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— Linda Castronovo teaches yoga and shiatsu. Her professional life is centered on touch and feeling. So there was a strange irony to the diagnosis of her son Andrew, at age four, with sensory integration disorder. It makes it hard for him to tolerate touch, sound, or any sort of social chaos. After he’d been asked to leave two different pre-schools for hitting, Castronovo learned he had Asperger’s syndrome – a high functioning form of autism.

“I was terrified that I was either going to be driving him to some special school for disturbed children, or he was going to be home with me. … I needed him to be able to learn in school, and the indications were that he wouldn’t be able to do it.”

She decided to go after his sensory system head on. After trying her own shiatsu on him, an occupational therapist recommended an unconventional brushing therapy: Castronovo would rub a hard plastic brush all over Drew’s body to stimulate his senses, and then apply deep pressure to help him tolerate the sensation.

“He was so afraid of being touched, the possibility of being touched, that he lashed out at people before they got close. It was four weeks after brushing where he played with another kid for the first time, and there was contact.”

Next, Castronovo tried something called auditory integration training to help andrew cope with loud groups of children. For ten days, he listened through headphones to distorted sound and music, interspersed with periods of rest. She says the process was grueling, but it seemed to pay off.

“The third day, he responded to an unfamiliar person for the first day in his life. I was sitting on a bench at this playground, and a kid asked him about his matchbox car, and he talked to him about it, showed it to him.”

After seeing progress, Castronovo decided to learn about other emerging therapies for autism. Researchers are looking into ways to not only teach social and cognitive skills, but also to change the course of the disorder entirely.

“You should not think of autism as a fixed disorder– you either have it or you
don’t. You wanna think of autism spectrum disorders as existing in varying degrees and intensities…”

Stanley Greenspan is a child psychiatrist who developed a popular and controversial treatment for autism.

“And even if they warrant the diagnosis, that doesn’t mean that child won’t improve or evidence patterns where they don’t show those symptoms.”

Greenspan’s program focuses on relationship skills. It includes speech therapy, family counseling, and biomedical intervention. But at the center is a technique called floortime – — an intensive form of play therapy that uses exaggerated pleas, body language, and performance, to entice a child to interact.

“Children with autism spectrum disorders are different in the way they respond to sound and touch and movment than let’s say, a child without these problems. Some children are hypersenstive….pull away from the world because they’re so sensitive to sound, but other children are just the opposite….it doesn’t register. The oversensitive child needs extra soothing, the underreactive child needs extra energy on your part. One, you’re going, hey look at the car…. The other, you’re saying hey look at that car. Wow.”

“Call it stand-up comedy to save your kid’s life.”

Patricia Stacey is a writer who just published a memoir – The Boy Who Loved Windows — about using floortime with her son Walker. For his first year of life, Walker showed little connection to others, little tolerance for sensory stimulation. Doctor Greenspan taught Stacey how to use floortime with her son.

“Greenspan said, he’s tired, why don’t you lay on his stomach and say, are you tired buddy?. I laid down on my stomach and said that. And then all of a sudden, he started kicking at me, in a playful way, and i started pushing at him, and he was kicking and he was laughing, and i was laughing, and then he just jumped up…and he was ready for more.”

After several years of intensive floortime and other therapy, Patricia Stacey says her son made a complete turn-around. He recently spent his seventh birthday at a bowling alley with 14 friends. He’s a first-grader in public school, and loves make-believe games – his favorite toy is a pirate ship.

“Where’s the other pirates? Oh here’s one. I named him, um, pickle ickle dickle, I think I’m going to name this guy nit wit!”

“He’s very outgoing. He runs into the library and jumps up on the stool and starts telling the librarian all the books he’s reading.”

So when Stacey heard about Andrew, Linda Castronovo’s son, she offered to teach them floortime. Stacey got on her hands and knees to join Andrew in a carwash game.

“I pretended I was a car. I took a car, put it in my hand, and spoke for the car, and I said, will you wash me! And drew ignored me, …”

Stacey didn’t stop until she got Andrew to look her in the eye and smile. At first, Castronovo found Stacey’s therapy awkward and overwhelming.

“I didn’t see it as a great step in any direction, and when he came home that very day and looked me in the eyes and told me he loved me for the first time, I burst into tears. and it totally sold me.”

“Floortime is a treatment that is quite popular, however there have not been any studies to show whether its effective.”

Doctor Shannon Kay runs the May Institute in West Springfield, a new school for children with autism. Kay believes floor time wrongly reinforces children’s odd social behavior. And she’s skeptical of many other alternative treatments, like some that Castronovo used.

“Autism, from the beginning, has been a magnet for snake oil remedies, for lack of a better term. Sometimes people are very desperate for treatment.”

The May Institute uses a traditional approach called applied behavior analysis. Kay says it’s a well-proven, Pavlovian method of conditioning.

“We teach play skills systematically. Children with autism may not like to play. They don’t pretend. They may not enjoy being with people, so we try to pair ourselves with things they already like. We do that by pairing social interaction with activities they enjoy already.”

But Greenspan says this method is outdated and fails to account for true emotional and imaginitive development.

“If you work with a child in a very rigid way, you get rigid behaviors. If you work with a child more spontaneously, following the child’s natural interests, you help that child become more spontaneous and flexible, and that’s we need to do.

Dr. Greenspan acknowledges there have been no random clinical trials of his method, but he says there is convincing evidence that floortime works, including long-term studies of his and other patients. Amherst child psychologist Karen Blum doesn’t believe you have to choose one approach or another. She uses a mix of therapies….from floor time, and behavior analysis, to picture therapy and interactive story telling.

“My goal is to see what’s out there and to have it inform my work. As I sit in front of the little guy who’s on my floor how do I enter his world, understand his world, and bring him into the larger world.”

Blum adds that some parents feel they just can’t manage everything an autistic child needs — often they can’t even find a trained child therapist. Federal officials unveiled a national autism treatment plan to help parents. It advocates for more medical research, earlier screening, and effective therapy. It’s responding in part to the huge jump in the number of autistic diagnoses. While the plan has a seven to ten year timetable, parent Linda Castronovo says there’s no reason not to try what’s already out there. She’s starting a shiatsu practice for children with development disorders.

— Karen Brown, January 18, 2006

Editor’s note: This is the latest story in a year-long commitment to covering mental health issues in Alabama. You can learn more about our “Making Sense of Mental Health”
project and find local mental health resources — as our commitment continues throughout the year — inside this website.

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Making Sense of Mental Health

The Floortime Foundation – advocating the method of autism treatment called “Floortime.”

The Dr. Stanley Greenspan – founder of “Floortime”

The May Institute: a network of centers to treat autism, using “behavior analysis”

The Cure Autism Now: an advocacy group pushing for more autism research. Website includes a number of other resources.

Families for Early Autism Treatment

National Association for Child Development

New York Times story on autism treatment