Case study FG (Challenging Behaviour and Anxiety)
FG is a 10 year old boy who attends a mainstream primary school. He has a diagnosis of autism and Attention Deficit Hyperactivity Disorder. FG has a keen interest in sports, displays strong skills in memory retention of factual information. He enjoys playing football, and talking about it with adults and peers. He likes routine and predictability, and can become anxious when plans change.
FG requires support in managing his emotional regulation, anxiety and organisational skills. He has many fears, including a fear of failure.
Support is required to manage his behaviour when faced with challenging situations such as ‘losing a game’, ‘making mistakes’ or ‘coping when others do well’.
FG was referred to Middletown Centre for Autism due to concerns in relation to high levels of challenging behaviour and anxiety that were evident across the home and school setting. FG highlighted his own concerns in managing his behaviour, and often engaged in negative self-talk about his behaviour in comparison to his peers. Following consultations with parents, professionals at school and FG the following areas of concern were identified:
- Understanding and recognising emotions, their physiological symptoms and associated behaviours. This was particularly evident with negative emotions such as anxiety, sadness and anger.
- Coping with challenging tasks at school.
- Organisation of materials, sequencing of tasks and homework completion.
- High anxiety levels, worrying about changes in routine, future events, distinguishing between fantasy and reality and irrational thinking patterns.
- Social Interaction with peers and siblings, often resulting in challenging behaviour occurring.
- Both family and school staff felt ‘out of their depth’ in supporting the challenges the FG presented with.
- FG was given explicit teaching in the core features of autism. This knowledge empowered FG to clearly understand why his behaviour may have differed to his peers. The ‘Big A workbook’ was chosen as one of the teaching tools for this lesson. To view a copy of the ‘Big A workbook’ click here.
- FG was taught to recognise degrees of emotions using the Incredible 5-point scale. This scale was used daily across the home and school setting, and following 2 months of intervention FG was independently able to request a break from a challenging environment prior to reaching high anxiety or frustration levels. To view an example of the Incredible 5-point scale click here.
- Capacity Building training took place across the home and school setting in ‘autism’, ‘anxiety management’ and ‘promoting positive behaviour’. These topics were chosen as priority trainings for both home and school, and ensured continuity of information and approach across both settings.
- Training was provided to the class teacher and resource teacher in the ‘differentiation of the school curriculum’ to incorporate special interests. Such teaching practices enhanced FG’s motivation to participate in challenging subjects and tasks. Strong partnerships between home and school ensured that any new strategies employed at school were communicated to parents, and trialled at home during homework activities.
- Visual Social Scripts were used across the home and school setting to coach FG prior to engaging in activities that may be challenging for him. The visual scripts ensured that FG was prepared for situations such as ‘losing a football game’ ‘not being chosen first’ or ‘making mistakes’. To view an example of a visual script addressing Coping with Disappointment click here.
- Social Behaviour Mapping and The Way to A resource book were used to map out the consequences of any behaviour in any situation. The purpose of the teaching tools was explained to FG in line with the core features of autism. This knowledge empowered FG to see the value in such resources and he requests to use them prior to social events or activities that he may find challenging. To view an example of a Social Behaviour Map click here.
- The Exploring Feelings resource by Tony Attwood was used to teach cognitive strategies for anxiety management. FG created an ‘emotional tool box’ to use as a relaxation tool within his home and school setting. Other resources based on Cognitive Behaviour Therapy were utilised to support negative thinking patterns such as ‘Overcoming Anxiety in Children and Teens’ by Jed Baker.
- Discussions took place in school around individualising behaviour management policies and plans. Behaviour policies were reviewed within the school to ensure children with autism were not being punished or excluded because of skill deficits.
- Team teaching was encouraged at school to ensure FG could participate in challenging subjects with his peers. This model of teaching involved two teachers to join collaboratively to ensure a successful model of inclusion was in place for FG to participate in class with his peers as much as is possible. Through collaborative teaching both teachers had the opportunity to share knowledge and practices, as well as provide the necessary support to FG during challenging activities.