Using a Person Centred Approach to Stress Responses 2

Background

PF was referred to Middletown Centre for Autism when he was 10 years old; PF  experiences a stress response that includes hurting  himself and damaging property this can involve hitting, kicking, throwing and self-biting. 

Triggers

PF is proficient in following a visual schedule using both photos and symbols. PF use of language is developing and when he is calm, he can make appropriate requests, comment, say people’s names and interact with adults. However, during times when he is frustrated PF does not always use words to communicate his needs or requests and instead can experience a stress response.   

PF has a mixed sensory profile. PF seeks out additional vestibular and proprioceptive input across environments throughout his day. If he has limited opportunity for this input PF will become emotionally dysregulated. 

The measures and supports outlined below were in place to support PF when he becomes stressed and / or overwhelmed.  The supportive adults caring for PF put their efforts into the proactive measures. PF’s wellbeing was always considered and the supportive adults used the strategies outlined to maintain PF’s sensory and emotional regulation throughout the day. The supportive adults also practised a Low Arousal Approach when around PF to maintain a quiet and calm environment.

Follow this link for more information on the Low Arousal Approach

Strategies

A range of sensory, behaviour and social emotional regulation assessments were completed with PF, his parents and school staff to gain a better understanding of his stress responses.  Observations were carried out at home and school. Strategies were implemented to ensure PF’s wellbeing across all areas and are outlined below:

Sensory Processing

  • PF will engage in a sensory diet which addresses his sensory needs throughout the day. These are visually structured for PF
  • In school PF will access outside playground equipment, the sensory room and class-based activities which will provide vestibular and proprioceptive input
  • PF will engage in sensory activities which have a calming impact on him. Quiet time is structured regularly throughout his day in a pop-up tent or relaxing area with a choice of preferred activities.

Follow this link for the sensory processing resource

Structure and Predictability

  • Visual supports are in place in the form of photo and symbol sequences
  • PF is fully aware of what is expected of him throughout the day and relies on his visual schedule to see what is happening next
  • Offering choice as often as possible during the day gives PF a sense of control and the ability to express himself. Choices are offered visually using symbols
  • During free time, calm time or outside play activities are visually presented on a choice board using pictures or symbols 
  • First/Then schedule is used to help PF stay on task where appropriate, for example mid transition from place to place.

Follow this link for further informaiton on visual methodologies

Communication

  • PF has access to visual supports to make requests and his needs known during times when he is frustrated and unable to communicate verbally
  • Introduction of ‘Finished’, ‘More time please’, ‘Help’ symbols were introduced.

Link to communication section

Health and Wellbeing

  • Physical activity is structured regularly throughout the day to ensure PF’s sensory wellbeing is accommodated
  • Regular communication between home and school to share any setting events that may increase the likelihood of behaviours of concern (e.g. sleep, sickness, toileting, change in routine). 

Link to wellbeing section

Requests and Instructions

  • Prior to an activity ending a countdown strip was introduced and used to prepare PF for when an activity was ending
  • PF had the opportunity to request more time using a symbol of a clock
  • Expectations were communicated in advance using visual supports.

Social Interaction

  • PF will experience regular opportunities for positive 1:1 experiences with familiar adults
  • Supportive adults modelled calm behaviour throughout the day.

Low Arousal Approach

Supportive adults followed the low arousal approach as described in the C.A.L.M document when high level behaviours of concerns occurred. 

  • Guide PF to a safe space to calm: bean bag, chair or blankets
  • Limit speech as much as possible, use visuals instead. If necessary, use calm reassuring voice. Do not shout
  • Adopt go slow approach
  • Remove the trigger
  • Offer distraction: use a visual to offer an activity or object
  • Supportive adult; stay calm and be mindful of facial expression, eye contact and body posture. 

Link to CALM in a Crisis