Thesis advisor: Callista Roy / Assessing pain in nonverbal children with intellectual disability (ID) is challenging. These children are at risk for having pain from complex medical conditions and treatments for these conditions (Breau, Camfield, McGrath, Finley, 2004). Compounding this, their pain cues are often misunderstood, given that they are nonverbal and limited by their physical abilities. Although, pain assessment tools for this population exist, there is a need for tools appropriate for a range of exhibited pain expressions. The general purpose of this study was to examine the words that parents of children with ID use to describe their child's pain responses in order to improve pain recognition and management. Specifically, the aims were to: 1) Identify common pain responses; 2) Examine the relationship between type of pain response and demographic characteristics; 3) Compare common pain responses to cues in the literature. A non-directed summative content analysis identified patterns in 335 parent described pain responses of 50 nonverbal children with ID ages 6-18 years. The relationships between type of pain response and selected demographic factors were examined. Then pain responses were compared to items of pain tools for this population. Seven distinct categories of pain expression were identified in the content analysis. The greatest percentage of pain cues were within the categories of vocalization (39.4%), social behavior (21.8%) and facial expressions (16%). Four categories: vocalization, social behavior, muscle tone and activity level included opposite responses to pain. Significant relationships between type of parent described pain expression and 1) pain severity; 2) causes of ID and; 3) the gender of the child found that type of pain expression changes with severity; that patients with seizure disorders expressed pain with vocal pain expression; and that females expressed pain with more social pain expression while males expressed with more vocalizations. The results support published evidence that parents can articulate their child's pain responses. The study also provides evidence of: 1) opposite pain responses within general categories of pain; 2) a significant relationship between type of pain responses and severity of pain, cause of ID and child gender and; 3) the comprehensiveness of pain assessment tools vary greatly. / Thesis (PhD) — Boston College, 2010. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.