Case Study: NLD, ADHD, Anxiety Disorder

Submitted by: Christine King COTA/L & Kathy Carley, MS, OTR/L
Organization: Project CHILLD, Beverly, MA
Client: GD, 20-year-old male

Clinical Diagnosis/ Presenting Problem: NLD, ADHD, Anxiety Disorder
GD’s mother is Assistant Dean at an alternative school, and referred GD to Project CHILLD for therapy. She referred her son because of the progress she’d seen other students make as a result of iLs. GD struggled through school with increasing episodes of depression and anxiety, attending four different high schools before graduating. GD is a gifted guitarist and after graduating from high school he enrolled in a music school in Boston but became so depressed he had to withdraw.  He then enrolled in a music school in Poland, but after a few weeks began having such severe anxiety attacks his family had to fly over and bring him home.

Primary Concerns as reported by GD and GD’s mother:

• Poor self-esteem
• Lack of motivation and initiative
• Passive non-compliance
• Difficulty with memory and problem-solving skills
• Not independent with follow-through on ADLs (activities of daily living) e.g. struggled with basic hygiene, sleeping and eating patterns, unable to follow a simple checklist to sequence his day or manage his own appointments and medications

At the time of intake GD was becoming increasingly argumentative at home, withdrawing socially and experiencing more frequent anxiety attacks. GD was unable to hold a job, and had recently been fired from a local grocery store.

Therapeutic Goals were established in a family planning meeting and are as follows:

• Improve self-esteem
• Improve self awareness and self expression
• Decrease anxiety
• Demonstrate increased motivation to engage in life situations.
• Increase independence in ADL’s: i.e. establish routines for hygiene, chores, eating and sleeping habits
• Increase independence in iADLs: i.e. actively engage in work or other activities in the community
• Improve communication
• Demonstrate increase ability to take responsibility for actions and behavior

Clinical Assessments Used:

• Dynamic Listening Test
• Scan 3-A (auditory processing)
• Clinical Observations
• Sensory Profile
• LIFT Assessment

Summary of Changes (test, observations, feedback, etc.):

Post-testing at the end of 31 sessions (over 3 months) showed the following:

• On the SCAN-A test for auditory processing GD’s overall composite score went from 83 to 104, with significant gains in subtests of Filtered Words (scaled score increased from a 6 to 13) and Competing Word DE (scaled score increased from 5 to 10).
• GD has made tremendous progress in the area of ADLs and iADLs. He independently applied for, interviewed for and secured a job. Relationships with his family have greatly improved and he is an active participant in meals and chores.
• GD’s family report improvement in GD’s ability to analyze and process a situation, and to express himself with clear, decisive language. They also report significant decrease in his anxiety with no signs of depression at this time.
• Six months post-program, GD is able to keep his schedule, has been promoted at work, and reports feeling like he is able to manage his anxiety with the strategies he has learned.

iLs Programming Used:

Days 1-4 utilized a combination of FSM, SIBW and Chant.

Daily observation forms completed by GD’s mother on day 4 noted increased energy. Mom was seeing more effort with chores and more follow-through, and reported that “GD seems less defensive.”

Daily observation form filled out by G.D. on day 5 reads “A new feeling of self, constant happiness, almost energized.”

At this point G.D. worked on a plan to address personal hygiene and a sleep routine/schedule, as well as strategies for keeping appointments.

Days 5-10 consisted of gradual filtering, moving through two filters per day as well as EHS1 and Chant.

Daily observation forms filled out by his parents state that G.D. is “More amenable-less argumentative, improvement in hygiene: showering, changing clothes more often.

G.D. is noticing things he would not have before, better able to express his needs, able to listen and engage in conversations involving constructive criticism.”

Days 10-15 utilized FM 8000 with EHS1 and Chant, and introduced Voice of the Mother.

G.D. reports noticing, “I look up when walking when I used to look down”.

Mom reports that G.D. is calmer overall and sleeping better.

Three-week break

Days 16-23 defiltration; using voice of the mother.

Daily observations from days 17-19 mom reports increased sadness. GD is less engaged in conversation, more lethargic, having trouble sleeping.

Daily observations from days 20-23 mom and GD both report a happy mood, more motivation, good communication within the family, and increased participation outside of the house. It is during this time period that GD independently secures a job.

Three-week Break

Days 23-31 Program consisted of SPL bandwidths, Chant and Active work consisting of chanting, humming, reading and vocalization exercises.

Six months post-program, GD is able to keep his schedule, has been promoted at work, and reports feeling like he is able to manage his anxiety with the strategies he has learned.