LEARNING DISABILITY PRACTICE April 2009 | Volume 12 | Number 3 23
Feature
and provide an environment in which he or she will
perform best. Ben's class has a daily routine that is
implemented through the use of a visual timetable.
each activity is represented by a word and symbol so
it is accessible to all members of the class and can
be held in place long enough for the individual to
process. The activities are sequenced in the order in
which they will occur and the progression from left
to right represents the progression of time. howlin
(1998) states this is important because it helps
pupils predict or know what will happen next. This
gives Ben time to see and accept the change, causing
him the minimum amount of distress. symbols of
activities can then be removed to show that they
have finished, which makes it clearer what the next
activity is. The timetable helps to reduce Ben's
anxiety and provides him with reassurance and a
predictable, effective learning environment (Williams
and Wright 2004).
Next goal in development
Ben's impairment of imagination hindered what i
believed to be a key goal in his development � the
ability to wait. Wing (1996) states: `The value of true
imagination and creativity is in associating past
and present experiences and making plans for the
future.' she believes that the autistic individual has
difficulty in comprehending the passage of time and
linking it with ongoing activities, and that this often
manifests itself in an inability to wait. Unexpectedly
having to wait causes Ben huge distress. This occurs
most often out in the community, away from his
structured environment, and displays itself as
challenging behaviour in the form of aggression
towards himself.
When Ben's class goes into the community there
are many unpredictable situations and Ben has to
wait. as a result, he frequently becomes distressed.
Much of the literature advises reducing waiting time
and avoidance of situations that the child may find
challenging. But this is not always possible. i felt
that if Ben was able to wait appropriately, he might
display challenging behaviour less frequently and
have an improved quality of life as a result.
Care planning
care plans are a way of systematically planning
and documenting interventions to meet individual
needs (Gates 2006). These care decisions should
be based on evidence, professional knowledge
and experience, and client preference. There
are numerous nursing models to help plan
care decisions. Gates (2006) advocates the use
of roper, logan and Tierney's (1980) model of
nursing, which i used to assess Ben's ability to
carry out each of the 12 activities of daily living
and produced the care plan shown (see Box 1). This
addresses the specific issue of maintaining a
safe environment, which is necessary because of
Bens risk of self-harm, while having to wait.
Reasons for care decisions
The plan aims to modify Ben's behaviour by
gradually increasing his acceptance of having to wait,
reducing the likelihood of him displaying challenging
behaviour and giving him new social skills.
i have chosen to use a traffic light card method
because it will augment verbal instructions by
providing visual cues that will help improve Ben's
communicative competence (howlin 1998). This
should help Ben's acceptance and understanding of
Box 1 Care plan for Ben
Activity of living: maintaining a safe environment.
Aim of plan: for Ben to be calm and relaxed when waiting.
This is to be achieved by modifying Ben's behaviour through effective
communication aids.
The overall aim is to reduce Ben's challenging behaviour (in the form of
self-harm) and increase his tolerance of having to wait for something.
People involved: all adults working with Ben at school.
Actions to be taken:
A traffic light card system will be used to communicate to Ben when he will
have to wait for something, when he should be waiting and when he can go.
This will be shown by giving Ben a red `wait' card, then replacing it with an
orange `waiting' card and finally giving him a green `go' card.
The system can be used in any social situation when Ben has to wait.
It can also be used in a situation when he does not necessarily have to wait in
order to increase his tolerance of waiting and to help him accept and understand
some social situations � for example, waiting for a turn on the swing.
The cards should always be taken when `out and about' in the community.
If it is anticipated that Ben will have to wait then he should be given the red
`wait' card and be told why he has to wait before the situation arises.
If the situation cannot be predicted, the red card should be given to him as soon
as the situation arises and, again, he should be told why he has to wait in a
calm and controlled manner.
Ben needs to be given the card to hold.
When it has been explained to Ben that he has to wait and why, he needs to
be encouraged to pass the card back and be given the orange `waiting' card.
Replacing the cards symbolises the passage of time.
Never tell Ben how long he may have to wait in case this cannot be adhered to.
Constantly reassure Ben while he is waiting with the orange card and praise him
if he is waiting appropriately, repeating phrases such as `good waiting'.
When the waiting period is over, ask Ben to give you the orange card then give
him the green `go' card.
Always explain to him why he can now go ahead with the activity. For example,
he can now go into the toilet because the person who was in there has now
finished and come out.
To be achieved by: ongoing intervention and assessed after each use, documenting
behaviour displayed.

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