Sunday, November 2, 2008

IM & Depression - Single Case

Carrie is a 35 year old woman who put aside her career several years ago to care for her two children. ages 3 and 6. Her six year old son has autism. Carrie took part in a 10-person study focusing on Interactive Metronome (IM) as an intervention for reducing stress in parents of children with autism. She, like others in the study, spends a great deal of time in doctor’s offices, therapy clinics and in school meetings. Carrie had little time for herself due to the rigors of caring for and supervising her son, which includes moderate assistance with bathing and grooming, hours in the kitchen preparing special foods, and constant supervision for his safety.

As part of the study, Carrie was given a small battery of pre- and post- IM assessments. The primary assessment tool was the Parental Stress Index (PSI), a standardized assessment that measures stress in parents with children 12 years and younger. Stress sources on the PSI are broken into two sections: Questions about the child and his/her characteristics and questions about the parent (including parenting itself).

Other assessments in the battery included the adult/adolescent version of the Sensory Profile and the 6-item IM Survey.

Carrie’s overall pre-score on the PSI demonstrated stress in excess of 4 standard deviations higher than the norm. All components including depression and health demonstrated large contributions to her overall stress levels. She was within 2 standard deviations from the norm in just one area, “isolation” (from peers, family). Previous studies on parents of children with autism indicate “somewhat” higher PSI scores on the child component items. Carrie’s scores are in excess of that.

Carrie's IM Survey scores indicate excellent rhythm & timing, good concentration and focus, fair memory recall and organization skills, and poor multi-tasking and coping skills,. She completed the adult Sensory Profile on the pre-test only and scored as “typical” in all areas.

The IM intervention program was set-up to allow a parent to complete a 25- 40 minute IM session while his/her child was in therapy elsewhere in the clinic. Each parent was expected to do sessions once or twice a week, as schedules permitted, for a total of 15,000 IM claps and taps of the hands, feet and novel combinations of both. It is thought that 15,000 repetitions is enough for the effects of IM to last with time. The program had two characteristics. First, once a parent established competence with IM tasks and had achieved average or better scores ( usually at session 2), he or she was given increasingly larger number of repetitions (up to 1000 repetitions) for both hands. This was usually completed on session 7. Second, starting at session 8, tempos were altered for some or all tasks in each session. A standard tempo is 54 beats/second - just lower than typcial hearbeat (60 beats/second). In session 8, the tempo was lowered to 46 for 200 repetitions and then lowered again to 40 for the remainder of the session. In session 9, the tempo was raised to 64 for 300 repetitions, raised again to 69 for 200 repetitions and then, back to 64, before ending on at a tempo of 54. In session 10, the tempo was lowered to 35 for the entire session. In 11, the tempo was raised to 72 for 400 repetitions, and then lowered to 54.

The rationale for higher tempos was to assist with multi-tasking. The life of the parent of a child with special needs is busy to the point of being overwhelming, and so increased multi-tasking would be a plus. Multitasking was directly measured on the IM Survey and indirectly measured as the competence component of the PSI.

The rationale for lower tempos was to assist with focus and concentration (measured on the IM Survey). In addition, the study team hoped for increased patience, as measured indirectly by acceptability (of the child) on the PSI. In fact, the lower tempos did try the patience of two of our test subjects to the point that they were allowed to forego those tempos. Carrie on the other hand persevered and completed those tasks.

As the program progressed, Carrie visibly relaxed. After 3 sessions, she said that she looked forward to coming, and she arranged for an extra session each week to complete the program faster. After 7 sessions, Carrie observed that she seemed to be “coming out of a fog”. She said that she hadn’t realized that she was depressed and had been so for a number of years. After 7 sessions, she arrived wearing new clothes and said her self-esteem had improved and that she now wanted to look good when in public.

At the end of the program, Carries’ scores for stress had decreased by 3.6 standard deviations – an impressive amount. Her stress scores for non-parenting factors is at the 64th percentile, and within the typical range for all parents. Her overall stress scores remain high, but as we discovered in the study, the life of a parent with a special-needs child is necessarily complex. Carrie’s overall score (86th percentile) is now the second lowest (second best) of our 10 parents.

In an interview six months later, Carrie said that her affect remains positive, her self-esteem is high, and she has good self-confidence. She said that she feels resilient to stress and handles it very well, without moving into bad habits such as binge eating. She said that she now has perspective on her life’s challenges, and she expressed confidence about handling challenges in the future.

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