Associate’s Name:
Tim Engels, MA, Sports Psychology

Associate’s Discipline:
Sports Psychology

Name of Organization:
Engels & Jones, Inc.

Comment by Ron Minson, MD, iLs Clinical Director

There is a great deal we can learn from this unique case presentation. To begin, the first two paragraphs in the history point to frontal lobe deficiency with a concurrent loss of inhibition resulting in a lack of impulse control, emotional regulation and poor decision making – highlighting a few of the consequences of low frontal lobe activation. In fact, the therapeutic goals as outlined are also clearly frontal lobe functions.

While the low IQ score of this case is outside the typical profile of iLs clients, keep in mind it should be taken with a grain of salt: it may or may not be accurate. Nevertheless, a perceived low IQ score should never discourage or prejudice us against what can be accomplished. The importance of parental/spousal support and the dedication of a skilled therapist are quite evident. As iLs was improving the function of the frontal lobes, the patient was then able to integrate the behavioral and emotional support from his environment.

Presenting Problem:
R is a 31 year-old male, diagnosed as developmentally disabled and with Asperger’s Syndrome. On the WAIS-III, his verbal IQ was 61, performance IQ was 62, and Full Scale IQ was 58.

Therapeutic Goals:
Goals included emotional regulation, better decision-making in most daily life situations, and more mature interpersonal interactions.

Background:
R’s mom approached me about working with him when he was 28 years old and had, in the past week, broken his cell phone, a window, and punched a hole in the wall during temper tantrums that he called “tornadoes” in his head.  Financially, he would immediately spend any money he had and use a credit card indiscriminately, so his parents had to closely manage his money.

He had significant problems with frustration, reacted very strongly to criticism, and was impulsive, quick-tempered, and obsessive.  Even minor changes to his schedule caused temper flare-ups.

R was employed in his parents’ business, but needed very close supervision.  He had failed to hold down any other job for more than a few months.  His emotional outbursts would get him fired.

R had a strong fear of rejection and difficulty trusting others.  He was living with his girlfriend.  They had credit card debt, spent their money impulsively and unwisely, and needed lots of supervision caring for their one bedroom condominium.  The friends they had were regularly taking advantage of them.

R was incapable of living on his own without significant supervision by his parents.

iLs Program Used:
R has been using the Total Focus Program for four years.  The family rented a system from me for several weeks, and quickly noticed so much improvement in emotional regulation that they purchased a system.  He repeated the Sensory Motor Program three times in the first 18 months, then moved on to the Concentration and Attention Program, Reading and Auditory Processing Program, and recently, Optimal Performance I.

He’s now using the Integrated Language Program.  R is using the iLs Interactive Language Program to improve his voice tone, volume and modulation after his dad mentioned that he sounded angry frequently and “yelled.”   After renting a system for a few weeks, R’s parents noticed a significant improvement in R’s vocal quality, and a more relaxed presence.  He has begun reading into the microphone (previously he wouldn’t read at all because it was too hard and embarrassing).  R is much more comfortable speaking in public, and is looking forward to working with clients of his dad’s business one on one and unsupervised.  They recently purchased their own iLs Interactive Language Program.

Summary of Changes:
Emotional Regulation: R’s emotional outbursts resulted in three broken cell phones the year he began therapy.  He would fight with his father daily, had temper tantrums on a regular basis, and his anxiety was evident in his tone of voice, which was loud and edgy.  He now works well with his father and accepts direction from him.   R handles changes in his life now with flexibility and accommodation, and his voice is quieter, more tempered and relaxed.  He has had the same cell phone for four years.

Organization and Independence: Before the therapy, R’s parents had to closely supervise his apartment cleaning and upkeep.  He was only allowed to have $20 at a time and a credit card was not allowed because of his impulsive spending.  Now, R and his wife take care of all shopping, cooking and cleaning.  He manages his own finances and can be trusted to use the credit card only for emergencies.

Conclusions and Recommendations:
The regular use of Total Focus Programs in conjunction with regular psychotherapy and ongoing support from his parents has helped R reach his therapeutic goals of emotional regulation, better decision-making in most daily life situations, and more mature interpersonal interactions.

His parents are feeling much less worried about his long-term prognosis and how much he’ll need their assistance.  His progress has significantly reduced their care-taking responsibilities.  R has an amazing ability to set challenging life goals and persevere in the face of others’ doubts.

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