Background and setting
Bob is 14 years old and attends a community special school. Bob has septo-optic dysplasia, moderate learning difficulties and autism.
Despite having severe visual impairment, Bob does not appear to be very disabled by his poor sight. He navigates around familiar environments independently; he has no significant difficulties with daily life skills; he reads print quite well, preferring N print size 32, but sometimes coping with much smaller print; he has some basic numeracy skills, enabling him to handle small sums of money; and he uses a computer well.
Overload
However, Bob's autism is considerably more disabling. It very significantly affects every aspect of his life.
In the past, Bob has often become overloaded with sensory information, sometimes very rapidly. Amongst the difficulties he reports are humming computers and laptops, fluorescent lights flickering and peers crossing their legs.
He is unable to tolerate crowded rooms and cannot cope if the entrance hall is bustling when he arrives at school: the noise, movement and unpredictability are simply overwhelming for him. In addition, he becomes very distressed if someone bumps into him. Arrangements have now been made for him to arrive at school a little later than his peers to avoid the early morning bustle in the entrance hall, and thus to avoid crowded situations.
The member of staff supporting Bob constantly monitors the environment to ensure it does not become crowded.
Initially, staff believed they were providing Bob with a clear boundary for acceptable behaviour by insisting that he attend every lesson in the classroom with his peers. In fact, Bob was unable to do so. He is now taught in a room by himself, with no other children, and with only one member of staff. Bob uses several rooms in the course of a week; each one contains a work-station which is a feature of the physical structure component of the TEACCH approach.
Dinner time at school was initially extremely difficult for Bob. It was common for him not to enter the dining hall at all. If he did enter it, he rarely stayed for more than a few minutes; typically he left very rapidly, sometimes swearing as he did so; on a few occasions, he hit a peer or member of staff as he left. Staff now understand that the dining hall is over-stimulating for Bob and he is no longer expected to eat his dinner there. He has his dinner (a packed meal which he brings from home) in one of the rooms he uses during lesson times. This is another example of Bob being able to avoid a crowded situation.
As noted above, Bob cannot cope if someone bumps into him. He is also unable to tolerate light touch that is intended to be communicative (eg to obtain his attention). However, Bob quite often asks someone to rub the top of his back, and seems to need this rubbing to be very firm. It is possible he finds this sensory integration activity calms him.
Communication
Bob's expressive language can appear to be quite sophisticated, resulting in staff over-estimating his level of understanding. In fact, he has significant difficulties understanding spoken language, except when it is greatly reduced and simplified.
Staff augment their spoken language with the printed word (in N print size 32, using the Arial font). This is particularly important when giving Bob instructions; this includes instructions concerning educational tasks and tasks around school (eg taking the register to the office). In effect Bob has a mini schedule for all tasks.
Because Bob interprets language very literally, it is essential to give him clear, explicit instructions.
Bob finds it difficult to respond appropriately to questions. Therefore, staff generally avoid asking questions, presenting Bob instead with a statement to complete. However, if he is calm, he does respond to simple questions such as "Do you want a drink?" If he answers "Yes," but does not spontaneously say what he wants to drink, staff offer him a choice.
Bob needs additional processing time, so often responds after a very obvious pause. Staff now adopt the "wait for eight" approach.
Interaction
He is sociable - on his terms. In other words, when he has something to say, especially when he wishes to make a request, he approaches another person and initiates contact; he is almost always polite and often charming. Sometimes, when Bob makes a request, it is not appropriate for the member of staff to grant it. For example, he likes to use the stapler in the school office, but cannot always do so. On such occasions, the member of staff responds to his request in a positive manner, redirecting Bob, using the now / then approach.
If someone else initiates contact with him, Bob's responses vary widely. When he is calm and relaxed, he typically responds positively and politely. However, when he is engaged in a task or a favourite activity, he is unable to respond. This is because he is single-chanelled and cannot attend to more than one thing at a time. When he is anxious or stressed, he sometimes responds in a way that most people regard as very rude: he may ignore the other person, or swear aggressively. When he is in crisis, he may hit the other person.
It is essential that staff understand when it is not appropriate to communicate with him. Staff no longer speak to Bob when he is engaged in a task or a favourite activity, very anxious or stressed, and certainly not when he is in crisis: they leave him to calm down alone. Thus staff provide Bob with a responsive environment.
Sensory needs
The practitioners supporting Bob are very aware of his sensory difficulties. They understand the need to:
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control the sensory stimulation in his environment
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provide a calm environment in which he feels safe and secure and which enables him to access educational activities.
They therefore consciously provide a low arousal environment. This is used alongside work stations, schedules and spoken language which is greatly reduced and simplified. Bob also understands that he can leave any situation and use a safe haven if he becomes too stressed, anxious or overloaded to cope.
Key strategies
The strategies described here have been very effective. The key ones are:
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arriving at school a little later than his peers to avoid the early morning bustle
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providing a room where he works alone
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using work-stations
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providing written schedules
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and greatly reducing and simplifying speech.
Since their introduction, Bob has been considerably calmer and more content, and has engaged more frequently and for longer periods in educational activities.