Case Study – Transitioning Back to School

Background

J was a 13 year old boy diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) at age five and autism at age 10.  When referred to Middletown Centre for Autism (MCA), J was a first year student in a Learning Support class in a post primary school for boys, however he had missed a large portion of his Primary 7 year due to school refusal.

J’s interests included supporting Manchester United and watching and talking about football.  He was motivated by all aspects of farming.  He liked talking about working on his family farm and liked talking about any farm related topic.  He had his own calf and cared for this with the help of his Grandfather.  J lived at home with his mother and older and younger sisters.

Triggers

After consulting with home and school the following triggers were identified:

J found change difficult.  His mother attributed anxiety associated with the thought of the transition to Post Primary School for J refusing to attend school during his P7 year.  At primary school, if J’s teacher informed the class that a substitute teacher would be covering, J would refuse to go to school.  At Post Primary school, if a substitute teacher was covering, J complained of feeling unwell and asked for his mother to be contacted to collect him from school, which she always did.   J also found smaller changes difficult, for example, family arrangements needing to change due to one of J’s sister’s plans changing unexpectedly.

J found verbal instructions difficult.  J would listen to an instruction, then nod his head indicating that he understood, but when he would go to execute the instruction, he would complete just the first or last part of the instruction.

Concentrating and trying tasks that were new or that J was not proficient with was challenging for him.  He would lose interest or give up quite quickly and request help from an adult.  He would persistently ask when he could move to the next task or activity.  If the adult encouraged J to attempt the task, J would become frustrated and upset and then refuse to attempt the task or activity again.

Strategies

A gradual approach to support J’s return to school was introduced. J and the MCA co-ordinator visited school for planned short activities that he previously enjoyed and the routine of J attending for one hour every Thursday was established.  During these initial stays in school, J worked with different but pre-identified, members of the Learning Support Team.  This enabled J to meet the team and to establish positive relationships with them.  The weekly visits were gradually increased; initially J attended two days but always stayed for the same length of time.  Over time, set days for J to attend were identified.  An individualised written schedule was consistently used to inform J about what he would be doing in school and a timer was set with J so he could see how long an activity would last.

Initially activities were planned based specifically for J, however this too was gradually extended with reverse integration (where a small group of mainstream pupils joined J in the learning support class for activities) being used to build J’s tolerance for engagement in activities alongside peers.  This also exposed J to the typical expectation of learning in a small group but with adult support.

A change system was introduced to help J cope with unexpected change.  This was supported by a social narrative called, Sometimes Plans Change Unexpectedly.  The school team initiated the teaching of the concept ‘change’ by changing a non-preferred activity to an activity they knew J would enjoy.

As J found following verbal instructions difficult, the teacher wrote the instructions down in sequence, then demonstrated how to complete the task.  J was also provided with a completed example of the task.  When possible, the school team utilised J’s special interest in farming when setting work.  His special interest was also used on visual supports, such as ‘Packing My Schoolbag’, ‘I Need a Break’ and ‘I Need Help’, to motivate J to use them.  These visual supports also enabled J to be an independent learner.   Additionally, Social Narratives were used to communicate and prepare J in advance for what he was expected to do during planned activities.  The teacher also informed the students when there was 10 minutes and then 5 minutes left in class.  This enabled J to prepare for the end of one activity and to prepare for the transition to the next.

The MCA co-ordinator also focused on teaching J emotional regulation skills. The 5 Point Scale and Body Mapping strategies were used to explicitly teach about emotions and how they impact on his body.  The body mapping enabled J to self-identify when he was starting to feel dysregulated and the options on the 5 Point Scale, personalised with images of farm machinery, enabled J to regulate himself.  J helped create his own Calm Kit which was kept in one of the Learning Support classrooms to which J had unlimited access. Additionally, personalised visual supports were created and used to redirect J to structured regulatory tasks to help with de-escalation when the school team noticed changes in his behavioural responses.

Summary

With the strategies detailed above, J was able to return to school and now attends regularly.  He was able to follow an individualised daily schedule independently and engage in learning alongside peers.  J’s mother reported that she frequently uses the social narratives created to help J understand why things sometimes change unexpectedly and reports that his tolerance of small unplanned changes is improving.  His mum also reported that the visual systems created collaboratively with the MCA co-ordinator are effective in helping J complete tasks such as emptying the dishwasher independently.

Reverse integration enabled J to participate in learning alongside his mainstream peers.  His teacher reported that J can cope with small group activities although with varying degrees of success dependant on J’s own emotional regulation.

J’s emotional regulation skills continue to develop.  Home reported more success than the school team, however after incorporating daily regulation time into J’s timetable, school  reported that he is more willing to try when things are hard and that he is using the communication cards prepared for him.

J continues to make progress at school and at home.  School reported that he recently took part in two trips with peers, to a school soccer match and to an end of term trip to a bowling alley.