Case Study: ADHD and Dyslexia

Associate’s Name & Discipline:
Emily Robins, MSOT, OTR/L

Name Of Organization:
St. Luke’s Witwer Children’s Therapy

Identification:
9 year-old female

Presenting Problems:

• Diagnoses of ADHD and dyslexia
• Sleep difficulties (3-5 hours per night)
• Difficulty with handwriting, fine motor/gross motor skills, and visual motor integration
• Difficulty with sensory processing and with transitions and/or changes in day-to-day life
• Other challenges include: core strength, visual efficiency, auditory processing skills, poor integration of respiration with functional tasks

Background:
Patient is a 9 year-old female with diagnoses of ADHD, dyslexia, and a history of torticollis. She was born 35 weeks gestation and spent 4 weeks in the NICU. The patient received prior outpatient occupational, physical and speech therapies beginning at 6 months of age. She has a history of difficulty sleeping since birth, typically sleeping only 3-5 hours per night. After waking up early in the morning, she is unable to return to sleep.

Therapeutic Goals:

1.      Improve sensory modulation, including sleep.

2.      Increase independence with self-care skills (shoe tying, fasteners, bathing, toileting)

3.      Improve bilateral coordination and balance in order to ride a bike independently.

4.      Improve visual motor and fine motor coordination for increased handwriting legibility.

iLs Program Used:
The iLs Pillow was loaned to the client for use at home to help her with sleep and anxiety. She used the iLs Pillow 7 nights in a row and then returned it to the clinic. An in-clinic iLs Sensory Motor Program (with bone conduction) was then begun and used simultaneously during occupational therapy (OT) sessions.

Other Interventions used:
Patient participated in outpatient OT 2-3 times per week for 60 minutes. Treatment sessions focused on improving bilateral coordination/motor planning, visual/vestibular/auditory neurological triad integration, core strength, upper extremity strength/stability, reflex integration, self-care skills and fine motor coordination. Simultaneous to OT sessions, she used iLs’ Sensory Motor program.

Summary of Changes:
Previous to using the iLs Pillow, the patient slept only 3-5 hours per night and typically was unable to go back to sleep. While using the iLs Pillow, she slept uninterrupted 8-9 hours a night for 5 nights, for the first time in her life. After 7 days, the family returned the Pillow. Immediately following, the patient began sleeping only 5-6 hours per night for 2-3 nights and then returned to her previous 3-5 hours per night.

The patient also reported feeling “not tired” during the time she was using the Pillow. The patient’s mother reported her daughter “was more tolerant of things going on around her” and “more alert…on top of it to answer questions.” The patient’s parents reluctantly returned the Pillow at the end of the 7-day loan period and requested information on purchasing one for long term use.

After acquiring an iLs Pillow to use permanently at home, this 9 year-old girl is again sleeping 8-10 hours/night. Her mother reports, “Her color is a lot better, doesn’t have that zombie look to her anymore. She seems to have more energy and is more accepting to every day ups and downs. She has been waking up and saying to me that she isn’t tried at all.”

Dr. Minson Comments:

This history of a 9 year-old girl with insomnia clearly demonstrates that improvement in her sleep pattern was by virtue of the iLs Pillow. Before the pillow she had sleep duration of only 3-5 hours. During use of the iLs pillow, she gratefully slept 8-9 hours uninterrupted, awakening feeling refreshed and “not tired”. Upon returning the pillow, she relapsed to her previous level of insomnia. This withdrawal effect proves categorically that the intervention was the determining factor for the improved sleep and it was not from other factors.

Disturbed sleep in children is on the rise in this country. We well know how disruptive loss of sleep can be for creating a myriad of emotional and behavioral problems, not only in children but also in adults. Irritability, short tempered behaviors and depressed moods are common with poor sleep. iLs is conducting multiple sleep studies with the iLs Pillow (ADHD, ASD and insomnia) over the coming 6 months to measure effects in a controlled manner. We are hopeful that there appears to be a simple and effective solution for mitigating the painful consequences that arise from lack of sleep.