Case Study: Autism and the Focus System

CASE STUDY SUMMARY

Organization:
Kids Kount Therapy Services, LLC

Associate’s Name:
Andrea W. Pointer, M.S., CCC-SLP; Shannon Norris, OTR/L; Cindy Dawkins, OTR/L

Associates’ Discipline: Speech-Language Pathology and Occupational Therapy

Presenting Problem:
Autism Spectrum Disorder with Pragmatic Language Deficits, Auditory Processing Weaknesses, Sensory Integration Dysfunction and Gross/Fine Motor Skill Delays.

Therapeutic Goals:
Goals of therapy focused on decreasing echolalia in conversation and improving the following: eye contact during conversation, initiations and engagement, auditory processing skills, pretend play, phonological awareness, verbal sequencing and expression, body balance and core strength, motor planning and sequencing skills, categorization skills, spatial orientation skills, localization of tactile stimulation, constructional praxis, bilateral coordination skills, praxis on verbal command and design copying to within normal limits as compared to peers.

Background:
Client was two years, eleven months at the time of initial testing (May 2008).  She was referred by her pediatrician due to her diagnosis of autism with the following areas of concern:  echolalia, poor language skills, fine and gross motor skill delays, delayed self-care skills, visual perceptual deficits, sensory integration dysfunction, auditory processing weaknesses and oral dysphagia.

At time of the initial evaluation, client presented with severe deficits with social-emotional engagement, ignoring communication attempts by others and closing circles of communication with avoidance and by increasing physical distance from others.

Socially/emotionally, the client was easily overwhelmed, was frustrated by daily activities, did not transition smoothly from one activity to another, lacked confidence with new environments and new tasks, lacked independence, was “needy,” had low self-esteem, and was impulsive.  She had poor short term memory, could not sequence tasks, and often failed to begin or to complete tasks or projects unless assistance was provided.  The client had difficulty finding clothes and getting dressed in the morning and preferred to avoid planning due to difficulty with tasks.

Unyte-iLs Program Used (program name, frequency, length, etc.):
Focus System: Sensory-Motor program sessions 1-60 at a frequency of three sessions per week for a period of five months.  Two sessions per week were conducted in the clinic and were paired with Occupational and Physical Therapy; the third session each week was conducted in the home environment by the client’s mother utilizing the PlayBook activities and a home program developed by Occupational and Physical Therapy.

Beginning with Session 52 of the Focus System: Sensory-Motor protocol, Speech-Language Therapy was introduced.  During this portion of the program, Speech Therapy (SLP) completed two songs per session while having the client participate in traditional speech-language activities, working on social skills, expressive/receptive language tasks, and articulation skills.  Thirty minutes of the sessions focused on utilizing the Focus System Expressive Language Kit (Actives/Expressive Phase).

Other Interventions Used:
Occupational, physical, and speech therapy combined with home activity programs utilizing the Focus System.

Results:

Prior to the Focus System, the client could not complete testing with the SCAN-3 for Children due to poor auditory attention, increased frustration with auditory tasks, sensory integration dysfunction/tactile defensiveness with headphones, and decreased comprehension of task directives. Post the OT/PT portion of the Focus System, the client completed testing with the following results:

Subtests

Auditory Figure Ground+8dB (distinguishing stimuli in presence of background noise):

Scaled Score-6; No ear advantage; Borderline weakness

Competing Words-Free Recall (repeating different words presented in separate ears simultaneously without requiring the client to relate a specific word to a specific ear):

Scaled Score-9; Right ear advantage typical for age/peer group; WNL

Filtered Words (distinguishing stimuli filtered at specific frequencies)

Scaled Score-5; Right ear advantage typical for age/peer group; Borderline weakness

Competing Sentences (repeating sentences presented in a directed ear while competing stimuli is simultaneously presented in the opposing ear)

Scaled Score-7; Right ear advantage typical for age/peer group; WNL

Time Compressed Sentences (repeating sentences presented in a directed ear without competing stimuli but at a rapid rate)

Scaled Score-4; No ear advantage; Borderline weakness

Based on results of testing, the client’s areas of weakness consisted of mild difficulty with background noise and filtered words.  Mild weakness was present with interpretation of rapid speech.

Post Focus System treatment utilizing a microphone unit which transmitted the speaker’s voice and ambient noise through air and bone conduction headphones, the client demonstrated the following gains:

During the initial screening, the client was able to identify filtered words with 23% accuracy.  At end of the intensive Focus System program, she scored within normal limits (80% accuracy or greater) on all filtered frequencies excluding 1000 Hz.

Filtered Words @ 1.5K-84% accuracy

Filtered Words @1.25K-80% accuracy

Filtered Words @1K-56% accuracy

Filtered Words @875-80% accuracy

Auditory Figure Ground tasks were completed with 75% accuracy prior to the second phase of the Focus System.  At the end of the intensive Focus System program, the client completed Auditory Figure Ground tasks with 89% accuracy.

Dichotic Listening tasks were completed with 39% accuracy prior to the second phase of the Focus System.  At the end of the Focus System program, the client was able to complete Dichotic Listening tasks with 67% accuracy.  Although weaknesses continued to be present, she also evidenced gains regarding attention to the task.

Auditory Memory tasks were completed with 66% accuracy (i.e. recalling three unrelated words in a series) prior to the second phase of the Focus System.  At the end of the Focus System program, the client was able to recall a series of three unrelated words with 91% accuracy.  Weaknesses were present with recalling four unrelated words in a series (22% accuracy).  However, she demonstrated increased independence with utilizing compensatory strategies (i.e. asking for repetitions).

Regarding frustration during interactions, initiations, engagement, pretend play, and reciprocal eye gaze:  all parameters are within a normal range post Focus System.  Echolalia has completely resolved with language content now being purposeful and meaningful!

SIPT results improved from the client exhibiting significant/below average impairments in all areas to all areas falling within normal limits.  Figure-Ground Perception and Localization of Tactile Stimuli fell within 0 to -1 SD from mean; Design Copying and Constructional Praxis were +2 SD from mean; and Finger Identification, Graphethesia, Praxis on Verbal Command, and Bilateral Motor Coordination fell within 0 to +1 SD from mean.  Client also progressed to catching a small ball with two hands, using correct pencil grasp, and following multi-step directions/motor planning skills within normal limits.

Conclusions and Recommendations:
This client is functioning socially in a regular classroom without support and evidences no symptoms of an autism spectrum disorder.  Although, she continues to be monitored every 3-6 months by Occupational, Physical, and Speech Therapy, no additional therapy has been recommended at this time.

Letter reversals and mild weaknesses in core strength have been reported and will continue to be monitored.  However, this client has progressed from being a child with severely impaired communication and social skills to functioning at a typical peer level.

Although this client made gains with traditional therapy, the therapists and parents will concur that the Focus System program was key in accelerating progress, promoting self-confidence, addressing auditory processing weaknesses more efficiently and effectively, promoting increased body awareness, and facilitating improvements in pragmatic language skills.  The statistical data provided in the test results indicate just a portion of this child’s Focus System successes.