Evidence based touch strategies are an important part of my occupational therapy interventions for children and adolescents with behavioral, psychiatric, developmental, and sensory processing challenges. Although touch is a component of typical attachment and development, many excellent mental health therapists do not include touch in their interventions with children and adolescents, and warned me against using touch when I began working in pediatric psychiatry 30 years ago. I include touch as part of my psychiatric interventions with children and adolescents based on research showing its efficacy for improving mental health and social skills in children and adolescents with Autism Spectrum Disorders, psychiatric disorders, behavioral problems, early trauma challenges, and sensory processing challenges.
Specific guidelines are needed when using touch with children and adolescents with mental health challenges, because these youngsters may have past experiences of physical abuse, sexual abuse or child neglect that make touch problematic. I always provide touch only after getting permission from the parent and child, repeatedly urging the youngster to let me know and any time if they want me to stop immediately, and in conjunction with their mental health therapist. Implementing touch in this manner, I have only had one incident of a child demonstrating distress as a result of being touched during my 20 years of full time practice, and have seen a dramatic reduction in physical and verbal aggression with improvements in behavior, social skills, and attention span.
My use of pressure touch in FAB “Functionally Alert Behavior” Strategies differs from traditional massage and brushing protocols. There is evidence for massage as an intervention to improve social skills with children who have Autism Spectrum Disorders and clinical experiences of scrub brushing improving behavior in children with sensory processing challenges, but both of these methods are sensory stimulation techniques that are implemented in a prescribed manner. In FAB Strategies pressure touch is included in the sensory modulation section as one component of an interdisciplinary program to achieve specific behavioral objectives. The touch is individually developed and modified by the therapist to achieve the child’s goals.
Touch pressure in FAB Strategies is provided through equipment, independent exercises, brushing, massage, or joint compression strategies. The touch pressure strategies are individualized and modified to achieve the child or adolescent’s specific behavioral goals (e.g., reduced physical aggression, reduced verbal aggression, improved communication, increased social skills). Equipment and exercises used to provide pressure touch in FAB Strategies include: theraband exercises, wall pushups, theraplast, playdoh, hugging a stuffed animal, a weighted blanket, a pressure or weighted vest, and a body sock. Pictures of the exercises and equipment touch strategies are identified on the FAB Coping Forms, and can be reviewed during the initial evaluation.
All of these strategies provide pressure through the joints. An advantage of the exercise and equipment touch pressure strategies is that they are controlled by the child or adolescent and can be done independently as a coping strategy. We have pressure receptors in our body (e.g., enabling us to point to our wrist with out looking) and exercises, equipment, or direct touch that activates these receptors provides youngsters with a calming sensation (e.g., like when a mother hugs her child) that can be a useful coping strategy.
Pressure touch can also be provided directly by therapists, parents, and teachers as a coping strategy using the FAB Pressure Touch Strategies. The FAB Pressure Touch Strategies (taught in my workshops) include the: head crown, shoulders squeeze, spine roll, back protocol, back, arm, legs, feet, and face strategies. Direct touch FAB Strategies listed on the FAB Coping Forms above include get a hug and FAB Pressure Touch (a variety of massage and brushing strategies begun with touch on the back). Direct touch may reduce physical and verbal aggression when no other strategies are affective, and can be beneficial to improve attachment and relationships. While some of the FAB Pressure Touch Strategies are currently used by physical and occupational therapists in FAB Strategies emphasis is given to how touch “feels” in the body, affects the child or adolescent’s energy level and tension, and enables them to achieve their behavioral goals. The link below shows the direct FAB Pressure Touch Strategies being done as a component of FAB Strategies with a preschooler who has Asperger’s Syndrome and behavior challenges http://www.youtube.com/watch?v=W8fMdJ6l0AM&feature=youtu.be
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Field, T., Henandez-Reif, M., Diego, M., Schanberg, S., Kuhn, C. (2005). Cortisol decreases and serotonin and dopamine increase following massage therapy. Intern. J. Neuroscience, 115, 1397-1413.
Mass. Dept. of Mental Health Safety Tool. (2006). MacLachlan, J. & Stromberg, N. Safety Tools.
Silva, L. M., Schalock, M. (2013).Prevalence and significance of abnormal tactile responses in young children with Autism. North American Journal of Medicine and Science, 6(3), 121-127.