Easter College

SPED DEPARTMENT
Easter Road, Guisad, Baguio City

MODULE 2- Case Study

SY 2020-2021

CASE STUDY

A case study is a detailed study of a specific subject, such as a person,

group, place, event, organization, or phenomenon. Case studies are
commonly used in social, educational, clinical, and business research.

A case study research design usually involves qualitative methods,

but quantitative methods are sometimes also used. Case studies are good
for describing, comparing, evaluating and understanding different aspects
of a research problem.

When to do a case study

A case study is an appropriate research design when you want to gain

concrete, contextual, in-depth knowledge about a specific real-world
subject. It allows you to explore the key characteristics, meanings, and
implications of the case.

Case studies are often a good choice in a thesis or dissertation. They keep
your project focused and manageable when you don’t have the time or
resources to do large-scale research.

You might use just one complex case study where you explore a single
subject in depth, or conduct multiple case studies to compare and
illuminate different aspects of your research problem.

Step 1: Select a case

Once you have developed your problem statement and research questions,
you should be ready to choose the specific case that you want to focus on.
A good case study should have the potential to:

 Provide new or unexpected insights into the subject

 Challenge or complicate existing assumptions and theories
 Propose practical courses of action to resolve a problem
 Open up new directions for future research
 Easter College
SPED DEPARTMENT
Easter Road, Guisad, Baguio City

MODULE 2- Case Study

SY 2020-2021

Unlike quantitative or experimental research, a strong case study does not

require a random or representative sample. In fact, case studies often
deliberately focus on unusual, neglected, or outlying cases which may shed
new light on the research problem.

Step 2: Build a theoretical framework

While case studies focus more on concrete details than general theories,
they should usually have some connection with theory in the field. This way
the case study is not just an isolated description, but is integrated into
existing knowledge about the topic. It might aim to:

 Exemplify a theory by showing how it explains the case under

investigation
 Expand on a theory by uncovering new concepts and ideas that need
to be incorporated
 Challenge a theory by exploring an outlier case that doesn’t fit with
established assumptions

To ensure that your analysis of the case has a solid academic grounding,
you should conduct a literature review of sources related to the topic and
develop a theoretical framework. This means identifying key concepts and
theories to guide your analysis and interpretation.

Step 3: Collect your data

There are many different research methods you can use to collect data on
your subject. Case studies tend to focus on qualitative data using methods
such as interviews, observations, and analysis of primary and secondary
sources (e.g. newspaper articles, photographs, official records). Sometimes
a case study will also collect quantitative data.

Step 4: Describe and analyze the case

In writing up the case study, you need to bring together all the relevant
aspects to give as complete a picture as possible of the subject.
 Easter College
SPED DEPARTMENT
Easter Road, Guisad, Baguio City

MODULE 2- Case Study

SY 2020-2021

How you report your findings depends on the type of research you are
doing. Some case studies are structured like a standard scientific paper or
thesis, with separate sections or chapters for
the methods, results and discussion.

Others are written in a more narrative style, aiming to explore the case from
various angles and analyze its meanings and implications (for example, by
using textual analysis or discourse analysis).

In all cases, though, make sure to give contextual details about the case,
connect it back to the literature and theory, and discuss how it fits into
wider patterns or debates.

Case study 1
Child’s name & age:
CD, 5

Main areas of concern:

Does not stay in seat, cannot complete work, very rough with classmates, refuses to sit
for circle time, occasionally hits and bites staff
Outline of case study
CD was referred to Middletown Centre for Autism due to an increasing number of
behavioural incidents. These incidents included physical harm to his teacher, classroom
assistant and some classmates. He would engage in these behaviours when his
teacher or assistant sat beside him to assist with work, yet at other times he would seek
hugs from staff. His teacher also reported concerns that he was not completing work
due to his inability to stay seated for more than 1-2 minutes at a time. She had observed
that the best times to complete work with him seemed to be after Break and Lunch
when he was able to sit for slightly longer periods. However, on wet days, his
engagement in tasks would deteriorate and he would have behavioural outbursts when
refused access to outdoor play.

Circle Time had become increasingly difficult with a number of behavioural incidents
and so CD was now removed from the classroom at these times and instead went to the
library with the classroom assistant. When he had been participating in Circle Time, he
had repeatedly pushed classmates sitting near him and on occasion had pulled their
 Easter College
SPED DEPARTMENT
Easter Road, Guisad, Baguio City

MODULE 2- Case Study

SY 2020-2021

hair and bitten them. He also tended to dominate the Circle Time activities, preferring to
talk about his preferred topics of Dr Who and snakes.

Arrival at school each morning was challenging as CD would run down the corridor,
crashing into others. When leaving the classroom, he would push and hit classmates
standing near him in the line or he would refuse to stand in the line.

Reports from school and educational psychologist indicated above average

performance IQ, and good expressive language skills with a broad vocabulary. CD
would initiate interaction with classmates but was becoming isolated from them as his
play was overly boisterous. He would not engage in playground games and he refused
to follow the rules, preferring to run around and crash into others or wrestle them to the
ground.

The parents stated that they were finding it difficult to manage behaviours at home and
that CD was hitting, kicking and biting them on a daily basis. They noticed that he was
calmer on days when they took him to the local park and when they engaged in rough
and tumble play at home.

Assessment and analysis

A Sensory Profile (Dunn, 1999) was completed and observations were carried out at
home and school with data collected over a 2-week period. Analysis was combined with
the assessment results from the specialist teacher, specialist speech and language
therapist and behaviour intervention specialist.

CD primarily presents as sensory seeking but with some indicators of sensory

overresponsiveness.

1. Sensory seeking

CD craves movement and therefore finds it difficult to stay in his seat or to sit still for
circle time, and likes to run at speed down corridors. He needs movement to keep his
brain alert; when he feels he needs movement he impulsively leaves his seat to stand
up or run about the room. When CD engages in physical activity (e.g. in the park near
home or in the playground), he appears calmer and more engaged because his sensory
need has been met.

CD also seeks proprioceptive, or deep pressure, input. His enjoyment of rough and
tumble play at home and in the playground demonstrates his need for intensive input to
his muscles and joints. He likes tight hugs from adults because these offer deep
pressure input. Unfortunately he does not understand that others do not seek similar
input and that his overly boisterous play is hurting others. These sensory processing
 Easter College
SPED DEPARTMENT
Easter Road, Guisad, Baguio City

MODULE 2- Case Study

SY 2020-2021

difficulties are further intensified by his limited social understanding. He is unable to

read the cues from other children that his behaviours are upsetting them and he does
not understand the rules of the playground games.

2. Sensory overresponsiveness

CD’s physical aggression towards others is due to tactile overresponsiveness. He hits,

kicks and bites when others stand or sit too close to him e.g. at Circle time, standing in
line or when staff sit beside him to assist with work. This close physical proximity of
others provides light touch and unpredictable touch which he is unable to tolerate. His
sensory processing difficulties mean that light and unpredictable touch is perceived as
painful and so he engages in aggressive behaviours as a way of moving people who
are too near him. He is able to tolerate hugs and rough and tumble play because these
provide predictable input and deep pressure rather than light unpredictable input.

Circle Time was also challenging for CD because although he has good expressive
language on his preferred topics, his receptive language skills were limited and so he
did not fully understand the discussions.

Behaviour Possible causes

Seeking movement inputLack of understanding of how

Not staying in seat long he was expected to sitLack of understanding of
tasks

Seeking movement inputAlso possibly related to tactile

Running down corridor overresponsiveness as he may be trying to avoid others
bumping into him in the corridor

Tactile overresponsiveness/fear of light and

Hitting, kicking and
unpredictable touchOn occasion these behaviours were
biting others (e.g. at
CD’s attempt to initiate rough and tumble play as he
Circle Time or when
was seeking proprioceptive inputAvoiding Circle Time
standing in line)
as he did not understand the discussions
 Easter College
SPED DEPARTMENT
Easter Road, Guisad, Baguio City

MODULE 2- Case Study

SY 2020-2021

Refusal to stand in line Tactile overresponsiveness

Rough and tumble

Seeking movement and proprioceptive inputLack of
play in playground and
understanding of rules in playground games
at home

Requesting hugs from

Seeking deep pressure input
staff and parents

Calmer/more engaged Sensory needs (movement and proprioception) have

after outdoor play been met and so he is more able to focus on tasks

Intervention strategies

1. Movin’ sit cushion

A Movin’ sit cushion is a wedge shaped cushion lightly inflated with air. The cushion
was provided for times when CD was required to sit to complete pieces of work. This
cushion provides additional movement input, which meets his sensory need without CD
needing to leave his seat. The wedge shape also provides additional proprioceptive
input as it pushes him forward on to his legs, increasing input to muscles and joints.

2. Therabands

Theraband is a band of stretchy material which provides resistance to the muscles. A

piece of Theraband was attached to the front legs of CD’s chair so that he could kick his
feet against it when he needed movement and proprioceptive input. Provision of this
foot fidget again helps him to stay in his seat for longer times.

3. Sensory Diet
 Easter College
SPED DEPARTMENT
Easter Road, Guisad, Baguio City

MODULE 2- Case Study

SY 2020-2021

A programme of movement activities was introduced to CD’s daily routine. He engaged

in 10 minutes of movement activities when he arrived at school in the morning and
again mid-morning and in the afternoon. These activities provided the movement and
proprioceptive input he craved, subsequently helping him to sit for longer periods. The
programme of movement activities also reduced his boisterous behaviours in the
playground as his sensory needs were being met at other times. The movement breaks
are included on his visual schedule so he can see when he will access activities. The
range of activities included:

 Lying on his tummy over a small exercise ball to complete activities e.g. throwing
beanbags at a target, completing a jigsaw
 Bouncing on a space hopper
 Crawling through a tunnel
 Propelling a scooter board
 Hopscotch
 Star jumps
 Running on the spot

In addition to the movement break, CD’s teacher or assistant will observe if CD is

becoming fidgety or disengaged and direct him to stand up and do 10 stretches before
sitting again to work. When CD is older, it is anticipated that he will be able to
independently request a movement break when he feels his attention deteriorating.

4. Backpack

CD was given a small backpack with a tin of baked beans inside to act as a weight. He
wears this when coming into school each morning which helps to regulate him and has
reduced the need to run down the corridor. He now carries this when transitioning
through corridors at other times of the school day, and when out with his parents e.g.
walking to the park, walking around the shopping centre.

5. Mat at circle time

CD was given a small mat to sit on during Circle Time and he is positioned beside the
teacher. His classmates were informed that they could not sit on or near the mat. This
has reduced CD’s fear that someone is going to sit too close to him and has therefore
helped him to sit for longer times in Circle Time.

6. Standing at the back of the line

CD now stands at the back of the line to avoid unpredictable physical contact from
others. He is scheduled for turns to be the leader, and at these times he is at the front of
the line, and the person behind is instructed to keep one arm’s length behind CD.
 Easter College
SPED DEPARTMENT
Easter Road, Guisad, Baguio City

MODULE 2- Case Study

SY 2020-2021

7. Visual strategies

Alongside the sensory strategies described above, visual strategies have been
implemented to facilitate communication and subsequently address some of the
behavioural concerns. Although CD appeared to have extensive expressive language
skills, these tended to be limited to topics of his choice (e.g. Dr Who, snakes, insects).
Assessment indicated difficulties in receptive language skills, meaning that CD did not
understand many of the tasks which were presented verbally in the classroom. This also
explained some of the behaviours in Circle Time as he was overwhelmed by the levels
of verbal communication, and so used the behaviours as a means of withdrawing from
Circle Time.

The following visual strategies were introduced:

 Visual schedule: This helps CD to understand when he is to work and when he will have
a movement break. This reduces anxiety and has a positive effect on behaviour.
 Structured tasks: A greater level of visual structure was introduced to CD’s work tasks
due to his difficulties in understanding verbal instructions. The visual structure provides
clear instructions and shows CD when a task is finished. This, alongside the sensory
strategies, helps him to sit for longer periods to engage in work and complete tasks.
 Visual timer: This is used to show CD how long he has to sit to do work and how long
he needs to sit in Circle Time.
 ‘Whose turn’ card: This is used in Circle Time to show CD when it is his turn to speak.

The intervention strategies used with this child/young person were introduced after
comprehensive assessment. These strategies were individualised to his/her specific
needs and will not be appropriate for every child/young person.

Case study 2
Child’s name & age:
AB, 12

Main areas of concern:

Playing with private parts, poking bottom, smearing faeces, refusal to have hair cut,
refusal to go to dentist
Outline of case study
AB was referred to Middletown Centre for Autism due to an increased frequency in
touching his penis and bottom in the classroom and public places. He had recently
started to pull faeces from his bottom and spread on desks in school and on the walls at
home. His parents reported this behaviour was also emerging in public places, such as
shops and on a recent trip to the zoo. AB’s teachers and parents could not identify any
 Easter College
SPED DEPARTMENT
Easter Road, Guisad, Baguio City

MODULE 2- Case Study

SY 2020-2021

triggers for these behaviours or any changes which may have elicited behavioural
changes. When he engaged in these behaviours, he would be removed from the
classroom, and sometimes had to be showered after smearing faeces. When out in
public places, his parents would take him back to the car, and then he would be
showered at home if necessary.

His parents reported that he had not had his hair cut in over a year and the dentist had
been unable to check his teeth over the last 2 years. When he was younger, they had
been able to hold him and apply deep pressure to keep him calm, but he had become
too strong and was now resisting this input and refusing to stay in the seat for the
hairdresser or dentist.

AB has limited verbal language and participates in minimal interaction with others. He is
slow to respond to verbal instructions in the classroom, and often seems to not hear
others speaking to him. He engages in several repetitive behaviours at home and
school, including pacing, flapping his hands in front of his eyes, humming loudly and
turning on taps to play with water in basins. His teacher has had difficulty in finding
functional activities in which he will participate.

Assessment and analysis

A Sensory Profile (Dunn, 1999) was completed and observations were carried out at
home and school with data collected over a 2-week period. Analysis was combined with
the assessment results from the specialist teacher, specialist speech and language
therapist and behaviour intervention specialist.

AB presents with a mixed profile of sensory overresponsiveness, sensory

underresponsiveness and sensory seeking.

1. Sensory overresponsiveness

AB’s refusal to have his hair cut and teeth checked indicated a hypersensitivity to tactile
input, especially light touch and unpredictable input from others. Observations indicated
overresponsiveness to noise as his repetitive behaviours increased significantly in noisy
environments (e.g. noisy classroom activities, shops, the zoo).

His habits of touching his private parts and smearing faeces appeared to be part of this
over responsiveness pattern as these behaviours were an effective way of being
removed from situations he found difficult to tolerate (e.g. shops, noisy classroom
activities, the zoo). These situations provided high levels of unpredictable sensory input
(noise, people standing too close, moving visual stimulation) which caused him anxiety
and resulted in these sensory avoidant behaviours.
 Easter College
SPED DEPARTMENT
Easter Road, Guisad, Baguio City

MODULE 2- Case Study

SY 2020-2021

2. Sensory underresponsiveness

AB was under responsive to verbal interaction with others. He did not respond to his
name or follow verbal directions. This is indicative of a pattern of auditory under
responsiveness and is further compounded by his limited understanding of verbal
language. He did, however, show immediate interest when visual strategies were
employed.

3. Sensory seeking

AB seeks out frequent tactile input, as indicated by playing with his private parts,
smearing faeces and playing with water. In these behaviours, he is in control of the
tactile input and so it is predictable and pleasant for him, (whereas hair cutting and
dental treatment is unpredictable input outside his control).

Further analysis of these behaviours showed that they often occurred when he was
under stimulated in the classroom and not engaged in functional activities. These
behaviours would escalate during less structured times, such as Choice time and Break
time. These behaviours were therefore being dually used to avoid sensory input (as
described in sensory over responsiveness above) and to provide input when under
stimulated.

It was hypothesised that AB may also have been motivated to smear faeces as he
enjoyed being removed for a shower as it provided an opportunity for water play which
he enjoyed.

Other sensory seeking behaviours, such as humming and flapping hands in front of his
eyes, were part of his sensory over responsiveness pattern. He engaged in these
behaviours when there was increased sensory stimulation around him (e.g. external
noise, people standing close to him, people moving around him) and was therefore
using these behaviours to block out such stimulation and to calm himself.

Behaviour Possible causes

 Seeking tactile input

 Onset of puberty
Playing with penis Seeking increased stimulation during unstructured

times
 Using behaviour as a way to avoid sensory input
 Easter College
SPED DEPARTMENT
Easter Road, Guisad, Baguio City

MODULE 2- Case Study

SY 2020-2021

 Seeking tactile input

 Seeking increased stimulation during unstructured
Poking bottom
times
 Using behaviour as a way to avoid sensory input

 Seeking tactile input

 Seeking smell input
Smearing faeces
 Using behaviour as a means to get a shower/water
play

 Tactile sensitivity
Refusing hair cut
 Fear of change/does not want hair to look different

 Tactile sensitivity
Refusing dental check
 Lack of understanding of what is happening

 Seeking auditory input (to block out background noise)

Humming
 Seeking tactile (vibrating input) to calm himself

Pacing  Seeking movement input (to calm himself)

 Seeking visual input (to block out unpredictable visual

Flapping hands in front
input around him)
of eyes
 Predictable repetitive pattern which is calming for him

 Seeking tactile input

Turning on taps/water
 Seeking increased stimulation during unstructured
play
times

Minimal response to  Underresponsive to verbal interactions

others  Limited understanding of verbal language

Intervention strategies
1. Tactile Activities
 Easter College
SPED DEPARTMENT
Easter Road, Guisad, Baguio City

MODULE 2- Case Study

SY 2020-2021

A programme of tactile activities was introduced to AB’s daily routine and these were
incorporated in his visual schedule. He engaged in at least 3 tactile activities each day
for up to 15 minutes each time (sometimes longer, depending on the activity). The
range of tactile activities included:

o Water play
o Sand play
o Finger painting
o Gardening
o Dough
o Finding objects in tactile boxes (boxes filled with uncooked rice, lentils and pasta)

This programme of activities met AB’s need for tactile input and subsequently reduced
sensory seeking behaviours, such as playing with penis and poking bottom.

Tactile choices were made available to him during Choice Time and play times. This
ensured he was appropriately stimulated at these times and therefore reduced his
sensory seeking behaviours.

2. Redirection to sensory alternative

At times, AB still touched his private parts and smeared faeces. Although the
programme of tactile activities had reduced these behaviours, additional strategies were
required. When he engaged in these behaviours, he was shown the ‘Stop’ symbol and
then redirected to either water play or dough. This provided him with a sensory
alternative for the tactile input he was seeking.

3. Calm breaks

Calm breaks were provided during activities which AB found challenging (e.g. Music,
Assembly, trips to shops and other noisy environments). He was scheduled for breaks
in these activities, ensuring that he did not become overwhelmed by sensory input. Staff
and parents also monitored signs of stress (e.g. hand flapping, humming, pacing) and
directed him for a calm break when these behaviours were observed. This then reduced
the more extreme challenging behaviours. It was important to provide the calm breaks
before he became totally overwhelmed by the environment.

Calm breaks involved transitioning AB to a quiet area using a photograph of this quiet
area. He was given a range of tactile objects which he found calming (koosh ball, stress
ball, gel toys).

4. Hair cutting
 Easter College
SPED DEPARTMENT
Easter Road, Guisad, Baguio City

MODULE 2- Case Study

SY 2020-2021

Several strategies were used to desensitise AB to hair cutting:

o Head massage: AB was given a head massage using firm pressure for a few minutes
before the hair cut.
o Deep pressure input: A weighted lap cushion was placed across AB’s lap to assist in
keeping him calm during the hair cut.
o Distractors: AB was given familiar structured activities (matching and sorting) to keep
him distracted while his hair was cut. These activities incorporated tactile materials
which was also calming for him.
o Desensitisation: AB’s mother cut his hair at home. His hair was cut once a week which
allowed him to become more used to the input, rather than waiting several weeks
between hair cuts. The length of time spent cutting his hair was gradually increased
each week as his tolerance improved. On week 1, the hair cut only lasted 30 seconds
and then the length of time was extended by 30 seconds each week until he was able to
tolerate a 3 minute hair cut. It was then possible to reduce the hair cuts to every other
week and eventually monthly.
o Dentist: A visual system was used to show AB how many times the dentist would look
in his mouth. This system consisted of 3 photographs of a dentist examining a person’s
mouth. This showed AB that he would have to open his mouth 3 times for the dentist
and then he would receive a reward (water play). This was immediately effective and
AB gradually became more used to the dentist examining his mouth.
5. Visual communication system

Visual communication strategies were introduced to facilitate AB’s understanding of

instructions. These strategies included:

o Individual visual schedule (using photographs).

o Transition cards to direct AB to check his schedule and transition to the next activity.
o Choice boards using photographs of activities available to AB.
o Choice boards at Break and lunch using photographs of food choices.
o Structured activities to clarify to AB what he was expected to do in different activities.

The intervention strategies used with this child/young person were introduced after
comprehensive assessment. These strategies were individualised to his/her specific
needs and will not be appropriate for every child/young person.

Reference:

https://sensory-processing.middletownautism.com/casestudies/case-study-2/
 Easter College
SPED DEPARTMENT
Easter Road, Guisad, Baguio City

MODULE 2- Case Study

SY 2020-2021

https://sensory-processing.middletownautism.com/casestudies/case-study-1/