Integrative Manual Therapy and Nutritional Wellness for Autism Spectrum Disorder
Is recovery from Autism possible? This is a common question in many parents’ minds today, along with: what will it take? Autism is a spectrum that includes many different disorders involving behavioral, learning, and socialization deficits. There are many different theories about the underlying causes of Autism Spectrum Disorder. To date, there is still considerable controversy as well as uncertainty. One commonality amongst more alternatively based practitioners is the level of toxicity present in children on the spectrum. This toxicity could be from many different sources such as heavy metal, pathogenic such as elevated levels of yeast or bacteria in the gut, residual virus load in the gut years after vaccination, and more. The road to recovery from Autism today is a reality for many, but not a short road. Understanding the process of recovery begins with having a more comprehensive understanding of Autism.
Autism Spectrum Disorder as a Classification System of Behaviors
Autism Spectrum Disorder is a classification system of behaviors that are commonly found in children diagnosed with Autism. Examples of these behaviors include: aggressive or self-injurious behavior when the child is abusive to themselves and/or their environment and family; self-stimulatory behavior, commonly referred to as ‘stimminess’, (i.e. repetitive rocking and repetitive motions of the hands in response to stimulation); and poor socialization when the child has difficulty with being around unfamiliar individuals and unfamiliar situations. It also includes speech deficit which may be present with no speech or impaired speech (they may only speak in one word or three word sentences and the speech may be appropriate or inappropriate); perseverative speech when the child desires something or asks a questions about something and the question is repeated over and over again, which is a component of obsessive compulsive disorder; issues with eye contact which may present as no eye contact or limited eye contact with familiar or unfamiliar individuals; distress behavior in response to change (i.e. the child may throw themselves on the floor and kick and scream in response to a sudden change in their routine); visual and auditory apraxia (this involves slow processing of visual and/or auditory information, i.e. the child is instructed to put their coat on and tie their shoes and get in the car but they have difficulty processing all of the different directions, or the child has difficulty processing visual information). This frequently involves hypersensitivity to light and/or sound or learning disabilities which are potentially secondary to the visual and/or auditory processing problems. A child with autism or autistic-like behaviors may present with any number of these behaviors and in any varying degree.
Functional vs. Structural Rehabilitation and Integrative Manual Therapy (IMT)
The road to recovery from Autism involves multiple interventions. More commonly known interventions for Autism fall into the category of functional rehabilitation, such as ABA (Applied Behavioral Analysis) therapy. This approach utilizes behavioral modification and repetitive teaching strategies to change autistic behaviors. Another example of functional rehabilitation for Autism is Auditory Integration Therapy (AIT). This approach uses various functional strategies to decrease sensory dysfunction, including self-stimulatory behaviors and hypersensitivity to sound. What is less commonly known in the field of Autism intervention is structural rehabilitation. The best example of structural rehabilitation is Integrative Manual Therapy (IMT). IMT is a manual/hands-on approach developed over the last thirty years by Sharon Weiselfish-Giammatteo, PhD, PT, IMT,C. This approach is gentle and non-invasive. An IMT practitioner, typically a physical therapist, occupational therapist, massage therapist, or chiropractor, uses their hands to assess, diagnose, and treat structural dysfunction in the body that may be contributing to these functional deficits.
Integrative Manual Therapy for Hypersensitivity to Sound
Let’s illustrate the difference between functional and structural rehabilitation with the following analogy: imagine a young child sitting at a piano. The child does not know how to play the piano and requires a piano teacher to teach the child how to play. Consider the piano teacher as the functional therapist. The child is taught how to play the piano and now can play beautiful music. But what if there was something wrong with the piano? What if the piano was out of tune or one of the strings was broken? The potential for beautiful music would be lost. Regardless of how skilled the child was at playing the piano, the music would not sound good. Now imagine that the piano was fixed by a ‘piano technician’ or a structural therapist. Once the piano was fixed, the child would have a new potential for playing beautiful music. The two go hand in hand. Let’s take this analogy one step further… imagine that a child has hypersensitivity to sound, auditory processing issues, and stimminess. Often in this situation, AIT is recommended. AIT is a phenomenal functional treatment approach. But what if the child suffered from severe compression of their inner ear? This is a very common ‘structural’ problem found in children with Autism. This dysfunction often is correlated with a long standing history of ear infections, which is also very common in children with Autism. If this structural dysfunction was present in the child, the AIT would be limited in its effectiveness. However, if the child went through a series of IMT sessions to correct the inner ear compression first, and thereby increase the child’s potential for improved sensory function of the ear and temporal lobe (auditory processing lobe of the brain), then the AIT would be much more effective in ‘functionally’ decreasing the sensory problems.
Integrative Manual Therapy for Aggressive Behaviors
Let’s use another example: aggressive or self-injurious behavior. Not every child with Autism has aggressive behaviors but often it is present and severe. Aggressive behaviors result from dysfunction of the limbic system. The limbic system is the core part of our brain—the part of our brain that we share with animals—the reptilian brain. When the limbic system is in a state of dysfunction, it contributes to a large range of behaviors, including aggression, rage response, obsessive compulsive behaviors such as perseverative speech and insistence on routine and sameness. Consider an adult that has suffered a traumatic brain injury and they regress in behavior and develop severe aggression. This is secondary to trauma to the limbic system. When the limbic system dysfunction is corrected, the aggressive behaviors dissipate. For decades, behavioral therapies have been used on children and adults with aggressive behaviors but to minimal success—because the dysfunction of the limbic system is not a functional problem. It is a structural problem—a structural dysfunction of the brain. Integrative Manual Therapy has been used successfully to correct limbic system dysfunction and reduce and correct aggressive behaviors in children and adults for many years.
Consider a lion that has been wounded—their rage response is incredibly heightened at this time. Rage is different from anger. When we are angry about something, there is rational thought involved. We are cognizant of consequences to our actions. Behavioral therapies (functional therapies) can be very successful when dealing with anger management. But when we are experiencing rage, we become reactionary. This means that we react without thinking. In times of rage, it is more challenging to think before we speak or act. Rage is the cause of many relationship problems. When a child is rageful, their actions, their aggressive behaviors, are not thought out. It is not as if they are saying to themselves that they are going to hit someone or bite someone. These behaviors are not under their control. In this situation, it does not help to yell at the child or try to reason with the child. These rage behaviors are about the limbic system. When the limbic system is in a state of ‘hyper-facilitation’, rage response is elicited. IMT can be used to ‘defacilitate’ and reduce tension at the limbic system, thereby reducing and eliminating aggressive behaviors overall.
Integrative Manual Therapy and Nutritional Wellness
In addition to the behaviors that are so common to Autism, children that are on the spectrum typically suffer from many digestive issues as well as food allergies. Many children with autism have eczema and other types of skin related issues. IMT can also be used to help restore immunity in the body and decrease inflammation in the gut. A typical IMT treatment program would include manual therapy techniques for the digestive tract in combination with a nutritional program that includes dietary intervention and nutritional supplementation. The nutritional supplementation and dietary intervention is helpful to accelerate recovery. For example, a Gluten-Free Diet is one of the more common dietary recommendations given to a child with Autism. Gluten is found in wheat, rye, barley, and oat. Gluten is pro-inflammatory. This means that when eaten, gluten will contribute to increased inflammation in the body, specifically in the body’s weakest systems. Most children with Autism already have digestive issues such as reflux, constipation, abdominal cramping, gas, and more. When gluten is consumed, the underlying problem may worsen. By removing gluten from the diet, much of the digestive problems disappear on their own. In addition to affecting the gut, gluten can also contribute to increased inflammation in the brain. Remember the child with aggressive behaviors secondary to limbic system dysfunction or the child with hypersensitivity to sound secondary to compression of the inner ear. All of these problems can worsen with increased inflammation.
The most successful approach to recovery from Autism is a multi-disciplinary approach, including structural therapies, functional therapies, and nutritional wellness. Using all of these approaches in concert leads to the most accelerated recovery from Autism.
Ayelet Connell-Giammatteo, PhD, PT, IMT,C is the Practice Manager and Director of Pediatrics for Regional Physical Therapy and Center of Integrative Manual Therapy and Diagnostics (CenterIMT), headquartered in Bloomfield, CT. She is also the Dean of the Connecticut School of Integrative Manual Therapy (CSIMT). Dr. Connell-Giammatteo has taught courses in IMT nationally and internationally for over 15 years. She received her doctoral degree focusing in neuropediatrics, with a concentration in autism.