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Brookdale Care News
A young man with Aspergers has a bright future
Posted: 2010-03-10 | Author: Autism News
Let me introduce you to Joe. He lives at one of Brookdale Care’s residential units for young adults living with autistic spectrum conditions (ASC) and also has a mild learning disability.
He is abright young man with aspirations to which we can all relate. He wants to make friends with people of his own age, to study at university, find a girlfriend and go abroad on holiday. He has good communication skills and is able to clearly express his interests.
However, Joe has difficulty understanding and negotiating social relationships and scenarios, and can find it difficult to take what he perceives to be criticism or to receive too much direction. He would strike up conversations with strangers in shops and make ‘friends’ on Facebook without being aware of the ‘stranger danger’ risks that such interactions can pose.
I’ve been at Brookdale for nearly eight years during which time I have undertaken a great deal of work with residents to achieve positive outcomes using augmented communication techniques. This is a way of communicating that supplements speech and written communications. It can include the use of pictures or symbols, gestures, facial expressions and signed languages. These skills, developed through TEACCH, PECS and Sign Language, provide professionals who support people living with ASC and a learning disability with an outstanding range of tools that can make a measurable, positive difference to people’s lives.
TEACCH (Treatment and Education of Autistic and related Communication Handicapped Children [University of North Carolina at Chapel Hill]) is an evidence-based service, training and research program for individuals of all ages and skill levels with autism spectrum disorders. PECS (Picture Exchange Communication System) begins with teaching students to exchange a picture of a desired item with a teacher, who immediately honours the request. For example, if they want a drink, they will give a picture of ‘drink’ to an adult who directly hands them a drink. Verbal prompts are not used, thus encouraging spontaneity and avoiding prompt dependency
The use of augmented communication has been invaluable in helping us to understand Joe’s aspirations and find ways in which we can support him in achieving them. Joe had already set some objectives for himself that he was very unwilling to deviate from – a girlfriend, a job and further education. So, the first thing we did together was to make a list of all the things he wanted to achieve in life. After we had done this together, we made a list of all the things that might prove difficult or hold him back from achieving these aims, such as misinterpreting other peoples’ words, actions, body language or gestures.
The next step was to plan what we could do to overcome these challenges, using examples of what he thought would work, using his wishes and known likes as an incentive. An early example of this was Joe’s wish to independently go out into the community.
To help Joe achieve this, and to improve his skills, we looked at the risks and challenges that made this difficult for him and worked together to find methods to overcome them. An example of the type of risk posed was Joe’s very direct approach to talking to new people and limited ability to accurately interpret their responses.
We discussed social rules to remind Joe of what the expectations were should he become anxious and we created social stories (examples of appropriate behaviour in particular social situations) that Joe could follow, providing him with a framework he recognised and understood for social interaction. Together, we planned how to recognise that positive steps had been achieved by devising a reward chart. Every time Joe followed his social story for acting appropriately as detailed in his progressionary pathway plan, and followed the social rules that together we had discussed and agreed, we recognised this by marking it on his reward chart. After Joe had achieved a certain set target on his chart, the reward was a trip to watch his favourite football team, Chelsea. The reward itself provided another opportunity for Joe to follow the same principles and practice using a social story to remind him how to behave appropriately in social situations, in this case a busy football stadium.
This brought great relief and support for staff when supporting Joe out in the community, and also ensured consistency as both he and the staff were following the same social rules. Teaching consistency and the provision of social stories allowed Joe to feel relaxed in quite complex social scenarios for the first time. We follow this same system for other aspects of Joe’s life. The next aim is a foreign holiday. We have implemented this as stage three in Joe’s progressionary pathway plan. The first stage was accessing the local community shadowed by staff, and the second stage was independently accessing further education.
At every stage we work together towards the next stage of development while retaining the skills learnt from the previous stage, such as interacting appropriately; being aware of community risks – ‘stranger danger’; and remembering the limits of communication with others. Also, at each stage, a higher benchmark is required on the reward chart to attain the goal indicated. This ensures a longer period of time spent practising and developing skills, with the specific aim of avoiding ‘ticking boxes’ where goals might be reached without really learning the skill.
This process has proved hugely successful in providing a clear, measured and predictable pathway for Joe, but it is essential to remember not to overload the process with too many stages, and to ensure that each stage of development will dictate the next.
Joe has been instrumental in leading this process so there is a real sense of achievement in determining the direction he wants to go and the aspirations he wants to turn into reality. Goals are set in the short, medium and long term. The short term objectives are larger and more detailed than the long term, as the difficulties and challenges faced while working through the short term goals dictate what areas of development will shape the long term goals.
While undertaking this work with Joe, it was important at every stage to remember the level of his ability to understand and process information, and not to overload him. Each stage was broken down into uncomplicated, clear terms within his vocabulary so that he knew what was being said at all times. Where required, this information was supported by the use of pictures. We had established this as Joe’s level of symbolic development through speech and language therapy assessments, so we knew he understood and related to this.
Joe was actively involved from the outset in setting the direction and choices in his plan. He never felt as though the plan was being dictated to him as he was instrumental in establishing its parameters and aims. As such, he is able to take the lead, with appropriate support at all times, in achieving his goals and securing his own independence.
Using the terms of reference from his social stories to help with social interaction, and with support from myself and the staff team, Joe is now working towards a BTEC National Diploma in IT and has begun to form his first peer relationships.
The use of augmented communications techniques and, particularly in this instance, the use of social stories and the reward chart, have really made a positive difference to Joe’s life and indeed to the lives of many other people living with ASC at Brookdale Care. We all know that effective communication is the cornerstone of successful human interaction. Augmented communications techniques provide an excellent tool for enabling better communication for all of us working with people living with ASC and/or a learning disability.’
Andrew Fairman is a domiciliary service manager at the independent provider of care and support to adults with autism and ASC, Brookdale Care www.brookdalecare.co.uk
This article was published in Social Caring Magazine, the journal of the Social Care Association, you can view the article and the full magazine on their webite Social Caring.