Pain in Children With ADHD: Mechanisms, Clinical Presentation, and Implications for Assessment and Management.

BACKGROUND/AIM: Pain assessment and management in children remain challenging, particularly in those with neurodevelopmental disorders. Attention-deficit/hyperactivity disorder (ADHD) is characterized by alterations in attention, executive function, emotional regulation, and reward processing. These domains are also critically involved in pain perception and expression. Emerging evidence suggests that children with ADHD may experience pain differently, display atypical pain behaviors, and face substantial challenges in pain assessment and treatment. However, the literature on pediatric ADHD and pain is fragmented across experimental, clinical, and behavioral studies. MATERIALS AND METHODS: This narrative review critically examines the neurobiological, psychological, and clinical interactions between ADHD and pain in children. RESULTS: We discuss proposed mechanisms linking ADHD to altered pain processing, summarize evidence on pain perception and expression, explore common pain conditions where this interaction is clinically relevant, and analyze challenges in pain assessment and management. Finally, we identify knowledge gaps and propose future directions toward function- and child-centered pain care. CONCLUSION: By considering ADHD as a modifier of pain experience and a potential contributor to pain chronification rather than a mere comorbidity, this review highlights the importance of adapting pain assessment and management strategies to the specific neurodevelopmental profile of pediatric patients.