Category Archives: Research

Omega-3 Fats Improve Behavior in Children

06

Proper nutrition during early childhood is essential for proper brain function. Poor nutrition in early childhood is associated with increased aggressive behavior through adolescence by negatively impacting brain structure and function. Brain abnormalities have been found not just in adults with aggressive behavior problems but also in children with aggressive behavior. As a result, improved nutrition through adolescence is thought to possibly help with behavior problems.

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Case Study #1 Supporting the Use of iLs

DATE: 07/02/2014

ASSOCIATE’S NAME & DISCIPLINE: Mark L. Prohaska, Ph.D. (Director; Licensed Clinical Psychologist, Clinical Neuropsychologist), Heather C. Miller, B.S. (Clinical Coordinator and iLs Associate), Michelle Campbell, B.A. (iLs Associate)

NAME OF ORGANIZATION: Neuropsychology Clinic, P.C.

Background:  H is an 11-year-old, right-handed female in the 5th grade who has a history of AD/HD (treated with Concerta).  She is an only child and lives with her biological parents.  She likes cats, collects statues, likes art and drawing, and is involved in the girl scouts.  H gets along well with her peers.  H’s mother reports that she was on bed rest for three months during her pregnancy due to preeclampsia; however, the delivery was unremarkable and H was early in reaching her developmental milestones (e.g., crawled at 4 months, walked at 7½ months, talked at 8 months).  H’s medical history is notable for allergies and reflux.  She has not required any surgical procedures and her neurological and psychiatric histories are unremarkable.  Her current medications included Zyrtec, Zantac, and Concerta.  Family medical history includes AD/HD (father and paternal grandmother). 

Presenting Problem: H had been taking Concerta with good results since first diagnosed with AD/HD in kindergarten; however, she required two increases in her dosage over the previous year that were believed to be factors in the her developing facial tics.  Although she typically earned A’s and B’s and there were no behavioral issues in the classroom, H was described as being distractible and as having difficulty staying on task which resulted in her having to take her classroom work with her to complete at home. This, in addition to her other assigned homework, was taking a very long time to complete and her mother was making plans to start home-schooling.  Similar problems were seen at home, where H was observed to be easily distracted and to take a much longer time to get tasks accomplished than she should.  Results of our initial evaluation estimated H’s overall abilities to be in the low average (nonverbal) to average (verbal) range; her performance on screening measures of academic achievement were somewhat above expectations based on her estimated level of overall ability with no evidence of an underlying learning disability.  H’s performance on formal cognitive testing revealed that she was performing below her potential in several aspects of cognitive functioning, most notably in the areas of attention and response control (auditory worse than visual).  This finding, coupled with her mother’s report of symptoms, problems in the classroom, and other evidence of deficits in attention that were significantly impacting her daily functioning, warranted a diagnosis of AD/HD, combined type.  Her mother also commented several times on H’s clumsiness and tendency to sporadically fall into stationary objects. Upon initial observation, it was noted that H exhibited extremely poor vestibular and proprioceptive abilities as well as poor coordination and somewhat awkward gross and fine motor movements.

Therapeutic Goals: Initially, sensory-motor integration and visuo-motor coordination activities; higher order attention, working memory, and executive tasks were later integrated into her therapies.

iLs Program Used: iLs Total Focus Concentration/Attention Program (40 one-hour sessions), three times per week (Monday, Wednesday, and Friday) in clinic; approximately six one-hour sessions were conducted at home due to scheduling conflicts.   

Other Interventions used:Cognitive-Behavioral interventions were utilized in conjunction with iLs to focus on specific functional difficulties and areas of cognitive deficit that were identified on neuropsychological testing and other data collected in the initial evaluation.

Post-treatment evaluation:  At baseline, H obtained an estimated Full Scale IQ of 85 (low average range).  An analysis of her index scores revealed slightly better developed verbal vs. nonverbal abilities (Verbal = 92, average range; Nonverbal = 83; low average range) (all based on mean=100; SD =15), a statistically significant though not uncommon difference that was seen in 25% of the standardization sample.  H’s post-treatment performance on this measure yielded a Full Scale Estimate of 103 (average range), representing an 18-point increase over her baseline performance.  This increase was largely due to a 25-point improvement in her nonverbal index, which reversed the verbal-nonverbal discrepancy that was present at her baseline testing. 

 

WASI – II

Subtest

Raw

T-score

Scale

Sum of T-scores

Composite

Score

%ile

Rank

Confidence Interval (95%)

Block Design

(17)30

(40)50

Verbal

(90)   97

(92)  98

30 (45)

(86-99)  91-105

Vocabulary

(25)30

(44)51

Nonverbal

(79)  110

(83) 108

13 (70)

(77-92) 100-115

Matrix Reasoning

(12)22

(39)60

Full Scale

(169) 207

(85) 103

16 (58)

(80-91)   97-109

Similarities

(22)23

(46)46

 

 

 

 

 

Confidence Level (IQ =(103  )

Difference

Raw

Significance

Base Rate

 

 

90%

68%

VCI>PRI

10

.15

20%

 

 

(85-87) 103-104

(85-86) 103-104

VCI<PRI

 

 

 

 

 

*pre-treatment scores are in parentheses

With the exception of psychomotor speed, H’s post-treatment performance on cognitive measures reflected an improvement to the average range of functioning in all cognitive domains, which correlates with the improvement of her estimated overall level of ability from the low average to the average range. 

 

Patient Profile

Percentile Range

> 74

25 – 74

9 – 24

2 – 8

< 2

Standard Score Range

> 109

90 – 109

80 – 89

70 – 79

< 70

Domain Scores

Subject Score

Standard Score

Percentile

Valid

Score

Above

Average

Low
Average

Low

Very
Low

Neurocognitive Index (NCI)

N/A

 

37

Yes

 

X

O

 

 

Composite Memory

100

 

47

Yes

 

XO

 

 

 

Verbal Memory

51

 

32

Yes

 

X

 

 

 

Visual Memory

49

 

63

Yes

 

XO

 

 

 

Psychomotor Speed

133

 

19

Yes

 

O

X

 

 

Reaction Time

677

 

55

Yes

 

X

O

 

 

Complex Attention

22

 

30

Yes

 

X

 

O

 

Cognitive Flexibility

25

 

40

Yes

 

X

O

 

 

Processing Speed

38

 

19

Yes

 

X

O

 

 

Executive Function

33

 

55

Yes

 

XO

 

 

 

X = Post-Treatment; O = Pre-treatment

 

In the area of attention, H’s baseline performance revealed significant deficits in auditory (though not visual) response control and low average abilities to sustain her attention over extended periods of time for both auditory and visual information.  H’s post-treatment performance in this arena revealed a significant improvement in auditory response control as well as in both auditory and visual sustained attention, both of which improved to the average range.

 

IVA Continuous Performance Test

Response Control

Attention

 

Baseline

Post Rx

 

Baseline

Post-iLs Rx

Full Scale Quotient

73

88

Full Scale Quotient

90

105

Auditory

55

75

Auditory

92

106

Visual

93

99

Visual

88

103

Lower scores reflect greater deficits

 

H’s parents completed the iLs checklist at baseline and post-treatment.  Their observations revealed no significant differences between baseline and post treatment ratings. 

 

iLs Checklist

 

Baseline

Post Rx

% Improvement

Sensory and Sensory Motor

37

37

0

Auditory/Language

14

15

0

Social/Emotional

15

13

0

Organization/Attention/Cognitive

19

14

0

Higher scores reflect greater deficits

 

At baseline, H’s parent’s ratings of her executive abilities on the Comprehension Executive Functioning Inventory (CEFI) resulted in an overall classification that fell in the low average range with lower scores in the area of initiation and significant relative weaknesses in attention (2nd percentile) and working memory (2nd percentile).  Post-treatment, H’s full scale score significantly improved from the low average to average range with statistically significant improvements being seen in the areas of attention, emotional regulation, flexibility, and working memory. 

 

Comprehensive Executive Function Inventory (CEFI)

 

Baseline

Post Rx

Significance

Full Scale

83

96

Significant

Attention

70

93

Significant

Emotional Regulation

80

95

Significant

Flexibility

106

124

Significant

Inhibitory Control

102

109

No Change

Initiation

78

90

No Change

Organization

80

85

No Change

Planning

98

105

No Change

Self-Monitoring

93

93

No Change

Working Memory

68

84

Significant

Lower scores reflect greater deficits

Summary of Changes: H’s full scale IQ estimate increased by 18 points (from the low average to the average range), mostly due to a significant 25-point improvement in her nonverbal index, which reversed the verbal-nonverbal discrepancy that was present at her baseline testing.  H’s performance on screening measures of academic achievement revealed no significant differences between baseline and post-treatment assessment, with her results being most notable for an unusual decline in word reading performance that is of uncertain etiology or significance.  H’s performance on formal cognitive testing revealed significant improvements on measures of complex attention, reaction time, cognitive flexibility, and processing speed, as well as significant improvements in auditory response control and both auditory and visual sustained attention.  Although her parent’s rating on measures of executive functioning suggested significant improvement in attention, emotional regulation, flexibility, and working memory, a comparison of baseline to post-treatment rating on other behavioral measures completed by H’s parents revealed no significant differences in symptom ratings that correlated with the improvements seen on formal cognitive testing and their functional ratings on the CEFI. 

 

 

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Significance of Bone Conduction Featured on CNN

Significance of Bone Conduction Featured on CNN

This is a great article from CNN that describes some spectacular uses for bone conduction, which is a feature of iLs therapy. Many parents are skeptical of bone conduction because it isn’t something that is commonly seen in behavioral therapy. This link is a good start to understanding its significance a little more clearly. 

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iLs and ASD

ASDs (Autism Spectrum Disorders) are characterized, in varying degrees, by difficulties in social interaction, verbal and non-verbal communication, hypersensitivities, attention, motor coordination and repetitive behaviors.

iLs addresses the development of whole brain/body integration through a staged developmental approach, starting with the fundamentals of sensory integration and then extending through more complex cognitive functions, including language, self-expression, and social skills. We support a multi-disciplinary approach to helping those on the autism spectrum, including behavioral, relationship-based, sensory and bio-medical methods. 

iLs & Other   Therapies:

iLs is an effective   intervention on its own or may be implemented in conjunction with a range of   other therapies, such as Speech, Occupational and Physical Therapy.

iLs and   Behavior-based Interventions:

Many ABA trained   therapists implement iLs alongside ABA. The benefits of this combination are   evidenced by both immediate (better quality ABA sessions) and long-term   results (social/behavior change is accelerated by improved regulation and   processing);

iLs &   Relationship-based Interventions:

DIR/Floortime,   Relationship Development Intervention (RDI) and SCERTS are excellent   complements to iLs’ approach. iLs headphone equipment can be worn   simultaneous to these approaches with children over 2 years of age.

Supporting Research

In 2012 an independent, non-profit research group conducted a survey with therapists who had used iLs with over 1300 children on the autism spectrum.

OUTCOME MEASURE

PERCEIVED FREQUENCY OF IMPROVEMENTS

 

Never

Rarely

Sometimes

Often

Always

Often+Always

Motor Coordination

 

1%

10%

40%

47%

87%

Self-Regulation

   

10%

46%

41%

87%

Sensory Int/   Processing

   

7%

40%

50%

90%

Arousal

   

13%

53%

28%

81%

Attention

   

13%

54%

33%

87%

Transitions

 

1%

10%

61%

24%

85%

Following Verbal   Directions

   

14%

47%

37%

84%


Spiral Foundation Study

The Spiral Foundation of Boston, MA conducted a controlled study of 18 children diagnosed with autism. Significant improvement was shown in the areas of social skills and emotional regulation; quantity and quality of atypical and problem behaviors including behavior during treatment; number and severity of autistic behaviors; and overall functional adaptive behavior skills; visual, fine and gross motor.  The iLs programs were conducted at home by parents. The full paper has been submitted for publication.

Clinical Feedback

Hundreds of iLs-trained therapists are working with the ASD population, and their constant feedback helps iLs management continually improve the program and training. Specific advice from experienced therapists using iLs with ASD includes the following:

  • Acclimation:      Begin with short sessions at low volume; be patient, most kids acclimate      within a few sessions but some take longer!
  • Resisting headphones:      iLs training includes tips on how to get headphones on kids who at first      resist the auditory and tactile sensations
  • Program Choice:      the iLs Sensory Motor program is specifically designed as a gentle program      for those with sensory processing challenges and hyper-sensitivity
  • Frequency:      longer programs with frequent sessions realize the best results, e.g. 4-6      sessions per week for 60 sessions (many kids prefer doing it daily once      they feel the more regulated effect)
  • Complementary:      iLs is typically, but not always, used in conjunction with other      therapies, e.g. OT, PT, Speech, ABA and Floortime. These therapies, and      others, are complementary and can be done simultaneous to iLs.

 Autism Survey with iLs Professionals: In what areas is iLs effective?

OUTCOME MEASURE

PERCEIVED FREQUENCY OF IMPROVEMENTS

Sensory-Motor/   Behavior

Never

Rarely

Sometimes

Often

Always

Often+Always

Acting Out

 

1%

20%

46%

28%

74%

Balance

 

1%

16%

42%

38%

80%

Digestion

3%

12%

27%

19%

5%

24%

Motor Coordination

 

1%

10%

40%

47%

87%

Motor Planning

 

1%

14%

41%

40%

81%

Self-Injurious   Behaviors

2%

1%

28%

20%

8%

28%

Self-Regulation

   

10%

46%

41%

87%

Sensory Int/   Processing

   

7%

40%

50%

90%

Self–Stimulatory   Behaviors

1%

3%

31%

31%

19%

50%

Sleep

1%

1%

25%

40%

12%

52%

Social-Emotional   Skills

Never

Rarely

Sometimes

Often

Always

Often+Always

Arousal

   

13%

53%

28%

81%

Attention

   

13%

54%

33%

87%

Awareness of   Personal Space

 

2%

19%

45%

25%

70%

Mood

 

3%

17%

50%

28%

78%

Self Confidence

 

1%

18%

46%

25%

71%

Sleep Transitions

 

3%

20%

36%

9%

45%

Transitions

 

1%

10%

61%

24%

85%

Language/ Academic   Skills

Never

Rarely

Sometimes

Often

Always

Often+Always

Auditory Processing

1%

 

11%

41%

38%

79%

Expressive Language

   

19%

44%

31%

75%

Following Verbal   Directions

   

14%

47%

37%

84%

Processing Verbal   Commands

   

13%

45%

36%

81%

Reading

 

2%

22%

40%

12%

52%

Social Skills

 

3%

24%

51%

20%

71%

Writing

1%

5%

27%

38%

12%

50%

 

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Introducing Dreampad

Introducing Dreampad

The Dreampad™ delivers music through gentle, calming vibration which only you can hear. The process brings about a relaxation response from the body and mind which has been aptly described as a “massage to the nervous system.”

*Reduce stress
*Improve sleep – falling asleep and staying asleep
*Decrease sensory hypersensitivity

Click the image above to learn more!

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