Paediatrician Dr. Laurence Sugarman is the chief author of a new article, "Symptoms as Solutions: Hypnosis and Biofeedback for Autonomic Regulation in Autism Spectrum Disorders," in the American Journal of Clinical Hypnosis. His studies have led him to the conclusion that the best way to help people with autism is to help them help themselves.
It is estimated that one out of every 88 children could be diagnosed to be on the autism spectrum disorder. There is no simple definition nor generally agreed upon single cause of autism, which is considered a disorder or syndrome that can affect people in any number of ways.
Typically, people with autism have an impaired ability to communicate, can be awkward in their social interactions and tend to focus on a narrow range of activities or behaviour that can "pull them apart from others," said Sugarman.
His article spells out his approach to treating children and teenagers with autism — a form of therapy that does not rely on medication and does not simply try to have the child suppress abnormal behaviour. "This treatment focuses on utilizing the self-regulating efforts of young people,"
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Ever since Dr. Leo Kanner, a psychiatrist at Johns Hopkins University School of Medicine, identified autism as a separate condition in 1943, different kinds of treatment have been tried.
Sugarman, who is a past president of the American Board of Medical Hypnosis, has focused on trying to reduce the high anxiety often found in children who have autism by using biofeedback and hypnosis. With biofeedback, sensors attached to the person and connected to a computer chart symptoms of anxiety — sweating, heart rate, breathing and skin temperature — so that the person is made more aware of the behaviour to be changed. "It's a mirror. Once you get the image in the mirror, you can change the image," said Sugarman about the value of biofeedback.
Measures of success
Sugarman's emphasis on self-regulation — with the person being treated developing ways of controlling symptoms — comes as autism has attracted considerable attention.
The one in 88 number of children with autism that the Centers for Disease Control and Prevention now uses marks a big increase from the one in 150 figure used for 2002.Some of the increase results from a broader definition of what falls under this disorder and a greater awareness of autism.
Autism is a condition — not a disease, with a cure. Success in treatment can mean the person is able to function better in society, hold down a job without being too anxious and be able to have relationships, said Robert Rice Jr., director of clinical internships in the mental health counselling program at St. John Fisher College.
“Many people with autism have high intelligence but still have trouble functioning successfully in society because they might have trouble communicating and dealing with anxiety.Many people with autism have high intelligence but still have trouble functioning successfully in society because they might have trouble communicating and dealing with anxiety,"
The spectrum of people with autism ranges from high-functioning professionals, such as doctors and engineers, to individuals who are unable to hold a job.
Hypnosis with autism: Who's in charge?
Hypnosis allows the therapist to better understand and motivate a person with autism without exercising control.
"It's important to understand that you're the boss," said Laurence Sugarman. "Hypnosis is a skill set a way of using my ability to communicate with you to help you change."
With hypnosis and hypnotherapy for autistic clients, the therapist tries to get the patient to focus on a favourite activity that makes the person more receptive to suggestions, said Dr. Daniel Kohen, a Minneapolis-based, developmental behavioral paediatrician who co-authored a textbook on hypnosis."The whole fundamental underpinning of biofeedback and hypnosis is that we have the capability to influence how our bodies work," said Kohen. Sugarman's approach of self-management of anxiety has appeal because the medications available for treating anxiety related to autism spectrum disorder are often ineffective or of limited effect on their own, said Dr. Susan Hyman, division chief of neurodevelopmental and behavioral pediatrics at Golisano Children's Hospital.
"Many families prefer a nonpharmacological approach — especially since the evidence-based literature has not clearly demonstrated the efficacy of medications for anxiety," added Hyman, who is also a professor of pediatrics at the University of Rochester Medical Center.
Hyman said that the many patients she has referred to Sugarman over the years reported excellent results. Sugarman does not have studies showing the results of his approach, though he expects some early returns from his work next year. He was helped in his article by Brian L. Garrison, his research assistant, and Kelsey L. Williford, an RIT student.
But music, rather than his therapeutic skills, introduced Sugarman to RIT. Sugarman plays the banjo, as does RIT President Bill Destler. And when the two first met at a social event in 2009, Destler acknowledged Sugarman's musical skills, and then said: "No offense but what's your day job?"
That opened the door for Sugarman to fill Destler in and eventually head up the new centre for applied psychophysiology at RIT. Music, said Sugarman, is a good metaphor for the self-learning that he is trying to instil. "The more you practice, the better you get."
As a paediatrician who developed an expertise in hypnosis, Sugarman began using biofeedback in his practice as he saw an increasing number of patients with anxiety, often associated with autism. Sugarman also uses his treatment at the Easter Seals Diagnostic and Treatment Center, where he sees patients twice a week.
He said that more often than not he doesn't use drugs in treating autism and it's certainly not his first option. "Our goal is not to rely on medication," he said. "Medication can be used to calm things down, but it's not the answer."
Sugarman tries to teach people with autism skills so that when they recognize they are stressed, they can control the symptoms and be more interactive with others. He does not use the word "autistic," but rather such terms as "people with autism" because it suggests a much more fluid situation.
The American Journal of Clinical Hypnosis article tells of a 10-year-old who "manifested social awkwardness and avoidance, repetitive behaviour (including foot tapping and rocking)," along with such other symptoms as monotone speech.
At school, the youth frequently needed breaks from the classroom to "calm down." Use of medication resulted in little significant benefit. The child likes to talk about railroad cars in great detail. Sugarman said that he delved into this topic to create a certain comfort level, which carried over to the youth feeling comfortable exploring other topics. Teaching people to self-regulate to turn down their anxiety levels and "feel good inside" is a key part of Sugarman's approach.
Sugarman's centre is based at RIT's Institute of Health Sciences and Technology, where he is a research professor, and is part of the college's push to have a presence in medical science. He also launched the Minding Anxiety Project, which applies Sugarman's techniques to RIT students who have been diagnosed with autism spectrum disorder. Nineteen students have completed the project, with five more now coming once a week. The students experiment with being hooked to the biofeedback device — so that they will learn methods of controlling anxiety. "Biofeedback is like a training wheel. The goal is take what you have learned and apply it to everyday life," said Anna Hope, clinical research coordinator at the center.
Sugarman is now opening up the biofeedback to any RIT student, with about 40 on the waiting list.
Another project Sugarman is helping develop is MindGamers, a video game to help people with autism work on self-regulation skills. He has teamed up for the project with associate professor Stephen Jacobs of RIT's School of Interactive Games and Media and Rice of St. John Fisher. Rice is testing the game with 30 teenagers who have autism. Those playing build the characters around their problems and strengths. They move an avatar — a virtual representation of the player that looks like a cartoon character. The game has two "imps" — virtual figures — with one representing desired behaviour, or "super you," while the other being behaviour to be avoided, or the "problem-based" imp.
Players are hooked up to biofeedback devices, and those showing low stress can more easily move down the hall of a fictitious middle school that has various stressors, such as a crowd of people or crooked posters. "When your stress level is low, you move more quickly through the game. When your stress level is high, you move more slowly and sometimes stop," Rice noted.
The parents' role
Sugarman also works with the support group AutismUp. His Parent Effectiveness Program shows parents of children with autism how they can assist their children. A parent who is calm, rather than frustrated, can better encourage a child with autism to modify behaviour.
"It teaches parents how to self-regulate so that they have more effective parenting skills," said Sarah Milko, president of the local group, which has about 1,300 members.
Her teenage son, who has autism, is in a study conducted under Sugarman's direction that teaches self-regulation. Every so often, Milko said, when her son shows signs of stress, she helps him practice what he has learned.
"I'll say, 'You know what, let's practice our breathing,' It helps him focus," said Milko.
Sugarman is also the chief author of TherapeuticHypnosis with Children and Adolescents. A new edition of this textbook has just come out.
As a clinical hypnotherapist who works with children and adults with Autism, articles and research like this are always useful. Parents should be aware of the role that they have in the relationship. It can be very difficult to remain calm and in control when dealing with an autistic child and this is why I often work with parents alone as well as with their children so that I can teach them effective techniques to control their own calmness levels.