Rolfing Autistic Children

Structural Integration, more commonly called rolling after its founder Ida P. Rolf, Ph.D., is a manipulative technique, involving the myofascial tissue, that systematically reorganizes the segments of the body along vertical and horizontal lines. It assumes that the body’s plasticity subjects it to disintegration, but that this same plasticity lends itself to re-integration as well. It also assumes that physical and psychological trauma are carried in the body as a muscular habit or set. In Ida P. Rolf’s words:

“An individual experiencing temporary fear, grief or anger, all to often carries his body in an attitude which the world recognizes as the outward manifestation of that particular emotion. If he persists in this dramatization or consistently reestablishes it … the muscular arrangement becomes set…. some muscles shorten and thicken, others are invaded by connective tissue, still others become immobilized by consolidation of the tissue involved. Once this has happened the physical attitude is invariable; it is involuntary … Such setting of physical response also establishes an emotional pattern … henceforth he lives, moves and has his being in an attitude.” 1

The process of rolling is designed to free these muscular sets. As a result most people find themselves experiencing their body in different and more positive ways; they also find themselves making positive psychological changes. With the autistic children the hope was to change the muscular sets and, hopefully, to change their body experience towards one of increased integration. Particularly since there is ample evidence that we create our world by projecting our internal awareness. Computers are an excellent example. In her book, Autism & Childhood Phychosis, Frances Tustin presents us with many ‘worlds’ created by autistic children’s projections of their body experiences.

As far as I know, the standard series of 10 rolling sessions had not been used previously with autistic children. Of the three children with whom I worked, two were in active therapy with Robert Olin, M.D., a Reichian and Gestalt therapist. The rolling was in addition to their psychotherapy. The third child was attending a small school with other autistic children and Dr. Olin wanted her to go through the rolling process before he started psychotherapy with her. My experience with these children indicates that rolfing is a valuable tool in accelerating psychological growth and in eliciting psychological material.

The first three sessions were essentially uneventful but revealing. Contrary to Feldenkrais’s observation that negative emotion is expressed in lessened tone of the dorsal extensors and a compensatory hyper tonicity of the flexors, two of the children displayed hyper tonicity of the extensor muscles of the back and decreased tonicity of the abdominal flexors. Child One, a boy of 7 years, moved in a simulated toddler fashion, that is, slightly pigeon-toed, belly protruding with a corresponding swayed back. His feet, ankles and knees were hard and bony and more appropriate to a 10 to 12 year old child; while his hands and wrists were soft arid delicate and seemed younger than his 7 years, but were more appropriate than his feet and legs to his torso and head. In general, he was slender, long muscled and long limbed, and appeared physically healthy.

Child Two, a girl of 5 years, was also slender and long muscled; and she almost always walked on tip-toe. I would have expected an anterior tilt of the pelvis – often seen in women who wear high heels – but her back was surprisingly straight. She indulged in a great deal of self-stimulation activity – rubbing her right eye, grinding her teeth mostly on the right side, flipping drawer pulls while simultaneously fondling a toy. Her favorite toy was a wind-up music box which she would hand to the nearest person to wind. She would then hold the music box to her ear and flip the metal drawer pull but not in an harmonious rhythm, at least to my ear. In addition, she was a self mutilation head hanger.

Child Three was a boy of 8 years with an entirely different structure. He had a density and solidly that reminded me of a Mack truck; however, his shoulders were small and delicate when compared to the sturdiness of his head, torso, arms and legs. He walked with an aggressive stride, holding his head down, not in a ‘hang-dog’ fashion, but more like a battering ram held in readiness. And in accord with Feldenkrais’s observation, his abdominal flexors in particular exhibited the expected hyper tonicity. Having been subjected to surgery at 2 months of age, his abdomen also had a large transverse scar which enhanced the shortening of the abdominal wall.

I had been concerned about how autistic children would not only interpret, but also how they would deal with the pain involved in the rolfing process. It was a short lived concern! Each child had his own style as do adults. Child One accepted the work with passivity. He would on occasion place his hand on mine but would not or could not exert an aggressive push in spite of my encouragement to do so if the pain became excessive for him. He would effectively prevent me from going beyond his capacity to deal with pain by weeping which seemed to come from a well of such profound sorrow that I could only hope the process would take some of that sadness from him. During the first three sessions breaks from the work were primarily to comfort him.

Child Two was the smallest and physically the easiest to work on, but not with, as she had developed squirming into an high art form. She had also developed an aggressive head banging technique; if my awareness wandered, she almost invariably banged me with her head. Sometimes it was just a thump on the chest, but more often it was a solid wade to the nose, cheekbone or lip. I admired her enormously for the ingenuity she displayed while simultaneously appearing withdrawn and closed off to contact. She taught me a great deal about maintaining my own center and awareness.

As could be expected from a child traumatized by surgery and prolonged hospitalization, Child Three expressed a great deal of fear and anger. And he had the physical strength and aggression to resist the work and to push me out. In addition, he had developed a mechanical personality over the years, expressed mostly by asking questions like “What’s your name?” “What kind of car do you drive?” “What color is it?” etc. etc. He would use this kind of questioning to delay or stop me from working. In spite of the fact that Dr. Olin had advised me about this technique, occasionally I would still fall for the ploy.

I was struck by the fact that each of the children approached the 4th session with a great degree of anxiety, expressed by more than usual reluctance to start, greater resistance to the work, more crying and increased expressions of fear. Since the hour dealt with areas near the genitals worry and fear through the session seemed appropriate to me, but I was puzzled by the heightened anxiety proceeding the hour. It seemed to me to indicate extraordinary sensitivity, although I am not sure whether it was pre-recognition of work in a disturbing area or whether it was a surprise to discover that there would be further work the 3rd hour completes a cycle within the rolfing process. Or perhaps it was an awareness of both factors. At any rate, it seemed to be an hour of transition.

Child One cried more than usual and it seemed to me to be from an even deeper level of sadness. The crying was not restricted to the genital area, but was just as deep when I was working on the inside ankle. It was after this hour that I learned he had been restricted in his movements because of casts on his legs to correct everted feet. This occurred when he was about 6 months old and continued for approximately 3 to 4 months. In an attempt to relieve the prevading sense of sadness I ended the hour by taking his feet and pumping them against my chest in a kicking fashion. I would then fall back in mock surprise much to Child One’s great delight. It was a game he ultimately initiated and executed with vigor and humor with no assistance from me.

The transition in Child Two was not as clear. She was the most relentless in maintaining her autistic behavior and only rarely would she allow me beyond her autism and then only for a brief moment of eye contact. Her dominant reaction during the 4th hour was anger. Her squirming was more pronounced, but, more importantly, her crying was less shrill and had a deeper, more ‘real’ quality.

It was an hour full of fear for Child Three. The closer I got to his genital area the more fearful he became. My expressed concern and awareness of his genitals were fruitless. He pushed, pulled, squirmed, yelled, yanked and in general and in particular did everything within his ability to escape the work. And although I considered my efforts valiant, I did not consider that his adductors had been adequately freed. It was an extremely difficult hour for both of us.

But it was the fifth hour that was the real turning point, particularly for two of the children. (The work in this hour is essentially on an in the belly.) Physically the work was very easy on Child One and Two their abdominal musculature was so without tonus that it was like working in butter. It was apparent that they had no muscular defensive ability to protect their vital organs. Metaphorically speaking it seemed that the very core of their being was totally vulnerable. It was as if they lacked the essential capacity to selectively armor themselves against stimuli. I imagine that total vulnerability would be like living without an evaluative editing mechanism which could lead to confusion about, perhaps between, inner and outer perceptions. This confusion may have something to do with the common ‘perversity’ of autistic children. Their efforts to achieve an integral self seem to be threatened as much be compliments as by ‘put-downs’; of course, both are forms of conditioning, even though compliments are more palitable. On one level I can see that this makes it difficult not only for parents and teachers, but for the child’s normal growth which involves selection and adaptation. On another level, I admire the purity of their refusal of all conditioning.

It was essentially after the 5th hour that Child Two started moving rapidly into more assertive behavior. She demanded a great deal of attention wanting to be with her mother all the time. Needless to say, this was not an easy change for the mother as it required a great deal more energy for a child already in need of more than usual time and attention. This child also demanded affection and holding from her teachers as well as from her family. But she did an interesting thing with me on those occasions when I held her.
If I tried to consciously allow a flow of what I considered ‘love’ to go to her (I was not ‘doing’ anything, just being conscious of ‘love’ going other), she would become restless and refuse to be held any longer. When I simply held her without trying to give anything, she would become quieter and allow herself to be held until it seemed time to pursue the rolfing again. Remarkable child her extra ordinary awareness and ‘perversity’ taught me many things. After the 6th hour work, on the back of her legs particularly, and after her 7th hour work on her head and neck, her habitual walking pattern started to change. She never completely gave up walking on her tip-toes, but she did walk with her feet in contact with the ground more often. The 7th hour also alleviated some of the distortions that were occurring in her face from the eye rubbing and teeth grinding activity; however, it did not eliminate those self stimulating activities, but the frequency seemed reduced for the next couple sessions. The 8th hour work demonstrated that the abdominal muscles had a vastly improved muscular tonus. And with this new found muscular defensiveness, Child Two displayed a decreased need to use squirming as a defensive activity. The 9th and 10th hours were unremarkable except that I did become aware of another aspect involved in her head banging. If she banged her head from a position in which she could not generate enough energy to really hurt herself, she would pause and then start crying loudly and deeply. The crying seemed inappropriate to the severity of the head banging. I noticed that if, in that split second pause, I would physically interrupt her by pulling her towards me, picking her up, or even giving her a mild swat on the rump and if I also verbally expressed my displeasure with a “Stop that! That upsets me!” or “I don’t like that!”, she would then respond with a mild whimper. I had no interpretation of this response but Dr. Olin suggested that, one, my response was appropriate to her behavior, and, two, that when I did not respond to her destructive behavior it emphasized her sense of separateness and loneliness. That feels right.

Child Two’s behavioral changes were more apparent within her familial and school environment, and they occurred rapidly but not dramatically. However, Child One’s behavior changes were immediately apparent during the rolfing sessions. Furthermore, the 5th hour was dramatic! I had been working on the psoas (a muscle deep in the belly) which had generated a great deal of crying and decided to take a play break to change the pace. I held his ankles and pumped his legs against my chest. I was aware that it was an activity and a playfulness appropriate to an infant, and I continued the playing. This game elicited laughter and fun. And then, as does an infant, he reached and touched my eyes, making sounds as if he were learning the word for eyes. I had responded – as most of us do towards and investigating infant – by saying ‘eyes’. This investigation proceeded over my entire face. He also reached out and took my hand, bringing the palm toward him, and examined it very closely but said nothing. This was the first time he had reached out in such an exchanging contact. Later I asked him if he could let me go in again to do additional work on the psoas. Not only did he give his verbal “O.K.”, but I could feel that consent within his body – there was a letting go. As the session ended he initiated the kicking me away with his feet game and added pushing me away with his hands. He seemed to enjoy using his hands and feet with control as if it was a joyful discovery of an ability to reach out and assert some power over external objects. We then went into the adjoining room and he started dressing. I was sitting in a chair about 15 feet from him, chatting casually with his mother. He gave me a quizzical look, took his undershirt and waved it at me in a disminning gesture, smiled widely and said, “Go away!” He had never been known to join two words together much less join assertive words with assertive action. Shortly following this, Child Three and his mother entered the room, whereupon, Child One, wanting to make contact, promptly went up behind Three, grabbed him by the shirt collar and turned him around – to the utter amazement of everyone in the room. Child Three was the top dog in the hierarchical structure among these children, a very bossy top dog too. Child One’s previous passivity would never have included such an aggressive interchange with three. Not only did this assertiveness continue at home and in school, but he started making inner/outer distinctions, that is, “your eyes” and “my eyes”. I must admit that during the 6th session I experienced a great deal of conflict between my goals as a rolfer and my desire to see his assertiveness firmly established.
I did not want to destroy his confidence in his ability to exert some control over what was happening to him. I must admit that I felt dissatisfied with the amount of work accomplished in that session. I don’t know that I needed to have been so concerned. The character of the sessions completely changed after that fifth hour. No more did he passively accept the work. Of course, he did cry, but he no longer seemed to need the comforting. Instead, he quickly recovered and would want to play. He developed the ability to move away from the work and to push me out, making my work physically much harder. I didn’t object to that, particularly when his mother reported that his rapidly developing sense of strength was leading him to explore the neighborhood and respond more gregariously with family friends. I did a great deal of musing about the work involved in the approaching 7th hour. His palate was formed into a high arch and he used his tongue in an unusual rolling/sucking way. I knew that I wanted to work in his mouth, particularly on the palate and tongue, but I had no idea how I was going to accomplish it, particularly without help. Again, I had no real reason to be worried. Although the session was not an easy one for him, he was cooperative and accepting of the inside mouth work. I had hoped that the tongue work might help clear some of his speech difficulties, but there was no immediate indication of any change in sound formations. The last three sessions were not unusual. He seemed to solidify his movement from sadness into exuberant and joyful assertiveness. As with Child Two, the later sessions revealed that he had developed the same defensive ability in the abdominal musculature.

In a different way, the 5th hour was also a significant turning point for Child Three. Knowing that there was a great deal of emotionally laden trauma because of his surgery, I had used opportunities in almost all the previous hours to do a little work on his belly; therefore, it was not a particularly difficult session for him. After completing the abdominal work, I was still frustrated about the unfinished work from the 4th hour and proceeded to work on the pelvic rami again. Immediately, Child Three broke through the mechanical level of his autism with a deeply felt and fearfully expressed “Don’t! That’s too scary!!” It was an appropriate expression of feeling with words not known to be in his vocabulary. The 5th and 6th hours were marked by Three’s allowing some close contact between us, but having to end the sessions with disruptive and provocative behavior, that is, throwing his clothes in water, throwing toys around, spitting at me, etc. Igeneral trying to undo any closeness that might have been established.

Other than forming the goal of getting Child Three’s ‘head on his shoulders’, I had not anticipated anything for the 7th hour. Ah, the vagaries … The session opened with Child Three expressing a desire to “wee-wee” on me. There seemed strong sexual overtones to the statement, but I didn’t know what to do with that so I simply dealt with the statement on a literal level. He then proceeded to “wreck” my breasts, which meant trying to pull them off. I told him that I understood about his being angry with breasts, but that I happened to like my breasts and intended to keep them and protect them if I could. He said he didn’t care, he was going to “wreck them anyway!” This was said with some humor, but also with an underlying fierce determination. His efforts were also determined. The “breast wrecking” activity continued through most of the 8th hour as well. During this session I asked him what he would do with my breasts if he did ‘wreck’ them, He said that he would take them home. I said, “And then what would you do with them?” He “I’d throw them away!” (Like any useless object?) I assured him that I wasn’t about to let him wreck my breasts if he was just going to throw them away. So he said, “Well, I’ll give them to Jane.” Jane is a family friend and has acted as a surrogate mother to him. Since Jane is also somewhat flat chested, I wasn’t sure whether it was a statement of humor or a hope for more nurturing from her. I then told him that when children are very tiny they drink milk from their mother’s breasts. And he said, “Not little boys.” I assured him that even baby boys did, but he said, “NO THEY DON’T!!” Unfortunately, in his case that is all too true. He was taken from the breast at 6 weeks old for surgical correction of a bowel obstruction. He remained hospitalized with an open solostomy and finally an anastomosis until he was almost a year old. Not only was he deprived of oral feedings through some of this time, but intravenous and subcutanious infusions required immobilization as well. Until this oral and nurturing deprivation became clear to me, I had remained confused about why work on the head and face elicited what I had considered at first to be sexual material. The sexual overtones seem to have been an example of what Frances Tustin calls “pseudo-phallic material associated with oral anxieties.”2 This may partly explain Child Three’s prevalent genital anxiety and even, perhaps, his habit of protectively covering his genitals when his level of excitement reached an eruptive stage. Of course, that habit also covered his “boy ness”. It finally became clear that the 7th hour head and face work elicited the oral anxieties that could be expected from such an early and prolonged period of deprivation. By the 9th hour the ‘breast wrecking’ game was over. Phew!! He did make a cursory gesture of wrecking just to let me know he had not forgotten about it. During a break I made. a comment about the transverse ‘dents” in his thighs caused by the subcutanious infusions. I asked him if he remembered being sick in the hospital. He replied, “Yes!!” He did not amplify so I asked if he had been afraid, but he said nothing. I told him that when I was in the hospital with a broken arm that I had been very scared because I felt very helpless and I was afraid because nobody I loved was there to take care of me. Again, he said nothing for a moment, then made a cursory, rather mechanical remark about my going back to California. Suddenly he moved into a completely new space. Ordinarily there was a constant rumbling going on within this child. He was like a minor volcano, but he now became quiet and peaceful – not withdrawn. He then said, “Would you work on my hand and make it happy?” Having visions of how unhappy it must have been tied to a hospital crib, I was only to eager to do so. And during the 10th session he allowed me to work on his feet, also to make them happy. But hands and feet were the only areas with which he could cooperate. Work in all other areas was still resisted.

In evaluating the children’s structures upon completion of the work, I could see that Child One’s sway back had improved, but it was not straight. He moved less like a toddler, but still not like a 7 year old child. However, there was certainly a more integrated flow of energy. I have already discussed the rapid acceleration of his psychological development, but I would like to add that he had been making slow but steady progress in this area. Child Two’s structural changes were reflected more in a decrease of rigidity. There was a sense that her energy was more grounded. Also, her face was more open, with better color, and it had less of a ‘folded in’ aspect to it. Child Three still walked with his head down, but his pelvis was under him more and his belly had lengthened. Some of his original density had been replaced by, at least, a little softness and an easier ‘flow’. These children are still autistic, but they have all taken a giant step forward. I would like to add that they enriched my life immeasurably.

1 Ida P. Rolf, Ph.D., Structural Integration, Published by author, 11 Riverside Drive, N.Y., N.Y. pp. 9.10

2 Frances Tustin, Autism & Childhood Psychosis, Science House Inc., 1972, P. 31Rolfing Autistic Children