The issue with many Aspie kids is that the ‘idea’ of pain is worse than actually ‘having’ pain; because their pain threshold is so high , they can be seriously injured and not be able to express it as ‘I am hurt’. The splinter or bruise they acquire doesn’t truly hurt, but the damage they see on the skin makes it looks different than normal which causes an abnormally high emotionally based response, as opposed to actually being reflective of the degree of pain felt.
Broken bones and severe infections may make them ‘moody’ or short tempered, instead of making them express their discomfort as what we typically see as pain. A paper cut is disturbing to look at as the skin is open, which creates a visual notification that something is wrong and leads to an over reaction. A broken bone which may have occurred a few hours ago, can not be pinpointed as the cause or even the source of pain because there is no obvious connection to their current mood, to their way of thinking.
It makes it imperative that a parent or caregiver look at mood changes in an Aspie child, far more closely than a neuro typical one, because it may indicate trauma or illness the child is not able to communicate. You can not trust them to tell you they are hurt or in discomfort because quite often, they may be injured and simply not realize it because their pain threshold is simply too high to show it the way we normally see it.
This is alarming for parents in a few ways; primarily, we feel guilt when we have delayed treatment because we did not notice the child was hurt. Perhaps the child was playing out of sight, at school or at an organized activity. A few days may pass and another parent may ask you how your child is doing because they witnessed them crash onto the ground in a spectacular fashion and were surprised they weren’t hurt.
This triggers you to connect the few days of the child’s increasingly bad moods to the event which occurred a few days ago and prompts you to question the child about what happened. They may only say “I fell” when describing the events. After you examine them, discover the bruised or tender foot and immediate trip to the Dr for x-rays, they are diagnosed with a broken bone requiring casting.
As the parent of a child with Aspergers, you have to be proactive in how you treat the child for injury or illness. Rather than waiting for the indication of pain or discomfort, you have to rely on subtle signs of mood or sleep changes. Even something like intolerance for noise or normal sibling interaction might be a sign that something is wrong and should be followed up on as simply assuming their behaviour is mood related could result in a delay in diagnosis of an underlying condition.
The other concern which relates to pain threshold is an Aspies inability to discern extreme heat or cold from normal temperatures. They are at serious risk of being burned or experiencing frostbite because they can not tell that their body is in pain which should indicate a change of their behaviour to keep themselves safe.
The thermostat of a hot water heater should be turned down when you have young children and it is imperative that you keep it lowered when you have an Aspie child. A permanent mark should be made on a single handled faucet, indicating where the tap should be placed when the water is turned on, so that by the time the child is old enough for privacy in the bathroom, they are in the habit of setting the temperature at the exact placement needed for their safety.
Of course each child has their own tolerances and an easy way for a parent to test out an issue is to ask the child to wash something for you at the kitchen sink under supervision. If you see that water at various and increasing temperatures is no problem for the child, you know there is an issue with their perception, and you need to react accordingly.
When it comes to cold temperatures, the issue about not understanding pain tolerance becomes a problem once the child goes to school. Even though the child has been sent with hats and mittens, they may not wear them and teachers may not understand the implications this carries when the child is diagnosed with Aspergers. A neuro typical child will get cold and put on the appropriate clothing so they are not uncomfortable. A child with Aspergers will not get this signal and as a result can suffer damage from exposure.
A very easy way to manage this type of situation is to teach the child to look for social queues which might indicate what they should do. Ask them to look at other children getting ready to go outside for recess. Are the majority wearing winter hats, mitts and boots? If the answer is yes, then that is what they wear as well. Perhaps you state that if 5 kids have hats and mitt combination on, then they must as well. You deviate it to what works with your child.
As the child becomes a teenager, part of the normal experience is to rebel against the dictates of parents and wearing of clothing that is season appropriate. An Aspie teen simply does not recognize that a winter coat for a sunny day in January at -20 is reasonable protection against the elements. Again, parents have to manage the situation daily to ensure no battles happen and that habits are ingrained long before there are issues. For instance, in November, all light weight socks are removed and replaced with thermal socks in case they forget to wear boots during the extreme weather changes that happen at the change of seasons. In the case of snowfalls, running shoes mysteriously ‘go missing’ so that first thing in the morning, the only thing the teen can find to wear are insulated hiking boots.
If the child has a sibling or a close friend they can mirror, again, it becomes a teaching tool for the parents to use which helps give clear direction to the Aspie teen. Plus, the habit of seasonal change should be established enough that the transition gets easier as they get older.
The reverse happens in the spring because now the habit of winter gear has to be transitioned. Teens with Aspergers have to be managed by their parents in a very similar fashion to how you managed skills with a toddler. You have to teach autonomy and responsibility while being mindful of their safety and security. You have to have discussions about that management as well. The teenager has to clearly hear that the mood/situation/experience is an expression of Aspergers so that they learn to understand their reaction is noticed by family and peers which creates awareness for them to incorporate it into how they learn in the future.
A child with Aspergers is at serious risk of injury or damage unless they are managed through adulthood, so they come to understand that various activities create injury and different situations require medical intervention, regardless of the perception they may have about the degree of discomfort they may or might not feel. It is imperative that parents and caregivers understand that a person with Aspergers is going to react vastly different than a neuro typical one to pain, discomfort and extreme temperatures and that intervention on their behalf will be required far more frequently than expected.