Case Study BC: Emotional Wellbeing and Anxiety

Background:

BC is a nineteen-year-old autistic man who has recently transitioned from Post Primary School to a work placement.

It has been noted that BC has a very good memory, a robust sense of humour and a keen interest in movies , with an extensive collection of DVD’s, Blu-rays and Video Cassettes. He has excellent computer skills and also enjoys art and drawing.

Factors Impacting Emotional Well-being:

In line with his diagnosis, BC presents with difficulties in social communication skills, sensory processing and significant challenges around flexibility and rigid thought patterns. Direct observations of BC, at home and in school, and from discussions with his parents, staff and BC, himself,  led to the identification of the main factors contributing to stress and anxiety.

Social Communication Difficulties:

• Conversations where others have a different opinion from him on an area of focused interest, proves difficult for BC. He finds it difficult to cope and tolerate differing perspectives, often culminating in elevated levels of stress and anxiety.
• Knowing what to do during unstructured times; these times are difficult and often lead to BC perseverating on negative thoughts and past events.
• Awareness of social difficulties; request to try to work on making “real friends” as opposed to acquaintances from online fora.
• Literal interpretation of language; frustration when others dismiss or do not understand his interpretation.

Sensory Processing:

• Finding it difficult to work in cluttered spaces.
• Being highly distractible, particularly if expected to listen to a lot of verbal direction.
• Sensitivity to certain noises, smells, and textures.
• Needing movement throughout the day

Rigidity of Thought:

• Worrying about changes to his current routine. The transition from education to work caused him increasing levels of anxiety. BC often became quite distressed, saying, “I don’t want my life to turn into a mess,” and desperately trying to find ways of maintaining contact with his school.
• Coping with deviations from his understanding of social rules – For example, not understanding why his parents would not consent to him watching particular 18+ rated movies, even though he is 19 years.
• Tendency to focus on events from the past, which he perceives to be negative and he now regrets. He speaks frequently about “alternative histories,” and his wish to change things that happened some years ago.

Emotional Regulation:

• BC did not have any awareness of his increasing level of stress when he encountered difficult situations or the skills to cope when faced with stressful events. Often, such events would result in an “emotional stress response,” where BC would engage in behaviours of concern, such as shouting, using bad language, slamming doors, or hitting out at others.

Strategies:

The following strategies were used to reduce stress and anxiety.

• Preparation for transition to work-placement:
  • Work-placements were identified based on core strengths and interests.
  • Systematic and gradual introduction, supported by familiar staff. Progress was carefully monitored
  • Star-Wars themed calendar with clear and concise information about the schedule for each day. (Star Wars Calendar)
  • Visual supports in work-placements (School to Work / Work placement / Vocational Employment / Voluntary Work)
    • Clear rules, timetables
    • Clear sequence of visual instructions relating to assigned tasks
  • Accommodations to address sensory processing needs; quiet place to calm, when needed; access to gloves, to handle difficult textures; request headphones, if needed; access to movement breaks, when required. (Sensory Resource)
• Specifically taught strategies to deal with events causing stress and anxiety. (Reducing Anxiety and Managing Anxiety)
  • Concept of “Energy Accounting”: awareness of items, events and thoughts that result in “loss” of energy – those, which cause stress and anxiety. Identifying specific activities that replenish “energy” – relaxation, time with special interests, drawing, listening to music (Visual things that increase energy for BC). BC is reminded to do this before his energy runs into the “Danger Zone”, perhaps resulting in an “emotional stress response”, https://www.abc.net.au/everyday/using-energy-accounting-to-manage-anxiety-and-find-balance/100097310
  • Learning to recognise physiological signs of stress (Where we feel anxiety) – increased heart rate, rapid breathing, sweaty palms, dry mouth. (Potential Signs of Anxiety)
  • Specific teaching about how to respond to these signs in a timely manner i.e. before your energy runs too low, Energy bucket, perhaps causing an “emotional outburst”. (Signs I’m feeling anxious) Cycle of An Emotional Stress Response,
• • Regular times and opportunities to meet with trusted mentor to discuss and problem solve around specific concerns or anxieties. Top Tips for Supporting Communication
• Structured weekly activities in the community:
  • Access to youth club twice per week
  • Gym/physical exercise weekly
• Managing Anxiety in the Classroom
• Anxiety, Volume 2
• Autism, Strategies to Help with Anxiety, 

BC transitioned successfully to two different work placements and continues to progress at each placement. The visual strategies introduced to support BC to manage stress and anxiety were very effective. BC is able to identify that his energy ‘is running low’ and opts to engage in calming activities to replenish his energy account.