About Face: Evaluating and Managing Tactile Impairment at the Time of Autism Diagnosis.

Evaluation for sensory impairment is a routine part of autism diagnosis. Sensory impairment of hearing, vision, or touch results in developmental delay and must be addressed before delay can resolve. Recent studies confirm that tactile impairment is present in autism and can be effectively treated with a tactile stimulation protocol. The research suggests a change in management at the time of autism diagnosis to include evaluation and treatment of tactile impairment. Here we validate screening and management tool for tactile impairment, the Autism Touch and Self-Regulation Checklist, in 404 typical and autistic preschool children. The tool assesses tactile impairment by location and severity. Autistic children were distinguished by mixed pain and numbness on multiple areas including the face and mouth (F = 412.1 (1,402);p < .000). Oral-facial tactile impairment interferes with the tactile stimulus to orienting. We hypothesized that oral-facial tactile impairment and difficulty orienting are predictive of ASD and that severity of tactile impairment is predictive of severity of ASD. Questions evaluating oral-facial and orienting responses correctly predicted 91% of the autism group. Severity of tactile impairment correctly predicted 81% of mild versus severe ASD. Results underscore the importance of evaluating and treating tactile impairment at the time of autism diagnosis.

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.

Tactile abnormalities are severe and universal in preschool children with autism. They respond well to treatment with a daily massage protocol directed at tactile abnormalities (QST massage for autism). Treatment is based on a model for autism proposing that tactile impairment poses a barrier to development. Two previous randomized controlled trials evaluating five months of massage treatment reported improvement of behavior, social/communication skills, and tactile and other sensory symptoms. This is the first report from a two-year replication study evaluating the protocol in 103 preschool children with autism. Parents gave daily treatment; trained staff gave weekly treatment and parent support. Five-month outcomes replicated earlier studies and showed normalization of receptive language (18%, P = .03), autistic behavior (32%, P = .006), total sensory abnormalities (38%, P = .0000005), tactile abnormalities (49%, P = .0002), and decreased autism severity (medium to large effect size, P = .008). In addition, parents reported improved child-to-parent interactions, bonding, and decreased parenting stress (44%, P = .00008). Early childhood special education programs are tasked with addressing sensory abnormalities and engaging parents in effective home programs. Until now, they have lacked research-based methods to do so. This program fulfills the need. It is recommended to parents and ECSE programs (ages 3-5) at autism diagnosis.

Qigong massage for motor skills in young children with cerebral palsy and Down syndrome.

In this article, we present a small randomized controlled study evaluating the effect of a dual parent- and trainer-delivered qigong massage methodology on motor skills and sensory responses in 28 children under age 4 with developmental delay and motor tone abnormalities. Fourteen children had high motor tone as a result of cerebral palsy (CP), and 14 children had low motor tone as a result of Down syndrome. Multivariate analysis and post hoc analysis of variance showed large effect-size improvements in Peabody Gross Motor Scale (PGMS) Object Manipulation scores (p < .01) and large effect-size improvements in overall PGMS scores (p < .04) in treatment versus control groups after 5 mo intervention. Follow-up evaluation 10 mo from the start indicated continued improvement. Sensory responses showed no treatment effect. The results suggest further investigation of qigong massage as a promising avenue for research to improve motor skills in young children with CP and Down syndrome.

Sense and self-regulation checklist, a measure of comorbid autism symptoms: initial psychometric evidence.

Sensory and self-regulatory symptoms make up most of the comorbid symptoms in autism and are associated with increased autism severity. We validated a parent-caregiver measure of comorbid symptoms in autism, the Sense and Self-Regulation Checklist (SSC), in 265 children <6 yr with typical development (n = 138), autism (n = 99), or other developmental delay (n = 28); Cronbach's α was .87. We report two new findings discriminating autism from other groups: (1) multifocal tactile sensory impairment, characterized by hyporeactivity to injurious stimuli and hyperreactivity to noninjurious stimuli (F[2, 262] = 86.8, p < .001) and (2) global self-regulatory delay (F[2, 262] = 122, p < .001). Both findings suggest an explanation for social delay in children with autism. The SSC reports a prevalence of sensory and self-regulatory findings approaching 100% in the autism group (96% and 98%, respectively), raising the possibility that sensory and self-regulatory difficulties represent a core part of autism.

Autism Parenting Stress Index: initial psychometric evidence.

Data validating the Autism Parenting Stress Index (APSI) is presented for 274 children under age six. Cronbach's alpha was .827. As a measure of parenting stress specific to core and co-morbid symptoms of autism, the APSI is unique. It is intended for use by clinicians to identify areas where parents need support with parenting skills, and to assess the effect of intervention on parenting stress. Mean parenting stress in the autism group was four times that of the typical group and double that of the other developmental delay group [F(2,272) = 153; p < 001]. An exploratory factor analysis suggested three factors impacting parenting stress: one relating to core deficits, one to co-morbid behavioral symptoms, and one to co-morbid physical symptoms.

Early intervention for autism with a parent-delivered Qigong massage program: a randomized controlled trial.

A recent randomized controlled trial (RCT) of a dual parent and trainer-delivered qigong massage intervention for young children with autism resulted in improvement of measures of autism as well as improvement of abnormal sensory responses and self-regulation. The RCT evaluated the effects of the parent-delivered component of the intervention. Forty-seven children were randomly assigned to treatment and wait-list control groups. Treatment group children received the parent-delivered program for 4 mo. Trained therapists provided parent training and support. Improvement was evaluated in two settings--preschool and home--by teachers (blind to group) and parents. Results showed that the parent-delivered program was effective in improving measures of autism (medium effect size) and sensory and self-regulatory responses (large effect size). Teacher data on measures of autism were confirmed by parent data. Results indicate that the parent-delivered component of the program provided effective early intervention for autism that was suitable for delivery at home.

A model and treatment for autism at the convergence of Chinese medicine and Western science: first 130 cases.

OBJECTIVE: To present a model for autism showing that impairment of sensory and self-regulation is the core deficit that underlies delays in social/language skills and abnormal behavior in autism; and to demonstrate the efficacy of a treatment for autism based on Chinese medicine. METHODS: Children with autism under 6 years of age were assigned to treatment or wait-list conditions. A total of 130 children were treated and the results compared with 45 wait-list controls. Treatment is a tuina methodology directed at sensory impairment--Kai Qiao Tuina. The treatment was a five-month protocol that was implemented daily by trained parents via trained support staff. The effects of treatment on the main symptoms, autistic behavior, social/language delay, sensory and self-regulatory impairment, as well as on parenting stress, were observed and compared. RESULTS: The treatment had a large effect size (P<0.0001) on measures of sensory and self-regulation. The evaluations done by pre-school teachers demonstrated improvement in the measures of autism (P<0.003), and were confirmed by evaluations done by parents (P<0.0001). There was a large decrease (P<0.0001) in parenting stress. CONCLUSIONS: Sensory and self-regulatory impairment is a main factor in the development and severity of autism. Treatment of young children with autism with Kai Qiao Tuina resulted in a decrease in sensory and self-regulatory impairment and a reduction in severity of measures of autism.

Qigong massage treatment for sensory and self-regulation problems in young children with autism: a randomized controlled trial.

Autism is commonly associated with sensory and self-regulatory disturbances. This article presents a randomized controlled study evaluating the effect of a 5-month intervention directed toward improving sensory impairment, digestion, and sleep in 46 children with autism < age 6. The intervention, Qigong Sensory Training (QST), is a qigong massage intervention based in Chinese medicine. It is two-pronged: Trainers work with children directly 20 times over 5 months, and parents give the massage daily to their children. Improvement was evaluated in two settings--preschool and home--by teachers (blind to group) and parents. Teacher evaluations showed that treated children had significant classroom improvement of social and language skills and reduction in autistic behavior compared with wait-list control participants. These findings were confirmed by parent data, indicating that the gains had generalized across contexts. A model and supporting data for understanding and treating sensory and self-regulation problems in autism is presented.

Outcomes of a pilot training program in a qigong massage intervention for young children with autism.

Sensory impairment is a common and significant feature of children on the autism spectrum. In 2005, a qigong massage intervention based on Chinese medicine and delivered by a doctor of Chinese medicine was shown to improve sensory impairment and adaptive behavior in a small controlled study of young children with autism. In 2006, the Qigong Sensory Training (QST) program was developed to train early intervention professionals to provide the QST intervention. This article describes the preliminary evaluation of the QST program as piloted with 15 professionals and 26 children and outcomes testing using standardized tests of sensory impairment and adaptive behavior. Results of outcomes comparing delivery by QST-trained therapists with delivery by a doctor of Chinese medicine showed that both groups improved and that there was no difference in outcome between the two groups. The intervention and training program are described, and implications for future research are discussed.

Improvement in sensory impairment and social interaction in young children with autism following treatment with an original Qigong massage methodology.

In clinical research, sensory impairment is considered one of the core deficits in autism and is associated with impaired socialization, behavioral disturbances and bowel and sleep problems. The effectiveness of the Cignolini methodology, an original Qigong massage methodology, in treating sensory impairment in young children with autism was evaluated in a small, controlled study. Thirteen children with autism between the ages of three and six received daily treatment according to the methodology for 5 months. Compared with untreated children, treated children experienced significant improvement of their sensory impairment (p < 0.01), and demonstrated increased social skills (p < 0.04) and basic living skills (p < 0.02) on standardized measures. In addition, all of the children with bowel and sleep abnormalities demonstrated improvement after treatment.

A medical qigong methodology for early intervention in autism spectrum disorder: a case series.

A medical Qigong protocol was applied to a group of eight autistic children under the age of six. The children received medical Qigong massage twice weekly from the physician and daily Qigong massage from the parents for a five-week period, followed by daily parent massage for an additional four weeks. Standardized tests showed a decrease in autistic behaviors and increase in language development in all the children, as well as improvement in motor skills, sensory function and general health.