It has long been recognised that children and young people with vision impairment (VI) display autistic-like behaviours, historically called blindisms. Today we know that autism is a very common additional need for children who have VI, with estimation that one in three may have co-existing autism and many who are without a clinical diagnosis show elevated social communication difficulties.
Francis was a student at a specialist school for children with vision impairment I used to work at. He has been blind since birth but also has a diagnosis of autism. He uses contracted braille, has a great passion for football and music, and enjoys nothing better than performing. When we got it right for Francis, things went well. If we made a mistake, we found out quickly. If we had to make a change to class routine, we would have to plan it carefully and support Francis through the process. If in crisis, he communicated frustrations by throwing objects, shoes being a favourite. But overall Francis was performing well at the school; his autism was understandable to us as teachers of children with VI. We thought we understood autism.
Claire was different to Francis. She had some functional vision and was diagnosed with autism as well as severe learning difficulties. Claire came to the school as a result of exclusion from two mainstream primaries that felt they could not meet her needs. Claire’s parents tried to enrol her into specialist autism schools but they were full. Those schools also argued that her primary disability was vision impairment. My team disagreed, arguing the reverse, but whoever was correct, there was a young pupil not receiving an education and that wasn’t right. We had been successful with Francis, so we thought all would be well. But it wasn’t to start with and so began our journey on a steep learning curve.
Claire quickly displayed those behaviours that led to exclusion from her previous schools. She had high anxiety levels and communicated this through behaviours, which were challenging to those supporting her and to her peers.
Our knowledge of autism simply wasn’t enough. Though staff were experts in the needs of learners with vision impairment, to successfully support pupils with VI and autism it was clear that the same level of expertise in autism was required.
We were very fortunate to secure a teacher working towards a MEd in Autism, who brought us the knowledge we needed. Our goal was to ensure that Claire would be included in the classroom. To succeed in this requires whole staff training around the impact of autism on the learner.
Here are some of the key points we learnt during training:
It’s important to be aware of the language you use to communicate with a pupil who has a dual diagnosis. For example, don’t use too many words and give the pupil time to process what you said.
Many people with autism have sensory sensitivity. Make sure you understand the impact of environment factors on the pupil to avoid anxiety-provoking situations, such as loud noise, warm temperatures or strong smells.
Partnerships with therapies are of paramount importance, such as occupational and speech and language, as only through a multidisciplinary approach can we hope to provide the right level of support to address the many needs which arise with autism with co-existing disabilities.
Occupational therapists prepare sensory diets using deep pressure, weighted blankets, mini trampolines and theraputty (like playdough for hand exercises), all of which help the pupil to regain focus and reduce sensory overload. Therapeutic use of the trampoline brought an enjoyable physical activity with opportunities to reinforce social skills and communication.
Speech and language therapists facilitate small groups of children to practise social skills, including play, turn-taking, listening and awareness of personal space.
Equine and animal therapies were particularly successful in Claire’s case, as the emotional bonds she quickly formed with the animals resulted in lowering anxiety.
A structured learning environment is needed and tools such as visual schedules can be made auditory through buttons which record 10 or 30 seconds of speech.
Claire became less anxious, with a reduction in challenging behaviours along with improved interaction with others. She started forming friendships and was able to integrate into class successfully.
At the beginning of the journey with our learners with vison impairment and autism, we thought we would find a unique way of working with those who have a dual diagnosis. This wasn’t the case. Teachers need to understand both in depth in order to find out what works with each unique individual.
About RNIB Three Spires Academy
RNIB Three Spires Academy is a special school in Coventry, England for pupils aged four to 11 with significant learning disabilities. Over half of the children have autistic spectrum conditions and others have additional needs, including sensory impairment and communication difficulties.