All names, ages, and identifying details in this case study have been changed or composited from multiple cases. This content is for educational purposes only. It does not constitute clinical advice and does not establish a clinical relationship.
Background
When a five-year-old boy I'll call Rohan came to our centre, he brought with him wonderful strengths: age-appropriate attention skills, strong visual-perceptual abilities, and a clear interest in sensory play, especially with play dough and gym balls. However, he faced significant barriers in communication. Because his sign manding (requesting) was still emerging, he often communicated his needs—whether seeking connection or needing a break from tasks—through physical responses like shouting, grabbing hands, and table banging.
Goals
Rather than focusing on compliance or merely trying to "stop" the behaviors, my goal was to empower Rohan with a voice. Our primary objectives were to:
- Develop functional communication, specifically teaching him to use signs to request preferred items.
- Support his nervous system by recognizing when he needed a break (escape) or connection (attention).
- Foster early play skills and social reciprocity in a compassionate, neurodiversity-affirming way.
Approach
Through a Functional Behavior Assessment (FBA), we observed that Rohan's behaviors were not "non-compliant"—they were clear communication. He was either seeking attention or trying to escape a demand. We implemented an assent-based intervention centered on Functional Communication Training. We taught him sign manding for highly motivating items like chips, toy cars, and physical play. When he showed signs of distress, we focused on co-regulation, avoiding forced eye contact and instead honoring his communication.
Data Snapshot
| Target Behavior | Baseline Frequency | Recent Frequency | Context / Function | | :--- | :--- | :--- | :--- | | Crying / Tantrums | 6 total incidents | 0 incidents | Replaced by better regulation | | Sitting on floor | 2 incidents | 0 incidents | Improved engagement | | Nipping / Shouting | Lower frequency | 63 incidents (spiked) | Correlated with a change in trainers | | Sign Manding | Minimal | Increasing | Developing as a primary communication tool |
Outcomes
The progress Rohan made in his initial phase was beautiful. Crying and dropping to the floor entirely disappeared from his sessions. He began exploring toys for sustained periods and engaging with up to five different objects. Most meaningfully, he started making spontaneous eye contact while signing for his needs—a huge milestone in social connection.
However, our data recently showed a spike in physical responses like nipping and table banging. By analyzing the context, we realized this coincided directly with a transition to new therapeutic staff. This was a vital reminder that for a neurodivergent child, a new face isn't just a change in routine—it's a shift in their ecosystem of trust.
Key Takeaway
Behavior is always communication, and trust is the prerequisite for learning. When a child's environment changes, we cannot simply push forward with demands. We must pause, prioritize relationship-building, and co-regulate until the child feels safe enough to learn.