Case Study - Jivan

Jivan is six years old. He has a diagnosis of septo-optic dysplasia. He is registered as severely sight impaired and has only a very small amount of peripheral vision. Jivan sometimes seems to be aware of an object which is nearby, but does not use his vision to examine it. He appears to see other people, as he sometimes approaches the teaching assistant (TA). Jivan has severe learning difficulties and autism.

He attends a mainstream school where he receives full time additional support from a TA. There is very infrequent input from an occupational therapist.

The school tailors provision to meet Jivan's needs: they take his needs, rather than access to the mainstream curriculum, as the starting point. For example, he has an interactive music session with the TA when the school has assembly. Jivan enjoys music and responds well to this session which is based on intensive interaction.

Jivan is physically mobile. He navigates independently in familiar areas but requires a sighted guide in unfamiliar locations. He is supported by a mobility officer who visits weekly for half a day. She uses part of this time to take Jivan to the multi-sensory room in a local special school. This enables her to promote his attention to stimuli using a sensory environment.

The staff who work with Jivan do not have a clear picture of how much spoken language he understands. In context he sometimes responds appropriately to a range of simple spoken instructions, e.g. "stand up," "come here," "give it to me," "put it down," "stop." However, he often fails to respond appropriately. Staff therefore augment their spoken language by using several signs to support Jivan's understanding. Practitioners offer him their hands, and place them under his, i.e. they use the hand-under-hand approach.

As well as using signs, staff have recently introduced some objects of reference, e.g. for "toilet."

A strategy which has proved very effective is the provision of a carpet tile to indicate to Jivan where to sit during "floor time".

In the past Jivan sang nursery rhymes and repeated single words. It is thought he sometimes echoed words in order to communicate. Currently, Jivan makes a lot of repetitive sounds. Staff do not believe he intends these to convey meaning. He does not communicate expressively using spoken language. However, occasionally staff feel he attempts to produce a word he has heard in an appropriate context. Jivan sometimes expresses his needs by guiding an adult's hand. He indicates he wants a drink by opening his mouth and thrusting out his tongue. Staff provide a responsive environment by responding to all of Jivan's behaviours that appear to be communicative.

Jivan usually tolerates interaction with familiar adults. Occasionally he nestles in close to the TA, perhaps indicating a need for physical contact.

Jivan does not appear to be aware of his peers, even when they try to initiate contact with him. He does not engage even in parallel play.

Elements of the TEACCH approach are used to support Jivan's engagement with educational activities: he has a clearly defined work space, similar to a work station and a finished box is used to help him to understand that an activity has ended.

As Jivan is very active, he is provided with opportunities for physical exercise each day.

Jivan is regarded as a "sensory seeker". He engages in a lot of self-stimulatory activities including rocking, hand flapping, twirling and jumping. He often taps items on his head, mouth and chest. These behaviours indicate Jivan's stress level: the more he engages in them, the greater his stress. The TA therefore monitors Jivan's behaviour. If he is becoming stressed, she takes him somewhere quiet to calm down alone.

On entering primary school, Jivan was unable to sit still for more than a few seconds. To increase the length of time Jivan sits on a chair, staff have adopted strategies suggested by the occupational therapist. Before asking him to sit on his chair during lessons, Jivan is prepared to participate in the educational activity. In addition, staff enhance his engagement in the activity.

Jivan, in common with many sighted autistic young people, has sensory difficulties with clothing and is therefore provided with some support.

Also in common with many sighted autistic young people, he has a restricted diet, and does not readily eat dinner at school. However, no programme is yet in place to promote healthy eating.

Jivan appears to have very little sleep, and frequently has a disturbed night. It is not unusual for him to arrive at school having been awake since 2am. He frequently falls asleep in school. Staff believe that his irritability may be linked to sleep deprivation and are therefore supporting his parents in seeking professional advice for achieving a good sleep pattern.

Jivan has no major challenging behaviours although he sometimes scratches and bites himself. These behaviours are thought to be related to his level of stress and tiredness. If she believes Jivan is becoming stressed, the TA first tries to calm him with an atom massager; if this fails to reduce his stress, she takes him for a walk to calm him.