INTERNATIONAL JOURNAL OF YOGA THERAPY — No. 12 (2002) 71

Integrated Movement Therapy™: Yoga-Based Therapy as a Viable and Effective Intervention for Autism Spectrum and Related Disorders Molly Kenny, M.S.

Abstract According to the DSM-IV-TR (Diagnostic and Sta- tistical Manual of Mental Disorders, Fourth Edition), an Integrated Movement Therapy™ is an individual individual must exhibit specific deficits in social interac- and group therapy approach that combines speech-lan- tion and communication skills, as well as stereotyped guage pathology, behavioral and mental health counsel- patterns of behavior, in order to be given a diagnosis of ing, and Yoga. It is taught by master-degreed therapists Autism or Asperger’s Disorder. These broad deficits who are also certified Yoga instructors. Although this manifest in specific ways, including, but not at all lim- approach has been successfully implemented with chil- ited to, failure to develop age-appropriate peer relation- dren with Attention Deficit Hyperactivity Disorder ships, lack of spontaneous seeking to share interests and (ADHD), Learning Disabilities, Pervasive Developmen- achievements with others, and lack of social or emo- tal Delay, Sensory Integration Dysfunction, Dyspraxia, tional reciprocity. Other symptoms include marked and other specific motor-based disorders, it has had impairment in conversational skills, stereotyped and especially consistent and remarkable results with chil- repetitive use of language, inflexible adherence to non- dren diagnosed with Autism Spectrum Disorders. Inte- functional routines or rituals, and stereotyped or repeti- grated Movement Therapy has six core principles: tive motor mannerisms and interests.2 structure and continuity, social interaction, language In the past two decades or so, the term Autism has stimulation, self-calming, physical stimulation, and gone from being a fairly obscure medical diagnosis to direct self-esteem building. being nearly a household word. Although it is unknown The following article will describe Autism Spectrum exactly how many children are affected by Autism Spec- Disorders in depth and will show how each of the six trum Disorders, recent studies indicate that as many as 1 core principles of Integrated Movement Therapy specifi- in 150 children could have Autism, making the disorder cally addresses the characteristics associated with five times as common as Down Syndrome.3 Even ten Autism. It will also note specific, documented improve- years ago, treatment options for this condition were lim- ments in all areas addressed based on qualitative ratings ited and relied heavily upon external reinforcement, scales and parent feedback. “earning rewards,” for reaching arbitrary, often semi- functional goals. Therapy was largely outcome driven Background and because of its formulaic nature tended to maintain the child at a level sufficient to support basic participa- “The essential features of Autistic Disorder are the tion in the world, but not always at a level to support and presence of markedly abnormal or impaired develop- encourage his or her full potential and participation. ment in social interaction and communication and a Children who showed more moderate expressions of the markedly restricted repertoire of activity and interests.”1 classic autistic symptoms, such as poor or nonexistent 72 INTERNATIONAL JOURNAL OF YOGA THERAPY — No. 12 (2002) social interaction skills, intense ously averting the eyes while talk- but much anecdotal evidence, sup- focus on seemingly random subjects, ing, or by completely averting the porting the relationship between or delayed or distorted language eyes from any attempt at eye contact, learning and Yoga, especially the skills, were not identified as being including a verbal request or even a effects of the breath on all aspects of “different” enough to warrant ther- physical cue. The term Asperger’s learning, including increased atten- apy at all, or, if they were, therapy Syndrome was adopted to indicate a tion/concentration and enhanced was geared toward mental health specific aspect of differential diag- mood. Yoga has successfully been counseling rather than to direct nosis; this label is applied when used as an intervention for Attention instruction in social or language there has been no delay in the lan- Deficit Disorder/Attention Deficit development. Based on the DSM- guage development of the child, but Hyperactivity Disorder and depres- IV-TR, the term Autism in fact all other characteristics of Autism sive disorders. For children with are evident.4 these disorders, for whom a more Treatment options have broad- competitive physical outlet may be ened to some degree, and more “high an exercise in frustration, Yoga has It is often unclear exactly functioning” individuals are now the advantage of being noncompeti- who should “treat” these being recognized as requiring treat- tive and providing an optimal envi- individuals, or how they ment specifically to learn social ronment in which to encourage skills and to increase self-esteem. risk-taking and increase self-confi- should be “treated.” Unfortunately, most intervention still dence—both integral aspects of remains heavily dependent upon effective learning. external reinforcement, and to meet There appear to be specific areas applies to a wide variety of individu- insurance or other arbitrary bureau- of the brain responsible for regulat- als, ranging from those who are non- cratic standards most therapies ing the functions that are defective or verbal and seemingly totally remain outcome driven. To make deficient in children with Autism. self-engaged and who require and matters worse, it is often unclear According to The Traumatic Brain receive special services to those who exactly who should “treat” these Injury Resource Guide, the function are highly verbal yet very socially individuals, or how they should be of the frontal lobe is to regulate con- awkward with poor conversational “treated.” Mental health therapists, sciousness (how we know what we skills and who even ten years ago speech pathologists, physical and are doing), initiate activity in would not have received any special occupational therapists, school psy- response to our environment, control accommodations or services, but chologists, and special education our emotional language and our certainly would have benefited from teachers all find these children in expressive language, assign mean- them. The children in this latter their classes and therapy rooms. ings to words we choose and mem- group, who previously may have Because they are often unclear on ory for habits and motor activities, been regarded as merely “quirky” or the most appropriate intervention for and perform problem-solving func- marginally disruptive, were eventu- the child, each professional ends up tions. The observed problems associ- ally recognized as being different providing an intervention for a spe- ated with frontal lobe dysfunction enough to require special services cific area of deficit related to that include: inability to plan a sequence and were classified as High Func- teacher or therapist’s own training or of complex movements, loss of tioning Autistics. needs, rather than providing a holis- spontaneity in interacting with oth- More recently, Autism has tic therapy that incorporates all ers, loss of flexibility in thinking, become a common diagnosis among modalities of learning and addresses persistence of a single thought, children with special needs, and the multiple overlapping areas of need in inability to focus on a task, mood diagnosis has been expanded and the child. changes, changes in social behav- refined. Although the general char- There is an abundance of ior/personality, difficulty with prob- acteristics remain the same, the diag- research with excellent data support- lem solving, and an inability to nostic criteria are such that they ing the relationship between learning express language.7 Based on many allow for a huge spectrum with and movement, and the positive years of observation and experience regard to the expression of the char- effects of multi-modal learning (i.e., with children diagnosed with Autism acteristics. A child may, for example, using more that one communication Spectrum Disorders, we hypothe- exhibit “poor eye contact” by nerv- modality).5 There is less research, sized that these children may have INTERNATIONAL JOURNAL OF YOGA THERAPY — No. 12 (2002) 73 specific deficits in frontal lobe func- Autism Spectrum Disorders will and Related Communication Handi- tioning. It therefore seemed logical include Asperger’s Syndrome.) capped Children), “organizing the that working directly to improve the Because many of the characteristics physical environment, developing function of the brain might improve associated with Attention Deficit schedules and work systems, making the “observed problem” more effi- Hyperactivity Disorder (ADHD) expectations clear and explicit, and ciently than the more conventional often manifest in children with using visual materials have been model of focusing only on the prob- Autism, ADHD also will be dis- effective ways of developing skills lem itself. cussed with diagnostic criteria intro- and allowing people with Autism to Integrated Movement Therapy duced as pertinent. use these skills independently of was developed to capitalize on the direct teacher prompting and cue- positive effects of movement gener- Structure and Continuity ing.”9 During the Integrated Move- ally and Yoga specifically, and to ment Therapy session, structure and directly affect frontal lobe efficiency, As students and teachers within continuity are established through thereby increasing physical and cog- the Ashtanga Yoga tradition, we are routine and repetition and by the use nitive functioning and improving especially aware of the effect of rep- of visual systems to convey rules for therapeutic outcomes in children etition on the body and the breath. In positive behavior and cause/effect with Autism Spectrum Disorders. our own practice, through repetition relationships. It has been our experi- we observe the body becoming more ence that a high degree of structure controlled and the breath becoming and repetition, as characterizes our Integrated Movement Therapy The repetition and routine established in the Yoga- Integrated Movement Therapy is based therapy session clearly provide each student the name of the approach we have developed at The Samarya Center with the necessary foundation to increase skills. and combines the knowledge and experience of professionals with steadier. We also see the mind grow- traditional Ashtanga Yoga classes, backgrounds and certification in ing more disciplined and focused. In allows the individual to safely and speech-language pathology, mental both adults and children, repetition appropriately explore the boundaries health counseling, and behavioral and structure are key elements to of his or her own capabilities and support into a Yoga-based therapy. support learning and confidence. In effectively learn to use areas of Integrated Movement Therapy individuals with Autism, the need for strength to support areas of weak- (IMT) has six core principles: struc- routine and repetition is often pres- ness, both physically and so- ture and continuity, physical stimu- ent to a pathological degree. Accord- cially/emotionally. lation, social interaction, language ing to the DSM-IV-TR, children The rules of the Yoga studio, the stimulation, self-calming (atten- diagnosed with Autistic Disorder physical boundary created by the tion/concentration/focus), and direct have “restricted repetitive and mat, the routine of taking off shoes, self-esteem building. Each of these stereotyped patterns of behavior” and the creation of a schedule all principles corresponds to specific manifesting in “apparently inflexible provide sameness and structure that areas of deficit associated with adherence to specific, non-functional build both confidence and compe- Autism and therefore has specific routines or rituals” and “stereotyped tence. The schedule created with the positive effects in the therapeutic and repetitive motor mannerisms.”8 students at the start of each session environment. Following are the core This need for routine and repetition allows the class to designate times principles of IMT as they corre- can be harnessed to increase continu- for movement and times for sitting spond to the diagnostic criteria for ity within and across therapy ses- still. This provides the student with a Autism (note: the term Asperger’s sions, and to ultimately increase clear picture of what to expect dur- Syndrome is applied when there has learning and independence in the ing the session and also the opportu- been no clinical delay in the lan- child with Autism. nity to direct the session according to guage development of the child, but According to the research and his or her preferred activities, allow- all other characteristics of Autism experience of the TEACHH institute ing for natural negotiation among the are evident. For this article, the term (Treatment and Education of Autistic teacher and the students. 74 INTERNATIONAL JOURNAL OF YOGA THERAPY — No. 12 (2002) Of the 24 kids we currently see Spectrum and related disorders. Sen- behavioral regulation, and general at The Samarya Center, all of them sory integration is the ability to take body awareness. have significant difficulties with in information through senses The inverted position is signifi- impulse control, sensory manage- (touch, movement, smell, taste, cant in potentiating vestibular and ment, and social interaction skills. vision, and hearing) and to put it proprioceptive awareness. Accord- Many are significantly language together with prior information to ing to research cited by Ann Brown- impaired. All of the students follow make a meaningful response. Sen- stone, M.S., O.T.R, “There exist the routine with minimal or no direct sory integration occurs in the central specific physiological events during instruction and comply with the rules nervous system and is fundamental total body inversion responsible for of the studio, including staying on to coordination, attention, arousal the therapeutic effects. The inverted the mat. The repetition and routine levels, autonomic functioning, emo- position was found to activate the established in the Yoga-based ther- tions, memory, and higher level cog- cilia of the vestibular system in such apy session clearly provide each stu- nitive functions. Children who a way as to increase tone, or muscle dent with the necessary foundation exhibit aspects of sensory integra- extension, in the postural muscles . . . to increase skills across all areas of tion dysfunction may show difficulty this mechanism of increased exten- language learning, social compe- with attention and regulation, sen- sor tone in the spine and chest chal- tence, and self-esteem. sory defensiveness, variable activity lenges the hypotonic (low tone) levels, lack of variety in play activi- effect of grief, depression, and other ties, clumsiness, difficulty calming negative affective states.”13 There- Physical Stimulation after physical activity, excessive fore, inverted positioning is also a seeking of sensory input, or exces- fundamental aspect of the Integrated Within the field of child devel- sive trepidation around seemingly Movement Therapy session. opment, it is widely accepted that innocuous physical tasks such as Handstands, as well as more movement increases language learn- climbing stairs, and behavior prob- moderate inversions, such as ardha- 10 ing. Empirically based research lems arising from this poor integra- indicates that exercise enhances gen- tion of sensory input. 11 eral cognition, and every speech The physical aspect of the Inte- pathologist notices that when a child grated Movement Therapy session, Within the field of child is engaged in movement, such as in therefore, not only capitalizes on the development, it is co-treatment with a physical or occu- positive effects of movement on widely accepted that pational therapist, more spontaneous learning but also uses specific âsana and complex speech occurs. Pairing and prânâyâma practices to encour- movement increases lan- physical movement with language age sensory integration, body aware- guage learning. learning appears to enhance recall ness, and appropriate risk-taking abilities and stimulate novel, appro- behavior and to increase coordina- priate language. The opportunity for tion and balance as well as the inter- candrâsana and trikonâsana, appear physical movement during an Inte- nal focus needed to be successful in to have an especially positive thera- grated Movement Therapy session novel physical tasks. We know that peutic effect, as they stimulate the also allows for experiential learning the vestibular system, the area of the vestibular and proprioceptive sys- of concepts related to impulse con- brain that is responsible for balance, tems and also have a significant trol, the ability to calm the body after is also responsible for regulating effect on the child’s self-confidence activity, and overall self-regulation. attention/concentration and behav- by increasing strength, coordination, While neither a diagnosis of ioral stability.12 We also know that and courage, while encouraging Autism Spectrum Disorder nor proprioceptive skills, or the ability to appropriate risk-taking behaviors. ADD/ADHD necessarily implies know where the body is in space, is Inversions have the added benefit of any specific physical limitation, it is crucial to developing both physical toning the core and curbing hyperac- a general observation that these chil- and social competence. Much of the tivity by calming the nervous sys- dren lack coordination and body physical practice in the IMT session tem.14 The repetition and routine of awareness. Sensory Integration Dys- then is focused on increasing movement sequences, including function is a disorder that very often vestibular and proprioceptive stimu- sûrya-namaskâra, increase the child’s manifests in children with Autism lation to increase sustained attention, ability to carry out motor plans and INTERNATIONAL JOURNAL OF YOGA THERAPY — No. 12 (2002) 75 again capitalize on the need for self-esteem and social communica- though, goes one step further, pro- structure and repetition. tion skills. Students in the Integrated viding physical fitness without com- Prânâyâma is introduced, both Movement Therapy program show a petition. The relative safety of Yoga to accompany and enhance âsana significantly improved ability to fol- allows [students] to explore [their] practice, but also as a practice in low motor patterns and to create and bodies and gain a sense of physical and of itself to harness energy follow motor sequences. We observe self-confidence, thus shedding feel- and increase attention/concentration. reduced sensory and tactile defen- ings of awkwardness [they have] With regard to specific breath tech- siveness; increased ability to transi- suffered most of their lives.”17 tion from high to low activity levels; Because children with Autism, by increased attention, concentration, definition, may have both “failure to Handstands, as well as and focus; and the courage and will- develop peer relationships appropri- more moderate inver- ingness to attempt physical tasks, ate to developmental level” and from seemingly simple activities “lack of varied, spontaneous make sions, . . . appear to have such as stair-climbing to more obvi- believe play,”18 they too frequently an especially positive ously challenging activities such as miss out on physical education, thus therapeutic effect. hand-standing. These observations, missing out on both the physical made in the context of the IMT ses- stimulation and the opportunity to sion, are reported by parents and interact socially and physically as niques, it is our experience that chil- teachers to be highly generalized to part of a team. Competitive sports dren can be taught to practice simple both academic and social settings. and physical activities that exceed ujayiî breath; short, simple inhale the capabilities and comfort zones of and exhale retentions; and 1:2 children with Autism Spectrum Dis- inhale-exhale ratios. Alternate-nos- Social Interaction orders often serve to aggravate and tril breathing, as well as alternate elicit the negative behaviors associ- movement patterns, or patterns that Key diagnostic indicators of ated with these disorders. cross the midline, such as parivritta- Autism Spectrum Disorder include It is our belief, substantiated by trikonâsana and variations, stimulate “the presence of markedly abnormal observation and experience with the parasympathetic nervous system, or impaired development in social both children and adults, that or the calming part of the nervous interaction” and “lack of social or increasing body awareness (labeling system, through integration of the emotional reciprocity.”15 Not surpris- body parts and developing the right and left sides of the brain.14 ingly, children with ADD/ADHD awareness to recruit specific muscu- Even our children who show the also have impaired social skills as a lature) is crucial to developing social most extreme deficits in attention/ result of their difficulty sustaining skills. Ann Brownstone, M.S., concentration and sensory integra- attention in tasks or play activities. O.T.R., notes, “The critical relation- tion are able to slow and calm their According to the DSM-IV-TR, the ship between the emotions and mus- breath with direct instruction, and to ADHD child, by definition, “often cle tone is well known to use control of the breath to control blurts out answers, has difficulty practitioners of Yoga. All aspects of superfluous and unwanted move- awaiting turn, and often interrupts or Yoga practice encourage develop- ment of the body and mind. intrudes on others.” 16 ment of awareness of the relation- In the almost two years that we In a recent Yoga Journal article, ship between the nervous system and have been developing the Integrated Fernando Pagés Ruiz writes, “Chil- somatic activity and thoughts and Movement Therapy approach, we dren with ADD frequently miss out feelings. With increased awareness have seen, and have had confirmed on physical education—not because and training of the mind, inhibition by parents and teachers, that these of physiological limitations but of unwanted responses becomes pos- children love coming to their Yoga because their inability to ‘play by the sible.”19 Through direct training with class, which is not always the case rules’ makes them . . . unpopular specific âsana and prânâyâma tech- when kids are coming to “therapy.” with their peers. . . . Therapists often niques, students in the IMT program Our students show significantly recommend martial arts for their show significantly increased propri- increased balance and coordination, ADD patients because it offers a dis- oceptive and tactile awareness. This as observed by therapists, teachers, ciplined, athletic outlet without the increased awareness ultimately and parents, and show increased pressures of a team sport. Yoga, increases social skills by helping the 76 INTERNATIONAL JOURNAL OF YOGA THERAPY — No. 12 (2002) children to maintain and respect and critiquing, working in pairs and students are instructed in rules for appropriate personal spatial bound- groups, using each other’s names in conversation, problem solving, and aries. The consistency of the ses- conversation, asking for help from brainstorming, younger students are sions, including the well-established peers, identifying attributes that provided with age-appropriate op- and consistently reinforced rules, make another individual appealing portunities for language learning supports the students in developing as a friend, and increasing basic through imaginative play. Sessions the internal control needed to inhibit for these children focus on the basic impulsive responses. The combina- foundations for language, including tion of cognitive and physical activi- Our students show sig- turn-taking, motor and verbal imita- ties and feedback from the group nificantly increased bal- tion, social-communication games, allows each student to develop motor sequencing, and developing awareness of feelings, thereby ance and coordination communicative intent. increasing self-confidence. Lisa . . . and increased self- In both the individual and group Slède, M.A., and Rachel Pomerantz esteem and social com- sessions, the children learn vocabu- summarize the positive effect of munication skills. lary, grammatical constructs, word Yoga on social interaction by stating, associations, and story sequencing. “Overall, [these are] the benefits of The repertoire of poses, categorized Yoga: rebalancing the body biologi- nonverbal skills such as eye contact in terms of animals/objects, body cally, reinforcing the ego (i.e., devel- and appropriate facial expressions positioning, Sanskrit names, and oping a greater sense of self- and expression of emotions. They level of difficulty all allow for both acceptance), diminishing pathologi- learn to take on roles as both leader spontaneous and directed brain- cal defenses, increasing feelings of and follower and accept imperfec- storming activities, as well as games autonomy, improving capacity for tions in abilities. involving describing and guessing contact with others, increased atten- from cues. The latter provides strong tion span, better handling of emo- consistent practice of more advanced tional reactions, and greater tol- Language Stimulation meta-linguistic skills in a naturalistic erance for frustration.”20 Each of context, always while capitalizing on these aspects promotes increased Although children with Autism the positive effects of movement on social competence, and in the IMT and related disorders have widely learning, especially on retaining and session encourages interaction and variable language skills, one of the generalizing of information. Activi- trust within the group. key diagnostic categories for Autism ties that focus on the ability to both The natural social connections is a “qualitative impairment in com- provide and follow very specific developed in the IMT session are a munication.” Based on the DSM-IV- instructions, as when directing peers clear departure from the contrived TR, the more specific manifestations into specific âsanas, encourage and and highly facilitated interactions of of this impairment include “delay in, develop the problem-solving and a more conventional “social skills or total lack of, the development of language clarification skills that group,” the primary therapeutic spoken language, . . . marked impair- students with high functioning intervention for older children with ment in the ability to initiate or sus- Autism lack. Additionally, having Autism Spectrum Disorders. Just as tain a conversation with others, students with Autism comment and we see in a regular adult Yoga class, stereotyped and repetitive use of lan- interact on a common third point of the children are coming together for guage, and lack of varied, sponta- reference, such as their Yoga class, a common goal, not specifically neous make believe play or social elicits: spontaneous commentary; related to deficit, and are developing imitative play . . .”21 Within the IMT asking for help, praise, and attention relationships based on that goal. session, there are multiple opportu- from and for others; and qualifying They learn to work within a group, nities for improving social-commu- of emotions—all areas of social notice the accomplishments of oth- nication skills and direct language interaction that are by definition ers, and identify areas for develop- learning. Depending on the age and lacking or deficient in the autistic ment in themselves and their peers. language level of the students, differ- child’s social repertoire. Encouraged in this more natural and ent aspects of language development The DSM-IV-TR lists “lack of noncompetitive context, the stu- are emphasized. While the older and spontaneous seeking to share enjoy- dents develop skills for commenting more conversationally competent ment, interests, or achievements INTERNATIONAL JOURNAL OF YOGA THERAPY — No. 12 (2002) 77 with other people,” and “lack of than by knee-jerk responses.24 Stud- idea of resting when it is first intro- social or emotional reciprocity”22 as ies show that in children with ADD, duced, nearly every one eventually two possible manifestations of an the right prefrontal cortex appears to asks for shavâsana, sometimes as impairment in social interaction. be underdeveloped, perhaps ac- soon as they come into the Yoga Because social interaction, or the counting for the difficulty these chil- room, indicating that they are not desire to communicate for more than dren show with inhibition and only aware that they feel tired or agi- just having specific needs met, is a concentration.25 Current research tated, but also that they know what critical aspect of language develop- also has shown significant func- might make them feel better. We ment, therapists working with a non- tional deficits in the prefrontal cor- have found that using eye pillows, verbal child must find ways to tex of children with Autism Spec- blankets, and music increases the motivate and engage the child to trum Disorders.26 Just as adults can length of time and the degree to develop spoken language. Because be taught in a typical Yoga class, which the students will fully rest. children are motivated by physical children can be taught to have more interaction, rather than the demand body awareness and be encouraged for spoken language on a reward to use internal techniques to increase Although most students contingent basis, the IMT approach focus and calming. resist the idea of resting is ideal for working with nonverbal A Yoga-based therapy approach children as well. It has been success- is ideal for teaching self-calming when it is first intro- fully implemented with this popula- techniques for several reasons. First, duced, nearly every tion and has resulted in significant the Yoga studio provides a calm, one eventually asks improvement within the therapy ses- peaceful setting unlike any the child sion in as few as six sessions. Spe- has experienced before, creating a for shavâsana. cific examples of improvements space in which the child senses an include carrying out of routine, fol- atmosphere of serenity, but also a Students also respond well to visual- lowing a visual schedule, verbal space in which making typical ization techniques and progressive identification of poses from picture responses is less fitting. The child relaxations. Practicing balancing cards, motor imitation of picture has no idea what “the rules” of this poses incorporating prânâyâma and cards and of therapist, initiating of new environment might be and so is the use of drishti, or gaze, increases and engagement in social interactive more thoughtful in his or her imme- students’ ability to focus and main- play routines involving turn-taking diate response to the environment. tain concentration by stimulating the and direct eye contact, increased The structure and continuity estab- vestibular system and the systems of time with activity, and imaginative lished and maintained within and the brain that control eye move- and symbolic play, all of which are across therapy sessions provides pre- ments. Both of these areas of the crucial building blocks to develop- dictability and clear boundaries that brain are involved in regulating ing functional communication and support calmness and trust. There focus and concentration.27 increasing expressive and receptive are no toys, fluorescent lights, or Because children with Autism language skills. busy waiting rooms to overstimulate Spectrum Disorders often have the sensory-defensive child. By defi- “stereotyped and repetitive motor nition, Yoga-based therapy encour- mannerisms (e.g., hand or finger Self-Calming ages increased body awareness and flapping or twisting, or complex so provides a natural setting to whole-body movements)” as well as Yoga, according to the great explore the capacity for control over “apparently inflexible adherence to sage Patanjali, happens when “there the body. Prânâyâma techniques can specific nonfunctional routines or is stilling of the movement of be taught and practiced. rituals,” they are easily aroused or thought.”23 From a neurological By finishing every session with highly agitated by changes in routine standpoint, the prefrontal cortex is shavâsana, students learn that they and, as described earlier, may also the area of the brain responsible for can take time out and rest in have sensory defensiveness. This working memory, a brain function response to somatic sensations with- aroused state, resulting from sensory associated with inhibition. Working out these breaks being interpreted as overload or lack of predictability, memory enables behavior to be punitive. In fact, in our experience, often elicits or exaggerates repetitive guided by ideas and concepts, rather although most students resist the motor mannerisms, also called self- 78 INTERNATIONAL JOURNAL OF YOGA THERAPY — No. 12 (2002) stimulatory behaviors, such as hand They learn to accept roles as both within each child, no matter how dis- flapping or mouthing of objects. Pro- leader and follower and are taught to tracting the external manifestations viding students with the ability to identify and articulate their own of the “diagnosis” might be. A clini- recognize low levels of agitation, as areas of strength as well as areas for cal approach, and the way most of us well as a variety of options for self- development. They are guided and in this field were trained in graduate calming, is an essential aspect of encouraged to both give and accept school, would have us take all the increasing both social competence compliments and critiques. All ses- pathological aspects of the child and and general well-being. According to sions end with an opportunity for work diligently at decreasing them, reports of parents and teachers, as children to name their own best thereby delivering to the parents a well as the experience and observa- attributes. It has been our experience more “normal” child as a result of tion of therapists, once students have that as children learn to recognize our therapy. Therapy goals that learned and successfully used the and articulate their own areas of “decrease unwanted behaviors” are techniques in the therapy session, strength, they develop a strong sense easier to both write and to show they are able to generalize them and of self-worth that they are able to change for, thereby satisfying the use them outside the Yoga setting maintain even through difficult bureaucracies paying for the therapy. and show increased self-mastery, social, physical, or academic situa- However, this only serves to rein- confidence, and positive self-image. tions. As they become more adept at force for both the child and the identifying areas of strength in their parent how different and disabled peers, they are able to make better the child is and how much he or she Self-Esteem Building choices with regard to friendships needs to be fixed. Conversely, the and also to internalize the attributes IMT approach works on the princi- Clearly, encouraging a sense of that make them appealing as friends ple that encouraging and developing belonging and predictability, in- to others. the self-esteem of the individual is creasing physical awareness and the single most important factor in competency, increasing language increasing skills in all areas of lan- and social-communication skills, A Yogic Perspective guage, learning, and social compe- and providing tools and techniques for Therapy: tence. To this end, in our therapy for self-regulation and calming all Divinity vs. Pathology we focus on what is right about contribute to enhanced confidence the child, the goodness or divinity and general well-being. It is our At its most deconstructed level, of the individual, and we write belief that developing and encourag- Integrated Movement Therapy our goals and develop specific ther- ing the individual’s self-esteem is the works because it addresses each apy programs to increase these posi- single most important factor in aspect of the individual with Autism, tive aspects. increasing skills in all areas of lan- using an empirically sound, highly guage, learning, and social compe- structured, multi-modality teaching tence. To this end, the IMT session method. There is, however, another Summary specifically addresses self-esteem integral aspect to this approach that, As Autism Spectrum Disorders are becoming more commonly diag- Providing students with the ability to recognize low nosed, it is crucial that specialists levels of agitation . . . is an essential aspect of increas- working with this population ing both social competence and general well-being. develop therapeutic interventions that address the whole child, includ- ing social and language deficits, sen- building, not just as a natural by- in the end, is truly the heart of this sory integration difficulties, physical product of increased competence in therapy and why it works. “Yoga- problems associated with poor motor other areas, but through direct based therapy,” by definition, should coordination and body awareness, instruction and awareness of individ- have a spiritual and philosophical and general self-esteem and overall ual self-worth. Students are actively bent that separates it from conven- well-being. Therapy should help encouraged to try new things and tional clinical interventions, that is, a these children not only maintain a accept imperfections in abilities. focus on the divine being that exists functional level, but it should also INTERNATIONAL JOURNAL OF YOGA THERAPY — No. 12 (2002) 79 encourage and expect development tal health counseling, IMT offers a 12. Love, Russell J., and Wanda G. Webb. and expression of each child’s full Yoga-based intervention that would Neurology for the Speech-Language Pathologist. 3d ed. Newton, Mass.: But- potential. The therapies that are cur- intuitively seem effective, especially terworth-Heinemann Medical, 1996. rently available to these children with children with Autism Spectrum 13. Brownstone, Ann. Therapeutic mecha- tend to be incomplete and splintered. Disorders at any level of linguistic, nisms of Yoga âsana. International Jour- They fall short in exploring and physical, and social competence. It nal of Yoga Therapy, 2001, no. 11. developing all aspects of the child’s has been our experience, and great 14. Sumar, Sonia. What is yoga? URL: development, especially in helping pleasure, to see this intuition borne http://www.specialyoga.com. the child to develop skills that can be out consistently in practice. 15. DSM-IV-TR, op cit. internalized and generalized, leading 16. Ibid. to greater independence and feelings 17. Ruiz, Fernando Pagés. Focusing on of self-sufficiency and self-worth. Endnotes ADD. Yoga Journal, Dec 2001. Integrated Movement Therapy, a 1. American Psychiatric Association. 18. DSM-IV-TR, op cit. holistic Yoga-based therapeutic Diagnostic and Statistical Manual of 19. Brownstone, op cit. intervention, has been successful in Mental Disorders (DSM-IV-TR). 4th ed. 20. Slède, Lisa, and Rachel Pomerantz. addressing each of the areas associ- Text revision. Washington, D.C.: Ameri- Yoga and psychotherapy: A review of the ated with a diagnosis of Autism can Psychiatric Association, 2000. literature. International Journal of Yoga Spectrum Disorder. The six core 2. Ibid. Therapy, 2001, no. 11. principles of IMT, based on com- 3. Nash, J. Madeleine. The secrets of 21. DSM-IV-TR, op cit. bined expertise in the areas of autism. Time Magazine, May 2002. 22. Ibid. speech-language pathology, mental 4. DSM-IV-TR, op cit. 23. Satchidananda, Sri Swami. Yoga Su- and behavioral health, and Yoga 5. Jensen, Eric. Brain-Based Learning. tras of Patanjali: Translation and Com- allow for direct instruction and San Diego, Calif.: Brain Store Inc., 2000. mentary. Yogaville, Va.: Satchidananda Ashram, 1990. development in all areas of deficit 6. Arnold, L. E. Alternative treatments for 24. Love and Webb, op cit. found in the child with Autism Spec- adults with attention deficit hyperactivity disorder (ADHD). Annals of the New York trum Disorder. 25. Jensen, Pauline. Research into the Academy of Sciences, Jun 2001. effects of yoga on ADHD. URL: Yoga is inherently, in its fullest 7. Lehr, Robert P., Jr. Brain functions and http://www.yogalinks.net/articles/ expression, a discipline that encour- map. In The Traumatic Brain Injury YogaAndADHD.htm. ages total personal development, Resource Guide. URL: http://www. 26. Nash, op cit. neuroskills.com/tbi/brain.shtml. encompassing physical, emotional, 27. Vestibular disorders: An overview. intellectual, spiritual, and social 8. DSM-IV-TR, op. cit. Mar 1995. URL: http://www.vestibular.org/ growth. Combining the power of 9. TEACHH (Treatment and Education overview.html. movement, breath, and body aware- of Autistic and Related Communication ness that is the core of a physical Handicapped Children): http://wings learningcenter.org/resources_4/teacch43 Yoga practice, the empirically based 8.html. evidence of the positive relationship 10. Jensen, op cit. © Molly Kenny 2002 of movement and learning, and the 11. Ayres, A. J. Sensory Integration and expertise and clinical experience of the Child. Los Angeles: Western Psycho- Tel.: 206-568-8335 speech-language pathology and men- logical Services, 1995. Email: [email protected]