About the Provider
Name: Shamala Manilall (with Jocelyn Olivia, OT and Chelsea Philipiew, Behavior Specialist)
Discipline/Credentials: Occupational Therapist, BSc. O. T. (c)
Modalities: Safe and Sound Protocol (SSP), sensory integration/processing, SCERTS, NDT
SP has a diagnosis of autism. He has auditory sensitivity and constantly seeks proprioceptive (deep pressure) input. He likes to confine himself in small spaces, or have a scarf or body sock around him. He has been constantly seeking regulation by putting his hands down his pants, and asks for hand squishes throughout the day. SP lives at home with his parents, older sister and younger brother. His older sister also has an autism diagnosis.
SP attends his community school and is in a fourth-grade classroom with his neurotypical peers. Shamala reports that the classroom environment is too overstimulating for SP, causing him to be more dysregulated than regulated throughout the day. He is on a modified program at school and spends a lot of time outside the classroom in a quiet space doing his work. He has full-time support from his emotional behavioral specialist (EBS), who mainly uses visuals, choices, movement breaks and one-to-one support outside the classroom. Although not addressed by his school team, SP’s parents indicate he has challenges with sleeping.
Due to SP’s continuous dysregulation in the classroom, he is unable to participate and engage, despite his interest in doing so. Because of this and the environment not being adapted to suit his needs, he worked outside the classroom for most of the day. When he is in the classroom, he is separated from his peers at his own desk. His Sensory Profile indicates strong aversion to auditory input and movement. The goal of intervention is to have him engage in work within the classroom and allow him to participate in activities with his peers.
Implementation of the SSP
The SSP was delivered to SP remotely with support from his EBS, who provided co-regulation as needed. He listened to the SSP music for 30-minute sessions everyday for 10 school days, unless he was absent. His preferred activities while listening included pedaling on a stationary bike, sitting quietly in a beanbag chair, or sitting in the sensory room. Prior to each session, he participated in a resource from his local school board called the FOCUS on Self-Regulation sequence (move, hold, breathe, pause).
SP showed an increase in tolerance for overstimulating environments, especially his classroom. He is now in the classroom all day, taking short breaks outside of the classroom for movement (five to 15 minutes) and FOCUS on Self-Regulation sequence activities. He is transitioning between activities using a visual timer, whereas last year he needed a lot of prompting and time for the transitions. SP switches between a regular chair and ball-chair with minimal prompting from his support staff. He is attending to his communication device, using it purposely and intentionally to make requests, and is even starting to use it to comment. Prior to the SSP, school morning drop-off caused a meltdown almost every morning. Now, SP happily transitions to school.
There is still minimal interaction with his peers, but his multidisciplinary team has found it easier to engage SP in academic activities, especially when using his device. SP’s teacher has noticed a difference, but relies on support staff for his programming and has not commented on any changes as she is not engaging with SP. Shamala reports that there’s minimal contact with family for comment and carryover of changes at home, although parents did report better sleep and less dysregulation.
The SSP made a difference in SP’s ability to regulate. Shamala reports that he requested the music again after completion of the first session, so she advised the team to create an alternative, non-SSP music list for him. He refused this music, took off his headphones and pointed to the SSP music on the iPad app. After a two-week break, he listened to about 15 minutes of the SSP each day for a week, which seemed to help regulate SP, allowing him to stay in class all day and participate.
Shamala reports that the team was surprised that SP understood the difference between feelings of regulation and dysregulation.
“It seems he is very aware of his body’s needs,” Shamala said. “It sounds like this is linked to his many requests for sensory input, especially deep pressure.”
As a result of the SSP, SP was immediately able to participate, become aware of his peers, make requests, and use his support team with more attention and engagement.
Discover the Safe and Sound Protocol
Developed by Dr. Stephen Porges, the SSP is a non-invasive acoustic vagus nerve stimulator that helps clients connect with themselves, others, and the world from a foundation of physiological safety.