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IM Training Sets the Stage for Success

Learn how Brian got back to acting, and not just acting out.

Brian is the youngest of three children and lives at home with his mother, father and two older siblings. He is seven years old. His parents reported that Brian was delivered full-term; however, he was born with Transient Tachypnea of the Newborn (TTN) causing respiratory difficulties which required the use of an incubator and oxygen. Brian spent approximately a week in the Special Care Nursery before being discharged. Although Brian experienced a difficult start, his parents reported that he is currently in good health. Currently, Brian takes the medications Tofrinal and Risperadol once daily. Brian was seen for Interactive Metronome training and evaluation at the Palmetto Language & Speech Center, LLC based on a physician referral. Caregivers expressed concern for Brian with regard to language processing, attention and focusing in activities of daily living (ADLs). During the evaluation, his parents reported that Brian exhibits low to no impulse control and a high degree of distractibility. Brian’s mother also reported that he has difficulty following directions given orally which results in directions being repeated several times. According to his mother’s report, Brian usually expresses his anger or frustration by yelling or having an “emotional meltdown.” His parents reported that Brian exhibits the following behaviors in his natural environment: short attention span, hyperactive behavior and repetitive habits such as chewing. Brian has a very good relationship with his parents. His parents reported that he has a better relationship with his sister than his brother but both struggle with Brian’s lack of impulse control. Brian attended Baptist preschool program until he was four years old. At that time, he began attending preschool at Lake Elementary. Brian then attended a 5-K program at Lake, where he is currently enrolled. His parents described him as “friendly, loving and smart.”

ASSESSMENT RESULTS

The Interactive Metronome (IM) is a brain-based rehabilitation assessment and training program developed to directly improve the processing abilities that affect attention, motor planning, and sequencing. This, in turn, strengthens motor skills, including mobility, gross motor function, and many fundamental cognitive capacities such as planning, organizing and language.

The normative ranges for IM performance are as follows:

There are fourteen tasks measured in the long form assessment taken at the beginning, middle and end of IM training. Brian completed 27 sessions over a three month period. The results are displayed in the following table.

At the start of training, Brian scored in the severe deficiency range on IM. After completing the IM training, Brian scored in the average range for IM. Along with IM training, the examiner also measured pre/post language, focus and attending skills.

FORMAL MEASURE OF RECEPTIVE AND EXPRESSIVE LANGUAGE

The Test of Auditory Processing Skills-3 (TAPS-3) was administered three weeks before IM training and again after his final session. The TAPS-3 was designed to assess the processing of auditory information that pertains to the cognitive and communicative aspects of language. The TAPS-3 subtests were designed to provide information for four areas: auditory attention, basic phonemic skills, auditory memory and auditory cohesion. Derived scores for the TAPS-3 can be obtained using raw score conversion to scaled score, standard scores, percentiles, and test-age equivalents. All subtests were presented in a quiet listening environment without distractions. Test results are categorized below.

Based on standard scores with the above measures, Brian showed significant gains in areas measured after receiving IM training. Brian showed gains in 8 out of 9 subtests measured. In addition, Brian’s overall standard score on the TAPS increased from 99 to 108.

The Social Emotional Evaluation (SEE) was administered pre and post-training to determine the child’s emotional and social awareness abilities. The SEE was designed to evaluate children from age 6:0 to 12:11. The SEE is composed of one supplemental subtest, four core subtests and a Social Emotional Questionaire that is completed by both a parent/ caregiver and a specialist, such as a SLP, and/or educator. Derived scores for the SEE can be obtained using raw scores, z scores (mean = 0, standard deviation = 1) and percentiles. This assessment is criterion-referenced and compares the child’s ability to a predetermined expected level of performance.

Based on raw scores, z scores and percentiles with the SEE measure, Brian showed significant gains in his social emotional language skills after receiving IM training.

The Test of Everyday Attention for Children (TEA-Ch) was first administered over the course of two days in order to obtain maximum results. The TEA-Ch was re-administered two months after completing IM training. The TEA-Ch was designed to determine the child’s relative attention across different capacities (selective/focused attention, sustained attention, attentional control/switching, sustained-divided, sustained attention/response inhibition). The TEA-Ch has an age mean of 10 and a standard deviation of 3. The child’s raw score can be converted to a standard score, which is the age scaled score.

The Test of Everyday Attention for Children (TEA-Ch)

Based on raw scores, age scaled scores and percentile bands with the above measures, Brian showed significant gains in areas measured after receiving IM training. Brian showed significant gains in 8 out of 13 subtests measured.

IM PARENT SURVEY

Brian’s parents were given parent surveys pre and post-IM training. The parent survey asks them to rate their child’s behavior on daily function tasks and communication tasks with ratings ranging from 1 being “strongly disagree” and 10 being “strongly agree.” For example, a daily function task item is “My child is able to multi-task well.” An example of a communication task is “My child indicates understanding of things being said to him/her.” The parents rated an improvement in 12 out of the 16 opinion statements after the completion of the IM training.

FUNCTIONAL OBSERVATIONS

Brian’s parents and his classroom teachers reported that he was unable to attend and focus when we first met for training consideration. Brian was impulsive and struggling with behavior outbursts in school and his natural environments. Caregivers reported that he has been prescribed a variety of medications to help manage anxiety, attention/focusing and behavior including Prozac, Risperadol, Adderal and Imipram. However, medications have been changed several times due to Brian having “three bad days for every two days.” His parents described a “bad day” as Brian acting “silly, using ‘bathroom’ language and being impulsive.” According to his mother, Brian’s teacher reported that he was sent to the administrative offices, was interruptive, slow to follow directions and disruptive. His teacher also “backed off” of academics with Brian to manage behavior. During his pre-assessment sessions, Brian struggled with sitting at the table and staying on task for more than twenty minutes. During IM training and post-assessment, Brian’s parents and others noticed marked changes in his ability to attend, focus and cope with ADLs. Classroom teachers reported big improvements in Brian, noting better skills with “behavior, interaction, attention and work completion.”

Teacher comments included the following:

“He seems like himself again.” “He read and answered questions and did his writing well without whining.” “Whatever is going on is really helping him!” “Please keep it up!” “Brian is interested in writing now and can write for some time.” “I can read what he wrote!” “He read with the middle-schoolers and with me in small reading groups and was able to stay on task.”

Brian’s parents shared that he is more cooperative with his siblings and peers. He is also easier to calm and better able to self-regulate before his emotions escalate out of control. Brian’s motor skills have improved with eye/hand coordination. He was very excited and proud to be able to keep up with his sister during a putt-putt golf game and was able to complete a full game with a very competitive score. One the most noticeable benefits and rewards for Brian was being able to act in local theatre. His mother shared that this was a dream for Brian, but he was previously unable to self-regulate, attend, or focus well enough to carry out such a task. Brian and his family were very pleased and proud of him for making such great gains in all areas.

SUMMARY OF FINDINGS

During pre-testing, Brian scored in the severe deficiency range. After completing the IM training, Brian scored in the average range. • In support of the IM assessment, the formal receptive language, expressive language and relative attention/focus evaluation measurements also support that Brian made significant gains.

RECOMMENDATIONS

 Reevaluate Brian’s IM scores in one year for maintenance. • To find out more information about IM updates, refer to IM website at www.interactivemetronome.com –

June K. Maranville, MSP CCC/SLP Speech-Language Pathologist

Bringing Joy Back Into Childhood

Kevin is a 3 and a half year old little boy who was born premature and demonstrates developmental delays. He attends a developmental preschool and receives occupational, physical and speech therapy. Kevin is non-verbal and communicates through facial expressions, vocalizations and crying. Kevin made fleeting eye contact and was easily overwhelmed with his classroom environment, which resulted in frequent crying, anxiety, fear responses and self-stimulatory behaviors. He would become overly attached to objects and became upset when he was encouraged to transition away from the preferred object. He demonstrated interest in toys but tended to roll them between his hands, exploring them visually and manually rather than playing with them in the manner in which they were intended. Kevin required extensive amounts of time to manage his sensory needs in his classroom and during his therapies, resulting in limited time spent on functional tasks. Kevin was very sensitive to noise and frequently covered his ears. He sought out deep pressure sensory experiences as well as linear movement experiences such as swinging and rocking. His teachers and therapists had significant difficulty engaging him in any type of structured task or play such as placing rings on a stacker, coloring or participating during clean-up time.

Due to Kevin’s difficulties, he was unable to be evaluated using a standardized assessment as he was unable to follow instructions or demonstrations to complete testing criteria. Through clinical observations, Kevin demonstrated all developmentally appropriate grasp patterns including a pincer grasp, but he had not yet mastered the ability to retrieve items from an open container or precision release skills such as stacking blocks. He demonstrated symmetrical bilateral hand skills as he was able to clap, hold and explore toys with both hands. He was able to use his hands supportively when he held or stabilized toys with one hand while he touched or explored it with his other hand. He did not demonstrate opposing hand skills. Kevin did not engage in coloring tasks or other classroom tasks requiring tool use.

Some of Kevin’s general therapy goals were to increase independence in classroom routines such as hand washing and toileting, expand his variety of play, increase participation in functional fine motor and gross motor activities, and improve nonverbal communication. In order to achieve these goals, Interactive Metronome® training was initiated. Interactive Metronome® (IM) is the only training program that improves timing in the brain in an organized, systematic, flexible and engaging format. Research shows that combining movement and cognitive tasks leads to better overall outcomes and improvements in fine and gross motor control, coordination, language and cognition, and enhanced balance and gait. IM is a patented and unique training tool that challenges thinking and movement simultaneously, providing real-time millisecond feedback to help synchronize the body’s internal clock.

In order to complete IM training, Kevin needed hand-over-hand assistance to tap the button trigger with both his hands and feet. During his first IM session, Kevin briefly performed gross motor rhythmical movements to Bringing Joy Back Into Childhood Amy Kampschroeder, IM’s default metronome setting (54 beats per minute). However, as soon as the IM metronome beat began, Kevin instantly calmed and was no longer agitated in any setting in which a metronome was used including his classroom.

Over the next 3 months, IM and a standard metronome was used with Kevin twice a week during therapy. In addition, his teacher and his mother used a metronome to calm him throughout the day, usually during nap and bedtime. Within one month, Kevin began to follow some of his classroom routine. For example, he reached for his teacher’s hand for the first time ever and then walked with her into the bathroom rather than crying and resisting the process. He was also sitting quietly at the table during lunchtime rather than crying and sometimes even ate his food. Kevin also demonstrated decreased aversion to loud noises. During one treatment session, he actually banged toys together creating a loud noise and then experimented making loud and soft noises.

After only 2 months of IM training, Kevin began making eye contact for several seconds at a time and was laughing and smiling in a gleeful manner. He began to increase his exploration of toys and even held a marker that he scribbled with for a few seconds. Kevin began playing purposefully with toys and demonstrated basic problem solving skills. For example, he placed a ring on a stacker independently and placed small toys into a container with a small opening. When one of the small toys missed the opening, he searched the surface for that specific small toy, ignoring all the others, in order to try to place the original toy in the container. He completed that task by placing all the toys in the container independently. His physical therapist reported that Kevin had remained in a calm state for a full 30 minute treatment session while making eye contact numerous times.

His therapists weren’t the only ones who noticed the changes in Kevin, his mother reported improved interaction and play at home with his sisters. Since she began using a metronome at home, he has shown improvements in his bedtime routine and sleep habits as well. His mother also noted that he understands simple language such as “no” much better. His teacher said that he shook his head “no” appropriately in response to a question he was asked. She also reported improvements in his ability to wash his hands from requiring hand-over-hand assistance to managing approximately 25% of the task himself.

Kevin has shown so much improvement and growth over the course of his IM intervention. The most significant changes have been in his level of interaction and engagement with others; his ability to achieve and maintain a calm state; and his ability to participate in functional tasks and play. Progress in these areas have led to greater development in his motor abilities, in addition to participation and toleration of classroom routines. Overall, Kevin is more animated and happy. He continues to surprise those around him with his growth and accomplishments

 

Get ADHD children to play outdoors more!

Can you remember playing outside as a kid? A time to run around and let loose, play with your friends and explore! You may remember walking or riding to school and making up all kinds of imaginative games on the greenbelt or in your back yard. Well, that doesn’t happen much anymore.

Today, children suffer from nature-deficit which links to health problems, including childhood obesity & diminished use of the senses, attention difficulties, and higher rates of emotional illnesses like anxiety and depression. If children are no longer outside playing and enjoying themselves, they do not learn to calm down and relax naturally.

Humans have a nature instinct known as bio philia—an innate bond we share with all creatures and plants in the natural world that we subconsciously seek. Nature provides a sense of wellbeing, it calms and comforts unlike what happens in any manmade environment. Spending time in nature reduces the level of human response to stress and allows one to recover from stressful situations more quickly.

We are all struggling to balance a million priorities and to make the best decisions for our family. Now that you know how critical it is to our children’s wellbeing for them to spend time outside in nature, you may want to take some steps:

  • Spend more time outside as a family. Don’t overthink this. Keep your children’s outdoor time unstructured–go for a walk, visit a local park, ride bikes, have a healthy meal in your backyard or garden.
  • Plan day trips and holidays based on National Parks or other outdoor experiences.
  • Teach children to “stop and smell the roses”. In other words, be mindful of nature around you.

Examine ways to minimise technology use in your house.

Help Your ADHD Child Deal With Perceived Failures

Failure may disappoint and hurt a child with ADHD, but it shouldn’t devastate him. His self-esteem takes a hit because he interprets each negative experience as further proof that he is a “loser.” The following words can be for any child but those with ADHD are far less resilient and struggle to contain their emotions.

  1. Very successful people fail sometimes — some of them fail a lot. Thomas Edison made 3,000 attempts before creating a light bulb that worked! Do we call Edison a failure? Of course, not. We call him a brilliant inventor. Help them to think of someone they know who preserves in spite pf difficulties
  2. Every failure can teach us something important. Help them to look for a positive, even a small one e.g. “what part did I do well?” or “what did I notice that I can use next-time?”– it is a wonderful mindset to take through life.
  3. Even though you fail at something, you are not a failure. You’re still a good person. Let’s think about all the good things you do and have done.
  4. We can succeed only if we’re willing to take risks and work hard. If you want to win the race, you have to enter the race and train to be a good runner. Winners don’t have a guarantee that they will win every race, but the chance that they will makes it worth it. Help them to think of a person they admire who has gotten up after losing, again and again.

 

Parents of children with ADHD

Parents often feel sorry for their child with ADHD (and for themselves), but these fleeting moments of pity usually come after a particularly difficult morning! However, one usually recovers from the pity party pretty quickly, because the truth is, if he didn’t have ADHD, he wouldn’t be himself! ADHD is as much a part of him as his big brown eyes and love for collecting marbles or stickies or insects! Many of the coolest things about the child are either a part of his ADHD or a direct result of it. Here are some of them…

Out-of-the-box thinking: He can drive one nuts with his refusal to adhere to “The Rules,” but he often does this in favour of seeking out other, more innovative—or occasionally, more obvious—solutions.

Tenacity: otherwise known as stubbornness! He drives parents and teachers half mad with arguments and tantrums – but he never really gives up and, given a chance, will persevere and resolve whatever problem he encounters.

Curiosity: The ability to perceive detail leads to a heightened level of curiosity. He has Googled and YouTubed everything from air ducts to black holes. No topic is too mundane for this child’s ADHD radar.

Sensitivity: ADHD comes with its fair share of difficulties, as every ADHD parent knows. However, it is awesome to see that his experience with ADHD, especially the more challenging aspects, opens his heart and mind to the struggles of others.

Spontaneity: We are all familiar with spontaneity’s evil twin, impulsivity, and how irritating, and downright dangerous it can be but the flip side of impulsivity is spontaneity. He is always suggesting fun things to do on a whim and it’s never a dull moment from there!

These are just a few of the things one will love about ADHD child. It is so easy for parents to lose themselves in the everyday battlefield of ADHD, to feel like the child might have missed out on a “normal” life as a result of having this disorder. But if we keep reminding ourselves of the many positives that accompany ADHD, we might come to the conclusion that “normal” really is just a setting on the washing machine.

6 Study Tips for ADHD Students

Doing homework and studying with ADD/ADHD can be more manageable when your child embraces techniques that help him to keep his mind focused on the task at hand. Traditional study methods of long study sessions and sitting at desks can have your child spending more time distracted than productive. That leaves no one happy and everyone frustrated.

Here are a few tips that will help to make homework/study easier:

  1. Move around: – having your child walk around while studying can help him to focus better.
  2. Speak out-loud: – When your child studies aloud, then her mind is more actively engaging with the material which means that it is harder for her mind to wander from what she is studying.
  3. Fidget: It is hard for students with ADD/ADHD to concentrate for long periods of time without moving around while learning. “Fidget tools” such as stress balls made with sand filled balloons, unfilled balloons, smooth rocks, or pliable wax should be kept on the desk for them to “fiddle with” with whenever they want to. I find “OT putty really hits the spot for these children. This can be sourced from: Hi-Tech, Montague Gardens, Tel 021 555 3913
  4. Change position: Even while remaining sitting, have your child sit in different positions. Sitting disks or exercise balls allow your child to move around while remaining sitting and the movements are more natural and less distracting than standing up to readjust.
  5. Work in increments: Studying in short bursts can help your child to be more productive at shorter time increments.
  6. Change subjects frequently: Have your child move onto the next subject as soon as he becomes easily distracted with one subject. This way your child can continue to engage with the schoolwork instead of being distracted.

While focusing on uninteresting topics can be torture for anyone, embracing ADD/ADHD study methods can make homework and studying easier and more enjoyable for all of us who struggle to concentrate.

If you think your child requires additional assistance with attention and concentration we are here to help with INTERACTIVE METRONOME

 

 

 

 

Giving your special-needs child the attention she requires

Do you concentrate on the positive in your child – traits like boundless energy, creative thinking and a giftedness with people? Do you praise your child and tell her that as a result of these traits she is going to go further in certain fields and types of work than other people who are quieter or have less of a lust for life?

If you do these things, then you are on the right path with your ADHD child. You know she has flaws but you appreciate her strengths. Most importantly, your ADHD child will then know that she should not feel less acceptable at school, among friends and family, or out in society as a result of her diagnosis.

As a working parent, you may feel that coming home after a long day of work to chores and an energiser-bunny child is – at times – simply too much for you to handle. Dr Phil reminds us on his website, drphil.com, that “an ADD diagnosis is not a sign of inferior intelligence or a disability.” So harness your child’s energy in chores that are safe and fun for her age group, and where she happily sees your face go from a grimace to a beam when the washing makes it’s way into the tub and all the leaves on the lawn are tidied into the organic recycling bin.

Devoting time in the early evening to something active – chores, a walk, cycle or swim with your child – and then to quiet time over homework or a book, instills a sense of routine in her, which she will look forward to. Probably Dr Phil’s most helpful advice is not to feel guilty about disciplining your ADHD child, especially at the end of a long day when you’ve reached the end of your tether: “You have to be willing to visit the structure. You have to be willing to bring the predictability, the consistency and the discipline. It’s not something you should feel guilty about; you should feel guilty if you don’t do it because she needs the structure. She needs the guidance. She needs the order. She needs the rhythm. She needs all of the things that are necessary to give her a chance to have a flow to her life.”