For Clarice, incorporating nurturing touch into the life of her family was natural. Her young son, Elliot, enjoyed receiving massage on a regular basis. When he was 3 years old, Elliot developed sensory issues. He started to refuse touch of any kind; clothing, the feel of grass, the feel of any food that he had experienced before, the feel of warm or lukewarm water. His muscle tone began decreasing and by the time he was 3 1/2 years old, he had lost all of his language abilities (previously he was bilingual), refused all eye contact and was unable to stand for more than 30 minutes at a time. He would not eat or drink anything other than milk, eventually regressing to the point when he could not verbally communicate and refused to eat.

Eventually his family would begin to unravel the mystery of how their little boy could be diagnosed with PDD-NOS, Autism, mental retardation and sensory integration disorder.

Autism Defined

The incidence of autism and autism spectrum disorders (ASD) is on the rise. In the United States, the Centers for Disease Control believe there are as many as 1 in 80 children affected by this group of disorders, and boys are affected 4 to 5 times as often as girls.

Autism is a complex developmental condition. Most children with autism are perfectly normal in appearance, but spend their time engaged in puzzling and disturbing behaviors which are markedly different from those of children who are developing on a typical spectrum. Autism, as we now know it, is incurable and the behaviors associated with the disorder persist throughout the child’s lifetime. Less severe cases may be diagnosed as pervasive developmental disorder (PDD) or Asperger’s syndrome (these children typically have normal speech, but they have many “autistic” social and behavioral problems).

One important note of clarity is that the diagnosis of Autism is one diagnosis under the umbrella of autism spectrum disorders (ASDs). It can be confusing to understand that there is a spectrum of diagnoses based on symptoms rather than all children being affected by the diagnosis of autism.

Having a diagnosis of autism interferes with normal development of the brain in the areas that influence reasoning, social interaction, motor skills, communication skills and attention. Developmental disorders occur across a spectrum, affecting individuals differently; some children lose the ability to speak, some might have motor impairment, and many lack social and emotional awareness. Behaviors range from hyperactivity to serious self-injury. Families and healthcare professionals often report that children might show lack of eye contact, as well as, have an aversion to touch and tactile stimulation. These disorders make it difficult for children with ASD to communicate with others, leading to frustrated social isolation.

Pediatric Massage Benefits Autistic Children

Researchers have found that children with autism spectrum disorders show less stereotypical autistic behavior, are more social and attentive after receiving massage therapy and have less anxiety. Pediatric massage might provide relaxation, stress reduction and calm muscle spasms. Over time, the child typically becomes more accustomed to tactile stimulation and the regular intervention of pediatric massage might be beneficial in reducing inattentiveness, touch aversion and withdrawal.

It is estimated between 56 percent and 83 percent of children with autism spectrum disorders experience sleep disturbances. Often, by incorporating massage therapy into daily routines, children with autism experience decreased issues with sleeping. When utilized by caregivers, massage therapy might help strengthen the emotional bond between parent and child.

Considerations for Pediatric Massage

It is important to remember that each child with an autism spectrum disorder will have his or her own individual symptoms of autism. A diagnosis is only one factor in determining the best care of the pediatric client.

Patience, patience and more patience is the first key to success. The child must feel safe and that respectful connection takes time. Often, there is susceptibility to sensory overload. So, it is important to begin with proper intention and gradually provide deeper tactile stimulation, while being very aware of non-verbal communication. Always speak to the child with the intent that he or she understands. Investigate what forms of communication are being used (i.e. ASL, picture boards, spoken language and written language). To the best of your ability, incorporate these communication methods in the session.

Respect and incorporate parents to help them understand this is a journey and not a sprint. It might take time to achieve optimal results. Acknowledge that each and every change is a small victory and a step in the right direction. Realize on some days, there will be a plateau and even possibly a regression.

Utilize structure around your sessions. Children with autism prefer structure and have difficulty with transitions and sudden change. Take your time to allow the child to become comfortable with the environment and you, if you have entered their safe space. Never insist that a child participate in the massage session. Speak calmly and lovingly, take your time and introduce slowly. Request that caregivers have items the child likes available during the session. A favorite blanket, toy or flashlight could become the engagement item the child needs to be comfortably present.

The Mystery Unravels

With Elliot, pressure and patience was the key. Pediatric massage was introduced slowly everyday, and sometimes even 3 – 4 times a day. We would avoid the feet, hands, shoulders and head. Once he realized there was no threat, he let me touch his back and face. The face is still a difficult area to receive touch. The success of introducing touch therapy to other areas of his body is surely attributed to mom continuing nurturing touch between our therapeutic sessions.

It is now, after four years of practicing this regimen, that both mom and I can provide a full body massage for Elliot. Now, he even loves his feet being massaged but can only tolerate deeper pressure on his hands and fingers, no soft touch at all. Mom has learned to brush his skin during bath time and then provide firm “washing” with a rough textured towel. Whenever these activities are incorporated, he makes lots of eye contact and motions for more. He now enjoys a rich sensory diet of activities such as being placed in a large comforter and rolled very snug, skin brushing and deep pressure pediatric massage.

When Elliot experiences a “meltdown” (outbursts due to sensory overload, specifically for Elliot issues with lights, shiny floors and balance), he now knows how to self-calm by taking deep breathes, holding something tight or hugging himself. In this way, he is beginning to utilizing touch and breathing as everyday self-calming mechanisms.

For massage therapists and bodyworkers working with children on the spectrum, remember the diagnosis does not give you the entire picture. There are no hard and fast rules for massage due to their individual preferences stemming from their ability to process sensory stimulation.

However, through the use of massage therapy, our basic human need for safe, nurturing contact is met with often wonderful results. For children with autism, it provides not only a positive experience of being touched but the effects hold lifelong benefits for the child and their entire family.

References:

• Autism Spectrum Disorders. (2010). Data and Statistics. Retrieved April 1, 2011, from Centers for Disease Control website: www.cdc.gov/ncbddd/autism/data.html.
• Autism Spectrum Disorders. (2010). Facts About ASDs. Retrieved April 1, 2011, from Centers for Disease Control website: www.cdc.gov/ncbddd/autism/facts.html.
• Cullen-Powell, L.A., Barlow, J.H., Cushway, D. (2005). Exploring a massage intervention for parents and their children with autism: the implications for bonding and attachment. J Child Health Care. 9(4):245-55.
• Escalona, A., Field, T., Singer-Strunck, R., Cullen, C., Hartshorn, K. (2001). Brief report: improvements in the behavior of children with autism following massage therapy. J Autism Dev Disord. 31(5):513-6.
• Field, T.(1995). Massage therapy for infants and children. J Dev Behav Pediatr.16(2):105-11.
• Glickman, G. (2009) Circadian rhythms and sleep in children with autism. Neuroscience & Biobehavioral Reviews 34(5) 755-768
• Hughes, J.R. (2008). A review of recent reports on autism: 1000 studies published in 2007. Epilepsy Behav. 13(3):425-37.
• Schreck, K., Mulick, J., Smith, A. (2004) Sleep problems as possible predictors of intensified symptoms of autism. Research in Developmental Disabilities 25(1) 57-66
• Silva, L.M., Schalock, M., Ayres, R., Bunse, C., Budden, S. (2009). Qigong massage treatment for sensory and self-regulation problems in young children with autism: a randomized controlled trial. Am J Occup Ther. 63(4):423-32.