Case Study: Asperger’s Syndrome, 17 year old male

iLs Associate:
Jodi Tucker, RDI ® Program Certified Consultant, Intensive Developmental Program Consultant

Organization:
Kids Matter Inc., British Columbia, Canada

Client:
“E” is a 17-year-old male

Background:
E is the oldest of three children living with his biological parents. Both parents speak Spanish and English with their children in the home. E is fluent is both languages. E is diagnosed with Asperger’s Syndrome and had undergone various CBT (Cognitive Behavioral Programs) and social skills consultation as a young child. E was moved to a homeschool environment in his elementary years due to very negative experiences in the school environment. E’s family chose to participate in a program called RDI ® (Relationship Development Intervention) and had been engaged in that program for over two years when the iLs program was started. E also received weekly appointments with an occupational therapist to address sensory needs prior to beginning the program.

Presenting Problem:
E presented as a high functioning, highly verbal young man. He has the capacity to be very pleasant and engaging with new people but would often become oppositional at home with his parents and hypersensitive to the behaviors of his siblings. This caused high tension in the home and emotional upset for all family members. E preferred to be in his room on his computer and required a high level of prompting and structuring to his day to engage in other activities in the home. E attends a local church function for youth every week and has a friendship with a few of the peers there; however, time spent with friends was limited to online or the group structure rather than seeking mutual engagement independently. Over time, the frequency and intensity of family discord was lessened by the RDI Program. However, E was still not able to identify strategies that would work for him to better manage his frustration tolerance and had a high level of externalization for problems and situations. E was identified as significantly at risk for mental health issues due to his high level of intelligence but low level of overall functioning. E had expressed to his parents that he wished to get a job and that he often felt bad about himself.

Therapeutic Goals:
E’s goals were to address the above findings in his developmental profile.

• Academic – processing, organization, problem solving, write clearly
• Personal – adaptable, self- regulation, coordination, balance, nail biting, GI issues, sensory struggles
• Social – interrupting people in conversations, focusing only on what interests him, anxiety and sensory over-stimulation in community environments (lights, sound, smells and textures)

Mom and dad expressed their desire that E feel less stress about sensory stimulation and be more aware of others’ feelings and interests.

iLs Program Used:
40 one-hour-sessions of the Sensory Motor Program, no less than three days a week. Sessions were conducted in the family home by a supervised technician who had been trained in the Guided Participation methods of the RDI Program, and occupational therapy appointments were discontinued.

E presented with strong resistance at the beginning of the program. He would frequently talk for the duration of the session in the initial few days. RDI Program strategies were used to increase engagement. Although E continued to talk/argue he responded to redirection and engagement increased.

Other adjustments to the iLs program included lowering the bone conduction volume (iLs equipment delivers music via both air and bone conduction) in response to E’s vestibular sensitivity. Additionally, around the 20th session, E also expressed that he felt awkward around his friends and that he wanted to stop. Using RDI Program strategies E and his technician discussed how positive changes were taking place and though he might “feel weird” for a while, it was ok and the feeling would pass.

Other Interventions Used:
E and his parents continued to receive ongoing RDI Program consultation for the duration of the iLs program. No other therapies were used.

Summary of Changes:

BASC-2 – the BASC–2 is a standardized behavioral assessment
Pre and Post-Program Comparison Charts Percentile Rankings

Composite Score Summary Percentile Ranking Comparison

Conclusions and Recommendations:
The findings indicate a dramatic improvement in problem areas. All areas of concern dropped out of the clinically significant/at-risk range with the exception of somatization. In all other areas Post-Program scores indicate E is within range of his same age/gender peers. The results also show a dramatic improvement in adaptability, social skills, leadership, activities of daily living, functional communication and adaptive skills. There remain on-going programming needs; however, the frequency and intensity of problems associated with low skills in these areas has been significantly lessened. E’s parents report that previous issues around helping with chores, expressing frustration effectively and demonstrating sensitive insight towards family members have been some of the most enjoyable changes they have experienced. E has also been able to successfully apply for and secure two part-time jobs. He went through the application process independently. E was hired in both instances. He was able at a later date to identify the better working environment and made a decision to resign from one of the positions. E handled these situations independently with no parental involvement at the workplace.

Six-Month Check-in with the Family:
“Our son, now 18, started RDI when he was 14 and then iLs when he was 17. Both experiences have been life changing for our son and for us as a family. Now, he has become more flexible. He can share his feelings and shows that he cares for others. He can better self-regulate himself and even help us regulate ourselves! One important improvement is to be able to start a new school assignment without frustration. Problem solving has become an easier task. Both RDI and iLs have helped him to switch from the static and frightening world to a more dynamic and enjoyable one. Managing unexpected situations without a meltdown has been one of the major improvements. Engaging in different conversations without bringing his favorite subject up is a great accomplishment. He has also become more independent. He can get ready and plan his day including taking the bus to go to the library and mall and even get a job without our intervention. Now, his future looks brighter and full of hope.” – E’s Parents

It is recommended that E and his family continue to engage the RDI Program as their foundation for engagement and learning with E. It has been suggested that ongoing iLs programming be considered to further advance specific issues as they arise.

Comments by Ron Minson, MD, iLs Clinical Director:
There are two factors that have contributed greatly to E’s progress with the addition of iLs to his ongoing RDI Program. One is the marked reduction in anxiety and the other is the improvement in communication and social engagement. Those familiar with Dr. Stephen Porges’ Polyvagal Theory will recognize immediately that these improvements are exactly what his research supports as due to the activation of the anterior vagal system. And iLs has direct input into this important anatomical and physiological system for emotional regulation and communication.

With the lessening of anxiety, E was liberated from the constricting chains of ongoing anxiety, with all its reactive behaviors, to be more available to the therapist and to fully participate in his RDI program. Feeling more relaxed, he was able to see options and opportunities for self-improvement. He then drew upon support from the frontal lobes for the initiative and desire to pursue them. Combining the auditory program with the movement activities sends input to the pre-frontal lobes, fostering their maturation and function for the motivation, planning, organization and initiation of action that may have helped E to seek out and obtain a job on his own.

The documented improvement in this young man with Asperger’s Syndrome is much appreciated as there are many who hold that these improvements are unlikely, if not impossible, with this population and at the relative late age of 17. Hopefully, others will be encouraged to add iLs to their practice to improve communication and social engagement where these skills may be sorely lacking.