Case Studies
Eleanor
Eleanor was four years old when I first met her. She was an only child of a single mother who was very devoted to her. Her mother said although Eleanor did not have an official diagnosis, and the pediatrician was unconcerned about her having a delay in development, she felt Eleanor was very behind. She described her child as having extreme auditory and tactile hypersensitivity. She hated loud noises and crowds, preferring to hide when it got too loud. She preferred to be naked and always took off her socks, shoes and pants whenever she could. Eleanor’s mother said she herself has had issues with auditory and tactile hypersensitivity, and she remembered her brother, Eleanor’s maternal uncle, having the same issues growing up.
Eleanor’s mother said she hadn’t put her daughter in prekindergarten because Eleanor didn’t like being around other children, she parallel played at best and got distressed in most social situations. Mother said Eleanor was more comfortable being around adults.
Her mother described Eleanor as being both awkward and poorly coordinated. She was fearful of being touched and cried when the car went over large dips and bumps in the road. Although Eleanor was able to talk, her mother said most of the time she seemed to not understand what other people were saying to her. Mother admitted she feared her daughter was autistic.
Despite trying to make Eleanor feel comfortable in my office she limited her engagement and participation. Her eye contact was poor and her eyes appeared to be darting all around the room and having a hard time focusing on any one thing. I was unable to touch her to get in the correct position for many of the evaluation tasks. She preferred to participate in the tasks she could do without help. I was able to test her dominance with some little games I use and although she had some difficulty following the instructions, after visual demonstration she was more successful. She was observed to have right hand and foot dominance, no eye dominance and preferred to listen with the left ear. She was noted to have poor awareness of the right side of her world and appeared to attend to things more on her left during the evaluation. She had a gross pencil grasp, gripping it very tightly and breaking several leads because she applied too much pressure on the paper. She was also noted to lack independent finger function, because she could not touch the tip of each finger to her thumb and she used raking type movements with all her fingers when manipulating small objects. Her body awareness was noted to be poor and she had difficulty staying focused on the tasks throughout our session requiring a lot of support to bring her back to complete the task. Her movement was stiff and used too much energy. Although I was unable to touch her to fully evaluate her muscle tone, she moved liked she had too much muscle tone.
In the early days of treatment proprioceptive (applying external, controlled pressure) and simple linear vestibular activities (back and forth/side to side movements) were used to gain a more regulated state and allow more touching and positioning. Therapeutic listening CD’s were played in the background and Eleanor was encouraged to play word and singing games during all motor activities. Eventually Eleanor became more comfortable with movement and touch. She was soon able to tolerate rotary vestibular activities (movement involving rotation) and “bumpy” input. She starting following directions more easily, was more motivated to participate in all aspects of the session and more actively engaged with other people.
Eleanor graduated to using a therapeutic listening program with headphones once she could tolerate the tactile input. Initially she used The Listening Program (TLP) innovated by Advanced Brain Technologies and her progress kicked into high gear. I have used TLP with many children with excellent results, but many families cannot afford the high price tag of the device and so listening was limited to our once weekly sessions.
With the help of a friend who just happened to be a musician, sound engineer and composer I was able to bring the In-Tuned™ sound project to the children and allow them to listen to therapeutic sound with more frequency and duration at low cost. Eleanor was one of the children who participated in the infancy stages of the sound project using low frequency sound at 24 Hz.
I met with Eleanor for formal evaluation three months after our first visit. Her mother said her daughter had been transformed. Eleanor no longer had any auditory or tactile hypersensitivity to speak of, and her socialization had improved so much she started attending a prekindergarten class. Her mother said her eyes did not jump around and she was more focused with activities. Eleanor now played cooperatively with other children. She also said she never cried anymore when going over bumps in the car and that Eleanor was getting to be more coordinated with her movement. Her mother said Eleanor would ask to do the listening, and noticed Eleanor was more focused, calm and more bodily organized when she listened regularly.
Eleanor participated in 100% of the evaluation tasks during the second formal evaluation. She let me touch and position her. She demonstrated visual attention and was focused throughout our session. She maintained good eye contact and did not need any support to complete tasks. Although she still had an immature gross grasp of the pencil she was able to gauge pressure more effectively and demonstrated independent use of her fingers during fine motor activities. Her body awareness significantly improved and she did not show any neglect to what was happening on her right side like she had three months earlier. Her dominance was tested again and she was fully right side dominant with right hand, leg, eye and ear preference. I was able to test for retained reflexes and she demonstrated a positive asymmetrical tonic neck reflex (ATNR), which may have contributed to having an increase in muscle tone. She also was able to follow all of the directions without the need for me to give her a visual demonstration for everything.
Eleanor had made significant improvement in the basics she needed to refine her skills. She was more aware, regulated and body confident. She was more social and more able to follow along with what was happening around her. She was also less hypersensitive so her willingness to engage improved exponentially.
Eleanor still had some postural and motor control issues after the first three months. She had difficulty with reciprocal and synchronized movements of the arms and legs, as well as difficulty converging with her eyes on objects, but she was well on her way to having all the skills of an average four year old. Eleanor was a happier child and her mother was happier as well.