By MILANO Melissa M2 PEADID
Role of the Verbal Level on the Expression and Evaluation of Pain in People with Intellectual Disabilities
M. Zabalia, D. Jacquet & L.M. Breau University of Caen
1. Introduction
Previous studies have shown that children with disabilities (i.e., multiple disabilities, intellectual disabilities, etc.) have a pain sensation often misinterpreted, so poorly treated. Some of these studies have demonstrated that children with multiple disabilities, and therefore unable to communicate through speech, exhibited specific behaviours when they felt a pain, for example: analgesic position, increased muscle tone, etc. Children with intellectual disabilities have delayed language development (i.e., phonology, syntax and lexical), which can bring about some difficulties in expressing pain. Indeed, many studies have focused on a direct link between language development and what is called cognitive development, that is, more generally, the intellectual level. However, this theory is controversial in the literature, so the study of M. Zabalia, D. Jacquet, and L. M. Breau aims to examine the role of the verbal level in the expression of pain in children with intellectual disabilities.
2. Method
In order to carry out this study, authors interviewed 14 children around age 15 with intellectual disabilities. Seven of them disclosed a moderate intellectual impairment, with an overall intelligence quotient between 45 and 52, and a verbal intelligence quotient between 46 and 50. The remaining seven children revealed a mild intellectual disability with an overall intelligence quotient between 54 and 70, and a verbal intelligence quotient between 54 and 64. These intellectual quotients have been measured using psychometric tools such as WISC-III (Wechsler Intelligence Scale for Children) and WAIS-R (Wechsler Adult Intelligence Scale). These children had no physical trouble, speech impairment or relational disorders. The causal factors of intellectual impairment vary from subject to subject, for example meningitis, premature birth, an anomaly in the brain, and so on.
The experiment was to present four pictures from a brochure of Sparadrap Association representing four different situations involving a character living a painful experience (i.e., fall, burn, vaccination, etc.). Participants asked to explain what they think about feeling’s characters in each particular situation, and then to assess severity of the pain using Visual Analogue Scales (EVA). This scale from 0 (i.e., no pain) to 10 (i.e., maximum pain) was usable from 5 years. Pain also evaluated by Faces Pain Scale Revised. Following this, the experimenter asked the participants to relate a similar experience (i.e., fall, burn, vaccination, etc.) and to evaluate the pain felt at this time. This is what authors called “reported pain”. For this purpose, the experimenter achieved a list of the vocabulary used by children and carries out a clarifying interview, which was a technique of verbalization in a way aided that related to a real situation. The test lasted about 20 minutes.
3. Results
The results of Visual Analogue Scales (EVA) showed that children rate the intensity of pain at an average of 8.4 in the condition involving images, compared to an average of 7.06 for the intensity of reported pain, based on their own personal experience.
The assessment of pain intensity using Faces Pain Scales Revised is 7.9 on average in the image-producing condition, compared to an average of 5.96 for reported pain.
There was a different meaning when assessing the intensity of the pain experienced by a fictional character on an image and the assessment of the intensity of reported pain regarding a personal experience. Severity of pain about characters on pictures tended to be overestimated compared to reported pain. We also noted that there was more extreme ratings for Visual Analog Scales (EVA) than for Faces Pain Scale Revised, but also that this was more common in children with moderate intellectual disabilities. Participants with a moderate verbal intelligence quotient tended to overestimate pain intensities in comparison with participants with a low verbal intelligence quotient, except for reported pain associated with vaccination situation.
There was no significant differences in the lexicon used between participants with low verbal intelligence quotient and those with moderate verbal intelligence quotient. Indeed, children used six words approximatively, to describe the pain and its intensity.
4. Conclusion
