14-year-old: early developmental trauma (adopted)

Summary Review.

 (before and after intervention)

Before intervention, she presented with significant difficulties with emotional regulation, sensory sensitivities and refusing activities. Parents reported anger/tantrums at least twice daily (lasting up to 1 hour) with shouting, pushing/thumping and occasional breakages, followed by withdrawal/going quiet and physical tension when attempts were made to discuss the incident. She was highly anxious and avoidant around personal care: she would avoid showering, hair washing could trigger extreme distress/hysteria, she resisted head extension (head going back) and she did not tolerate others touching/helping around her head; day-to-day hygiene required multiple adult prompts. She also showed marked vestibular (movement) sensitivity and movement avoidance: she became distressed with backward head positions, disliked feet leaving the ground, and reported/experienced car sickness and post-session nausea when movement input was increased.

In addition, she presented with restricted eating (limited range/brand and texture preferences; avoided eating with others), sleep-related anxieties (fear of the dark; prolonged settling), and reduced independence/confidence (e.g., reluctance to go upstairs on her own, or walk independently). Communication about feelings was limited; she often answered only direct questions, did not readily share about school/day-to-day experiences, and found it difficult to identify and verbalise emotions. School participation was impacted by noise/crowds, with reliance on ear defenders and avoidance strategies, infact school was a big challenge for her.

Following ASI intervention (37 sessions), she has made meaningful, measurable improvements in emotional regulation, tolerance of movement and daily functioning. Her anger outbursts hardly happen and are less intense (typically verbal rather than physical), with improved awareness of others and reduced duration (often around 10 minutes), although she still benefits from an adult prompting her to prevent escalation.

Her movement tolerance has increased significantly: she can now engage in graded activities and PE, involving head movement, and backward-leaning positions, and “feet off the ground” challenges with reduced resistance, improved balance/core control, and no ongoing reports of post-session sickness; she is able to hold her head up, sit without fidgeting, and participate in multi-swing sequences with greater confidence.

Functional self-care has improved: she will now shower, no issues, hair washing is calmer and independent, she can tolerate hygiene routines (still requiring prompts at times).

Broader participation gains have also been noted: she is trying a wider range of foods, is able to eat at school and has managed eating out, and her sleep and night-time continence have improved (no more bedwetting and reduced sleep-related anxiety). Socially, she has made and is maintaining friendships, is more willing to talk, and can share worries/experiences more readily; she has demonstrated increased resilience and empathy (e.g., supporting a younger peer) going away on residentials (previously impossible) and is more able to cope with busy environments, supported by minimal practical adjustments.

Overall, she is more confident, more communicative, and more able to engage in everyday routines and school life with reduced distress. One of the most important changes is her growing ability to express herself. Whereas before she would often withdraw when something was wrong, she can now explain her worries and talk about problems with her friends, parents and teachers at school. She is “finding her voice” being able to say when something isn’t right and ask for help.