How can I tell you where it hurts, when I can't talk?
When Liam was small and we didn't yet know he had autism he used to get rampant tonsilitius.
I would take him to the Doctor, get the antibiotics and then fail hopelessly at getting Liam to take them (because he was so sensitive to taste and smell) so bacteria being who they are would then build themselves up and mutate into something even stronger and more painful.
Even with this septic mess of a throat, Liam would continue to run around and play until suddenly he would go pale and listless.
I would take him back to the Doctor only to see him CRINGE as he examined the tonsils and say
"They are VERY infected" then look at me like I was the worst mother in the world, write a new prescription and say firmly "complete the course" as if I was too busy smokin, drinking cider and playing the slots to ensure that my son took his medicine.
Eventually after many flare ups and visits and hiding of medicines in food (a bad idea) and asking if they could be administered by injection (no!) I was advised by a teacher "that medicine was medicine and it had to be taken as such".
So I stopped hiding it in yoghurt and chocolate pudding and milk (and putting him off all of these) and I wrapped him in a towel like a cat, and gave him the infant drops made up to maximum strength until he did finish a full course and kicked the bug.
And I learned that our kids do not understand how to "Act Sick".
Now kick aside any assumptions about "high pain thresholds". You cannot put yourself in another person's body and count the number of pain receptors they have. If you don't believe me, try googling "Dislocated limb vs Child Birth" and see what comes up.
I've had both and I can say I went back for another go at child making, but I never put my thumb anywhere near a conveyor belt again.
So No, Autistic people are flesh and blood and they feel pain to the same or lesser or greater degree as anyone else.
What they don't do naturally is learn to act like they are in pain.
Wives and Mothers have to learn this from experience. If you have a filthy cold and feel like shite, DO NOT load the dishwasher, make the lunches and lay out tomorrow's school uniforms and then expect someone to bring you a lemsip while they do the baths and bedtime routine. Because your significant other will assume since you are well enough to do the first chores, it is perfectly okay for them to watch Arsenal defeat Barnsley while children run rampant, unwashed, unbrushed and wide awake; while you cough up a lung.
Nope, you have to take to your bed like a Victorian heroine the minute your partner gets home, and stay there while they cook the wrong dinner, and make strange lunches and put saucepans on the top shelf of the dishwasher and wine glasses on the bottom.
Hold your forehead and cough weakly when you are asked how you are. And when they go out (to McDonalds to get a better dinner probably) THEN you run around with the hoover and make sure everyone has clean socks and undies for tomorrow. Then jump back into bed.
Our kids with Autism, have to be Taught to do this. Because the ability to think like someone else, to imagine how someone else is thinking, is SUPER difficult for our guys - we have to teach them that telling us about something internal, is going to be rewarding.
You start small, you start with something that is obviously and visibly painful; like a stubbed toe, or a bump on the knee. (for ethical reasons you cannot create these opportunities, wait for them to happen)
Stop them and sit them down while you rub the knee or toe and kiss it, apply savlon and comfort them verbally. Give them hugs or pats while repeating "Sore Knee, OUCH!, Sore Knee".
In other words give positive 1-1 attention for the visible injury.
At the same time you should be using separate opportunities to build body awareness.
Show me, Point to, What's This? for Tummy, Forehead, Teeth, Chest, Nose, Eyes, Ears and Groin.
Tutors and Teachers do this by direct teaching, using physical prompts, flash cards and often a doll or toy to point to the relevant body parts.
Parents can just throw these in in tickle and cuddle games, or while dressing.
And the idea is that they would learn to generalise - taking the extra attention they get for showing you a hurt knee, and learning to show you a sore tooth, ear, or tummy/groin.
Which you can then treat with calpol, bongela or a trip to the doctor for further investigation.
This "program" worked magnificently with Boo. Who will demand a Doctor for a hangnail or call for an ambulance if he bumps his funnybone.
But when he did have an ear infection recently, when he told us "The ear is sore" he was right. And the Doctor didn't treat me like a serial killer, because it wasn't that bad.
For Bratty, it is much harder as she does not have the verbal language to tell us her arm, leg or ear hurts. So we rely on visuals like pictures:
You can create your own picture cards using images from these free websites:
But how do you make sure those pictures are where you need them, when they do fall down?
Well now there is an App for that! Go here to learn more.