"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 coexisting 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 • • • • • • • Difficulty mixing with other children Acts deaf; doesn't respond to verbal cues Insists on sameness; resists changes in routine or learning No real fear of dangers Difficulty in expressing needs; uses gestures or pointing instead of words Inappropriate laughing or giggling May not want cuddling or act cuddly • • • • • • • • • Noticeable physical overactivity or underactivity Avoids or has little or no eye contact Inappropriate attachment to objects Spins objects Sustained odd play Standoffish manner; prefers to be alone Insensitivity to pain Echolalia (repeating words or phrases in place of normal language) Uneven gross/fine motor skills. (May not want to kick ball but can stack blocks) 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-OnDemand 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. TEACCH and REACCH Programs 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, nonjudgmental 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.