At birth new parents often wrap their crying babies up tightly; instinctively they’re using deep pressure to soothe their distressed infants. Deep touch pressure may benefit your child on the autism spectrum too—in this article we’ll take a closer look at deep pressure therapy; what it is, and how it could help your child.
What is deep pressure therapy?
The American Journal of Occupational Therapy defines deep pressure as the sensation experienced when hugged, squeezed, stroked, or held (Krauss, 1987).
One of the pioneers in this field, Dr. Temple Grandin, has personal experience with sensory processing issues. As a child she was overly sensitive to both touch and sound. Despite displaying symptoms early on, Dr. Grandin only received an official autism diagnosis in her 40s.
She developed a deep touch pressure device to overcome her oversensitivity to touch. She conceived the idea while observing cattle on a relative’s farm. The animals squeezed through chutes and came out noticeably calmer. The positive effect of deep touch pressure on the animals inspired Dr. Grandin’s design; she perfected it and called it the Temple Grandin Hug Machine (Grandin, 1992).
Dr. Grandin and others’ research led to studies confirming what parents already knew from observing their special needs children; deep pressure touch can calm an aroused child. Pressure therapy may lower an autistic child’s level of anxiety; anxiety which may result from the child’s inability to process sensations from their body and the environment appropriately.
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Autism Therapies and Solutions
More than three-quarters of children with autism may have sensory integration symptoms too; a child with autism therefore has a high chance of facing sensory processing challenges.
Neurotypical brains process input from the senses in an appropriate way. Not only the senses of sight, hearing, smell, taste and touch. But three additional senses of proprioception, vestibular and interoception; which also provide crucial information to the brain.
The proprioceptive sensory system provides input to the brain from our muscles and joints. Our brain uses this input to plan movements and coordinate the body. It provides us with a sense of body awareness. In the American Journal of Occupational Therapy several authors reported on the motor control issues resulting from poor proprioceptive processing among children with autism (Blanche, Reinoso, Chang, Bodison, 2012).
A good example to illustrate how the tiny sensory receptors of muscles and joints tell our brain where our body parts are, is observable when placing a fork in your mouth. You wouldn’t need to see your mouth or the fork to place it correctly; it’s largely down to your proprioceptive receptors giving your brain the required input.
How does deep pressure therapy work?
Deep pressure therapy or firm tactile sensory input can provide proprioceptive input to the entire body. Administering deep pressure through a firm hug, swaddling, weighted vest or blanket could have a calming effect, potentially reducing stress and anxiety in autistic individuals. When a child with autism also has a sensory processing disorder, deep pressure therapy could furthermore promote body awareness.
Deep pressure touch works because the weight or pressure applied provide proprioceptive input. This input could calm the central nervous system which aids the processing of sensory information (Grandin, 1992).
If you’ve seen your autistic child seeking out deep pressure, it may be because they are seeking out proprioceptive feedback or input. They may show a strong preference for tight clothing or prefer to sleep under heavy blankets and pillows. Tactile input of this nature may leave them calm, relaxed and focused.
Embracing a child’s natural preference for deep pressure, parents may choose to invest in a weighted blanket or vest. The added weight puts pressure on joints and muscles, giving the brain a better sense of where the body is in relation to space. This could be one of the reasons deep pressure provides a sensation of being grounded.
Deep pressure therapy can also have an impact on the autonomic nervous system (ANS). This system regulates body processes and consists of the sympathetic nervous system (SNS) and the parasympathetic nervous system. Your SNS (sometimes referred to as fight or flight system) takes charge when you’re faced with a stressful situation.
Our body depends on this natural alarm system, but if it stays in charge for too long, feelings of anxiety and irritability may result. Your parasympathetic nervous system, also known as the rest and digest system, has the opposite function, it slows down your heart rate and relaxes muscles.
Ideally these two systems should work in harmony to regulate complicated processes in our bodies, however, individuals with sensory processing disorders often suffer from imbalances. Deep pressure therapy may help with regulation. It may also aid in the production of feel good neurotransmitters like dopamine and serotonin, our so-called happy hormones.
Dopamine and serotonin produced through deep touch pressure could decrease or counteract the effects of cortisol, our body’s main stress hormone. This may be significant for your special needs child who may experience anxiety and stress on a regular basis.
Many occupational therapists endorse deep pressure touch or stimulation because they believe it changes physiological arousal (arousal such as an escalation in blood pressure and respiration rate, and decreased activity of gastrointestinal system).
Because of the link between autism and abnormal physiological arousal, deep pressure therapy is said to be especially beneficial for children on the autism spectrum. It may decrease arousal and reduce feelings of stress and anxiety.
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A 2011 study published in the Journal of Medical and Biological Engineering found encouraging deep pressure therapy results; “For patients with high levels of anxiety or [physiological] arousal, [deep pressure touch] interventions acts as a calming or focusing agent to increase activity in the parasympathetic division of the the autonomic nervous system.” Weighted blankets benefited study subjects by lowering anxiety and inducing better sleep (Chen, Yang, Chi & Chen, 2012).
Should pressure therapy work in a similar fashion for your autistic child (by increasing activity in his or her parasympathetic system) it could calm him/her down and reduce stress. Any parent who’s seen their child in an agitated emotional state, will find these possible benefits encouraging.
Benefits of deep pressure therapy for children with autism
The benefits of deep pressure therapy may be particularly valuable for your autistic child. Anecdotal evidence suggests children on the spectrum benefit from deep pressure in many different ways; with most parents testifying to a significant reduction in tension and anxiety after pressure therapy. These results are encouraging and will hopefully pave the way for future research.
A pilot study using the Grandin Hug Machine (Edelson, Edelson, Kerr, & Grandin, 1999) obtained encouraging results when investigating the effects of deep pressure on arousal and anxiety reduction in autistic children. The study found support for the hypothesis that deep pressure therapy may have a calming effect for persons with autism, particularly those with high levels of anxiety and arousal.
Another study, investigating the effects of deep pressure on young people with autism, found deep pressure to be of immediate benefit to the participants with autism (Bestbier, Williams, 2017). The study did find a wide variety in response and recommended careful monitoring of participants’ response to the pressure.
The same study concluded deep pressure to be statistically significant for the young, autistic participants. The children did benefit, but in different ways, raising the point that deep pressure therapy should be tailored to each child’s specific needs.
Research highlights just how individualistic children with autism are, and how varied their responses are to tactile input. Each child should be observed carefully and deep pressure therapy should be adjusted to ensure the treatment is beneficial. Deep pressure therapy may have been even more effective in some of these studies, had the therapy been tailored to the autistic child’s individual needs.
Signs your child is seeking deep pressure input
Clinical studies and anecdotal evidence may give parents hope, but what signs should you look for to establish that your child is seeking out deep pressure?
The following list is not comprehensive, but may indicate a child’s craving for deep touch pressure:
- Sleeps with a number of heavy blankets (even in summer), prefers to sleep under pillows or with excessive number of stuffed animals
- Likes tight clothing, may request for shoelaces to be tied very tightly, wraps elastic bands around arms and legs
- Enjoys being wrapped up, swaddled, or hugged tightly
- Enjoys being in small spaces
- May engage in seemingly ‘inappropriate’ behavior, such as touching people, licking surfaces, mouthing non-food items, seeking sensory input
- Grinding teeth, head banging
- Behavior that searches out tactile input like leaning into people or continuously crashing into furniture
Deep pressure activities to try at home
Occupational therapists often recommend a weighted blanket, lap pad or weighted vest when parents want to start deep pressure therapy. These products may reduce anxiety, calm your child down and improve focus, amongst many other benefits.
There are also activities you can try at home with your child to see how they react to deep touch pressure. It may take a while for him/her to enjoy the sensation, but if a child has a continued negative reaction the therapy should not be continued without consulting with an occupational therapist.
Some of these activities are:
- Wiilbarger’s Brushing Protocol
- Bear hugs or squishing the child with large pillows, being careful not to apply too much pressure
- Rolling a child firmly in a blanket or gym mat, like a burrito or mummy
- Rolling a large ball (therapy ball) over the child using firm but not excessive pressure
- Deep massage
It’s very important to never force these activities! If your autistic child has a sensory processing disorder (causing heightened tactile sensitivity) these activities may not be suitable. Start slow and observe your child’s response carefully.
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While more research is needed to see how children on the spectrum with different sensory issues respond to deep pressure therapy, the current verdict is positive with benefits like reduced stress, increase in happiness, and a significant calming effect.
There are many remarkable products, engineered to provide the maximum benefits of deep touch pressure. You may want to discuss options like weighted vests, blankets, and lap pads with your occupational therapist.
Your child may be asking for deep touch pressure by engaging in sensory seeking behavior. Start by giving your child bear bugs, wrapping your arms all the way around him/her. Take note of your child’s response and make sure the level of pressure is appropriate. You could then involve your occupational therapist, asking for advice to incorporate touch therapy in your daily life.
Bestbier, L., & Williams, T. I. (2017). The Immediate Effects of Deep Pressure on Young People with Autism and Severe Intellectual Difficulties: Demonstrating Individual Differences. Occupational therapy international, 2017, 7534972. Retrieved January 13, 2021, from https://doi.org/10.1155/2017/7534972
Blanche, E. I., Reinoso, G., Chang, M. C., & Bodison, S. (2012). Proprioceptive processing difficulties among children with autism spectrum disorders and developmental disabilities. The American journal of occupational therapy:official publication of the American Occupational Therapy Association, 66(5), 621–624. https://doi.org/10.5014/ajot.2012.004234.
Chen, H.Y., Yang, H., Chi, H.-J., & Chen, H.-M. (2012). Physiological effects of deep touch pressure on anxiety alleviation: The weighted blanket approach. Journal of Medical and Biological Engineering, (33)(5), 1-8.
Grandin, T. (1992). Calming effects of deep touch pressure in patients with autistic disorder, college students, and animals. Journal of Child and Adolescent Psychopharmacology, 2(1), 63-71. doi: 10.1089/cap.1992.2.63. Retrieved January 13, 2021, from https://doi.org/10.1089/cap.1992.2.63
Krauss K. E. The effects of deep pressure touch on anxiety. The American Journal of Occupational Therapy. 1987;41(6):366–373. doi: 10.5014/ajot.41.6.366. Retrieved January 14, 2021 from https://doi.org/10.5014/ajot.41.6.366
Stephen M. Edelson, Meredyth Goldberg Edelson, David C. R. Kerr, Temple Grandin; Behavioral and Physiological Effects of Deep Pressure on Children With Autism: A Pilot Study Evaluating the Efficacy of Grandin’s Hug Machine. Am J Occup Ther 1999;53(2):145–152. https://doi.org/10.5014/ajot.53.2.145