A Case Study: Jill

Jill is a six year-old girl who is currently enrolled in a classroom for students with a diagnosis of autism. Jill was born two weeks premature, following a pregnancy that her mother reports as "a very stressful time". At birth, Jill was small and jaundiced. Her sucking reflex was poor and weight gain was slow. It is reported that Jill cried extensively and withdrew from attempts to cuddle or comfort her physically. She had a hard time taking her bottle and preferred a cup. A pacifier is still used, as are many other oral motor strategies. Her mother reports that Jill never ate baby food and preferred unusual things like beef, hamburger and juice. She was an active toddler and "on the go" until she was put to bed. Jill sleeps for four to six hours and then is up for four to six hours.

Some of Jill's behaviors have remained consistent since early childhood. She is sensitive to loud noises and reacts with fear to low frequency sounds. She responds to some children's music with laughter and will become still in order to listen. She has very little interaction with others and makes her needs known by crying and screaming. When others approach, she will leave the area or make distressed vocalizations. She has difficulty with change and transitions and works to make sure that objects are kept in the same place. Her activity level is high and she is in nearly constant motion that includes running, jumping, climbing and flapping her hands. She seeks out pressure touch by wedging herself under cushions and tucking herself tightly under her covers at night. Jill prefers not to wear clothing, explores her environment by putting objects in her mouth and prefers crunchy food (but resists the use of a spoon).

Jill has been on a sensory diet that includes pressure touch and joint compressions with the Wilbarger Protocol, numerous pressure touch activities through objects (e.g. being squished under pillows, mats and air cushions), climbing activities and work on the trampoline. Since implementation of the sensory diet (in place for 18 months), she is sleeping for longer periods, making more eye contact, crying less to express needs and starting to come to familiar adults when she wants something.

She is also able to better tolerate sitting at the table with others and is working on the TEACCH program to learn independent work skills and to follow a visual schedule. The classroom teacher utilizes many other visual strategies and uses simple signs with the students. She participates in most activities with direct physical assistance and hand over guidance.

This past fall Jill was started on a Therapeutic Listening® program that includes use of EASE and EASE 2. Behavioral responses to the program were immediately observable! During the first listening session she bounced with her therapist on an inner tube and imitated use of blowing toys. She was making eye contact and smiling. This level of interaction and engagement was astounding to everyone in the room. After listening, she sat very calmly and seemed to be "seeing" her classroom for the first time. She looked at each wall and then looked at each adult (the speech therapist, physical therapist, teacher and childcare worker were all present). At lunch that day Jill ate a banana for the first time. The next listening session was even more dramatic. Jill came into the classroom distressed and resisted the morning snack routine. Once the headphones were in place, Jill immediately calmed, picked up her spoon to eat yogurt, signed "more" when she was done(!) and then took care to empty her bowl. While working with her therapist, Jill (still listening) was making nice eye contact. Because she had not been wearing her hug vest for the listening session, this was offered to her. When asked "Jill do you want your hug vest?" she made postural adjustments (leaned forward, raised arms) and said "hug, hug". These words were the first words ever heard by her therapist and some of the few ever said.

Jill's gains on the Therapeutic Listening® program continue. She demonstrates a more optimal level of arousal and is engaging actively in the classroom routine. Her receptive language has improved tremendously (or perhaps it's her new ability to respond). When asked by her classroom teacher where her barrettes were, Jill hopped off the swing, got the barrettes and brought them to her teacher. The teacher was amazed. Her parents are also delighted with the changes. Jill now requests to sit on her mother's lap, is engaging in purposeful activity rather than being in constant motion, and is eating and sleeping better.

--Lori Redner, OTR (Grand Rapids, MI)