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Advice please?


narnia
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We have a lovely child, who was doing well with us. He started attending an Opportunity group in November, in theory to help with his speech and language. he is still awaiting a formal diagnosis, but everyone is agreed that he appears to be on the Autistic spectrum.

Now, here is the problem : since he has been attending the other group, his behaviour has become extremely disruptive and aggressive. He constantly snatches and grabs things form other children and screams and flaps his hands if other children try to play with things that are intended to be for a group times.Today we had to physically prevent him throttling a child who had a toy that he wanted! We had worked very hard to settle him into the group and it is heart-breaking to see this change in behaviour. His mum told us that on one occasion when she collected him from the other setting, he was strapped into a chair whilst all the other children were running around. She didn't feel able to question why this happened, but her son appeared to be distressed by the experience. He has also started 'self-pleasuring' ( very regularly)' which is not something noted previously. He definately seems to be regressing rather than PROgressing. Mum says there are 5 other children in the group, all of whom she describes as having 'much worse problems than X'.......he now spins,screams, squawks,, flaps and throws himself on the floor with no apparant sign of awareness of space, other children or risk of harm to himself. I don't have much experience of ASD ..we have a psychologist coming out to do an assessment in two weeks time, in order to finally and formally put a name to this child's condition. In the meantime,help! Is ASD a condition that becomes worse over time?? What am I missing and how do i help this child?? Mum says she doesn't really want him at the other setting, and is waiting until his assessment has taken place before she removes him. I feel at a huge loss......we get no help, no assistance and no strategies to help, yet we WERE making good progress. What has gone so wrong?

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Does he have to go to the Opp Group, maybe its a step to far for the little lad who had obviously settled with you? Mum doesn't sound very happy with the new setting either and I would have definitely have had something to say about him being strapped to a chair! What transition to the new setting did you do? Have you done any cross visits/information sharing? Is it not possible for him to see SLT independently or in your setting? Its heartbreaking when you can see all your hard work slipping away but don't give up yet, keep supporting him and his parents and I am sure he will settle back soon xxx

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Our local opportunity group are very good at working with the other settings... all children react differently to an environment with children that have many needs.. we had one who used to copy behaviour so the Opp group was not best for him so they came to us and the Opp group offered support

Is it possible for you to do a visit to the group, see what they are doing, maybe you feel continuity is important with all doing the same , that you would like to learn what they are doing and how you could extend this in your setting... it may give an insight into the group and allow you to give parent more support .

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If this child is on the autistic spectrum then something he will find very difficult is a lack of routine and consistency in his day. His behaviour may well be his way of expressing his confusion and anxiety. Is this something you feel able to mention to whoever has placed him in the other group? He may also be finding the behaviour of other children in the opportunity group difficult to understand, as social understanding is another thing that children with ASD find difficult. If these children have behaviour problems then even more so. Being strapped in a chair would be very worrying and likely to cause him great distress. It is difficult to know who would think that was appropriate and wonder what the reason for this was!? If I was his Mum I would be asking questions, but know that that can be hard to do if you are feeling insecure and concerned.

As Inge has suggested perhaps you could visit the other group and see what is going on.

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Hi narnia

 

We have had quite a few children through our setting with ASD or similar concerns. We have several things that work in different situations for example:

visual time tables, now and then boards and spot timers (this is particularly good for supporting sharing and staying at an activity for longer periods if attention of focus is an issue) use visual cues (pictures or actual objects) to support all verbal comments made by staff.

we also use sign a lot in our setting both for us to use with a child and for children to use with each other. This can help with giving him a way to communicate (either through words or sign) feelings although this does take some time but may eventually help him not to throw himself about. Also sign would hopefully help him to communicate and maybe lessen his frustration until his language 'caches up'.

lots of soft spaces can be helpful as not only are they good for settling but can be 'go to' spaces when the rest of the environment get too much for them and they need time out.

lots of noise, lots of colour and busy environments can all be hard to cope with so soft spaces, quiet spaces and even if its a tent in the corner (these would be used not as a way to separate this child out but as a safe space he can take himself to if he needs to)

sensory play is always good water, sand, play dough, cause and effect toys etc...

We also had a daily planer type thing which mum had at home which had pictures of our setting and picture of the other setting he attended and she could use this as a visual support for where he was going and when so Monday morning our picture a picture of food underneath for dinner and then the picture of the other setting under this, so he could clearly see where and when around simple key times he understood he was going to be (hope that makes sense)

 

sorry this all feels very hurried but hope it helps feel free to get back to me if you want me if you think I can help

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I'm responding in a hurry here because I'm about to dish up our evening meal but I had to say this.

Autism doesn't tend to get worse over time. However most children's symptoms of Autism seem to get worse if their anxiety levels increase.

In my opinion (and I have done two days of Team Teach training on restraint) it is never acceptable to tie a child down as a form of behaviour management or restraint. I can't see any mention of this child's age but, if this was anything other than a toddler strapped into a high chair with reins to prevent him from falling out and hurting himself, it is totally unacceptable.

Has this mother been given copies of restraint policies or records? If her son has been restrained they should have given her copies of incident reports and these should be very detailed.

I can't help feeling very concerned about this.

I'll give it some more thought and come back later this evening.

Edited by Upsy Daisy
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Most importantly, don't despair, you're already helping him and have helped him in the past, that's why he's made progress. As others have said, the behaviour is in response to what's happening, the change in routine, different venue, children and people. Christmas can also be unsettling and it could be that returning after the holiday has been difficult, added with the Opportunity Group experience and it's all too overwhelming.

 

I'd be very concerned about the restraint. Children can only be restrained if they are a danger to themselves or others and the restraint must be proportionate to the situation, it should only be used as a last resort when all de - escalating strategies have been tried. The sequence of events should have been documented and a member of staff should have discussed what happened with mum, with a plan of how they would avoid it happening again by implementing more effective strategies. I can completely understand why mum doesn't want to say anything but I really think she should. I would certainly be distressed if I'd been restrained in that way.

 

Are there particular activities he/she enjoys, a member of staff they have a closer bond to or can mum suggest anything to help? As has already been suggested, I'd recommend mum setting up something visual so he/she knows what's happening each day.

 

The increased amount of "self pleasure" could be a way of distracting/soothing himself, it could be a sign of anxiety. You need to make sure you and mum are dealing with it in the same way, without him thinking it's "bad." In my experience, distraction is usually the best strategy.

 

Try to decide as a whole staff team how you will react when he throws himself to the ground, grabs something from another child etc and check mum agrees. If he's very distressed, it's usually easier and safer to move the other children by using songs and rhymes as you move them. Eg. The Grand Old Duke of York. If he's verbal, could you model what he needs to say eg. You need to say "can I have a turn?" or can you have a general session with all the children where you tell them what to do if someone is hurting them? You could use puppets, teddies or members of staff. Eg. You need to say "Stop, you're hurting me!"

 

If possible, everyone should be reacting in the same way, including the staff at the Opportunity Group and mum. Try to identify triggers by the behaviour by using an ABC sheet (attached). Although this may seem like more work, if all staff are responsible for filling it in, it's not too time consuming and after a session or two, you can usually identify a pattern. It would also be very helpful for the Educational Psychologist to see.

 

Most importantly, give yourselves a pat on the back. This little boy is very lucky to be attending a setting where staff are asking advice about what they need to do, rather than what the child needs to do - that doesn't happen everywhere. Good luck.

ABC Observation Record SheetSheet number.doc

Edited by katkat1972
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