Finn is 12 years old on the autism spectrum with a moderate learning disability. He attends the setting as an emergency case with his form teacher from school. Finn has asthma and has come to see you because of a potential allergic skin reaction to using mohair and alpaca wool in his lesson on textiles. He is breathing in a shallow way and he is clearly stressed and upset about having to come to the setting as an emergency. Finn has a piece of string that he is holding up in front of his eyes. It rotates one way, then the other and then Finn holds either end and pulls it tight. His form teacher says this is a routine that Finn employs during times of stress.

Strategies

• Allow Finn to keep hold of the string as this may serve to calm him.
• Ask Finn to breathe in time to the particular movements of the string.
• Ask his form teacher to assist you in this and model a steady rate of breathing.
• Ask the form teacher to give you background to the skin reaction, while you are encouraging steady breathing.
• Find out details of the management of Finn’s asthma.
• Assess the level of intervention needed, once you feel Finn’s stress levels are declining.

You may also wish to use other de-stressing activities but often it is better to start with a strategy that the patient has devised for themselves rather than introducing anything new.