Case Study - Stacey

Stacey, who is 6 years 3 months old, has Leber's amaurosis. She is registered blind, having light perception only. She sees natural, artificial and reflected light.

Stacey received a diagnosis of autism at the age of 2½. She has moderate learning difficulties. However, staff comment that she is "bright"; they feel that once her needs with regard to both her visual impairment and her autism are better addressed, she will "take off".

Stacey attends a mainstream school with full time additional support from a teaching assistant (TA), including break and lunch times. A Qualified Teacher of the Visually Impaired visits the school periodically to advise staff in facilitating Stacey's access to education. A member of the Advisory Service for autism also provides advice.

To support Stacey's mobility around school, there is a rule that everyone walks on the same side of the corridor. In addition, Stacey has been made familiar with all the routes she takes within the school. Each room is labelled to indicate the activity that takes place there. Moon is used for labelling alongside a tactile version of a pictorial symbol.

To promote her independence, staff have labelled items in the classroom and cloakroom. Stacey's drawer and those of her peers, and her coat peg have been labelled, using Moon. In the medium term, it may be possible to use Moon to augment spoken language for Stacey.

In the classroom Stacey initially found it difficult to focus on activities, becoming very distracted when other pupils passed close by. The movement of her peers near her made her anxious, as she could not understand why they were out of their seats, nor where they were going; she seemed to believe that everyone else was leaving. Staff think this caused her to panic, as she had not been told to go anywhere. To enable Stacey to focus more easily, she now has a work station, a component of the TEACCH approach.

When she entered her current class, Stacey did not cope with the transition from lesson to lesson. A counting strategy is now used to inform her of when to expect each lesson to end.

Stacey has a carpet tile to inform her of where to sit square during circle time.

In order to provide Stacey with access to information readily available to her sighted peers, the TA informs her of what is going on in the classroom. However, this is done briefly; thus, the TA avoids providing verbal commentaries.

When the teacher gives Stacey an instruction, the TA attempts to provide her with sufficient processing time: she waits. Nevertheless, the TA sometimes feels Stacey has not understood. To check that Stacey has understood the instruction, the TA asks her to say in her own words what it is she has to do.

The occupational therapist has assessed Stacey and found that she is both hypo- and hyper-sensitive to touch, depending on her environment and the nature of the tactile stimulus. She believed Stacey's poor sitting posture indicated a need for increased vestibular and proprioceptive input, and gave advice about improving sitting posture. The occupational therapist also provided a programme to support Stacey to engage in messy tactile activities.

Stacey sometimes pinches her peers. Staff believe she does not intend to hurt them. Instead, they view this behaviour as habitual and fulfilling a need for a good deal of sensory input. Staff therefore enable Stacey to fulfil this sensory need appropriately by providing an Eggcersiser.

Stacey is rather rigid with regard to change, and initially found it difficult to cope with changes of routine. The TA now informs Stacey of impending changes in the usual routine. This appears to have helped her to cope with such changes. In addition, the TA has worked with Stacey since she started school, and has built a close relationship with her, which has contributed to building Stacey"s trust. It is thought that this has also contributed to Stacey becoming rather more flexible.

Stacey's attention skills have improved recently as a result of the programme to improve her sitting posture. However, during periods of "independent time" Stacey is unable to attend to any activity for more than about two minutes, after which she engages instead in rocking. Independent time provides "space" between educational activities. However, because these periods are unstructured, Stacey does not understand what she should do, and lacks the ability to select a functional activity for herself. Consideration is now being given to making the periods between educational activities more supportive for Stacey. She has a high level of energy and presents as restless; she also requires a good deal of sensory input. Therefore, it is likely she will have opportunities for physical exercise and opportunities to use her Eggcersiser.

Stacey gains a great deal of satisfaction from independent movement around the school play area during break times. Foam padding is used to reduce the risk of injury from collisions with obstructions.