Issue link: https://www.massageandbodyworkdigital.com/i/1439667
L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 65 first, such as "elephant" or "tombstone." Think laterally if this happens: Both suggest a sense of heaviness or pressure. Ask where the elephant is, what it's doing. If they say, "sitting on my chest," you have an answer. In a manual therapy scenario, autistic people may well prefer or request "deep massage" because of this characteristic of altered sensory perception. This is not the time to correct their terminology; they are asking for it either because deeper pressure is felt to be comforting, or because they can't actually feel you at all. Adapt your technique within safe boundaries if possible, or attempt a different approach. Assisting an autistic client to articulate (find the words for) their interoceptive state may be one of the greatest gifts you can give them. TAKEAWAY Though these issues may sound daunting to practitioners, they are still more daunting to the autistic person seeking, and not receiving, help. From the practitioner or educator perspective, they should not be any more trouble than handling clients with other sensitivities. This is a vibrant, often gifted, and certainly widespread community that deserves the same opportunities for support and respect as all other communities—and it is particularly bad for members of ethnic minority and LGBTQ+ communities who are also autistic. With 20 years in teaching and more than a decade in journalism and academic publishing, Sasha Chaitow, PhD, is series editor for Elsevier's Leon Chaitow Library of Bodywork and Movement Therapies and former managing editor of the Journal of Bodywork & Movement Therapies. Based between the UK and Greece, she teaches research literacy and science reporting at the University of Patras, Greece. She is also a professional artist, gallerist, and educator who exhibits and teaches internationally. won't out of embarrassment. If they don't rebook that day, call them a few days later to show that the incident is forgotten, and gently inquire whether they would like to try another session; they will most likely be grateful for the second chance. Preserve their dignity and give them a way out of that situation by offering them options. In the even more unlikely event that the client experiences a meltdown in your presence (only likely to occur under extreme, cumulative anxiety), you need to be even more careful. A meltdown can look like a temper tantrum, but is actually sensory overload tipping the person into a state of emotional dysregulation that feels like extreme fear. If this happens, don't attempt to talk back to them, don't touch them or invade their personal space, and don't verbally attack or shame them. It is not about you, and they are not a threat. They are already ashamed of losing control, and it is themselves they are upset with. Follow the same steps as for a shutdown, speaking softly and gently. Again, give them space and a graceful way out by reassuring them that you understand what is happening, and you are not judging them for it. Pain Threshold Autistic people display both reduced and overactive responses to pain, with some demonstrating a very high pain threshold under some conditions. Two points to note include history taking and assessment procedures: Asking "does this hurt" or using a pain scale may be very misleading with these clients. Due to the often overly literal interpretation of speech, using the word "pain" or asking, "Does this hurt?" may be counterproductive (if they don't perceive it as pain, they won't know what to say even if they do feel distressed). Help them evaluate their pain by asking, "What do you feel?" and ask for the quality of the sensation instead (heat; texture, e.g., hard/ soft/tight; or ask them to compare it to something, e.g., rock, velvet, needles, insects walking). Never correct their wording; work with what they give you. They may respond with "tingling, discomfort, pressure," or similar, in which case you can gently probe for more detail. They may even respond with something that doesn't make sense at large emotions (it is a myth that they don't), both positive and negative, or others who come across as entirely "flat," but who in fact may experience emotions so strongly that they have subconsciously—or very deliberately—shut them down in order to cope or out of fear of being judged (this may well have somatic manifestations). In non-autistic people, stressors tend to be experienced as a peak after which their emotional state returns to baseline; in autistic people, it is often more of a staircase—a peak followed by a plateau, rising further each time rather than returning to baseline. That means stress becomes compounded until they reach a state of such intense overwhelm that it results in a meltdown or shutdown. Those more experienced in coping with these issues may display avoidant behavior when they know they're approaching that point of no return, and that avoidance may also manifest in hesitancy to adopt a regimen, allow certain sensory experiences, and so on. Great care is needed not to try to force that avoidance—if they can't, find a way around but don't push them past their anxiety threshold. Take things slowly, ask permission for everything you do, and if they express discomfort, stop and ask whether they want to explain to you what is happening (take care this doesn't sound like you're interrogating or patronizing them— let them know you want to understand so they will feel comfortable with you). In the unlikely event the client does experience a shutdown in your presence, they are likely to go silent and refuse further communication or communicate nonverbally. If this occurs, tell them you are going to step out of the room for a few minutes, and that you'll come and see how they feel in a little while. Give them 10 minutes, then if they are still uncommunicative when you return, reassure them that you understand they may not feel up to carrying on, end the session without embarrassing them, and offer a new appointment if their condition warrants it. Alternatively, end the session and tell them to take the time they need to come and meet you outside the treatment room—and allow them at least 10 minutes. Don't leave it to them to get in touch—they probably