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Case Study:   Attention, Learning & Behavioral Difficulties 

Author:
Patrice Whiting, MA. Ed.,Elementary Learning Support Specialist,
Oakland Christian School, Auburn Hills, MI.

Case:     ‘A’ is a 7-year old girl challenged by attention, learning and behavioral difficulties

Abstract:
The iLs program was implemented in a school setting, in addition to other complementary interventions with the iLs Dreampad used at home as a sleep aid. The subject, a first-grade student, presented with attention, focus, organizational, problem solving and motor skills deficiencies that led to her testing, on average, one grade level below norm.   She also struggled with appropriate social interactions, sleep and bed wetting.  iLs was used from May to December of the same year.

By the end of the program, Student A’s NWEA reading scores had gone from 1 year below Norm  to above Norm, her NWEA Math scores increased from 1 year below Norm to above Norm, and her Lexia Core 5 Reading score increased from one year below grade to grade level.  Her parents report that she has become an avid reader, is able to sleep through the night, and is no longer bed wetting.  Teachers report that she is more alert at school and shows new motivation for tackling school challenges.  Overall, her executive function skills, emotional regulation, organization, and self-confidence have shown significant changes which affect all aspects of her life.

Background & Presenting Problems:
Student A began iLs as a first-grade student who demonstrated attention and focus deficiencies, impulsive behaviors, a lack of self-monitoring skills and short-term memory deficits.  She demonstrated deficiencies in organizational, problem solving and motor skills.  She was testing almost one grade level below norm in many areas including language arts, reading, working memory and math skills.  Despite substantial tutorial support using evidence based interventions (Orton-Gillingham), Student A’s early literacy level fell below the first grade levels.

Socially, Student A has always been a loving and caring child.  She struggled to appropriately express herself and/or interact with her peers, thus causing disagreements or exclusion from social/play activities in the school setting. Student A’s parents disclosed that the child was having emotional worries and upsets at home, was not sleeping well at night, had been bed wetting and often slept with one or both of the parents.

Therapeutic Goals: 

  • Improve the development of the body organization through sensory-motor integration (honing in on balance, coordination, large and fine motor skills).
  • Improve basic focused attention to tasks through attention-concentration integration (developing less distractibility, steps in a process, remaining with the tasks at hand, and eventually develop some problem-solving skills).
  • Develop and improve basic rhyme, alliteration, decoding, and literacy skills more consistent with grade level norms through reading-auditory processing integration.
  • Improve and develop short-term memory deficiencies, build upon body posture, enhance listening skills, and literacy through the Language Program.
  • Improve social interaction with peers through problem solving/role play.
  • Improve sleep habits.

iLs Programs Used
This therapy began in May and continued through December with only one two-week break.  The parents, educational staff, and support specialist agreed this might prove successful with little intermission.  These programs were customized to meet Student A’s needs. 

  • iLs Total Focus – Sensory Motor (1-33) Concentration and Attention, Reading & Auditory Processing Each session was 60 minutes long, three times per week.
  • iLs Interactive Language Program – added once Student A was in the Reading & Auditory Processing Program
  • Dreampad – nightly

 Other Interventions Used:

  • Educational interventions including Orton-Gillingham , Everday Mathematics and one-on-one tutoring
  • Ritalin
  • Role playing and Ballet classes
  • Parents were very collaborative, consistent and supportive with all of the expectations and goals. 

Summary of Changes:
The iLs Symptoms Checklist is used to assess the changes in symptoms ‘before’ and ‘after’ a successfully completed iLs program. A lower score indicates a reduction in symptoms, i.e. improvement.

Bar Graph PIC MONKEY 1

 

Pre-iLs May Post-iLs Dec
NWEA Reading RIT score 158
(1 year below Norm RIT)
180
(4 points above Norm RIT)
NWEA Math RIT score 152
(1 year below Norm RIT)
183
(5 points above Norm RIT)
Lexia Core 5 Reading Level 5
(1 year below grade level)
Level 12
(Mid 2nd grade level)

 

CRI Assessment Pre-iLs
May
Post-iLs
Dec
 Fluency 50% 99%
Retelling 62% 100%
Comprehension 65% 100%
Critical Thinking 48% 100%
Sight Word Lists 55% 90%
CMI Assessment Pre-iLs
May
Post-iLs
Dec
Numeration 60% 85%
Counting 55% 90%
Patterns 60% 100%
Computation/Facts 55% 80%
Problem solving 40% 72%


School staff observations:

  • Student A has become a hard, diligent, worker in second grade. She is becoming a better listener and thus she remembering what needs to be done on each assignment.  She is also quite independent in her efforts, with less and less redirection.”
  • Student A is improving greatly in her decoding of unknown words as well as remembering what she has read.”
  • Student A is becoming a solid second grader this trimester.”
  • “She has grown in her coordination and dexterity. Her skills in physical education and in play at recess are very improved.”
  • “There has been much social growth over the past few months. Student A is playing cooperatively and working out difficult situations in relationships with her peers.”
  • Student A is so much more in tune during our Music and Spanish classes this year! She is so involved and participatory.  I have not had to reel her in yet this trimester.”

Parental observations and comments: 

  • “She is definitely more willing to try something she is not sure of. Her self-esteem has improved since she started iLs therapy. We no longer hear comments of nobody liking or playing with her.  She has had numerous play dates now, she has friends. She is also treating her little sister much better, less jealousy.  She is sleeping more now and using the Dreampad.  No more bed-wetting!”
  • “As far as school goes, there have been changes like night and day. No reprimands, notes, or calls from teachers/staff concerning her behavior or academics.  She is reading more fluently and her vocabulary is increasing to the point that she amazes us at times.”
  • “Daily routines and independence in self-care are gaining, however she does need reminders.”

Conclusions And Recommendations:
Eight months later, Student A (now age 8) has successfully developed her body organization; she is more balanced, coordinated, and can cross her midline with little difficulty.  Her large and small motor skills are fine-tuned a bit and developing close to her age level. Her sensory processing is also more intentional at this time and relaxed.

Once the motor skills and regulation were developed the transition into the focus and attention was smooth.  Student A had to strive to listen and do things in a timed or sequenced manner, but this quickly improved.  Her impulsive movements, verbalizations, and distractibility all faded incredibly quickly.  Student A is more intent on listening to directions geared towards tasks as well as class discussions.  She is less impulsive in her responses as well; she is tending towards listening first before she speaks.  She is more able to understand content and succeed.  She is also gaining self-confidence.

At the present time multi-step processes or tasks are a challenge for Student A.  However, she is determined and gives it her best.  She does not get upset or anxious anymore; she just steps in and tackles the problem or activity.  Her parents have stated that these multiple- step difficulties are mentioned at home, yet their support through these has been positive collaboration.  We are all working with Student A through this.

As seen in the data above Student A has made marvelous strides in decoding, fluency, literacy, comprehension, language, and auditory processing.  We are astonished at her improvements!  Student A begs for books to read each night at home, she is eager to discuss her readings the next day, and she is beginning to write more cognizant responses to her readings.  Her math skills have improved immensely.

The Language Program has built up Student A’s processing, accuracy in reading, more focus and attention in listening, clear and concise fluency, as well as a great sense of humor.  She has loved all of her Language Program sessions thus far.  She begs to have more each week.

Student A has impressed all of us with her social and emotional improvements.  She has more control of her emotions, no tears or upsets at school. Her parents tell us she does have occasional outbursts at home with them.  Student A has many friends now and arranged play dates for Christmas vacation.  She sleeps through the night now; and, therefore, she is more alert at school, ready to tackle whatever is placed before her.  iLs has proven beneficial to Student A’s overall development in executive function skills and processes, as well as her self-confidence and motivation.

Comments by Ron Minson, MD iLs Clinical Director:
The first thing that grabbed my attention, other than the superb gains that were achieved, was the first bullet under Ms. Whiting’s therapeutic goals: namely, “to develop body organization through sensory motor integration”. Improving reading and language skills was not the first order of business! Getting body organization to support cognitive skills came first. I want to congratulate Ms. Whiting on understanding the vital importance of establishing subcortical body organization to reach gains that every teacher hopes for.

And that is what happened. As motor skills, balance and coordination came under unconscious, automatic control, the brain was freed up to make all the other gains in communication, math, reading, emotional and behavioral regulation. The astute combiningof iLs programs and inclusion of the Interactive Language Program and Dreampad rounds out a well designed program.

The parent-teacher collaboration, every step of the way, is gratifying to see and added immeasurably to the success of this case. I hope that other teachers will benefit from this case and from Ms. Whiting’s courage to try iLs on her own with a number of students. The results led to iLs being made available in the school to help other children with learning problems.

Lastly, the lessening of distractibility and improved attention suggest an appointment with the pediatrician. In my clinical practice, it was possible to decrease or remove many children from stimulants after a successful therapy such as this.

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