Hi I'm Dr. Mary Barbara, autism mom
behavior analyst, and registered nurse. My
video blog last week was on ruling out
medical issues before treating problem
behaviors in children with autism. So if
you haven't watched that yet, please go
back to marybarbera.com/video
to watch last week's blog first. So 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 severe language impairments to
indicate that they're in pain and tell
you where the pain is coming from?" When
Lucas was five years old he had
surgery to remove his tonsils. My
friend who was a pediatric nurse warned
me that about five days after surgery it
was common after tonsillectomies for the
scabs in the back of the child's throat
to fall off and it might be really
painful so I shouldn't be too alarmed if
Lucas woke up screaming around night
five. So just as my friend predicted on
night five, Lucas woke up in the middle
of the night screaming in pain and for
the first time ever labeled his pain by
yelling out "Arthur's tooth." You see,
one of Lucas's favorite videos at the
time was a video called "Arthur's Tooth"
where Arthur, the character on the TV, had
his tooth pulled and he screamed in pain
obviously coming from his mouth. So this
was kind of funny and then for over 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 similar
question to Laurie Frost, an SLP and a
co-creator of the PECS system many years
ago. Laurie'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 either
saying "boo boo" or "ouch" or labeling the
body part "arm, arm, arm, hurt," whatever the
child can understand and hopefully
repeat. Even if your child or client is
speaking, he or she might need additional
visual support to learn this important
and often abstract concept. To teach
labeling of pain, I would recommend you
try to put a real band-aid on a large
picture of a boy on his various body
parts and have your child fill in the
blank, "booboo on the boy's knee" or "the
boy's head 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 things
like 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 your
children body parts, click the link right
below if you're watching this video
anywhere other than marybarbera.com,
please hop on over to my website leave
me a comment and check out the other
blogs there and I'll see you next week.