KYLE'S STORY – ASD/PDA/ADHD

Social context

NB Names altered for anonymity

OUTCOMES and IMPACT

By March kYLE showed less defiance, more engagement and less negotiation, asked about the 'box to be ticked.' He was also able to use the toilet. Mum shared ‘he is talking about his emotions at home which he has never done before.’

April saw a change of length of session to 1 hour. He completed a cutting task and removed himself from session but returned and re-engaged. Mum shared ‘he is not so aggressive with his brother as much and will talk or ignore behaviours around him.’

May brought the ability to communicate anger towards coach and wait in safe spaces and respect boundaries. However, he regulated his behaviour a little less. Mum shared that soiling has become less

During July he adhered to all PPE and worked with the small animals with no input from coach. He engaged with folder work with no resistance.

Pathological Demand Avoidance (PDA) is a condition which is part of the autism spectrum and is characterised by an overwhelming need to avoid or resist demands. ... Like many other people on the autism spectrum, people with PDA experience high anxiety levels and can feel that they are not in control. Young people with PDA can switch from passive to aggressive very quickly. They may apologise yet do the same thing again straight away, whereas young people with ASD are seldom impulsive, tending more to work to their own rules and not put an act on for anyone.

QUOTE

Feedback from school:

‘Thanks.  These updates are really lovely!  It is great to see that Ben is engaging so positively with you.  We have his PEP today so I will be asking for funding for another 6 weeks.’

Background to case

Kyle lacks understanding of rules and boundaries and demonstrates demand avoidance behaviours. He has difficulty expressing himself when frustrated and struggles to transfer the emotional regulation skills he has learnt in a 1-1 environment into larger group situations or with his peers. He finds it difficult to calm down once upset.

Kyle has excessive emotional outbursts and can display concerning behaviours towards staff and peers, such as pushing, hitting, kicking, punching, climbing, scaling fences, shouting, hiding, refusal to comply, damaging property and throwing items and he relies on adult support to intervene. Incidents are unpredictable and impulsive and can occur more than three times a day. Triggers include being told no/not being able to do what he wants, unstructured activity, transition times, increased pressure, lack of personal space and having to share.

He is at risk of permanent exclusion due to this concerning behaviour and concerns for his own safety. He does not recognise or understand the impact of his behaviours on others and demonstrates no desire to change these behaviours.

Process at The Seeds of Change

Kyle did not like other people being in his space and found it difficult to wait his turn, often interrupting other’s conversations. He choose not to respond to request/instructions, particularly if being asked to take part in something he does not want to do. He showed little awareness for danger.

Kyle demonstrated a very short attention span and would only engage in play independently for limited amounts of time and flitting from one activity to the next, spending a very short amount of time at each (up to two minutes).
Bob his chosen horse was definitely the hook to keep focus and engagement and the therapeutic element of grooming relaxed and grounded him, allowing for turn taking in conversations becoming more noticeable.

Kyle enjoyed practical tasks and outdoor learning such as herd and small animal observation.
In the classroom, we used a visual timetable and picture prompts. Giving choice of 1 or 2 ideas and using checklists worked well and enabled him to complete simple class based activities and wear correct PPE without questions or resistance. Eventually retention of focus increased during a task or activity for up to 30 minutes engagement.
As Kyle would throw or self-sabotage if challenged, we put structure in place over several weeks. We continually reinforced boundaries and expectations in safe spaces and modelled behaviours and expectations.