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.)
Matthew Clarke
An eleven
year old boy with perplexing behaviors and Tourette’s Syndrome
As she shared tales of life with her son Matthew, Molly’s anguish became evident. The escalating intensity and frequency of Matthew’s peculiar behaviors left Molly grappling with her own emotions and unsure of where to turn next for help. At a HANDLE Community Information Night, Molly told of how Tourette’s Syndrome, along with other puzzling and distressing behaviors, were stifling the chances of a normal life for Matthew, as well as for their family.
Life moved at a stride far too rapid for Matthew. Consequently, he proceeded through his day at a pace others would find excruciatingly slow. Once awake in the morning, it took a considerable length of time before he was ready to eat breakfast. Following breakfast, he needed time to recover before getting dressed then another long wait was essential before he could brush his teeth. The velocity of an ordinary day easily overwhelmed Matthew, and his response was often physical. If he could not be allowed the luxury of moving to his own internal rhythm, he was apt to throw-up.
Matthew’s days were punctuated with various motor tics, including jumping and eye blinking. They came and went, as tics do. His family was unsure if his frequent gagging was a tic or if Matthew was experiencing stomach problems. Matthew endeavored to disguise his vocal tics by using a high-pitched voice and acting clownish. At eleven years old, Matthew did not drift too far from Molly, and he needed to know where she was at all times. He was compelled to physically touch Molly, hug her, kiss her, or tell her he loved her every few minutes.
Matthew’s sluggishness and inability to separate from Molly rendered a traditional school setting impossible, so Molly home-schooled him for the past two years. Academically, writing and math were both problematic and he was unwilling to read anything but short, simple books. Although Matthew was very creative and loved history, science and art, Molly was becoming increasingly doubtful that he would be able to accomplish much in the way of academics as his tics and idiosyncratic behaviors had lately become irrepressible and ceaseless.In utero, Mathew had been anchored in position by his umbilical cord, which was less than nine inches long and was stretched so tight that it resembled a thread, rather than a rope. Essentially immobile, Matthew’s jawbone had been molded around his shoulder where it was wedged.
Despite a post-date delivery by C-section, Matthew’s APGAR was satisfactory and he did not require additional time in the hospital.
At home, however, Matthew had difficulties sleeping and was generally discontent. When he was two months old, doctors discovered that Matthew had a double hernia. Once repaired through a surgical procedure, Matthew’s disposition mellowed and he was able to sleep. The respite, however, was short lived. Matthew experienced convulsions following his second DPT shot between three and four months old. His chronic ear infections through age two prompted more surgeries -- two sets of tubes and two eardrum grafts. His severe asthmatic condition necessitated the use of a nebulizer around the clock.
As Matthew matured, sensory integration problems surfaced. Matthew was hypersensitive to light, sound, smell, touch, and taste. He demonstrated aversions to various textures in food. Going barefoot was unpleasant for Matthew, and at eleven years, he had only just learned to tolerate walking in the sand. He was somewhat compulsive about hand washing, although he hated, almost feared other encounters with water. He would shower reluctantly, and only if his mom or dad were with him in the bathroom.
At the time of his HANDLE assessment, Matthew had been taking Risperdol to help relieve some of his symptoms, but the medication had caused him to gain unwanted weight.
Those who come to The HANDLE Institute seeking relief from the symptoms of Tourette’s Syndrome typically suffer from a heightened sensitivity to light. As the practitioner and intern observed Matthew crawling under chairs and covering his head to ease his discomfort with the overhead lighting, they immediately recognized that Matthew was no exception. When the lights were dimmed, and pastel paper was substituted for white, not only did Matthew perform better on the visual worksheets, but he also experienced fewer tics.
Additionally, Matthew was quite challenged on tests requiring accurate binocular vision. On the Brock string test, he was unable to bring the near bead into focus, and he was confused by a different task that entailed visually untangling images from one another. Binocular weakness was further confirmed in a task that employed glasses with different colored lenses. Despite these visual disturbances, when asked to close his eyes, Matthew was reluctant to do so, although we were able to use a bandana as a blindfold to complete these portions of his assessment.
On the auditory sequencing segment, the "k" sound caused him noticeable difficulty, until the final test item, which he got right on the first try, having been told that it was the last one. When answering questions after listening to a thirteen-word sentence of simple structure, he was unsure of some details. Although Matthew enjoys listening to stories, and ordinarily comprehends their meaning, Molly indicated that he often has difficulty following directions, and works best when given one instruction at a time.
Matthew generally seemed to avoid moving his arms across the center of his body, commonly known as midline crossing. He also had a great deal of trouble performing a repetitive motor pattern on a button sorting task, particularly when distracted by conversation. Matthew also struggled significantly when asked to alphabetize the names of five animals in his head, however, on an organizational task that was spatial in nature, involving no words, he did remarkably well.
During the assessment, evidence of low muscle tone was noted. This was established based on Matthew’s tendency to either lean on the desk unless he was in motion. It appeared that he remained in motion because Matthew intuitively knows that there is less effort required in sustaining motion than in overcoming inertia. Additionally, the movement was a means of activating Matthew’s severely inadequate vestibular system, thus helping him to maintain an alert state and equipping him with the ability to focus on performing the assessment tasks.
In fact, Matthew’s vestibular system was so fragile that a pace of life easily tolerated by most people caused Matthew to throw up. The gestational circumstance of being anchored in utero, coupled with a thread-like umbilical cord that was surely unable to transmit an adequate supply of nutrients to a growing baby, were likely to have compromised his developing vestibular system in the womb.
Proprioception, a sense of ease with one’s own body in space, is supported by a healthy vestibular system. In Matthew, this sense was greatly underdeveloped. This was one reason why Matthew was hesitant to close his eyes during specific assessment tasks, and his mother’s proximity was so vital to his sense of security. His proprioceptive weakness, in fact, produced such insecurity in Matthew that, at eleven years old, he would not go solo into the men’s room, but continued to request that his mother accompany him to the women’s room.
Matthew showed a clear preference for his right hand, right eye and yet it appeared that the right hemisphere of his brain was dominant. (Generally, it is assumed that brain dominance develops on the side of the brain that is opposite to the dominant body side.) When interhemispheric integration, the connection between the two sides of the brain, is not strong, it is difficult to engage in fluid mental processing in coordination with motor planning and execution of behaviors. Matthew’s reluctance to cross the midline of his body, difficulty with alphabetizing words mentally, and his confusion on the button sorting task indicate that Matthew’s interhemispheric integration needed strengthening to enhance his mental efficiency.
From his early and repeated experiences with medication (steroids before the age of two for his asthma, numerous antibiotics for his chronic ear infections, later medication for his tics and quirky behaviors) and with anesthesia for his several surgeries, the practitioner suspected toxins as a causative factor in Matthew’s many hypersensitivities. This suspicion was supported by Matthew’s adverse reaction to a DPT immunization. It is possible that Matthew’s fetal development was also affected by toxins, since his father, a boat builder, had almost continual exposure to toxic substances.
Given the extreme fragility of his systems, Matthew’s initial program of activities was very gentle.. Slow movements designed to carefully stimulate the vestibular system were recommended. Additional activities of drinking through a crazy straw and blowing air through a tube were suggested to reduce light sensitivity and refine visual binocularity. Face tapping, joint tapping and the peacemaker massage were intended to strengthen proprioception and muscle tone, and a simple clapping game to enhance interhemispheric integration was proposed. Together, these activities fashioned the essence of Matthew’s program. Adjunct therapies and activities, such as cranio-sacral therapy for releasing tension in his skull and spine, as well as in myofascial (connective) tissue, were also suggested to complement the activities.
Immediately following Matthew’s evaluation, Molly stopped giving Matthew the Risperdol on the decision to fully immerse themselves in their HANDLE program and gauge the results without the interference of medication. (Please note that this is not a procedure that HANDLE practitioners recommend, as it is generally unwise to discontinue medication abruptly and without medical supervision.)
Initially, Molly reported a slight increase in Matthew’s activity level and ticking after the cessation of his medication. However, his throwing up decreased markedly from numerous times a day to just once in a week. Molly discovered that performing the tapping and massage activities prior to Matthew’s rising helped to get him started in the morning and also provided him some relief from nausea.
Three weeks into Matthew’s program, we received a call from Molly. She was concerned that Matthew’s symptoms were beginning to worsen again, and that perhaps the current activity program was stressing Matthew. Molly was advised to eliminate certain activities and do fewer repetitions of others, always being mindful of the notion of gentle enhancement.
A month passed between Molly’s anxious phone call and Matthew’s next follow-up appointment. At this check-up, Molly reported notable signs of improvement. His tics were diminishing and the only incidence of throwing up was that morning when Matthew felt pressured to hurry due to his HANDLE appointment.
Soon Matthew began to test his ability to detach from Molly. He became comfortable sitting on the opposite side of the room from her and his drive to make physical contact was abating. On the ferry, Matthew felt competent enough to lead the way and even went alone to the men’s restroom!
He was now entering into social relationships with greater confidence. An overnight visit with a friend, which would have previously taxed him beyond his capacity, he managed handily. At his next visit, he made direct conversation with his HANDLE therapist rather than allowing Molly to confer on his behalf. At another appointment, we explored the origin of Matthew’s gagging, and learned that it began when a bully once tried to force Matthew to eat a snail. At this time, we introduced another complementary therapy Emotional Freedom Technique (a system relying on a structured series of reflex points on which to tap) to help diffuse the intense feelings associated with that experience.
Matthew’s focus was sharpening, and he began to read more frequently. He started enjoying math, and his handwriting improved. Although Matthew still moved slowly, he and Molly were finding that they could spend more time on his daily schoolwork.
When a succession of illnesses in Matthew’s family added considerable stress to their lives, regular implementation of Matthew’s activity program suffered. It was reassuring to Matthew, his family and his HANDLE practitioner that, during this time, he did not lose much of the progress he had made. The tics that did begin to reappear went away within a few days of resuming his program.
It was not long before people in his community began to recognize positive changes in Matthew. When the family doctor dropped in to check on Matthew’s dad during his illness, he noticed Matthew sitting calmly in a chair, conversing. He was amazed, as the last time he had seen him, Matthew was displaying many uninhibited motor movements and bouncing about the room. The doctor looked inquisitively at Molly and asked, "What happened?"
By the end of the six-month HANDLE consultation period, food no longer induced Matthew’s gagging at all. Matthew’s nausea was gone, even when he hurried or was unable to complete his morning routine of exercises before going out into the world. Since stopping the Risperdol, he had lost twenty pounds. Swallowing pills was a new skill that Matthew developed, and Molly was able to introduce a regimen of vitamin supplements specifically designed to ameliorate Tourette’s symptoms, and she began to augment his diet with fish oil so Matthew could benefit from its Omega 3 and DHA components—finally able to provide him the nutrients his body had not received adequately in utero and in his first eleven years.
For Matthew, an occasional eye tic is the only reminder of life before HANDLE. Matthew no longer uses a falsetto voice to mask vocal tics, as the tics have vanished. Molly is now considering activities Matthew can accomplish independently in the community, and she is anticipating some much-deserved time for herself. Molly now has hope for Matthew’s successful future, and Matthew, too, recognizes his success as a triumph. On New Year’s Eve, Molly asked Matthew what had been the best part of his year. His answer… “HANDLE!”
