Ann* is a lady with a severe learning disability and autism who, at times, exhibits very challenging behaviour. She is verbal with a limited vocabulary and is very able to communicate her needs and choices.
Ann* is hypersensitive to touch stimuli and will often scream if she is touched, even gently, without warning. Ann* becomes very anxious in busy, crowded environments which will often result in shouting and lashing out. She also has no real concept of waiting and expects everything to happen immediately.
Ann* has been living at our services in since 2012 and, largely due to the introduction of a very structured, person-centred support plan, she has slowly adopted coping strategies that enable her to manage her behaviours. The support team at our services in Eastleigh have developed a relationship with Ann* that is both enabling and empowering.
Structuring daily activities
Ann* becomes overwhelmed by the structure of her day and becomes extremely anxious about upcoming events, to the point where she is unable to focus on or enjoy the task in hand. In an effort to mitigate these anxieties, Ann* chooses her activities for the day on a “now” and “next” basis so that future events do not affect her ability to function in the present.
A typical conversation with Ann* will be along the lines of;
Ann*– “What are we doing?”
To which support staff will respond with a detailed description of what is happening now.
Ann*– “What are we doing after that?”
To which support staff will answer “when Ann* has finished what she is doing now, Ann* has chosen to do…”
Ann*– “What about later?”
To which the response will always be “later, when we have finished what we are doing now, we will make a plan with Ann* but we don’t need to worry about that now”.
Ann* has a very good memory so when she asks what is happening next, staff will often repeat the question back to her so that she has the opportunity to feel comforted and self-validated by being able to answer the question herself.
The challenges Ann* has faced with public transport
Travelling on public transport, particularly buses, has been a difficulty for Ann*. The complexities of catching a bus can be daunting for many neuro typical people but for someone with autism, limited capacity and at times overwhelming anxiety, it can appear unachievable.
Over the last few years the support team at our services have been working intensively with Ann* to get her to a point in her development where bus travel has become a familiar task with reduced anxieties. She even copes well with un-foreseeable events with careful support, encouragement, diversion and distraction techniques.
Ann* has a working knowledge of Makaton and staff will use Makaton signs to reinforce what they are saying to her. The staff found that she will respond to visual cues above auditory ones and by using both forms of communication, there’s a better chance that she will relax sooner when she becomes distressed.
Supporting her to successfully overcome the challenges
The support team implemented a programme, which has been specifically designed to meet the needs for Ann*. This included role modelling, forward-planning, positive risk-taking and celebrating each achievement.
Over the last few years Ann* has progressed and is now able to manage bus travel well, in small doses. A typical trip will be;
- Ann’s* support team will ask her what she wants to do that day and measure her mood and willingness.
- If at all possible, a bus trip will be incorporated into the plan.
- Staff prepare her with the information using the conversation format described earlier.
- Ann* and her support team will walk to the nearby bus stop.
- They’ll wait together for the bus. If it’s crowded or Ann* seems unsure about what is going to happen, her support team will talk calmly to her about what to expect and where they are going.
- When the bus arrives, a decision needs is made as to whether Ann* is calm enough to proceed or whether the trip is aborted.
- If the journey proceeds, she will often get on the bus first despite encouragement to wait. This can be a trigger point if other people are pushing past her. Supporting staff are mindful of this and will often say in a voice that is loud enough for the surrounding people to hear, “It’s OK Ann*, I’m sure these nice people will let you get on the bus first”. This approach tends to alert the people around her, whilst acknowledging that she may be struggling with the social norms of bus travel.
- Ann* will show her bus pass to the driver and be guided to an empty seat by her support team. Staff will always place Ann* on the inside seat to separate her from passing members of the public.
- The length of the journey is a judgement made at the time by the supporting staff.
- Alerting the driver that they want to get off at the next stop, navigating down the aisle to the doors and waiting for the bus to stop.
- Getting off the bus and orientating herself sufficiently to know where she is in relation to where she needs to be.
- Whatever the outcome of the journey, Ann’s* achievements are celebrated with her.
Currently she is at a stage where bus trips are more often successful than they are un-successful. Ann* is enjoying bus trips so much so that she now actively asks if activities will include a bus trip.
This progress is down to Ann’s* hard work, the support and patience from staff, as well as the teams enhanced level of understanding gained through the National Autistic Society’s accreditation process.
*Some of the details have been changed for confidentiality reasons.