Case Study – Bereavement
F was a seven-year-old boy diagnosed with autism who attended an autism class in a mainstream school. F had difficulty communicating. He could verbally request everyday needs and preferred items using symbols or photos and relied on a symbol schedule. F presented with challenging behaviour and sensory processing differences. He sought out additional sensory input across different contexts.
F lived with his parents and older brother. In the year prior to his referral to Middletown Centre for Autism (MCA), F’s sibling died unexpectedly. This was and continues to be, an extremely sad and difficult time for the whole family. School and home found it difficult to support F with this bereavement. Counselling was not available to F due to his communication difficulties.
A small number of people including immediate family, a key support worker in the family home, and key staff members in school, interacted and supported F across the day and week.
F’s sister’s death was a source of understandable grief causing him to seek out his sister’s toys and belongings. His parents reported that F would tear-up photos of his sister which his parents believed was due to F feeling sad and seeing them therefore he wanted them removed.
School reported that since F’s sister death, his emotional responses to challenges, including challenges he previously coped well with prior to his sister’s death, had intensified and he often cried inconsolably when frustrated.
All who supported F in school and at home reported that despite following a consistent routine daily with a variety of tasks, at times F would get anxious and refuse to transition. They also reported that when a member of this close circle was absent for an extended period of leave, F’s behaviour became challenging and he had physiological manifestations (such as eczema) flare up.
The MCA co-ordinator created a memory box which F helped to decorate. He picked photographs of his sister and used these to decorate the outside of the box. F and his parents collated items personal to his sister, such as hairbands, one of her bottles, her favourite books, her teddy and other toys she played with and placed these inside the box which F had unlimited access to at home.
The MCA co-ordinator adapted the book called ‘I Miss You, A First Look at Death’ by Pat Thomas. F’s parents read this to F frequently.
A social narrative was created using personal pictures of the family and of F’s sisters grave and this was used to explain to F what had happened. Due to F’s communication needs the content of the social narrative was kept factual, for example,
My name is F (photo of F inserted)
This is my family (Photo of family of 5)
I have a brother called Y (Photo of Y)
I had a sister called ______ (Photo of sister)
_________ died. (Picture of coffin)
We remember _________ (photo of grave)
The ‘I Miss You: A First Look at Death’ book along with other publications such as The Invisible Leash by Patrice Karst about the death of a child’s pet dog were added to F’s classroom library.
To let F know what he would be doing on a daily basis, a symbol and word daily schedule was implemented at school and home. To further support F, a small photograph of the staff member supporting F was placed beside the symbol.
To prepare F for when a member of his close circle of support was going on leave provided, a pictorial social narrative was provided which explained why the person was going to be absent. For example, Mrs B will be off on Tuesday as she is going to the doctor to have her leg examined. Mrs B will see F on Wednesday. If the person was off for a longer period of time, the social narrative was supported by placing a small photo of the person on the date they were due to return on F’s monthly planner.
At home, to prepare F for times when his parents would leave home together similar visual strategies were used. A social narrative informing F that his parents would be out and the approximate time of their return was created. F’s daily schedule communicated what he would be doing while they were away and an activity F enjoyed doing with his parents was identified for their return.
F’s parents continue to talk to F often about his sister; what happened to her and how they miss her and feel when they think of her. F continues to access the memory box frequently. At times he will quietly take the objects out and look at them, at other times he will seek out his sister’s favourite DVDs and say her name as he watches it. F is very motivated by music; his parents are now considering music therapy as an accessible way of further supporting F to process and express his grief.
School reported that the daily schedule and in particular the social narrative and photos of the staff member are working effectively. His teacher reported that F now engages in all the activities planned for the class and whilst he still has emotional responses when feeling frustrated, they are reducing in intensity. School also advised that F will at times, seek out the publications in the class library on death of a loved one.