REI for Adult Autism, Sleep and Bipolar – A Case Study

Even though the REI Custom Program is implemented at the listener’s home and we create the recordings based on a comprehensive intake questionnaire, I still occasionally get to play live for a client before they start their program.

In this case study, I met with the subject, Russell, in the group home where he was living and played for him twice before making the REI recordings. Russell was 38 years old and had been at this facility since its inception 11 years previously. Prior to then, he was cared for at home by his family.

According to records, Russell was diagnosed with autism and bipolar disorder. He had very limited communication skills and was functionally non-verbal. The facility staff described that his communication consisted of mostly pointing, directing and vocalizing (mostly with grunts and other non-language cues). He also exhibited severe often self-injurious, self-stimulatory behaviors, the most significant of which were head-banging, anal-digging, and forehead-scratching.

The issues they were most concerned about, and the reason for wanting to do the REI Custom Program, were his self-injurious behaviors and his bipolar symptoms including, poor sleep and a starvation/binge-eating cycle (where he often gained and lost up to 10 pounds through his cycles).

The severity and frequency of his self- injurious behaviors increased when he was on the depressed side of his bipolar cycle. The staff reported that when he was depressed he needed near-constant redirection to keep him from engaging in these self-abusive behaviors. He was also difficult to engage in activities such as doing chores and interacting with the animals. Instead, the staff described him as lethargic and moody.
 
He, they stated, preferred to sleep during the day or to sit by himself and self-stimulate until asked to stop. He would generally stop when asked to but approximately 30% of the time the staff noted that they needed to physically stop these behaviors. This was done by gently pulling his hand away from either his face or anus or by moving him from the wall that he was banging his head-on. He rarely put up much resistance and seldom expressed any agitation to this redirection.
 
The staff described that Russell hadn’t eaten yet the first day I met with him and had eaten very little in the past 2 weeks since his depressed cycle began. The staff noted that he had lost 7 pounds already since the end of his last manic period.
 
I met Russell in the main group living area where he was sitting by himself. He made no response when I said hello to him and simply sat in his chair with his hand to his forehead. He wore a bandage and was lightly scratching at it as I talked to him.  A staff member pulled his hand away and he fidgeted with it in his lap for a short while before returning it to his forehead where he started scratching again.
 
I began playing the drum. Nothing in his behavior changed for a few minutes until which time he was noticed to be scratching less on his forehead. After approximately 10 minutes he was no longer scratching his head and his hands were clasped in his lap while he sat nearly motionless. His gaze was fixed in front of him and it didn’t appear that he was looking at anything in particular. The staff mentioned that he seemed much calmer, referencing his voluntarily stopping his self-stimulation.
 
He continued to sit quietly with his hands in his lap for about 15 minutes after I stopped playing. At that point, one of the staff came to get him to take a walk outside, which he did without resistance.
 
I met with Russell a second time before making his REI recording so that I could observe him when he was in a manic state. The director called me about 2 weeks after my first visit informing me that he was now manic. When I arrived at the facility he was agitated – evidenced by his pacing back and forth while wringing his hands. I was informed that he hadn’t slept well the last few days and had, in fact, had been under constant supervision for the past 2 days for fear of him hurting himself with his self-abusive behavior.
 
I quickly got out my drum and began playing. His reaction was immediate – he stopped pacing and turned to me, frozen. He stood nearly still for the duration of my playing (approximately 12 minutes). When I stopped he turned and quietly left the room. One of the staff members remarked on how calm he seemed at that moment.
 
The director related that his bipolar cycles were pretty regular – the manic period lasted about 2 weeks and the depressed period lasted between 2 and 3 weeks. He currently wasn’t taking any medication for this because they had tried various ones that had not been successful. They were currently taking a break from medications of any kind.
 
Russell received his REI recording three days after my last visit while he was still in a manic period. Because he was having trouble sleeping it was recommended that he listen at bedtime. Upon my follow-up visit after four weeks, the staff noted that his daily REI tracking log reflected that he fell asleep while the recording played the first night and, aside from 3 nights the first 2 weeks, he fell asleep before the REI recording ended (this is within 20 minutes, a much shorter time than was typical for his manic periods).
 
When his cycle shifted to a depressed mood, the staff continued to play the REI recording at bedtime because it was the easiest time of day for them to play it. He continued to fall asleep while the recording played, though it wasn’t unusual for him to fall asleep within this timeframe when he was depressed before using the REI recording.
 
The staff instructed Russell on how to turn on the recording himself at bedtime and, except for a few days during his depressed cycle, he did so without prompting.
 
The staff had also taken to playing his REI recording during the day during his depressed period (in addition to playing it at night) and they noted that his mood seemed to elevate and he became more active throughout the day. The staff also noted that his self-abusive behavior had lessened. This change in self-abusive behaviors began being noticeable after just over 4 weeks after beginning REI.
 
For the next few months, Russell continued listening to his REI recording at bedtime and during the day during his depressed cycle. Staff tracking revealed that his frequency and intensity of self-abusive behaviors were progressively lessening. When I went to see him at the twelve-week point, he had no sores or scabs on his forehead, at a state that the staff describe as unheard of before starting REI.
 
The staff also described that his manic and depressed cycles were noticeably less severe. When he was most recently manic he was much calmer and was sleeping every night. The staff also described that when he was depressed he was less lethargic and easier to engage in activities. He was also eating three good meals a day.
 
After 6 months, the staff noted that Russell demonstrated an improvement in his symptoms of bipolar disorder – his cycles weren’t as deep, the lows weren’t as long, and he was better able to handle the depressed side when it did occur. The director said that he was no longer listening to the REI recording every day but when he did listen before bedtime he would sleep deeper and wake more rested. After talking with the staff, they agreed to try to be more consistent with playing his recording and in helping him remember to turn it on before going to bed.
 
You can learn more about the REI Custom Program by clicking the Custom Program tab above.

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