Sunday, June 22, 2008

Working with adults and teens

I plan to move into an adult practice during the next year. My husband and I are looking at a possible site for the clinic today. We will offer Interactive Metronome, Therapeutic Listening, Samonas Listening, psycho-therapy, and sensory integration therapy.

It is interesting for me to see and compare the difference in working with adults versus children. The poor folks who were sensory kids, but did not get therapy are now sensory adults who have self-adapted to the world around them and may still have a lot of difficulties in coping, adapting and interacting. The therapies that I use with children work with adults. The biggest problem is simply reducing the accumulated baggage that an adult has from years of dealing with physical, mental and sensory issues in the form of praxis, autism/Asperger's syndrome, and/or overall poor inter connectivity to the world and other people. Having access to psycho-therapy will help.
I am expecting to see fewer adult clients with autism than I do in my pediatric practice, but this will be offset by clients with traumatic brain disorder (TBI) and aging-related problems including stroke. I expect the same number of sensory-related issues and the issue of self-regulation will still play out strongly. For outcomes: those with auditory issues will be able to relax and be less volatile, those with vestibular issues will appear to be smarter and will probably act-out less. Those with social issues will lose fear of social situations and pay attention to social rules. Folks with TBI will find increased organization.

I'm not sure what to expect with teenagers. Probably a mixture of everything but stroke. And probably plenty of clients with autism.

My study of the adult parents of children with autism is near completion. There are still 2 post-tests to complete and then we can look at the results.

Auditory Fight or Flight

A large number of my pediatric clients have auditory issues. For most, the noise of a cafeteria or gym is too much to handle and they are put into fight or flight movement with unexpected or loud noises. They have been known to scream, run and cry in response to everyday situations making them very unpopular with teachers. In addition, they may talk to themselves or make unusual noises (vocal tics for example) that drive classmates nuts. These poor children have a very hard time making and keeping friends.

These sensory kids may or may not have autism - and it seems that a lot of them are on a sort of continuum from "typical" to "high functioning autism". My first step is to give the children strategies to keep their cool. I recommend earplugs (with a pediatrician's approval), or headphones in noisy environments. There are chewy necklaces and pencil grips that can provide them with oral input and serve to limit the vocal tics. Then I discuss ways to self-calm using breathing and focus on breathing. With one bright child, I explained what fight or flight means and suggested that she provide herself with self talk by telling herself that she is safe and that her reaction to noise is just an over-reaction by her body.

These strategies help, but not all children can use them independently. My next stage of therapy is twofold - vestibular stimulation and a listening program. We have Therapeutic Listening at our clinic.

Vestibular Stimulation
Given that the vestibular and auditory "organs" are in close physical proximity, it is common for a child with auditory issues to have vestibular problems as well. I look for dizziness or fear, and treat it by finding the plane (lateral, vertical, horizontal) and type of movement (rotational, linear, stationary, head down, etc) that makes the child dizzy or fearful. I then acclimate the child to the difficult positions and types of movement by alternating them with safe movement (usually linear swinging). I count out loud so that the child knows when the movements will start and end. This helps to remove fear. I have them check themselves for dizziness, and report on progress. These types of vestibular problems usually heal in just a few 15-minute sessions. It is harder to accomplish with a child with moderate-severe autism because they may not pay attention to what I am telling them (or may not initially trust me) and so go into a state of fear. The trick with them is to go slow and back off if it looks like it's going to backfire.

Listening Program
I am still new to listening programs, but have seen progress with my kids and my colleague's clients, too. Therapeutic Listening (TL), as I mentioned in another post, has 4 classes of CDs: self regulation, time and space, praxis and connectivity (to the environment). I use the self-regulation CDs to help reduce the fight or flight response and the time and space CDs to help with correcting the auditory imbalance itself. After that, I move to the connectivity CDs to try and help re-integrate the child into his/her environment, with the hope that it'll help with social issues.

The self-regulation CDs appear to make a person more passive - which can be good or bad. I tried a week's worth myself and had a friend do so, too. We both became noticeably calmer, but more passive. I stopped standing up for myself. I certainly don't want that to happen with my clients. So, when I see that symptom, I move to a third stage - Interactive Metronome (IM). Perhaps not a full program, but certainly enough to break the passivity and induce a shot of confidence. With one client, I moved in and out of TL and IM in the hopes that he would find an easy place to settle. It appears to have worked and he is discharged. I'll check back in a few months to see if he is still doing well.

Wednesday, June 18, 2008

Stay tuned

I have been incredibly busy the past few weeks - as all pediatric OTs certainly have been. I'll post updates and new material in the next several days and weeks. Lots to talk about!