Background and setting
Sarah is nearly 9 years old. She has septo-optic dysplasia, with no observable use of vision. Sarah has severe learning difficulties and a diagnosis of autism. Sarah attends a special school for children with visual impairment.
Sarah is physically mobile. She has a long cane. During lessons with a mobility officer she is being taught to use her long cane and to trail with her hand. In fact, the cane can be seen as part of the task structure during mobility lessons, a component of the TEACCH approach. It may help her to stay on task.
Sarah has additional support at all times in school. To provide predictability and security, staff try to ensure that all events she is informed of in advance do actually happen.
Communication
Sarah is regarded as having good contextual understanding of spoken language, although there is little, if any, objective evidence for this is. However, it is recognised that it is important for staff to augment their spoken language to support for her understanding, using Total Communication: thus, a timetable which uses objects of reference, and a finished box, sounds of reference and on-body signing are employed.
Routine is used to in some situations to help to communicate with Sarah; for example, music lessons always follow the same clear routine.
Sarah communicates expressively using facial expressions, vocalisations, body language, motor actions and spoken language. The latter consists of single words and short phrases; she produces a lot of echoed language, both immediate and delayed. This sometimes appears to be communicative. To support Sarah's expressive communication, staff provide a responsive environment.
Transitions
Although Sarah is provided with information about forthcoming events using her timetable, she frequently asks what will happen later, indicating she is rather anxious about this.
Sarah used to find transitions difficult. She now copes more readily. It is likely that using her timetable to inform her of what is about to happen supports her to cope with transitions.
Interaction
Sarah is described as sociable, although interaction is always on her terms. She sometimes appears to enjoy interaction with an adult; for example, during Tacpac® sessions she engages in simple conversations with the member of staff supporting her. She also enjoys rough and tumble play on some occasions. Sarah does not interact with her peers.
Diet
In common with many sighted autistic children, Sarah eats a very restricted range of foods. Because her diet lacks several key nutrients, her health is compromised. Sarah is pre-occupied with meals and snacks, often presenting as anxious about them. It is possible she is concerned that the next meal or snack will contain food items she finds aversive.
With the long-term aim of providing Sarah with a healthier diet, and reducing her anxieties about food, a programme is in place to promote healthy eating. This is carried out in the classroom and involves presenting her with a food she is less keen on, though not one she actually finds aversive.
At times Sarah presents as being very anxious. When the programme to broaden her range of foods was first introduced, staff predicted it would raise Sarah's anxiety level. Therefore, a counting strategy is used to inform Sarah when to expect the end of the activity. This helps Sarah to manage her anxiety.
Anxiety and stress
Routine is very important to Sarah and she sometimes becomes very stressed if there is an unavoidable change in her routine. Thus, as far as possible, staff keep to Sarah's usual routine.
Sarah becomes anxious when another child in her class cries. In this situation, the TA uses a sensory integration strategy (deep pressure) to calm Sarah. This has been recommended by the occupational therapist.
Sarah sometimes becomes very stressed. When in crisis, she shouts, screams and hits her own head. Initially, Sarah is left to calm down alone. However, if she does not calm spontaneously in three minutes, she is taken out of the situation and taken for a walk to calm down.
Sensory needs
Sarah's sensory needs are addressed with sensory integration activities based on advice provided by the occupational therapist. Tacpac® is also used.
Medical needs
Children with septo-optic dysplasia may have several medical needs; for example, it is important to stabilise hormone levels. Sarah is therefore monitored closely by her consultant paediatrician. School staff, in conjunction with her parents, monitor Sarah's health and provide information as appropriate to the paediatrician.