Helping Autistic Children Express Feelings
Scale of One to Ten for Children with Autistic Spectrum Disorder
May 13, 2009
Children (and adults) with ASD are likely to become anxious in situations where events or feelings are vague, unexpected or open to interpretation. A seemingly straightforward question such as “how are you feeling?” may be challenging and difficult to answer because of its subjective nature.
What is a Ten-point Rating Scale?
A scale of one to ten is simply a rating scale, with zero being the lowest rating and ten being the highest. Initially, it should be introduced as a visual prompt drawn onto a piece of paper. As the child becomes familiar with the concept, he or she may become able to memorise the scale and “picture” it without actually having to see it.
This ten-point rating scale can be used in a wide range of situations to help children identify how they are feeling in a very literal, methodical manner, taking the guesswork out of their reactions and avoiding an emotional response disproportionate to the stimulus. For example, when a child with ASD has a tummy ache, he or she is unlikely to intuitively distinguish between a small hunger pain and a gripping upset stomach pain. This may lead to all tummy discomfort triggering a highly emotional response and causing extreme distress.
In the case of tummy ache, instead of asking the open-ended question “how do you feel?” an adult can refer to the ten-point scale and ask a more specific question such as “how bad is the pain on the scale of one to ten?” "Is the pain at number one, number five or number ten?” Over time, the child should be able to link experiences of differing kinds of pain or discomfort with a measure of severity, enabling him or her to gauge an appropriate response (for example, trying to ignore a “number 1 pain” but going to the toilet urgently, or seeking help, for a “number 9”).
When to Use a Ten-Point Scale
Possible situations:
- Headache (or other pain)
- How scared the child is
- Feeling sick
- Needing the toilet (degree of urgency)
- How bad a situation is (for example, if the child has lost or broken something)
- What might happen as a result of a bad situation (for example, how dire the consequences might be having dropped or lost something).
The ten-point scale can be used in conjunction with a “feelings board” which encourages children to use pictures of faces to represent how they are feeling. For example, in the case of tummy ache, the child could choose from a selection of expressions ranging from “worried” to “acute pain”.
Social Stories
The rating scale could also be used with Social Stories to help the child understand what happens when he or she gets tummy ache, as follows:
- Sometimes Jack gets a tummy pain. The pain comes from inside Jack’s body and tells Jack what his body is feeling.
- Jack might have a pain because he is hungry or because he needs to go to the toilet.
- Nothing bad will happen and Jack is not scared.
- Jack remembers the scale of one to ten and tries to feel whether the pain is a small pain or a big pain.
- A small pain is number 1, 2 or 3.
- A medium pain is number 4, 5 or 6.
- A big pain is number 7, 8, 9 or 10.
- Jack will tell (name of adult) how big the pain is. If it is a very big pain, Jack will ask (adult’s name) to help him make the pain go away.
The ten-point rating scale is a simple, yet highly effective, strategy for visualising the severity of problems. It helps children to understand unexpected events by gaging how bad they are, thereby minimising the associated feelings of panic or anxiety.
