OBSERVATIONS ON CLIENTS W/ AUTISM & ASPERGER'S.

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© Colin Rossie 2008. Not to be printed or used without permission of the copyright holder.

There is a world of difference between autism & Aspergers Syndrome (AS). What I write in the following article is from the coalface: over the last 9 years I have worked with people from both communities over a wide age range.

AS has a whole spectrum from mild to severe. I would differentiate it from autism, even though the DSM IV puts it into the autism range of disorders. My personal observation is that autistic people tend to look inward, minimize engagement with the external world and are easily stressed by it. Aspies will engage with the external world, but in a way reminiscent of children: great enthusiasm, but with the narrow focus of the special interests that takes their attention. They are interested in everything, but ESPECIALLY in their specific thing(s).

Because of both personal and clinical experience, I feel the DSM-IV's diagnostic criteria should be refined even further. It is commonly reported that in movement and coordination those with AS can be awkward, ungainly, clumsy, stiff & un-coordinated. While this is true of the majority, in my observation a sizeable percentage (maybe 20%) have an exceptional, almost unnatural, grace, coordination & balance in their movement. For example, from a Rolfing perspective, it is really difficult to pick if they internals or externals, G or G prime oriented. A deciding factor seems to be training early in life- particularly if it was dance, martial arts or yoga. Distance running also seems agreeable with them. Weights and gym work earlier in life do not seem to have the same effect.

Some symptoms often associated with autism spectrum & AS (ADD/ADHD/ lack of focus) may be secondary to not receiving appropriate support or to poor diet. They may be more of a misdiagnosis. AS clients could possibly become easily bored with routine if it does not support where their mind travels- for them, it is hard being a square peg in a round hole. Often the neurotypical world does not treat Aspergers as a unique variation of the human experience with equal validity, instead trying to make Aspies conform to behaviours and ways of being that, while those of the normal world, are foreign to their way of being: "notions not our own, nor suited to us". If being academically bored is not recognized it could lead to high school dropout; not being diagnosed can lead in extreme cases to violent behaviour (both physical &/or verbal) in social interactions, social and academic failure, drug & alcohol abuse, inability to form or maintain relationships and other self-destructive behaviours. Socially and emotionally, they are like children for life, needing a lot of hard work, nurture and support. If they receive this, they can blossom and their high intelligence and special talents can contribute positively to the world around them. To use a motor vehicle as an analogy, not all cylinders are firing emotionally, and those that are often do so inappropriately.

Clinical anecdote is no substitute for solid research, but it can inform the way we work & become the raw data for further hypotheses; what I write is based on observation of 40 plus clients over the last 9 years. I’d be interested to know the experiences and observations of other massage therapists and bodyworkers, what they think of what I relate and any further observation, experiences and thoughts that could contribute to this discussion.

Regarding autism:

Generally I find those with an autism diagnosis difficult to co-opt into the participation part of Rolfing, though this may apply across the spectrum of massage and bodywork. Depending on the degree of autism and age, their responses can range from:

• A lack of any sense of involvement (generally found in extreme autism and the very young, often clients 'sent' along by anxious parents/ caregivers), to
• Finding it a nice thing to look forward to but without true engagement (generally moderate autistics, adolescents & older children, curious adults), to
• Being obsessively engaged in Rolfing (no particular demographic- I have had a 9-year autistic boy who, after session one, read everything he could about Rolfing and wanted to come every day for 10 days! Others google more info than either you or I would know was out there); through to
• Anger (generally adults or those unhappy people "sent" by somebody for work).

Some fellow bodywork practitioners have noted that it can be a problem if their client has been "sent" for work (by a parent, caregiver or partner) and are unwillingly participants in the process. In my experience, it would be unlikely to get an autistic client otherwise- bodywork would not be on their horizon under normal circumstances.

As with any client, range & type of contact varies. In young children and those with extreme autism, I forgo the concept of a Rolfing series that aims for specific, sequential outcomes. Without trying to be prescriptive, I've found the following approachs generally work well: start with light contact that gradually increases compression/ pressure in one area without moving much or quickly. If I can engage the client, I will involve them in movement- not always easy. Set it up really well - explain and demonstrate what you want and encourage them gently. Applaud their efforts no matter how far removed it is from what you would have liked the outcome to be. Not having done much cranial training, I tend to refer all ages to the local osteopath, so they receive cranial work concurrent with my work.

My experience is that it is not unusual to see autistic clients only a few times; sometimes they or their caregiver/ partner opt entirely for cranial work, sometimes there is impatience that Rolfing is not a magical, quick- fix silver bullet with immediate results. Sometimes, especially if they’ve been 'sent' along, the client may want it to fail, so only come for one session. I've heard variations on the following after one session: "See! Happy now? I've done that Rolfing thing you wanted me to do!". Sometimes though, even if it is exceptionally gentle, the physical contact can be too much for them, too confronting.

Regarding Aspergers:

Aspergers clients, on the other hand, are usually entirely different. If they've been 'sent', the trick is to engage them. Once you've done that, they can be the most enthusiastic, compliant clients. If they have come of their own accord (movement and co ordination problems sometimes bring them, sometimes Rolfing has been casually mentioned to them and they've run with the recommendation), I generally find they have well researched not only Rolfing on google but also everything they can find about me before they arrive on the doorstep. They can be among the most enthusiastic clients, sometimes a little too enthusiastic. They can take you very literally- be prepared for the odd turn of phrase, the peculiar emphasis on words and patterns, the overdoing it, the enthusiasm that can seem bordering on mania. Once you have engaged them, they can talk endlessly about the minutiae of their responses to the work you undertake together.

I involve them in a lot of active movement participation while working their tissue in order to enhance their proprioception & coordination; also lots of basic, perceptual movement work lying supine, in sitting and off the table (both standing and lying on the floor). I also utilize props such as yoga blocks, Torson bolsters, Duradiscs and Swiss balls (both semi inflated as well as fully inflated) to introduce novelty to their sensory experience and engage them in different ways of thinking about how they use their body. I always introduce these new inputs gradually and explain fully what we are trying to achieve and why. Though their curiosity can be utilized in sessions, they can also be easily overloaded. Sometimes the unexpected, the change from routine, can disrupt their comfort zone, but if they can see the logic in what is being attempted they can usually embrace it with enthusiasm.

Because the bodywork experience can be quite profound for them, they may begin to regard you as their best friend for life. But AS clients can also be incredibly awkward socially and not forthcoming, so working with them involves treading a fine line: to engage them so they feel involved with the process without allowing the new best friend forever attitude (which erodes the therapeutic relationship). It is also possible to be bored to death by their enthusiasm.

Be aware of boundaries: sexual boundaries will not be the problem, time and appropriate disclosure will be. Friendships for them can be based on shared special interests rather than any deep amicability or compatibility. This friendship thing can be a steep learning curve for the therapist. No matter what their age, I find it helps me to think of dealing with a very precocious, curious child (think 8 year old) with the emotional volatility of the early teens thrown in, and all the obsessiveness that could be attendant upon those two ages. Another attitude I find useful to adopt I term “the distant relative”: politely engage them when they are there, no need to do so until they are back again.

Jum tungan, an Indonesian saying, "time is rubber", can typify their approach. Let them know at the start of the session what time you have to finish with them so they are aware of your boundaries. As clients they can often have no sense of time, being either late or extremely early. No strategy you may have in place for this will affect them profoundly; they seem impervious, so as a therapist you need to be tough. Never start the session earlier than the time you have scheduled it for. I sometimes use the strategy of telling them finish time is 15 minutes earlier- that way they can have their talking time and I can still keep on schedule. If they are enthusiastic about the work, they can talk to a (sometimes boring) standstill about it. Coincidentally, if they are enthusiastic about your work, they will talk to everyone about you, becoming a walking, talking advertisement for you. Of the 5 principles of Rolfing, always wholism, but in their case especially closure.