or ambiguous. This distinction helps understand how pain is expressed and perceived in children.
Area of Science:
- Pediatric Psychology
- Pain Management
- Behavioral Science
Background:
- Pain behaviors in children are often observed, but their underlying control mechanisms (automatic vs. voluntary) are not fully understood.
- Existing observational pain measures may not adequately differentiate between these types of pain expressions.
Purpose of the Study:
- To investigate whether pain behaviors in children aged 4-12 can be classified as automatic or controlled.
- To identify distinct categories of pain cues used in observational pain assessment tools for children.
Main Methods:
- A systematic literature search identified 66 pain behavior items from 21 studies on children's observational pain assessment tools.
- 277 participants rated these items on scales measuring automaticity and control.
- Factor analysis was used to group the pain behavior items.
Main Results:
- Factor analysis revealed three distinct factors: 'Automatic' (e.g., facial expressions, vocalizations, consolability), 'Controlled' (e.g., intentional movements, verbalizations, social actions), and 'Ambiguous' (e.g., voluntary facial expressions).
- These findings support a dual-processing model of pain expression in children.
Conclusions:
- Pain behaviors in children can be reliably categorized as automatic, controlled, or ambiguous.
- This classification has implications for understanding pain perception, severity judgments, and the child's social-environmental control strategies.
Abstract:
Some pain behaviors appear to be automatic, reflexive manifestations of pain, whereas others present as voluntarily controlled. This project examined whether this distinction would characterize pain cues used in observational pain measures for children aged 4-12. To develop a comprehensive list of cues, a systematic literature search of studies describing development of children's observational pain assessment tools was conducted using MEDLINE, PsycINFO, and Web of Science. Twenty-one articles satisfied the criteria. A total of 66 nonredundant pain behavior items were identified. To determine whether items would be perceived as automatic or controlled, 277 research participants rated each on multiple scales associated with the distinction. Factor analyses yielded three major factors: the "Automatic" factor included items related to facial expression, paralinguistics, and consolability; the "Controlled" factor included items related to intentional movements, verbalizations, and social actions; and the "Ambiguous" factor included items related to voluntary facial expressions. Pain behaviors in observational pain scales for children can be characterized as automatic, controlled, and ambiguous, supporting a dual-processing, neuroregulatory model of pain expression. These dimensions would be expected to influence judgments of the nature and severity of pain being experienced and the extent to which the child is attempting to control the social environment.
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