This article was updated to provide a new summary and resources.
Many youngsters on the autistic spectrum display signs of hypersensitivity to touch. Diane Corson, OT, PT, incorporates therapeutic body brushing into her work as a licensed occupational therapist when treating children with tactile defensiveness.
Part of the therapy Corson provides includes training parents in the technique of body brushing. “Parent compliance is a problem with body brushing, as in any other home exercise,” explained Corson. “When done sporadically, the parents usually report mild to moderate improvement. Yet, when the effort is consistent, the results tend to be excellent.”
According to Corson, the brushing approach, which is not used on infants, helps children who overreact to tactile stimulation. The technique requires use of a specific nonscratching surgical brush that is used on most of the body. “It is important not to use it on the stomach and face. The arms, legs, hands, back, and soles of the feet are brushed with firm, brisk movements. This is followed by a technique of deep, joint compression. Parents are trained in the method, which may initially need to be done for 3 to 5 minutes, 6 to 8 times a day.
“As the child begins to respond more normally to touch, the time needed for brushing is reduced. Body brushing and joint compression are combined with other occupational therapy techniques — they are not the total answer to sensory problems.” Pat Wilbarger, OT, MEd, who developed the body brushing technique, would be the first to agree that brushing should be used as part of a multifaceted approach. Wilbarger, who has worked with thousands of children here and abroad, contends that sensory, defensiveness is an underlying factor in a variety of conditions ranging from colic to adolescent hyperactivity, but she proposes that all sensory deficit areas — not just tactile — need to be addressed for best results. According to Wilbarger, there is a growing respect for the concept of sensory deficits. She points out that some university-level studies in neurophysiology are now being used to document and monitor sensory defensiveness, providing objective measures for the first time.
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Over the last several years, the interest in body brushing has outpaced formal training, giving Wilbarger some concerns. She reports that the technique is often casually shared, or passed on inaccurately. Also, people are often not educated in the specific type of brush to use, and substitutions are inadvisable. The correct brush is very inexpensive, but manufactured by only one company in Europe.
Wilbarger, who sells the brushes and conducts workshops, commented, “I checked with professionals who had learned the technique second-hand and found only 25% were doing it correctly. Generally speaking, when the technique is used improperly it will simply be less effective. But, people need to know that if they use this method on the stomach/abdominal area, it can not only be counterproductive but even dangerous. I must stress the need for proper training in this technique, as well as in joint compression.”
A sensory integration therapist must first determine the sensory areas involved. This is accomplished through a diagnostic interview with the family to understand the behaviors of concern as well as typical daily situations the child faces. Emphasis is placed on the youngster’s reactions to conditions like sounds and lights, different types of foods, voice pitch or quality, nail or hair cutting, clothing textures, visual contrasts, and changes in ground level (suggesting gravitational insecurity). Gaze aversion, if any, is noted. Once the conditions are defined, a therapeutic program is devised that requires professional training and a strong commitment by the parents. Body brushing, along with joint compression using one’s hands, may be among the approaches recommended.
Summary: While some parents and therapists report improvement with body brushing or joint compression, formal research on the techniques and their results is lacking. Key factors for success appear to be related to a child’s need for stimulation, the skill of the person providing the treatment, and whether a child is willing to participate, or enjoys the efforts. Given the wide variability among children who are on the autistic spectrum, it can be expected that some will benefit from this approach and some will not. For parents wishing to try body brushing, be sure to seek some training from an occupational or physical therapist first.