Strategies - Underlying principles
- Team approach
- Families as members of the team
- Additional support
- Promoting consistency amongst team members
- Tailoring provision to address the young person's needs
- Knowing the young person really well
Building the young person's trust in his / her practitioners
Saying the young person's name first, before saying anything else
Avoiding requests and instructions to make eye contact / look at you
Supporting the young person with the hand-under-hand approach
Team approach
Most young people with visual impairment and autism are supported by a class teacher and at least one teaching assistant. This could be termed the core team; these are the members of staff who are in daily contact with the young person.
Around this core team is a wider team consisting of a range of practitioners with different expertise. The precise composition of this wider team varies widely. It may include a qualified teacher of the visually impaired (QTVI), a mobility officer / teacher / habilitation officer, a teacher who is a specialist in autism, a speech and language therapist, an occupational therapist, and a music therapist.
Other practitioners may also be involved on a more occasional basis, such as an educational psychologist, a consultant paediatrician or a member of a Child and Adolescent Mental Health Services (CAMHS) team.
The precise composition of the multi-disciplinary team around any individual young person with visual impairment and autism must depend on the needs of that young person. It is important that schools make appropriate referrals and seek the advice and expertise of as wide a range of practitioners as necessary.
Staff training
Staff training is clearly important. Some young people have as their class teacher a qualified teacher of the visually impaired (QTVI). This is typically the case for those young people who attend a special school for young people with little or no sight. It is also the case for some young people in other types of special school. Some class teachers have received additional training in autism. This is typically the case for those young people who attend a special School or resource base for young people who have autism. If the class teacher is a QTVI or a teacher who is a specialist in autism, clearly there is no need for the wider team to include such a teacher.
Some teaching assistants (TAs) supporting young people with visual impairment and autism have received training to work with visually impaired young people. In some cases, they have undertaken the Partners in Learning course. Some TAs who work in a special school or resource base for sighted autistic young people have received training in autism. It is likely that only a few TAs have received training in supporting young people who have both visual impairment and autism.
The picture regarding the wider team is likely to be very variable. In the last few years several one-day courses have been provided in the UK to provide an introduction to practitioners working with young people who have both visual impairment and autism. Practitioners from a variety of backgrounds have attended these courses, but knowledge of and expertise in the co-occurrence of visual impairment and autism is still not widespread. This applies to QTVIs, teachers of autistic young people, mobility officers / teachers / habilitation officers, speech and language therapists, occupational therapists, music therapists, educational psychologists, paediatricians and CAMHS staff. There is a pressing need for more training to be provided.
The team approach in practice
Amanda is supported with a core team consisting of a teacher, two teaching assistants (TAs) and a psychology graduate. Around this core team is a wider group of additional practitioners: a speech and language therapist, occupational therapist, educational psychologist and the school nurses. There is also close contact with Amanda's parents, ensuring that people in the family are members of the team.
The teacher is responsible for Amanda�s overall programme. She works with her on a 1:1 basis twice a week and coordinates the team working with Amanda (including the speech and language therapist and occupational therapist). The psychology graduate works with Amanda twice a day, for a total of 1 hour 45 minutes on an individual basis. The two TAs work individually with Amanda for the remainder of the day. Areas covered by staff working individually with Amanda include reading, writing, mathematics, communication, fine motor activities and sensory work. The TAs accompany Amanda to all out of class activities.
Families as members of the team
Families play a central role in supporting all young people and ideally should be seen as a key part of the team. In many cases, of course, such contact is with the young person's parents. However, it is important to recognise that in some families other members play a leading role.
Ali's school has very close links with his parents. Ali's parents share their knowledge of him with staff at his school. This has supported staff in getting to know him really well. For example, Ali's parents have reported that he responds appropriately when they say "careful" and "step up / down" at home. Promoting consistency across the two settings in this way helped Ali to settle into school.
Jivan's school uses a home-school communication book to maintain regular contact with his mother. These links are strengthened by the mobility officer who works with Jivan both in the school and in his family home.
Amanda's parents are involved daily in her support by means of notes in her school diary. The information provided by her parents in the morning enables staff to predict Amanda�s mood and emotional status and thus plan effectively for the coming day. The information provided by Amanda�s parents has contributed to promoting her positive behaviour , her emotional wellbeing and her learning.
Similarly, at the end of the school day, school staff provide a brief report in her school diary on Amanda�s mood and emotional status for her parents. This supports her parents in promoting Amanda�s positive behaviour and emotional wellbeing at home.
Parents and school staff also exchange information about the activities Amanda has experienced. This enables her parents to talk with Amanda about what she has done in school; similarly, it enables school staff to talk with Amanda about what she has done at home.
In addition, when Amanda moved to her present class, the core team met with her parents to ensure they had up-to-date information about Amanda.
Additional support
Many young people with visual impairment and autism receive considerably more support than their typically developing peers.
As described below, some of the young people featured in the case studies have support from a designated teaching assistant (TA).
However, it is important to consider the potential problems of providing a designated TA for a young person. For example, if the designated TA is away from work for some reason, it may be difficult for another member of staff, who will inevitably lack detailed knowledge of the young person, to provide cover. Also, young people with visual impairment and autism have difficulty generalising what they learn. This means that a young person may only use skills with the familiar, known member of staff, and not with anyone else.
There are other risks with having a considerable level of TA support, whether this is provided by just one designated TA or a number of practitioners. As explained in the section on promoting peer relationships, having a high level of support from members of staff is likely to hinder the young person's peer relationships. And, it can be a serious barrier to the young person acquiring mobility and independence skills.
For example, Sarah has individual support at all times in school. In contrast, Sebastian has additional support provided by two teaching assistants (TAs). They are permanently attached to his class where he is taught with six other young people who have little or no sight and additional needs.
Ali attends a special school for autistic young people where there is an individualised approach; each young person has a designated teaching assistant (TA) who has the opportunity to get to know the young person really well and to build a close relationship with him or her. However, it is not only Ali's designated TA who works with him; additional staff (teachers and other TAs) are involved too. Nevertheless, in order to reduce the demands on Ali, the number of additional staff who support him is minimised. Furthermore, his designated TA is assigned to Ali for most of the school day, with additional staff being involved only for short periods. Although Ali's designated TA has a little contact with other young people, she is not assigned to any other individual. Thus, she has been able to get to know Ali really well and to build a very close relationship with him.
Given Ali's age (he is only 4), the complexity of his difficulties and his sociability, he is regarded as needing the stability and security afforded by having a designated TA for most of the school day. The school is aware that as Ali settles and matures, it will be important to decrease the involvement of his designated TA and to increase the number of other staff members who work with him. This should ensure he does not become emotionally over-reliant on one member of staff and will also support
Cecily has full time additional teaching assistant (TA) support; this role is currently shared by two of the school's TAs. Thus Cecily is not emotionally over-reliant on one particular TA.
Jasper has full-time teaching assistant (TA) support, but this is shared by three TAs. Staffing is thus arranged to encourage the generalisation of learning across staff members. The TAs communicate effectively with each other to promote consistency.
Dominic has full-time additional support in class shared by several teaching assistants (TA). They work out of the resource base for young people who have visual impairment. Sharing additional support amongst two or more TAs:
Promoting consistency amongst team members
With any team there is a risk that the support provided is fragmentary; the larger the team is, the greater this risk becomes. The team approach may even become counter-productive if practitioners are inconsistent in their approach. The members of a good team will work hard to ensure there is a consistent approach for a young person with visual impairment and autism. In essence, promoting consistency requires all members of the team to:
All 3 of the TAs who support Jasper know him really well and communicate effectively with each other to ensure consistency of provision. They briefly exchange their experiences of working with Jasper at the end of each day and have a more formal meeting with the class teacher every week. To support Jasper to cope with transitions around school, consistent routes have been devised. Plans have been drawn and distributed to key staff so they can support Jasper to use them. This promotes consistency amongst staff.
Dominic's mainstream school has a resource base for young people with visual impairment. To promote consistency, practitioners in the resource base have produced a Student Profile which is made available to staff throughout the school. In Dominic's Profile, school staff are also asked to read the autism training notes thoroughly.
Tailoring provision to address the young person's needs
Young people with visual impairment and autism have a wide diversity of needs. These needs cannot always be properly addressed with the provision suitable for the vast majority of young people. It is often necessary to tailor provision for the individual. Some examples of how provision can be tailored are given here.
When Jasper had the infection which caused his sight loss, he was absent from school for 5 months. Following this period, he was gradually re-introduced to the school he had attended previously; initially, he attended for just one hour per day; this was slowly extended, so that he now attends almost full-time, though he arrives a little later than his peers, and leaves a little earlier.
Jasper could not tolerate being with other young people when he first re-entered school. A room was therefore set aside for his sole use where he was supported by one member of staff. It was decided at this stage that it was important to ensure that Jasper did not come to rely on only one member of staff. However, it was also recognised that a lot of change was inappropriate, so two members of staff shared Jasper's support, alternating from day to day. He now works in the classroom with his peers, whom he tolerates well.
When Jasper first returned to school, his curriculum centred on activities and materials he had liked prior to his absence; there was an emphasis on sensory experiences.
Although the above refers to a young person returning to school after a break, a similar approach could be used to support a young person being admitted to school for the first time.
Charles follows an individualised curriculum, not a modified version of what is provided for his typically developing peers.
Jivan's school takes his needs, rather than access to the mainstream curriculum, as the starting point in tailoring his provision. He does not follow the same programmes of study as the other young people, but staff attempt to provide timetabled learning activities that are broadly in line with the curriculum area being accessed by his peers. Where this is not possible, Jivan follows his own programme.
An aspect of addressing Jivan's individual needs is that he has an interactive music session with a teaching assistant when the school has assembly. Initially, Jivan did attend assemblies with his peers. However, it quickly became clear that Jivan did not have any understanding of them; did not enjoy them in any way; and did not cope in this situation: he became very restless, and engaged in sensory-seeking activities which were distracting for his peers; on some occasions, he became distressed, probably because he had no sense of what was required of him. In contrast, Jivan enjoys music and responds well to the interactive sessions.
Knowing the young person really well
It is crucial that the practitioners who support a young person with visual impairment and autism know that individual really well. It can be seen as essential in preventing under-achievement educationally, and thus to promoting learning. It is also central to meeting the young person's all-round needs, perhaps especially to promoting emotional wellbeing and to promoting positive behaviour.
In order to meet the needs of a young person with little or no sight, it is necessary to have a good understanding of visual impairment in the broadest sense. In addition, it is necessary to understand the particular nature of the individual young person's visual impairment and how that impacts on his / her daily life, wellbeing and learning.
In order to meet the needs of a sighted autistic young person it is necessary to have not only a good understanding of autism in the broadest sense, but also a good grasp of the particular nature of the individual young person's autism and how that impacts on his / her daily life, wellbeing and learning.
So, in order to meet the needs of a young person with both visual impairment and autism, it is necessary to have the full range of understanding outlined in the previous two paragraphs. But, although necessary, that understanding is not sufficient. It is also important to understand how the visual impairment and the autism interact and the overall impact this has. The likelihood is that it will not be a simple matter of adding the impact of the two disabilities together. The overall impact is likely to be greater than the sum of the two parts. In addition, there is potential conflict between meeting the young person's needs which arise from the visual impairment and meeting those which arise from the autism. For example, light touch is often used with visually impaired young people, but is not recommended for those who also have autism. Many sighted autistic young people learn most effectively through vision. This will not be possible for a blind autistic young person. For an autistic young person with only a little sight, the visual strategies commonly employed with fully sighted autistic learners will almost certainly have to be adapted. A more detailed discussion of this is provided in the introduction to the strategies.
Thus, addressing the needs of a young person with visual impairment and autism means knowing that individual very well. A really effective practitioner is able to view the world from the young person's perspective. Clearly, this is very demanding of practitioners. It means understanding
- understands what others communicate
- processes sensory information
- understands events
- understands people
- learns
- is affected by anxiety and stress.
One of the teaching assistants (TAs) who support Cecily has been supporting her for seven years, the other for four years. Both TAs have come to know Cecily really well, and this is thought to be a major factor contributing to the progress Cecily has made.
Dominic has a Student Profile which was produced by the staff of the resource base for young people with visual impairment in his mainstream school. In this profile, members of staff in the school as a whole are also asked to read the autism training notes thoroughly. Producing his Student Profile required staff to know him really well. In turn, of course, it supports other staff to get to know him.
Amanda is supported with a team approach. Because most team members have worked with Amanda for lengthy periods, they have come to know her really well. In addition, a detailed handover took place when Amanda moved to her present class; members of the team were made familiar with a range of documents: her care plan, school report and reports from the speech and language therapist, occupational therapist, educational psychologist, and school nurses. As there is also Amanda's parents are considered to be members of the team, key staff met with them to ensure they had up-to-date information about Amanda.
Knowing the young person really well relies on several inter-related processes:
Each of these processes informs the others. For example, Monitoring the young person's behaviour and moods and responding appropriately becomes easier as the team gains more knowledge of the young person; in turn, knowing the young person really well enables the team to respond more effectively to the young person's behaviour and moods.
Building a close relationship with the young person
Building a close relationship with the young person requires staff to:
In essence, building a close relationship with the young person requires the provision of a responsive environment.
For an article which discusses the importance of building a close relationship with the young person, see Samways and Bell (2010).
Building the young person's trust in his / her practitioners
All young people require staff they can trust if they are to thrive and learn. For typically developing young people, this is not an issue practitioners need to pay particular attention to. However, autistic young people do not readily trust other people, so practitioners need to make a special effort in this regard.
Autistic young people have difficulties understanding the behaviour of other people, whom they find unpredictable. There is a very real risk that young people with visual impairment and autism will find the people who support them untrustworthy, unless the practitioners make a special effort to avoid this.
For those a young person with visual impairment and autism who has some understanding of spoken language, the tendency to interpret everything literally can further compound matters. For example, typically developing young people readily understand that when the teacher says "We'll do that in a minute", he / she does not mean, literally, that the activity will take place in 60 seconds; they know the teacher means "soon". But a young person with visual impairment and autism may well expect "a minute" to mean just that. When he / she finds that it does not, the young person may experience anxiety or stress and may take the view that the teacher is not to be trusted.
In fact, abstract terms like "soon" are also difficult for autistic young people, as they have no clear meaning; to make things worse, different people tend to use such terms in slightly different ways; and many people are rather inconsistent � what Mr. Smith means by "soon" on one occasion may be very different from his meaning even a few minutes later.
So, trusting practitioners can be very difficult for young people with visual impairment and autism. Practitioners can build the young person's trust in them by:
Providing an effective greeting; saying "goodbye"
Greeting a young person with visual impairment and autism may be very important. This is because, with little or no vision, the individual may not realise someone else has come into the same space and is now close by. It is important, then, that all practitioners greet the young person on first coming into contact. By providing a greeting, the practitioner is ensuring from the outset that the young person knows who is interacting / communicating / working with him / her.
However, there are occasions when practitioners should not spontaneously greet, or, indeed, initiate communication in any way at all with the young person. For example, when passing a young person engaged in a transition of location, it may be preferable simply to walk by without acknowledging him / her. This is because transitions can be very difficult for young people with visual impairment and autism; greeting the young person will, at best, be distracting; worse, it may cause increased anxiety / stress / arousal, making the transition even more difficult. In fact, the young person could become overloaded, or even go into crisis.
Also, a practitioner who approaches a young person who is engaged in an educational activity should not spontaneously greet the individual or initiate communication in any way; this will minimise the risk of distracting the young person.
Some young people with visual impairment and autism have a special interest, something to which they devote a great deal of time, energy and enthusiasm. An individual who is engrossed in an activity involving a special interest is unlikely to be able to switch focus and attend to a greeting.
A practitioner who is greeted by a young person who is engaged in a transition of location, an educational task or an activity involving a special interest should respond: in this situation, the young person has initiated interaction and deserves a positive response. However, the response should be low-key and should be sensitive to indications provided by the member of staff supporting that young person.
Practitioners should not only greet the young person on the first appropriate occasion in the day; for example, they should also give a greeting
Providing an effective greeting may help to allay the young person's anxieties: being unsure about the identity of the other person can be very unsettling for visually impaired young people, especially for those who also have autism. The precise nature of the greeting will vary from one practitioner to another. It is also likely that any individual practitioner will provide a different greeting for different young people.
The key thing is to ensure that the individual recognises the practitioner. Timothy is a teaching assistant who supports two young people who have visual impairment and autism, neither of whom was observed in the course of the Project's work. One of these young people, Yaqoob, has a reasonable understanding of spoken language and has an excellent auditory memory. The likelihood is that Yaqoob would recognise Timothy just by hearing him say "Yaqoob. Hello." However, Timothy is aware that unfamiliar people greet Yaqoob by giving their names, and feels it is important to be consistent. Thus, Timothy always says "Yaqoob. Hello. It's Timothy." Note that Timothy says Yaqoob's name first, before saying "hello". This is to gain his attention.
In contrast with Yaqoob, Annabel has very little, if any, understanding of spoken language. Nevertheless, Timothy speaks to her in his greeting, reducing his spoken language to "Annabel. Timothy." Again, Timothy says Annabel's name first. Annabel participates effectively with Timothy in Intensive Interaction . In that situation, Timothy sometimes vigorously rubs the back of Annabel's head, which she always responds to positively. Thus, Timothy augments his spoken greeting by rubbing the back of Annabel's head. In addition, Annabel enjoys rubbing her hand over Timothy's face. He therefore offers Annabel an opportunity for this: using the hand-under-hand approach, he offers her his hand by placing it under hers; if she seems to be happy with this, Timothy guides her hand to his face, encouraging her to rub it. Timothy's greeting of Annabel, then, includes his spoken greeting, augmented with rubbing the back of her head and inviting her to feel his face. Timothy's greeting of Annabel may last for three minutes, illustrating the need to provide the young person with sufficient processing time.
In this context, it is useful to note that young people with visual impairment and autism typically require more processing time than their non-disabled peers. A useful strategy in this respect is the "wait for eight" rule. But some young people need much more than the eight seconds stipulated there.
Not only is it important to greet the young person effectively; the practitioner should also provide an effective "goodbye." Again, this is relatively easy with an individual such as Yaqoob. Timothy simply says "Yaqoob. Timothy's going. Bye!" The importance of providing an effective "goodbye" was underlined for Timothy when he observed a very experienced and effective teacher in conversation with Yaqoob. They were standing in the school corridor, where they had met when walking in opposite directions. There was a lull in the conversation, which the teacher thought indicated Yaqoob had nothing further to say. Without realising the impact it might have on Yaqoob, the teacher then continued to walk towards the classroom. Yaqoob had no idea the teacher had moved away from him, and attempted to continue the conversation. When Timothy described what had happened to the teacher, she was appalled with herself, and vowed she would always let Yaqoob know in future when she was moving away.
Saying "goodbye" to Annabel is more difficult because it is not at all clear that she understands its meaning. Nevertheless, Timothy regards it as important. He says "Annabel. Timothy going. Bye." There is a contrast with his greeting, as he does not rub Annabel's head, or invite her to rub his face. However, he does invite Annabel to join him in signing "goodbye" using on-body signing.
Not only does Timothy greet Yaqoob and Annabel when first meeting them each day; he also does so when he comes back into contact with them following his morning and afternoon breaks and dinner. He also says "goodbye" before these events.
Saying the young person's name first, before saying anything else
When communicating with a young person who has both visual impairment and autism, it is important to obtain his / her attention before giving an instruction, asking a question or providing information. The most effective way to do this is by saying the young person's name first, before anything else, and then pausing. The need for this is explained in more detail elsewhere.
To ensure Cecily attends to them when they address her, staff say her name first, before saying anything else to her, i.e. before giving the instruction, asking the question, or providing the explanation. If the person addressing Cecily fails to do this, she is not aware that she is being addressed, and does not attend. Even when sitting beside Cecily, it is important for the teaching assistant (TA) to obtain her attention first. The TA says "Cecily" and then "waits for eight". This provides Cecily with time to process what is required of her and to switch her attention. A typically developing learner would probably look at the TA. Because of her visual impairment and her autism, Cecily does not do so; she pauses and stills. The TA interprets this as indicating that Cecily is attending and then speaks to her.
When her teacher addresses the whole class, and wishes to include Cecily, she makes this clear to Cecily. The teacher says "Cecily, everyone," and then "waits for eight". If the teacher fails to name Cecily in this situation, she does not switch her attention, because she is not aware the teacher means her.
Initially, some staff believed Cecily was being rude when she did not respond. This is not the case. Cecily, in common with many autistic young people, is single-channelled and cannot attend to more than one thing at a time. Therefore, when she is engaged with a task, she cannot attend to someone else speaking to her.
For Tyler, this strategy is extended. This is because he becomes confused when he happens to hear a member of staff speaking to a colleague or to one of his peers. Tyler always assumes the remark, question or instruction is addressed to him. Therefore, no matter who they are addressing, staff always say the person's name first, before saying anything else.
Avoiding requests and instructions to make eye contact / look at you
Although Dominic does have a little useful vision, he does not look towards a person addressing him. This is likely to be the case for other young people with a little functional vision and autism.
It is important to understand that many autistic people do not make eye contact with or look towards the person addressing them. This is because they are single-channelled and cannot attend to more than one thing at a time: thus, they can look at another person, or they can listen to that person, but they cannot do both. In fact, some autistic adults report that it is painful to make eye contact with another person.
It is very important that practitioners do not instruct, or even ask, a young person with visual impairment and autism to make eye contact / "look at me".
Supporting the young person with the hand-under-hand approach
Many practitioners are familiar with the hand-over-hand approach: typically, when physically prompting a young person, the practitioner places his / her hand over the young person's. Practitioners are very strongly advised not to employ this strategy with young people who have visual impairment and autism.
Instead, practitioners are advised to adopt the hand-under-hand approach. For more information about this approach, see Lee and MacWilliam (2008) and Miles (2003).
The hand-under-hand approach is appropriate in all contexts when supporting a young person with visual impairment and autism; for example, when
The hand-under-hand approach is preferable to the hand-over-hand approach. An important reason for this is that the hand-over-hand approach can be equivalent to blindfolding a sighted person: young people with visual impairment and autism are likely to need their hands for accessing the world. When a practitioner takes a young person's hands by using the hand-over-hand approach, this can seriously restrict access to the world, or even prevent it.
In fact, using the hand-over-hand approach is likely to cause the young person to pull away and resist, resulting in the interaction being aversive rather than enjoyable. This is especially likely if the young person is tactile defensive. This is much less likely to occur with the hand-under-hand approach.
In summary, the hand-under-hand approach allows the young person to:
The following is a powerful illustration of the effectiveness of the hand-under-hand approach. Jane, (not observed by the Project team) is a young adult who has severe learning disability, little vision and a significant hearing loss. She presents in a way that is very similar to that of many people with Autism.
In a craft activity, Alistair, a member of staff, was trying to support Jane to remove some masking tape from a picture frame. Alistair was using the hand-over-hand approach. Initially, Jane withdrew her hands and vocalised in a way that indicated she was unhappy. However, Alistair did not respond to Jane's vocalisation or to her withdrawing her hands; he continued with his attempt to support her to remove the masking tape. Jane pulled her hands away again, this time much more assertively, and her vocalisations became louder. Still Alistair failed to respond to Jane, and continued with the hand-over-hand approach. Yet again, Jane very clearly withdrew her hands; by now, she was very distressed.
Douglas, another member of staff, asked Alistair if he could support Jane. Alistair agreed. Douglas had experience of using the hand-under-hand approach. He waited several minutes for Jane to calm down, and then initiated contact with her. Once Jane had recognised Douglas and appeared to be at ease with him, he attempted to support Jane to remove the masking tape. He gently placed the fingers of his right hand under the palm of Jane's right hand. Saying nothing, he gradually guided Jane's hand towards a small piece of masking tape that was sticking up from the picture frame. Jane indicated she was willing to participate in this: she seemed content to allow Douglas' fingers to remain in contact with her hand, and to allow Douglas to guide her hand. She was now producing the kind of vocalisations staff interpreted as 'happy' sounds. Douglas guided Jane's hand in such a way that her index finger came into contact with the piece of masking tape that was sticking up. When Jane was aware she was in contact with the masking tape, she brought her thumb and index finger together to grasp it. Douglas then guided her hand up and away from the picture frame and towards her. Thus, Jane pulled the masking tape off the picture frame.
So, Alistair's attempt to use the hand-over-hand approach failed: it did not enable him to support Jane to remove the masking tape; indeed, worse than that, it resulted in Jane becoming very distressed. In contrast, the hand-under-hand approach was completely effective: Jane was supported to remove the masking tape, and presented as calm and content.
Supporting the young person to cope with transitions
In the context of young people with visual impairment and autism, the term 'transition' has one basic meaning: "change". However, it has several uses. Perhaps the most frequent use refers to a change of location, i.e. to moving ("transitioning") around the physical environment. Such a transition of location might be from
However, transition can be used to refer to any change, such as a transition from
Because many young people with visual impairment and autism do not cope well with change, transitions can be extremely difficult for them. It is important to understand that what may appear to be a simple transition may, in fact, be a very complex set of transitions. For example, the beginning of dinner time at school might involve many transitions, including the following:
Each of the transitions within the overall one may give rise to anxiety about exactly what will happen, and for how long.
Some transitions also involve changes in the level and nature of sensory stimulation. For example, in the overall transition described above, mention is made of the likely increase in sensory stimulation when the last morning lesson ends. In addition, transitioning to the toilet and then to the dining room will involve further changes.
As the young person transitions from the classroom to the toilet, there may be considerable noise and movement in the corridor if a lot of other young people (and staff) are moving about. It is common for young people to be jostled as they pass along a corridor, so physical contact may also be involved. This kind of touch is very unpleasant for some young people with visual impairment and autism, including Cecily and Bob. Indeed, the possibility of being touched may cause considerable anxiety.
Visiting the toilet may involve considerable sensory stimulation; again, this is very unpredictable, certainly with regard to smell. Sound tends to be amplified in toilets; there may be a lot of movement; lights may be bright; if clothing needs to be removed or adjusted and the individual needs support, physical contact with another person may be involved.
Once in the dining room, there will be yet more sensory stimulation. There is likely to be a mixture of smells (yet again unpredictable). There will almost certainly be a lot of noise, particularly if the room is large and sound echoes in it. Queuing may involve more jostling and physical contact.
In some schools, the transitions between the classroom and dining room and back again involve going outside. If this means being outside for several minutes, it may be necessary for the young person to put on, and then remove, outdoor clothing. This adds further to the sensory stimulation. The weather may add still more sensory stimulation if it is wet, cold, hot or windy, for example.
transitions, then, can be very unpleasant, even overwhelming, for sighted autistic young people; they can increase anxiety and stress and raise arousal levels. Having little or no sight is likely to make transitions of location even more difficult for young people with visual impairment and autism.
Practitioners should be aware of how many changes and how much sensory stimulation each transition involves. Regardless of the nature of the transition, practitioners should provide the young person with sufficient processing time to adjust. If the overall transition involves several other transitions, it may be important to pause at each step.
They should constantly monitor the young person's behaviour and moods in any case, but in the run up to a transition this can be particularly important. They should continue to monitor the young person throughout all transitions. Practitioners should also constantly monitor the environment. This may be particularly important during a transition of location, when, for example, a corridor that is peaceful could quickly become very noisy. Practitioners should become experts at predicting, and therefore avoiding, difficulties.
A young person may need to have a transition delayed or brought forward. This may be an ad hoc, "one-off", arrangement when the individual is particularly anxious, stressed or aroused. It may be a more permanent arrangement. This is the case for Bob, who cannot cope if the school's entrance hall is bustling when he arrives at and leaves school: the noise, movement and unpredictability are simply overwhelming for him. Therefore, he is supported in his transitions into and out of school: he arrives and departs earlier than his peers. This means staff ensure Bob avoids a crowded situation as he transitions into and out of school.
For some young people with visual impairment and autism, providing a low arousal environment may be essential in supporting transitions. In effect, Bob arriving at and departing from school earlier than his peers is an element of his low arousal environment.
As a key element in all work on mobility skills is to minimise anxiety, stress and arousal levels, transitions of location require consistency amongst team members.
Several other strategies are particularly important with regard to minimising anxiety, stress and arousal levels during transitions of location; they are
Sarah used to find transitions of activity and of location difficult. She now copes more readily. It is likely that using her timetable to inform her of what is about to happen supports her to cope with transitions.
Staff support Jasper's transitions around school with objects of reference.
When she entered her current class, Stacey did not cope with the transition from one lesson to the next. A counting strategy is now used to inform her of when to expect the current activity to end.
Amanda uses vision to independently navigate short distances (e.g. back to class from other parts of school). Nevertheless, because she finds it difficult to initiate sequences, transitions of location can be difficult for her: they can result in her becoming anxious, and experiencing urinary incontinence. Several strategies were therefore adopted
On returning to school at the start of this academic year, Amanda initially appeared to cope well, but gradually presented with some difficulties as she settled back into the school routine. A feature of this is that she now finds some transitions of activity extremely difficult; this is particularly the case with swimming and sessions using TacPac�. Transitioning to these activities also involves a transition of location. The strategies to support Amanda with transitions of location (listed above) are now insufficient on some occasions when transitioning to swimming and sessions using TacPac�. However, this is not always the case; at other times, Amanda copes well with the transitions to these activities; indeed, Amanda sometimes finds TacPac� calming. When she presents as very anxious or upset about a transition to a different activity, practitioners reduce the demands on her by removing these activities from her programme.