iLs Associate:
Becky Payne, MEd, CCC-SLP Speech Language Pathologist

Background:
“H” is an 11-year-old female diagnosed with ADD, Dyslexia, visual processing issues, mild expressive language delay and sensory processing issues. She was 10 years 10 months when she started iLs. H has been in speech therapy since she was 18 months old for language and articulation difficulties.

Presenting Problems:

  • Reading: At age 10, H was reading and spelling at a second grade eight-month level. She was in part-day pull-out special education for reading and spelling.
  • Handwriting: H has very poor handwriting skills. Her teacher requested an OT evaluation for her handwriting. The evaluation was postponed by the school; in the meantime, her mom consulted with an OT and purchased pencil grips and raised line paper.
  • Body Awareness: H has low awareness of where her body is in space and has poor organization. Her work on her desk top overflows to the next child’s desk without her awareness.
  • Personal Awareness: She always looks disheveled, with pockets out, zippers unzipped, clothing on backwards or twisted and un-brushed hair. She is unaware that kids make fun of her.
  • Sensory: She is an oral seeker, and constantly has a very small non-edible item in her mouth. She chews small holes in the neck or the wrist of her shirts.
  • Coordination: At home, H is clumsy, almost every night at the dinner table she knocks over something. She makes a humming-like noise when she eats. She easily trips or will accidentally step on toes as she approaches a person to talk to them.
  • Impulsivity: H is impulsive, resulting in spills and breaks as well as frequent interruptions while others are speaking.

Therapeutic Goals

  • Increase body awareness and proprioceptive ability
  • Increase visual processing abilities
  • Improve handwriting – both size and legibility – with or without writing aids
  • Reduce oral seeking behavior (esp. non-edible items)
  • Increase reading and spelling to age level

iLs Program:
The Sensory Motor Program on the iLs Total Focus system at home two-four times a week, including Playbook activities (balance, visual tracking, proprioceptive). The remainder of the session she would do “crafts” such as needle work, crochet, knitting and coloring or participate in golf drills set up by her father. The 60 sessions began in September and were completed February. Each 60-min session took place in her home.

Other Interventions:
H received speech therapy during this time at school and used pencil grips. Screen time was monitored to less than two hours daily and overall sugar intake was reduced in the beginning of the program, but the family reported they became a little lax toward the end.

Summary of Changes:

  • Handwriting: The most obvious improvements made by H were her handwriting and reading. Her handwriting size decreased significantly as well as spacing, neatness and letter reversals (see handwriting samples below). The school informed H’s mother that her handwriting was so improved she would no longer qualify for an OT evaluation. The school accredited H’s success to the “response to intervention” and “whatever you are doing at home.”
  • Reading: At Parent-Teacher conferences, H’s teacher reported she is currently reading at a fourth-year first-month level and spelling at her grade level with a reduced list size. H’s teacher moved her from special ed reading to the regular education classroom. She actually enjoys reading now.
  • Personal Development: After 30 iLs sessions, H began coming home from school upset. When questioned why, she would talk about other kids hurting her feelings. This was the first time that H showed awareness of other children in her class talking about her. Before this, she had lived in her happy bubble with no idea what went on outside. H also began to question things and argue with her parents at this point in time.
  • Coordination: Her parents report she is showing improved motor function, e.g. fewer spills and falls, and increased social and personal awareness. H now takes more care in her appearance, and shows more organization in her day-to-day activities. Although she continues to seek oral stimulation, she became more aware of appropriate vs. inappropriate items to chew. Gum is made available to her when she is not in school. Athletically she continues to show more and more progress with golf. Her family is thrilled with the academic, personal and athletic changes she has shown as a result of the iLs program.

Conclusions and Recommendations:
It is recommended that H continue with 40 sessions of the iLs Concentration & Attention Program in the Summer. Hopefully, she will be able to continue speech therapy simultaneously.

iLs Case Study: ADD, Dyslexia and Sensory Processing

Handwriting Samples at Session 1 and Session 20 of iLs

Comments from Ron Minson, MD, iLs Clinical Director:

iLs Case Study: ADD, Dyslexia and Sensory Processing

Handwriting Sample at Session 40 of iLs

The marked improvements in handwriting, reading and social awareness support the argument that higher cognitive processing depends upon an organized subcortical system. Her clumsiness, disorganization, lack of personal and spatial awareness and poor sports skills all point to a lack of organization at the body (subcortical) level. This deficit results in her having to use all her higher level thinking and processing skills just to manage her body with nothing left over for the cognitive demands made upon her (reading, writing, personal awareness and social interaction).

The iLs Sensory Motor Program combined with the Playbook activities helped bring about a rapid improvement in gross motor organization and improved body and spatial awareness. Handwriting, a fine motor function, depends greatly upon good gross motor organization. Once this was established (as evidenced by fewer spills, less clumsiness and better sports performance), her handwriting improved rapidly. Further, her personal awareness and social skills improved as her body and spatial awareness improved. Her higher cognitive functions are now supported by good subcortical organization, the foundation for higher learning and performance.

iLs Case Study: ADD, Dyslexia and Sensory Processing

Handwriting Sample at Session 60 of iLs

Thus freed up, she is developing an independent sense of “self” that can interact with the environment instead of just being acted upon by the environment. She questions her parents and asks questions in ways that she did not before. Albeit painful, she has better awareness of what others say and how they act toward her. And, finally, as a child’s sports, social skills and academic performance improve, so does their self-esteem and self-confidence as we see with this lovely young girl.  Addendum: I would strongly urge the inclusion of the iLs Interactive Language Program (ILP) along with the speech therapy at this point.

 

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