Case Study: Tabitha, 3, Autistic Traits

Tabitha is 3½ years old. Growing up in a bilingual household, she was meeting, and often exceeding, many milestones for her age. Certain habits, and social development, were of concern to her parents from age 2, and they expressed this to their GP (medical doctor). He advised them to wait another two or three years before applying for an assessment, as her symptoms appeared mild, and she was verbal after all. In particular, by age 3½, her parents were worried about:

• Lack of social interests: Tabitha simply ignored children of her age in the morning playgroup she was attending. They were of no interest to her, there was no eye contact and she appeared to treat them as objects rather than entities with needs and feelings, despite encouragement and gentle guidance. This attitude was also displayed towards her younger sister, though she was never mean to her despite various encroachments on her play domain. By contrast, Tabitha engaged with adults very differently. While shy and reserved, she would let ‘big people’ into her sphere of play, making eye contact when she suspected an opportunity to learn something, gain access to toys and activities she enjoyed, or demonstrated a skill such as getting a keyboard to make sounds, which she commented on in short phrases that were mainly instructions, rather than questions.

• Sensitivity to sound: Tabitha was at ease with music that she liked, and her father’s impressive vinyl collection treated her a wide range of genres, from classical piano concertos to rock of the 70s. She was fascinated by the electric keyboard in her living room, and warmed up to anyone playing it with skill, despite having first voiced her disapproval of new people entering her family home. Louder, and/or unexpected sounds however startled her and could set off an outburst that she would take a while and much comforting to calm down from.

• Inflexibility and mild repetitive, restrictive behaviour: Tabitha was inquisitive though shy, and open to new activities, however when plans did not suit her, she would become obstinate and resistant. Rationalising and negotiation cemented her stance; her temper would flare and it would take significant time, effort and distraction to calm her down again. One such ‘bribe’ involved watching a Romanian children’s series on her iPad, and this was the only show she tolerated; attempts to expand her interests in this regard were met with animosity and outbursts. She could watch the same episode over and over again for hours, curtailment of which would also require significant effort and distraction. While watching it, she was happy and attempted to copy songs and snippets of dialogue.

• Immersion in complex tasks: Less of a concern, but noteworthy, was Tabitha’s ability to solve hundred-piece puzzles, an occupation that would captivate her full attention. Locked in her realm, she would be unphased by activity around her, even sounds or new people in the room, as she would talk to herself while demonstrating remarkable aptitude and drive until she had finished it and would announce this with pride to her proud parents. Tabitha was also able to recognise and differentiate between complex skeletal representations of organic chemistry symbols that her mother had drawn on a board for her own study, a talent the surprised parents would foster with considerable admiration. She was able to navigate an ipad with ease, but would neither share this with her younger sister. 

Tabitha’s parents had heard great things about neurofeedback in their home country, and her mother’s medical background strengthened her initiative to be proactive at the earliest stage in her child’s development. 

We began with a brain map at Tabitha’s home. Her mother was at work while her father was looking after the two young daughters, and he welcomed the social component of a new person breaking this isolated routine. Tabitha witnessed this rapport and overcame her initial suspicion and resistance quickly. Watching and listening to someone play on the electric keyboard fascinated her, and within an hour she had built up sufficient trust to let a new person put a shower cap-like device on her head. We obtained a qEEG recording that provided the necessary data for analysis.

Tabitha’s brain map showed the refreshing finding that she was open to new perspectives and not relational, or self-centred in her thinking, an important transition that happens between age 3-5. She exhibited various trauma-like markers, including an emotional sensitivity to auditory input, and a sense of feeling underloved or lack of emotional sense of safety. There were various anxiety markers, and confirmation of her hypervigilance, shyness, obstinacy, loner qualities, and mood regulation issues, while being overly primed by her environment. Fear and anxiety were prevalent markers we needed to address while strengthening her Default Mode Network sites.