Case Study S (Personal Organisation, Food Preparation, Tooth Brushing)

S is a nineteen-year-old man who at the time of referral, was preparing to transition from secondary school to a work placement.

Background:

S is a nineteen-year-old man who at the time of referral, was preparing to transition from secondary school to a work placement. He has a diagnosis of Autism Spectrum Disorder. S is a very capable and bright young man with an exceptional memory and a fantastic sense of humour. He has a keen interest in movies and has an extensive collection of DVD’s, Blu-rays and Video Cassettes. He has excellent computer skills and also enjoys art and drawing.

Factors impacting development of life-skills:

In line with his diagnosis of autism, S presents with various challenges which have impacted on his ability to develop important life-skills.  Specifically, social communication deficits, sensory processing difficulties and challenges around executive functioning have contributed significantly to his challenges in learning and developing important life-skills.

Areas of Concern:

During the assessment period, parents and staff shared concerns regarding S’s pending transition to a work-placement and his challenges related to self-care (e.g. tooth-brushing) and employability skills (carrying out responsibilities and completing tasks). Specifically, reports and observations suggested that:

  • S is quite disorganised and forgetful at times.
  • S was very dependent on his parents for a range of activities: to help him to get ready in the morning, pack his bags for additional activities such as PE and work-experience. Parents would also prepare all meals and snacks.
  • Parents, school staff and S himself reported challenges around fidgeting and becoming distracted during tasks, particularly if required to listen to a lot of verbal directions.
  • S finds it difficult to work in cluttered spaces. S is sensitive to certain noises, smells and textures.
  • S reported that he doesn’t like brushing his teeth or the taste of the tooth-paste.

Strategies:

Preparing for the day ahead:

  • S had a StarWars themed calendar which he updated each Sunday evening. All known daily activities for the week ahead including school, PE days, work-experience, youth club and social outings were scheduled on the calendar. This was clearly displayed in his bedroom.
  • Mini-checklists: Checklists which corresponded with each activity were written and stored in a small accordion file. S would check his calendar, go to his accordion file and retrieve the checklist which corresponded to the scheduled activity for that day. The checklist served as a visual reminder and a guide to instruct S about what he needed and enable him to pack his bag independently. Checklists were also developed using the I Get … My Schedules at Home app on S’s mobile phone.

Preparing snacks:

  • S informed parents and MCA coordinator of snacks that he would like to be able to prepare for himself.
  • Each snack was visually structured; i.e. a sequence of visual pictures, reflecting what utensils S needed and what ingredients/food items were required. Each step involved in making the snack was presented in a visual sequence for S. This was based on the visual format presented in Just Look and Cook Book
  • S was taught each step of the sequence. MCA coordinator modelled use of the visual supports, then supported S with completion of each step as required before fading out and leaving S to prepare his snack independently using visual supports only.
  • S had difficulty touching some food textures (e.g. meat). Gloves were left available to S to use as he wished.

Brushing Teeth

  • Visual Social Narratives were used to explain to S the importance of maintaining good oral hygiene. A Social Behaviour Map was used to support S’s understand of the importance of identifying and maintaining oral hygiene.
  • With S’s consent and his parent’s permission, video was taken of S brushing his teeth. This video formed part of the pre-intervention baseline.
  • S also watched a you-tube video on how to brush your teeth correctly. He reviewed his own video and noted some useful changes he should make to his oral hygiene routine.
  • A visual sequence of instructions was placed in the bathroom to support S’s independence with tooth-brushing. A two-minute digital timer was also used.
  • S opted for a ‘flavour free’ toothpaste as he didn’t like the taste of regular toothpastes.
  • S worked through this routine twice per day.