Autism spectrum disorder (ASD), condition present in early childhood characterized by difficulty communicating and forming relationships. Although ASD can be diagnosed at any age, autistic-type behaviors usually manifest in the first three years of life. ASC can be classified as mild, moderate, or severe based on presenting signs and symptoms. 

The diagnosis of ASD is on the rise, which has been attributed to changes in its definition and expansion of the diagnostic criteria. Approximately 1 in 59 children have been identified with ASD. This condition is more common in boys than in girls (4 : 1). All previous subtypes of ASD, autism, Asperger syndrome, pervasive developmental disorder–not otherwise specified, childhood disintegrative disorder, and Rett syndrome are now diagnosed as ASD.

The cause of ASD is unclear, but it is generally accepted it is due to abnormal brain chemistry and a combination of genetic and environmental factors. An important genetic link has been found because ASD tends to run in families.

Affected people fail to establish normal peer relationships and prefer to play alone. Children with ASD often prefer to play alone. They may avoid eye contact and have an aversion to touching and cuddling. People with ASD often exhibit: (1) delayed or absent verbal communication, and (2) an inability to initiate or sustain conversation; words or phrases may be repeated verbatim but without the understanding of how to use them. The person may engage in repetitive motions (e.g., spinning, rocking), have a narrow interest range, and possess a superior memory of certain facts (e.g., U.S. presidents). Another characteristic is the preference for routines, and people with ASD may display anxiety and distress when their preferred behavioral patterns are interrupted.

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An individualized treatment program seems to be the best approach to help the person learn social skills and adaptive responses. These modalities include applied behavior analysis, speech-language therapy, and occupational and physical therapy. Sensory integration therapy also may be used. Antipsychotics and antidepressants may be used to manage symptoms.

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Massage and ASD – If this is the client’s first massage, ask about intolerances to touch and hypersensitivities to 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 massage. Additionally, some clients with ASD prefer a side-lying position, especially if this is the way the client calms down or falls asleep. Consider incorporating qigong massage (rubbing, patting, shaking, PROM) into the session to improve treatment outcomes.

If this is not the client’s first massage, ask about previous massage experience (as you would with any client), duplicating elements the client enjoyed and avoiding problematic ones. Because of the preference for routine and sameness, whatever routine is established, use the same routine during subsequent sessions. The preference for sameness extends to placement of furniture and fixtures in the massage office. It is also helpful to talk the client through the treatment to avoid stress related to unpredictability experienced from social touch (Kuehn, 2016).

Individuals diagnosed with ASD may have preference for deep pressure, which may reduce touch aversion, nervousness, and anxiety (Grandin, 1992). Furthermore, children diagnosed with ASD favored weighted blankets over non-weighted blankets (Gringras et al, 2014), which suggest use of weighted or heavy blankets may be appropriate for these clients. If the client displays any signs of distress while using a heavy or weighted blanket, remove it immediately. Additionally, if the client displays any signs of distress during the massage for any reason, discontinue the massage and reschedule for another day.

Consider teaching parents or caregivers how to massage the affected child, making massage more accessible to the child and giving parents/caregivers another way to care for and nurture the child. Limit techniques taught to gliding and kneading and convey the same precautions licensed practitioners follow, such as avoiding skin lesions.

research iconResearch. A 15-minute massage using moderate pressure administered 2 days a week for 4 weeks by a volunteer student to fully-clothed autistic children reduced touch aversion and off-task behavior (Field et al, 1997). The same effects were seen in the touch control group who were held in the student’s lap while engaging in educational games. Orienting to irrelevant sounds and stereotypic behaviors also decreased in both groups; however, it decreased more in the massage group. Children who received a 15-minute moderate pressure massage by their parents prior to bedtime every night for 1 month exhibited fewer sleep problems and less stereotypic behaviors and more on-task and social relatedness behavior during play observations at school (Escalona et al, 2001). Parents who massage their autistic children reported feeling physically and emotionally closer to them (Cullen-Powell et al, 2005). These benefits were maintained at follow-up for parents who continued to use massage at home. Both male children with autism who received a 20-minute daily massage from their mothers and the mothers themselves had increased levels of oxytocin during the massage periods compared with the non-massage periods (Tsuji et al, 2015). Walaszek et al (2017) conducted a literature review on the efficacy of massage in the treatment of autism and found massage reduces the child’s anxiety, improves social communication, and promotes the formation of closeness and bonds with the parents thus bringing the prospects for better development of the child.

A 15-minute qigong massage administered daily to young children with autism at bedtime by their parents decreased tactile impairment, self-regulatory delay, and parenting stress (Silva & Schalock, 2013). Again, parent-delivered qigong massages of 15-minutes in duration administered before bedtime showed normalization of receptive language, autistic behaviors, sensory and tactile abnormalities, and decreased autism severity (Silva et al, 2015). In addition, parents reported improved child-to-parent interactions, bonding, and decreased parenting stress. Rodrigues et al (2019) conducted a systematic review to examine the efficacy of qigong massage on children with autism and stated this type of massage appears to decrease the severity of individual sensory, behavioral, and language components of autism, and improve self-control, sociability, sensory and cognitive awareness as well as healthy-physical behavior. Besides positive effect on children and adolescents with autism, benefits seem to extend to parents and caregivers.

Lastly, children with developmental delays but no clear diagnosis (e.g., autism, cerebral palsy, etc.) who received a 20-minute massage twice weekly for 12 weeks exhibited improvements in motor scores and sensory sensitivity behaviors or sensory processing (Lu et al, 2019).

Picture Credits:

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altogetherautism.org.nz/what-is-autism/

References:

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), 245-255.

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), 513-516.

Field, T., Lasko, D., Mundy, P., Henteleff, T., Kabat, 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.

Grandin, T. (1992). Calming effects of deep touch pressure in patients with autistic disorder, college students, and animals. J Child Adolesc Psychopharmacol, 2(1), 63-72.

Gringras, P., Green, D., Wraight, B. et al. (2014). Weighted blankets and sleep in autistic children: a randomized controlled trial. Pediatrics, 134(2), 298-306.

Kuehn, E. (2016). Research into our sense of touch leads to new treatments for autism. Retrieved from http://sitn.hms.harvard.edu/flash/2016/research-into-our-sense-of-touch-leads-to-new-treatments-for-autism/

Lu, W.P., Tsai, W.H., Lin, L.Y., Hong, R.B., Hwang, Y.S. (2019). The beneficial effects of massage on motor development and sensory processing in young children with developmental delay: a randomized control trial study. Dev Neurorehabil, 22(7), 487-495.

Rodrigues, J.M., Mestre, M., Fredes, L.I. (2019). Qigong in the treatment of children with autism spectrum disorder: systematic review. J Integr Med, 17(4), 250-260.

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.

Silva, L.M., Schalock, M., Gabrielsen, K.R., Budden, S.S., Buenrostro, M., Horton, G. (2015). Early intervention with a parent-delivered massage protocol directed at tactile abnormalities decreases severity of autism and improves child-to-parent interactions: a replication study. Autism Res Treat, 2015, 904585.

Tsuji, S., Yuhi, T., Furuhara, K., Ohta, S., Shimizu, Y., Higashida, H. (2015). Salivary oxytocin concentrations in seven boys with autism spectrum disorder received massage from their mothers: a pilot study. Front Psychiatry, 6, 58.

Walaszek, R., Maśnik, N., Marszałek, A., Walaszek, K. Burdacki, M. (2017). Massage efficacy in the treatment of autistic children – a literature review. International Journal of Developmental Disabilities, 64(4), 1-5, DOI: 10.1080/20473869.2017.1305139

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Dr. Susan Salvo is a massage therapist, author, educator, researcher, explorer, and perpetual student. To learn more, check out the “About Susan” tab. You can contact Susan at susansalvo@hotmail.com.