Case Study AB: Emotional Wellbeing and Personal Care

AB is an 18 year old autistic female. She attends a mainstream Post-Primary School. AB was working towards achieving an A-Level in Art, in which she displays skill and talent.

Background:

AB is an 18 year old autistic female. She attends a mainstream Post-Primary School. AB was working towards achieving an A-Level in Art.

AB has an extensive vocabulary with articulate verbal skills, however, these can deteriorate when she is stressed. At such times, AB may not speak at all or speaks in such a low tone that she is difficult to comprehend.

AB tends to move through school with her head lowered and her body turned away from others. She leaves class a few minutes earlier than her peers to avoid the busy corridors. AB rarely makes eye contact and often speaks in a very low tone. She displays difficulty with social interaction outside of her family home. She rarely participates in any social activities with her peers and attends few family social events.

AB also ceased caring for her hair, which is of great concern to both her and her family. AB also finds it difficult to accept gifts.

The Adolescent/Adult Sensory Profile (Brown and Dunn, 2002) was administered with AB to assist in the understanding of why she may respond in certain ways to sensory input in the environment. While results indicated that AB did not indicate significant difficulties in sensory processing, she can be distracted by background noise and competing sounds within her environments. AB actively tries to reduce sensory input, by, avoiding noise, eating similar foods and avoiding close physical proximity to others. AB also likes to sit with the lights off.

Areas of Concern:

  1. Changes to routine at home or at school
  2. Difficulty with developing flexible thinking
  3. Managing her personal hygiene
  4. Maintaining conversations during social situations
  5. Managing time effectively with regard to her school work, which can lead to increased anxiety

Strategies

  • AB was introduced to weekly social skills groups, which included investigating and discussing tasks in a secure environment aimed at meeting the needs of all Post-Primary students. Interesting tasks and activities were presented over a series of months to promote attention, peer engagement, social interactions, build trust and communication amongst peers.
  • AB identified that she preferred taking a bath to a shower, as she does not like the noise of the shower. (Visual to Support Taking a Bath) This Step-by-Step Social Narrative was used with AB, clearly breaking into management chunks, the schedule of having a bath.
  • Visual Social Narratives were used to explain to AB the importance of maintaining good personal hygiene.  (Social Behaviour Map) Fiona Speirs ‘A PHSE Programme for Learners with Autistic Spectrum Disorders’, https://www.milton-keynes.gov.uk/assets/attach/24203/ASD-and-relationships1-2-.pdf was used to support AB understand the importance of identifying and maintaining personal hygiene.
  • A desensitisation programme was designed to encourage AB to wash small amounts of her hair gradually over time. She was encouraged to start at the bottom and gradually work her way up to the scalp over a number of weeks. (Hair Washing Steps)
  • It was felt pertinent to introduce AB to the concept of a worry box, http://www.health.harvard.edu/blog/two-techniques-for-reducing-stress-201104092235 to allow her to write down her feelings and post them into a box she had decorated herself, so that they could be discussed at a time convenience to her mum. (Worry Box) Professor Barry Carpenter recommends offering a Happiness Box, where the proactive, positive approach to difficulties can be taken and offers an alternative to worrying. Please view the webinar from Kari Dunn Buron, When My Worries Get Too Big
  • Development of an Emotional Toolbox, http://www.autismtoolbox.co.uk/about-autism-toolbox, which was designed in the form of a poster in order to use AB’s artistic skills. She drew all the options available to her when she is feeling anxious. (AB’s Emotional Toolbox).
  • AB was encouraged to engage in activities which help to promote good mental health e.g. walking, yoga and deep breathing. The Take Ten programme was used to provide a visualisation for deep breathing. (Watch Progressive Muscle Relaxation video)
  • AB was taught more about her diagnosis of autism. ‘Aspergirls’ by Rudy Simone was used to teach AB about other young women who have been diagnosed with autism and how they have learned strategies to overcome day to day challenges.
  • Work was completed in the home environment with siblings in order to build positive relationships e.g. candle and jewellery making.
  • Development of a Social Narrative to help with accepting gifts (Social Narrative, Accepting Gifts)
  • AB was supported to go on community outings, going out for tea and shopping. She also attended a cushion making workshop, which built on her love of artistic activities.
  • AB was encouraged to develop and use timetables for her study, which provide a visual prompt of deadlines. Middletown Centre for Autism Research Bulletin, Visual Strategies.   She also began using a diary to note important deadlines and form ‘to do lists’ which she could tick off once completed.

Further resources

Visual supports aimed at helping to promote independent personal care are available from the Centre’s Social Media platform.

Edel Quinn, a Middletown Centre Trainer/Advisor, shared a webinar, “Developing a Worry Jar”, which shares the premise of the Worry Box discussed earlier.

Jill McCanney, another of the Centre’s trainer/advisors and a Specialist Occupational Therapist, delivered two webinars, registering with the Centre’s Online Learning is needed to access the following webinars.

  1. “An Introduction to Sensory Processing”
  2. Supporting Engagement in Personal Care