Wednesday, 8 July 2015

Massaging autism (continued)

A quote to begin:


"Tactile-based interventions such as massage therapy were the most promising intervention in reducing behavioral problems."

Derived from the systematic review results published by Farahiyah Wan Yunus and colleagues [1] looking at the current collected literature on sensory-based interventions for "children with behavioral problems", researchers zoomed in on massage therapy as perhaps being something requiring further investigation. Said therapy also potentially overlaying onto the label of autism too.

I've previously covered some of the peer-reviewed literature mentioning massage and autism before on this blog (see here) and the idea that Qigong massage for example, might hold some important benefits for some on the autism spectrum [2]. The intervening few years have seen some further developments in this area that might be useful to bring to your attention.

So:

  • Starting with the 2011 review from Lee and colleagues [3] the message was one of 'limited evidence for effectiveness' when it came to massage therapy and autism. Further: "all of the included trials have high risk of bias" was something denoting care in making too much of the scientific effects of massage for cases of autism.
  • The authors of the Qigong massage - autism paper were not however ready to give up quite yet on looking at massage and touch when it came to autism as per the results of their analysis of a "qigong massage database" [4] (open-access here) and the suggestion that "tactile impairment in young children with autism is treatable with a qigong massage protocol." Yes it was a retrospective review but keep it in mind for now.
  • Zen shiatsu was the name of the massaging game in the paper from Burke [5] (open-access here) and a case report of "a seven-year-old male with a diagnosis of autism who was given 20-min Zen Shiatsu sessions weekly for six consecutive weeks." Zen Shiatsu by the way refers to a specialist type of massage that "uses finger pressure, manipulations and stretches" [6] as part of its approach. The author reported that there may be more to see when  it came to "the child's overall quality of life" improving over the course of the intervention period.
  • Yet more from Silva and colleagues [7] (open-access here) was published quite recently and the "first report from a two-year replication study" on massage therapy as part of Qigong Sensory Treatment (QST) intervention for children diagnosed with autism. "This is the first evidence-based intervention for tactile abnormalities in children with autism that effectively treats them with a massage protocol rather than making environmental accommodations to them" was the claim made by authors, together with data suggesting that massage may indeed have some positive effects for those on the spectrum (and their families). Even Brondino et al [8] acknowledged that massage was one of the complementary and alternative medicine (CAM) options that showed 'promising results'.

Allowing for the fact that there is quite a lot more science to do in the area of massage and autism including some further research on the hows and whys of touch/massage when it comes to the display of core and peripheral autism features, I'm minded to suggest that the future looks rather bright for massage therapy. I know touch and the whole sensory side of autism can be a sticking point for some people on the spectrum [9] but 'beware of sweeping generalisation' is all that I will say. The idea that: "Parents reported feeling 'closer' to their children and felt that the touch therapy had opened a communication channel between themselves and their children" should also not be under-estimated in light of other findings (see here).

If one also starts to look at the effects of something like massage on some of the comorbidities that seem to be over-represented when autism is present (think ESSENCE) such as attention-deficit hyperactivity disorder (ADHD) for example [10] one gets the impression that the hows and whys might be quite a bit more complicated than first thought.

Music: White Stripes - Hotel Yorba.

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[1] Wan Yunus F. et al. Sensory-Based Intervention for Children with Behavioral Problems: A Systematic Review. J Autism Dev Disord. 2015 Jun 20.

[2] Silva LM. et al. Early intervention for autism with a parent-delivered Qigong massage program: a randomized controlled trial. Am J Occup Ther. 2011 Sep-Oct;65(5):550-9.

[3] Lee MS. et al. Massage therapy for children with autism spectrum disorders: a systematic review. J Clin Psychiatry. 2011 Mar;72(3):406-11.

[4] Silva L. & Schalock M. Treatment of tactile impairment in young children with autism: results with qigong massage. Int J Ther Massage Bodywork. 2013 Dec 3;6(4):12-20.

[5] Burke A. Zen shiatsu: a longitudinal case study measuring stress reduction in a child with autism spectrum disorder. Int J Ther Massage Bodywork. 2014 Dec 2;7(4):23-8.

[6] Robinson N. et al. The evidence for Shiatsu: a systematic review of Shiatsu and acupressure. BMC Complement Altern Med. 2011 Oct 7;11:88.

[7] Silva LM. et al. 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;2015:904585.

[8] Brondino N. et al. Complementary and Alternative Therapies for Autism Spectrum Disorder. Evid Based Complement Alternat Med. 2015;2015:258589.

[9] Cullen L. & Barlow J. 'Kiss, cuddle, squeeze': the experiences and meaning of touch among parents of children with autism attending a Touch Therapy Programme. J Child Health Care. 2002 Sep;6(3):171-81.

[10] Maddigan B. et al. The effects of massage therapy & exercise therapy on children/adolescents with attention deficit hyperactivity disorder. Can Child Adolesc Psychiatr Rev. 2003 Mar;12(2):40-3.

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ResearchBlogging.org Wan Yunus F, Liu KP, Bissett M, & Penkala S (2015). Sensory-Based Intervention for Children with Behavioral Problems: A Systematic Review. Journal of autism and developmental disorders PMID: 26092640