Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.
Jonathan Clark teaches children with developmental and communication disorders. He is also a certified massage therapist with a dream. "There are so many different things that massage helps adults with," said Clark recently from his office at The Matthew Reardon Advanced Academy in Savannah, Ga. "I know it relaxes me to the point I can focus. I thought maybe it could help a child focus."
Putting words into action, in early 2002 Clark sought permission from school officials and parents to conduct a pilot study within the school setting. Among his subjects was an 11-year-old autistic male. "This student had an expressive language deficit which inhibited him from communicating with others," said Clark. "His attention span was very short and he would only attend to tasks for one to two minutes at a time. This, coupled with other issues, led to severe behavior problems. Uncontrollable fits of anxiety and rage were noted throughout the school day. Yelling, screaming, hand-biting and violent, side-to-side rocking took place with each attack. Several behavior interventions were attempted without positive results."
Amazingly, this same student was receptive to the hour-long massage sessions (primarily head and facial) Clark administered for nine consecutive days. On the days he received massage, the student's behavior improved dramatically. "His attention span increased from two minutes to 10 minutes," said Clark. "He could attend to tasks longer and was more receptive to interaction and redirection in the classroom."
Previously, an episode of agitation might last a full hour. On massage days, the student was able to calm down within minutes. "His screaming would knock your head off," said Pam Thornton, the student's lead teacher. "He would scream at the top of his lungs. He would not sit and would walk away," she said, describing the child's behavior prior to massage intervention. After massage, "he seemed peaceful and more focused. I think it was the best thing for him. It's just amazing. I wish it could have continued on a regular basis." Thornton noted that in the absence of massage treatment, the student reverted to noncompliant behavior and screaming episodes.
Clark fashioned his dream on the framework of pioneering research with autistic children conducted at the Touch Research Institute in Miami, Fla. He has completed two case studies and is determined to continue in-school application of his skills if he can get grant funding. While Clark's work had significant impact, massage therapy is not part of his job description at the Academy and was only provided to students within the study period. But this small project highlights a major breakthrough in the understanding and treatment of autistic spectrum disorders. Once thought to be aversive to attachment and touch, children with autistic behaviors have been shown to respond to the bonding process and, as is evident in Clark's work, are in fact calmed by touch. Autistic Syndrome Disorders
Autism in children was first described in medical literature in 1943 by Dr. Leo Kanner, a psychiatrist at Johns Hopkins University. He noted these children were self-absorbed, exhibiting problems in communication, social interaction and behavior. Similarly, pediatrician Hans Asperger of Austria applied the term in 1944 to children who, despite having normal intelligence and verbal skills, were socially inadequate and prone to bizarre obsessions.1
In 1967, Freudian psychologist Bruno Bettelheim published a book on autism titled The Empty Fortress. He proposed that mothers of autistic children were cold and rejecting, and in response, the children developed an inability to communicate or form interpersonal attachment. In Bettelheim's view, widely accepted at the time, it was in the best interest of the autistic child to be removed from the mother's care and institutionalized in a setting that would provide the missing acceptance and love.
Although the specific causes (there may prove to be many) of autism are still debated, mothers are no longer on the hot seat. More recent investigation by experts in the field have given a different view -- that of a malfunctioning brain. By and large, autistic children are raised at home under their parents' care while attending special school classes designed to meet their challenging needs. Living and working with autistic children is at times both frustrating and rewarding. Symptoms can range from screaming fits and long, drawn-out episodes of self-stimulating behaviors to mute withdrawal.
The brain disorder specific to autism manifests itself in a variety of ways, but most pervasively "affects a person's ability to communicate, form relationships with others and respond appropriately to the environment."2
Beyond this shared deficit, each child displays symptoms to a varying degree and cluster. The disorder is generally recognized by age 2 and persists throughout life. The child is noted to be aloof, resisting affection or interaction and avoiding eye contact. Language skills are delayed or absent. According to the National Institute of Mental Health, as many as half of autistic individuals remain mute throughout their life. Some who develop language use it in odd ways, repeating what they hear echolalia), failing to structure complete sentences, using single words or displaying a sing-song, robotic voice.
In any event, with or without words, the child lacks the ability to make requests for his needs or to respond appropriately to his environment. With advancing age, problems in self-control emerge, including aggression and angry outbursts, or repetitive movements such as rocking. Many autistic children have sensory malfunction as well and are averse to certain sights, sounds, smells or touch.3
Within the United States, diagnosis of autism banks primarily on the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders in its current form, the DSMV-IV. But some controversy regarding diagnosis criteria exists among experts, both stateside and throughout the world. In the DSMV-IV, autism falls under a broader category of Pervasive Developmental Disorders (PDDs) which includes Asperger's Syndrome, an autistic syndrome in which the individual exhibits autistic behaviors but appears to reach normal intelligence and developmental milestones in early childhood. In fact, there are several other distinctly classified disorders in which autistic behaviors are present.4
Children with autism typically test out as mentally retarded, although 10 percent or more have average or exceptional intelligence.5
But herein lies a quirk in the system -- in the presence of major language deficits, how can intelligence be accurately tested? Communication remains the primary challenge in autism and without communication, all else falls to the side.
Research of autism has uncovered brain abnormalities in some autistic people, both structural and biochemical.6
Some experts, such as Bernard Rimland of the Autism Research Institute in San Diego, Calif., have been investigating alternative approaches in determining causative or interactive factors and subsequent biomedical treatment. From viral infections to pollution, no stone has been left unturned in the search for causes, and current treatments cover the gamut from nutritional programs to immune system boosters.7Touch, Connection and Control
As the concept of autism as a specific disorder first became more organized, it was presumed autistic children lacked the ability to form emotional attachment to their parents and other significant caretakers in their life. In recent research studies, the opposite has been shown, with study subjects showing a clear preference for those with whom they are in close daily and supportive contact. However, this attachment does not transfer to an internalized working model for establishing appropriate relationships in general. What is lacking in the autistic is the ability to empathize with and take on the other person's viewpoint, thus their social communication is stunted.8
It is this basic need for and response to attachment that allowed Clark to establish a therapeutic connection through massage with the students in his study. Because much of his work is provided one-on-one, he was accepted as a standard and integral part of the daily routine.
Four years ago, Clark was working with children in a mental health clinic. His clients included those with behavior problems and attention deficit hyperactivity disorder (ADHD). A supervisor who left the facility for a job at Reardon encouraged Clark to hire on at the school as a teacher's assistant and he's been there since. Concurrently, Clark was working toward another goal, to become a massage therapist. In April 2001 he entered classes at Savannah School of Massage. As his training in massage progressed, he considered the benefits massage could have for children as well as adults. "In the classroom," said Clark, "attention span is not there so much." After completing massage training, he sought permission from the school and parents to explore the possibility of helping his students increase concentration and classroom performance.
"I had some help from other teachers in other classrooms. The biggest plus for me was that I had a bond with the children. They were secure enough with me to let me perform the massage. You have to form a special bond with a child for them to let you touch them and basically they trusted me. You have to have a lot of patience. Initial touch is a basic to get them to relax."
Clark has used cranial massage along with some compression and other basic techniques for the children with autistic behaviors. He has found sacral rocking very relaxing for his students. "It's real popular with the kids," he said. "When I'm with a child and put my hand on their shoulders, they might ask for a rub, in some way, shape or form. I'll ask them if they know what a massage is and if they would like one. When I bring the table in, they are curious." Students have also shown an interest in Clark's massage training, sometimes questioning him about his school. "I let them know in order for them to get what they want out of life, they need to go to school, that it's a positive thing."
While assisting at a summer camp retreat for children with multiple sclerosis, Clark donated massages to the staff. "Wherever possible, I try to help. I don't mind helping people. I try to make it known massage is for everyone." Even teachers and parents at the school are offered a little shoulder massage throughout the day.
Donald Hall, Ph.D., director of the academy, was highly instrumental in Clark's project, not only clearing the way administratively, but also in developing a scoring system to assess improvement in the students' performance following massage treatment. "What we did," said Hall, "was initially look at what massage would do for these kids in learning. We tracked learning for that individual for that specific task. It seemed it was helping at least in the pilot studies we've done. We tried to keep it as scientific as we could, with control variables and a written procedure."
In the pilot studies, students served as their own controls. The project included a three-week trial period with massage and another three-week period without massage. Clark would then document how many minutes a student would stay on task and the amount of work accomplished during that time. The daily routine was kept consistent, as were other factors, such as room temperature and atmosphere.
The 11 students at the Reardon Academy all have neurological and communication problems with deficits in speech and language, although not all are labeled as autistic.
Clark also worked with 13-year-old Jason, diagnosed with fetal alcohol syndrome and Tourette's syndrome. Jason was given primarily cranial massage therapy, along with effleurage and petrissage on the neck, back, shoulders, hands and fingers in a 15-minute session, once per day, for three weeks.
According to Janet Long, his aunt and caretaker from birth, Jason's autistic-like behaviors decreased during the pilot project and have continued to do so with home treatments by Clark. In the school study, Jason's tics (involuntary repetitive movements) diminished significantly, resulting in increased concentration and attention to task. Clark added, "This decrease of undesirable behaviors directly impacted his academic performance and social interactions." He was able to complete 25 math problems within a 28-minute time frame as compared to completion of only one to five problems within the same time frame during the three-week control period without therapy.
"I can tell a difference in his work and with learning," said Long. "He is more on task when he has this massage. I think it's been wonderful because it's made him more relaxed." Long noted that Jason's personality seems to have changed. He's become more outgoing and less frightened of personal interaction. "He's more of a little ham. He enjoys it. Jason is a very nervous person and massage releases a lot of stress. At night when we do homework, he's much calmer."
Clark also worked with a 9-year-old male whose screaming in the classroom was a constant occurrence. "It really altered his learning," said Clark. On massage days, the student would help Clark set up the table, put the sheets on and climb on the table, usually cooperating with him for most of the hour-long session. Following massage, his attention span lasted at least 5 to10 minutes. "Some days he would sit up or get a little antsy," said Clark, "and it took a few times to get him situated. There were certain massages he would enjoy -- on the feet, fingers, hand and head. He liked the pressure and loved to be touched. A head scratch or cranial rub soothed him." In beginning sessions, Clark focused on making the child comfortable and building a rapport. "After that, I was able to work on him for a large amount of time. The main key is patience."
For the children whose lives and bodies Clark has touched, massage has opened a doorway to new possibilities and accomplishments. "Currently," said Clark, "many types of therapies are included in the multidisciplinary approach to the treatment of autism, like music, art, occupational and speech. I feel that massage therapy is a beneficial therapy approach that is currently overlooked. I am convinced that massage therapy can have a positive influence on the social and academic performance of children with autism."Shirley Vanderbilt is a staff writer for Massage Bodywork magazine.