April is National Autism Awareness Month, a good time for massage therapists to understand the benefits of healthy touch for clients with this condition.
Alex is an affectionate, 10-year-old boy who loves to draw and has quite the sense of humor. He was diagnosed with PDD-NOS (atypical autism) when he was 3 years old.
As a baby, he developed normally—but then, after he turned 2 years old, he started to display quirks.
Alex was asked to leave two preschools because of his meltdowns, where he would flap his hands, stand on his toes, screech and cry.
“We couldn’t go out to social gatherings, or even to the grocery store, until we obtained help from our local school district when he turned 3,” says Alex’s mom, Catherine Podd, L.M.T., a pediatric massage therapist of Greendale, Wisconsin.
“He hated light touch,” she said, “tags in shirts, noises from crowds of people and bright lights in stores.
When Alex was 5 years old, his first occupational therapist discovered he calmed down when she gave him a firm bear hug.
Alex is among the children swept up in a global epidemic, one of diagnoses of developmental disorders on the autism spectrum, at an ever-growing rate.
In 1980, autism diagnoses alone were 1 in 5,000; the most current data from the U.S. Centers for Disease Control and Prevention indicates that rate is now 1 in 88 children.
Boys appear to be affected four times as much as girls.
Through the use of massage therapy, these kids’ basic need for safe, nurturing contact is met, with often wonderful results
All children require nurturing touch to thrive, and for those on the autism spectrum, specialized touch therapy is required. Using specialized touch, we are able to meet these children with care and affection where they are.
Pediatric massage provides a positive experience of being touched, and the effects hold lifelong benefits.
The cost of a child’s lifelong care can be reduced by as much as two-thirds, when early diagnosis and appropriate interventions are put in place, according to the Autism Society of America.
Understanding Autism
There are numerous theories on the causes of autism; however, no one can define what causes autism and its related disorders, including Asperger’s syndrome, an autism-like condition usually without language delay, and various pervasive development disorders (PDDs).
(In December of 2012, the American Psychological Association announced Asperger’s disorder would no longer be a separate diagnosis but would instead be incorporated into the diagnosis of autism-spectrum disorder.)
Autism itself is classified within the scope of autism-spectrum disorders, and each diagnosis under this umbrella presents differently.
Other diagnoses within the spectrum include Rett syndrome, pervasive developmental disorder-not otherwise specified and childhood disintegrative disorder.
According to the Autism Research Institute, autism is a severe developmental disorder that begins at birth or within the first two-and-a-half years of life.
Most children with autism are perfectly normal in appearance, but spend their time engaged in puzzling behaviors that are markedly different from those of neuro-typically developing children.
Usually diagnosed by the age of 3, this complex developmental condition affects a child’s ability to develop normal language skills, form relationships or respond appropriately, and is characterized by early onset of a lack of attachment, failure to cuddle as an infant and an almost complete disassociation with the environment.
Autism, as we know it, is incurable, and the behaviors associated with the disorder persist throughout the child’s lifetime.
Touch Helps
The common belief that children with autism do not like to be touched is false.
Autism is characterized with sensory malfunction and dysfunction of the tactile system, often making a child averse to certain sights, sounds, smells or touch.
Given that children with autism have been reported to be opposed to physical contact, it is interesting that many massage therapists and parents are finding great success with the use of massage therapy for those considered to be on the spectrum.
“People with autism-spectrum disorders often struggle with increased sensitivity to sensory stimuli, including tactile stimulation, and massage provides a comforting experience of tactile stimulation while also helping to decrease pain amplification through desensitization,” explains Dustin P. Wallace, Ph.D., assistant professor of pediatrics at the Integrative Pain Management Clinic and Division of Developmental and Behavioral Sciences at The Children’s Mercy Hospitals and Clinics in Kansas City, Missouri.
Just because a child doesn’t communicate in a way you understand, does not mean he lacks IQ points.
Carter was diagnosed with Asperger’s disorder in July 2008, shortly after his 5th birthday. In December 2009, he was diagnosed with attention deficit hyperactivity disorder.
Carter has always been full of energy and rarely napped, even as a baby, but his interests never included Lego or Thomas the Tank Engine. Early on, his obsessions were animals and the alphabet.
Carter would line everything up alphabetically and made sure all his toys were in order.
“[Carter] could tell you just about anything you wanted to know about any animal, including their scientific name,” says Carter’s mom, Angela Ajamie, L.M.T., of Grafton, Massachusetts. “When he was 3, he spelled [with blocks] ALBATROSS on the living room floor. When I asked him how he knew how to spell that word, he answered, ‘I read it in the dictionary.’ Carter could read Dr. Seuss books by the age of two-and-a-half.”
Meeting Children Where They Are
Pediatric massage therapists are taught to meet children where they are and help them connect with the world around them.
“In the medical setting, children are oftentimes already withdrawn, scared and maybe confused,” says Jennifer Townsend, a neurologic-therapy fellow at Dell Children’s Medical Center in Austin, Texas.
“The child with autism has all of these reactions in addition to trying to take in new sensory information,” she said. “It can be very difficult for them to make new connections with people while in this new setting.”
Children, parents and other health care providers have commented on the fact that pediatric massage therapists can make a child feel more comfortable in clinical and other settings where their interventions are employed.
Research indicates pediatric massage therapy also lessens anxiety and stress.
For each child, there is no exact protocol to follow, which means the same massage strokes, activities or songs we sing may change from moment to moment.
Communication and engagement are often stressful for the child, but are imperative in a session, which should be child directed.
This communication and engagement may include a series of gestures, hand placements, nonverbal gestures or nonlanguage sounds.
The massage therapist should take the time necessary to find the correct method of communication, and respect the child’s need for the therapist to communicate in a way that best serves each individual child.
“The individuality and uniqueness of each child is one of the biggest challenges in working with children on the autism spectrum, and also one of the biggest rewards,” says Elizabeth Schroeder, occupational therapist and massage therapist at Children’s Mercy Hospital in Kansas City, Missouri.
“These differences make it nearly impossible for there to be any one trick or treatment that works with all children on the spectrum,” she said. “Each therapy session looks and feels different between each child and between each session for one child.”
Pediatric massage therapists provide touch therapies to children in a variety of settings, including the hospital, therapy centers and private practice.
In all settings, connecting with the children is important; just as important is connecting with parents.
Mothers and fathers may have questions about pediatric massage techniques, application and benefits.
Taking the time to answer questions and, when possible, providing hands-on demonstrations, may make the difference between connecting with parents or not.
Collaborate
Educating children, parents and other health care professionals can help make a therapeutic session successful.
“Many children won’t just hop up on the table and tell you their ailments,” says Podd. “A pediatric massage therapist can make a parent and child more comfortable, take time with the child, and use different techniques that might help the child feel at ease.”
Working with pediatric clients means you not only work with them, but also their parents, and in some cases, their health care team.
Using a strategy to ensure a collaborative approach is essential.
Being respectful of specific culture, time and priorities for the client, family and team is imperative.
“In regard to working with health care team members, the therapist should be prepared to educate the team about massage,” says Schroeder. “It is the therapist’s job to educate the team about massage, touch and how they can use it appropriately in their own tasks with the child.”
An Individual Approach
“Working with children gives you a different point of view when you are in the treatment room,” says Podd. “It might take weeks to even get a child on the table, but it teaches you to slow down and respect that space again.”
For children on the spectrum, the therapist should be aware of the child’s possible anxiety about being touched.
This stems from tactile hypersensitivities and previous touch being interpreted as painful or confusing.
Therapists should move cautiously and respect the child’s cues. Take your time to recognize a child’s likes and dislikes associated with types of touch, textures, sensory considerations and type of lubricant.
Whenever we use massage, we must first obtain the child’s permission.
Children may not always provide direct eye-to-eye contact or a verbal “yes.”
Establishing nonverbal communication and using slow transitions are important. If a child does not prefer direct eye-to-eye contact, do not force it, as it may feel confrontational.
For many children with an autism spectrum disorder, there is susceptibility to sensory overload, and they may lack feeling or awareness. It is important to begin with still hands and gradually work deeper.
“Using pediatric massage with my son has been fun and has even helped in practicing communication,” said Alex’s mom, Catherine Podd. “For parents who have a hard time with children that are not affectionate, it can be an alternate way to be able to have that physical connection.”
No two children with the same diagnosis will likely present exactly the same. Slow down, take your time, and enjoy connecting with these kids.
Tina Allen is the founder and director of the Liddle Kidz Foundation. She is an international author, lecturer and authority on infant and pediatric massage therapy. Allen travels in a tour bus 365 days a year teaching courses internationally, and is the proud mother of Otis. She wrote “Essential Touch for Children: Pediatric Massage” for the October 2012 issue of MASSAGE Magazine. She wrote “Better Body Awareness,” on how children who receive massage become more spatially aware and have better body awareness.