Podcast Summary: ADHD Experts Podcast

Episode 577: Why Chronic Pain Is So Common Among Neurodivergent Youth
Date: September 30, 2025
Speakers: Dr. Anna Wilson, Dr. Gloria Hahn
Host: Carol Fleck

Episode Overview

This episode explores why chronic pain is significantly more prevalent among neurodivergent youth, focusing on those with ADHD and autism. Pediatric psychologists Dr. Anna Wilson and Dr. Gloria Hahn provide a comprehensive review of definitions, prevalence, underlying neurobiology, clinical presentation, and practical strategies for supporting children and young adults living with these co-occurring challenges. The episode includes evidence-backed insights and recommendations for parents, clinicians, and educators.

Key Discussion Points & Insights

1. Defining Pain & Chronic Pain

[02:49] Dr. Anna Wilson

• Updated Definition of Pain:
  • Pain is "an unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage."
  • Pain is always personal and is influenced by biological, psychological, and social factors.
  • Important to differentiate pain from nociception—pain always involves the brain.
  • A person’s report of pain should be respected: "Verbal description is only one of several behaviors to express pain. Inability to communicate doesn’t negate the possibility that a human or non-human animal experiences pain."
• Types of Pain:
  • Acute pain: Short-term, typically due to injury/illness, easy to validate.
  • Chronic pain: Persists beyond expected healing time (commonly >3 months), involves nervous system changes, often invisible and misunderstood.
  • Nociceptive pain: Resulting from tissue damage (e.g., burn, broken bone).
  • Neuropathic pain: Caused by nerve damage (e.g., diabetic neuropathy).
  • Nociplastic pain: Altered pain processing without clear tissue/nerve damage—common in conditions like fibromyalgia, chronic headaches.

2. Prevalence & Impact

[07:32] Dr. Anna Wilson

• In General Youth: About 20% of children under 18 experience chronic pain.
• High Impact: 4.5–8% experience pain interfering significantly with life.
• Consequences: Chronic pain increases missed school, depression, anxiety, impaired social/physical function, and sleep problems. It also affects the whole family—causing missed work, financial stress, and family dynamic changes.
  • “Chronic pain in kids really impacts the whole family...” (08:38)

3. Chronic Pain & Autism

[10:39] Dr. Gloria Hahn

• Emerging Research: Individuals with autism have higher rates of chronic pain and other physical health issues.

• Prevalence:

  • 8.2% of all children experience pain (parent report).
  • 15.6% of children with autism experience chronic pain.
  • Up to 20% if autism co-occurs with other developmental conditions (e.g., epilepsy, cerebral palsy).
  • Clinics see 30–40% of chronic pain patients with autism, with overrepresentation among teen girls.

• Clinical Presentation:

  • Pain is often widespread, not localized.
  • Frequently co-occurs with symptoms like autonomic dysfunction (POTS-like symptoms, GI discomfort, chronic fatigue).
  • High rates of joint hypermobility (EDS or suspected EDS).

  “...many of the youth with chronic pain and autism presenting to pediatric pain clinics have pain in multiple different areas...” [12:36]

4. Chronic Pain & ADHD

[14:53] Dr. Anna Wilson

• Understudied Field: Little published research on chronic pain in youth with ADHD.
• Key Findings:
  • ADHD is present in 15–25% of youth with chronic pain conditions (higher than general population).
  • In limited studies, up to 65% of youth with ADHD report chronic pain.
• Potential Mechanisms:
  • Increased injuries due to impulsivity/hyperactivity.
  • Attention plays a large role: shifting attention away from pain reduces perception.
  • Chronic pain can reduce attention span over time.
• Shared Neurobiology: Significant overlap between chronic pain, ADHD, and autism.

5. Neurobiology: Why Chronic Pain Is Common in Neurodivergent Youth

[17:48] Dr. Gloria Hahn

• Nervous System Imbalance:

  • Central (brain, spinal cord) and peripheral nervous systems process sensory info and respond to danger/safety.
  • Sympathetic system (fight/flight) often overactive in neurodivergent individuals; parasympathetic (rest/digest) underactive.
  • Neurodivergent youth have higher baseline stress, anxiety, trauma exposure, and sensory sensitivities.
  • “Pain occurs when there is an imbalance of more sympathetic compared to parasympathetic activity.” [19:20]

• Fear Avoidance Model:

  • Negative experiences with pain lead to fear and avoidance, decreasing activity and engagement in life.
  • This cycle can result in deconditioning, depression, and more disability.
  • Recovery Pathway: Exposure to safe activities can help reduce fear and rebuild function.

6. Clinical Presentation in Neurodivergent Youth

[28:34] Dr. Gloria Hahn

• Sensory Sensitivities & Overwhelm: Sensitivity to lights, noise, touch, making environments like school more stressful.

• Sleep & Fatigue: Major issues in autism/ADHD and chronic pain—worsen pain and difficulty functioning.

• Cognitive Rigidity: Obsessive, all-or-nothing thinking patterns can center on pain.

• Social Difficulties: Higher exclusion, bullying increase stress, leading to more pain.

• Loss of Special Interests: Decreased participation in valued activities or “special interests” can signal pain interference.

  “Reduced engagement with special interests can be an important indicator of how pain is interfering with an individual’s life.” [34:14]

7. Strategies & Treatment Approaches

[35:39] Dr. Anna Wilson

• Biopsychosocial, Multidisciplinary Care: Involves physicians, psychologists, PT, OT, tailored to the individual.
• Focus on Function, Not Just Pain Reduction:
  • Goal: return to valued activities.
  • Outpatient, but intensive options exist for severe cases.
• Adapting for Neurodivergent Youth:
  • Address sensory supports, individualized behavioral/social supports.
  • Address sleep, nutrition, daily routines.
  • Incorporate special interests as motivators.
• Caregiver Guidance:
  • Start low, go slow—gradually increase activity.
  • Reframe negative interpretations—behavior might be due to overwhelm or executive dysfunction.
  • Use visual/physical reminders for pain management strategies.
  • Parent self-care is crucial; “black diamond parenting.”
• Takeaways:
  • “Understanding some of this basic pain neurobiology can be really helpful. Understanding that pain may be different in neurodivergent individuals is important and that treatment is available and you can support your child’s comfort and help improve their function over time.” [42:25]

8. Q&A Highlights

Advocating With Clinicians

• [44:31] Dr. Anna Wilson: Doctors often lack pain education. Providing resources (e.g., the Comfortability Program) can help educate them.

  “Surprisingly, veterinarians get more education about pain than human doctors do...” [44:36]

Advocating in Schools

• [46:28] Dr. Gloria Hahn: Seek documentation, initiate a 504 plan specifying accommodations for pain.
  • Accommodations: pacing the school day, providing breaks, sensory supports.
  • “Helping school staff understand that pacing the day is going to be important...” [47:48]

Identifying Pain Triggers

• [48:51] Dr. Anna Wilson: Chronic pain may not have a clear trigger; best to focus on lowering “baseline stress” (using the boiling pot and potatoes metaphor).
• [50:45] Dr. Gloria Hahn: Prioritize teaching regulation/relaxation strategies instead of searching endlessly for triggers.

Supporting in College/Hyperfixation on Pain

• [51:48] Dr. Gloria Hahn: Hyperfixation can amplify pain; CBT strategies and redirecting to adaptive, enjoyable activities can help.
• [53:24] Dr. Anna Wilson: “Engaged distraction”—help students get involved with activities that are pleasant and comforting.

Parental Doubt & Guilt Over Child’s Pain

• [54:19] Dr. Anna Wilson: “Pain is real,” even if psychosocial dynamics or secondary gains play a role. Focus on validating experiences and supporting function.
• [56:01] Dr. Gloria Hahn: “Validating the child’s experience... is really important.” Seek to understand what pain is communicating and adjust environments to reduce threat signals.

Notable Quotes

• “Pain always involves the brain.” — Dr. Anna Wilson [03:09]
• “Official prevalence estimates [of chronic pain in neurodivergent youth]... are still being established.” — Dr. Gloria Hahn [13:53]
• “ADHD is present in 15–25% of youth with chronic pain conditions, which is higher than the general population prevalence.” — Dr. Anna Wilson [15:43]
• “Pain occurs when there is an imbalance of more sympathetic compared to parasympathetic activity.” — Dr. Gloria Hahn [19:20]
• “Reduced engagement with special interests can be an important indicator of how pain is interfering…” — Dr. Gloria Hahn [34:14]
• “Having chronic pain is like having a car with four flat tires… what is really needed is a coordinated set of multiple approaches.” — Dr. Anna Wilson [36:18]
• “Start low and go slow.” — Dr. Anna Wilson [39:45]
• “Black diamond parenting.” — Dr. Anna Wilson [41:45]

Timestamps for Key Segments

• 02:49 — Definitions and prevalence of chronic pain
• 10:39 — Chronic pain in autism
• 14:53 — Chronic pain in ADHD
• 17:48 — The neurobiology of chronic pain and neurodivergence
• 28:34 — How chronic pain presents in neurodivergent youth
• 35:39 — Comprehensive treatment strategies and parental guidance
• 44:31 — Q&A: Advocacy with clinicians
• 46:28 — Q&A: Advocacy within schools
• 48:51 — Q&A: Identifying triggers
• 51:48 — Q&A: Supporting college students and managing hyperfixation
• 54:19 — Q&A: Parental doubts about pain

Additional Resources

• Slides and recommended resource sheet available at attitudemag.com (search podcast 577)
• The Comfortability Program (referenced for both families and clinicians)

Summary:
Drs. Wilson and Hahn deliver a nuanced, compassionate, evidence-based exploration of the intersection between chronic pain and neurodivergence in youth. They explain the underlying neurobiology, discuss practical barriers and solutions, and provide hope and concrete strategies for families and professionals navigating these complex issues. Their collaborative, validating language and focus on functional improvement offer a roadmap for better understanding and supporting neurodivergent youth in pain.