Poor Sakura Vol 1 Download.epub

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Vaniria Setser

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Jun 29, 2024, 10:45:55 AM6/29/24

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The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) recently included sensory processing abnormalities in the diagnostic criteria for individuals with autism spectrum disorder (ASD). However, there is no standard method for evaluating sensory abnormalities in individuals with ASD.

Fifteen individuals with ASD and 15 age- and sex-matched controls were enrolled in this study. We compared objective pain sensitivity by measuring the pain detection threshold and pain tolerance to three different stimuli (electricity, heat, and cold). Then, we compared both subjective pain sensitivity, assessed by the visual analog scale (VAS), and quality of pain, assessed by the short-form McGill Pain Questionnaire (SF-MPQ), to determine the maximum tolerable pain intensities of each stimulation.

Poor Sakura Vol 1 Download.epub

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Our results suggest that the cognitive pathways for pain processing are impaired in ASD and, furthermore, that our methodology can be used to assess pain sensitivity in individuals with ASD. Further investigations into sensory abnormalities in individuals with ASD are needed to clarify the pathophysiologic processes that may alter sensory processing in this disorder.

Autism spectrum disorder (ASD) is a neuro developmental condition characterized by compromised social interactions, reduced verbal communication, stereotyped repetitive behaviors, and restricted interests [1]. The prevalence of ASD has increased to 1.0 % worldwide [2, 3]. However, the cognitive basis for ASD remains poorly understood and, as with other psychiatric disorders, the defining criteria are difficult to establish and measure objectively. The latest diagnostic criteria for ASD in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) include the category of sensory abnormalities. However, no standard method exists to assess these symptoms in ASD. The ability to directly measure the degree to which sensory abnormalities exist in individuals with ASD would help to better define the severity of the disorder as well as the effectiveness of treatment options.

These previous studies employed different types of stimulation and different assessment tools. Therefore, the inconsistent results may have been due to different methodologies. Moreover, these studies did not distinguish subjective pain sensitivity from sensory perceptions [12]. Previously, investigators relied on direct or indirect stimulation. Experimental stimulation with instruments detected sensory thresholds but did not detect subjective pain sensitivity [19]. Other examples of direct stimulation included venipuncture [4] and dental care [6]. The levels of administered stimulation also differed across participants. The indirect forms of stimulation applied in the previous reports depended on imagining painful situations [12]. Moreover, although pain is a subjective experience, most previous reports assessed pain sensitivity among individuals with ASD using observer reports [12].

To examine whether individuals with ASD have impaired sensory perception, subjective pain sensitivity or both, we first compared the pain detection thresholds and pain tolerance in these individuals compared with those of controls. Then, we defined the intensity at which each stimulation led to pain. Next, we compared the quantity and quality of subjective pain sensitivities to maximum stimulation levels between groups. Subjective pain sensitivities were assessed to avoid observer bias. We used two of the most popular assessment tools to evaluate subjective pain sensitivity: the visual analog scale (VAS) [25] and the short form of the McGill Pain Questionnaire (SF-MPQ) [26], both of which are brief. The VAS assesses subjective pain intensity, and the SF-MPQ provides data regarding pain intensity and pain type [26]. Thus, we assessed the characteristics of pain sensitivity among individuals with ASD.

We obtained data from patients with ASD from the research bio-resource of the Human Brain Phenotype Consortium in Japan ( -web.sakura.ne.jp/consortium.html). Each patient with ASD was diagnosed by at least two trained child psychiatrists using the DSM-5 criteria. The participants were screened for comorbid psychiatric diagnoses and neurological disorders that might affect somatosensation. The diagnoses were based on unstructured or semi-structured behavioral observations of the patients as well as interviews with the patients and their parents or caregivers, as previously described [27]. In addition, the Autism Diagnostic Interview-Revised (ADI-R) [28], the Pervasive Developmental Disorders Autism Society Japan Rating Scale (PARS) [29], and the AQ-J [30] were used to evaluate ASD-specific behaviors and symptoms, as previously described [27]. Patients were recruited at Osaka University Hospital.

A previous report provided a detailed description of the healthy controls [31]. Controls were recruited through advertisements or silver centers. These participants were excluded if they had neurological, psychiatric, or chronic pain disorders. Individuals taking psychotropic or analgesic drugs during the course of the study were also excluded.

When participants could no longer endure the stimulus, stimulation was immediately stopped. Therefore, the methodology for pain tolerance was non-invasive and left no after-effects on the participants. The study was approved by the ethics committee at Osaka University. We obtained informed consent from all individuals regarding the methodology.

To our knowledge, this is the first report to investigate sensory abnormalities related to pain in individuals with ASD using well-controlled stimulations. We distinguished physical sensory thresholds from subjective sensitivities to determine whether sensory abnormalities were based on the perception or recognition of certain stimulations. Then, we compared the subjective pain sensitivities between groups with regard to painful stimulations. We found that the sensory perception of pain was not impaired in individuals with ASD. However, individuals with ASD had hyposensitive subjective pain sensitivities compared to controls. These results suggest that individuals with ASD have impaired cognitive processing with regard to pain. This finding was most clearly observed with regard to the electrical stimulations. Using this method, we identified characteristics of pain sensitivity among individuals with ASD.

There are two possible causes for this latter observation. One possibility is that the differences were due to earlier detection in individuals with ASD. Another possibility is that individuals with ASD might push the button earlier than the controls, regardless of their detection threshold. This latter hypothesis is inconsistent with many reports that have suggested the presence of motor dyspraxia or clumsiness in individuals with ASD [36]. Furthermore, between-group differences did not exist in the minimum detection thresholds with regard to heat stimulation (Fig. 1b), suggesting that participants with ASD responded appropriately. These results suggest that individuals with ASD are hypersensitive to weak electrical and cold stimulations. Because our sample size was small, additional investigations with a larger sample size are warranted. The VAS scores for discomfort differed across stimulation types. Thus, the unpleasantness associated with strong stimulations among individuals with ASD differs across stimulation types.

Several tools are available to assess pain sensitivity in individuals with ASD. Sensory symptoms have often been evaluated in children with ASD using caregiver reports [8, 9]. One of the most common sensory measurements for individuals with ASD is the sensory profile (SP) [37]. Individuals with ASD might not express their pain sensitivity in the same way as typically developing individuals [12]. Individuals with ASD have less intense reactions than controls [3], which have been interpreted as indicating a lack of sensitivity [3, 22]. Thus, caregiver reports might be inaccurate representations of pain sensitivity in individuals with ASD. In addition, several self-reports have been created. The adolescent/adult SP (AASP), which was developed from the original SP [38], contains questions regarding other factors that might influence sensory experiences and affective reactions [39]. Both the AASP and the Sensory Over-Responsivity Scale have a similar problem [39], which is their dependence on the recall of sensitive situations. Therefore, these assessments can result in inaccurate answers because of ambiguous memories. Moreover, stimulation intensities are not always strong enough to cause pain, and they can differ across participants. To investigate pain in individuals with ASD, then, it is essential to evaluate both physical pain thresholds and subjective pain sensitivities using a sufficient number of stimulation types to ensure that pain has been evoked. Moreover, the assessment of pain itself is important. Our current methodology was able to resolve all of these problems.

Inconsistencies exist between this study and previous reports. One study reported that pain detection sensitivities for cold and heat stimulation were more sensitive among individuals with ASD than controls [19]. Because our groups included approximately twice as many participants as this study [19], these inconsistencies may have been due to difference in sample size.

We also measured the quality of pain sensitivity in this study. The affective aspects of subjective pain sensitivities of individuals with ASD were less intense than those of controls. Previously, the distress caused by sensory processing dysfunctions among individuals with ASD has led to self-injurious and aggressive behaviors [40]. Hypersensitivity is often correlated with increased anxiety [8]. Therefore, we hypothesized that the affective aspects of pain sensitivity would be high among individuals with ASD. On the contrary, these individuals reported lower levels of the affective aspects of pain than controls. However, individuals with ASD might have hypersensitive minimum detection thresholds. Our results suggest that the hypersensitivity to weak stimulations among individuals with ASD provokes strong reactions. Previous reports have shown that individuals with ASD have poor emotional control [41], which supports our findings.