My video blog last week was on ruling out medical issues before treating problem behaviors in children with autism. So please watch last week’s blog first if you haven’t done so already.
This week I’m going to answer the question I get often that goes something like: “How do you teach children with autism and severe language impairments to indicate that they are in pain and to tell you where the pain is coming from?”
When Lucas was 5 years old he had surgery to remove his tonsils. My friend, who was a pediatric nurse warned me that about 5 days after surgery, it was common with tonsillectomies for the scabs to fall off. This might be really painful so I shouldn’t be too alarmed if Lucas woke up screaming around the fifth night. Just as my friend predicted on night 5, Lucas woke in the middle of the night, screaming in pain and for the first time labeled his pain by yelling out “Arthur’s Tooth.” You see one of Lucas’ favorite videos at the time was a video called Arthur’s Tooth where Arthur had his tooth pulled and screamed in pain coming from his mouth. For a year or two later, if Lucas skinned his knee or banged his elbow, he would yell “Arthur’s Tooth” as he rubbed the painful body part.
When I became a BCBA a few years after Lucas started describing all pain as “Arthur’s Tooth,” I was curious as to how to best teach children to talk about pain. I remember asking a very similar question to Lori Frost many years ago. Lori’s response was to make sure you label and preferably have your child label 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 by saying boo-boo or ouch. 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 speech generating device and/or with sign language. I have found that receptively touching and expressively labeling body parts are usually prerequisite skills for labeling pain so I would also recommend working on Mr. Potato Head and other body part 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. To watch a free video on how to use Mr. Potato Head to teach children body parts, click here.
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