When it comes to supporting autistic children in the classroom, teachers put a whole range of adjustments in place. It may be that students are given extra time on specific tasks, have texts in a format that is more accessible to read or are allowed to leave the lesson a little earlier to avoid the corridor rush.
But new research, published earlier this year by the Brighton and Sussex Medical School (BSMS), suggests that teachers should also consider adjustments around pain management.
The study highlighted the link between neurodivergence and physical health issues, and found that people with autism, attention deficit hyperactivity disorder (ADHD) and Tourette’s syndrome are more than twice as likely as the general population to have hypermobile joints and are far more likely to experience pain on a regular basis.
Sometimes children are formally diagnosed with Ehlers-Danlos syndromes (EDS), or joint hypermobility syndrome (JHS), but it is tough to get this diagnosis. More often, children are said to have symptomatic hypermobility (SH).
Symptoms are wide-ranging and include pain, tiredness, dizziness, brain fog, anxiety, headaches, migraines, jaw pain, ear pain, eyesight or vision issues, bone and muscle pain, allergies and nerve fibre pain.
The conditions can also result in dislocations, laxity joints, soft tissue injuries, gastrointestinal issues, heartburn, ulcers, painful spasms while eating, reflux, vomiting and bowel bladder issues.
Legally schools must provide for pupils with medical conditions but, because diagnosis for these conditions isn’t common, needs can go unmet.
Where students are experiencing pain, the most important thing a teacher can do is to acknowledge it: dismissing it can cause a huge amount of trauma and, indeed, lead to the pain getting worse.
Communication with pupils, parents, carers, allied professionals and good support groups is vital, and school nurses, occupational therapists and physios can all offer great advice.
But, beyond facilitating those conversations, there are adaptations that teachers can make to their everyday practice to support students.
Neurodivergent students in pain: how can teachers help
Comfort in the classroom
In many primaries, carpet time is a regular part of the day, but pupils experiencing SH will often need more support to be comfortable: this could be with a cushion, a chair or simply being allowed to sit against a wall. They also may need to move around more: don’t dismiss this as fidgeting, as it could be an issue with pain or proprioception.
In secondary schools, pupils may need backs to the stools often found in science classrooms and sometimes need to raise their legs if they feel dizzy or faint.
There are other considerations to make around things like pen licences, too. Pupils with SH may also have poor core coordination, plus weak ligaments in the finger joints: this can make holding certain pens or pencils painful. Instead, teachers should look for other ways for pupils to write, for example, with a device that has touch typing for accessibility.
Getting around the school
A weak musculoskeletal system can lead to injuries, and therefore, adaptations should be put in place when carrying heavy equipment or school bags. Allowing students to use a bag that has wheels on can be a big help, as can a lift pass so they don’t have to carry bags full of books up flights of stairs.
However, movement shouldn’t be limited completely: students need to be able to maintain their health and muscular strength. The key is understanding that there may be flare-ups here and there, and having the adjustments ready to go.
Considerations around exercise and sport
While it’s important for students to keep moving, PE teachers need to be flexible.
Tiredness is a huge part of SH: be aware that while the pupil might even be running around for one lesson, in the next one they might need a wheelchair or complete rest for a few minutes.
Pupils might find all sports difficult: temperature changes can cause dizziness, rashes and fainting, they may have problems with fine and gross motor coordination, or they may struggle with loud sounds, smells and lighting. Activities can also be painful due to soft tissue injuries or joint issues, which are often not visible until too late. Senses like proprioception and interoception also play a big part here, some children might not feel the slow build-up of pain until it hits them out of the blue.
Here, teachers need to be understanding and have conversations with students about what amount of activity or sport they are comfortable with.
Alternatively, if pupils do excel at one particular sport, they will need to be reminded not to do too much, and encouraged to rest so they don’t overextend and hurt themselves.
Adjustments for food
As well as pain from standing, walking and sitting, students can experience a lot of pain around eating, due to swallowing and reflux issues, stomach spasms, IBS and injuries.
These students need to have more time to eat their food, and may need to eat smaller meals, but more frequently. In some cases, they may have special feeding shakes. Working with the child to make the necessary timetable adjustments around this is key. Examples include allowing children to be in both lunch sittings so they have extra time, letting them eat while sitting down at break time and allowing them another food break in the afternoon.
Parents might advise but, often, little and often is good. If they have SH, they may need lots of water and salt packs, especially on hot days. If they are hypoglycemic they may need energy packs to stop flares. Ideally, this all needs to be in their health care plan.
They also will need a toilet pass that they can use regularly and without question. Some may need reminding to go, and when they do, more time to do so.
Unexplained marks or injuries
Teachers do need to follow mandatory safeguarding procedures if they spot any unexplained marks or injuries, but also take the time to ask parents if they have any diagnoses of connective tissue disorders that could explain bruises or pain. This can save a lot of anguish and time, and also help to highlight anything parents haven’t noticed themselves.
Jane Green is a professional educationalist Autism lead UK, exAHT and now advocates and advises on autism, EDS and symptomatic hypermobility. She founded and chairs the multi-award-winning SEDSconnective. She tweets @JGjanegreen.
