Theme ‘touch and pain’

‘Touch and pain’ is a theme in the chapter ‘interior design’ (See The recommendations). Many people on the spectrum are over- or under-sensitive to pain, something which architects and others who deal with people with autism need to  know.

Abnormal pain experiences are poorly understood, especially in autistic children. There is relatively little empirical knowledge about it according to Nader et al.  These authors remark that much of the scarce research which does exist is unreliable because it makes use of the parents’ impressions of their child’s pain experiences which aren’t very adequate. Autistic children appear less inclined to communicate about their pain and/or to look for comfort. Therefore parents have a tendency to underestimate the pain of their autistic children.

An important hypothesis is that the so-called opioid system is hyperactive in children on the spectrum. This system acts, among other things, to relieve or suppress pain. This hypothesis is controversial; both the aforementioned Nader et al. and Tordjman et al. reject the opioid hypothesis. However, clinical experience doesn’t support the more or less ‘opposite’ hypothesis, that people on the spectrum experience pain the same way as neurotypicals but express it differently, either.

Dutch researchers Huisman & Visser who interviewed people about their living experiences, say that clear-cut solutions for oversensitive touch do not exist:
“because this problem is very diverse. Some children with autism have trouble touching a younger sibling, or don’t want to be touched themselves. It’s very important to respect this and not hug the child. If objects are concerned, the material plays a big part. People with autism are often sensitive to wool. Woolen blankets can be replaced by a cotton duvet or be rolled into a duvet cover.”

A high pain threshold (or under-sensitivity) is apparently so common for people with autism that it’s included in the psychiatric handbook DSM.

We hasten to add that oversensitive touch also occurs, and so can – in other words – be a case of hypersensitivity. Temple Grandin for instance wrote ‘overly sensitive skin can be a big problem. Shampooing actually hurt my skin. To be lightly touched appeared to make my nervous system whimper, as if the nerve ends were curling up.’

A collaborator of the Kannerhuis says:
“disturbed pain reactions – the amplified or reduced perception of pain stimuli – can lead to a reduced perception of heat (and of the blisters too) and of pain as a signal of disease. Also, an inability to recognize when a specific pain occurs: after a very demanding skating trip a boy wakes up in pain. In a panic he calls his parents because he thinks he is seriously ill. When one of his carers inquires some more, he discovers it is a muscle-ache.”

All these insights are relevant for architecture as it relates to autism in two ways:
It’s important to minimize the risk of injury when constructing, installing or decorating walls, furniture, play-installations etcetera. Make sure the conditions – such as the very essential sightlines – for supervision are met.

Since the theme of ‘touch and pain’ is particularly relevant in schools, it’s treated separately here.
Also there is a personal account from someone who had such trouble on a daily basis.


Nader, Rami, Tim F. Oberlander, Christine T. Chambers., Kenneth D., Craig, ‘Expression of Pain in Children With Autism’, In: Clinical Journal of Pain, 20(2004) 2(March/April) 88-97.
Tordjman, Sylvie, George M. Anderson, Michel Botbol1, et al., ‘Pain Reactivity and Plasma b-Endorphin in Children and Adolescents with Autistic Disorder’, In: Plos One, 4(2009) 8(August) 1-10.)
Huisman & Visser
Nisette and Joke Visser, ‘Resultaten van het onderzoek naar omgevingsinvloeden (3)’, In: Engagement (2008) 5 (oktober/november) 24-26.
KannerhuisTemple Grandin
Grandin, T., ‘My experiences with visual thinking, sensory problems and communication difficulties.’ The Center for the Study of Autism. 1996.