Case Study: Down Syndrome, frequent ear infections

Associate Name: Jennifer Griffith, OTR

Name of Organization: Milestones Therapeutic Associates – TX

Age/Gender of Client: 9-year-old male with Down Syndrome, frequent ear infections

Testing:  No formal assessments were done before or after the SSP due to Spanish-speaking mother (could not complete questionnaires),  client’s minimal verbal speech and lack of ability to complete standardized assessments; thus,  all information was obtained through review of clinical record, discussion with primary OTR and post-program – parental interview through translator.

Presenting Problems: (request for inclusion in SSP Beta-test):

• Severe anxiety in noisy and/or crowded environments
• Significant over-responsivity to sounds
• Lack of consistent response to requests or name calling
• Poor sleep quantity and quality

Summary: D has been receiving direct OT services in our facility for several years with slow but steady progress.  He has had some inconsistent experience with musical intervention programs (other than the SSP) with minimal results.  He is a member of a large very supportive family who speaks only Spanish in the home.  However, he attends public school in a self-contained classroom where information is presented in both English and Spanish.  D has few spoken words, but attempts to communicate through combination of words, sounds and gestures, and he appears to have understanding of basic requests.  He is shy but friendly, but he is extremely hesitant to participate in social activities, particularly when there are loud, unexpected noises.  It should be noted that D has had a long history of ear infections resulting in the placement of PE tubes four times during early childhood and having tonsils, adenoids and scarring removed surgically in 2012.  He has most recently had an ear infection approximately three weeks ago (after SSP completion).

The SSP was performed in a very quiet environment with only D and OTR present.  During the 5 consecutive days of listening in a clinic-based setting, D participated in arts, crafts, building and game play.  Although he frequently attempted to verbally communicate and sing along with familiar songs in the program, he was encouraged to focus on listening.  The changes described by his mother during and after the program are remarkable and are detailed as follows:

• After Day One of the program, D slept throughout the night for the first time. Prior to this, his mother had to stay near the bed until he fell into a restless sleep, awakening MANY times each night.
• After Day Two- D participated in his school Thanksgiving program in which he sang and danced in front of a large crowd of his peers. Although he had been practicing to participate in this annual event, every previous attempt to do so was met with severe anxiety and not only could he not participate in the program, he had not EVER even ATTENDED due to noise level!!
• D’s mother reports that since SSP completion, D is much more interactive with kids. He approaches others to join in  play or conversation.  He sings and dances frequently.
• Prior to SSP, D refused to go to family gatherings or parties. He would hide in the bathroom away from all the activity.  Over the holidays, he attended a large family gathering  and even danced!
• When D’s mother calls him from another room in the house, he now quickly responds to his name as and asks “yes Mom?”. This is a complete change from before use of SSP.
• D’s mother reports that he had frequent urinary incontinence and needed to be continually reminded to go to the bathroom. Since he has completed the SSP, he has not had a single ‘accident’ and has become independent in toileting.
• Lastly, and most remarkable – Every year in our community, we have a well-attended large holiday parade complete with floats, high school bands, fire and police department activities, musical guests and participation by other community organizations culminating in an elaborate firework display. Every year the family attempts to attend, but if they are able to go at all, D usually sits in the family van wearing headphones watching movies.  This year, for the very first time, he stood near his family outside and watched every participant including observing and cheering during the firework finale!!!

Overall, D has had an extraordinary response to the SSP.  This progression has allowed him to participate in family events, attend social gatherings, interact with family and peers and become overall less anxious and express happiness.  His mother tearfully expressed her gratitude for this opportunity; she is enthusiastically looking to future options for improvement including her son’s participation using the Unyte-iLs Focus System.

The following images are of D participating in things he had never tolerated before SSP.