Case Study: *(names changed)
Jack is a 14 year-old teen who is transitioning from homeschool to public high school. He has been homeschooled since mid-fourth grade when school got “difficult” and kids got “mean”. He has a diagnosis of Tourette’s Syndrome that is manifested by intermittent body movements and a speech processing delay.
Although he has not been diagnosed, his behavior suggests high functioning autism. He is very ritualistic, displays rigid thinking, poor eye contact, cannot make inferences and has difficulty understanding simple “jokes”. With his fixed sense of “right and wrong” and “fairness”, he has little tolerance for “gray areas” and /or “maybes”.
Initially seen in OT for fine motor issues, Jack is now able to write legibly in cursive and paraphrase articles from the newspaper etc.
He prefers to memorize rather than reason out tasks and has difficulty with organization and sequencing. When “stumped” he sits and waits for the OT to help him as he does at home with his mother/teacher.
He has returned to OT to learn basic high school survival skills inclusive of but not limited to note takings, task organization and social awareness of self and others.
The differences between homeschool and high school are huge. At home he does not need “ask” for help because his needs are anticipated in school he will need to raise his hand and ask for help.
At home he gets immediate feedback as to whether he is right or wrong and gets redirected. At school he may have to wait days to get a test and or homework back.
He likes to try things first to see if he can do and then he will ask for help. Often in school there are no instant “replays”.
It is difficult for him to reason out what he needs to ask and/or how to ask it. He is used to immediate intervention. In school with often 27+ children in a room learning to wait and move on while you are waiting is a necessary skill.
At home mom “waits” for him to write his responses, in school the pace is much faster.
At home mom can offer “cues” as needed, at school this is not usually an option.
Many of the kids he will meet will have been together since elementary school. And although there is novelty to being the “new kid” social adaptation and learning how to go with the flow are essential school/social survival skills.
Occupational Therapy Interventions (partial list of ideas)
Create motivation: easier said than done but help to delineate the difference between fun and happiness. With fun being equated with a movie or an amusement park experience (all you have to do is “show up”) and happiness being equal to learning and achieving something. Get the teen to name something he has done that is “fun” and something that he has conquered as “happiness”.
Teach how to ask the question: Provide novel experiences that he has not done before (pedaling a foot bike, etc.) and get the teen to think through the process of learning what he/she already knew and what they had to learn.
Make a process booklet for reference: outline in booklet form what are the elements of getting a task done (i.e., establishing what comes first, how to know when you are done, how to proof-read, create priorities, etc.) Let the teen talk and the OT write and then review it (with them with them using their own words) for understanding.
Role play classroom situations: inclusive of note taking and the elements of how to get down the main ideas; capturing key words, working in a group or with (an assigned) peer. What do you do if you do not like the person?
Practice task problem solving: use visuals—what happens when the teacher want “X” and you are sure it is “Y”. Taking correction is a very big part of this. Reasoning and keeping things in perspective, not making a “fix this” into an “indictment” of yourself and/or self-worth. Learning the art of compromise.
Mind shakers: things to do that can help you “get back” when you go “blank”; repeat in your mind the words you are hearing, write the last word you recall, blink hard and fast 2-3 times, etc.
Facilitate study habits: when appropriate have the teen learn something as if they had to teach it to someone else. The best way to learn something is to teach it. Practice cross referencing notes with textbooks or online information and write write write write it down!! Research has shown that our immediate memory lasts just under 10 seconds for full recall.
Experience using inferential thinking: Use scripts from plays or movies (there are plenty of them online from old radio shows, etc.) and have the teen say in their own words what they think might happen next and why.
Teach debate techniques: substantiating what you say with actual facts instead of feelings to support your argument/reasoning. This will help with thought organization and sequential thinking.
Transitioning from the slower individualized pace of homeschool to the often “hard knocks” of high school can put that teen on a sharp learning curve, but with careful preparation and “behavioral tricks” in his “back pocket” it can be done—and furthermore it can even be fun.