CASE STUDY |
(The client's name has been changed to honor the family's request for confidentiality. All other details of the case are factual.)
Alan Lazarus
10 Year-old Boy Diagnosed with ADHD
"My son Alan went from crying at the prospect of doing homework
to the Honor Roll! This program really works!"
Referral Concerns Recommendations Background Information Follow-Up Observations Post Script of Concern Conclusions
When Alan first came to HANDLE he was a ten year old fifth grader with a history of problems in school. Teachers reported his "approach to class work is very chaotic", and he rarely could focus on one task for longer than two to three minutes. His mother said she had to "repeat instructions over and over". His school performance was getting worse each year. He was diagnosed with ADHD and it was suggested he begin Ritalin therapy. His mother was not willing to follow this course, so she was very interested when she heard David Essel recommend HANDLE for similar concerns on his national radio talk show, "David Essel ALIVE!".
During the assessment additional concerns were mentioned, including: Alan wished he could get his school work in on time and not be behind his classmates. His mother related the teacher's concern of his difficulty with verbal instructions, and her own concerns of Alan crying over his homework, and falling down a lot. Throughout the evaluation Alan was very cooperative although at times extremely lethargic.
Alan's birth had been traumatic. After 36 hours of labor the doctors had pulled Alan out so forcefully that he received a black eye. As a baby he was very sensitive to light and noise. He had sinus and ear infections frequently. His mother reported that he achieved early development milestones (crawling, walking talking, etc.) a little earlier than average. He crawled, however, without touching his knees to the ground. His mother stated that she frequently needed to sing for long periods of time before he would fall asleep, and that even today he tosses and turns once asleep. Alan felt he had out grown these behaviors. He added, however, that he did fall out of bed sometimes, even quite recently. He reported that he gets car sick, and that rides like a merry-go-round make him dizzy. Alan said he dislikes tight pants and tags in his shirt. He is also sensitive to some smells.
Alan spent most of the evaluation swiveling and rolling around in the office chair designed specifically for those who need such movement in order to focus their attention. For many of the exercises, he propped his elbow or arms on the table. He even turned the chair around so the back of the chair would support him as he leaned over to work. For tasks that he found extremely tiring (visual tracking in particular) he propped his head up with both hands to keep it still, and to allow his eyes to work without worrying about his body. Even so, his head moved while his eyes tried to track.
Whenever Alan was asked to write or draw something his thumb always avoided contact with the pencil. He also immediately shoved the paper and pencil away from him as soon as he was completed with a given task, so he could clear the surface for his arms, to again prop himself on the table.
Alan worked very hard during the evaluation. He was able to complete all the tasks and to recall correctly on most tasks of short term memory for tasks he had moved through, but had an extremely delayed response time, especially when multiple manipulations or sequencing was required. On occasion, Alan felt that he could remember the item only if he could draw it. On a structured task of midline crossing and interhemispheric integration, although he had begun to move buttons correctly in an alternating pattern, he got very confused as soon as he was engaged in conversation and expected to continue the learned movement pattern.
Although Alan exhibited right eye and hand dominance, he had some rivalry between his eyes. This inconsistency in focus seemed to cause him to loose his place at times. One of the ways this was noted when he was asked to point at the evaluator's nose. He had a tendency to close one eye to avoid seeing two fingers.
When given a series of nonsense syllables to repeat he had particular difficulty accurately recalling syllables with the "K" sound.. He demonstrated extreme delay in alphabetizing the names of five animals without writing their names, although he had excellent recall for the animals even half an hour after first working on the page where they were drawn.
Alan's sensitivity to certain fabrics, and his avoidance of contact between the pencil and the tip of his thumb were among the indicators that his sense of touch is irregular. That is, he is hypersensitive to tactile stimulation. This can be an extremely distracting condition.
Alan's reported car sickness, his need to swivel and move in the chair, his difficulty processing the "k" sound, and some of his sleep problems are indicators that he has a weak vestibular system. The following issues related to muscle tone, proprioception and visual tracking also support the conclusion that Alan's vestibular system is not strong enough to support the many functions for which it is responsible. Both his fine and gross muscle tone are weak. Because of this he needs to prop himself on the desk, support his head in order to use his eyes, and take breaks. The weak muscle tone also reduces the speed in which he can respond to any direction or perform any task.
His proprioception is weak, and with his eyes closed and without the ability to cognitively monitor his movements, he is so unsure of himself that he was still falling out of bed. Alan demonstrated many signs of visual deficits. He is extremely light sensitive. He has prescription bifocals at the age of ten. The rivalry between his two eyes is confusing, because he cannot be certain which eye is leading at any given moment unless he closes one eye or the other, in which case he loses three dimensional perception. Alan demonstrated distrust of his visual perception and visual memory, and took a long time to organize on all of related tasks.
The problems caused by Alan's weak muscle tone, poor proprioception and hypersensitive tactile sense are further aggriavated by his immaturity in differentiating or controlling which part of him he needs to bring to a given response. He tends to respond with some uninhibited reflexes and by brining more muscle groups into the task then necessary. This is turn causes problems in focusing on and internalizing the intended motion, since unintentional movements are also occurring.
In addition, Alan has difficulty with interhemispheric integration, the process through which both side of the brain work together efficiently. Alan tends to rely primarily on his right cerebral hemisphere ("right brain") functions-- creativity, whole picture, timelessness, etc.-- and uses a great deal of energy to access his left cerebral hemisphere ("left brain") functions--analysis to parts, sequence, orientation in time, etc.
With such a large number of number of immature and irregular systems, it is obvious that Alan did not have the underlying support systems for focusing and sustaining his attention flexibly and for completing tasks. All of which leads distress in relationship to school work, and to ultimate failure to achieve in school.
Alan received a customized program of activities, exercises and nutritional recommendations. The focus was to strengthen the weak underlying functions and to enhance the connections among the various functions. His program included several activities to strengthen his vestibular system. All of these were constructed to require no special equipment nor any significant reliance on muscle tone. In fact, the vestibular exercises and the special massage recommended to reduce Alan's hypersensitivity to touch were also targeting his muscle tone issues, to help strengthen this crucial function.
Simple, nontaxing activities were suggested to strengthen Alan's visual functions and reduce his light sensitivity, without stressing his weak vestibular system or relying on muscle tone and differentiation of eye movements from head movements. Other activities focused on increasing his ability to respond in a differentiated manner to stimuli, and to trust his sense of body in space. Yet other exercises helped develop the communication or integration between the two sides of his body and his brain, again without taxing other weak systems. Alan also was encouraged to supplement his diet with omega-3 fatty acids, to ensure myelination of those neural pathways which the exercises were creating and strengthening.
Alan's initial assessment took place in May. By the end of January of the following year, his mother wrote the following letter to David Essel to thank him for the referral to HANDLE.
Dear David Essel, Last year I was listening to your show and you recommended the HANDLE Institute for an alternative therapy for ADHD. At the time my son, then 10 in the 5th grade, had just been diagnosed with ADHD and the only thing I knew for sure was that under no circumstance was I going to give him Ritalin. My son's performance in school was getting worse each year. He could not keep up with the class. He was in a special math class. By far the most alarming consequence of his problem was that he couldn't seem to get in gear. I would watch as the class was given an assignment or taught a lesson. All the kids would get out their materials and follow along. My son would fumble around confused and scattered. He would finally get the materials together but by that point he had missed so much of what was being conveyed that he wouldn't be able to catch-up. At home under a constant barrage of haranguing him to do his homework, he would burst into tears.
I reached out to the HANDLE Institute like a life line. The thing that impressed me the most was they said they could cure him. Not regulate him with drugs but actually fix the problem which was weak neural connections. The other thing that was surprising was their total empathy with the kids. Children with this malady are socially scarred. They are always getting into trouble for their actions and people just don't like being around them. At the Institute however, they are accepted unconditionally for who they are. I have to admit, I was uncomfortable watching my son roll around the room on a chair and handle their video equipment. Well that was last year. We didn't actually get to the exercises until right before the 1996 school year began. I just received his first trimester report card. He had straight A's and B's and made the honor roll. I want to thank you for making such a tremendous difference in our lives. I love your show. Keep plugging the HANDLE Institute. It really works. Sincerely,
Hallette
Alan's family had received pre-authorization from their insurer to pay eighty percent of the cost of the HANDLE assessment and treatment program. When faced with the invoice, the claim was rejected on the grounds that the child was now ten years old, and developmental concerns were no longer covered. It seems ironic that the insurance company would have agreed to pay for regular visits to a medical doctor and for the monthly costs of prescription medication for an indefinite number of years, but refused to pay for treatment that dealt with the problems at its roots. Perhaps the case of Alan and so many others will convince both medical practitioners and insurance companies alike that treating the problem at its roots is preferable to merely masking the symptoms of a disorder day after day and month after month with prescription drugs.
