Joe first came to The Talking House clinic in July 2017 aged 2½. At that point, Joe’s parents were concerned that he was using less than ten single words and his ‘tantrums’ were becoming difficult to manage as he was becoming more and more frustrated. Joe’s communication needs are complex and this case study provides an overview of the work that we have done with Joe so far to develop his communication and the progress that he has made.

Background

The first time Laura met Joe, Joe could not cooperate with any activities that Laura had chosen or play with any toys he had chosen for more than a few seconds. He was following some single word instructions but often needed a non-verbal cue (such as a pointing gesture) to help him to understand. Joe communicated by taking an adult by the hand and reaching for things he wanted and hitting out at adults and screaming when he was told not to do something.

How we helped Joe:

Laura worked with Joe’s parents, his grandmother, his nursery staff and eventually his school staff to increase Joe’s attention and to develop his communication skills so that he could get his needs met appropriately.

Initially, Laura saw Joe for direct therapy sessions at home. It was important to use Joe’s interests and strengths within therapy to help him to engage. Joe and Laura spent a lot of time running under, and swinging in, a parachute! ‘Ready, steady, go’ games and the introduction of a now/next board (like the one below) supported Joe to share attention with adults for longer periods of time. By increasing shared attention, Laura was able to create more opportunities for language learning.

Joe was introduced to Picture Exchange Communication System (PECS). PECS teaches children to exchange a symbol to request something they want. Joe learnt this system quickly and after only a few sessions began independently searching through his book of symbols and seeking out his parents in other rooms of the house to make requests such as ‘I want singing’. Laura then visited Joe’s nursery where she provided training for Joe’s key worker on the use of PECS. Quickly, Joe began to use spoken language to communicate. The use of symbols served to reduce Joe’s frustration and to increase his vocabulary so not only did he begin to use spoken words to make requests, his language in play also emerged. Joe was soon introduced to sentence strips to help him to use short sentences and increase his verb vocabulary (‘Mummy stretch slinky’).

As Joe made fantastic progress with his spoken vocabulary and his use of short sentences, the use of symbols was faded out and Laura was able to work with school staff on developing Joe’s social interaction with his peers. A small group was set up for Joe to practise communicating and turn taking with other children.

Joe’s progress to date:

Joe is now in Reception class. He was diagnosed with autism at the age of 4. He is able to sit on the carpet with the rest of his class and cooperate with short learning tasks. His vocabulary (the words he knows and uses) is now average for his age and he is attempting to use longer and more complex sentences. Joe loves imaginative play and he enjoys directing the Year 6 pupils how to play his games at play times! While Joe continues to find it difficult to manage his emotions at times, he is beginning to successfully express himself using language when he not happy with something, for example, ‘we don’t want to go to assembly’!!

Laura continues to work with Joe, his family and school staff to develop Joe’s sentence structures, narrative skills and social skills. Joe is working on being able to retell an event through practical and fun activities which are motivating to him such as building rockets. Laura’s role is now largely to give ongoing advice to the key adults in Joe’s life.

Well done Joe!!

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