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Tuesday, October 4, 2011

When a Hurt is Overwhelming - An Aspie Tale

For years I have noticed that often there is no small ouch for my son. That is the one aspect of Asperger's that really gets to me. As his mommy I hate to see him in pain. Even if I know the pain in reality should be on the low end of the spectrum his reaction to it is on the hight end of the spectrum and above. Unfortunately I am so used to his over reaction (or a reaction that is not what is socially expected) that it is possible to trivialize it and miss a real major injury. There have been a couple occasions where he really was hurt and I didn't react to it because I assumed it was an over reaction.

In the last two or three months it has escalated. His reactions have been getting worse. He is sure that he has broken a bone and screams. He runs back and forth screaming "HELP ME, HELP ME, HELP ME!!!!" Any parent would panic when they heard this reaction from their child. Watching and listening to this reaction is heartbreaking. A mommy's instinct would be to grab the child get in the car and go to the Emergency Room. I have almost done just that. The decision to go or not to go is a difficult one.

First I have to get him to stop running. This in itself is difficult. Have you ever seen a trapped insect trying to get out of it's enclosure? It is a similar scene. He can not stop running back and forth. Combine that with the crying and screaming and it is a scary scene. The screaming is a combination of pain, fear and confusion. How I don't panic when I hear is beyond me? The only way to get him to stop running is to be calm, speak softly and actually catch him. Yes, I actually have to get in his path and grab a hold of him.

At this time there is no way to hug him, which is what my instincts are screaming at me to do. I have to, almost at the same instant I catch him, access the injury. The first step is find out where the injury is. Sometimes he can't tell me and sometimes you can't tell what hurts by looking at him. Again the key is a soft calm voice and often physical contact. I will stoke his back and get down to his level. I listen to him and do a quick visual assessment. Then the hard part, I have to get him to show me the injured body part.

I have fallen down the stairs and broken my ankle. My foot was turned 180 degrees. Visually when I saw my foot my heel was in the front and my toes were facing behind me. It was such a foreign sight that my First thought was that I had lost my toes. When I lived out of state I crashed my bicycle and put a spoke through my knee. I picked up my bike and walked him. The amount of blood was staggering. The reaction I am hearing and seeing from my son is a reaction a one would expect from a child if they had injuries similar to these. I look and brace myself expecting such an injury. Will a bone be broken? How much blood is there? Will I have time to get him to the hospital?

Now I know the odds are that the injury is nothing compared to the reaction. But once I thought he was over reacting and got mad at him, he really did get hurt pretty badly and I felt like the most horrible mommy ever. I look and there is no blood, no broken bones and no life threatening injuries. Maybe 30 seconds have gone by and now I have to also deal with the reactions of other people in the vicinity.

My daughter is scared, she now is also crying because like me she is neuro-typical and her impulse reaction is something horrible happened to her big brother and he is in trouble. My husband is freaking out, he may not be neuro-typical, his brain I think works more similarly to P's brain than mine. His first reaction is also that something bad has happened but instead of a quick assessment he often will react like my son is. His voice gets louder and it sounds like he is yelling. In other words chaos is all around me and it is overwhelming.

Today P fell off his bike. We could hear the scream from inside the house and it was LOUD! In runs my son screaming "HELP ME, HELP ME, HELP ME, HELP ME!" He announces to us that he broke his bone. This has been his assessment of the last three or four similar incidences. I start my assessment and my husband starts to yell. In case you are ever in a situation like this there is one thing an adult should not do, that is to panic and yell. It often makes the child more upset. It is like throwing gasoline on a fire. Not a good idea.

Chaos is erupting my husband is yelling, my daughter is crying and my son is running back and forth in the living room screaming "HELP ME, HELP ME, HELP ME, HELP ME!" I catch him and force him to show me his thumb. No blood, no swelling, no dislocation, okay nothing too bad. At the same time I tell him that he is okay and announce to my crying daughter that P is okay. This also allows him to hear that it really is okay.

Now daddy is yelling "How can I help you? What do you need?" Seriously, P has no idea, he is in pain and it is overwhelming. He hears that he is okay, but his nervous system is telling him that he isn't. He reacts because that is how he is hardwired. Daddy hears that he is okay but sees that he is reacting like it is a sever injury. Instead of listening to my calmness and reassurance that his son is okay he tries to assess the situation independently. He does this by yelling asking P over and over again if he is okay. Unfortunately P believes that it is worse than it is and this combination is making the situation worse. I am hugging my son, often a bear hug can help calm the over-stimulation. It makes him feel safe and my reassuring voice also starts to calm him down.

He breaks lose and starts running now and daddy keeps asking him what does he need. Maybe a minute has passed and it feels like eternity. He starts to understand that he is okay and pauses occasionally to catch his breath. Now my husband is yelling at me because he doesn't understand what I am doing. He reacts like P does to pain, a little pain causes a major reaction. They are two peas in a pod this way. Just breathe! That instant where I had assessed the situation now comes back to me, did I get it wrong? Should I really take him to the hospital or immediate care? So many things are happening all around me that will start to doubt myself. I have taken first aid courses as well as classes for CPR certification. I am not a first responder, but have gone through the training for first responders in another state. I examine his thumb again and it really does seem to be okay.

Not even two minutes have passed. My son is starting to calm down, he is asking me to hold him and announcing that he needs help in rotation. B has stopped crying but now my husband is upset that I am trivializing his pain, especially since I hurt myself last night trying to catch the air conditioned as it fell out of my second story bedroom window. Gravity won and I learned to never do that again.

Finally P allows me to help him calm down. I rub his back and stroke his arms and hair. I speak softly and slowly and reassure him that he is alright and that his thumb is fine, no bones are broken and it will be okay. He can now look at his thumb and accepts the liquid pain reliever. The chaos is ending and our lives start to return to normal.

I want to be able to teach him to self sooth, I want to teach him that the pain he feels is not on the same scale as his injury. I just don't know if I can. His reactions are getting worse and I don't know if I can always stay calm and help him. What happens when I am not there? What do you do when the hurt is overwhelming?

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