About the Provider
Name: Zita Dube-Lockhart
Disciplines/credentials: Core-selective evaluation approach (C-SEP), cognitive processing therapy (CPT), cranial electrotherapy stimulation (CES)
Modalities: Corrective exercise strategies, active play therapy, adaptive movement specialist, trauma-informed exercise facilitator, Safe and Sound Protocol (SSP)
Client Background
Name: James (pseudonym)
Age and Gender: 12-year-old client who is non-verbal and unable to identify pronouns. He/him are used at this time.
Program Delivered: Safe and Sound Protocol (SSP) Core (Hours 1-5); Connect (Hour 1)
James presents with autism and is non-verbal, expressing himself primarily through body language and vocalizations. James was diagnosed with autism at three years old and has never acquired expressive language but his receptive language skills are significantly more advanced. He presents with significant developmental differences impacting his gross and fine motor development, his use of speech and alternative language and social behavior.
James lives with his two birth parents and one younger sibling. The home is calm, stable and loving. Both parents are highly educated in early child development and mental health, acting as strong advocates throughout James’ life. The home is a supportive environment with caregivers who have made his mental and physical health priorities. He is not currently on any medications, and has a full-time aide assisting him in a semi-inclusive learning environment.
James experiences significant difficulties with calming his body and maintaining physical regulation. However, he is generally predisposed to a joyful temperament, has a high level of affect and social connection, and is usually a very gentle child. Although James typically presents as very calm, regulated and happy, he has had previous periods of high-intensity emotional outbursts that sometimes included mild aggression in his younger years.
He is extremely hypersensitive to sounds, lights, chaotic spaces and touch but is generally very emotionally flexible and adaptive to his environment, and enjoys a rich and active social life in his community. He is loved and respected by his supportive adults and peers, and is generally considered to be thriving despite his very significant barriers.
James often experiences difficulties with transitioning from a school- to home-based routine during the early parts of the summer. This summer, James’ parents and school team had noticed this transition was significantly more impactful than prior years. James will be moving to a new school for junior high school, leaving behind the learning environment he has been accustomed to for the past seven years, contributing to the heightened impact of this transition.
His anxiety and distress at this change was noticeable throughout June, with his school team noting increased repetitive and stereotyped behaviors (RSB). He was significantly more prone to emotional outbursts of frustration and anger, and began showing early signs of aggression. This behavior is extremely unusual for him as he is typically quite gentle. He also experienced significant sleep challenges that were not able to be adequately met with melatonin.
These signs of dysregulation continued to increase over the course of July, not only in frequency but also intensity, and James’ aggression began to exhibit itself daily toward all members of his family, including his younger sibling and grandmother. His parents described his distress and behaviors as “the most challenging period of their parenting experience.”
Implementation of the Safe and Sound Protocol (SSP)
James is very sound sensitive and has rejected listening to music with headphones in the past, signaling that he would require significant preparation before beginning SSP Core. For several weeks, the process of the SSP was discussed with and in front of him, and it is believed that he understood what he was going to undertake as he showed zero indication of hesitation or anxiety with wearing the headphones and listening to a full session of SSP Connect as a trial.
It was collaboratively decided that SSP Core should be attempted as quickly as James’ nervous system allowed. James co-listened to SSP Core with his mother while driving in the car, a long-established safe location for him. The 60-minute sessions were delivered every other day for nine days. James was encouraged to hold hands with his mother, father and sometimes his sibling during the listening-driving sessions.
He also had several different sensory toys and was given open access to drinking water, which was a regulating strategy for him. Following the SSP Core sessions, James was encouraged to actively move his body.
It’s important to note that while listening to the SSP is generally not recommended while in a moving vehicle, providers are ultimately advised to collaborate with clients and their caregivers to create individualized listening plans that best meet the needs of the client.
Response
Upon completing the first hour of SSP Core, James began experiencing positive changes immediately. He had his first restful sleep in several days, waking up calm and rested with no indication of significant dysregulation outside of one short emotional outburst with minor aggression. By day two, the improvements were significantly more noticeable. James had his first full day without any aggressive outbursts in at least four weeks, and was noticeably physically and emotionally calmer.
His RSBs were down significantly, and he showed several signs of affection and connection with his caregivers and former teachers when he visited his sibling’s school. He spent the whole day and evening smiling, which was noticed by everyone around him. These changes lasted throughout the entire delivery of the SSP and continue to persist now, a full month after completing the program.
With the exception of very minor incidents, his aggressive behaviors have almost completely disappeared. James is able to calm himself more quickly and easily in moments of frustration and anger, even more so than before the summer transition began.
Discussion
The entire family expresses significant relief at knowing that James is no longer living in a perpetual state of crisis and fight-or-flight. He has regained the ability to safely connect with them again, and their quality of life has improved immeasurably.
“It is difficult to assess why this protocol was such an effective tool for James, as he is not able to give us a first-person account of what he experienced,” Zita said. “However, it is clear that it evoked a strong neurological shift in him that even he recognized, as he was eager to take part in the protocol every day and was even reaching for the headphones and asking for the music by the fourth hour.”
The SSP Core Wonder playlist also contains many songs that are familiar to James and would remind him of safe and happy experiences in the car and his home with his caregivers and sibling.
The SSP was delivered in a very safe environment, as James was surrounded by people he loved and felt safe with, including Zita, with whom he has established an intimate connection. He was able to allow himself the space to explore the program in his own way and on his own terms.
“I believe that this was a critical element in why the program was so successful,” Zita said. “His entire team was deeply invested in making the experience a safe, positive, consent-focused one. James was often reminded that he could take off the headphones if he wanted to, and that if he didn’t want to do the program, he didn’t have to.”
Every single caregiver in James’ life, including his parents, sibling, grandparents, school team and social circle have noticed the extreme differences in his temperament. His nine-year-old sibling describes it as if “a light switch went off inside his brain, and he remembered what it felt like to not be scared and angry all the time.”
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