Pain Perception in Neurodivergent Individuals: When Pain Signals Get Scrambled

Written by: Jasmine K. Y. Loo (Psychologist)

Understanding the Neurodivergent Pain Experience

Pain is something that most of us would generally want to avoid experiencing; it’s unpleasant, to say the least. That said, pain is also one of the most fundamental ways our bodies communicate that something is wrong.

But for many neurodivergent individuals (NDs), that message doesn't always come through in a predictable way. While some people may experience pain with hypersensitivity (intensely magnified) or hyposensitivity (dampened or barely noticeable), others may experience something even more perplexing — an inconsistent reaction to pain.

This means that a minor injury (like a paper cut or a tight shoelace) might cause intense, persistent distress, while a serious injury (like a broken bone or severe infection) might go unnoticed until external signs — like swelling or fever — make it obvious. This paradox can leave parents, caregivers, teachers, and even medical professionals scratching their heads, unsure of how to respond.

The Reality of Inconsistent Pain Perception

It's not uncommon to hear exasperated parents exclaim in bafflement, “No one even realised their arm was fractured until it swelled up like a loaf of bread!” Stories of ND children and adults walking around on sprained ankles, not noticing burns until someone else points them out, or having an extreme reaction to a loose thread brushing against their skin, are surprisingly common. But why does this happen?

A few key neurological and sensory factors contribute to this inconsistency:

• Interoceptive Differences – Interoception is the sense that helps us understand internal bodily signals (e.g., hunger, thirst, the need to use the bathroom, and pain). Many neurodivergent people have interoceptive differences, making it harder to recognise and interpret pain cues accurately.

• Divergent Sensory Processing – Some individuals process sensory input in ways that amplify small discomforts but completely overlook major injuries. This could mean experiencing significant distress over a tight sock seam but barely registering a deep cut.

• Delayed Processing of Pain – Some NDs have a delay in perceiving pain, meaning that the discomfort only registers minutes, hours, or even days later. By then, the injury may have already worsened.

• Masking & Learned Responses – Many NDs have learned to suppress their natural reactions to pain, especially if their past experiences with healthcare professionals or caregivers have led them to think they are “overreacting” or be dismissed. This can lead to them unintentionally downplaying serious injuries.

The Dyspraxia Factor: Increased Risk of Injury

For those with dyspraxia (current formal diagnostic name being Developmental Coordination Disorder) or proprioceptive differences, inconsistent pain perception is often paired with a greater likelihood of getting injured in the first place. These individuals may:

• Be more accident-prone – Due to challenges with balance, spatial awareness, and motor coordination, dyspraxic individuals may trip, bump into things, or misjudge distances more frequently than their peers.

• Have difficulty noticing injuries – Because of proprioceptive differences (the sense of one’s own body position in space), some individuals may not immediately register that they have sustained an injury — especially if there is no immediate pain. Then, when pain or bruising eventually appears, there may be no obvious event to connect it to, leaving them puzzled about how it happened. Without a clear cause, they might end up brushing it off rather than recognising it as something that may need attention.

• Struggle to identify the cause of pain – Even when pain is noticed, some NDs may have difficulty connecting it to a specific injury or event, making it harder to seek appropriate medical attention.

This combination — higher likelihood of injury and reduced awareness of pain — can lead to a cycle where injuries are frequent but often go untreated, increasing the risk of complications like infections, misaligned fractures or chronic pain conditions.

The Risks of Unpredictable Pain Responses

When someone isn’t aware of, or is reacting to pain in atypical manners, the following risks emerge:

• Injury Going Unnoticed – Broken bones, infections and other significant injuries may go untreated for too long, leading to complications.

• Difficulty Communicating Pain – If an ND has inconsistent pain responses, their concerns may not be taken seriously when they do express discomfort, which can further erode trust in medical professionals.

• Self-Injury Without Awareness – Some NDs may engage in certain repetitive movements, like persistently chewing at the inside of cheeks or picking at skin, without realising the extent of the damage being done.

Practical Strategies for Staying Safe

For those who experience inconsistent pain perception, here are some practical ways to safeguard their health and wellbeing:

• Regular Body Check-Ins – Make it a habit to visually inspect for bruises, swelling, cuts or other signs of injury, especially after a fall or a day with high physical activity.

• Use a Pain Rating Guide – Since pain perception can be unreliable, using a simple visual pain scale (like the "Wong-Baker Faces Pain Scale" or a numbered system) may help with gauging whether an injury requires medical attention.

• Reframe Scanning for Pain - When NDs experience difficulty in accurately perceiving pain before it is at an extreme level, it can be helpful to reframe the way we scan our bodies. Instead of focusing purely on identifying pain, try scanning for physical sensations such as pressure or tension. For those whose brains may not register sensations as pain but are instead perceived as discomfort or tightness, this method can assist in earlier identification of areas that may need attention. Shifting the focus from pain to tension/pressure can make it easier to address underlying issues before they escalate into full-blown discomfort or injury.

• Set Daily Hygiene & Health Reminders – Since some injuries or discomforts, like infections, dehydration, or dental issues, may not feel urgent, scheduling routine hygiene check-ins (e.g., drinking water at set times, scheduling 6-monthly dental checkups, etc.) can be helpful in preventing any concerns from festering into something serious.

• Advocate for Medical Attention When Unsure – If something doesn’t look right (even if it doesn’t feel painful), it’s better to check in with a trusted doctor rather than risk ignoring a potentially serious problem. Make sure to give the doctor clear information about your inconsistent pain responses, or hyposensitivity to pain, if they had not been told before.

• Educate Caregivers & Professionals – Parents, teachers and healthcare professionals should be aware that pain responses in neurodivergent individuals may not be typical, and that all reported discomfort should be taken seriously — even if it seems minor.

Final Thoughts

Pain perception in neurodivergent individuals is not always logical or predictable — and that’s exactly why awareness and proactive strategies are crucial. Whether it’s hypersensitivity, hyposensitivity, or an inconsistent mix of both, recognising these differences can lead to better self-care, more effective medical support, and a greater understanding of neurodivergent sensory experiences.

Being "tough" and ignoring pain is not a badge of honour — it’s a potential risk. So whether it’s a stubbed toe or something more serious, listening to your body (even when it’s confusing) is an essential form of self-care.

Do you work with the neurodivergent community and are committed to the ongoing learning of neuro-affirming practices? Apply for a NAPAA professional membership today to access a growing library of member exclusive resources.