Case Study – Social Anxiety & Phobia

Background

B was a 13-year-old young man with a diagnosis of autism and ADHD.  He lived at home with his mum and was an only child.  At the time of his referral to Middletown Centre for Autism (MCA), B was a pupil of a local high school, having transferred from another high school in the area, but had not attended yet.  He had a history of school refusal behaviours which started when he was preparing to transition out of primary school to post primary school.

B enjoyed playing on the PlayStation, taking his dog for a walk to the local park, building his own creations out of wood and scraps of metal and watching football.

Triggers

After consulting with B’s mum and with school the following was identified:

B found it difficult to enter the school building when other pupils were around.  He was able to go into the building while classes were on and walk around the corridors with a familiar staff member but did not feel comfortable entering a room with other pupils visible.  He also found reassurance in having his mum wait at the entrance of the school during his short visits so he could leave quickly if he felt he needed to.

B struggled with the social use of language in particular interpreting the intent of his peers. For example, when passing other pupils on the corridor who were laughing and joking, he automatically presumed they were talking about him despite there being no indication of this.

He found it difficult to interact and engage with unfamiliar adults and peers.  He found it challenging to know what to talk to others about, how to initiate a conversation, and how to maintain it.

Strategies

The starting point was to establish what the anxiety triggers were and to identify what B knew about his reaction to these triggers.  B’s mum was provided with autism-friendly information on anxiety, what purpose it serves and techniques to manage it.

B’s mum, the ASD teacher and the MCA co-ordinator worked collaboratively to devise a plan for B to attend school and to work one-to-one with a familiar Classroom Assistant in a two classroom mobile for a short-agreed time each day.  The use of the mobile meant B did not have to worry about passing other pupils in the main building or them coming into his classroom unexpectedly, which was a source of anxiety for B.  As the weeks progressed close liaison with B continued to ensure he felt ready to extend his time in school and to be exposed to other pupils gradually.

The mobile had two classrooms; initially B and the Classroom Assistant worked in one classroom while the second classroom was vacant.  As time progressed, a teacher and a small group of pupils started to use the second classroom.   At the beginning of this part of the intervention B was anxious and found it hard to concentrate even when the door was closed to the hallway where access to the second classroom was, but as time progressed B became more relaxed knowing there were other pupils in the next classroom.  This progressed slowly and gradually to B knowing that there was going to be a planned interruption by a pupil who entered B’s classroom to collect something.  Over time, the door between both classrooms was left open to further increase the exposure to B’s fellow pupils.  This progressed to B completing a short piece of work in the other classroom with a small group of pupils present to B successfully participating in a small group activity with peers.

To support B develop a trusting relationship with school staff and to reduce his anxieties regarding predicting expectations for his time at school, a word only timetable was introduced. This was also visible in the classroom along with detailed information on what work B was expected to complete daily while in school.  It also detailed the staff member who would be working with B that day him and information on who would support him the following day in school.  This information allowed B to prepare in advance.  The school team ensured that B’s timetable and workload was adhered to.

To support B in increasing his social communication and competencies, the Social Thinking and Me programme was used.  This supported B increase his awareness about core concepts of social learning, such as Flexible Thinking, Thinking with your Eyes, Expected and Unexpected Behaviours, Thoughts and Feelings and helped B to develop skills to enable him become a competent social learner.

Summary

It was important that the adults supporting B collaborated with him to ensure the speed of progress was planned and at an appropriate pace and that structure and routine were used.

Using the above interventions meant B was able to attend school on a consistent basis.  Teaching B about social communication meant he was able to start building relationships with the staff who support him in school.  His mum reported that he continues to make gains and that he hopes to make friends with his new peers in school over time.