Helping Autistic Children Cope with Accidents
Teaching Children with ASD about Getting Hurt
May 15, 2009
Children are naturally upset when they hurt themselves, but most are easily comforted by kind words, a cuddle and some simple first aid. However, children with ASD are likely to suffer a much higher level of distress, even in the event of a very minor incident such as a small bump or a bruise. This may automatically trigger a strong, and frightening, emotional response (panic) which overwhelms the child and may be disproportionate to the accident itself.
Coping Strategy for the Child with ASD to Learn
A child with ASD will benefit from learning a coping strategy to use in situations such as the school playground, park or at a friend’s house. Such a strategy will remove panic associated with not knowing what to do, and give the child a clear set of steps to focus on (both calming and practical), avoiding the automatic “nought to sixty” emotional response.
A possible coping strategy could consist of three simple instructions, such as:
- Stand still and count to ten
- Tell a grown-up exactly what happened using a slow and calm voice
- Show the grown-up which part of the body is hurt and ask “please will you help me?”
Explaining what Bleeding is to a Child with ASD
Children with ASD may not be “in tune” with their bodies; they may not intuitively realise when something is wrong or may mis-read signals such as tummy ache or a swelling. Social Stories are an effective way of introducing new concepts and could be used to explain what happens when someone falls over, is sick or cuts a knee. Bleeding can be particularly traumatic for a child with ASD, who may not understand what the “red stuff” is. A story about falling over could be written as follows:
- Sometimes people fall over and hurt themselves. This is called an accident.
- The person might cry and scream or shout in a loud voice because falling over hurts.
- Sometimes, falling over makes people start bleeding. Blood is the red liquid inside our bodies. It comes out if the skin gets cut or broken.
- Blood isn’t bad but the broken skin must be cleaned to get the dirt out of it.
- If (child’s name) hurts himself he will not be scared because (child’s name) knows what to do
Review the three steps that the child should follow:
- Count to ten
- Tell a grown-up exactly what happened using a slow and calm voice
- Show the grown-up which part of the body is hurt and ask “please will you help me?”
Expressing Pain by Answering "How Much does it Hurt?"
Children with ASD often find it difficult to rationalise what has happened and distinguish between minor scrapes and more serious accidents. Another useful strategy is a one to ten rating scale, whereby zero is the lowest rating and ten is the highest . An adult can help the child cope with his or her feelings by asking the child to attribute a number to the severity of pain, for example “two” for a small pain and “eight” for a lot of pain. This helps the child to visualise the pain sensation and alleviate some of the associated panic and anxiety.
A coping strategy (step-by-step set of instructions) reinforced by a Social Story, is a highly effective means of helping an autistic child to understand what happens when he or she (or another child) has an accident, thereby reducing the associated confusion and distress. It could be further supported by the use of a “feelings board” to help the child express how he or she is feeling using pictures of faces.
