Adam Case Study
Background
‘Adam’ is an autistic, non-verbal, individual with a severe learning disability and history of challenging behaviours. Following a previous Supported Living placement breakdown,
In June 2018, Adam was detained under Section 2 of the Mental Health Act and admitted to Goodmayes Hospital. We transitioned Adam from here to our Lonsdale Drive, Supported Living Service, in March 2019. Hospital staff predicted on his discharge that he would return there within two weeks due to the severity of his behaviours.
Pen picture before M&M
Behaviours of concern before any interventions by M&M:
Physical aggression towards others
- High arousal levels and rise in anxiety due to unpredictability
- Defecating in inappropriate places, e.g. living room floor, corridor, kitchen, bedroom
and outdoors - Damage to property and objects
Support Interventions
M&M introduced a number of structured interventions to support Adam, including:
- Daily schedules & objects of reference to support communication
- Rota board updates to reduce anxiety around staff changes
- Incident reflection workshops to assess and improve responses to behaviours
- Structured teaching & skill development to promote meaningful engagement and independence
- Sensory accommodation including label-free clothing and a jacuzzi for relaxation
- Health & wellbeing initiatives, such as a weight loss plan and regular exercise outdoors.
Transition Planning
Adam struggled with change, we implemented a detailed transition plan, including a countdown calendar, social stories, and gradual visits to his new home.
To improve predictability and allay anxiety, it was important that Adam understood which staff was supporting him each day. Initially, we started by showing him images on the board for him to understand who was supporting him at any given time.
Emotional Regulation & Wellbeing
Given Adam’s non-verbal status, distress was communicated through aggressive and destructive behaviours. Stability was supported through preventative strategies including consistent staffing, meaningful engagement, clear and predictable structure, and involvement from family members.
Daily schedule & Objects of Reference
Adam was supported with symbol-based communication but struggled with this. With input from Speech and Language Therapy we introduced objects of reference (e.g., key for park, plate for food) for support. Staff underwent training and role-play exercises to ensure consistency.
Coping with Sensory Input
Adam exhibited severe distress when encountering clothing labels. Staff adapted by ensuring all labels were removed. Additionally, he discovered a liking for water-based activities, leading to the installation of a jacuzzi for therapeutic use.
Skill Development & Community Participation
Adam has been involved in cooking and food shopping to increase his independence and community participation by using relevant objects of reference, enabling Adam to understand the steps involved in each activity.
Maintaining family relationships
Every fortnight, Adam is supported to visit his family and spend quality time with them.
Keeping Healthy
Staff support Adam to go for walks daily. His favourite park is Gunpowder Park. When Adam was discharged from the hospital in March 2019, his weight and BMI indicated that he was obese. Therefore, a diet plan with varied menu and daily activities was created.
Achievements & Improved Quality of Life
- Increased independence: Adam now participates in cooking and shopping using visual guides.
- Family engagement: Adam has maintained positive connections with his family.
- Health improvements: Through a structured diet and exercise plan, Adam reduced his weight and improved his BMI to healthy levels.
- Community inclusion: Regular community outings and dining out experiences support his social engagement.
Summary
While Adam still experiences moments of distress, he has remained stable and happy in the community for over five years. Contrary to initial expectations, he has not required hospital readmission and continues to thrive under M&M’s support.