Case Studies

CASE STUDY #1

Client Presentation:
12 year 10 month old male, 7th grade.
Diagnosed with ADHD-Inattentive Type in 3rd grade.
Has taken medication for ADHD (tried several different medications).
Suffering side effects of medications: insomnia, decreased appetite, and headaches. Medication discontinued.
Teachers’ comments: inattentive, not completing and turning in assignments, poor organization and math skills.
Grades dropped 10 pts–put back on Adderall 10mg right before Brain Training began.
Parents concerned with medication side effects and want to discontinue use.
Other concerns: poor self-esteem, poor social skills, isolates at home playing video games, and poor body image–tall and lanky for age.

Initial Assessment:
Naglieri Nonverbal Ability Test – Form A–IQ 137  (Very Superior), 99%.
Integrated Visual and Auditory Continuous Performance Test (IVA+) results did not support a working diagnosis of ADHD; response control was weak; visual and auditory processing were out of balance–responding to auditory stimuli was weaker than visual.
Multidimensional Anxiety Scale for Children (MASC) indicated slightly above average rating for Separation/Panic and Social Anxiety; and Performance Fears was much above average. Overall anxiety disorder index indicated he was borderline for an Anxiety Disorder.

Recommendations:
21-One hour Brain Training sessions with a personal trainer combined with ADHD Coaching tips for organizational skills (last 15 minutes of each session).
Develop positive rewards system in place of restrictions or in combination: with written contract.
School accommodations recommendations submitted to school though parents.

Results:
NNAT (Form B): IQ 142 (VS), 99.7%, (Positive increase: 5 pts).
MASC – Anxiety Disorder Index within normal limits: exception–Performance Fears slightly elevated-age related.
IVA+ – Visual and Auditory Processing became more balanced.
Medication continued at current level (no dosage increase).
Teachers’ reported improved concentration, focus, and organizational skills with increase in grade averages.
Parents reported increase in self-confidence, social skills, and overall behavioral improvement.

Recommendations after Brain Training:
Encourage intellectual potential through extra-curricular activities (i.e. MENSA, tech camps, clubs).
Consider Pre-AP or AP classes for 8th grade as student is bored.
Continue positive rewards system with written contract.
Reevaluate medication needs after school begins.

 

CASE STUDY #2

Client Presentation:
12 year old male, 6th grade–local ISD Sp Ed Program, diagnosed with ADHD at an early age, has received treatment since that time which has helped to some degree. However, the severity of his symptoms and the magnitude of their interference with his functioning at home and school concern the parents greatly. He was adopted from a foreign country at an early age which makes his history more complex, offering the possibility of unknown genetics, prenatal exposure, early neglect, emotional trauma, and other factors that may or may not be contributing to his struggles. Although his symptoms are considered “classic” for ADHD, his failure to respond better to medication and his increasing academic struggles make the parents wonder if there are other co-morbidities that may be involved.

Medications: Concerta, Strattera, Tenex, Risperdal, Claritin, Singular, Melatonin, and Omega-3

Initial Assessment:
Naglieri Nonverbal Ability Test – Form A–IQ 124 (Superior), 95%.
Integrated Visual and Auditory Continuous Performance Test (IVA+) results did not support a working diagnosis of ADHD. There was a 35 pt difference between Full Scale Attention Quotient=122 and Full Scale Response Control Quotient=87  signifying difficulty with response inhibition; a 30 pt difference between his Sustained Auditory Attention Quotient=117  and Sustained Visual Attention Quotient=87 indicating difficulty with visual processing; and he was over processing in the area of Speed with Auditory Speed Quotient=141 and Visual Speed Quotient=136. On a measure of impulsivity and response inhibition, his Auditory Prudence score of 80 showed problems with auditory impulsivity, and his Visual Prudence score of 63 revealed he is likely to be over reactive and/or easily distracted by changes in his visual environment.

Recommendations:
21-One hour Brain Training sessions with a personal trainer combined with ADHD Coaching tips for organizational skills (last 15 min of session). Minimum, many need more.
Develop positive rewards system in place of restrictions or in combination; with written contract.
Parents to monitor medication and side effects.

Results:
NNAT (Form B):  IQ 127 (Superior), 96%, (Positive increase: 3 pts).
IVA+–Visual and Auditory Processing became more balanced.
Medication continued at current level (no dosage increase).
Decreased constant movement, constant talking, rocking, and interrupting conversations.
No Teacher reports as Brain Training was completed over the summer.
Parents reported increase in self-esteem, social skills, and behavior improvement at home and in the community.

 

CASE STUDY #3

Client Presentation:
19 year old male, sophomore at a local University on scholarship, studying Biochemistry, wants to attend Medical School, will need a 3.75 GPA and a good MCAT score to be considered. He has a part-time job (15-18 hours during school and full-time in the summer) and he is involved in many sports related activities: Cross Country and Fencing for school plus many additional sports for fun, has many friends, and no specific girlfriend. He graduated from high school having taken all AP classes making A’s/B’s and earning 40 hours of college credit, was a National Merit Scholar, not diligent with homework or studying; could memorize easily and get by without studying. Freshman year: 1st Semester-15 hours, GPA=3.6, stated “hard school”; 2nd Semester-15 hours, GPA=2.9, comments: “classes harder, tried to study, was around friends that did not have good study habits”.
Diagnosed ADHD in elementary school, but never took medication.
Parent reported problems with disorganization, distracted at college, too many activities, high energy, does not sleep much or well.
Client reported when he was 8 years old he was playing with a cousin on a tombstone at a funeral, fell and hit his head, requiring 2 staples in right frontal lobe.

Initial Assessment:
Naglieri Nonverbal Abilities Test: client was too old for test norms.
Integrated Visual and Auditory Continuous Performance Test (IVA+) results supported a working diagnosis of ADHD – Inattentive Type; some problems in visual processing were noted in impulse control under high demand conditions, processing auditory information and staying focused on the task at hand when it involved repetitive auditory attention–these lapses in auditory attention are likely to impair his ability to perform in demanding situations or when stressed (these lapses occurred under high and low demand conditions).

Recommendations:
11 – One hour Brain Training sessions with a personal trainer.
10 – Ninety minute Brain Training sessions with a personal trainer combined with ADHD Coaching to provide tips on organizational and time management skills (45 min each).
Customized program to focus on strengthening auditory skills and creating more balance between auditory and visual processing abilities.

Results:
Client reported Brain Training improved his ability to concentrate on academics and improved grades.
ADHD Coaching helped with his organization, study skills, and his ability to cope with both the academic and social demands of college.
Brain Training began in the summer and was completed before final exams; Fall semester GPA=3.4, a .5 increase from Spring GPA=2.9.
Follow up: Spring semester–doing great, “this semester seems easier and my grades are A’s/B’s!” He was preparing to take the MCAT and applying to Medical School.

 

CASE STUDY #4

Client Presentation:
10 year old male, 4th grade
Diagnosed with ADHD in 2nd grade
On medication for ADHD (has tried 5 different meds)
Suffering from side effects from medications: insomnia, decreased appetite with significant weight loss, and dark circles under eyes.
Teachers complaining of impulsivity, inattention, excessive talking, not completing and turning in assignments.
Parents concerned with medication side effects and wanted to discontinue use.
Low self-esteem, poor social skills

Initial Assessment:
Naglieri Nonverbal Ability Test – Form A–IQ 101 (Average), 53%.
Integrated Visual and Auditory Continuous Performance Test (IVA+) results did not support a working diagnosis of ADHD (client on meds). Showed an 18 point difference between sustained auditory attention and sustained visual attention with visual being weak.
Multidimensional Anxiety Scale for Children (MASC) indicated much above average for physical symptoms (tense/restless and somatic/autonomic subscale) and social anxiety (humiliation/rejection subscale). Overall anxiety disorder index indicated an anxiety disorder.

Recommendations:
Parents to take test results to Pediatrician showing MASC assessment and medication package insert (not recommended for use in children with anxieties) and ask to reduce medication as brain training increases ability to focus.
21 – Ninety minute Brain Training sessions with personal trainer combined with Biofeedback for anxiety and ADHD Coaching tips for organizational skills (45 minutes each).
School accommodations recommendations submitted to school through parents.

Results:
NNAT (Form B):  IQ 109 (Average), 73% (Positive increase: 8 pts).
MASC – Anxiety Disorder Index within normal limits with average physical and social symptoms of anxiety for age group.
IVA+ – Visual and Auditory Processing became more balanced.
Medication discontinued (side effects eliminated).
Increased appetite and weight gain.
Insomnia eliminated (sleeping 8-10 hours per night)
Teachers reported better concentration, focus, and organization skills with improved grades.
Parents reported increased self-esteem, social skills, and overall behavior improvement.

 

CASE STUDY #5

Client Presentation:
10 year old female, 5th grade
Previously diagnosed ADHD – Inattentive Type in 1st grade
Client reported problems with reading comprehension and math.
Teachers reported poor organizational skills, trouble focusing in class, and completing and turning in classwork and homework.
Parents reported she spends long hours every night on homework and continues to have poor to failing grades in all core subjects.
Medical History: normal birth and development, no significant concerns noted.

Initial Assessment:
Naglieri Nonverbal Ability Test – Form A– IQ 107 (Average), 73%.
Integrated Visual and Auditory Continuous Performance Test (IVA+) results did not support a working diagnosis of ADHD.
Strong Auditory Dominance, is easily distracted by auditory stimuli and has weak visual skills.

Recommendations:
21 – One hour Brain Training sessions with a personal trainer
Customized plan to focus on strengthening visual skills and creating more balance between auditory and visual processing abilities.

Results:
NNAT (Form B): IQ 109 (Average), 73%, (Positive increase: 2 pts).
Visual and Auditory Processing became more balanced.
Grades improved from failing to a “B” average student.
Math grade went from 65 to 91 in six weeks.
Homework time went from several hours per night to half.
Teacher reported increased concentration, focus, and improved organizational skills.
Parents reported an overall happier child with more self-confidence in her ability.