Radha Mongia and Niamh Roberts are PBS (Positive Behaviour Support) practitioners within a care company that provides bespoke services to adults with learning disabilities and/or autism. This article has been written to share strategies that can be adapted on a case-by-case basis to help autistic individuals build coping skills and improve their quality of life. To protect the confidentiality of the people discussed within this article, pseudonyms will be used.

Introducing Jay

Jay is a very outgoing and enthusiastic individual who loves to garden and go on bike rides. Additionally, he has always loved trying new restaurants and experiencing new foods. One of Jay’s favourite activities is to do arts and crafts, as well as socialising with others when cooking and out at restaurants.

When Jay first arrived at the care provider, he experienced huge amounts of anxiety and struggled with change. For example, Jay struggled to cope with any adaptation to his routine, changes in staff members during the day or changes in the weather. Sadly, this meant that Jay would experience huge amounts of anxiety when small changes happened, and would hurt himself as a response. Jay also experienced anxiety around health conditions, broken and missing items, and found it difficult to communicate his worries.

Strategies for Jay

We worked with Jay to try several strategies to build his ability to cope with change, whilst improving his quality of life and providing as much choice as possible. First, we built an activity schedule with Jay. This consisted of a two-week schedule in which he could plan activities he enjoyed, meals to rotate and a list of alternatives if there was an unforeseen and uncontrollable change, such as rain on a day that Jay had planned a bike ride. Jay found that this helped to provide structure, routine and build his skills in coping with change.

Next, we worked with Jay to build his communication methods by using social stories. These stories broke down information using visuals and simplified language to explain processes that previously made Jay feel anxious, due to his unfamiliarity with these processes. For example, if holidays and events needed to be cancelled, we would use a social story to explain to Jay when they would be rebooked or the new details of the event.

Through the use of these stories, Jay was better able to communicate which areas he needed to be further explained, and which areas he needed further support with. Through this approach, we were able to identify a range of common situations, such as unexpected changes to staffing due to illness, items breaking likes bikes meaning activities had to be changed and unexpected weather changing activities and plans for the day where Jay would become anxious because he didn’t fully understand the situation. Individuals supporting Jay were then able to help him to develop coping strategies and problem-solving exercises to practice when these common situations arose. Jay was then able to use these self-coping strategies to lower his anxiety levels and develop his own social stories to communicate to the individuals supporting him where he needed further support.

Introducing Ken

Ken is the second individual discussed in this article. He is a vivacious young man, who loves Manchester City Football Club and anything relating to football. He is a sociable person who will engage in joke-based conversation with most people.

Ken has a diagnosis of a mental health condition which can result in him experiencing paranoia. Unfortunately, due to poor care and Ken being sectioned prior to joining his care provider, his paranoia and anxiety significantly increased. Because of Ken’s previous experiences of poor care, he refused all health checks and would not engage with health professionals. We wanted to support Ken to confidently receive the healthcare he needed, so we worked with him to develop similar strategies to reduce his anxiety.

Strategies for Ken

To help Ken reduce his anxieties around health appointments, we developed strategies with him to build his understanding of what the appointments were for and their importance. Similarly to Jay, we used social stories to visually explain to Ken the procedure involved at a dental appointment. This included the steps that would take place and visual representations of the instruments that would be used throughout the procedure. We also showed Ken a video to further explain the process.

Once Ken had this information, we had a meeting with him to check whether he understood the purpose and process of the procedure, so we could be confident that he could make an informed decision. Ken was able to clearly inform Niamh of the procedure and went on to express his wish for the procedure to take place.

Once Ken had chosen to have the treatment, he was reintroduced to the dentist to further familiarise him with the room and the dentist. Ken’s favoured staff were with him to support him throughout the procedure, providing verbal praise and talking Ken through which step of the social story was next.

Ken was able to complete this health appointment which previously, he would have refused to attend, which ultimately could have been detrimental to his health. Overall, this strategy has helped Ken to undergo a procedure to maintain his health and improve his quality of life. We will continue to work with Ken to use similar strategies to support him in future situations.

Conclusion:

As both individuals faced different challenges, these examples demonstrate how similar strategies were used to improve the skills and quality of life of both individuals, reducing their levels of anxiety in the process. For each strategy to be effective, it was vital to know and understand the individual, adapt any support and intervention to their own particular needs, background and personality, and always see them as an individual.

References have been provided below for the evidence basis of the PBS strategies discussed within the article.