Case Study - Archie

Archie, who is seventeen, attends an all age special school. He has been diagnosed with Laurence Moon Bartel Biedl Syndrome (LMBBS) and autism. Archie has moderate Learning difficulties.

Archie's peripheral vision is poor, reducing his field of vision. Practitioners in his school have been informed that

• his field of vision will probably reduce further
• ultimately, he may be left with some central vision
• but it is possible he will lose all useful vision.

Archie has mobility training with a mobility officer. He has a long cane. He is adept at using the long cane to move independently around the school. The cane can be seen as part of the task structure, a component of the TEACCH approach. It may help him to stay on task. Archie enjoys the sensory information he obtains from his long cane, and it helps him to manage his anxieties and can therefore be seen as calming. He has been provided with trails and landmarks.

Because his vision is deteriorating, Archie is being taught braille. Currently, staff augment their spoken language for Archie with tactile versions of abstract symbols. It is possible that braille will become the most appropriate means for augmenting spoken language for Archie.

Archie has unrealistic expectations about being able to drive and to live an independent life in the future, and refuses to accept that he is likely to lose his sight. Although it is not unusual for young people to find it hard to come to terms with losing their sight, Archie's difficulties are compounded by his autism. This is because he does not readily understand that another person may have a different perspective from his own, and he tends to reject any view put forward by someone else. He has weekly counselling sessions to talk through the future and his prospects.

Archie has communication difficulties. For example, he requires longer to process verbal information, particularly when it is addressed to the whole class. Staff therefore provide Archie with additional processing time by using the "wait for eight" rule when asking questions and giving instructions.

Archie talks to himself a great deal. Staff believe he does so to reassure himself about what is happening next. He has a history of repeatedly asking staff questions about the next event. This infuriates his peers who constantly tell him to be quiet. To reduce Archie's anxiety about forthcoming events and, therefore, his repetitive questioning, he now has a tactile timetable, another component of the TEACCH approach. Staff also respond to Archie's questions in a positive manner. His repetitive questioning is reducing.

Archie is not sought out by peers, as he presents as arrogant and bossy. He repeatedly tells off other young people when he believes them to be behaving inappropriately. This stems from his autism: although he has learned certain rules about acceptable behaviour, he does not understand that what is unacceptable behaviour in one context may be acceptable in another. For example, he understands that interrupting a peer during question and answer sessions in class is not permitted. But he thinks that the same rule applies to conversations between peers at dinner time. A programme is in place which uses "jigsawing" to promote Archie's peer relationships.

Despite support to enhance Archie's conversational skills, he still lacks the ability to participate adequately in conversations. Staff are introducing a story to support Archie's social understanding of peer relationships; it explains the difference between conversations and formal turn taking interactions.

Archie often rocks when standing on the spot, which some staff feel is inappropriate. For the present, staff accept this behaviour which may serve a calming, self-regulatory function.

Archie has good attention skills when he is motivated. Thus staff always endeavour to build tasks and activities around his interests and skills.

Archie really enjoys listening to music and often sings along, although he has no special musical abilities. However, Archie's interest in music is employed to prepare him to participate in educational activities and to enhance his engagement in them.