Enter the Therapy Zone

At the Spectrum Center, listening therapist Alison Welsh helps Jacob Yount, 5, read. The Washington area is a major center for innovative treatments for children with neurological and behavioral problems, but do they really work? (Lucian Perkins - The Washington Post)

Team Hailey has an impressive lineup. Besides Dynamic Development's Leyden and Harris, it includes Washington visual-cognitive optometrist Harry Wachs, Manassas sensory-motor gym specialist Parviz Youssefi and speech pathologist Crystal Payne of Metropolitan Speech. Recurring roles are also played by Wieder and nutritionists Kelly Dorfman and Dana Laake, and pediatric allergist Richard Layton. In the past, Hailey has also seen the Spectrum Center's Valerie Dejean and been tested by an associate of Silver Spring psychologist William Stixrud. Though she never consulted with Greenspan, Hailey's mother has attended at least 10 conferences helmed by his organization, and for many years she incorporated his and Wieder's "floor time" principles into an intensive at-home program for Hailey.

Hailey also gets regular nutritional and blood analyses, and takes various vitamin supplements. She also does regular activities like ballet, drama, art, horseback riding, swimming and karate along with home versions of some therapies.

Stop 1: Time to Move

We took the Manassas exit and drove past the Best Western Battlefield Inn to a warehouse district where GMS is located. Hailey changed into gym clothes and jogged into a big room painted with colorful stars and planets and filled with swings, ropes, balance beams and a climbing wall.

The gym holds standard gymnastics and movement classes. But its Sensory Motor Integration Division has classes and camps that incorporate "physical fitness, perceptual motor integration, motor planning, problem-solving, body awareness and social interaction" for kids with developmental and learning delays. GMS charges $650 for an evaluation and $192 a month for one sensory-motor class a week.

In one corner, a boy pushed through a spider web of bungee cords, which Youssefi said applied pressure to the skin of children with aversion to certain touches and textures. Other kids were tracking footsteps arranged in pigeon-toe and duck-walk patterns to stimulate their reflexes. Hailey's group was jumping off raised blocks, using their hands and feet to improve depth perception.

There was an enormous swinging device that Youssefi has named after himself -- the P-Y Swing. It is a padded hexagon with a panel of lights inside and headphones through which "heavenly, beautiful music" is piped.

Youssefi said his research shows that sensory-motor therapy enhances movement and motor planning, and aids in reading, writing, language development, cognition and social awareness. The therapy has helped Hailey in confidence, problem-solving and engagement with the world, he said. "The way she communicates today -- I put a number on it, 500 times better."

Though occupational and physical therapists have helped people improve functioning for years, there is no conclusive evidence about the impact of sensory-motor gym programs. In fact, there isn't even consensus about occupational therapy using sensory integration techniques.

A school psychologist set off a big debate when he claimed in a 2002 article in the National Association of School Psychologists' newsletter that "there is no evidence that SI [sensory integration] therapy is or has ever been an effective treatment for children with learning disabilities, autism, or any other developmental disability." Until better evidence exists, he added, the "public should not be guinea pigs."

In response, Lucy J. Miller, associate professor of rehabilitation medicine and pediatrics at the University of Colorado Health Sciences Center, said studies suggest that the intervention works and warned that children who suffer symptoms of sensory processing impairments need support now, while research continues.

Stop 2: Listen, Please

By 9 a.m. the next day, Tina and Hailey were back at Dynamic Development. Hailey was doing a "calming" loop of auditory training, followed by a session of Interactive Metronome, a computer-based timing therapy that is based on the musical metronome and is purported to increase attention and focus. She was also going to work on neurofeedback, a form of biofeedback.

Dynamic Development offers a "dynamic listening" program based on the Tomatis method. During her calming loop, Hailey listened to unfiltered music to counter what the therapists said were predictable side effects of heightened emotion and frustration after finishing a regular loop the previous week.

Hailey sat on the floor listening through headphones, playing with lavender "gak" for tactile and sensory stimulation. Then she moved to a marker board. Her therapist pointed to letters and asked Hailey to think of an adjective that started with the letter while touching her left or right foot. "I don't know," Hailey said. "Can we not do this?"

"If you can't come up with an adjective, give me a noun."

"I don't know any adjectives that begin with A," Hailey said, and then stabbed her foot on the floor and wimpered a little. "I'm sorry, I just don't want to do this."

"Look at me, tell me how you feel."

"I feel upset," she said, eyes downcast. "It's too hard. Angry!"

"I'll make it easier for you. I really like how you use your words to tell me. Let's change to nouns."

"Ambulance!"

"Very good!"

Mainstream professional organizations aren't convinced about the effectiveness of auditory integration therapy. Last year, the American Speech-Language-Hearing Association, the national credentialing organization, declared that auditory integration training "does not meet scientific standards for efficacy" that would justify its practice by audiologists and speech-language pathologists. The American Academy of Pediatrics issued a similar policy statement. But Spectrum Center director Valerie Dejean says there are a wide variety of auditory therapies and that she regularly sees major changes in young children as a result of the Tomatis type practiced at her center. Some parents say it has dramatically improved their children's lives. Ever since Dejean appeared with a suburban Virginia mother on NBC's "Today" show last year to talk about her daughter's "awakening" from autism after undergoing the therapy, the center has been booming.

Dejean acknowledges that more good research needs to be done, but she pointed to a meta-analysis of data from five research studies evaluating the use of the Tomatis method in children with learning and communication disorders that showed positive linguistic, psychomotor, personal and social adjustment, cognitive and auditory effects.

In our case, at least, we felt that Tomatis made a big difference with Maddie. "It really helped turn things around," Diane Lewis, our daughter's long-time speech therapist, told us.

Stop 3: The Vision Thing

Hailey finished her morning session at Dynamic Development and headed downtown to the Vision and Conceptual Development Center near the Watergate complex.

Harry Wachs, who founded the center 12 years ago, was in his office testing a 10-year-old autistic boy from California.

"He spends 12 weeks a year here, six to seven hours a day," said his mother, a doctor from Santa Monica who asked that her name not be used to protect her son's privacy. "We're spending our life's fortune here, too, but you would not believe the progress he's making." She said he had developed more complex language and a larger vocabulary since undergoing the therapy.