 PRIMARY DIAGNOSIS |
 |
 Reactive Attachment Disorder, severe
Expressive Language Disorder |
MEDICATION HISTORY
None known
FAMILY HISTORY
Biological Father: learning disabled. Reported behavior problems in childhood and adolescence. Addiction to alcohol, marijuana, and crack cocaine.
Biological Mother: Speech problems and behavior problems in childhood and adolesence. Epilepsy. both parents were foster children themselves.
Present situation: The state has custody of KG. History of multiple foster care placements. Moved due to his need for constant supervision and dangerous behaviors. At the time of this report, he is placed (Winter 1998) in foster home with no other children and with intelligent, caring parents who are presently preparing to adopt him. These parents brought KG to me within a week of his arrival for training. They have paid for his training out of pocket.
Relevant Past History:
Pregnancy was marked by exposure to mother's seizure medication, either Depakote or Dilantin. Mother had grand mal seizure the day before delivery. Labor was precipitous (25 minutes) with birth weight of 5 lbs. 7 ozs.
First six months he was said to have seizures, pneumonia and anemia. During first year functional difficulties noted included unpredictable appetite, poor sleep, headbanging, and hospitalization for failure to thrive. Apparent fall from a 3rd story window at age 3 years. Two serious attempts to kill younger sibling.
PRESENTING PROBLEMS and RESPONSE TO NEUROFEEDBACK (35 sessions)
|
1. Nightmares and night terrors throughout most of the night. Very poor sleep, usually less than three hours, needs attention throughout the night. Doesn't nap. Uses grunts instead of speech. Does not obey.
| NIGHT TERRORS ELIMINATED. NIGHTMARES ALMOST ENTIRELY GONE. SLEEPS THROUGH NIGHT, AVERAGING 12 HOURS. PARENTS ABLE TO PUT HIM TO BED AND LEAVE ROOM. NAPS EVERY DAY. These changes occurred within the first week of training. |
2. Hyperactivity-unable to sit for more than a few seconds
| SITS FOR 30 MINUTE SESSIONS WITH MOM NEXT TO HIM. ABLE TO COMPLETE TASKS. ABLE TO SIT FOR 15 MINUTE PERIODS PLAYING. |
3. Aggressive behavior
4. Grinding teeth
5. High pain threshold
6. Manipulative/controlling behaviors
7. Speech delay
| EXPRESSIVE LANGUAGE HAS WORSENED |
8. Tantrums
9. Anxiety
| LESSENED TREMENDOUSLY. PREVIOUSLY, VISITS WITH NATURAL PARENTS WOULD LEAVE HIM IN A STATE OF TERROR FOR DAYS. |
10. Impatience
| STILL EVIDENT/ LESS SEVERE |
11. Lack of trust
| EVIDENCE OF A DEEPENING TRUST WITH FOSTER PARENTS AND OTHERS |
12. Abusiveness to animals
| NONE OBSERVED. HE HAS NEED TO BE TAUGHT HOW TO BEHAVE WITH CATS IN HOUSE |
13. Sexualized behavior
| GREATLY REDUCED, NOW RARELY SEEN |
14. Refused physical contact
| INSISTENT ON GETTING HUGS |
15. Avoids eye contact
| WILL LOOK YOU IN THE EYES WHEN ASKED TO. THIS HAS TAKEN A LOT OF WORK WITH FOSTER PARENTS. |
16. Defiant
| AT TIMES, MUCH LESS THAN BEFORE TRAINING |
17. Unable to play with other children
| IS ABLE TO PLAY WITH NEIGHBOR'S CHILD IN POSITIVE MANNER |
18. Lacks remorse
| BEGINNING TO SHOW SIGNS OF GENUINE REMORSE |
19. Accident prone
20. Punishment has no effect on behavior
| PARENTS DO NOT USE PHYSICAL PUNISHMENT. HE IS BEGINNING TO UNDERSTAND BEHAVIOR and CONSEQUENCES :CAUSE AND EFFECT |
21. Lacks appropriate fear
|
|
Sessions (#) |
Site(s) |
Reward Band |
Inhibit Band |
Min. |
|
1 |
C4 |
10-13 |
4-7 |
18 |
|
5 |
C4-P4 |
10-13 |
2-7 |
18-30 |
|
15 |
C4-P4 |
9.5-12.5 |
2-7 |
30 |
|
2 |
C4-P4 |
9.5-12.5 |
2-7 |
29.30 |
|
C3 |
13-16 |
2-7 |
.30 |
|
4 |
C4-P4 |
9.5-12.5 |
2-7 |
29 |
|
C3 |
13-16 |
2-7 |
1 |
|
7 |
C4-P4 |
9.0-12.0 |
2-7 |
30 |
|
1 |
C4-P4 |
9.0-12.0 |
2-7 |
29 |
|
C4-FP1 |
9.0-12.0 |
2-7 |
1 |
Unable to test with TOVA
KG has made remarkable progress. He seems to be quite a different child. I am again trying left side training as his expressive speech has deteriorated. He is becoming very frustrated in his attempt to express himself and wants very badly to do so.
Given his response to the first three months of training, it is reasonable to assume that KG's prognosis is good. We anticipate that he will need in excess of 100 sessions. With the continued support of excellent foster parents and NF, KG has a very good chance to work through a terrifying, neglectful and abusive beginning.
UPDATE: KG is now adopted, his language is improving significantly ( he speaks on the answering machine), he is a well behaved, and a genuinely affectionate 6 year old child. He is being home schooled because he still experiences some difficulty in large groups. He is also being trained with neurofeedback ( now over 150 sessions) regularly at home by his parents, who are actively lobbying the State to cover Neurofeedback training for attachment disorder. He is at grade level. He still sleeps twelve hours a night and plays in his room on his own until his parents come for him. His parents report that the changes in him, the ongoing changes, continue to amaze them. 'He is truly learning to trust and to love.'
Catherine Rule, M.Ed.,CAGS, CRC
|
