Associate’s Name & Discipline:
Lynn Schoeneck , OTR/L

Name of Organization:
Porter Academy

Presenting Problem:
Inattention, hyperactivity, aggression, poor peer interactions, auditory processing difficulties, making disruptive sounds or screaming during class

Background:  
Male, age 7 years, 8 months (pre-test Jan 2010); 9 years, 0 months (post-test May 2011)
Diagnosed with Asperger’s, ADHD, Anxiety during transitions

Therapeutic Goals:
Improve auditory processing, improve attention, decrease hyperactivity and aggression, improve self-regulation, improve bilateral coordination and balance

iLs Program Used:
Spring 2010: Sensory Motor – 50 hours of Sensory Motor Program
Fall 2010 and Spring 2011 – 60 hours of Sensory Motor Program

Other Interventions used:
Received occupational and speech therapy within a group setting as part of the curriculum at Porter Academy.

Conclusions and Recommendations:
The improvements that made the biggest difference for this boy were in auditory processing, attention, and self-regulation.  His auditory processing improved from “disordered” to “normal” in every category and overall auditory processing composite improved from 0.1% to 81%.  While he was previously unable to sit for 15 minutes straight and attend to an academic task, he now has no trouble attending to task, even during independent centers.

His improved ability to self-regulate has also had a great impact on his functioning.  He used to be aggressive (punching/throwing pillows, screaming in people’s faces); this has completely stopped.  He can still get overly excited at times, but his ability to bring himself back to a “just right level” has improved dramatically (he can do this on his own and in a timely manner).  His overall academic and social functioning has made an impressive turn, and he is a much happier child.

COMMENTARY BY RON MINSON, MD, iLs Clinical Advisor and Advanced Trainer:

This very interesting case illustrates a number of features worth noting. As he gained control of his externalizing behaviors – aggression, hyperactivity and conduct- his anxiety may have temporarily increased.  It isn’t clear since the original teacher rated him as having more anxiety but a new teacher after the summer break rated this as typical. Nevertheless, let’s assume he is more anxious. How can we account for this? His increase in self-control has to come from increased self-awareness in order to alter the behavior through increased self-control.

With this increased self-awareness comes a sense of insecurity which I like to call “stage fright.” With all the changes, he might be feeling, “I don’t know how to act.” He is in a new body, so to speak, uncertain how to act if not doing the old acting out behaviors. Yet, in spite of this anxiety, he has shown an increase in leadership, thus, increased responsibility, uncertainty and anxiety.  The increase in somatization, although scoring typical (the scores are at the extremes of typical), is understandable given his increase in self-awareness. Before, I doubt if he had much awareness of himself; his behaviors suggest he impulsively expressed whatever he felt toward the world. Hopefully, with time and more listening he will continue to improve his social skills, gain confidence and reduce his anxiety. I think the higher frequencies from the next program will help in this regard.

Summary of Changes: (tests, observations, feedback, etc.)

Auditory Processing as measured by the SCAN 3: C – January 2010 and August 2011

Summary: Improved in every category of the SCAN-3:C diagnostic tests from disordered to normal. Auditory Processing Composite improved from 0.1% to 81% over a time span of 1 ½ years.

Raw score Scaled score Percentile Descriptive Category
Auditory Figure Ground +8 – January 2010

0

1

0.1%

Disordered

Auditory Figure Ground +8 – August 2011

40

14

91%

Normal

Filtered Words  – January 2010

14

5

5

Borderline

Filtered Words  – August 2011

29

10

50

Normal

Competing Words – Directed Ear – January 2010

10

1

0.1%

Disordered

Competing Words – Directed Ear – August 2011

43

11

63%

Normal

Competing Sentences – January 2010

24

4

2%

Disordered

Competing Sentences – August 2011

68

12

75%

Normal

Auditory Processing Composite – January 2010

51

0.1%

Disordered

Auditory Processing Composite – August 2011

113

81%

Normal

Gross Motor Skills as measured by the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition

Summary: His motor skills improved by over one standard deviation in the area of bilateral coordination and over two standard deviations in the area of balance.

BOT-2
(scale score: mean = 15, SD=5)
Bilateral Coordination Balance
January 2010 10 7
May 2011 16 19

Behavior Assessment System for Children, 2nd edition (BASC-2: parent rating scale)

Summary

  • Externalizing Problems: In January, he ranked as having more problems than 75% of the population (at risk) in the category of externalizing problems (hyperactivity, aggression, conduct problems).  By May 2011, the same teacher ranked him has having more problems than 52% of the population (typical).
  • Internalizing Problems: While his depression ranking improved, his anxiety and somatization got worse over this time period.  From talking with his teacher, this may be associated with increased social interaction (and the stresses involved with managing friendships) and a more difficult work load.  His 2011-2012 teacher ranked his anxiety back down to 52% (“typical”).
  • Behavioral Symptoms Index: Overall improvement in this area went from having more difficulties than 86% of the population (at risk) to having more difficulties than 66% of the population (typical).  This section includes ratings on atypical behavior (86% to 65%), withdrawal (95% to 91%), and attention problems (80% to 58%).
  • Adaptive Skills: Overall improvement from 23% to 30% (higher scores better on this section).  The specific areas in which he displayed the most improvement include leadership and functional communication.
Externalizing Problems: Teacher Rating
higher scores indicate more problems
T score Percentile Rank Descriptive Classification
Externalizing Problems composite – January 2010

55

75%

At Risk

Externalizing Problems composite – May 2011

48

52%

Typical

Hyperactivity – January 2010

65

91%

At Risk

Hyperactivity – May 2011

52

69%

Typical

Aggression – January 2010

50

64%

Typical

Aggression- May 2011

46

45%

Typical

Conduct
Problems – January 2010

49

55%

Typical

Conduct
Problems – May 2011

47

51%

Typical

 

Internalizing Problems: Teacher Rating
higher scores indicate more problems
T score Percentile Rank Descriptive Classification
Internalizing Problems composite – January 2010

49

51%

Typical

Internalizing Problems composite– May 2011

61

88%

At Risk

Anxiety– January 2010

58

81

Typical

Anxiety – May 2011

82

99%

Clinically Significant

Anxiety – October 2011 (different teacher rater)*

48

52%

Typical

Depression– January 2010

47

51%

Typical

Depression – May 2011

45

38%

Typical

Somatization– January 2010

42

19%

Typical

Somatization – May 2011

50

66%

Typical

* I compared January 2010 to May 2011 so the ratings were completed by the same teacher.  However, looking at the Fall 2011 ratings, his anxiety was rated much lower.

Behavioral Symptoms Index: Teacher Rating
higher scores indicate more problems
T score Percentile Rank Descriptive Classification
Behavioral Symptoms Index composite– January 2010

61

86%

At Risk

Behavioral Symptoms Index composite – May 2011

52

66%

Typical

Atypicality– January 2010

59

86%

At Risk

Atypicality – May 2011

50

65%

Typical

Withdrawal – January 2010

69

95%

At Risk

Withdrawal – May 2011

66

91%

At Risk

Attention Problems – January 2010

60

80%

At Risk

Attention Problems – May 2011

51

58%

Typical

 

Adaptive Skills: Teacher Rating
lower scores indicate more problems
T score Percentile Rank Descriptive Classification
Adaptive Skills – January 2010

43

23%

Typical

Adaptive Skills – May 2011

45

30%

Typical

 

 

 

 

Adaptability – January 2010

51

50%

Typical

Adaptability – May 2011

45

30%

Typical

Social Skills – January 2010

51

53%

Typical

Social Skills – May 2011

47

40%

Typical

Leadership – January 2010

38

12%

At Risk

Leadership – May 2011

44

31%

Typical

Study Skills – January 2010

44

29%

Typical

Study Skills – May 2011

42

23%

Typical

Functional Communication – January 2010

34

8%

At Risk

Functional Communication – May 2011

46

30%

Typical

The BASC-2 teacher rating scales provided additional information about improvements in attention, leadership, and functional communication.  When asked in person how this child has changed since January 2010, the teachers reported that he can now work independently, he now has healthy peer relationships, his ability to maintain a calm alert state has improved dramatically (from less than fifteen minute stretches to up to an hour), and, when his arousal level does escalate, his recovery time has decreased dramatically.

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