ADHD Case Study 3

KW – 9 Year Old Male with ADHD with stammering

DIAGNOSIS
 ADD/ADHD
 Stammered oral communication
 Lack of concentration
 Aggression

 HISTORY
Perinatal: prenatal stress or injury–respiratory, prenatal drug exposure to unknown , 5 wks Respiratory problems after birth; placed in foster care after birth;placed in adoptive home at 2 months; adoption final at 2 years.

Growth and development: activity level normal to high; gross motor skills normal/fine motor slightly slow; many ear infections/does not like to be touched /held; some aggression; right handed; lack of appetite; some stammering.

Physical traumas: none known.

 PROBLEMS
From Children’s Problem Check List:
 Emotions: some anxiety, no depress, fears bugs and public speaking
 Self-concept: likes himself
 Peers and play: friends–many friends, frequently on again and off again relationships
 School: work about half done, not neat, all directions not followed, some problems with other students and occasionally with teachers, it was suggested Rusty repeat 4th grade
 Language and thinking: verbal expression poor, very good memory, confused frequently, reading very good, spelling very good, writing poor, math good, art poor
 Concentration and organization: attention poor, very distractible and impulsive
 Activity level and motor activity: over active, coordination slightly slow, a little accident prone, slight vocal tic (stammers when under stress)
 Behavior: a little uncooperative, definitely inflexible, unpredictable, manipulative, defiant and aggressive
 Values: lies a lot, no cheating or stealing, does know right form wrong, does have guilt feelings
 Habits: little sleep needed (child reports that he does not dream), enuresis until age 4-5, poor appetite, no known food sensitivities, craves sugar, is compulsive with Nintendo
 Health: is not ill frequently as when younger, headaches a lot, some stomachaches, no allergies or asthma or fatigue or pain or seizures, no hearing problems except when not paying attention, no vision problems, under medical care for AD/HD.

From Child’s Check List:
From Parent’s Check List:
 Have trouble falling asleep  Picks at things (nails, fingers, hair)
 Feel restless a lot of the time  Excitable, impulsive
 Sometimes do things without thinking even though I know I might get into trouble  Difficulty learning
 Hard time paying attention  Restless in the “squirmy” sense
 Afraid of meeting new people or doing new things  Fearful of new situations, people or places, or going to school
 Sometimes tell sorties that are not true  Tells lies or stories that aren’t true
 Quiet and shy around people  Shy
 Things just happen and they are usually not my fault  Denies mistakes or blames others
 I don’t give in easily and like to argue  Quarrelsome
 Hate it when someone tells me what to do  Disobedient or obeys but resentfully
 I start things but have a hard time getting them finished on time or at all  Fails to finish things
 Once I start something I find it hard to stop (tapping, wiggling, humming, etc.)  Distractibility or short attention span
 Have headaches a lot  Headaches
 If something seems to be hard to do I usually want to give up  Doesn’t get along well with brothers or sisters (some)
 Don’t get hungry very often  Easily frustrated in efforts
 Have a hard time sitting still through an entire meal  Problems with eating (poor appetite)
 I eat when not hungry  Problems with sleep (hard time falling asleep)
 My brother/sister gets more stuff and attention than I do.  Feels cheated in the family circle (questions his adoption).

 CURRENT MEDS:
Adderol for ADHD, 15 mg daily

 TRAINING HISTORY:

 1. C3 beta 5 periods, C4 SMR 6 periods, C4 SMR 7 periods, C4 SMR 4 periods

notes: did practice TOVA twice before completing test–shuts down under pressure

 2. C4 SMR 3 periods, C4 SMR 7 periods, C4 SMR 4 periods, C4 SMR 4 periods

notes: Client didn’t sleep well last night, went to bed around 9 and fell asleep around 1 am. Could have been any number of reasons, from doing beta (?) to having his TV taken away.

 3. C4 SMR 2 periods, C4 SMR 6 periods, C4 SMR 5 periods

notes: trouble getting to sleep, had “slight accident” after last session, 2-21/2 hrs to get to sleep and woke 3x before 7 am. wants to try another game…very high theta

 4. C4 SMR 5 periods, C4 SMR 10 periods

notes: sleepwalking but not since the night of the 12th of August. no longer has been sleepwalking…mother just made me aware that he has in the past

 5. C3 beta 5 periods at F 14 filter (11-14 Hz), C4 SMR 15 periods at reg. filter

notes: asleep in 20 minutes and sleeps the night, wakes bright and ready to go, not groggy when awakened as in past…father noted that Client is reading longer and plays games better, seems to have better recall (rules and how to play).

 6. C3 beta 5 periods (11-14), C4 SMR 15 periods

notes: second session today, likes beta; says it is easier.

 7. C3 beta 8 periods (15-18), C4 SMR 12 periods

notes: better at explaining math problems, sleeping very well, got up on his own this a.m. Mom cut med. on Saturday, no difference. Before when cut med. it was noticed right away.

 8. C3 beta 10 periods (4 at 15-18, 6 at 11-14), C4 SMR 10 periods
 9. C3 beta 5 periods (11-14), C4 SMR 15 periods

notes: headache and didn’t sleep well last 2 nights, not stuttering as much. Wiggly today.

 10. C3 beta 10 periods (11-14), C4 SMR 10 periods (One Month later)

notes: Did another TOVA today. Still forgetting assignments and forgets to turn in school work completed at home. Not stuttering unless pressured, used to be all the time.

 11. C3 beta 11 periods (11-14), C4 SMR 9 periods

notes: A+ on spelling test, very responsible Friday and over weekend.

 12. C3 beta 5 periods (11-14), C4 SMR 5 periods
 13. C3 beta 5 periods (11-14). C4 SMR 5 periods

notes: been having some trouble sleeping, sleeps better when sessions are consistently spaced during week. Small amp waves today.

 14. C3 beta 10 periods (11-14), C4 SMR 10 periods
 15. C3 beta 5 periods (11-14). C4 SMR 5 periods

notes: stammering is better, even his drawing has improved.

 16. C3 beta 1 period (11-14), C3 beta 5 periods (11-14), C4 SMR 7 periods
 17. C3 beta 5 periods (11-14), C4 SMR 5 periods  18. C3 beta (11-14 Hz) 9 periods, C4 SMR 11 periods

notes: Had trouble concentrating today.

 19. C3 beta (11-14 Hz) 10 periods, C4 SMR 9 periods (2 Months since start)

notes: still sleeping well, speech improving…little stutter now except when under pressure, grades all above class overage on progress report.

 20. C3 beta (11-14) 10 periods, C4 SMR 9 periods

notes: did 3rd TOVA today

 21. C3 beta (11014 Hz) 9 periods, C4 SMR 10 periods

notes: Client scored higher in every area on TOVA, insurance approved 20 more sessions, mom is ecstatic.

 22. C3 beta (11-14 Hz) 2 periods, C3 beta (11-14 Hz) 3 periods, C4 SMR 5 periods
 23. 10/28/98 C3 beta (11-14 Hz) 8 periods, C4 SMR 11 periods  24. 10/29/98 C3 beta (11-14 Hz) 9 periods, C4 SMR 7 periods (changed reference to Pz at 11)

notes: sick with bronchitis, on antibiotic. Switched to C4/PZ at 11 and coughing seemed to have calmed to almost nothing.

Letter from Mother

EEG Spectrum
c/o Catherine Lewis

As per your request here is an update on that which we have observed to be KW’s progress since he started his biofeedback 10 weeks ago

1. KW has gone from taking 1 1/2 hrs to fall asleep, while waking several times afterward, to falling asleep in less than 20 min. And waking only on a rare occasion.

2. KW’s speech disorder of repeating 4-5 words 20 times before completing a sentence is reduced to repeating only 3-4 times when he is tired.

3. KW no longer picks at his fingernails.

4. Last year KW lost 2 1/2 lbs and since his treatment he has gained almost 4 lbs.

5. With each progress report that comes home from school, we see a decline in missing assignments. KW’s organizational skills and responsibility levels are improving.

6. KW is now able to make eye contact with other people and will exchange common pleasantries. Prior, he would not look or answer strangers and 50% of the time it was the same with familiar acquaintances.

7. One of the main problems was that KW would have complete verbal shut downs when challenged or afraid. He has only had 2 or 3 during the beginning of the treatment. We used to experience these on a weekly basis, 2-5 times per week.

KW is much more in control of himself. He is more subdued but not lethargic. He is getting along better with his friends and is a much happier child over all. We are very pleased with the results. KW’s meds were reduced from 15 mg. Adderol to 10 mg. After a few weeks. We are looking forward to the absence of meds all together.

Thank you

Catherine Lewis
EEG Spectrum of Modesto
P.O. Box 577493
Modesto, CA 95357-7493
209-544-1611

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