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Case Study: Hyperactivity; Sensory Seeking Behavior; Poor Gross Motor and Fine Motor Skills

🕑 6 minutes read
Posted February 25, 2016

Associate’s Name & Discipline:
Cindy Dawkins, OTR/L & Andrea Pointer, CCC-SLP

Kids Kount Therapy Services, Daphne, AL

Case Background:
“J” is a male, age 4 years, 11 months at the time of evaluation, diagnosed with Autism by pediatric neurologist at an autism diagnostic center.

Presenting Symptoms:
Hyperactivity; sensory seeking behavior; poor gross motor and fine motor skills; bothered by all background noises; poor language processing; articulation deficit; phonological awareness delays and auditory memory weaknesses.

Summary of Changes Post-Therapy:

  • Four months after initiation of combined OT, SLP and iLs therapy, J’s Pediatric Neurologist, who had initially diagnosed him, removed the autism diagnosis after noting the increased executive functioning and gains in socially appropriate behaviors.
  • School noted improved concentration and attention in class; J longer needed supports (i.e. paraprofessional, accommodations) in the classroom.
  • Parents report J  began dressing himself independently with one request, began pretend play and use of creativity (less stereotyped activities);  began following 1-2 step requests without repetitions; improved self-control and self-regulation;  decreased in bedwetting initially and then stopped; began completing work at school.

Childhood Medical History:
Mother was induced 10 days early with labor lasting 17 hours with 3 hours of pushing.  Forceps and Vacuum were used as he was positioned/lodged face-up in the birth canal.  He weighed 6 lbs., 14 oz.  Apgar was abnormal, he required oxygen.  He was jaundice and had a slight fever after birth.  As an infant he was colicky, a poor sleeper, and had inconsistent sleep/feeding routines.  J had severe reflux and received an upper GI accompanied by medication until after age 1.   He had frequent colds and ear infections from 6-8 months, and tubes were inserted at 8 months.  He had RSV at 18 months.

Therapeutic Goals:
Goals addressed the following skills through Occupational and Speech-Language Therapy paired with iLs:  Distal fine motor grasp, bilateral hand coordination, legible number/letter replication, visual motor skills with corner formation, vestibular integration with static positioning, phonological blending, auditory word discrimination, phonological segmentation of compound words, auditory comprehension of stories (2-3 sentences in length), auditory memory for directives and 3 segments of information, and answering WH-questions regarding function and attributes.

iLs Program Used:
Twenty-one sessions of 80-minutes each were conducted initially with the iLs Pro:  6 organization sessions, 5 transition sessions, 5 activation sessions with introduction of the iLs Interactive Language Program (ILP).  Following a break for insurance reasons, an additional fifteen 80-minute sessions using the iLs Pro were completed.  After this period of clinic-based intervention with iLs, the family chose to purchase an iLs Total Focus system to use at home.  Since that time, they have completed sessions in Sensory-Motor and Concentration/Attention programs.

Other Interventions:
Occupational Therapy and Speech-Language Therapy

Conclusions & Recommendations:
J was re-evaluated at 5.7 years of age, 8 months after beginning therapy:

  • Bilateral coordination skills continued to improve; he began playing catch with his Dad for the first time midway through the program.
  • Auditory comprehension improved from severely delayed to mildly delayed, and auditory memory of numbers progressed from moderately delayed to an average range.
  • Auditory distractibility was decreased, and he was responding appropriately to more auditory input.  His behavior was generally calmer, with inconsistent issues around excitability and activity level.
  • Improvements in verbal creativity, phonological segmenting and blending progressed from moderately delayed to an average range.
  • Although J continued to struggle with handwriting, his letters became smaller and more legible. He was cutting with scissors, folding paper and producing a distal grasp with writing.  SIPT results continue to show significant difficulty with tactile and proprioceptive processing.
  • After he received his iLs Focus home unit, he began seeing Occupational Therapy and Speech Therapy on alternating weeks.  On his last consult, reading, tracing, and handwriting had all improved.  His mother is continuing to follow up at home with the iLs Playbook activities, a home sensory gym, Handwriting without Tears program and outdoor play.  J will be starting soccer soon.
  • Recent testing showed the most exciting gains in language processing.  J progressed in all areas on the Language Processing Test-3:  Elementary from borderline and below average scores to average and above average scores.  His therapists and family are thrilled with this most recent progress!
Sensory Integration and Praxis Test Summary: Pre iLs                                             Post iLs
Visual Perception:
Space Visualization -1.14            Mild dysfunction                   
Figure Ground Perception -.81              Average
Somatosensory (tactile and proprioceptive processing):
Manual Form perception -3.00            Severe Dysfunction          -3.00
Kinesthesia -3.00            Severe Dysfunction          -2.75
Finger identification -.37              Average
Graphesthesia -.94              Average
Loc. of tactile stimuli -3.00            Severe Dysfunction           -1.59
Praxis on verbal command -1.11            Mild dysfunction
Design Copy -1.80            Mild dysfunction                -1.67
Constructional praxis -.90              Average
Postural praxis -.77              Average
Oral praxis 1.17             Above average
Sequencing praxis -1.01            Mild dysfunction
Bilateral motor coordination .19               Average
Standing and walking balance -2.08            Definite dysfunction
Motor accuracy -.71              Average
Postrotary Nystagmus -1.81            Mild dysfunction

Miller Function and Participation Scales:

  3.9 years 4.11 years 5.7 years
Fine Motor 3.3 years 4.1 years 4.1 years
Visual Motor 3.9 years <4.0 years 5.5 years
Gross Motor   <4.0 years 4.6 years

The Print Tool:  3/26 legibility of letters from model (10%).  Left to right formation (30% ).

TAPS:                                          Pre iLs                                       Post iLs

Word Discrimination    8    5
Phonological Segmentation    4    8
Phonological Blending    5    8
Number Memory Forward    6    9
Number Memory Reversed    2    1
Word Memory    8    5
Sentence Memory    5    6
Auditory Comprehension    3    7
Auditory Reasoning    7    7

SCAN-3:                                     Pre iLs                                     Post iLs

Auditory Figure Ground +8 dB (AFG)    4    9
Filtered Words (FW)    5    11
Competing Words-Directed Ear (CW-DR)    2    2
Competing Words-Free Recall (CW-FR)    5    8
Competing Sentences (CS)    8    9
Auditory Processing Composite    65    84

Parent Report on J Regarding Changes During Therapy
J’s parents were diligent in keeping track of his changes.  Here are some of their notes:

  • He can regulate himself better.
  • More in touch with his feelings and emotions.
  • OCD tendencies still present, but are smaller and more controlled.  Progression over last 2-3 years:  A/C units, ceiling fans/oscillating fans, cardboard roll from paper towels and toilet paper, presently obsessed with keys and key rings. Less fixated on spinning objects.
  • His diet changed.  He now likes strawberries, mushrooms, cheddar cheese, triscuit crackers and pickles.  He would never touch these before.
  • Carries on/initiates conversations on telephone; not just answering questions with yes and no. More expressive/descriptive…like the thoughts were trapped inside of him before iLs.  His favorite saying is “Let me tell you something”…then will give you this long elaborate story.
  • Easier to discipline.  Use check mark/reward system with occasional time out. Initiates more activities without being told to do so…will clean room, get dressed, got to bathroom, take plate to sink, change clothes after school.
  • Handwriting slow, but making progress.
  • Loves to color! (mom’s favorite) most amazing change since starting iLs. Began coloring during Concentration and Attention sessions # 36 and 37.  Very detailed and inside the lines.  Would sit for ~ 30 min every night just to color before going to bed.  Still loves to color, but not as detail oriented since starting back on Sensory-Motor. Before iLs, he never wanted to touch crayons, or he would only scribble 2-3 lines across a page.
  • Huge improvement with hand-eye coordination.  He was never able to play catch with his daddy before.  Also able to hit ball with bat when pitched ~ 50 % of the time.
  • No more separation anxiety after 3 months of program.
  • Sleeping habits have improved tremendously!  It use to take 2+ hours for him to settle down at night before falling asleep.  Now it takes ~30 min and he falls asleep within 10 min after we leave the room.
  • Still very impulsive and craves deep pressure, but not as often. Still impulsive, but showing more signs of self-control.
  • Unaware of body sensations but… bowel movements have improved.  Used to go to the bathroom every 3-4 days and sit for ~ 20 to 30 min before finishing, now he goes daily and takes him 10-15 min.
  • “Overall, it has been absolutely amazing and a true blessing to watch our precious little boy blossom while on the iLs program!”
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