Case Study – Fear of Separating from Parents, Rigidity with Leaving Home and Trying New Things
A was a 10-year-old female diagnosed with autism. When referred to Middletown Centre for Autism (MCA), A was a pupil at her local mainstream primary school, however she had not attended school on a full-time basis for three years. This was despite school reducing her timetable from full time to part-time, lessons moving from in class with peers to one-to-one in a quiet area outside the classroom and then moving her classroom from inside the school building to a mobile classroom near the entrance to the school building.
A had a keen interest in art, Pokémon and animals, especially cats. She had a strong visual learning style with a preference for order and routine which drew her to technology and science-based topics. She lived at home with her mum, dad and two older siblings.
The MCA Co-ordinator supported A as she prepared to transition to the autism class in the school.
After consultation with A’s parents and with school the following triggers were identified:
A found it difficult separating from her parents. She was happy to separate from one parent at a time but her parents reported that she would have a panic attack when they both left the house at the same time.
A struggled to leave the house. Her parents reported that she would not eat before a planned outing and would complain of tummy ache immediately before leaving home. A would also ask several questions based on the exact details of the outing such as who else would be there, how long they would stay, and what would she, her siblings and her parents do when away from the house.
Both home and school reported that A found it difficult to try new things including things they knew she would enjoy. A would repeat that she could not do it and would get very upset when something new was presented.
Preparation for A separating from her parents while she attended school started in the family home. A was provided with a narrative explaining the length of time she would spend in the classroom, who she would be working with and that her parent would sit on a chair outside the classroom, then a chair at the front door of the school, then wait in the car. The social narrative also communicated where her parent would collect her at the end of the school visit. A and her parents visited the autism class a number of times to ensure she was familiar with the staff and with the setting. Initially only the autism teacher was in the classroom, but each time A visited, the number of other people in the classroom increased as did the time A spent in the classroom. When A returned to school, there were 5 other pupils with autism in her class all attending on a full-time basis. Initially A attended for an hour each day, with the time gradually increasing as the weeks progressed until A was attending school every day for part of the day.
To further support A, the MCA co-ordinator created a book with photos of A with each of her parents and with her cat which she was able to look at in school. A scarf with Dad’s aftershave and Mum’s perfume was also placed in A’s schoolbag. A had unlimited access to these resources while in class . Regulation strategies including Star Breathing and Grounding Exercises were practised with A at home before being used in school.
A visual system allowing A to communicate her anxiety level to the school team was devised and practised in the home before being transferred into school. It was based on the traffic light colours: green-I am ok, orange-I need calming strategies, and red-I need to phone my Mum or Dad. As the start date approached, A told her parents she felt ready to attend school when the other pupils were in class and to stay without them.
Even though A was a fluent reader and had previously followed a word schedule in school, the MCA Co-ordinator identified this was challenging for A when her anxiety was elevated therefore a word and symbol schedule was introduced at home and in school. The schedule was placed on A’s desk before she arrived into class. After approximately 3 weeks A started to independently use her word and symbol schedule.
A’s teacher adapted the class timetable so that subjects which were highly motivating (such as science and technology) took place when A was present, which then encouraged attendance.
The MCA co-ordinator introduced anxiety management strategies to support A leaving the house. Initially visual supports and regulation strategies were introduced and practised at home for less challenging transitions, for example, leaving home to purchase food for A’s cat, then leaving home to visit her grandparents before progressing to leaving home to visit school.
Worry Time was also introduced and added to A’s daily schedule for after tea-time each evening. This provided A with time to discuss any worries. The MCA co-ordinator introduced the Think Like a Scientist strategy to support discussions, again tapping into A’s interest in science and technology.
The MCA coordinator used the publication ‘When My Worries Get Too Big’ by Kari Dunn Buron along with a body outline to explore the concept of anxiety and how it presented physically. Star Breathing and Grounding Exercises were reinforced.
In order to support A trying new things, choice b were developed for use at home and school. The boxes were filled with items A liked, including Pokémon and a project book about cats. After A tried a new lesson or activity in school, she could choose an item from the box and engage with it before transitioning to the next lesson. This helped motivate A and helped her regulate after trying something new.
These strategies worked to support A’s return to school and attendance at school on a consistent basis. School and home reported that any minor amendments to the transition plan were made at a pace that suited A. Because of this this, A built up familiarity and trust with the school team who used visual supports consistently. A’s parents reported that because careful consideration was made by all supporting A as to how autism impacted on her ability to be flexible and adapt to change, they were able to be out of the family at the same time and that the family had recently started to go on outings together. Both school and home reported that A continues to attend school daily and is progressing in school.