One of the challenges of Dan’s autism is his high pain threshold. We often don’t know that something is wrong until it is very wrong. Recently Dan went to bed one evening perfectly fine, but the next morning he could barely hobble to the kitchen table to have breakfast.
What’s wrong? Why are you limping?
Show me Ow.
Dan rubbed his left thigh and sure enough, there seemed to be a red mark, although he is unable to tell us how it happened. Without witnessing an accident or injury, we often never know how the bruises come about. But we do know that when Dan says “Ow”, it means it really hurts.
Autism and a high pain threshold often go hand in hand. In his book, The Complete Guide to Asperger’s Syndrome, Tony Attwood notes that people on the spectrum often do not “show distress in response to levels of pain that others would consider unbearable” and this can often result “in frequent trips to the local casualty department.”
Yes, hospital emergency departments are something we have had experience with over the years, for both detected and undetected injuries and illnesses. Dan has a tendency for hitting his head and has the scars to prove it. It’s amazing how much blood can pour out of a body part that appears quite bony, but at least this kind of injury doesn’t go unnoticed.
Dan received his first scar at the age of two, just prior to the birth of his sister, Bec. We were shopping for a new single bed for Dan and as we wandered around the furniture store, he tripped over a rug, flew through the air and collided with a bed. Needless to say, we didn’t buy that one. A few years later, Dan was kneeling on a chair at the kitchen table, when…bang! His chin hit the table. Blood streamed down his chest. Off to the hospital again and another scar.
The most recent emergency trip was just a few years ago. Dan was riding his bike around our property and ran smack into the loader. Dan had his hat on, so the brim hid the bottom edge of the loader bucket and, as Dan prefers to look at his shadow while he is riding, he probably wasn’t looking where he was going either. At least this time he let the nurse put in a few stitches. That was a first.
Infections though, are a different story. Tony Attwood highlights how ear infections and tooth aches can often go undetected until they’ve reached a very serious level. Dan had a lot of ear infections when he was young, but he never complained and rarely cried, so it wasn’t until we noticed him pulling on his ear that we knew something was wrong. It was often quite difficult trying to make medical staff understand the reality of life with a non-verbal child who has a high pain threshold.
Our most recent injury started with the limp, but then it got worse. Apart from the limp, Dan seemed okay. Then we noticed he looked a little pale. And before we knew it, up came his breakfast. Great – a tummy wog. At least this time I managed to get him to direct it into a bucket – that is a first and a really big step forward for Dan. Usually he just gets so distressed, well, it just goes everywhere. But we weren’t done yet.
While he was taking it easy, a small pile of books fell onto Dan’s foot. Ow! And it was the same foot that was already limping. It was only later that I discovered he had a sore toe as well.
What’s this? When did this happen?
Yes, I can see it is ow.
This is where the sticker comes in. Sticker is Dan’s word for bandaid. Bandaids are wonderful inventions. They can miraculously heal any sore spot. So, while I’m putting the sticker on….what’s this under your foot? Tinea? What next? After a visit to the doctor and the podiatrist, I spent the next week playing tug of war with a sore foot as I vainly attempted to inspect sore spots and apply cream and stickers. Thankfully, the tummy is now settled, the limp has disappeared and we are down to just one sticker on the foot.
Vigilance is really important if you have a non-verbal autistic child with a high pain threshold. It is so easy to miss something because your child is happy, active and continuously singing. But then again, perhaps vigilance is important for people without a high pain threshold too. We all need someone who can look beyond the “everything is okay” facade and ask the question: are you okay? And sometimes we need to be truthful and say “Ow”. Being vigilant and looking out for each other means we can all live happier and healthier lives.
Attwood, Tony 2008 The Complete Guide to Asperger’s Syndrome, Jessica Kinglsey Publishers:London, pp 288-289.