Treating a Child with the Label "Autism Spectrum Disorder" Using Integrative Manual Therapy: Looking Below the Surface
Author: Eleanor Rice, MA, OTR
Abstract: This case study focuses on a five-year-old boy with the label of Autism Spectrum Disorder. Upon evaluation, the boy presented with predominantly low muscle tone and hyperactivity. The body was treated with Integrative Manual Therapy and Sensory Integration. After therapy was completed, the body presented with a significant change in his behavior and interaction with others, including an increase in his verbalization and appropriateness of his interaction.
Key Words: Autism, Pediatric, Sensory Integration, Hyperactivity
History
Ben, age five years, two months, was referred for an occupational therapy (OT) evaluation in September 1998 by his speech and learning specialists who felt he might need sensory integration (SI). The immediate problem prompting this referral was his inability to sit long enough to do a computer-based test that was necessary to begin a speech and educational program.
Ben had been in a special need's class receiving occupational and speech therapy. He was also receiving private speech therapy (ST). Reports indicated he was hyperactive with an "Autism Spectrum Disorder" and possible low muscle tone. He had been through auditory training with reported success in 1987. All who worked with him agreed that he had a severe speech disorder, had difficulty sitting still, gave no eye contact and had frequent behavioral outbursts. There was an early problem with excema and continual craving for sugar. Frequent ear infections were treated with antibiotics and bilateral tubes.
Evaluation
Ben resisted entering the clinic, refused to give the therapist eye contact or to answer questions. He was defensive to all sensory stimulation (e.g., resisted touch, made increasingly higher vocalizations with hyperactivity). He had predominantly low muscle tone with muscle spasms occurring throughout the entire body. There was limitation of motion throughout the spine, pelvis, shoulder girdles, and extremities. Postural asymmetries were evident throughout his body; there was no active trunk rotation. He sat in a functional scoliosis, unable to find a position of comfort; therefore, he moved over the entire surface of his seat, constantly shifting weight. This made it clear that he did not have a stable base from which to effectively use his upper extremities. The same problems were observable when he was on his feet (e.g., he was unable to stand still).
Initial Treatment
At this time, I had taken three courses with Dialogues of Contemporary Rehabilitation (DCR): Developmental Manual Therapy, Myofascial Release, and Integrative Manual Therapy for the Autonomic Nervous System (Advanced Strain and Counterstrain). It was clear that the structural work of Integrative Manual Therapy (IMT) needed to be performed before the SI and the functional work. I explained this to his mother and the referring professionals. I decided that Ben would receive IMT for 2/3 of each session followed by a few minutes of SI or other functional work. Unfortunately, our schedules were both so busy that therapy did not begin until December, 1998. He then attended therapy once or twice a month for 45-minute sessions.
Initial treatment with Integrative Manual Therapy consisted of the following techniques: Diaphragm releases of the thoracic, respiratory and cranial diaphragms (1); Myofascial Release (MFR) Diaphragm releases (2); MFR Defacilitation of the spine (2); MFR Articular facial release of the pelvis, sacrum, lumbosacral junction, thoracolumbar junction, and cervicothoracic junction (2). At the end of each session, Ben was given a few minutes to play on the vestibular equipment or to sit at the desk drawing and doing other perceptual activities.
Initial Outcome
Following these procedures, Ben had become less defensive to touch and was beginning to verbalize complaints rather than acting them out physically. Involuntary spasms of various muscle groups had decreased. He was able to sit at the table and the computer testing program had begun. The initial referral goals were attained.
Additional Treatment
In March of 2000, Ben was taken to Regional Physical Therapy (RPT) in Bloomfield, Connecticut for evaluation and treatment. In addition to the formal evaluation report, the rehabilitation recommendations from Sharon W. Giammatteo, Ph.D., PT stated that "there appears to be a significant inflammatory process". The recommendations were as follows:
Final Outcome
By this time, I had participated in over twenty additional courses with DCR and was eager to implement the above suggestions. There were major changes before even half of the program had been completed. Ben was walking into the clinic, getting on the treatment table, requesting a favorite video, and asking reasonable questions about treatment. He was looking at people as he talked to them and his appearance had improved greatly. He progressed from making one request (prone swinging in the net) to asking to do a variety of things (e.g., play with a toy, draw pictures, play a game). He complied with requests to sit and write at the desk. He was MAINSTREAMED in school. His play on the vestibular equipment had become more organized and tactile defensiveness was reduced.
In December 2000, Ben walked into the clinic and said "I wish you had a sign on your door like Marcia." I asked "what do you mean?" He said, "Marcia has a sign on her door, she is going away for two weeks, I wish you had a sign on your door saying Ben does not have to come back here ever again." I reported this conversation to Marcia, his speech therapist. This was impressive communication for Ben. Shortly after this, we gave him a vacation from therapy. He will return to therapy this spring and we will refer him back to RPT for additional assessment and treatment planning.
Discussion
This is an ongoing treatment plan. There is still extensive structural work to do in order to improve this boy’s quality of life and to help him reach his full potential. It is essential to look beneath the surface of the behavior and beyond the labels applied by society for the structural areas of dysfunction. IMT produces structural change, which then creates unlimited possibilities for growth and development
References
1. Weiselfish-Giammatteo S. Integrative Manual Therapy for the Autonomic Nervous System and Related Disorders. Course Text 1998
2. Weiselfish-Giamatteo S. Myofascial Release -- An Approach to Soft Tissue Mobilization with Fascial Fulcrum for the Orthopedic and Neurologic Patient. Course Text 1997.
3. Weiselfish-Giammattteo S. Assessment, Integrative Diagnostics and Integrative Manual Therapy for the Lymphatic System-Level One; Congestion Therapy (An Introductory Course). Course Text 1999.