Improvements in Compulsivity, Graded Symptom Checklist Score, Stability Scores, and Oculomotor Function after Neurological Rehabilitation for a 13-year-old Male Patient with Autism Spectrum Disorder with Echolalia and Attention Deficit/Hyperactivity Disorder

Presentation: A 13-year-old male patient presented to Plasticity Brain Centers for evaluation and treatment of symptoms relating to his previously diagnosed Autism Spectrum Disorder (ASD) and Attention Deficit/Hyperactivity Disorder (ADHD).

Findings: Upon intake, the patient was anxious, exhibiting echolalia, and performing self-stimulation behaviors. He was wearing a chef’s hat, noise-cancelling earphones and carried a stuffed animal for comfort. Oculomotor apraxia was present in all planes. Vestibular ocular responses (VOR) were decreased in gain bilaterally. Optokinetic responses (OKR) were decreased with rightward and downward stimulation. A Comprehensive Assessment of Postural Systems (CAPS®) (Pagnacco 2014) was performed assessing balance and stability, on a solid and foamed surface, with eyes opened and closed. The average stability score was 59.55%. When his mother was asked to rate his symptoms on a graded symptom checklist (GSC) (Simon 2017), he scored 59 with a symptom count of 15.

Methods: A 7-day, multi-modal program of neurological exercises was administered in 15 one-hour treatment sessions (Carrick 2017). Each session consisted of repetitive peripheral somatosensory stimuli, neuromuscular reeducation exercises (Antonucci 2016), vestibular rehabilitation exercises, orthoptic exercises, and off-vertical axis rotation (Gdowski 1999) utilizing a multi-axis rotational chair (MARC).

Outcome: Upon exit, the patient was alert and exhibiting echolalia and pacing. He did not have or wear any comfort items. Oculomotor apraxia resolved. VOR was appropriate bilaterally. OKR were appropriate in the horizontal and vertical planes. The symptom severity score decreased to 26 (-55.93%) with a symptom count of 7 (-53.33%). Stability scores improved, with the average stability score of 74.20% (+ 24.60%).

Conclusion: The authors suggest further investigation into multi-modal, intensive approaches to decrease compulsion and symptom severity scores and increase stability scores in patients with ASD and ADHD.

References:

1. Antonucci MM, Link PE, Barton DA and Carrick FR (2016). Improvement in muscle tone, coordination, balance, ocular-motor function, and communication in a 6-year-old male with developmental delays after 5 days of ReceptorBased treatment. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function. doi: 10.3389/conf.fneur.2016.59.00067 
2. Carrick FR, Clark JF, Pagnacco G, Antonucci MM, Hankir A, Zaman R and Oggero E (2017) Head–Eye Vestibular Motion Therapy Affects the Mental and Physical Health of Severe Chronic Postconcussion Patients. Front. Neurol. 8:414. doi: 10.3389/fneur.2017.00414 
3. Gdowski GT, McCrea RA. Integration of vestibular and head movement signals in the vestibular nuclei during whole-body rotation. J Neurophysiol (1999) 82:436–49 
4. Pagnacco G, Carrick FR, Wright CH, Oggero E. In-situ verification of accuracy, percision and resolution of force and balance platforms. Biomed Sciences instrumentation (2014) 50:171-8 
5. Simon M, Maerlender A, Metzger K, Decoster L, Hollingworth A, McLeod TV. Reliability and Concurrent Validity of Select C3 Logix Test Components. Developmental Neuropsychology (2017) Oct; 0: 1-14. Doi: 10.1080/87565641.2017.1383994. Epub 2017 Oct 25.