Primary
Primary Case Study - Child 1
Background
Peter is 5 and a half at the time of writing. He was diagnosed deaf at the age of 3. He has a profound loss in one ear and a mild loss in the other. He was given hearing aids and investigations into the cause of deafness and cmv was cited. From the start he was not keen to wear his hearing aids and despite consistent efforts and a desensitising programme he does not wear any amplification equipment. He enjoys wearing a hat.
Diagnosis
He was diagnosed with Autism at the age of 4.
He attended a nursery for hearing children and was placed in a unit for autistic children attached to a mainstream school. He was regularly visited by a ToD and had regular SLT advice and OT advice.
The recommendation was to use PECS more than 40 times a day for him to adopt the system. However this was not consistently used at school and concerns were raised by his ToD that he had no communication system in place or developing.
Typical behaviours and sensory issues
When he gets very excited he flaps getting progressively faster and falls to the ground. When he does not want to do something he runs away or falls to the ground and will kick and cry at length. However he has been seen to comply to a request after this.
It is difficult to anticipate what causes meltdowns as there is not always the same pattern. He has sensory issues relating to food and toileting.
He grinds his teeth much of the time and stills and points to the corner of his right eye when asked to do something. This then moves on to a physical outburst or falling to the floor when the request is repeated.
Communication
He has no interest in communication other than to satisfy his direct needs when he will take you to something but prefers to be independent and for example helps himself to food if he can. Eye contact is rare. Joint attention is limited to an iPAD activity although this is short lived as he tries to take over and move to another app. He is biddable on occasions and will follow an established routine. He is very affectionate with outward signs to his family. He has offered a wry smile to a favourite peer and will play alongside a few chosen ones but not with them.
Greatest current challenge
One of the biggest challenges was toilet training as he was wearing nappies at home and school. This was successfully tackled using a set routine comprising chronological cartoon type line drawings combined with an iPAD with the word ‘toilet’ which he typed when it was felt to be a time as a prompt and also as a need from him.
He has responded to music from the whiteboard, rocking to the rhythm and to music played at a distance into his good ear through a headphone or earpiece held at a distance from an iPAD.
He understands 2 stages of now and next. An egg timer has been successfully used to move him from one activity to another. He will try new things in his own time so a useful strategy is to leave things about for when he is ready.
Interests and strengths
He is fascinated by technology and computers in particular hacking into parents’ details on the tablet. He can retain visual patterns and has a wide graphical vocabulary; when asked to complete a cvc word to match a black splodge (ink) he wrote ‘shock!’. He removed ‘dog’ and ‘cat’ from Proloquo2Go and typed in ‘raccoon’ and ‘horseshoe crab’. He draws well although has an unorthodox pencil grip. He loves the trampoline at home and trips to the beach.
He has an obsession for a time which he defers to whenever he can and replaces this by another eg monsters; alphabet fonts.
After completing a task in the provision, he is happy to spend some time in mainstream on class or parallel activities and shares a teaching assistant experienced with autistic children.
Questions which arose:
Concern from school on how to impact his learning at the pace of his peers?
How long should we encourage him to try his hearing aid?
What is the best form of communication?
What is the correct placement to meet his needs?
Successful strategies:
Use of the iPAD for understanding toileting and to alert the ‘need to go’
Using print to convey meaning and instruction
Egg timers to regulate time spent on an activity and to move him on to the next activity.
Recent outcome:
He has moved to a school for profound and complex needs which is also the outreach base for SI services.
PECs is being used more successfully.
Parents feel confident that his ongoing needs will be met.
