I recently received a question related to my last blog on the importance of looking at medical issues before treating problem behavior. The question was, “How do you teach children with autism and severe language impairments to indicate they are in pain and to tell you where the pain is coming from?” I remember asking a very similar question to Lori Frost (co-creator of the Picture Exchange Communication System – PECS) years ago when I attended an introductory PECS workshop. Lori’s response was to make sure you label and preferably have your child label (with speech, PECS, or sign) when he has something visible that is obviously hurting him. In other words, when your child has a skinned knee or when he gets a bee sting, make a big deal out of labeling the pain for him. This is an important step with the goal that eventually your child will be able tell you he has internal pain which you can’t see such as a head ache or belly pain.
For a non-vocal or minimally vocal child, you might try — Boo Boo (with a Band-Aid picture card or the words) on my ___________ or my ___________ hurts and have your child fill in the body part by speaking or choosing a picture of a body part from an array. Even if your child is speaking, he or she might need added visual supports to learn this concept. To teach the labeling of pain, I would also recommend you try to put a real Band-Aid on a large picture of a boy (on various body parts) and have your child fill in the blank –boo boo on the boy’s ___________ or the boy’s ___________ hurts. You could also use the same idea to teach this concept with a simple talking device and/ or with sign language. I have found that receptive body parts and tacting body parts are usually prerequisite skills for labeling pain so I would also recommend working on these programs when your child is not in pain.
I believe the ability to label pain is an important skill which can and should be taught. For more information including details about my book, The Verbal Behavior Approach: How to Teach Children with Autism and Related Disorders.