Robert doesn’t explain himself.  He cannot tell how he sees, feels, hears, smells, or tastes the world.  He knows many words but he is still not able to connect these words with himself.  They remain  mostly the domain of the outside world.  They exist to describe the environment around Robert.   I suspect that for Robert, the word “table”  exists  the same way the real table exists. Outside of his head.   Words  don’t seem to address his senses. The most troublesome consequence is the fact that he cannot state that something hurts and point to the painful part of his body.  It is my understanding that quite a few children with autism had this problem at some point of their lives  and some still might have.  I failed to teach Robert to tell what hurts, to point to the place that hurts.  And yet, from observations and subsequent medical diagnosis, I know that he was in pain many times.  The tragedy is, that  when confronted with a child who has tantrum, screams, hits himself, aggresses  toward others  but cannot tell or show what hurts, many caretakers and medical professionals  immediately assume that the screaming is a result of autism not of the pain.  Many years ago, just a few miles from our town, the young man with autism died because the people who supposed to take care of him restrained him forcefully while he had ruptured spleen. His reaction to the pain: screaming, “not cooperating”, not walking  was diagnosed “as typical autistic behavior”.  What was “autistic” about it was  this young man’s inability to communicate his pain to others. A mother of a teenager with autism told me how much time she spent at the emergency room trying to convince medical personnel that her son was seriously ill.  But since he couldn’t point or tell, since he acted in a way that appalled nice nurses and busy doctors, they came with a quick diagnosis – autism. Typical autism!  Luckily for the boy, the mother stood her ground. She stated, “He has had autism all his life, but he has never screamed like that before.” Another test was performed and hernia on the brink of rapture was found and removed.

Robert can answer many questions about pictures presented to him.  He can do it with correctly built sentences (but terrible pronunciation) , yet at the same time he cannot answer basic questions about his life.  He still cannot tell what hurts.

So, is there a way to teach that skill without actually causing pain?