Abby was a happy, energetic and friendly five-year-old female with Sensory Processing Disorder and PDD-NOS. She was adopted at 15 months and, according to the limited medical records available, may have had a minor brain injury or been sensorily deprived during her time at the orphanage. Since being adopted Abby received therapy services to address her sensory issues.

When Abby completed the REI Custom Program intake her issues were as follows:

• Anxiety: Abby was anxious over transitioning from one activity or environment to another and afraid of loud and stimulating public places. She tended to lash out (scratching, hitting) others when over-stimulated or anxious. She would rock her body back and forth and engage in other repetitive behaviors to self-soothe. She was also notably fearful of the dark and of monsters.
• Inattention: Her mother reported that Abby had difficulty focusing and staying on task. She was easily distractible and restless and fidgety when asked to attend to a task. She would often act impulsively, though she was not a thrill-seeker.
• Language delay: Abby had difficulty expressing herself. She often repeated words or phrases, had difficulty with pronunciation and enunciation, often reversed her pronouns, and had problems finding the right words to say even if she knew them.
• Sensory seeking behavior: Abby was a highly energetic child who would seek highly stimulating activities. She often craved pressure to self-soothe. She had difficulty with motor planning and didn’t know where she was in space, frequently bumping into others.
• Sensory aversion: In spite of her sensory seeking behavior, Abby was also often sensory aversive. She was easily startled, reacted aggressively to light or unexpected touch, and disliked physical contact.
• Social interaction difficulties: Abby prefered to interact with her family and had difficulty knowing how to engage with other children. She required prompts to interact unless it was a high-energy activity, such as playing tag.

Abby listened to her REI Custom Program recording once a day at various times based on her schedule. Times were generally between 8am and 10am or between 6pm and 8pm.

Many people ask about the best time of day to play their REI recording. In the long run it doesn’t matter – we can achieve the same net results as long as the current recording is played once a day. In the short run, the time of day you play the REI recording can have an impact on behavior for that day.

Abby’s varying schedule illustrates this concept really well. For example, she seemed calmed by the recording when it was played. In the evening this made the transition to bedtime easier. Even on the first day of listening, her mother reported that she was more compliant with her routine of brushing her teeth and putting on pajamas when she listened at 7pm.

When listening in the morning (8am) Abby also demonstrated calm from her REI recording. She dressed without complaint and allowed her mother to comb her hair without fidgeting. This calm effect seemed to last: According to teacher reports, Abby did a better job following directions and staying on task on the days she listened in the morning.

These immediate effects of listening can help you decide what time of day to play an REI recording. For most of our clients we recommend bedtime for three reasons:

1. The evening transition is often difficult because the client is tired therfore is often more resistant. Calming can only help this resistance.
2. Most of our clients have a hard time falling asleep. Turing on the recording when the light is turned off generally helps with falling asleep.
3. The evening routine usually ends with some quiet time and it’s often easy to fit the REI recording into this time. 

Abby benefited well from the calming effect of her recording regardless of when it was played, so the best schedule for her was one in which her mother could find the time to play the recording.

After 2 weeks Abby showed improvements in:

• Eye contact. This was noticed not only by Abby’s parents but also her teacher, who in one instance, remarked how Abby looked her in the eye and said she understood when her teacher explained that Abby could play with her friends after school if she followed directions during the day. She complied and was able to follow directions.
• Transitions. She was less reactive/resistant to going to bed and school.
• Language: Began using full sentences.
• Sensory defensiveness. She was less bothered by having hair combed and would sit quietly rather than fidget or pull away.

Abby was clearly getting a fair amount of stimulation from her REI recording, which allowed for some good initial gains. On the flip side, she also craved more sensory input such as jumping on a trampoline and running around.

For her next recording we chose to address her sensory seeking behavior, knowing we would be slowing the progress of her language improvements, as sensory modulation and language development require two different types of REI stimulation. Her other issues, anxiety and attention, generally didn’t require this shifting focus since we can address them in each context. Over the remainder of her REI Custom Program we alternated the focus of Abby’s program between language/social and sensory.

This meant that each new track pushed one area forward while stalling, and some cases slightly back-tracking, the other. For example, during track #5 Abby showed significant improvements overall in her ability to appropriately interact with other children and her language showed improvement. While at the same time, she still needed to seek sensory input by jumping and swinging and she exhibited anxiety, particularly over loud noises, the dark, and monsters. 

On the other hand during track #4, when we focused on the sensory processing, Abby showed improvement in sensory seeking activities such as running and jumping and engaged in more quiet activities including pretend play. Her langauge, however, regressed. She returned to repeating words and phrases, something she stopped doing once she began her program. Her mother felt that some of the vocal perseveration was due to anxiety over her school situation – there was a new student in the class that was impulsive and loud – but this behavior matches the give and take that can happen when switching the focus of an REI Custom Program.

Over the next several months Abby made progressive gains across the board from this alternating pattern in REI stimulation levels. Most notable from the start of the program were:

• Language: She was now using pronouns properly more consistently. The fluidity and composition of her sentences also improved significantly.
• Social: She was interacting more appropriately with other children. She was more talkative with them and was able to engage without needing prompts from adults.
• Anxiety: Overall Abby was less resistant to transitioning to and from school and with her bedtime routine. She still exhibited some anxiety when she was tired or over-stimulated.
• Attention: Abby was more compliant with directions from her parents, therapists and teachers and was better able to attend and stay on a task asked of her.
• Sensory seeking behavior. She was less compulsive about seeking sensory input from running, jumping or swinging. During the last three tracks of her program she exhibited some self-stimulatory behaviors, such as rocking and jumping, but the timing of this matches with her returning school where there are other children who are anxiety provoking to her (crying and screaming)
• Sensory Aversion. This area improved most notably in her reduced resistance to having her hair combed. She was also better able to handle noisy environments, though she could still get over-stimulated by them if she is tired.

Abby continues to listen to REI recordings as we adjust her recordings to further her progress.