Medical Necessities Part 2: Teaching the Word, “Hurt”

As I said in my last blog post, “hurt” is an impossible thing to see, which makes it very difficult for children with autism to learn.  In typical development of language and theory of mind, children first learn words as they apply to themselves and their own experience.  Therefore, that’s how we should teach words to children with autism.

Capitalize on Teachable Moments

I typically begin teaching the word, “hurt,” using a picture symbol as a visual support.  When I see the child get hurt, I say, “ouch!  That HURTS!” and show them the picture symbol.  This is the symbol I use, courtesy of the Boardmaker program by Mayer-Johnson:


Since I’m not in the business of hurting children, being able to capture moments of pain means having the picture symbol at the ready so that I can capitalize on teachable moments.  As I mentioned before, though, when children are not in their optimal state of emotional regulation (as no one is when injured), this is not the best moment for them to learn.  That’s why we also have to use this strategy when “hurt,” relates to ourselves, and others too.

Plan for Learning Opportunities

As I’m accident prone, I have plenty of opportunities in a day to use “hurt,” but I’m also a fantastic actress in the young child entertainment genre.  So, using my crazy good acting abilities, I also might fake some injuries when a child IS having a more emotionally regulated moment, so that they might have more and better opportunities to learn.  When I do, I have my picture symbol right there.  The more dramatic you can be, the better.  I’d recommend saying the same phrases you say when the child is injured—“Ouch!  That HURTS!” (using the appropriate facial expression.)  Show them the picture symbol for “hurt,” as you say the words.   You should do the same when your child sees others who are hurting.  In addition to helping them learn the word and concept of “hurt,” you’ll be working on helping their theory of mind development as well.

You might also plan structured symbolic play (pretend play) routines with your child utilizing the word, “hurt.” Depending on your child’s level of symbolic play development, you might “play doctor,” either in a child-object (doll/stuffed animal) situation, in which the adult or child is acting on the doll/stuffed animal; or an adult-child role play situation (in which one person is acting on the other).  Symbolic play routines are set up in a similar way to functional activity routines, which I discussed in my previous post.  Within a symbolic play routine, you would identify your target vocabulary (in this case, the word, “hurt”) and consistently facilitate understanding and use of the word, supported with a picture symbol.  We’ll talk more about setting up symbolic play routines as we continue on our little journey together, but please ask your speech-language pathologist, teacher, or therapist for more information on how you might do this in your home.

Help Your Child Make the Word His Own

Make helping your child to understand the word, “hurt,” a constant throughout your day, both in real-life occurrences and in moments of play.  Think of it as your “word of the week.”  Bring your target word into every situation with you.  As a parent, you are your child’s first and often best teacher.  With guidance and consistency, you can do this!

Once your your child been introduced to the word and picture symbol for “hurt,” be sure that you give your child access to the picture symbol you have been using.  This picture has become a word to that child, and we don’t take words away from people.  Be sure you place it with your child’s other picture symbols, if he has them, or post it somewhere in your family room or playroom, so that it’s there if and when your child needs it.

So, that’s the nutshell version of helping you teach the word, “hurt.” Next stop, teaching body parts.


**The concept of “emotional regulation” comes from the SCERTS Model (Prizant, Wetherby, Rubin, & Laurent, 2007).   Pamela Rollins, MS, CCC/SLP, also incorporated elements from the SCERTS model into her own theoretical model, detailed in Facilitating Early Social Communication Skills: From Theory to Practice (in press, due out summer 2014).  The learning principle of first teaching a word or concept in a specific context, and then generalizing across partners and contexts is rooted in the science of Applied Behavior Analysis (Lovaas), but, here, is done so in the less structured, naturalistic context of the home.

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