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"Intrusion" and
Interaction Therapy for Riders with Autism
By Hana May Brown, L.P.T.
Reprinted from NARHA
Strides magazine, July 1996 (Vol. 2, No. 3)
When I began working as
a therapist/instructor at the Ride On Therapeutic Riding Center in Houston, TX,
most of my students had either physical or learning disabilities. In 1989, I
also began to work as a developmental motor teacher and "floated" at
the Westview School, a private school for children with special needs, ages 2-6
years old. Although Ride On, at the time, had predominantly older children and
adults, I decided to include the Westview students in the program.
In January 1990, a
little girl, two years and 10 months old, was assigned to me with the diagnosis
of "low tone." Her doctor came to this conclusion because she was
very inactive and had just recently begun to walk with the help of intensive
physical therapy.
I tried to do a motor
assessment of Heather and found some very conflicting results. She was
extremely strong when she wanted to avoid or resist an activity, and she became
hysterical when I made her change positions (stand to sit, prone to supine, and
back again). Moving from place to place also seemed painful according to her
reactions. A simple game of "Ring around the Rosy" appeared to be
pure torture. Was mobility really painful? If left on her own, Heather could
move about without any evidence of pain. All other areas of school were just as
confused about Heather. She spent most her day crying and being extremely
upset.
Heather's mother
received a referral to Dr. Stephen Gutstein, a child psychologist, for
evaluation and possible treatment. He was doing some exciting work with
children with autism, which, at this point, seemed to be a possible diagnosis
for Heather.
Dr. Gutstein felt that
Heather was autistic and began to work with her at his office and at the
school. I saw him work and was totally fascinated with his approach, which he
called "intrusion" therapy. Dr. Gutstein felt that these children
were happiest and most comfortable in their own small, confined, predictable
worlds. This explained her reaction to any change, including crawling, walking
and changing her position. It seemed that once the intrusion was made, Heather
could build on that experience and expand her world.
The underlying
scientific basis of this disorder could be from any or all areas of sensory
defensiveness and neurochemical deficiencies, but at this point all I was
interested in was process of remediation. The "why" belongs to the
researcher; the "how" must be the focus of clinicians, primarily
because of the severity of the presenting problem and the need to correct it
and alleviate all the physical or emotional pain. The clinician uses the
researchers' findings as a basis for the treatment, but must also bring his art
of tuning-in to each individual and developing a treatment plan. This plan must
be flexible and innovative as well as specific for the particular child's complex
array of problems.
I decided to include
Heather in Ride On's schedule. I prepared the volunteers to expect a screaming,
crying child and told them we were not hurting her in any way. In simple terms,
we were not breaking her down and harming her emotionally. Instead, we were
breaking into her world and welcoming her into ours. I hoped the horse would
help her accept us. I also hoped she would feel that the horse made all this
"pain" bearable and worthwhile.
As expected, the first
time she came out she was very upset being in a different place. The only thing
that seemed to calm her was Ride On's therapy horse, "Allison." It
took three people to get the helmet and belt on. Putting her on the horse was
also an ordeal. However, once she sat down and started moving she became quiet.
Everything was fine until we stopped the horse and began to teach her that a
kissing sound would make her go. "Kiss" was used because at the time
Heather was non-verbal. Once learned, Heather was less upset about stopping
because she could make the horse go. This was the first step of teaching her
that communication was power. Occasionally she could not make the sound. She
became extremely agitated and out of her mouth came, "giddy up, get
going!" We learned that speech was there, only hidden or blocked. We were
thrilled and soon heard from her speech therapist that she was saying more
words, especially "horse" and "Allison."
Every week things
improved. We were able to build on the previous experiences. For example,
during the second week Heather's helmet went on with no resistance. By the
third session, Heather would go and get her own helmet and belt. The results of
imposing appropriate experiential "trauma" were consistently
positive. The first time we went outside the arena for a trail ride she became
hysterical. The next time we left the arena, she was smiling and happy. Games
that were upsetting became fun. We had finally introduced some joy into her
life. "Allison" was her focal point, her motivator, her reason for
accepting this "other" scary world.
Heather rode for four
years, including her first year in public school. At that time I saw that she
had developed the ability to gain self-control when she began to get agitated.
Heather is now a very active, verbal third grader.
Since introducing
Heather to therapeutic riding, Ride On has served many more riders with autism.
They have all shown the same signs: crying, screaming, having physical
tantrums, and exhibiting various avoidance behaviors such as flopping and
becoming limp. All have responded to the "intrusion" in much the same
way, i.e., acceptance of their new experience, and
most of all, joy. Ride On has since expanded its therapy to include interaction
and more emphasis on appropriate communication.
Through interactional
therapy, more emphasis is being placed on social adaptation for the autistic
child and adult. Studies have shown that a high functioning, verbal autistic
person cannot become totally independent or successfully use his strengths
without the ability to adapt to society's definition of acceptable behavior.
Ride On has introduced interaction, the basis of socialization, through the
technique of riding double, face to face, on a bareback pad. This method in
conjunction with the elements of changing horses, partners and directions has
brought about some fascinating behaviors.
Initially there is gaze
and touch avoidance with varying degrees of both verbal and physical
resistance. All these behaviors have improved over time, and on several
occasions, have led to fun and games and joy. Society expects a person to
relate to another's presence and to interact appropriately. These children
began to see that they had to adapt if they wanted to continue riding. An
employer or client will expect no less of them.
Positive feedback from
parents, teachers and therapists indicates the validity of therapeutic riding
as a treatment for autistic children. One mother said that her son's problems
with disruptive and non-compliant behaviors were finally overcome through his program
at Ride On and had "carried over into other areas of his life in school
and home." Another mother stated, "I gave you a screaming, kicking,
biting animal and you gave me back a little girl."
Dr. Gutstein wrote,
"I have personally witnessed the wonderful results that are obtained when
these children, many of whom have little sense of their own bodies in space, or
little contact with the outside world, come in contact with the Ride On
experience. The children develop special relationships with the horses that
quickly generalize to increased contact and involvement with teachers, trainers
and family members. The sense of confidence and competence they gain from their
horsemanship is unparalleled by any other experience."
Hana May Brown is the
director and instructor of Ride On, which she founded in 1983 in Houston, TX.
She also teaches children with disabilities at the Westview School in Houston.
Hana is a NARHA Registered Instructor, and presented "Therapeutic Riding
as a Treatment for Autistic Children" at the 1994 NARHA Annual Conference.
Autism and
Therapeutic Riding
Reprinted from NARHA
Strides magazine, July 1996
Autism is a
developmental disability that often appears during the first three years of
life. Autism is associated with abnormalities in brain structure and
neurological disorder of the brain's function. It vacillates between being the
third and fourth most common developmental disabilities. It occurs in
approximately 5-15 per 10,000 births. It is four times
more common in boys than it is in girls. Autism is not determined by racial,
ethnic, social, lifestyle, educational or psychological factors.
Autism has been
referred to as a spectrum disorder. Its symptoms and characteristics can vary
drastically in degrees from mild to extremely severe. The incidence of
duplicate characteristics in children is extremely unlikely. The belief that
autism has a genetic basis has been suggested.
Autism can co-exist
with any other condition that any person may have. The most common co-existing
condition is mental retardation. Diagnosis is not easily made and specialists
agree it cannot be made without taking a careful examination and developmental
history from family and persons involved in a child's or adult's life.
The following are some
of the most common symptoms or characteristics that a person with autism is
affected. Changes in a child may begin to develop between the ages of 24 to 30
months. Delays in language, play or social interaction may become noticeable.
Communication -- language
develops slowly or not at all; use of words without attaching the usual meaning
to them; communicates with gestures instead of words, short attention spans.
Social Interaction --
spends time alone rather than with others; shows little interest in making
friends; less responsive to social cues such as eye contact or smiles.
Sensory Impairment --
unusual reactions to physical sensations such as being overly sensitive to
touch or under-responsive to pain; sight, hearing, touch, pain, smell and taste
may be affected to a lesser or greater degree.
Play -- lack of
spontaneous or imaginative play; does not initiate others' actions; doesn't
initiate pretend games.
Behaviors -- may be
overactive or very passive; throws frequent tantrums for no apparent reason;
may perseverate on a single item, idea or person; apparent lack of common
sense; may show aggressive or violent behavior or injure self.
Autism Characteristic
List
ˇ
Difficulty
mixing with other children
ˇ
Acts
deaf; doesn't respond to verbal cues
ˇ
Insists
on sameness; resists changes in routine or learning
ˇ
No
real fear of dangers
ˇ
Difficulty
in expressing needs; uses gestures or pointing instead of words
ˇ
Inappropriate
laughing or giggling
ˇ
May
not want cuddling or act cuddly
ˇ
Noticeable
physical overactivity or underactivity
ˇ
Avoids
or has little or no eye contact
ˇ
Inappropriate
attachment to objects
ˇ
Spins
objects
ˇ
Sustained
odd play
ˇ
Standoffish
manner; prefers to be alone
ˇ
Insensitivity
to pain Echolalia (repeating words or phrases in place of normal language)
ˇ
Uneven
gross/fine motor skills. (May not want to kick ball but can stack blocks)
ˇ
Displays
extreme distress for no apparent reason
From "What is
Autism," Autism Society of America, 7910 Woodmont Ave.,
Suite 650, Bethesda, MD 20814-3015, 1-800-3AUTISM. For more information, use
the Autism Society's Fax-On-Demand service, 1-800-FAX-0899.
References: Children
with Autism: A Parent's Guide, edited by Michael D. Powers, Psy D. Woodbine
House, 1989.
A Parent's Guide to
Autism, by Charles A. Hart, Pocket Books, 1993.
Diagnosis of the
Syndrome of Autism: Question Parents Ask, B.J. Freeman, October 19, 1993.
Medical
Considerations for Therapeutic Riding
By Deborah Kohn
There is no one approach for working with autism. Because of the
wide spectrum of characteristics and symptoms, several varieties of therapies
are utilized. Many of these include behavior modification, speech language
therapy, vision therapy, sensory motor and sensory integration. All of these
can and are addressed in therapeutic riding classes.
Winslow Therapeutic
Riding Unlimited of Warwick, NY has been fortunate to learn about and utilize
the TEACCH Program. TEACCH is the acronym for Treatment and Education of
Autistic and related Communication Handicapped Children, a program established
by the University of North Carolina. The practices employed in the TEACCH
Program address at least three major areas impacted by autism: communication,
social and organizational skills.
We have found that we
must enter the autistic person's world and not expect them to live in ours. For
instance, autistic persons have little or no sense of time, (beginning, middle
or end). The unknown can catapult a youngster into
despair. Change can be catastrophic. In the sensory areas autistics see and
often fixate on the smallest details. Tactile sensitivities can become
defensive or overstimulated.
Through the use of
visual cues, TEACCH provides visual clarity. First in the form of three
dimensional objects, then with communication aids (icons). The TEACCH program
provides visual clarity to answer ("What do I have to do? How much do I
have to do? When will I be finished?"). Basic concepts, such as
first-then, are introduced. This improves communication which in turn improves behavior.
Each task is described using a picture icon without and then eventually with
written language. Being concrete in what task is next allows this system a
foundation to be put into place. Thus, the learning process begins. One-on-one
relationships can enhance this program and it is ideal for a team teaching
situation.
Independent work
systems that begin with a simple schedule and build to provide more involvement
is the key to the TEACCH Program. Each individual is color-coded and has their
own individual daily schedule that they approach and organize from top to
bottom and left to right. This method helps the child become more independent
and gives a sense of predictability by eliminating unknown factors. Independent
transitions from one activity to another is now possible. This, after all, is
what we strive for in our therapeutic riding classes.
REACCH grew out of the
success we saw put into practice through TEACCH (and most of all the
metamorphosis of the children utilizing the program). REACCH (Riding Education
of Autistic and Communication Handicapped Children) begins from the moment the
children leave school for the stable. It continues as the children successfully
follow their schedule which takes them to their helmets, guides them to leading
their horses and accompanies them as they mount and point to their walk-on
icon. The children now easily make the transition from one activity to another,
whether it be developmental vaulting maneuvers, practicing their verbal whoa's
or hugging their horse upon completion of their ride. There are sometimes
subtle but multiple successes in our children's affected areas of development,
especially the enjoyment and tolerance of movement of the horses. Our icon use
has not inhibited the development of speech. It has provided the rider with a
visual cue for what they want to say and now can attempt. The REACCH Program is
built on sticking to a schedule. Riders need to trust their schedules to let
them know what will be expected. Once this expectation is met, you and your
rider will be more flexible as small and larger changes take place, first in
riding and eventually in their daily living activities.
The extraordinary value
of the horse in working with those with autism begins with human-animal
bonding. Therapy horses have first and foremost a temperament that provides a
safe, non-judgmental and tolerant base that is conducive to exploration by the
rider. Those with tactile sensitivity have an opportunity to work through their
defensiveness through the sensory processing work on horseback. It has been
noted from teachers and parents that autistic children have improved in most
areas of sensory processing and their reaction to the world around them much
more completely after riding.
Deborah Kohn is the
program director/head riding instructor of Winslow Therapeutic Riding Unlimited
of Warwick, NY. Deborah has worked with riders with autism at Winslow for four
years.