Harry, who is ten years old and has Asperger syndrome, has come to the surgery with a suspected sprained ankle. His Mum accompanies him. Although his ankle looks bruised and swollen, Harry is immersed in playing on his GameBoy. You question Harry but the only information you can get out of him is about the injustice of the Sports teacher not allowing Harry to carry on playing in the Team game. His Mum says he has valiantly attempted to walk from the car to the setting without any fuss or support. Harry appears to show no expression of pain and presents as not feeling the obvious discomfort. This could be because his pain threshold is somewhat higher, or because he does not know how to express his pain.

Strategies

• Ask Harry if he can assist you in your enquiries/to find out more information.
• Be advised by his mother who will know Harry and how pain manifests for him.
• Point out the difference between his two ankles.
• If necessary use a measure to show him the difference.
• Ask Harry concrete and specific questions to ascertain the injury, e.g. ‘What happens when you try to put weight on your foot?’ rather than relying on Harry’s pain perception or self-assessment.
• Base your assessment and diagnosis on the assumption that Harry has a very high pain threshold that does not reflect the extent of the injury.
• Explain your diagnosis very clearly and state explicitly what needs to happen next, including ‘rules’ about what Harry must and must not do to protect the injury.
• If possible, provide written/visual information or sources of further information so that Harry and his Mum can look at this together at home.