Therapeutic Listening: Sensory Processing Disorder Therapy

Sara was adopted by American parents from a Russian orphanage at the age of four and spoke no English when she began school at age five. Prior to intervention, Sara exhibited a number of symptoms of sensory processing disorder.  She could only attend to tasks for 5-10 minutes, had tactile hypersensitivity (she disliked hugs and refused various foods based on texture and temperature), had difficulty calming herself for sleep, was easily frustrated, prone to tantrums, and struggled with transitions. In addition, Sara also had minimal eye contact with others and a high, shrill voice that she could not modulate or control.

After initial testing, Sara’s occupational therapist saw her every other week and started her on Therapeutic Listening, for therapy of her sensory processing disorder, which was implemented by her parents two times per day, seven days a week from August 2004 until March 2005. Her pre and post-SIPT scores illustrate the dramatic changes that Sara made in her ability to process sensation. Although she had a continued tendency to reverse some letters and numbers, Sara’s handwriting showed marked improvement in both her fine motor control and her ability to use space.

Sara’s parents and therapist observed many exciting improvements in her sensory processing abilities over the course of her therapy. These changes included: increased appetite and willingness to try new foods, increased tolerance for touch, increased eye contact, increased attention to tasks, and increased ability to achieve an appropriate arousal level. Even more, Sara spontaneously began to grade her voice and whisper, reported hearing a clock ticking and birds chirping for the first time, and even began hugging her grandmother. Through her drawings, Sara clearly illustrated how her world had come alive.

Sara also made significant improvements in her handwriting skills. Prior to Therapeutic Listening, Sara’s handwriting sample revealed difficulties with legibility, spacing, and spatial organization. When attempting to write the entire alphabet, she omitted 12 letters, and of the 14 letters that she did write, only 5 were legible. When attempting to write numbers 1 through 10, she omitted 2 numbers. Of the 8 numbers that she did write, only 2 were legible.

After Therapeutic Listening was implemented as a therapy for her sensory processing disorder, Sara demonstrated many improvements in handwriting. In her post-listening handwriting sample, Sara wrote all 26 letters without any omissions and with 100% legibility. Spacing between letters was appropriate, letter height and size were consistent between all letters, and smaller printing and the ability to write in a straight line revealed better spatial organization. In the number writing sample, Sara was able to write all 10 numbers with no omissions. Spacing between numbers was more appropriate and number height was consistent between all numbers. Nonetheless, correct number orientation still remained an issue, as 4 numbers were reversed.

Sensory Integration Therapy: Therapeutic Listening

Allison was a bright 8-year-old girl whose school occupational therapist had concerns regarding her sensory integration. Allison presented with postural-ocular issues and bilateral integration difficulties, which impacted her visual motor and perceptual abilities. Handwriting was an area of concern with her teacher, as her letter size was very inconsistent (getting increasingly smaller as she moved across the page). She also struggled with the construction/manipulation of materials, often feeling stressed about the task because she did not know where or how to begin. Following Allison’s completion of a modulated and Fine Tuning Therapeutic Listening program as part of her Sensory Integration Therapy, her teachers noted an improvement in her production of written work. Her bilateral coordination improved and she was able to participate in athletic activities with more fluidity.

*Made gains of 7 years, 2 months in visual-motor skills in 4 months’ time.

*Made gains of 4 years, 5 months in visual perceptual skills in 4 months’ time.

Clinical Note

Although Allison’s overall score jumped dramatically, the score on the Motor Coordination subtest dropped. It is interesting to note that this pattern has occurred many times. It is particularly unusual since, as Hall and Case-Smith (2007) found, functional skills such as handwriting and drawing often improve. It seems possible that this test is not sensitive enough for the earliest changes that occur.

Therapeutic Listening: Sensory Defensiveness

As an infant, Adam’s development appeared typical; however, his parents soon discovered that something was seriously wrong. At 13 months of age, Adam started exhibiting symptoms of severe sensory defensiveness.  He stopped verbally responding to all social cues. He also stopped sleeping. When describing the family’s nighttime experiences, his mother stated, “[Adam] would scream for hours in a very high pitched squeal…sometimes I would just stand in the shower to block out the sound.”

Adam’s sensory defensiveness had an impact on many aspects of his life.  His mother also stated “Adam was afraid of everything.” He was terrified of people, did not like to be touched, and had impaired registration of pain. Adam’s mother spoke of a day when he placed his hand in an open flame in the fireplace. He initially appeared indifferent to the blisters on his hand, but once the pain had registered, Adam could not be comforted. His mother said, “All I could do was stand there and cry.”

Adam had great difficultly with social interaction. His verbal communication consisted of grunts and sounds, and eye contact was avoided. To his parents, it seemed that the only time Adam was happy was when he was alone in his darkened room.

Due to an early history of reflux, Adam also had feeding challenges. His appetite was extremely poor; his diet was limited to eight specific foods, which could be summed up in two categories—starch and peas.

Upon an occupational therapy evaluation, it was determined that Adam displayed symptoms indicative of severe sensory defensiveness. The subsequent treatment plan included the Wilbarger Touch Pressure Protocol and the Therapeutic Listening program using modulated music.

Within the first month, Adam was beginning to sleep through the night, demonstrated increased babbling and eye contact, and began experimenting with expressions of affection including cuddling, hand holding, and hugging. Adam’s gains continued to unfold as the weeks and months went by.

After seven months of using Therapeutic Listening for his sensory defensiveness, Adam had made great improvements in social engagement, speech and language development, sleeping behavior, and play activities. Adam was displaying increased eye contact and began to play with other children. He no longer screamed through the night and was now approximating 175 words. He demonstrated an overall drive to explore his environment and engaged in previously feared activities such as sand-play and hair washing. In the end, his mother stated, “Adam has come so far…it feels wonderful.”

Therapeutic Listening: Sensory Integration and Defensiveness

A Family’s Journey

He was two years and eight months old when I noticed Tony becoming moody and a bit difficult to handle. He refused to wear certain clothes because they bothered him, became more cautious, cringed at louder sounds, and displayed minimal eye contact. I told myself, “It’s because I am expecting a new baby,” and we managed. As he developed, I noticed he was a bit clumsy and enjoyed crashing his body around like a football player. I told myself, “He is just big and is just being a boy,” and we managed. The following spring, when he was three and a half, Tony refused to play at the park, appearing to be fearful of heights and disliking any kind of moving equipment. I wondered to myself, “What is going on?” And still, we managed. Things got a little tougher as he turned four and became more demanding and less tolerant of change and transition. I wondered, “What is happening to my little boy?” And we tried to manage.

During Tony’s fifth summer, everything fell apart. We were at a baseball game, and afterwards, there was a fantastic display of fireworks. The bright lights and loud sounds sent Tony racing up the bleachers through the crowd until he reached the top with nowhere to go. When I caught up to him, he was pale, panting, and drooling with eyes wide and darting. He appeared to recover from this experience. However, another event occurred a few days later. We were up north celebrating the Fourth of July at a small town parade when a large storm suddenly broke with rolling thunder, and with nowhere close for shelter, we were soaked. This put Tony over the edge. He became fearful of going outside on gray, cloudy days, then on days where there were white, puffy clouds, and then going out in general. His fears grew, as he used logic to expand them. Any event away from home was met with monstrous tantrums lasting for over an hour. He became very rigid about how things were done. Clothing became a huge daily issue. Our family was being held hostage in our own home. I was starting to fall apart too, and Tony was due to start Kindergarten in a few short weeks. We could no longer manage on our own.

As a pediatric physical therapist, I was familiar with sensory integration dysfunction, and I suspected that this was the root of Tony’s problems. We sought help from a wonderful child psychologist, who was well versed in sensory integration dysfunction. She assisted Tony with the immediate fear issues. We also sought Occupational Therapy services at Capernaum Place with Nancy Jackley, OTR. Tony was identified as having moderate tactile and auditory defensiveness, vestibular issues, and delayed gross and fine motor function. Weekly treatment with home programming began, and we saw improvements over time. There were peaks and there were valleys. It was like riding a roller coaster, and when he would fall apart, sometimes I fell apart with him.

I had heard about the Therapeutic Listening program at a conference on Sensory Integration and at a local seminar. As I listened to the presenter, it seemed as though she was describing my son as if she knew him. I knew that Therapeutic Listening was worth exploring. Nancy then attended special training to integrate Therapeutic Listening with Tony’s OT program. At the time we started with the headphones, Tony was having a lot of trouble, tantrums lasting for an hour to an hour and a half in the mornings about getting dressed before school. We were down to two pairs of shorts, a pair of sweat pants, and one and a half pairs of socks that he would wear, and he absolutely could not tolerate having his shoes tied. The impact of Tony’s first listening session was immediate and dramatic. Following that first session, Tony had his second soccer game. As he had flatly refused to attend the first game, our highest expectations were that he would watch from the sidelines without fussing too much. Instead, he suited up in a brand new soccer uniform complete with knee high socks, shin guards, and new cleats that he even allowed us to tie. He played the entire game. And best of all, he enjoyed it. We were amazed! The extreme tantrums quickly dissipated over the following week. I also noticed improved social interaction and play with peers.

It has been four months since we started Therapeutic Listening®. When it was time to try weaning from the music, I was reluctant because things were going so well. Tony did regress, indicating that he had not had enough yet. A more intensive program followed with successful weaning. We are approaching the second level of treatment.Tony’s motor skills have improved, and we are trying a period of decreased OT in the clinic, while continuing with the Therapeutic Listening® at home and physical therapy to focus on his balance and gross motor needs. There are times that I need to consult with Nancy, his OT, by phone to adjust his program. As a therapist, I am still in the process of understanding how this treatment works. On the other hand, as a parent, I do not worry about how it works and just celebrate that it does for Tony! Tony is in first grade this year, and every day as I see him off to the school bus, I remember where we were and appreciate where we are now and the far-reaching impact that his therapies have had not only on his life, but also on that of our entire family. And now we are able to do so much more that just manage.

Note: This is part of an article on Therapeutic Listening by Nancy Jackley, OTR, that was published in the Capernaum Pediatric Therapy, Inc. parent newsletter in the Fall, 2000. Capernaum Place is a pediatric outpatient clinic in Crystal, MN that uses Therapeutic Listening as an integral part of its practice. For more information, contact Nancy Jackley at (763) 533-0363.

Autism Therapy with Therapeutic Listening

Charles was a 14-year-old eighth grader who exhibited symptoms of autism. Charles’ mother was concerned about his poor social and motor skills. He also struggled with listening in noisy environments, which made listening to his teachers difficult and necessitated closed-captioning when watching television. His language was often hurried and mumbled, which made making friends difficult and created frustration for Charles.

After three months of Therapeutic Listening as therapy for these autism symptoms, Charles made significant improvements in auditory processing, which is seen in his scores of the SCAN-A. Charles’ perception of sound, particularly in complex auditory backgrounds, had improved dramatically. This in turn, was reflected in his ability to articulate his own speech more clearly. One weekend at the museum, Charles’ mother could clearly understand everything he said as he read the excerpts outside each exhibit. Since he was now able to discriminate spoken words efficiently and effectively, he no longer needed to use the closed-captioning during television shows.  Furthermore, Charles was now more confident in his ability to communicate with his peers and was able to make new connections.

Charles’ improvements as a result of using Therapeutic Listening for his autism therapy can be seen in his scores on the Beery VMI.  On the Motor Coordination subtest, Charles made a gain of one year and one month in three months’ time. His improvement in motor skills was reflected in his desire to participate in more athletic activities, whereas previously he was only interested in stationary activities such as drawing and watching television.

Autism Therapy using Therapeutic Listening

Ned was a non-verbal 25-year-old man with Autism and Pervasive Developmental Disorder (PDD) in addition to several other diagnoses including blindness and WAGR syndrome, which required a kidney transplant. He was referred to occupational therapy for self-injurious behavior and to increase his acceptance of tooth brushing. Ned had a gum overgrowth from the immunosuppressant drugs he began taking after the transplant and sensory defensiveness around his face. His mother also hoped the therapy would help Ned with some basic communication. If he could learn to answer yes/no questions, at least they could know if he was in pain or if he needed something.

After two months of Therapeutic Listening as Autism Therapy, Ned’s symptoms had improved.  Ned’s mother called to tell the therapist that Ned had spoken a two-syllable word—his first since he was 18 months old. Ned’s vocabulary continued to expand to 50-60 words. His personal assistant noticed Ned speaking a new word nearly every day. Furthermore, his mother reported that Ned began responding yes and no appropriately to questions, which thrilled her. She stated, “[Ned] has had a “language explosion” since he began Therapeutic Listening. Keeping up with his new words is a challenge for us!”

Autism Therapy using Therapeutic Listening

Jill is a six year-old girl who is currently enrolled in a classroom for students with a diagnosis of autism. Jill was born two weeks premature, following a pregnancy that her mother reports as “a very stressful time”. At birth, Jill was small and jaundiced. Her sucking reflex was poor and weight gain was slow. It is reported that Jill cried extensively and withdrew from attempts to cuddle or comfort her physically. She had a hard time taking her bottle and preferred a cup. A pacifier is still used, as are many other oral motor strategies. Her mother reports that Jill never ate baby food and preferred unusual things like beef, hamburger and juice. She was an active toddler and “on the go” until she was put to bed. Jill sleeps for four to six hours and then is up for four to six hours.

Some of Jill’s autism related behaviors have remained consistent since early childhood. She is sensitive to loud noises and reacts with fear to low frequency sounds. She responds to some children’s music with laughter and will become still in order to listen. She has very little interaction with others and makes her needs known by crying and screaming. When others approach, she will leave the area or make distressed vocalizations. She has difficulty with change and transitions and works to make sure that objects are kept in the same place. Her activity level is high and she is in nearly constant motion that includes running, jumping, climbing and flapping her hands. She seeks out pressure touch by wedging herself under cushions and tucking herself tightly under her covers at night. Jill prefers not to wear clothing, explores her environment by putting objects in her mouth and prefers crunchy food (but resists the use of a spoon).

Jill has been on a sensory diet for her autism therapy that includes pressure touch and joint compressions with the Wilbarger Protocol, numerous pressure touch activities through objects (e.g. being squished under pillows, mats and air cushions), climbing activities and work on the trampoline. Since implementation of the sensory diet (in place for 18 months), she is sleeping for longer periods, making more eye contact, crying less to express needs and starting to come to familiar adults when she wants something.

She is also able to better tolerate sitting at the table with others and is working on the TEACCH program to learn independent work skills and to follow a visual schedule. The classroom teacher utilizes many other visual strategies and uses simple signs with the students. She participates in most activities with direct physical assistance and hand over guidance.

As part of her autism therapy, this past fall Jill was started on a Therapeutic Listening® program. Behavioral responses to the program were immediately observable!  During the first Therapeutic Listening session she bounced with her therapist on an inner tube and imitated use of blowing toys. She was making eye contact and smiling. This level of interaction and engagement was astounding to everyone in the room. After listening, she sat very calmly and seemed to be “seeing” her classroom for the first time. She looked at each wall and then looked at each adult (the speech therapist, physical therapist, teacher and childcare worker were all present). At lunch that day Jill ate a banana for the first time. The next Therapeutic Listening session was even more dramatic. Jill came into the classroom distressed and resisted the morning snack routine. Once the headphones were in place, Jill immediately calmed, picked up her spoon to eat yogurt, signed “more” when she was done(!) and then took care to empty her bowl. While working with her therapist for her autism therapy, Jill (still listening) was making nice eye contact. Because she had not been wearing her hug vest for the listening session, this was offered to her. When asked “Jill do you want your hug vest?” she made postural adjustments (leaned forward, raised arms) and said “hug, hug”. These words were the first words ever heard by her therapist and some of the few ever said.

Jill’s gains on the Therapeutic Listening® program continue. She demonstrates a more optimal level of arousal and is engaging actively in the classroom routine. Her receptive language has improved tremendously (or perhaps it’s her new ability to respond). When asked by her classroom teacher where her barrettes were, Jill hopped off the swing, got the barrettes and brought them to her teacher. The teacher was amazed. Her parents are also delighted with the changes. Jill now requests to sit on her mother’s lap, is engaging in purposeful activity rather than being in constant motion, and is eating and sleeping better.

–Lori Redner, OTR (Grand Rapids, MI)

Attention Deficit Hyperactivity Disorder – ADHD Therapy

At 13 years old, Lily was a sweet young woman with a warm heart. She was an average student who did not receive ancillary services at school; however, her poor concentration and organizational skills were impacting her ability to reach her potential in school. Her pediatrician was considering an ADHD diagnosis due to attentional difficulties. Lily also had a history of seizures, which were under control with the use of medication. Her parents considered the option of ADHD medication, but they were fearful of combining them with the seizure medications. As a result, they sought other Attention Deficit Hyperactivity Disorder (ADHD) Therapy to help Lily.

Due to ADHD, Lily experienced several skill deficits that made school difficult. She had attentional challenges, inadequate core support, impaired visual motor skills, and difficulties with auditory processing. Lily was so easily distracted that she could not do homework without constant adult supervision. Any noise in the environment pulled her attention away from what she was doing. In addition, Lily did not demonstrate adequate core support for attending, which contributed to her inability to focus and pay attention.

Lily also had poor visual motor skills, which created problems at school. On the Beery VMI, Lily’s performance fell at the 25^th percentile. This affected Lily’s accuracy and efficiency in reading and comprehension. She added or skipped words while reading, and this often changed the meaning of the material. Lily had particular trouble comprehending literature, geography, and other non-fictional information where changing the details changed the whole meaning.

Lily had difficulty with discriminating auditory input. This was demonstrated in her performance on the Auditory Figure Ground subtest on the SCAN-A, which was in the 25^th percentile.  Lily’s struggle with auditory processing meant she continually missed important pieces of information during class lectures. By the time she had processed the teacher’s words, she had missed the next few details of information. This became even more pronounced as the complexity of the auditory environment increased. The sounds of the other students moving in their chairs, papers rustling, the sounds outside the classroom window, and the sounds of the lights and fans created a daily challenge as Lily tried to stay focused and to discriminate the teacher’s words from these background noises.

Two weeks before starting her Therapeutic Listening as part of her Attention Deficit Disorder Therapy, Lily began working on core/breath activities in the clinic. These activities were implemented in her home program along with Therapeutic Listening. Lily did not receive any other interventions during this time. In just ten weeks, Lily made some significant changes and achieved all of her goals.

As a result of using Therapeutic Listening as a part of her ADHD Therapy, school became easier and more enjoyable for Lily as some of her sensory-motor issues were addressed. By the end of therapy, she showed an improved ability to discriminate auditory detail, which is particularly important in distracting environments such as the school classroom. This change was confirmed by her performance on the SCAN-A Auditory Figure-Ground subtest. Her visual motor skills also improved, and as a result, Lily was able to read and comprehend her assignments more accurately and complete her homework without reminders or parental involvement.

Lily also showed increased postural activation and endurance and improved in motor planning and sequencing during novel activities, which was seen in the improved scores of Interactive Metronome activities. These changes made movement more pleasurable for Lily. To her parents’ surprise, she began to get up earlier than usual so that she could go for a walk before school.

With her increased energy and improved concentration, Lily was able to function more effectively both at home and in school, and had more free time for the things she enjoyed doing.

Therapeutic Listening for Fetal Alcohol Syndrome

Kameko was adopted at the age of 16 months from Kazakhstan, where she had been cared for in a group home. Kameko was diagnosed with Fetal Alcohol Syndrome (FAS). Her adoptive parents had become concerned about her decreased participation in daily activities due to irritability, sensory defensiveness, and high arousal level.

When Kameko was two years and seven months old, they sought out some occupational therapy services. However, they were about to the leave the United States to return to their home in the Philippines where clinic-based services were limited. Although Kameko would have benefited from ongoing therapy as therapy for her Fetal Alcohol Syndrome, she was seen in the clinic on only two occasions—first for an evaluation and five days later to instruct the family on a detailed home program.

Kameko was described as a hard-to-console baby, and as her development progressed, her poor modulation continued to create difficulties in many areas of her life including arousal level, sleep schedules, toileting, attention, transitions, and relationships with others.

Kameko had a number of symptoms as a result of Fetal Alcohol Syndrome.  She had defensive responses to touch, particularly around her head and face. She refused to be cuddled or held by her parents and essentially resisted all forms of physical interaction. During therapy, if the therapist touched her, she would forcefully shout “no” and push the therapist away.

Kameko had difficulty with transitions, which resulted in frequent tantrums and episodes of uncontrollable crying. Since she could not effectively self-regulate, her mother discovered a strategy that Kameko could tolerate; she would hold Kameko tightly in her lap with her arms and legs restricted and rock her.

Kameko was in a state of high arousal 90% of the time, and she quickly became over-aroused during movement play. She appeared to have a lack of safety awareness and would run away from her caregivers to random destinations. She jumped on unstable surfaces without any apparent fear of falling, and was also under-responsive to pain—she did not even cry when she fell and cut her head.

Kameko was easily distracted by visual and auditory stimuli and the family could not even dine in a restaurant, since with all the distractions, she could not focus well enough to eat. In the clinic, her therapist observed that she did not focus on novel auditory or visual stimuli.

Basic regulation of homeostatic functions (such as sleep and toilet training) required assistance of her parents. Kameko fell asleep easily, but was a restless sleeper and awoke easily. She would wake six to eight times per night, 95% of nights, leaving everyone exhausted. Kameko could not indicate the need for toileting or a diaper change and resisted toilet training by screaming when placed on the toilet.

Kameko’s play skills were limited and her brief periods of independent play mainly included mouthing, banging, and throwing objects. She sought out rough play and usually did things with excessive force.

Kameko preferred intense movement activities such as swinging, bouncing, jumping, hopping, and running. Her approach to these activities appeared impulsive and disorganized. She dragged her toes in an unusual gait pattern and constantly wore out the front part of her shoes. With this gait pattern, she appeared clumsy and fell frequently.

Kameko needed maximum assistance to complete simple three-piece puzzles and needed ongoing direction and assistance for other fine motor activities. For example, she would not carry objects and could not open jars or lids.

Kameko had a flat affect, limited emotion expression, limited language skills, and did not acknowledge the presence of peers. These things, in combination with her poor play skills, meant that making peer connections was difficult.

Kameko’s limited communication skills also impacted her ability to related to her family. She occasionally used some two-word utterances, but most often these were unintelligible. When her family encouraged her to imitate words, she screamed. She could not communicate her desires by pointing and could not answer simple questions.

After Therapeutic Listening

Kameko became more regulated soon after starting Therapeutic Listening therapy for Fetal Alcohol Syndrom. Kameko began sleeping through the nights and began indicating the need for a diaper change. Even more, when placed on the toilet, Kameko would produce a bowel or bladder movement, although this was inconsistent. She also remained dry throughout the night. She even began to be able to do previously impossible tasks such as eating at a noisy McDonald’s during lunch.

As a result of the Therapeutic Listening therapy, Kameko also became more accepting of physical interaction. Her mother was thrilled that she wanted to cuddle as a part of her bedtime routine, and Kameko often sat in her mother’s lap for up to 20 minutes in church.

Kameko’s play skills expanded, and she began to string together longer sequences of action. She started to use her hands more and even put together a twelve-piece puzzle independently. She also enjoyed playing with Play-Doh and sorting objects and twice completed a four-step obstacle course independently.

Kameko’s body language and verbal communication also improved. Her parents reported seeing her first instances of emotional expression, including happiness, smiling, laughing, sadness, remorse, and empathy. She pointed appropriately when questioned about her story books, was more willing to imitate words, and took the initiative to talk despite struggles with pronunciation. She correctly labeled animals verbally and even put together a three-word sentence, “Help giraffe tail.”

Although she was only in therapy for Fetal Alcohol Syndrome for ten weeks, Kameko made some remarkable gains. As she became more calm and organized, her world opened up, and she was better able to function and show her potential.

Therapeutic Listening & Cerebral Palsy

Clinical Note: Many individuals with the diagnosis of cerebral palsy also have sensory integration issues that can impact their motor control. Therapeutic Listening can be helpful for this.

Abby was a seven-year-old girl with a diagnosis of mild cerebral palsy and strabismus at the time of evaluation. She had been adopted from a Ukrainian orphanage at three years of age. Although having cerebral palsy created a variety of motor difficulties, Abby’s parents were particularly concerned with her fear of activates that required balance. She avoided playground structures and was fearful when walking up or down stairs or over uneven surfaces such as her backyard. Even when she was holding on to an adult or stationary object, she expressed great fear of these movements.

Abby struggled with the ability to modulate sensory input and self-regulate. She had poor control of regulatory functions, which were likely complicated by her neuromotor condition. She did not have any nighttime bladder control and had frequent daytime bladder accidents. Although Abby was able to fall asleep without difficulty, she was a restless sleeper and would often be found in odd sleeping positions during the night. In addition, her poor self-regulation led to frequent tantrums, which could be triggered by a simple request to clean her room or pick up her toys. These tantrums usually lasted 15-20 minutes.

Abby had an incessant need to touch or mouth objects and often chewed on ties of her clothing, doll hair, or plastic toy pieces. Abby also had mild tactile defensiveness and could not tolerate being barefoot.

It was difficult for Abby to complete daily tasks such as eating, dressing, and picking up her toys in a timely manner. She was somewhat disorganized in her approach to these tasks. Also, she was easily distracted and had difficulty tuning out background noise. The distractibility made it challenging for her to do seated task work both at home and school, and also impacted her ability to transition between activities. She repeatedly forgot what she was supposed to be doing and needed verbal cues to move to a new task. At mealtimes, she was often so distracted by the items on the table or by playing with her food that it could take over 30 minutes to eat a meal. After her bath, Abby would become distracted by the toys in her room and forget to start her dressing routine. If not given repeated verbal reminders, she could be distracted for 20-30 minutes before transitioning back to her original task.

Abby’s poor body scheme and lack of spatial awareness impacted her dressing, handwriting, and ability to maneuver through her environment. Abby struggled with putting clothes on and finding objects in her room. Even after demonstration, she put clothing on backwards and often could not find clothing items in her drawers. Abby struggled not with the formation of letters, but with the ability to spatially place them on a page. Abby was accident prone and often bumped into objects while trying to navigate within a space. This was true for familiar environments as well as unfamiliar environments. She was also fearful of putting her head under water at the swimming pool, which may have indicated a discomfort with the changes to the spatial environment.

Abby’s underdeveloped movement patterns restricted her ability to interact with people and objects. She struggled with motor skills such as hopping, jumping, skipping, and running, and she fatigued quickly during these activities. Abby also had difficulty assuming and maintaining antigravity flexion and extension postures. She was unable to separate eye movements from head movements, and often used whole body movements instead of rotating at the head/neck, shoulders, or trunk.

After Therapeutic Listening

With the start of a Therapeutic Listening program, Abby made good progress in her motor skills, spatial awareness, postural control, self-confidence, and overall regulation. While at times she had fluctuations in bladder control, sleep, and mood, this is often a part of the process of learning to regulate and usually resolve over time.

Staying dry overnight had been a longtime struggle for Abby. She began staying dry more often soon after starting her listening program. The longest she used to be able to go without a wet pull-up in the morning was two or three nights. However, at the time her mother reported, she had thirteen consecutive dry nights.

Listening also created a shift in Abby’s overall attitude. Her tantrums diminished, and when she did have a tantrum, she was able to calm herself and recover within a few minutes. Her parents reported that she was generally on a “fairly even keel.” Even out of town friends who saw her infrequently commented that she seemed unusually clam.

Abby became increasingly more cooperative and helpful. She began playing with her little sister—even comforting her when she was upset. In addition, she regularly put on her music and headphones independently and began doing her homework without complaint.

Abby became more organized and better able to care for her belongings. For example, she organized her clothes in her dresser and her DVD collection for the first time. She also began keeping her toys and drawing supplies organized and even initiated cleaning up on her own.

Movement and motor skills improved dramatically for Abby, along with her increased self-confidence with both swimming and walking. She began swimming underwater at the shallow end of the pool. Additionally, the school physical therapist noted that she had better coordination on the BOSU ball and that her jumping skills on a small trampoline were improving; she was showing better coordination and landing with bent knees. Her balance continued to improve, and she was able to spin a full turn on one foot. Her mother reported that she had walked all around a park wearing flip-flops.

Her aunt noticed that when she held Abby’s hand, she no longer used it for balance and strength as they walked. When the family was camping, Abby insisted on walking to the bathroom by herself. Additionally, for the first time ever, she was able to jump from the bottom step onto the floor without holding something to stabilize herself. She began seeking out opportunities for running, climbing, and jumping. Her coordination on the swings was also improving; she pumped more strongly and more rhythmically. She also enjoyed climbing on the play structures at the park that had previously been too challenging for her.

Abby’s fine motor skilled similarly improved. She was able to write longer paragraphs, was sequencing stories, and began attempting to spell words on her. She also had more even pressure and increased line control when coloring. Additionally, Abby’s parents reported that she had better attention and fine motor skill when she was working with her Lite Brite.

Therapeutic Listening & Hard of Hearing

Belle was a bright four-year-old who was hard of hearing and communicated primarily through sign language. This was an ongoing source of struggle for her, especially in instances when she attempted to engage with another. Often, in frustration, she would act aggressively towards herself or others by biting, pinching, kicking, hitting, or pilling hair. Belle also struggled with regulation of her sleep-wake cycle and experienced frequent night waking, up to four times a night. Belle was frequently on-the-go and strongly preferred movement activities over stationary ones. She also constantly sought oral input by mouthing, biting, or chewing objects.

At the start of her OT evaluation, Belle was quite shy and needed support and reassurance from her mother to participate in activities. Initially, she only referenced her mother and did not make direct eye contact with the therapist. Belle moved quickly from one activity to another. The longest she stayed with a single activity was 20 seconds, and most ranged between five and ten seconds before she was eager to transition to something new. She abandoned any activity as soon as it became challenging, and once she was ready to quit an activity it to ok extended coaxing to get her to repeat it. Vestibular input triggered Belle’s attention, so her therapist attempted to engage her with a variety of swings and suspended Lycra activities. However, these did not settle or calm her in any way. Although she frequently hung upside down from the ropes in the clinic, Belle startled when she was bounced backwards in the suspended Lycra and immediately tried to flee.

Belle had poor balance between flexion and extension on the scooter board and had difficulty maintaining an upright posture on the tire swing; she hugged the swing, keeping her trunk in full contact with it and her head in extension. In addition, her overall movement patterns were dominated by symmetry. For example, when she was maneuvering herself out of large pillows on the floor, there was a complete lack of rotation through her trunk. Relying solely on symmetrical movement patterns meant she could only orient to those people or objects directly within her line of sight and in “near space” (within three to five feet of her).

Belle’s startle to backwards movement suggested that she was insecure, not with gravity, but with backwards space. She was comfortable having her feet leave the ground and her head moving in all places, except backwards. These things, in addition to her drive to hang upside down, suggest a picture of “spatial insecurity” rather than a true gravitational insecurity.

After Listening

When a spatially-enhanced CD was played over open speakers, Belle’s posture immediately became more upright in the tire swing. Soon she was fully erect with her arms extending from her body to hang onto the swing. She began playing with different postural movements on the swing. For the first time, she oriented to people and things in “far space” (i.e., beyond five feet). She began making eye contact with all people in the clinic, waving to them as she swung around. She also demonstrated more trunk rotation as she oriented to people and objects outside of her visual field. In addition, Belle appeared to be calmer and had improved attention.

When putting headphones on for the first time, Belle immediately oriented to the music. Her entire body stilled and her eyes moved back and forth from right to left as she listened intently. While listening, Belle was able to sustain attention to activities for much longer periods of time and no longer quickly moved from one activity to another.  This was observed in the tire swing where she remained for 12 minutes compared to the initial 5-20 duration. During listening, Belle made several attempts at language, using intonation and longer strings of words. She also attempted to coordinate pushing and pulling to propel a platform swing. She even used trunk rotation on the swing to notice the therapist sitting behind her.

After listening, Belle began a more organized process of selecting activities. She relayed her interest to the therapist, searched for the needed equipment, and helped set up the space for the activity. She appeared more aware of the space around her. At one point she cleared a number of therapy balls out of the way that would have impeded her on the scooter board.

Therapeutic Listening ignited Belle’s postural muscles, and she began to show an internal drive for mastering skilled activities such as the scooter board and climbing in the Lycra. She remained prone on the scooter board for 11 seconds and supine for 15 seconds at a time. Although she continued to have difficulty with head/neck flexion and repeatedly fell off, Belle clearly wanted to master this activity, and she persevered with it for a total of four minutes. In the Lycra, Belle was able to climb from layer to layer, with assistance, all the way to the top. She remained in the top layer and bounced for a while before climbing down. She clearly enjoyed the challenge of climbing and was no longer bothered by backwards head movement.

Therapeutic Listening for the Gifted and/or Typical Child

Savannah was an engaging, bright, and dynamic 12-year-old girl. She was a good student and active in sports and drama. However, she struggled with staying alert and attentive throughout the school day and often returned home only to fall apart over “seemingly nothing.” Her mother felt that these mood swings were more than the typical teenager. In addition, her mother was concerned about Savannah’s low energy level, frequent night waking, and sensitivity to certain types of clothing and sounds.

Savannah had difficulty with a variety of clothing textures. She would not wear anything made of silk, cotton waffle-weave, sequins, or wool. Additionally, she could not tolerate tight clothing. She would not wear any turtlenecks, tight collars or cuffs, full-length shirts, short skirts, or short shorts. Her socks needed to be free of wrinkles and twisted seams. She also preferred to wear boys’ pants, as they were cut looser than girls’ clothing. Due to the limitations in clothing choices, Savannah dressed quite differently from her peers.

Thunderstorms would leave Savannah almost immobilized with fear, and she could hear thunder 30 minutes before it actually arrived in the area. In addition to her intense fear of thunderstorms, Savannah feared high winds and tornadoes. She needed her parents to be at her side throughout the duration of a storm, whether it meant her parents stayed with her in her room or the whole family stayed together in the basement. She also had difficulty with other low-frequency sounds including blenders, food processors, cell phone vibrations, and fire truck sirens. Any of these sounds frightened her so much that she had to seek the comfort of one of her parents.

Although teens often have limited food preferences, Savannah’s diet consisted almost entirely of chocolate chip pancakes, mashed potatoes, cheeseburgers, tacos, grilled cheese sandwiches, eggs, and cereal. She hated the smell of garlic, and if her mother used even the smallest amount while cooking, Savannah refused to eat the dish.

Savannah had difficulty falling asleep and woke frequently during the night. She needed her mother to stay in her room until she fell asleep. She also needed music to play continuously through the night, or she would wake up immediately. Despite all the adaptations to help Savannah sleep, she still awoke frequently during the night. Her sleep-wake patterns and overall arousal level were also impacted by daylight savings time changes and the decreased sunlight during the winter. By age ten, Savannah avoided sleepovers or trips away from home due to her sound sensitivity and difficult sleep patterns.

Savannah was easily distractible, which made it difficult to do homework or be attentive throughout the school day. She had difficulty sitting still and often rocked in her chair in order to keep her arousal level up. She also used background noise, such as music or television, as a way to increase her arousal level and stay focused.

Despite being very active in soccer and drama, Savannah had underdeveloped core postural strength. Her ability to sustain a static position against gravity was significantly less than average for her age group, and she often leaned on objects or people, rather than actively maintaining an upright, neutral posture. In addition, Savannah was not able to move her eyes smoothly and efficiently during tasks such as reading or copying from the blackboard.

After Listening

In addition to Therapeutic Listening, Savannah’s occupational therapy consisted of core posture and breath activities. Within the first two weeks of starting her Therapeutic Listening program, Savannah was able to fall asleep with more ease. Eventually, she was able to fall asleep without her mother in her room or with the music. By the end of therapy, Savannah’s sleep-wake cycle was so well regulated that daylight savings time no longer bothered her, she was able to participate in sleepovers with friends, and even attended a week-long band camp and slept in a dorm. Getting good quality sleep also meant Savannah awoke easily in time for school, had more energy throughout the day, and had less frequent mood swings.

Within a few days of starting her listening, Savannah was more sparkly and alert. Her emotional outbursts became infrequent and her disposition was more positive towards school and her friends. Savannah’s social world and extracurricular activities expanded dramatically once her sensory modulation and regulation issues were resolved. She also became more expressive regarding her opinions, especially with her parents. If her mood started to spiral downward, she was gaining the self-awareness to pull herself back together.

Savannah also experienced less defensiveness to sounds, clothing, and food. She was able to make it through two tornado-warning sirens without difficulty. In addition, she was becoming more comfortable wearing girls’ clothes and began to pay more attention to her appearance. As a result, she no longer felt so odd in relation to her peers. Savannah’s oral defensiveness diminished, and she eventually became more willing to try new foods and even enjoyed some of them.

Savannah did her home program of core/breath activities independently, and her overall strength and endurance improved dramatically. This directly impacted her performance in soccer, and near the end of her therapy, she played her best soccer game ever. Savannah’s therapist reported she had age-appropriate postural and ocular skills with saccades and pursuits that were smooth and efficient, meaning her eyes were beginning to work more optimally.

Therapeutic Listening & Prenatal Substance Exposure

Thomas was an imaginative and playful four-year-old with signs of attachment disorder. He was particularly reactive to light, sound, and touch, and as an infant and toddler he required constant movement to feel calm. While in utero, Thomas’ mother was dependent on cocaine and used substances regularly for the first three months of her pregnancy (before knowing she was pregnant) but also in her latter months. Thomas spent the first weeks of his life with his mother. After that his father and step-grandmother took care of him, moving him back and forth between their homes every four days.

Thomas’ step-grandmother, Martha, was a special education teacher and had become alarmed about some of his odd behaviors. For example, he had a constant need to be bounced, and although he loved to be held, swaddled, and confined, he would scream when he was put down. As he grew, he screamed in response to certain stimuli such as brushing his teeth, being moved from a shady spot into the sun, and hot temperatures (as in food or bathwater). When he was in a public bathroom, he would cover his ears and run out as if the sounds were too loud for him. Thomas also showed signs of tactile defensiveness; he did not like cuffs on his sleeves or zippers on his clothes and hated putting his hands in the mud.

Thomas had particular ideas about how things should look, feel, and be done. For example, when he began eating solid foods, he would scream if he saw a Cheerio that was not formed in a perfect circle. Martha also noted that if she had one strand of hair out of place, he would stop what he was doing, return it to place, and then continue with whatever task was at hand. Thomas loved to play and was fortunate to have a step-grandmother so willing to play with him. In his younger years, she spent an average of seven hours a day playing with him, encouraging full range of motion in his arms and legs while he crawled and doing her best to establish spatial awareness and sensory comfort.

As Thomas got older, he did not engage in spontaneous, creative play. Instead he gave Martha exact instructions and screamed if she did not follow them precisely. For instance, when they played with cars on a ramp, Thomas would tell her when to move her car, where to move it, and how long to wait before moving it again.

After Therapeutic Listening

Following her training as a special education teacher and her intuition as a grandmother, Martha implemented several therapeutic activities in their daily routine. While Thomas was in his bouncing stage from days to seven months old, she began having him listen to a Therapeutic Listening CD over speakers. She combined the listening with good food and active crawling and sensorimotor games. Martha reported that after one week, his need for bouncing had decreased by 70 percent.

When Thomas was old enough to use headphones, Martha started him on a Therapeutic Listening program. As he progressed in his program, Thomas became more tolerant of low-frequency noises, and his sensitivity to tooth brushing subsided. He also became more flexible in his play, more amenable to change, an gained better body control. For example, he began to be able to balance on one foot instead of toppling over as he had always done.

Therapeutic Listening for Adults

Stefanie was a 40-year-old artist, photographer, and filmmaker with a history of learning delays and attention difficulties. It appeared that some of her difficulties were related to poor auditory processing. When she entered school, tests revealed a 30% hearing loss. No one was very concerned about the loss because, by then, Stefanie had taught herself to read lips so she could understand spoken language quite well.

As Stefanie grew older, other difficulties began to emerge. She would skip lines while reading, was somewhat clumsy at gross motor games, had no sense of direction, had a constant fear of tripping and falling, and had fleeting, unfocused attention. All of these challenges made school activities, particularly academics, difficult. Her parents and teachers often believed Stefanie was not fully applying herself, and although her difficulties seemed subtle, Stefanie always knew “there were pieces missing.”

As an adult, Stefanie had to make audio recordings of all meetings that she attended because of the vast amount of auditory information. After each meeting, she painstakingly transcribed everything word-for-word. She could only transcribe one word or short phrase at a time.

Therapeutic Listening afforded Stefanie significant results in a short period of time. After listening to one CD for only a few days, Stefanie realized she could transcribe whole sentences at once, making the task far less tedious. After a few weeks, Stefanie reported hearing the refrigerator running for the first time and stated that she no longer feels like she has “holes” where she missed developmental milestones.

Stefanie always loved birds, so when her therapist gave her Nature Pop (with bird sounds as an ambient background to the pop music), she soon found herself going out to take pictures of birds. Her work has evolved into beautiful fine art photographs and prints of birds in flight. For more information about her work, visit her website at: stefanieatkinsonphotography.com.

Therapeutic Listening: Gearshifters

Justin was a six-year-old boy diagnosed with autism. He had been listening to the Therapeutic Listening CDs for several months in an occupational therapy program. While on a break from his Therapeutic Listening program, he saw his occupational therapist one time per month. Prior to one of his monthly visits, his home therapist contact the occupational therapist to let her know that in the previous two weeks, Justin had become very aggressive at school. The episodes consisted of a lot of pinching, attempts at biting, head-butting, and other aggressive behaviors. The home therapist was puzzled by this behavior because Justin was often quite clam and happy immediately before and after each behavioral outburst. She noted that during the episodes, Justin’s arms, legs, and neck would become very rigid, and he would tightly clench his jaw.

When Justin arrived at the clinic, the therapist used the one of the Gearshifter selections from the Therapeutic Listening library. Justin listened while he relaxed in large crash pillows. Justin immediately snuggled into the pillows and buried himself, where he stayed the remainder of the listening session. After listening, he was calm and able to transition easily—even to non-preferred activities. The therapist recommended that Justin listen to the Gearshifter in the morning on school days to determine if this might help avoid the afternoon behavioral episodes at school.

A couple of days later, the home therapist contacted the occupational therapist. She said Justin had a behavioral episode that morning. After that, Justin listened to the Gearshifter while he sat in his beanbag chair, and the therapist noted , “The rest of the day was AMAZING!!!” She continued to use the Gearshifter as a part of Justin’s program at school and noted that if they gave him the CD as soon as his behavior started to escalate, they were able to regulate his mood and avoid an outburst.