Can studies of pain help to bridge the gap between sensory and social impairments in autism?

In May of 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM) will release its 5th edition. In this edition, the DSM-IV-TR categories of autistic disorder, Asperger disorder, childhood disintegrative disorder, and pervasive developmental disorder (not otherwise specified) will be combined into a single “autism spectrum disorder” (ASD) category. ASD will be diagnosed according to two symptom domains: “social communication impairment” and “restricted interests/repetitive behaviors.” The latter domain includes an additional feature that involves “hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment” (Huerta et al., 2012). The relationship between the symptom domains that comprise ASD is not well-understood, and it has been suggested that these domains are largely independent (Dworzynski et al., 2009). Unusual sensory processing in ASD may, however, be associated with a disruption in higher-level social processes (Leekam et al., 2007), and therefore the social and sensory features of ASD may be inherently linked. In this general commentary, we propose that pain, as both a sensory and social experience, provides a potential paradigm with which to explore the relationship between sensory abnormalities and social impairments in ASD.