Using a Person Centred Approach to Stress Responses 1
ST, a 17 year old young man was referred to the Centre as he presented with a number of behaviours of concern such as hitting, throwing, ripping clothes and other items, defecation, and urination in inappropriate areas. ST also has difficulty in self-regulating his emotional responses to some sensory input and can at times demonstrate a stress response to stimuli that he dislikes and finds stressful.
ST uses strong communicative acts to express his needs, wants and to protest. It is however noted that communicative function is impaired when ST’s sensory regulation and/or emotional regulation is unbalanced.
Environmental influences may at times cause specific emotional reactions with ST, those of which include proximity to specific others, high pitch sounds/vocalizations and the use of excessive language when direction to a planned activity. During unstructured time, ST can engage in ripping of clothes/throwing of objects/smearing.
The first step was to explore what factors were triggering the behaviours of concern. A range of sensory, behaviour and communication assessments were completed with ST, his parents and school staff. Observations were carried out at home and school. Analysis was combined with the assessment results from the specialist occupational therapist, specialist speech and language therapist and behaviour intervention specialist.
It was evident from results that ST is sensory seeking of visual, proprioceptive (body awareness) and vestibular stimuli (movement). As such, strategies identified for ST employed, where possible, these sensory elements.
The following strategies were implemented with the aim of reducing destructive behaviours such as ripping clothes/ throwing objects and smearing:
Strategy One: Ensure ST was aware of what was expected and reducing unpredictable events. Strategies included:
- Individual visual photo schedule.
- Transition cards to direct ST to check his schedule and transition to the next activity.
- Choice boards using photographs of activities available to ST.
- Structured activities to clarify to ST what he was expected to do in different activities.
Strategy Two: Reduce the likelihood that ST will engage in behaviours of concern to avoid situations which he finds difficult to tolerate such as noisy environments, people standing too close. Strategies included:
- limit verbal commands when directing with visuals
- comment rather than question
- imitating vocalizations/word combinations that ST has initiated himself.
- See best practice resource for more communication ideas.
Strategy Three: Introduce a programme of sensory activities to ST’s daily routine through his visual schedule: Strategies included:
- Walking / carrying activities
- Using the therapy ball
- Balancing activities
- Calming proprioceptive/ deep pressure activities
- Link here for sensory resource for more sensory ideas
- More information on handling an emotional outburst can be found here
- Link here for teenage resource