Background and setting
Stacey, who is 6 years 3 months old, has Leber's amaurosis. She is registered blind, having light perception only. She sees natural, artificial and reflected light.
Stacey received a diagnosis of autism at the age of 2½. She has moderate learning difficulties. However, staff comment that she is "bright"; they feel that once her needs with regard to both her visual impairment and autism are better addressed, she will "take off".
Stacey attends a mainstream primary school with full time 1:1 support from a teaching assistant (TA), including break and lunch times. A Qualified Teacher of the Visually Impaired visits the school periodically to advise staff in facilitating Stacey's access to education. A member of the Advisory Service for Autism also provides advice.
Mobility and independence
To support Stacey's mobility around school, there is a rule that everyone walks on the same side of the corridor. In addition, Stacey has been made familiar with all the routes she takes within school. Each room is labelled to indicate the activity that takes place there. Moon is used for labelling alongside a tactile symbol.
To promote her independence, staff have labelled items in the classroom and cloakroom. Stacey's drawer and those of her peers, and her coat peg have been labelled, using Moon. In the medium term, it may be possible to use Moon to augment spoken language for Stacey.
Physical structure
In the classroom Stacey found it difficult to focus on activities, becoming very distracted by children passing by. The movement of children near her made her anxious, as she could not understand why the children were out of their seats, nor where they were going; she seemed to believe that everyone else was leaving. Staff think this caused her to panic, as she had not been told to go anywhere. To enable Stacey to focus more easily, she now has, in effect, a work-station, frequently used as an element of the Physical structure component of the TEACCH approach.
When she entered her current class, Stacey did not cope with the transition from lesson to lesson. A counting strategy is now used to inform her when to expect the end of lessons.
Stacey has a carpet square, an item which is compatible with the Physical structure component of the TEACCH approach. She sits on the carpet square during circle time.
In order to provide Stacey with access to information readily available to her sighted peers, the TA informs her of what is going on in the classroom.
Sometimes the TA feels Stacey has not understood an instruction given by her teacher. This is despite waiting to provide her with sufficient processing time. To check that Stacey has understood the instruction, the TA asks Stacey to say in her own words what it is she has to do.
Sensory needs
The occupational therapist found that Stacey was both hypo- and hyper-sensitive to touch, depending on her environment and the nature of the tactile stimulus. She believed Stacey's poor sitting posture indicated a need for increased vestibular and proprioceptive input, and has given advice about improving sitting posture.
As Stacey was initially reluctant to engage in tactile activities, the occupational therapist provided a desensitisation programme.
Stacey sometimes pinches her peers. Staff believe she does not intend to hurt them. Instead, they view this behaviour as habitual and fulfilling a need for a good deal of sensory input. Staff therefore enable Stacey to fulfil this sensory need appropriately.
Change
Stacey is rather rigid with regard to change, and initially found it difficult to cope with changes of routine. The TA now informs Stacey of impending changes of routine. This appears to have helped her to cope with such changes. In addition, the TA has worked with Stacey since she started school, and has built a close relationship with her, and built trust. It is thought that this has also contributed to Stacey becoming somewhat more flexible.
Engagement in activities
The TA feels that Stacey frequently opts out by disengaging with the activities provided for her. On these occasions, she ceases to attend to the task, and staff are unable to direct her back to it.
Stacey's attention skills have improved recently as a result of the strategy for improving sitting posture. However, during periods of "independent time" Stacey is unable to attend to any activity for more than about two minutes, after which she engages instead in rocking. Independent time is unstructured, the intention being that it provides "space" between educational activities. However, because these periods are unstructured, Stacey does not understand what she should do, and lacks the ability to select a functional activity for herself. Consideration is now being given to making the periods between educational activities more supportive for Stacey. She has a high level of energy and presents as restless; she also requires a good deal of sensory input (see above). Therefore, it is likely she will have opportunities for physical exercise and opportunities to use the toy which enables Stacey to fulfil a sensory need appropriately.
Stacey gains a great deal of satisfaction from independent movement around the school play area during break times. Foam padding is used to reduce the risk of injury from collisions with obstructions.