10-year-old boy with hearing impairment advances beyond expectations 

About the Provider

Name: Sharon Stultz
Discipline/Credentials: Special education (SPED) teacher, child and family therapist, MEd, EdSp, MA intern, AAC
Modalities: Safe and Sound Protocol (SSP), Eye Movement Desensitization and Reprocessing (EMDR); Tension, Stress and Trauma Release (TRE®); Integrated Family Systems; Gestalt; cognitive behavioral therapy (CBT)

Sharon has been delivering the Safe and Sound Protocol (SSP) since spring 2018 and has worked with over 300 SSP clients.

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Client Background

Name: Nicolas (pseudonym)
Age and Gender: 10-year-old boy
Program Delivered: Safe and Sound Protocol (SSP) (Core hours 1-5)

Nicolas’ parents had concerns about his language development and emotional regulation. They reported signs of severe developmental delay and were specifically interested in Sharon’s experience with autism diagnoses. Nicolas lives with his parents, who are warm and caring, in a good marriage and financially secure. He has a strong attachment to both parents, and his home and school environments are stable. 

Prior to beginning the SSP, he had speech and language services, an occupational therapist, and a teacher for the deaf to support him in school, in addition to being on the Nemechek Protocol for several months. 

Currently, he has a one-on-one teaching assistant that provides support throughout the day. Over the past year, these services have been reduced significantly. Initially, one-on-one support services were needed to manage deafness, dysregulation and sensory needs; presently, they remain in place only to support deafness. 

Nicolas’ treatment goals were to improve emotional regulation, his capacity for receptive and expressive language, and to address developmental delays, particularly theory of mind.

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Implementation of the SSP

Nicolas completed his initial round of the SSP in person with Sharon in 2018. In July 2019, he did two additional, consecutive rounds in his home. The first round was delivered through a Bluetooth speaker, with his hearing aids removed for an hour per day, for five consecutive days. The second round was delivered over 10 days, titrated to 30-minute sessions due to observed dysregulation. The third round followed the same titration model but was delivered through headphones and lasted two weeks due to an interruption from sickness. 

During sessions, Nicolas played independently with bubbles, lighted balls, Kinetic Sand, Play-Doh, and LEGO bricks. At this point in his development, he did not engage in reciprocal play.

Nicolas was also on the Nemechek Protocol, Coseva Advanced TRS, and slept on a grounding mat. Throughout treatment, speech and occupational therapy services remained constant (he has since been discharged from occupational therapy, while speech services continue). Previously, he received speech services twice per week, but the frequency has decreased to once every two weeks.

Response

It has been five years since Nicolas began his SSP treatment. His mom reports that his speech has “really exploded.” Due to his hearing loss, phonics was never an accessible learning method. But after the SSP, he has begun reading and writing, and is more independent in class. 

Six weeks after his first round, the below results were reported.

His occupational therapist reported the following: 

“I went into school today and it was wonderful to see Nicolas so settled in his new classroom environment and so incredibly regulated.

“I liaised with his TA, who reports that Nicolas is currently so regulated that he is not needing to access the nurture space outside of the classroom for anything other than his SLT and OT therapy programs. He is accessing his sensory box items in assembly and managing to sit calmly for the duration.

“During carpet time, Nicolas is sitting on his circular air cushion at the front of the class and his core is significantly improved, as he is no longer needing to lean against a cushion or piece of furniture and he is remaining regulated with increased attention levels. 

“He is engaging in increasing whole-class learning as well as individualized learning with his TA, but is remaining in the class following the structured learning sessions for the duration of each day. His TA reports that Nicolas is coping well in the main playground area and is regulated when he transitions back to class with no current issues during these unstructured times. The progress is significantly positive.” 

His mom reported the following:

“We also went for his audiology appointment today and apparently the hearing in his left ear for one of the frequencies improved. [I was] not sure that was possible but it could just be better listening? They want him back in three months to do some more testing.”

By March 2019, according to his hearing evaluation, Nicolas was “only a year behind on receptive [language] and has caught up with his age group on production.” In 2018, his score was a 38, an age equivalent of under 3 years and 9 months. By 2019, he scored a 69, an age equivalent of 4 years, 11 months.

Sharon reported that as with the curriculum, the British Picture Vocabulary Scale (BPVS, a receptive language assessment) has gotten much more difficult. She explained, “We are generally seeing deaf children scoring two years below their age when they are in key stage one. So this is a brilliant score for Nicolas and shows how his vocabulary has moved on from last year.” 

Present-day observations

During the 2022 school year, Nicolas’ SPED service provider shared that he was the only child who made advancements and met his SPED milestones during the time impacted by COVID-19. Each year, Nicolas’ milestones are increased because he continues to advance steadily. His mom says that when he’s on a computer, he is mostly engaged in research and has a phenomenal visual memory. For example, when Queen Elizabeth II died, Nicolas was frequently the source for historical knowledge related to the royal family.

Nicolas’ behavior had become level and regulated. After just his first session, he began opening doors for others and demonstrating prosocial behaviors on many occasions. His parents are no longer receiving phone calls from the school and instead, the staff frequently remarks on how cooperative and engaged he has become. They have reported that Nicolas is much easier to work with. He received “Reader of the Week” and “Headmistress” awards, and is the strongest reader in his level. Sharon reports, “Mom and dad were worried that Nicolas might never have friends because he was so socially detached, but mom reports that Nicolas now has three close friends (two boys, one girl) that have play dates with [him] regularly.” 

During the sessions, Nicolas’ behaviors varied: he has a stim of grinding his teeth, which could be quite loud at times. Sharon reports, “We did not bother to ask him to be quiet because he simply did not understand the request and it would have been dysregulating. Two of the five days, he was completely silent and building while he listened.” 

Sharon was able to observe that one of his ears was getting red because he wasn’t wearing headphones. 

Three weeks post-SSP, Nicolas’ parents reported the following:

“Today, we went to [the city] and he was great. We were not able to get into [an] exhibition (he was really looking forward to it) since it was fully booked so we went to Seaworld. No tantrums or unhappiness — we had to pinch ourselves because a change in plans never go[es] down well. So much more interactive – we were amazed.

“Speech clarity is now good enough that I can understand him most of the time. He went into the dark rooms, including the glass tunnel where you can see the fish swimming around you. Last time we came, he hated it and freaked out. This time he loved it.

“He also had to see the 4D movie twice. We walked and walked (about 12,000 steps on my watch) and he did not complain. He was a trooper. He is walking with his head tilted,  sometimes to the left and sometimes to the right. Sharon told me this has something to do with the vestibular system. This is new, so I assume something is happening/healing? He is also constantly hungry, more so than usual.”

“Nicolas went swimming with his dad on Saturday and he absolutely loves it. We will sign him up for some lessons once his communication is better.

“He went to a birthday party yesterday and he went up to adults and children alike telling them, ‘I am Nicolas, Nicolas with an N,’ and he drew an N in the air. I had a bit of a chuckle. He was fine interacting with kids and he absolutely loves the animals. There was one moment where he had to share and he did not want to — there were some tears but I explained once the other boy has finished he can have it again. No meltdowns. Later in the day, he waited patiently until it was his turn to feed the wallaby.”

Discussion

Nicolas was one of Sharon’s first SSP clients five years ago. She says, “The SSP was able to bring Nicolas’ system to a calm state, allowing his social system to connect with the rich environment his parents work so hard to provide for him. It worked because we listened to the client’s nervous system and adjusted as needed. We were cautious, not aggressive.”

When he refused headphones, Sharon worked with Dr. Stephen Porges to devise a means of delivery with high-quality stereo Bluetooth speakers placed less than three feet away on either side of Nicolas. 

“Given all the precautions presented during training, we were nervous that he would not get a very good exposure to the music, especially because we were using speakers, and it would affect the outcome,” she added. “But the gains emerged steadily and we were astounded at how quickly the shifts took place. 

Sharon explained that because she only had two weeks to spend with nine clients across three different regions of the U.K., there was no room to pause or take it slow.

During his second round of the SSP eight weeks after the first, Nicolas became dysregulated within the first few sessions, prompting titration experimentation. Sharon learned to lower the volume when clients presented with nausea during listening. 

When sleep disturbances occurred, a day would be skipped and listening sessions would be slowed to 15 minutes. If tolerated well, it was increased to 15 minutes twice per day, and then increased to one 30-minute session per day. This model allows Sharon to treat many sensitive children in private practice and schools with positive outcomes, except when working with clients with autism, “In these clients, we work with Dr. Porges’ original model unless dysregulation manifests.”