Case Study: Ross

Therapist: Marga Grey

Issues & Programs

What were the problems?

Ross is diagnosed with Autistic Spectrum Disorder and was referred to address toileting and speech problems. He had previously attended speech therapy for 2 years. He presented with a range of sensory integration problems including tactile and auditory defensiveness and movement seeking behaviour. These issues meant that he avoided specific touch, was a picky eater, he was very energetic and continuously on the move and that while he became excited by unexpected loud noises, he also made a lot of loud noises. He used few words and would often rather use actions than words to communicate his needs. He was reluctant to participate in activities at school and could only be persuaded with specific measures and rewards.

What did Marga do?

The Wilbarger Therapressure Protocol
Sensory Integration based treatment - In therapy sessions and at home different movements were introduced through mainly suspended equipment.
Parent education
School visit to discuss his behaviour with his class teacher and to give her advice on how to react to aggressiveness.
Auditory Integration activities - In therapy sessions it has been noted that he’ll stop during his play to listen to modulated music. Although he refuses to wear headphones; he is listening to classical music, which seems to calm him. He is seeking auditory sensations and the use of headphones with the specific modulated music will be introduced again in 2 month’s time. In the meantime other sounds, music and songs are introduced to prepare for the use of the modulated music.

What did Ross' parents do?

Consistent attendance to Occupational Therapy every week to fortnight
Consistent application of the Wilbarger Protocol and sensory diet
Integration of strategies learned in therapy in everyday life.
Environmental set-up for touch and movement activities at home
At home his mother focuses on providing opportunities to experience the touch and movement activities introduced in therapy sessions. The family encourages him to play using deep touch and movement. He is encouraged to listen to specific music and he sings along with his mother.

What were the Outcomes?

The tactile defensiveness has normalized and Ross now seeks cuddles, tickling and soft wrestling, wheras these were avoided before. At present he seeks deep pressure tactile sensations, which are calming for him.

Ross was previously seeking inversion movement (head down) but now enjoys movement in all directions in a hammock, usually in the supine position. He is experimenting with positions and movements on the scooter board, firstly on his back but now also on his tummy and while coming down a slope. This means that he doesn’t need the safety of the hammock so much but can explore outside his own body space. He has started to jump with two feet together and also off couches and steps. This means that his gravitational security (lack of confidence with movement when his feet are off the ground) has improved.

He uses more words and language, mainly to obtain what he wants to do or to have.

At school, Ross is now completing cut and paste activities and is proud of his achievements.

Further observations show Ross has made progress at home in the following ways:

Less irritated and calmer behaviour
Easier transition from one activity to another
They have noticed incidents where he indicated that he hurt himself (e.g. after falling) whereas previously he didn’t notice this
He has indicated that he has wet his nappy
He is using a greater variety of noises and he is using more words functionally and otherwise
In therapy sessions I have observed that he is calmer, he interacts more with me, is using more words, has more eye contact and is better focused on an activity. He is less disruptive; seldom runs away from an activity and if so, he does it to initiate a catching game with the therapist. He has progressed from involvement in his own body space to reaching to other objects, experimenting with apparatus in the therapy gym and initiating the use of different apparatus.

Where to from here for Ross

Focus for future therapy will be to address auditory processing and to introduce a structured sensory diet as part of his daily routine at home and at school. This will include specific toilet training.