Understanding the impacts of chronic pain on autistic adolescents and effective pain management: a reflexive thematic analysis adolescent–maternal dyadic study

Jordan, A., Parchment, A., Gauntlett‐Gilbert, J., Jones, A., Donaghy, B., Wainwright, E., Connell, H., Walden, J., & Moore, D. (2024). Understanding the impacts of chronic pain on autistic adolescents and effective pain management: a reflexive thematic analysis adolescent–maternal dyadic study. Journal of Pediatric Psychology, 49(3), 185-194. https://doi.org/10.1093/jpepsy/jsae004

Publication date: 7 Feb 2024 Added to AutiHub: 5 Jul 2026 Type: Article Article language: English

This publication is integrated into AutiHub through:

Authors

Publication authors
9
Publication authors identified as autistic
1 / 9 (11.1%)

Abstract

OBJECTIVE: Sensory elements are core features in chronic pain and autism, yet knowledge of the pain experience in autistic adolescents is limited. Little is known regarding how autistic adolescents experience chronic pain, manage their pain and perceive psychological treatment for their chronic pain. METHODS: Ten autistic adolescents (6 female, 3 male, and 1 self-identified as agender) with chronic pain and their mothers (n = 10) participated in semistructured interviews concerning their perceptions of living with chronic pain. Participants were recruited from U.K. pain management services. According to preference, interviews were conducted individually (n = 10) or dyadically (n = 10 participants across 5 dyads). Data were analyzed using inductive reflexive thematic analysis. RESULTS: Two themes were generated. Theme 1, "overstimulated and striving for control" described how adolescents' experience of heightened sensitivity enhanced adolescents' levels of anxiety and subsequent pain, illustrating a reciprocal relationship between anxiety, pain, and sensory elements. Theme 2, "not everyone fits the mold" captured how autistic adolescents positioned themselves as distinct from others due to the unique nature of being autistic and living with pain. This sense of difference negatively impacted adolescents' ability to engage with and benefit from the standard treatment for chronic pain. CONCLUSIONS: Findings suggest that autistic adolescents living with pain experience pain and face barriers to effective pain treatment. Our results identify the need for educational resources to facilitate clinicians to better understand the experience of autistic adolescents living with pain. In turn, such understanding may improve treatment and outcomes in this population.

Bibliography cited by this reference

Cited references are imported from external metadata sources when they are available. The list may be partial.

Bibliography inclusion overview

These indicators describe the cited bibliography imported for this publication. Cited-reference metrics use the cited-reference total as denominator. Cited-author metrics state whether they use all cited-author occurrences or only occurrences linked to authors already integrated in the AutiHub database. They use cached links between cited authors and authors integrated in the AutiHub database. Last computed: 16 Aug 2026 11:30.

Cited references
56
Total cited references integrated for this publication.
Cited references with an identified autistic author
5 / 56 (8.9%)
Cited author occurrences identified as autistic
7 / 219 (3.2%)
Among occurrences linked to AutiHub author records: 7 / 62 (11.3%). Distinct cited authors identified as autistic: 6 / 190 (3.2%).
Cited author occurrences linked to AutiHub author records
62 / 219 (28.3%)
Distinct linked cited authors: 49 / 190 (25.8%)
Linked cited-author occurrences not identified as autistic
55 / 62 (88.7%)
Among linked cited-author occurrences only. Across all cited-author occurrences: 55 / 219 (25.1%). Distinct linked cited authors not identified as autistic: 43 / 49 (87.8%).
  1. Ronald S. Kaiser , Mira Mooreville , Kamini Kannan (2015). Psychological Interventions for the Management of Chronic Pain: a Review of Current Evidence . Current Pain and Headache Reports, 19(9), 43. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  2. C. S. Allely (2013). Pain Sensitivity and Observer Perception of Pain in Individuals with Autistic Spectrum Disorder . The Scientific World Journal, 2013(1), 916178-916178. Wiley.
    Crossref OpenAlex OpenCitations
  3. Sarah Wigham , Jacqui Rodgers , Mikle South , Helen McConachie , Mark Freeston (2015). The Interplay Between Sensory Processing Abnormalities, Intolerance of Uncertainty, Anxiety and Restricted and Repetitive Behaviours in Autism Spectrum Disorder . Journal of Autism and Developmental Disorders, 45(4), 943-952. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  4. Andrew K. Shenton (2004). Strategies for ensuring trustworthiness in qualitative research projects . Education for Information, 22(2), 63-75. SAGE Publications.
    Crossref OpenAlex OpenCitations
  5. González Moreno, Andrés Santiago (2013). Diagnostic and Statistical Manual of Mental Disorders . American Psychiatric Association.
    Crossref OpenAlex OpenCitations
  6. Abigail Jones , Line Caes , C Meghan McMurtry , Christopher Eccleston , Abbie Jordan (2021). Sociodevelopmental Challenges Faced by Young People with Chronic Pain: A Scoping Review . Journal of Pediatric Psychology, 46(2), 219-230. Oxford University Press (OUP).
    Crossref OpenAlex OpenCitations
  7. Emma Fisher , Emily Law , Tonya M Palermo , Christopher Eccleston (2015). Psychological therapies (remotely delivered) for the management of chronic and recurrent pain in children and adolescents . Cochrane Database of Systematic Reviews, 4(3), CD011118-CD011118. Wiley.
    OpenAlex
  8. Leonie J. T. Balter , Camilla Wiwe Lipsker , Rikard K. Wicksell , Mats Lekander (2021). Neuropsychiatric Symptoms in Pediatric Chronic Pain and Outcome of Acceptance and Commitment Therapy . Frontiers in Psychology, 12, 576943. Frontiers Media SA.
    Crossref OpenAlex OpenCitations
  9. Caitlin B. Murray , Cornelius B. Groenewald , Rocio de la Vega , Tonya M. Palermo (2020). Long-term impact of adolescent chronic pain on young adult educational, vocational, and social outcomes . Pain, 161(2), 439-445. Ovid Technologies (Wolters Kluwer Health).
    Crossref OpenAlex OpenCitations
  10. Robert Elliott , Constance T. Fischer , David L. Rennie (1999). Evolving guidelines for publication of qualitative research studies in psychology and related fields . British Journal of Clinical Psychology, 38(3), 215-229. Wiley.
    Crossref OpenAlex OpenCitations
  11. Sarah Bargiela , Robyn Steward *Autistic author. Learn more… , Will Mandy (2016). The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype . Journal of Autism and Developmental Disorders, 46(10), 3281-3294. Springer Science and Business Media LLC.
    AutiHub · Autistic Scholars Crossref OpenAlex OpenCitations
  12. Reuven Dar , Dennis T. Kahn , Ran Carmeli (2012). The relationship between sensory processing, childhood rituals and obsessive–compulsive symptoms . Journal of Behavior Therapy and Experimental Psychiatry, 43(1), 679-684. Elsevier BV.
    Crossref OpenAlex OpenCitations
  13. Ayelet Ben-Sasson , Eynat Gal , Ronen Fluss , Neta Katz-Zetler , Sharon A. Cermak (2019). Update of a Meta-analysis of Sensory Symptoms in ASD: A New Decade of Research . Journal of Autism and Developmental Disorders, 49(12), 4974-4996. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  14. Erin Rotheram‐Fuller , Laura MacMullen (2011). Cognitive‐behavioral therapy for children with autism spectrum disorders . Psychology in the Schools, 48(3), 263-271. Wiley.
    Crossref OpenAlex OpenCitations
  15. Virginia Braun , Victoria Clarke (2019). Reflecting on reflexive thematic analysis . Qualitative Research in Sport, Exercise and Health, 11(4), 589-597. Informa UK Limited.
    Crossref OpenAlex OpenCitations
  16. Kate Cooper , M.E. Loades , Ailsa Russell (2018). Adapting psychological therapies for autism . Research in Autism Spectrum Disorders, 45, 43-50. Elsevier BV.
    Crossref OpenAlex OpenCitations
  17. John Sturgeon (2014). Psychological therapies for the management of chronic pain . Psychology Research and Behavior Management, 7, 115. Informa UK Limited.
    Crossref OpenAlex OpenCitations
  18. Virginia Braun , Victoria Clarke (2021). Can I use TA? Should I use TA? Should I not use TA? Comparing reflexive thematic analysis and other pattern‐based qualitative analytic approaches . Counselling and Psychotherapy Research, 21(1), 37-47. Wiley.
    Crossref OpenAlex OpenCitations
  19. Micah Mazurek , Paul Shattuck , Mary Wagner , Benjamin P. Cooper (2012). Prevalence and Correlates of Screen-Based Media Use Among Youths with Autism Spectrum Disorders . Journal of Autism and Developmental Disorders, 42(8), 1757-1767. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  20. Virginia Braun , Victoria Clarke (2022). Thematic Analysis . In Encyclopedia of Quality of Life and Well-Being Research (pp. 1-7). Springer International Publishing.
    Crossref OpenAlex
  21. Jonathan A. Smith (1996). Beyond the divide between cognition and discourse: Using interpretative phenomenological analysis in health psychology . Psychology & Health, 11(2), 261-271. Informa UK Limited.
    Crossref OpenAlex OpenCitations
  22. Inese Gobina , Jari Villberg , Raili Välimaa , Jorma Tynjälä , Ross Whitehead , Alina Cosma et al. (2019). Prevalence of self‐reported chronic pain among adolescents: Evidence from 42 countries and regions . European Journal of Pain, 23(2), 316-326. Wiley.
    Type: Article DOI: 10.1002/ejp.1306 OpenAlex: https://openalex.org/W2885855098
    Crossref OpenAlex OpenCitations
  23. Emily M. Istvan , Rose E. Nevill , Micah Mazurek (2020). Sensory over-responsivity, repetitive behavior, and emotional functioning in boys with and without autism spectrum disorder . Research in Autism Spectrum Disorders, 75, 101573. Elsevier BV.
    Crossref OpenAlex OpenCitations
  24. David H. Skuse , Will Mandy , Jane Scourfield (2005). Measuring autistic traits: heritability, reliability and validity of the Social and Communication Disorders Checklist . British Journal of Psychiatry, 187(6), 568-572. Royal College of Psychiatrists.
    Crossref OpenAlex OpenCitations
  25. Daniel G. Whitney , Danielle N. Shapiro (2019). National Prevalence of Pain Among Children and Adolescents With Autism Spectrum Disorders . JAMA Pediatrics, 173(12), 1203. American Medical Association (AMA).
    Crossref OpenAlex OpenCitations
  26. Rinat Gold , Miriam Faust , Abraham Goldstein (2010). Semantic integration during metaphor comprehension in Asperger syndrome . Brain and Language, 113(3), 124-134. Elsevier BV.
    Crossref OpenAlex OpenCitations
  27. Jillian C Sullivan , Lucy J Miller , Darcy M Nielsen , Sarah A Schoen (2014). The presence of migraines and its association with sensory hyperreactivity and anxiety symptomatology in children with autism spectrum disorder . Autism, 18(6), 743-747. SAGE Publications.
    Crossref OpenAlex OpenCitations
  28. Jeremy Gauntlett‐Gilbert , Hannah Connell , Jacqui Clinch , Lance M. McCracken , G. Deml , Mark Varrelmann et al. (2013). Acceptance and Values-Based Treatment of Adolescents With Chronic Pain: Outcomes and Their Relationship to Acceptance . Journal of Pediatric Psychology, 38(1), 72-81. Oxford University Press (OUP).
    Crossref OpenAlex OpenCitations
  29. Emma Fisher , Lauren C Heathcote , Christopher Eccleston , Laura E Simons , Tonya M Palermo (2018). Assessment of Pain Anxiety, Pain Catastrophizing, and Fear of Pain in Children and Adolescents With Chronic Pain: A Systematic Review and Meta-Analysis . Journal of Pediatric Psychology, 43(3), 314-325. Oxford University Press (OUP).
    Crossref OpenAlex OpenCitations
  30. Camilla Wiwe Lipsker , Sven Bölte , Tatja Hirvikoski , Mats Lekander , Linda Holmström , Rikard K. Wicksell (2018). Prevalence of autism traits and attention-deficit hyperactivity disorder symptoms in a clinical sample of children and adolescents with chronic pain . Journal of Pain Research, Volume 11, 2827-2836. Informa UK Limited.
    Crossref OpenAlex OpenCitations
  31. David Moore (2015). Acute pain experience in individuals with autism spectrum disorders: A review . Autism, 19(4), 387-399. SAGE Publications.
    Crossref OpenAlex OpenCitations
  32. Emma Fisher , Emily Law , Joanne Dudeney , Christopher Eccleston , Tonya M Palermo (2019). Psychological therapies (remotely delivered) for the management of chronic and recurrent pain in children and adolescents . Cochrane Database of Systematic Reviews, 4(4), Cd011118. Wiley.
    Crossref OpenAlex
  33. Carly Johnco , Eric A. Storch (2015). Anxiety in youth with autism spectrum disorders: implications for treatment . Expert Review of Neurotherapeutics, 15(11), 1343-1352. Informa UK Limited.
    Crossref OpenAlex OpenCitations
  34. Abbie Jordan , Myfanwy Williams , Abigail Jones , Melanie Noel , Alexandra Neville , Jacqueline Clinch et al. (2023). Pediatrician Explanations of Pediatric Pain in Clinical Settings: A Delicate Craft . The Journal of Pain, 24(8), 1396-1405. Elsevier BV.
    Crossref OpenAlex OpenCitations
  35. Kirsti Malterud , Volkert Dirk Siersma , Ann Dorrit Guassora (2016). Sample Size in Qualitative Interview Studies . Qualitative Health Research, 26(13), 1753-1760. SAGE Publications.
    Crossref OpenAlex OpenCitations
  36. Sarah Hampton , Carrie Allison , Simon Baron-Cohen , Rosemary Holt (2023). Autistic People’s Perinatal Experiences II: A Survey of Childbirth and Postnatal Experiences . Journal of Autism and Developmental Disorders, 53(7), 2749-2763. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  37. Tamara Kalandadze , Courtenay Norbury , Terje Nærland , Kari-Anne B Næss (2018). Figurative language comprehension in individuals with autism spectrum disorder: A meta-analytic review . Autism, 22(2), 99-117. SAGE Publications.
    Crossref OpenAlex OpenCitations
  38. Hannes (2011). Supplementary guidance for inclusion of qualitative research in Cochrane Systematic Reviews of Interventions . Supplementary guidance for inclusion of qualitative research in Cochrane Systematic Reviews of Interventions.
    Type: Other
    Crossref
  39. Mike K Kemani , Marie Kanstrup , Abbie Jordan , Line Caes , Jeremy Gauntlett‐Gilbert (2018). Evaluation of an Intensive Interdisciplinary Pain Treatment Based on Acceptance and Commitment Therapy for Adolescents With Chronic Pain and Their Parents: A Nonrandomized Clinical Trial . Journal of Pediatric Psychology, 43(9), 981-994. Oxford University Press (OUP).
    Crossref OpenAlex OpenCitations
  40. Victoria Clarke , Virginia Braun (2014). Thematic Analysis . In Encyclopedia of Critical Psychology (pp. 1947-1952). Springer New York.
    OpenCitations
  41. Chetna Sethi , Clare Harrop , Wanqing Zhang , Jill Pritchett , Allison Whitten , Brian A Boyd (2019). Parent and professional perspectives on behavioral inflexibility in autism spectrum disorders: A qualitative study . Autism, 23(5), 1236-1248. SAGE Publications.
    Crossref OpenAlex OpenCitations
  42. Gabriella Jones , Vinay Shivamurthy (2022). OA02 Paediatric chronic pain and Autism Spectrum Disorder: is there a link? Rheumatology Advances in Practice, 6(Supplement_1). Oxford University Press (OUP).
    Crossref OpenAlex OpenCitations
  43. Srinivasa N. Raja , Daniel B. Carr , Milton Cohen , Nanna B. Finnerup , Herta Flor , Stephen Gibson et al. (2020). The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises . Pain, 161(9), 1976-1982. Ovid Technologies (Wolters Kluwer Health).
    Crossref OpenAlex OpenCitations
  44. Sarah Vaughan , Francis McGlone , Helen Poole , David Moore (2020). A Quantitative Sensory Testing Approach to Pain in Autism Spectrum Disorders . Journal of Autism and Developmental Disorders, 50(5), 1607-1620. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  45. Leann Smith DaWalt , Jinkuk Hong , Jan S Greenberg , Marsha R Mailick (2019). Mortality in individuals with autism spectrum disorder: Predictors over a 20-year period . Autism, 23(7), 1732-1739. SAGE Publications.
    Crossref OpenAlex OpenCitations
  46. Jun Liu , Lucy L. Chen , Shiqian Shen , Jianren Mao , Maria Lopes , Siyu Liu et al. (2020). Challenges in the Diagnosis and Management of Pain in Individuals with Autism Spectrum Disorder . Review Journal of Autism and Developmental Disorders, 7(4), 352-363. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  47. Janet Harris (2011). Supplementary Guidance for Inclusion of Qualitative Research in Cochrane Systematic Reviews of Interventions .
    Type: Article OpenAlex: https://openalex.org/W2980356892
    OpenAlex
  48. Stephanie Petty , Milja-Leea Bergenheim , Georgina Mahoney , Lucy Chamberlain (2023). Adapting services for autism: Recommendations from a specialist multidisciplinary perspective using freelisting . Current Psychology, 42(9), 7489-7500. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  49. Morgan Brett (2022). How to do qualitative interviewing . How to do qualitative interviewing.
    Type: Other
    Crossref
  50. Debbe Thompson , Janet A Deatrick , Kathleen A Knafl , Veronica M Swallow , Yelena P Wu (2022). A Pragmatic Guide to Qualitative Analysis for Pediatric Researchers . Journal of Pediatric Psychology, 47(9), 1019-1030. Oxford University Press (OUP).
    Crossref OpenAlex OpenCitations
  51. QSR International NVivo 12 (2022). 2024032020165982000_jsae004-B38
    Type: Other
    Crossref
  52. Qualtrics (2022). Online computer software . Online computer software.
    Type: Other
    Crossref