Originally published in Massage & Bodywork magazine, September/October 2010. Copyright 2010. Associated Bodywork and Massage Professionals. All rights reserved.
Children with special needs are both a reward and a challenge to treat. While these children may bring a host of issues to your treatment room--loss of movement control, speech difficulties, or even incontinence--it's also their unique needs that inspire therapists, stimulating their creativity and therapeutic approach, with successful client growth often being the end result. Here are 11 elements that have been tried and true in my work with special needs children, and a young girl named Sophie, in particular.Meet Sophie
It was two years ago when Sophie first came to see me. I remember her eyes as they scanned the room. Barely pausing, she was soon exploring the space, circumambulating the periphery, pausing at significant places like at the photograph of my energy medicine teacher, Mary Iino Burmeister. Cathy, Sophie's mother, stood at the entryway, smiling as she tracked her mobile, inquisitive daughter. The two had come to see if my work could help this special needs child who, as a toddler, was diagnosed with Rett Syndrome, a genetic developmental and sensory dysfunction. Now, at 11, Sophie continues to benefit from the sensory integration journey we started together that day.
Rett Syndrome is a little known condition, but the lessons that Sophie teaches are for a broad spectrum of needs that apply to adults, as well as children. My TARA Approach team and I are learning more about sensory integration every day, and what we develop as a result can be used by the adults who see themselves in the children we portray. 1. Use Attuned Communication
Sophie's characteristic gait veers slightly to the right and her chest is compressed. These are the by-products of the hand-clapping (one hand pushes repetitively into the palm of the other) that is the keynote of Rett Syndrome. Another structural consequence of the hand-clapping is a predictable scoliosis that will demand the greatest optimism and creativity to combat. Scoliosis for the child with Rett Syndrome is an osseous gauntlet, summoning the bodyworker to attention. If we can orchestrate an effective harmony of fascia, bone, and energy to offset scoliosis growth, it will be paramount to Sophie's journey.
Cathy is the ultimate hands-on parent and is a model of what every special needs child requires. Cathy will explore whatever will make a difference for her daughter. She is always ready and open and trusts in the guidance that directs her to practitioners. Cathy heard about how I combined therapies, integrating mental and emotional healing with energy medicine and cranial treatment. What she couldn't have predicted was the link that her daughter and I made almost immediately. Even before she was on the treatment table that first day, Sophie and I were resonating with each other. Now, two years later, it's easy to see the impact of the interventions we discovered and implemented for Sophie's evolution. The way Sophie and I understand each other, I believe, contributes to this success.
Seeing how Sophie responded to me with expression, vocalization, movement, and gesture, I knew from the beginning that she understood my words and intentions. Despite her limited vocabulary, we created a fluid dialogue. Some would say that Sophie has no language at all and that our communication is wishful thinking. Nevertheless, there is evidence from the perceptions of others who knew nothing of my relationship with Sophie that after she began her TARA Approach sessions of integrated therapies that a new level of social engagement became dramatically apparent. Her mother testifies to the fact that Sophie began to reach out in new empathic ways to others not long after our initial meetings.
When working with Sophie, I respect her directives and honor all her requests for changes in treatment and decisions about when treatment starts and ends. I read her body as an advertisement of her needs and talk to her about everything that I do. I make suggestions for her self-care, including visualizations and healing imagery. She responds. The results are evident.
For instance, I treated Sophie one day when she was alarmingly collapsed, folded over, and stooped in a way that I had never witnessed before. While treating her, I spoke about how she could see herself as upright. I encouraged her to visualize herself as long and tall, with a fluid, relaxed spine that supported her body. My worst fear, and her mother's nightmare, was that the scoliosis would win, overtaking any effort to stimulate length in Sophie's spine. Was that what we were seeing now with her collapsed body?
I oriented instead toward the resilience in Sophie's tissue and her vibrant will. I spoke adamantly and decisively about the unquestionable possibility that she could arise out of this collapse and find her own vertebral grandeur. I honored her need for rest and recommended a warm bath following treatment. When I saw Sophie two days later, she was upright. That was several months ago, and while she has not collapsed to that extent since, we are pursuing structural support in the form of a soft bracing system to counteract the pull of the scoliosis and to supplement treatment.2. Create An Alliance With Family
A key element to working with special needs children is to form a working alliance with the parents or other family members (grandparents are great allies). Having family members replicate some of our session work at home is a critical component for success. The repetition of interventions deepens the repatterning process on multiple levels, from bone to neurology. When protocols are reiterated daily, the body finds a new way of being and has difficulty reverting to obsessive and destructive patterns that are historically ingrained.
By educating and empowering parents to treat their children and be an integral part of the process, you give them the tools to affect change. Cathy was able to utilize those tools during an outing with Sophie and some other children to a museum. The experience was starting to overstimulate Sophie, and her body protested loudly that she could not tolerate so much input. Cathy took Sophie aside and proceeded to use the calming techniques I had taught her. Within minutes, Sophie's nervous system came to peace and she was able to enjoy the rest of the day with her family and friends instead of heading into a full emotional and physical meltdown.
The reenforcement of treatment at home creates a seamless fabric of lifestyle change that wraps the nervous system in a glove of harmony, smoothing away the wrinkles of distortion from internal and external stressors. When children are exposed frequently to new coping mechanisms, their awareness of the behavioral options available to them expands exponentially. This is sensory and kinesthetic learning and it speaks dramatically to their growing minds and bodies. They are no longer trapped in the neurological ruts of dysfunction. Alternatives provided by compassionate helping hands eventually turn into the child's internally initiated self-regulation.3. Treat The Child As An Individual
Children with sensory needs must be seen as individuals. They have a broad spectrum of sensitivities calling for various qualities of applied therapeutic touch. The therapist who can alter the depth and quality of contact according to the needs of the child will be most helpful. The same child may require different kinds of touch on different parts of her body. Or, a child may need one kind of touch one day and another kind on another day. The possibilities are endless. They can even vary from one hour to the next. For this reason, attunement is the directing principle.
It is important that practitioners, regardless of the condition of the child, speak directly to these young clients and involve them in the process, all the while asking for their permission to move forward in the treatment.
My own treatment repertoire revolves primarily around subtle touch applications like energy medicine and cranial treatment, but there are times when these do not provide sufficient input for the client's sensory needs. I sometimes must employ a firmer and deeper contact on the bioelectrical sites or cranial positions to stimulate a change sufficient to evoke nervous system reorganization. How do I determine when this is required? This is when attunement and body reading must be precise, particularly when a child does not use specific language as a primary means of expression.
To make these assessments, the practitioner needs to be attentive to:
- Engaging gestures, including the client turning toward the practitioner.
- Hyper- or hypotonicity in tissue.
- Facial expression, particularly in the eyes.
- Jittery or squirmy movement patterns.
- Sound patterns that can be protests, directives, instructions, comments, or appreciation.
- Validating all perceptions by querying the child.
- Withdrawing movement, where the client retreats or turns away from the practitioner.
No matter what their age, physical challenge, or expressive capacity, trust and acknowledge that your client understands your intentions. Create agreement about signals that indicate positive or negative responses, like raising eyebrows or blinking once or twice.
These communications, in themselves, are interventions. They create an environment of safety that allows the child to feel seen. Special needs children have often been prodded and poked, objectified and studied. This creates a layer of medical trauma that must be unraveled to reveal nervous system health and provide receptivity to treatment.
Sophie's mother always supports and encourages this avenue of attuned communication and replicates it herself. She speaks lovingly to Sophie, making sure that she understands what is said about, and to, her. She never infantilizes Sophie or under-estimates her sensitivity and capacity. This opens neurological pathways for growth. This is generally good parenting, but it is especially true for a child who does not have full access to speech or who struggles in any way with communication and expression.4. Focus On Integration
For sensory needs clients, it's important to focus on creating an integrative therapeutic framework. All applied touch interventions and dialogue must provide stability and enhanced sensory processing. This is the frame into which specific modalities are placed to create an overall treatment picture.
Be mindful that every client's nervous system is different. Diversity is the nature of humanity. For some people, sensory processing can be overwhelming or disabling. For clients who are heavily defended, their armoring may surprisingly be a call for stronger sensory input. Virtually all challenged children, no matter what their diagnosis, have sensory struggles. This means they need help processing their sensory intake whether it is tactile, vestibular, or proprioceptive. And we, the adults around them, are the ones who must help. Applied touch therapies are excellent resources for integration, even when (and perhaps especially when) the child has issues about touch.
Bodywork interventions, including various types of massage, energy practices (particularly those balancing the bioelectric meridian circuits), and all forms of cranial and physical/manual therapy serve integrative functions, but they must be titrated according to the individual. Practitioners need tools specifically to identify mind-body congruence, behavioral and emotional coherence, effortless and coordinated movement, and appropriate social engagement. 5. Match The Treatment To The Child
Matching the child with the specific interventions he or she needs is both the art and the science of the health care we provide.
One of the differences between masterful and mediocre treatment is whether the practitioner depends on the use of protocols or their own assessment of the client. Is the practitioner remembering a systematic approach, or reading tissue with their hands and the client's state of being with their eyes and their intuition? I believe that a brilliant therapist has an expanding medicine bag of highly developed skills they can match to different needs at different moments. Children respond immediately to their practitioners. Who you are, as well as what you do, is incorporated into their therapeutic experience.
Recently I was working with a 4-year-old boy with sensory needs. After about 10 minutes, it became clear to me that he was not going to get on the treatment table despite his parents' strong encouragement. I asked him if I could treat him on the floor where we were sitting. He said, "A little." I honored his boundary and treated him with subtle energy for less then 10 minutes, telling him everything I was doing. I listened to his pulses, told him what I heard, and treated that. Then I got out the toys. We played side by side imaginatively, creating a fantasy world together, for over an hour. Woven into this play time were healing stories that, through suggestion, addressed his needs. After our session, his parents reported that he was especially calm and loving. While to an outsider it might appear that I was "just playing," in fact I was being therapeutically specific to this child and what he could tolerate and accept. 6. Allow The Child To Be The Director
Children are a vulnerable population. Their innocence and dependency call for us to be protective and to actively advocate for their highest and best interest. This is why it is best that parents be fully involved and fully informed of the treatment interventions, as well as become coparticipants in the administration of the treatment. Parents are not just observers or bystanders to treatment sessions. They serve best when they are actively engaged--whether that means hands-on, verbally, or energetically. Their full attention and engagement increases the power and safety of all treatment applications.
I also recruit the children themselves as active practitioners in the sessions. This is always my preference. When children are fully engaged, they are also fully protected because nothing is happening to them that they are not conscious of and informed about. Acknowledging that the child is the center and director of the healing process not only empowers them, it also reveals the truth of any healing dynamic. This key ingredient is not only a critical component, it is also a subset of all the other ingredients.
To protect the child, the practitioner obviously needs appropriate release forms that authorize pediatric treatment for a child and that are signed by both parents and/or guardians. You also will likely want to include releases to speak with the other practitioners who are engaged in the child's health care. Creating a team of health-care practitioners is always to the child's and the parents' advantage. When the providers are in dialogue with each other, they can work more effectively together and separately. Periodic team meetings, with parents and child present, are bonus opportunities to reap the rewards of the team's combined wisdom and insight.
It is also helpful if the therapist is networked with other practitioners that the child may need, including medical doctors, occupational therapists, physical therapists, psychologists, and speech therapists. Knowing a community of well-trained, compassionate, neurodevelopmentally savvy therapists is a bonus when working with children, particularly those who are sensory challenged. In my work with Sophie, for instance, I have collaborated with a Thai yoga massage therapist and a Rolfer. Team treatment is always refreshingly productive. It evokes a shift in consciousness by tapping into the pool of collective healing. This leads to finding new ways to support structure and enhanced perspectives on mind-body integration. The practitioners learn from each other and the client's body learns from everyone.
Interestingly, the four- or even eight-handed approach does not necessarily create sensory overload. Instead, I observe that the client usually flows with the treatment, feeling the mutual focus of the practitioners. Children enjoy being the recipient of so much positive attention. During team treatment, it is especially important the child feels in control. Sophie can always signal the end of this or any session. She has vocal and expressive ways of doing this that are recognized by everyone in the room. In team treatment especially, assuring client empowerment is a prerequisite to starting the work.7. Have Faith In The Family's Healing Capability
Having faith in the power of the children and their families to heal themselves is the essence of sustainable, family-centered health care. This includes the capacity of children to engage directly with their own nervous systems to create new options. Of course, children need the guidance and support of the adults around them, but I suspect we have long underestimated the capacity of children of all ages to be proactive regarding their own health, including challenged children, children without access to language, and children with special needs.8. Acknowledge The Child's Learning Style
Children's imaginations are usually undamaged by the restrictive strictures of the so-called "real" world. It helps to know as much as possible about how the individual child's mind works. For instance, some of their wonderful brains are primarily visual; others are kinesthetic. Some children can learn more readily from the way we speak and others will have a very literal response to the words we use. An attentive practitioner can decipher a child's learning style through their interaction with them, but it can be helpful to have lead information from parents when that is available.
For the special needs child, acknowledging that there might be different ways to incorporate the skills or information you want them to integrate will be especially helpful in your process. Here are some ways to incorporate the various learning styles for your client.Suggest Visualizations
Once you have a framework for communication, you can suggest visualizations to support the child's healing process. I have already mentioned how I encourage Sophie to see her spine as long and tall and straight. I gave Sophie a picture of a well-aligned spine to help her with this visualization.
This tool has worked with many others, including a young client of mine who was not accepted at school by some of the other children because of his neurodiversity and speech impediments. He did not look forward to growing up into a world of bullies where he perceived himself as unacceptable. He therefore kept undermining his growth. He wet his pants, behaved childishly, and resisted learning. I asked him to visualize himself surrounded by good friends with whom he was laughing and speaking easily. I invited him to see that he had friendships with people who saw him as the wonderful, bright being he was. I proposed a visualization of himself as a happy young man, thriving in a world that honored his unique gifts. Within a very short space of time, the boy stopped his temporary incontinence and began to progress with his reading. With his mother's help, he was consistent with both the visualizing and with energy treatments that were creating increased neurological resonance between his right- and left-brain hemispheres. When I saw him last, he was talking happily about his friends and enjoying school.Movement For Coordination, Integration
Movement has many gifts. It simultaneously releases and expresses the body and stills the mind. It discharges while refueling. Everyone needs movement. Children's growing bodies especially crave physical outlet. Giving children therapeutic movement that combines healing and expression with structural and energetic integration is a smart idea. Here are some of the movement tools I incorporate into all my sessions with children:
- For integrative movement, I playfully walk around my studio with my client or move joyously with them when the session is over to help them incorporate the changes that have occurred in their body during treatment. As we do this, I observe the shifts in their gait, symmetry, proprioception, and balance. This also allows the child to experience our relationship in motion and in space.
- I give the child a movement-based toy at the end of the session. This is not an expensive gift, but one I know is age-appropriate and will get them to move. A small rubber ball that they will immediately start bouncing is a great tool for the child. A bottle of bubbles is another inexpensive and successful option as they can chase the bubbles or dance with them as they float in the air. All of this is done intentionally, with an eye to integration.Storytelling For Neurological Resonance
Storytelling is a co-participatory experience. It is not a dictated monologue. Storytelling stimulates image-making which generates neurological hemispheric resonance. Children particularly love stories about themselves. If the child is able to use language easily, I often make an agreement with them that we will tell a story together. I provide the first few sentences and they chime in. We continue back and forth, frequently telling a story about their day, their dreams, their fears, and their hopes. Children also enjoy stories about their births, about how they have grown, and about their triumphs and accomplishments. They like to hear stories about other children their age, and about adventures that await them. Other ideas include stories about pets (humanize a pet and take it on an adventure), trips to magical lands, or other adventures (get lost and then found, climb mountains, meet other creatures, or make friends with plants). When creativity is flowing, the sky is the limit.
I often have the experience of just looking into a child's eyes and letting an entire story emerge from the synthesis of their energy and mine. I use the storytelling experience to stay in contact with the child while treatment continues. It helps enormously to keep a child focused and relaxed during the session. Art For Hand-Eye Coordination
My most popular art activity involves asking the child to draw or trace their hands and/or feet. During the process, I show them how they can hold their fingers and toes to create nervous system reorganization and balance their emotions. They can then color and decorate their drawings at home with family members as a way to deepen the learning experience.9. Guide Children To Be Proactive
Providing children with enjoyable ways to self-treat is how you can ensure they will continue treatment on their own. I enjoy giving children self-care assignments that are playful and invite them to experience the joy of healing for themselves. Imagine their delight and confidence when they see their improvement as a result of their own self-care. This is part of guiding children to be proactive in their own healing.
Teachers and others in the child's educational world (tutors, aides, and child-care providers, for instance) can be informed of how the child is using self-care practices. They can encourage the child to employ these practices as resources when they are stuck. There are several tools the client and her family can use to keep engaged and remain proactive in the healing process. Start by using those the child is familiar with and that have already been incorporated into the therapeutic protocol:
- Ask them to hold areas of their body in polarity and attend to the shifts in their nervous system responses.
- Suggest movement practices to help them discover their own coordination and integration.
- Suggest visualizations.
- Use art for expression and eye-hand coordination.
- Use storytelling to arouse positive neurotransmitters.10. Have Fun
There is no doubt that children with special needs can be challenging to treat. They sometimes cannot control their movement, their sounds, or even their eliminations. Their communication is frequently indirect, unexpected, and often requires that the practitioner go beyond language, rationality, and cognition. The structural needs of these children are complex and unusual, creating a unique opportunity for the practitioner to think broadly and go beyond standard applications. These clients require more engagement and presence.
Show your special needs client how much you enjoy being with them through your smiling expression. Have fun mirroring back the special gifts you see in their eyes. When you are truly having fun, it is contagious. Experience the joy of being present to the special world your sensory needs pediatric client opens up for you, and the opportunity they provide for you to make your unique contribution of love and skill to their life.11. Don't Be Afraid Of Special Needs Children
It is precisely the uncharted territory of serving children with special needs that excites me, along with the promise of making a substantial, recognizable difference in their well-being, and in the lives of their families. This is the promise of serving this vivid, intense, and needy population. Don't be afraid to work with these children, but be open to how you can serve them with your inventiveness and skill, and how you can contribute to the enrichment of their lives. Stephanie Mines, PhD, is conducting clinical trials testing the applied touch aspect of the TARA Approach with autistic children. She is the author of numerous articles on pediatric treatment and the book
The Dreaming Child: How Children Can Help Themselves Recover from Illness and Injury (The DOM Project, 1998), which is available through her website, www.Tara-Approach.org. Her newest book in progress is
New Frontiers for Sensory Integration.