Learning Disabilities Case Study 3

18 Year Old Male with Learning & Communication Disorders

M
age 18
IQ less than 45 on the WISC-R

First seen late March 1998

M had come at his mother’s requested. M is the product of a normal delivery. Development entirely normal until age 2, then child continued to develop with the exception of speech. At age 5 he was evaluated for school and placed in special classes where he received speech therapy. At age 9 he had a seizure, and was placed on tegratol which was discontinued after 3 years. No other seizures have been reported. Child behaved well, was passive, “not a problem”. His very concerned, proactive mother felt he could do better, and sought additional evaluations and help for him. At age 15 he was placed on a trial of ritalin for 1 month. The family was not satisfied with the results and dc the prescription. At one point they also tried a brief course of acupuncture but discontinued because client resisted.

 Previous reports:
Psychiatric report 10/4/95: Young man of 15. Diagnosed Learning Disorder NOS; Communication disorder NOS; r/o ADD

Psychological testing 10/11/95: WISC R – verbal less than 45, Performance less than 45, Full scale less than 40. Verbal tests: Information-1; Similarities-1; arithmetic-1; digit span-1. Performance: Pict. completion-1; pict. comprehension-1; block design-1; coding-1.

EEG 11/15/96. “16 yo male with memory loss”. Waking 21 channel EEG reveals posterior dominant rhythm of 11 hz and 30-40 uV bilaterally. Anterior head regions contained admixtures of similar and faster frequency activities. Vertex sharp waves and symmetrical sleep waves did not occur. Photic stimulation elicited no occipital driving force or abnormal discharge. Normal waking EEG.


Neurological 1/21/97: 16 yo male dx with PDD, mild MR. In special education, no particular problems. Hx probable seizure age 9, on tegratol from 9 until 12. Nothing remarkable.


3/29/98 – first visit. Performed TOVA, placed electrodes and took sample brain waves. M was resistant. TOVA not scorable because he had pressed microswitch continually, with no regard to the display. He kept asking for the “video games”. He squirmed in the chair and took the electrodes off his head. He didn’t like the video display and the trainer removed his hands from the switches. He kept asking to leave.

Discussion with mother about poor prognosis and her need to carefully evaluate results so she didn’t waste money. Case conference following evaluation about training.


 Treatment Protocol:
C3 Beta, (15-18 hz) C4 SMR (12 to 15 hz) using standard EEG Spectrum filters.

NFB clinical course: (Scores represent average for entire session) 3/28/98 – very uncooperative. 3 attempts made at training
T -13.6 SMR 7.5/high beta 9/9
T -9/1 SMR 5.5/high beta 6.1
T -12.1 SMR 7.5/high beta 6.1

4/4/98 – not a happy camper. Complies with Mom’s demand. Uncomfortable with electrodes
T – 13.6/SMR 6/ Beta 3/high Beta 7.0

4/11 – a little more comfortable but still “squirmy” and reluctant
T – 6.3/SMR 4 Beta 2/high Beta 4.1

4/18 – cooperative
T -6.7/Smr3 Beta 3.9/high Beta 3.9

4/25 – Mom notes slight improvement in verbal skills. He participated at family gathering
T -4/Smr 2.9, Beta 4/high Beta 2.4

5/2-cooperative
T – 5.9/SMR 2.9 Beta 4/high Beta 4.3

5/5 – cooperative and talkative – “what’s this. What’s that? Why?” He traced the cable connections
T -7.0/SMR 2.9 Beta 4.2/high Beta 4

5/16-Mom has been shuttling between this city and another for her job.
T -11.3/SMR 6 Beta 4.3/high Beta 10.9

5/20-OK. Mom pleased with progress, says others are commenting on M’s increased alertness and interest in things
T -12.8/SMR 6.2 Beta 6.6/high Beta 7.7

6/6 Mom reports things are all right. M cooperative, alert, interested and playful in session.
T – 11/SMR 6.9 Beta 7.3/high Beta 8.6

TOVA- M is cooperative, talks about the display and how hard it is to figure out which square to choose. Completes the entire test without squirming or compulsively clicking the microswitch. TOVA is scorable. Mom and lead clinician review M’s progress, Mom schedules more sessions with understanding that attendance will be erratic because of family vacation and her work demands.

6/13-Mom reports that M has been taken on by local auto mechanic to train to help out in shop
T -12.3/SMR 6.7 Beta 7.2/high Beta 8.6

7/11
T – 10.4/SMR 6.9 Beta 7.7/high Beta 8.8

7/15-Mom reports that M works for auto mechanic for a few hours each day and is paid. Mom lets us know that she is being temporarily transferred to another city and will schedule more appointments when she’s back in town. Mom is extremely pleased with M’s progress.
T – 9.0/SMR 4 Beta 5.8/high Beta 4.1

10/1 Mom has been returned to this city, but leaves every third week. Appointments resume. Mom and lead clinician again review M’s progress.
T -9.2/SMR 5 Beta 6.6/high Beta 7.3


 Reported Behavioral Changes:
On initial evaluation 3/18/98: (Mother’s report & clinicians observation)

M comes in reluctantly, hides his head, wrings his hands and tee shirt. Mom instructs him to “behave”. M reluctantly sits in front of client instrument. TOVA is demonstrated. He consistently looks away. When he spots the microswitch, he picks it up and clicks in repeatedly, rocking forward and back, muttering “video games, video games”. Mom instructs him to look at the screen. He closes his eyes, looks away. TOVA instructions are given several times. He states he understands. Practice test is given, he starts to respond to screen, then gets interested in clicking the microswitch. During TOVA he clicks the microswitch with no regard to screen display.

M takes a break. Process of NFB is explained and equipment demonstrated. then sensors are placed on M’s head and NFB begun. He is very uncomfortable, takes the sensors off his head, says he’s not crazy, won’t be “shocked” (Dad works in a psychiatrist hospital). Clinician demonstrates the sensors, shows that no electricity comes through them. He reluctantly allows the process to begin again. Doesn’t like video display, takes sensors off. Video display is changed and process repeated. Clinicians call it quits for the day.

Mother reports that M is essentially passive and slightly oppositional. He doesn’t ask questions, doesn’t show interest in much beyond his computer games. He takes whatever food is offered to him. He’ll do what he’s asked to do when prodded but doesn’t take much initiative. In school he sometimes runs around, talking out of turn. He comes home and stays home, doesn’t have interest in going out, even to the store. Doesn’t do much around the home. She knows he can cook some, but he doesn’t. He can clean and vacuum when she prods him, but he doesn’t. He can iron clothes but doesn’t. His job at home is to take out the garbage, and she has to be very firm to make him perform that job. He likes to look nice but waits for her to lay out his clothing. He’s able to take care of all his personal needs and does so without assistance, although she sometimes has to remind him. He can talk but usually doesn’t, and limits his utterances to a few words. Mom states that he can speak more clearly than he’s shown us during the hour, however he usually doesn’t unless she really forces the issue. He can travel independently to and from his high school by public transportation, transferring buses. He learned to travel 4 years ago, quickly and easily, and is proud of this ability.

Her goal for him is to become independent enough to have a little job so he has something to look forward to in life. She thinks he needs to be able to read a little, at least street signs, in order to hold a job.

After 10 sessions 6/6/98 (Mom’s report and clinicians’ observations)

On the TOVA M sits down readily, takes up the microswitch, goes through the practice test, asks to see the display again, then works hard to click the microswitch in response to the display. M allows sensors to be placed on his head and helps in the process by putting gel on the sensors and holding them on his head for a moment. He engages with the EEG display, works hard to “win” keeping up a conversation with the clinician about his week.

Mom states that he is more articulate and speaks more readily. He has been telling her he feels good when he leaves neurofeedback. He has begun to ask for what he wants. He’s been commenting on things his father says. His speech is easily understood. He seems more aware of outside events. He shows interest in news casts on television. He pays attention to street signs, commenting “I didn’t know that was “x” road”. He seems to be aware of local geography. He’s been remembering things he was told for over a week.

He’s become more active on his own behalf. He asked to go to a party, and has begun to go to the store when he comes home from school. He shows interest in his meals by asking for certain dishes. He has occasionally made a lunch for himself when no one was available to do it for him. He’s begun preparing his own breakfasts. He’s begun choosing and matching his own clothes without any help.

In school he sits in class, asks questions and participates. He seems more interested in things.

He’s more cooperative. He’s been cleaning his own room and has started to vacuum downstairs. Mom has found him a training position as a helper in a local auto shop. He’ll be cleaning up and helping with the work as much as he can. He recently changed the oil in the family car.

In summary, mom states that he seems quieter in himself, much better spatially, and demonstrates more consistent functioning, with a push towards independence. There’s been some improvement in memory and an increase in quantity and clarity of speech. He seems more connected.

On return to training (10/2/98 after 16 sessions) (mom’s observations)

Speech has remained clearer. M is often talkative and playful with others. He sounds out syllables in reading, both at home and school. He reads street signs, is aware of the location os shops in his neighborhood. He listens to what he’s told, asks questions which facilitate getting an activity done correctly. He follows directions.

M doesn’t cause problems at school, at home, or on the street, and demonstrates a cooperative attitude. M continues to improve his independence skills. He packs his lunch for school, makes a simple meal for himself when he’s hungry, automatically clears the table, makes his mom’s life easier by helping her without being asked. He puts out the garbage, remembering the correct day, vacuums all of the house except the stairs, keeps his room neat and clean, and continues to iron his clothes. His money skills have improved. He can be sent to the store for several items, waits for change, counts it, and has started helping others in his school program count change.

The auto shop hired him on a part time basis during the summer, and he will be working there on Saturdays during the school year. This is a paid position. He puts in batteries, changes tires, cleans up, locates tools.

Mom still has concerns about his memory, but says he’s able to remember anything that interests him.

3/10/99 – PS – M still comes for training approximately 1 x month because both he and his mom agree that he retains his gains better with a refresher. He’s reading simple children’s books now.

Brooklyn Biofeedback Assoc., 17 Bergen St., Brooklyn, NY 11201-6301 (718) 935-0046 *

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