Case Study - Tyler

Tyler is 11½ years of age and attends a special school for young people with visual impairment. Tyler has optic nerve hypoplasia and an abnormality of the cornea. He does not have any useful vision and is registered as severely sight impaired.

Tyler is physically mobile. He uses a long cane for independent mobility. In unfamiliar situations he relies on a sighted guide.

School staff and his parents consider Tyler to have autism, but a formal diagnosis has not been made. His skills are a little below the level expected for young people of his chronological age; however, he does not have significant learning difficulties.

Tyler's expressive language is good in that he has an extensive vocabulary and creates long, complex sentences. However, he understands spoken language less well than his expressive skills suggest. This means it is crucial that practitioners reduce the amount of spoken language they use with Tyler and simplify it.

Tyler needs additional time to process spoken language, so it is important to provide sufficient processing time and use the "wait for eight" rule. If Tyler fails to respond after an appropriate interval, the instruction or question is repeated in exactly the same form as the original.

Tyler's understanding of language, written as well as spoken, is very literal, so staff avoid metaphor, simile, sarcasm and idioms.

Because Tyler interprets language literally, he has sometimes responded in what might seem to be a rude, cheeky or flippant manner. He has done so in response to indirect instructions such as "Can you go to dinner now?" and "I want you to go to your classroom now." Staff now avoid giving such indirect instructions, and give explicit instructions.

His social communication skills are poor. He is deeply interested in vehicles and talks a great deal about this topic. Once he is talking about vehicles, Tyler finds it very difficult to change the topic or to stop talking.

Tyler often used to talk about vehicles during lessons. Therefore, staff avoid triggers; they do not:

• initiate any conversations with him about vehicles
• mention vehicles within his hearing.

He has now been given a clear boundary concerning this issue: "Work in lessons. Talk about vehicles at break." If he does talk about vehicles in a lesson, the rule is repeated and he is redirected to the task. He is also praised when he is attending to the task by being told "You're working well. That's good." Tyler now rarely talks about vehicles during lessons.

Tyler is sociable, and enjoys having conversations with adults. He rarely interacts with his peers.

Tyler becomes confused when he happens to hear a member of staff speaking to a colleague or another pupil. Tyler always assumes the remark, question or instruction is addressed to him. Therefore, staff always place first the name of the person being addressed, before making the remark, asking the question or giving the instruction.

Routines are very important to Tyler and he copes most effectively when there is order in his life. Thus, staff keep to his usual routine as far as possible, and the class layout remains constant for extended periods. Tyler becomes anxious when any change affects his belongings or learning space. Staff try to minimise change and the effects on Tyler. They do so by making only one change at a time, and ensuring those changes are as small as possible.

Tyler is fascinated by regular patterns in the environment. His teacher therefore builds tasks and activities around this interest and skill. For example, he motivates Tyler and extends his number skills with the use of a braille number square.

Some elements of the TEACCH approach are employed:

• the classroom is zoned, which helps to support Tyler's understanding of what he is required to do
• he has an individual work space, in effect a work station; this helps to address his distractibility.

To reduce the risk of Tyler becoming overloaded, staff provide a low arousal environment.

Tyler learns most effectively with numerous short periods of work rather than fewer, longer sessions. He is also provided with "space" between educational activities when he is able to relax, or have physical exercise.

Tyler responds to praise which is used to motivate and encourage him.

As he works very slowly, Tyler is allowed extra time to complete tasks and to make transitions of location from one part of the school building to another; see waiting and providing time.

He has mild tactile defensiveness. This is not considered to present Tyler with any significant difficulties, and is therefore not currently being addressed.

Tyler has support from a mobility officer. Because of his deep interest in vehicles, Tyler has difficulty attending to what he is doing in mobility sessions in the community. The mobility officer therefore monitors the environment to check whether there are any interesting vehicles close by; she also avoids the trigger of referring to vehicles as much as possible. Indeed, she understands that it is not appropriate to initiate communication at all with Tyler, unless she needs to do so in relation to his mobility task. This is because he is single channelled: if he is listening to the mobility officer, or talking to her, he cannot attend to using his long cane or think about where he is going. In fact, 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, as long as there is no conversation.