A Case Study: Paul

Paul is a 19 year-old man who has participated in a classroom for students with autism since he was four years old. Paul was born full-term following an uncomplicated pregnancy, and his growth and development in the first year was within normal limits. His parents describe him as a "good baby" who needed very little attention. He was generally healthy except for recurrent respiratory problems and fluid in his ears, requiring the insertion of tympanostomy tubes.

Paul's parents first became concerned by delays in his speech and language development. They recall early unusual behaviors that included a disinterest in toys or play and captivation by lights and shiny objects. Paul made random noises, played with 'fuzz' or’ lint', spent much time wandering about and flapped his hands. His expressive and receptive language skills progressed very little over the years in treatment.

Paul is currently enrolled in a classroom that emphasizes functional living skills and independent behavior. A visual communication system is in place for all of the students. Paul typically brings an adult over to the object he needs. On a very rare occasion, Paul will gesture or use a picture cue. His response to verbal instructions for familiar tasks remains context dependent (e.g. If told "Get your coat" Paul will respond as other students are getting their coats).

Paul currently exhibits sensitivity to complex noise and responds by teeth grinding, plugging his ears with fingers and vocalizing. He becomes agitated in response to low frequency sounds such as motors, lawn mowers, and vacuums, and will plug his ears, bounce and make distressed vocalizations. Paul also has an avoidance of imposed touch. He prefers to touch objects only with his fingertips or not at all. He will seek out strong proprioceptive input and calming vestibular input.

He frequently walks with a bouncing gait, is fearful of imposed movement and will not climb onto unstable surfaces or moving equipment.

Paul has had many sensory diets over the years that included use of pressure touch techniques, use of weighted vests and blankets, functional activity that would provide proprioceptive input, work on trampolines and therapy balls, and regular introduction to swimming. Despite a comprehensive intervention program that included use of a functional autism curriculum and occupational and speech therapy services, Paul's functioning remained much the same as it was in the past. Recently his classroom teacher became concerned about Paul's resistance to any activity, and his parents are overwhelmed with aggressive behaviors while at home.

Paul recently started on a Therapeutic Listening® program that included use of an EASE Disc. The results have been remarkable! Paul is more actively exploring his environment and his sensory sensitivities are reduced. After listening only once, Paul was able to put his hands in water used to wash tables. This would have been intolerable to Paul before. Recently while on a walk, the class passed a lawn mower. Paul looked at the mower and kept walking. His tolerance to the low frequency noise as well as being able to localize to the sound was new. Paul is also interested in communication and is walking up to adults and gesturing. Receptive language has been another dramatic area of improvement. While in the classroom the teacher said, "Boy, I'm hot. I need a coke". Paul went to the refrigerator, took out a coke and plopped it on the table in front of the teacher! This type of response and ability to act on the statement was amazing to all who know Paul.

Although the program is in the early stages, results continue to be noted. Paul seems to have come alive. He is active at home, but is no longer aggressive. Home issues are being addressed, including the need for a communication system and sensory diet as well as for structured activity. Paul's listening program will become a regular part of his sensory diet and will be adapted as his needs change.

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