Autism spectrum disorder (ASD), as defined by the Diagnostic & Statistical Manual of Mental Disorders-5th Edition, is a condition present in early childhood characterized by difficulty communicating & forming relationships. These behaviors usually become apparent in the second or third year of life. The levels of functioning within the disorder is categorized as mild, moderate, or severe based on signs & symptoms.
The diagnosis of ASD is on the rise, which has been attributed to changes in its definition & expansion of the diagnostic criteria. The CDC estimates that 1 in every 68 children have ASD (1). This condition is more common in boys than in girls (4 : 1). Since the revision of the DSM-V, all of the previous subtypes of ASD, autism, Asperger syndrome, pervasive developmental disorder-not otherwise specified, childhood disintegrative disorder, & Rett syndrome are now all embedded within the one diagnosis of autism spectrum disorder.
The cause of ASD is unclear, but it is generally accepted that it is due to abnormal brain chemistry, a combination of genetic, & environmental factors. An important genetic link has been found, as ASD tends to run in families (2).
Affected persons fail to establish normal peer relationships & prefer to play alone. They may avoid eye contact, have an aversion to touching & cuddling. Persons with ASD often exhibit delayed or absent verbal communication & an inability to initiate or sustain conversation; words or phrases are repeated verbatim but without the understanding of how to use them. The person may engage in repetitive motions (e.g., spinning, rocking), exhibit a compulsion for sameness, have a narrow interest range, & possess a superior memory of certain facts. Another characteristic is the preference for routines. Persons with ASD may display anxiety & distress when their preferred behavioral patterns are interrupted.
An individualized treatment program seems to be the best approach to help the person learn social skills & adaptive responses. These modalities include applied behavior analysis, speech-language therapy, occupational & physical therapy. Sensory integration therapy may also be used.
Massage Therapy & ASD – If this is your client’s first massage, ask about intolerances to touch as well as other hypersensitivies such as sounds, smells, and textures, making modifications to treatment when needed. Shorter sessions may be more appropriate during the first few sessions to learn how the client with ASD handles the massage.
If this is not your client’s first massage, ask about previous massage experience (as you would with any client), duplicating the elements the client enjoyed and avoiding the ones that were problematic.
Massage decreased touch aversion & orientation to extraneous environmental sounds (3), increased on-task behaviors (3, 4), reduced tactile impairment (5), promoted social relatedness & better sleep (4). Be sure to teach parents & caregivers how to massage children diagnosed with ASD. Parents who massaged their children with ASD experienced less parenting stress (5), & a stronger physical & emotional bond (6). These feelings persisted with continued massage (6). Because of the preference for sameness, it is recommended that whatever routine is established, that same routine be used in subsequent sessions. The preference for sameness extends to the placement of furniture & fixtures in the massage office.
Children who have autism had a preference for weighted blankets over a non-weighted blankets (7), which suggest that heavy blankets might be appropriate for these clients. If the child or client displays any signs of distress while using a heavy or weighted blanket, remove it immediately. Additionally, if the clients displays any signs of distress during the massage for whatever reason, discontinue the massage & reschedule for another day.
Articles and Journal Referenced:
- Field, T., Lasko, D., Mundy, P. & Henteleff, T., Kabot, S., Talpins, S. & Dowling, M. (1997). Brief report: Autistic children’s attentiveness and responsivity improved after touch therapy. J Autism Dev Disord, 27(3), 333-338.
- Escalona, A., Field, T., Singer-Strunk, 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), 513-516.
- Silva, L., & Schalock, M. (2013). Treatment of tactile impairment in young children with autism: results with qigong massage. Int J Ther Massage Bodywork, 6(4), 12–20.
- 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.
- Gringras P. et al. (2014). Weighted blankets and sleep in autistic children: A randomized controlled trial. Pediatrics, 134(2), 298-306.
Susan Salvo is a board certified massage therapist with 30+ years of experience. Susan is passionate about massage therapy and massage education. You can contact her at email@example.com.