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.