Communication Skills Can Help Individuals with Special Needs Express Pain, Avoid Acting Out

Categories: Applied Behavior Analysis; ASD and DD, Adult-focused; ASD and DD, Child-focused; Brain Injury

Medical conditions and physical problems are often overlooked as causes for unusual changes in behavior in individuals with special needs, but are often the very reason these behavioral changes occur.

Most of us turn to over-the-counter medications, ask a loved one for assistance, or make an appointment with a physician when we feel ill or experience discomfort or pain. Some individuals with special needs, however, may lack the necessary communication skills to express their wants, needs, or feelings. They may not be able to alert others to the fact that they are experiencing a physical problem.

When an individual who is unable to communicate falls ill or feels pain, it is not uncommon for him to resort to inappropriate and challenging behaviors. For example, he might throw a plate onto the floor in an attempt to let his caregiver know that something is wrong. That action might also be an attempt to get out of eating dinner because chewing food exacerbates the pain of a toothache.

Challenging behaviors can also be an attempt to alleviate painful symptoms. For example, a person may bang his head on a table or wall because the pain caused by the head banging is more bearable than the internal throbbing of a migraine headache.

An individual who is acting out may also be trying to communicate hunger, thirst, constipation, or the need to urinate – uncomfortable situations that most of us deal with daily. If we are hungry or thirsty, we eat or drink. If we need to use the restroom, we do. But if an individual who relies on the assistance of caregivers can’t effectively communicate these basic human needs, he may engage in challenging behaviors.

One effective method to assist individuals with special needs who have difficulty communicating uncomfortable physical symptoms is to teach them “functional communication,” or alternative methods of communication. At May Institute, we teach sign language and the Picture Exchange Communication System (PECS). Many of our residential sites have picture books and boards full of pictures (icons) depicting favorite items and activities, physical conditions, and community locations. We use these icons to facilitate communication and to encourage the individuals we serve to make choices. With these alternative communication methods, we can either teach an individual to use a sign that indicates “headache” or point to a picture depicting a person with a headache. Both methods provide the individual with an appropriate way to communicate the same problem.

Just as challenging behaviors can be a way to get attention, escape a task, or alert a caregiver to a minor physical discomfort, they can also serve as a way to communicate more serious medical problems. If a problem behavior is new, sudden, or unusual, then there is a likelihood the individual is trying to express pain, discomfort, or distress. For this reason, medical causes for behavior change should be ruled out immediately. This is especially important when working with aging adults who are susceptible to arthritis, broken bones due to osteoporosis, diabetes, or Alzheimer’s disease. An appointment with a primary care physician is an important initial step, as this doctor will assess the problem and refer the individual to a specialist if needed.

Learning functional communication can provide the individual with another way to express a want or a need and help him communicate the fact that he is in pain or experiencing physical discomfort. It can replace challenging behaviors and provide him with more control over his environment. More importantly, the ability to communicate pain or physical discomfort can ensure that the individual will receive appropriate and timely medical treatment.

By Teka J. Harris, M.A., BCBA

About May Institute
May Institute is a nonprofit organization that is a national leader in the field of applied behavior analysis and evidence-based interventions, serving autistic individuals and individuals with other developmental disabilities, brain injury, neurobehavioral disorders, and other special needs. Founded nearly 70 years ago, we provide a wide range of exceptional educational and rehabilitative services across the lifespan. For more information, call 800.778.7601 or visit