Case Study - Winnie

Winnie is nearly 12 years old. She has septo-optic dysplasia; she is totally blind with no light perception. Winnie has severe learning difficulties and a diagnosis of autism.

Winnie attends an all age special school for young people with severe learning difficulties. She has additional support from a teaching assistant (TA) for about 75% of the school day.

Winnie is physically mobile and relies on a sighted guide.

It is not clear how much spoken language Winnie understands. To support her understanding, staff augment their spoken language using

They also reduce the amount of spoken language and simplify it.

Winnie's intentional expressive communication is very limited. It appears to consist only of using the sign for "me". However, she appears to use this sign to convey more than one meaning. To facilitate Winnie's expressive communication, staff provide a responsive environment and use intensive interaction.

In most situations, Winnie takes no active interest in her peers. However, she occasionally appears to respond to a peer during some interactive sessions in which a resonance board is used.

Although Winnie is not particularly rigid with regard to routines, staff inform her of impending changes in the usual routine.

Winnie learns most effectively when she has numerous short periods of work rather than fewer, longer sessions. She is also provided with "space" between educational activities when she either has her favourite activity (listening to music) or a walk incorporating sensory integration strategies. The latter were recommended by the occupational therapist.

Naturally, Winnie is more likely to engage in an educational activity which is intrinsically meaningful or interesting to her, but this is not always possible. On these occasions, the TA enhances her engagement in educational activities by quietly singing to her, which Winnie finds calming.

It is essential for the TA to monitor Winnie"s behaviour and moods during a work session for signs of increasing stress / anxiety. If necessary, she brings the session to a close to avoid Winnie going into crisis / overload.

Winnie has a range of sensory needs. Perhaps the most difficult to manage is that she finds other people's noise aversive; it can make her very stressed / anxious. The TA therefore monitors the environment, specifically, the level of noise in the classroom. When Winnie becomes stressed by the noise in the classroom, the TA calms her, usually by taking her for a walk. In some circumstances, the TA uses sensory integration activities to calm Winnie.

Staff working with Winnie avoid triggers and occasionally take her to a safe haven to avoid her going into crisis / overload.

Winnie has some tactile defensiveness, though she has made progress in this respect. When she first went to school, Winnie found all messy activities very aversive. She therefore has support to engage in tactile activities. A programme is in place to promote Winnie's tactile exploration.

Several years ago, Winnie was assessed by an occupational therapist who then recommended some sensory integration activities which are still used.

Winnie's favourite activity is listening to music. This activity frequently follows a period of work.