Individualized Therapeutic Environments for Pain Management in Children with Autism Spectrum Disorder: A Scoping Review.

BACKGROUND/OBJECTIVES: Children with autism spectrum disorder (ASD) present unique challenges in pain assessment and management because of differences in communication, sensory processing, and pain expression, increasing the risk of pain underrecognition and inadequate treatment. This scoping review aimed to map and synthesize current evidence on pain processing, expression, assessment, and management in children with ASD, identify available pain assessment tools and interventions, and examine the contribution of individualized therapeutic environments to pain management. METHODS: This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). PubMed, Scopus, and Web of Science were systematically searched for studies published between January 2020 and December 2025. Search strategies combined Medical Subject Headings (MeSH) and free-text terms. Two reviewers independently screened studies extracted data using a standardized form, and synthesized findings narratively. No formal methodological quality appraisal was undertaken, consistent with PRISMA-ScR recommendations. RESULTS: Included studies demonstrated substantial heterogeneity in pain perception and expression, with atypical behavioral responses, sensory differences, and communication difficulties frequently hindering pain recognition. Individualized, multidimensional pain assessment integrating behavioral observation, caregiver reports, and validated assessment tools was consistently supported. Sensory adaptations, tailored communication strategies, caregiver involvement, distraction techniques, and virtual reality showed potential to improve pain-related experiences and reduce procedural distress. However, evidence remained predominantly observational, methodologically heterogeneous, and limited by few psychometrically validated ASD-specific assessment instruments and the absence of standardized clinical protocols. CONCLUSIONS: Current evidence supports individualized, multidisciplinary pain assessment and management for children with ASD. Nevertheless, substantial evidence gaps remain, highlighting the need for validated ASD-specific assessment tools, standardized clinical protocols, and high-quality studies evaluating pharmacological, non-pharmacological, and technology-assisted interventions.