Introduction to Leadership Concepts and Practice.docx

Introduction to
Leadership: Concepts and
Practice

Contents
Introduction ............................................................................................................. 1
Chapter 1: Treatment for Sensory Processing Integration ....................................... 3
Creative Counseling Methods for Autism Treatment .......................................... 9
Aims and Techniques of Sensory Integration Therapy....................................... 16
Chapter 2: Techniques for Auditory Training ......................................................... 26
Objectives and Techniques in Sensory Integration Therapy .............................. 28
Historical Context of Interventions for Developmental Disabilities .................. 39

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Introduction

In the ever-evolving landscape of special education and developmental
treatments, progress is not just an aspiration but a relentless pursuit driven by
compassion, innovation, and dedication. "Advancements in Special Education and
Treatments for Developmental Challenges" stands as a testament to the
remarkable strides made in these fields, offering a comprehensive exploration of
the latest breakthroughs, methodologies, and practices that are reshaping the
landscape of support for individuals with developmental challenges.
This book serves as a beacon of knowledge, illuminating the path forward
amidst the complexities of developmental disabilities. It is a collaborative effort,
bringing together the insights and expertise of leading scholars, researchers,
clinicians, and educators who share a common commitment to enhancing the
quality of life for individuals facing developmental challenges. Through their
collective wisdom and tireless efforts, this volume emerges as a repository of
cutting-edge knowledge, evidence-based interventions, and innovative
approaches aimed at empowering individuals with developmental disabilities and
their communities.
The chapters within this book offer a diverse array of perspectives, spanning
from theoretical frameworks and research findings to practical applications and
real-world case studies. Each chapter is meticulously crafted to provide readers
with a nuanced understanding of the multifaceted nature of developmental
challenges and the myriad strategies available for addressing them.
Central to the ethos of this book is the recognition of the inherent dignity
and potential of every individual, irrespective of their developmental differences.
It embraces a person-centered approach, emphasizing the importance of
fostering environments that are inclusive, supportive, and conducive to the
holistic development of individuals with developmental challenges. Through the
lens of empowerment and equity, this book seeks to challenge stigmas, dismantle

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barriers, and promote the full participation and integration of individuals with
developmental disabilities in all aspects of society.
Moreover, "Advancements in Special Education and Treatments for
Developmental Challenges" celebrates the spirit of innovation and collaboration
that drives progress in these fields. It explores the transformative potential of
emerging technologies, interdisciplinary collaborations, and community-driven
initiatives in enhancing the efficacy and accessibility of special education and
developmental treatments.
As we embark on this journey of exploration and discovery, it is our hope
that this book will serve as a catalyst for dialogue, reflection, and action. By
disseminating the latest research findings, sharing best practices, and fostering
collaboration across disciplines, we aspire to catalyze positive change and
advance the well-being and inclusion of individuals with developmental
challenges in our society.
In essence, "Advancements in Special Education and Treatments for
Developmental Challenges" is more than just a book—it is a testament to the
resilience of the human spirit, the power of knowledge, and the transformative
potential of collective action. It is a call to arms for all stakeholders—educators,
practitioners, policymakers, advocates, and community members—to join hands
in creating a more inclusive, equitable, and compassionate world for individuals
with developmental challenges.

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Chapter 1: Treatment for Sensory
Processing Integration

DIR/Floortime, a therapeutic approach pioneered by Stanley Greenspan
along with collaborators Serena Wieder and Nancy Thorndike Greenspan, has
evolved over several years to address the complex needs of children on the
autism spectrum. Its inclusion in this discussion stems from its classification as an
"alternative" or "controversial" treatment, as described by certain proponents of
unconventional therapies for children. Unlike Applied Behavior Analysis (ABA),
which primarily aims at suppressing autistic behaviors and fostering compliance
to external commands, DIR emphasizes the cultivation of spontaneous
communication, empathy, and introspection.
Rooted in Stanley Greenspan's conceptualization of emotional
development, DIR draws upon a synthesis of Jean Piaget's theories of intellectual
growth and Sigmund Freud's insights into emotional maturation. Both Piaget and
Freud propose a stage-like progression of development, wherein each stage
builds upon the accomplishments of earlier phases, suggesting that mastery of
earlier developmental milestones is crucial for advancing to higher levels of
functioning.
Central to the DIR approach is the belief that developmental progression is
multifaceted, encompassing not only cognitive and behavioral domains but also
emotional and social dimensions. Thus, DIR interventions prioritize fostering a
child's capacity for self-expression, understanding others' perspectives, and
engaging in reciprocal interactions, in contrast to the behavior modification
techniques emphasized in ABA.
By integrating elements of play, exploration, and emotional attunement
within a supportive environment, DIR seeks to address the underlying socio-
emotional deficits observed in individuals with autism spectrum disorder,
promoting holistic development and adaptive functioning across various life
domains.

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According to Greenspan's developmental framework, successful navigation
through several key stages is essential for individuals to emerge as competent
adolescents poised for a healthy transition into adulthood. Initially, during the
infantile phase, establishing shared attention and regulation is paramount. This
involves the infant's receptivity to pleasant stimuli from caregivers, such as
soothing sights, sounds, and movements, and the development of the capacity to
derive comfort from these interactions. Typically occurring within the first few
weeks of life, this stage lays the foundation for future social and emotional
growth.
Subsequently, in the following months, infants progress to derive pleasure
from engaging and connecting with others, particularly primary caregivers. This
stage marks the emergence of a budding capacity for interpersonal relationships
and social bonding, setting the stage for more complex forms of communication
and interaction.
The third stage, as delineated by Greenspan, involves the development of
what he termed "two-way intentional affective signaling and communication."
Here, infants demonstrate attentiveness to caregiver cues and signals, while also
exhibiting their own ability to convey needs and desires through gestures and
expressions. This reciprocal exchange forms the basis for effective communication
and lays the groundwork for further social development.
Moving forward, Greenspan identifies a fourth stage characterized by the
establishment of extended chains of co-regulated emotional signaling and
collaborative problem-solving. This involves the ability to initiate interactions with
caregivers, convey needs persuasively, and engage in cooperative problem-solving
endeavors. Caregiver responsiveness and engagement are pivotal in nurturing
these developmental milestones, fostering a sense of efficacy and mutual
understanding.
The subsequent stages outlined by Greenspan involve the progression
towards symbolic communication and emotional cognition. The fifth stage entails
the emergence of symbolic thought, enabling children to express emotions and
communicate using words rather than solely relying on actions. This marks a
significant cognitive leap, allowing for more nuanced expression and
understanding of emotional experiences.

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Finally, Greenspan describes a "building bridges" period, where children
begin to conceptualize emotions in more nuanced terms and recognize gradations
in emotional intensity. This stage involves the ability to articulate complex
emotional states and understand the interplay between one's own feelings and
those of others. Through this process, children develop a deeper understanding
of emotional dynamics and interpersonal relationships, laying the groundwork for
healthy emotional development and social integration into adulthood.
While typical developmental trajectories often see children achieving
milestones of emotional and cognitive development by the time they reach
school age, Stanley Greenspan posits that autistic children often struggle to
master even the foundational stages of this developmental sequence. Advocates
of the Developmental, Individual-differences, Relationship-based (DIR) approach
maintain that engagement in this personalized, one-on-one therapy can catalyze
developmental progress and enable autistic individuals to transcend their
limitations.
However, the plausibility of certain aspects of DIR therapy is subject to
scrutiny. Firstly, there is the assumption that addressing developmental delays
necessitates replicating or simulating earlier developmental experiences. This
assumption appears incongruous with the efficacy demonstrated by some
interventions tailored to address delayed development in children. For instance, a
five-year-old with speech delays typically benefits more from age-appropriate
speech therapy interventions rather than attempts to recreate early language
acquisition experiences, such as employing "infant-directed talk," which are
crucial for infants' language development. Similarly, instances of growth and
developmental delays stemming from malnutrition are not rectified by reverting
to an infant's milk diet.
A second area of contention regarding DIR pertains to the notion that
therapy can induce new experiences mirroring earlier developmental stages, thus
effectively rerouting faulty developmental trajectories. This premise encounters
challenges when juxtaposed with the concept of epigenesis, as elucidated in Erik
Erikson's personality theory. According to this framework, personality
development is influenced by both inherent predispositions and environmental
factors, with shaping occurring gradually and resistive to abrupt transformations.

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These theoretical quandaries are further compounded by contemporary research
implicating genetic factors in the etiology of autism spectrum disorders (ASD),
suggesting that optimal developmental experiences for autistic children may
diverge from those typical of neurotypical development.
These critiques underscore the need for a nuanced understanding of the
underlying mechanisms driving developmental progress in autistic individuals and
prompt a reassessment of therapeutic approaches to better align with the unique
needs and challenges inherent in ASD.
Given the emphasis on individual differences within the Developmental,
Individual Differences, Relationship-based (DIR) approach, it follows that the
experiences of children undergoing DIR treatment may vary significantly. For
instance, speech and occupational therapies often assume critical roles in
addressing specific challenges faced by individual children, particularly those
related to motor planning difficulties or sensory sensitivities and processing
issues, which are frequently intertwined with the broader clinical picture.
Integral to the DIR protocol is the recommendation of eight to ten daily
sessions lasting twenty to thirty minutes each, focusing on one-on-one play
interactions. These interactions may involve various participants, including
therapists, parents, other family members, or even volunteer neighbors,
reflecting the collaborative and inclusive nature of the therapeutic process.
Undoubtedly, the investment required in terms of both time and financial
resources for families engaged in DIR can be substantial. However, the potential
payoff in terms of improved outcomes for severely autistic children, potentially
leading to the attainment of normal functioning, renders such sacrifices
seemingly worthwhile. Anecdotal accounts on some websites suggest such
remarkable outcomes, fueling hope and optimism among families grappling with
autism spectrum disorders.
Yet, despite these promising narratives, the empirical evidence supporting
the efficacy of DIR remains limited. While a chart review examining 200 cases
offers some insights, a more rigorous investigation is warranted to establish a
robust evidence base for DIR. One notable study followed up with sixteen
adolescents who had undergone DIR treatment following an autism diagnosis

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several years prior, revealing overall positive outcomes both academically and
socially. However, such studies represent only a small fraction of the
comprehensive research needed to unequivocally endorse DIR as an evidence-
based intervention.
Additional studies, such as the pilot study conducted by Solomon, Necheles,
Ferch, and Bruckman, provide further insights into the potential benefits of DIR.
This study, employing a pre- and post-design where parents were trained in DIR
techniques and children were evaluated by blinded raters, yielded promising
results, with significant improvements observed in a subset of participants.
However, the inherent limitations of the study design, including the lack of a
control group and the inability to ascertain whether observed changes were
attributable solely to DIR interventions, underscore the need for more robust
research methodologies to ascertain the true efficacy and effectiveness of DIR in
treating autism spectrum disorders.
While the reports on the outcomes of children undergoing DIR treatment
paint an optimistic picture of their potential for success later in life, there remains
a significant gap in our understanding regarding the comparative effectiveness of
DIR versus other therapeutic approaches, or even the natural progression of
autistic individuals in the absence of treatment. Without robust comparative
studies, it's challenging to ascertain whether the positive outcomes attributed to
DIR are truly unique to this intervention or simply reflective of the passage of
time or other factors.
To address this gap, rigorous research designs such as randomized
controlled trials (RCTs) are essential. However, as of now, DIR lacks a substantial
body of high-quality evidence, although promising research efforts appear to be
underway. For instance, Pajareya and Nopmaneejumruslers conducted a study
where children were randomly assigned to receive either routine care or routine
care supplemented with approximately fifteen hours per week of home-based
DIR therapy. Interestingly, the group receiving DIR showed a significant advantage
over the control group, although the absence of reported effect sizes leaves room
for interpretation. Moreover, the association between the intensity of DIR
therapy and improved outcomes raises questions about whether the observed

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benefits are merely a result of increased interaction with adults rather than
specific features of the DIR approach itself.
Similarly, Casenhiser, Shanker, and Stieben embarked on a preliminary
investigation involving an RCT comparing DIR with standard community care.
However, despite initial findings, a final report detailing the outcomes of this trial
seems to be pending, leaving uncertainties about the replicability and
generalizability of the results. Notably, independent replications of these studies
are conspicuously absent from the literature, underscoring the need for further
validation and corroborative evidence.
Moreover, while the positive effects of DIR therapy are often highlighted,
the absence of studies examining potential adverse events associated with this
approach is notable. Without a comprehensive understanding of both the
benefits and risks of DIR, clinicians and families are left without crucial
information needed to make informed decisions about treatment options for
autistic individuals. Thus, future research efforts should prioritize not only
establishing the efficacy of DIR but also exploring its safety profile and potential
drawbacks.
The classification of DIR as an unconventional or alternative treatment
warrants scrutiny, particularly in light of the foundational principles underpinning
the theory. While some authors have positioned DIR as such, it's essential to
recognize that the theoretical underpinnings of DIR draw heavily from established
psychological and developmental theories that are standard fare in introductory
psychology and social work courses. Stanley Greenspan's integration of Piagetian
and Freudian concepts, while innovative in application, does not inherently
involve esoteric or unconventional ideas.
Moreover, the theme of reworking developmental stages, a central tenet of
DIR, is not exclusive to alternative therapies but finds resonance in various
conventional therapeutic approaches as well. The notion of addressing
developmental deficits and facilitating progress through revisiting earlier stages of
development is a common thread in many therapeutic modalities.
While it's true that Greenspan himself entertained some unconventional
ideas, such as prenatal communication posited by Ernst Freud in a paper included

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in a book edited by Greenspan in 1981, the essence of DIR therapy appears more
aligned with conventional therapeutic principles than alternative or
unconventional ones. However, it's worth noting that despite its conventional
underpinnings, DIR therapy still lacks a robust evidence base, which raises
questions about its efficacy and validity as a therapeutic approach.
The fact that the term "DIR/Floortime" is trademarked and that courses and
conferences on DIR are widely promoted by the Interdisciplinary Council on
Development and Learning (ICDL), an organization founded by Stanley
Greenspan, adds another layer of complexity to the debate. While ICDL offers
certification levels in DIR therapy, the commercialization of the treatment raises
concerns about the influence of commercial interests on the dissemination of
information and research findings. The proprietary nature of service-marked or
trademarked treatments may impede the transparent sharing of relevant data,
thereby complicating efforts to evaluate DIR therapy's evidence basis and
effectiveness.
Creative Counseling Methods for Autism Treatment
In addition to the conventional treatments widely accepted within the
medical community, there exists a spectrum of therapies that fall under the
category of "alternative," characterized by their lack of evidentiary support and
often implausible nature. This section will delve into some of the most prevalent
examples of such alternative therapies, focusing specifically on those that could
be considered forms of psychotherapy. While certain methods may involve
physical components, strictly medical interventions like chelation therapy to
remove alleged heavy metals will not be addressed here.
Within the realm of treatments aimed at manipulating emotional
attachment and addressing "attachment disorders," there lies a historical
connection to the treatment of autism. In the past, there was a belief that autism
was linked to attachment issues, even thought to be caused by them.
Consequently, holding therapies (HTs), which were initially developed to address
attachment problems, were also utilized in attempts to treat autism. This
convergence was partly fueled by the advocacy of prominent figures in the autism
community, such as Bernard Rimland, who expressed interest in HT, and Temple

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Grandin, a high-functioning autistic individual, who likened HT to her positive
experience with a "squeeze machine."
Despite initial interest, objections from other autism advocates and adverse
publicity stemming from harm caused by HT practices led to a decline in its use
for autism treatment in the United States. A personal account from a British
individual who underwent HT for autism in the 1980s highlighted strong
objections raised at a young age, prompting the cessation of the treatment by the
individual's father. Presently, HT for autism is relatively rare in the United States
and Britain, yet it remains a contentious issue in countries like Germany and the
Czech Republic, where its practice persists and may have even expanded.
In 2013, APLA, the Czech autism advocacy organization, organized a
conference specifically addressing HT and other alternative therapies,
underscoring the ongoing concerns surrounding these practices within the autism
community.
Martha Welch, a prominent American psychiatrist who studied under the
tutelage of Nikolaas and Elisabeth Tinbergen, introduced a therapeutic approach
known as Direct Synchronous Bonding (DSB). This method was designed
specifically for autistic or oppositional children and involved intense face-to-face
and belly-to-belly contact between the child and their mother. For younger
children, the technique required the child to sit astride the mother, who would
tightly embrace the child while enduring potentially prolonged periods of
resistance, crying, and emotional turmoil. Throughout this process, both the
mother and child were encouraged to express a spectrum of emotions, including
both negative and positive feelings.
In instances where the child was older or larger, the procedure adapted to
accommodate the physical differences. The child would lie supine while the
mother lay prone on top, holding the child's hands and arms and striving to
maintain eye contact. Similar to the method for younger children, this approach
emphasized the importance of enduring resistance and fostering emotional
expression during the bonding session. Martha Welch initially detailed this
technique in an appendix to the Tinbergens' 1986 publication and later
elaborated on it in her own book, "Holding Time."

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Welch's approach to DSB was rooted in the belief, common at the time but
now largely discredited, that autism stemmed from deficiencies in the interaction
between mother and child. Her method was thus conceived as a means of
rectifying this perceived deficit through intensive physical and emotional
engagement. Welch's work garnered attention and she even embarked on a tour,
including stops in Britain, where she demonstrated DSB for groups of mothers
and autistic children, an event captured and documented by the BBC.
However, as scientific understanding evolved and the etiology of autism
came to be viewed through a more complex lens, Welch gradually shifted her
focus away from autism treatment. Instead, she redirected her efforts toward
Reactive Attachment Disorder (RAD), renaming her therapeutic approach as
Prolonged Parent-Child Embrace (PPCE). Studies conducted on PPCE suggested its
effectiveness in treating RAD, as evidenced by pre- and post-treatment
evaluations. Notably, in this transition, autistic disorders were no longer
highlighted or addressed within Welch's therapeutic framework.
During her tenure in Germany, Jirina Prekop, another disciple of
Tinbergen's, advocated for a form of holding therapy (HT) reminiscent of Martha
Welch's method. Often referred to by various names in translations such as
Festhaltetherapie, Terapie Pevneho Objeti (TPO), Hard Hug Therapy, or simply
Holding Therapy, the approach championed by Prekop gained recognition among
her followers, with the term TPO commonly used to describe it, even in English
translations.
Much like Direct Synchronous Bonding (DSB) and Prolonged Parent-Child
Embrace (PPCE), the central technique of TPO involves a mother restraining her
child in a face-to-face position, whether it be on her lap or with her lying prone
atop the child. This daily ritual, lasting an hour or more, is characterized by the
expression of both negative and positive emotions by both participants, as they
grapple with the challenges and nuances of their relationship dynamics. Notably,
TPO is often employed as a therapeutic intervention for autistic and oppositional
children, whom Prekop has famously labeled as "little tyrants."
While Prekop's methods have remained relatively consistent since the
1980s, her theoretical underpinnings have evolved over time, necessitating a
critical examination of the plausibility of TPO in two distinct sections.

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Initially, TPO seemed to be grounded in ethological principles such as
imprinting and supernormal releasers, concepts previously discussed in this
chapter. However, the applicability of these principles to humans, particularly in
the context of autism, remains unsubstantiated. Moreover, TPO's premise that
autism stems from deficiencies in early life experiences lacks empirical support,
as there is no evidence to suggest that autistic children have been treated
differently during infancy compared to neurotypical children.
Furthermore, TPO's reliance on physical restraint contradicts conventional
notions of sensitive and responsive parenting, resembling instead the intrusive
parenting styles associated with adverse outcomes. Proponents of TPO argue
implausibly that parental authority and physical restraint foster emotional
connections and attachment. However, the absence of physical restraint in typical
early parent-child relationships, as evidenced by the successful development of
normal relationships among physically handicapped and blind parents and
children, challenges this assertion.
Additionally, the emphasis on emotional expression and venting in TPO
contradicts established practices aimed at promoting improved self-regulation
and reflective parenting. While it is conceivable that oppositional children may
exhibit compliance in response to exertions of parental authority and physical
restraint under certain circumstances, the overall plausibility of TPO as a
therapeutic approach remains questionable, particularly in light of its divergence
from developmental evidence and established best practices.
In more recent years, Jirina Prekop has reconfigured the theoretical
underpinnings of TPO, integrating influences from various alternative therapists.
Departing from its original framework, the theory behind TPO has expanded to
encompass the assertions of notable figures such as psychologist Stanislav Grof,
who posited that prenatal experiences can be elucidated through consciousness-
altering techniques like LSD and breathwork. Additionally, Prekop has drawn upon
the insights of psychologist Daniel Casriel, who advocated for the importance of
emotional bonding facilitated through chest-to-chest positioning and eye contact.
Moreover, TPO's evolution has been influenced by the spiritualist
perspectives espoused by family therapist Bert Hellinger. Collaborating with
Hellinger and incorporating his views into her work, Prekop has embraced the

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notion that TPO engenders spiritual communication between mother and child,
transcending objective measurement. Furthermore, she has adopted Hellinger's
belief in a hierarchical family constellation, wherein submission to paternal
authority is paramount, and disobedience by mothers to their husbands renders
them ineligible for TPO assistance.
However, these ideological shifts within TPO's framework have drawn
criticism for their departure from established principles of memory, attachment
theory, and family dynamics. The insistence on hierarchical structures and
spiritual communication diverges significantly from mainstream psychological
understanding.
In terms of empirical support, the emphasis on evidentiary basis for TPO
has evolved over time. Initially, Prekop cited the endorsement of Tinbergen as
evidence of TPO's scientific rigor, emphasizing its purported scientific grounding.
Prekop and her colleagues conducted several investigations into TPO outcomes,
albeit without meeting the criteria for evidence-based treatments. These studies,
characterized by unblinded parent assessments, including a telephone survey
conducted years after a parent workshop, reported positive outcomes. While one
small study employed a randomized design, others relied on before-and-after
comparisons or compared TPO to no treatment. However, the absence of
replications, whether independent or otherwise, casts doubt on the robustness of
these findings.
In recent times, Jirina Prekop has veered away from seeking scientific
validation for TPO, instead embracing a religious or spiritual framework akin to
the philosophy favored by Bert Hellinger. Renouncing the notion of TPO as a
therapeutic intervention, Prekop now characterizes it as a "lifestyle" choice,
rooted in principles of spirituality rather than clinical efficacy. She has shifted her
perspective on the origins of autism, attributing it to contemporary societal
factors such as social isolation and excessive screen time. In response, Prekop
advocates for TPO as a means of reverting to more primitive and ostensibly
healthier modes of existence.
Despite the evolving narrative surrounding TPO, research into its potential
adverse effects has been conspicuously absent. Personal accounts from
psychologists in the Czech Republic reveal a reluctance among adults who

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underwent TPO as children to share their negative experiences publicly. These
individuals reportedly harbor deep-seated aversion towards TPO but refrain from
speaking out due to various reasons.
Moreover, an edited volume in German sheds light on the disillusionment
experienced by parents who were persuaded to adopt TPO for their children.
They recount TPO group sessions characterized by cult-like practices, including
ritualistic songs, dances, and pantomimes, prompting them to reconsider the
treatment's efficacy and impact on their children's well-being.
In terms of categorizing TPO within the framework of alternative
treatments, it aligns with the manipulative class, given its reliance on physical
restraint and coercive practices. However, it also exhibits characteristics of the
transcendental category, as it emphasizes spiritual connections and purportedly
seeks to transcend conventional therapeutic approaches. This duality underscores
the complex and contentious nature of TPO within the broader discourse on
alternative therapies.
The Son Rise program, born out of the experiences of parents grappling
with autism in the 1970s, has since evolved into a commercially available
treatment and training regimen, with a plethora of books and DVDs elucidating its
methodology. Central to the Son Rise philosophy is the assertion that autism
stems from a deficit in bonding, a claim that underscores the program's emphasis
on fostering deep connections between caregivers and children on the spectrum.
Key components of the Son Rise approach include creating a non-
distracting environment conducive to learning, a practice supported by
conventional teaching theories that prioritize focused attention. Furthermore, the
program advocates for a technique known as "joining," whereby caregivers
engage in imitation of the child's self-stimulating behaviors. While imitation is a
natural response of parents to infants, its application to older children may raise
questions about the assumption that the program seeks to recreate missed
developmental experiences.
A cornerstone of the Son Rise methodology is the promotion of eye contact,
viewed as a crucial element in facilitating social communication. While the
significance of eye movements as social cues is widely acknowledged, the

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program's insistence on eye contact as a prerequisite for human interaction may
be subject to scrutiny, particularly in light of the fact that blind children can
develop robust social skills without relying on visual cues.
Moreover, the Son Rise principle of "joining" by imitating self-stimulating
behaviors appears to draw inspiration from Dance and Movement Therapy,
suggesting an eclectic approach that borrows elements from various therapeutic
modalities.
Although the Son Rise program's focus on creating enjoyable experiences
and fostering learning and self-regulation through positive interactions is
plausible, some aspects of its methodology warrant further examination.
Clarification is needed regarding the concept of "bonding" and its precise role in
the program, while the assumption that imitation can recreate missed
developmental milestones may require empirical validation. Nonetheless, the
program's overarching goal of nurturing deep connections and promoting growth
and development in children with autism reflects a commendable commitment to
supporting individuals on the spectrum and their families.
The Son Rise program, known for its robust commercialization efforts, has
taken steps to protect its intellectual property by copyrighting its name and
trademarking the title of its institution, the Autism Treatment Center of America.
However, criticisms have emerged regarding the program's portrayal of Applied
Behavior Analysis (ABA), with accusations of inaccurate statements and a
tendency to caricature the ABA perspective in a manner unbecoming of
professional discourse within the mental health community.
Despite its widespread commercialization, the Son Rise program has yet to
undergo a comprehensive outcome study evaluating its efficacy in treating
autistic children. While a feasibility study involving twelve children has been
conducted, questions linger regarding the program's fidelity to its principles,
particularly given the emphasis on sincerity and heartfelt engagement as
prerequisites for success. This raises concerns about the consistency of
intervention delivery and other factors crucial to the interpretation of outcome
studies, a point underscored by Williams, who questioned the adequacy of
treatment fidelity in such studies.

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Moreover, research conducted by Williams and Wishart on family
experiences with the Son Rise program revealed a disparity between perceived
benefits and drawbacks. Notably, the absence of formal studies examining
adverse events further complicates the understanding of the program's overall
impact on families and individuals with autism.
In the context of the National Center for Complementary and Alternative
Medicine (NCCAM) classification system, the Son Rise program exhibits
characteristics of both the manipulative and transcendental classes. While
aspects of manipulation may be present, such as the commercialized nature of
the program and its copyrighted and trademarked elements, the program also
espouses a transcendental belief in the essential role of caregiver sincerity and
heartfelt engagement in achieving successful outcomes. This duality underscores
the complexity of evaluating alternative treatment approaches within the realm
of autism intervention.
Aims and Techniques of Sensory Integration Therapy
The HANDLE (Holistic Approach to NeuroDevelopment and Learning
Efficiency) method, developed by Judith Bluestone and marketed through the
HANDLE Institute, encompasses a range of therapeutic approaches and devices
aimed at addressing various aspects of neurodevelopmental challenges. Autism,
according to practitioners of HANDLE, is viewed as an extreme manifestation of
an anxiety disorder, often accompanied by hypersensitivities, low muscle tone,
and digestive issues, forming part of a broader syndrome.
One notable aspect of HANDLE therapy involves the use of red and blue
"3D" glasses, as described by Westhoff. These glasses are purportedly employed
to encourage both eyes to work in concert, thereby potentially improving visual
coordination. However, the rationale behind this approach remains somewhat
obscure, especially given that most children with uncorrected strabismus, a
condition involving misalignment of the eyes, are not diagnosed with autism.
In addition to the utilization of specialized glasses, HANDLE therapy
incorporates a variety of unconventional exercises. For instance, drinking through
a twisted "crazy straw" is purported to stimulate rhythmic coordination between
the brain hemispheres, cranial nerves, and eye convergence, purportedly
preventing light sensitivity associated with visual coordination issues. However,

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the scientific basis for such claims is tenuous at best, and the relevance of these
exercises to autism remains unsubstantiated.
Another HANDLE exercise involves face-tapping along the lines of the
trigeminal nerve, synchronized to the rhythm of a familiar nursery rhyme. This
practice, which also extends to tapping above the ears to purportedly enhance
hearing via bone conduction, lacks a clear connection to autism and is met with
skepticism regarding its efficacy.
Furthermore, HANDLE therapy incorporates exercises aimed at enhancing
interhemispheric integration and differentiation of fingers and hands through
interlocking and alternating finger movements. However, the purported link
between these exercises and autism is not elucidated, leaving their efficacy in
addressing autism-related challenges uncertain.
Interestingly, some HANDLE techniques, such as reflexology, draw
inspiration from complementary and alternative medicine practices. Yet, the
application of reflexology in the context of HANDLE therapy is deemed
implausible by critics, further highlighting the need for rigorous scientific scrutiny
of such methodologies within the realm of autism intervention.
While proponents of the HANDLE approach assert that autism represents
an extreme manifestation of anxiety disorder, the plausibility of this claim
remains debatable, particularly in light of the treatment methods endorsed by
HANDLE practitioners. Indeed, the therapeutic activities recommended by
HANDLE focus predominantly on integrating the functioning of both hemispheres
of the brain, with little direct emphasis on alleviating anxiety-related symptoms.
While it is conceivable that anxiety may play a role in certain cases of autism, the
logical connection between anxiety and the proposed treatment methods is not
explicitly established within the HANDLE framework.
Furthermore, the effectiveness of HANDLE interventions in addressing core
symptoms of autism, such as poor communication between the two sides of the
brain, is called into question by the lack of empirical support. While some
individuals with agenesis of the corpus callosum, a condition characterized by the
absence of the bundle of nerve fibers connecting the brain's hemispheres, may

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also exhibit autistic traits, it is implausible that HANDLE exercises could rectify
such a significant developmental anomaly.
The evidentiary foundation for HANDLE remains sparse, with limited formal
research conducted to assess its efficacy. For instance, Suliteanu conducted a
before-and-after study involving twenty apparently non-autistic children in a
Mexican orphanage, employing a combination of HANDLE techniques such as
face-tapping and dietary modifications. While Suliteanu reported positive
outcomes, the study lacked investigation into potential adverse events, leaving
the safety profile of HANDLE interventions largely unexplored.
Similarly, another study featured on the HANDLE Institute website involved
five clients diagnosed with autism or similar conditions, who underwent
individualized HANDLE treatments over several months. These treatments
included activities like using "crazy straws" and engaging in tongue exercises while
looking in a mirror. While the therapist reported various improvements for each
student, the absence of adverse event monitoring raises concerns about the
potential risks associated with HANDLE interventions.
Within the framework of the National Center for Complementary and
Alternative Medicine (NCCAM) categories, HANDLE appears to align with the
manipulative class, given its reliance on unconventional techniques and the
limited empirical support for its efficacy. Despite the fervent advocacy of its
proponents, HANDLE's plausibility and safety profile remain subjects of ongoing
scrutiny within the scientific and medical communities.
Biofeedback emerges as a therapeutic approach aimed at empowering
clients to gain mastery over various aspects of bodily functioning, such as
relaxation, through the utilization of techniques that involve the visual display of
physiological measurements. When targeting brain functioning specifically, these
methods are often referred to as "neurofeedback." Proponents of biofeedback
therapy for autism attribute autistic behaviors to potential disruptions in brain
functioning, positing both hyperconnectivity and hypoconnectivity within neural
networks as contributing factors.
Initially proposed as a potential treatment for autism in the 1990s,
biofeedback holds promise in assisting individuals in acquiring control over

19

typically involuntary bodily functions, including the modulation of specific brain
wave patterns. These patterns serve as indicators of the collective activity of
neuronal groups, offering insight into the underlying mechanisms of autistic
symptomatology.
The plausibility of biofeedback therapy for autism is underscored by the
well-established association between genetic and nervous system anomalies and
the condition. Given this understanding, it stands to reason that alterations in
nervous system activity could manifest as observable changes in autistic
symptoms. However, it is essential to acknowledge that this perspective may
overlook the influence of learned behaviors resulting from the lived experience of
autism and societal responses to autistic symptoms.
Indeed, the reliance on a "pathophysiologic rationale" in advocating for
biofeedback therapy implies a simplistic understanding of the complex interplay
of factors contributing to autism. By extrapolating from neurobiological
abnormalities to the assumption that a mere reversal or redirection of these
elements can yield effective treatment outcomes, proponents may overlook the
nuanced nature of autism spectrum disorder and the multifaceted interventions
required to address its diverse manifestations.
Moreover, literature discussing biofeedback as a potential treatment for
autism often emphasizes the plausibility of its mechanisms, delving into detailed
explanations of how anomalies in brain connections may contribute to the
manifestation of autistic symptoms. However, rather than presenting robust
outcome studies, much of the published material tends to focus on theoretical
underpinnings, thereby obscuring the lack of empirical evidence supporting its
efficacy.
While some research purports to validate the effectiveness of biofeedback
for autism, these studies often suffer from methodological limitations. Many are
characterized by uncontrolled, unblinded designs, relying on pre- and post-
treatment assessments analyzed through multiple t-tests rather than more
appropriate multivariate analyses. Notably, a randomized controlled trial failed to
demonstrate any significant effect of biofeedback on autistic symptoms,
regardless of whether changes in brainwave patterns were observed.

20

Furthermore, despite sporadic mentions of adverse events associated with
biofeedback, there has been a notable absence of systematic data collection in
this regard. While isolated reports suggest potential side effects such as nausea,
irritability, headache, and cognitive impairment, the causal relationship between
these occurrences and the treatment remains unclear. Only one documented
case of regression in an autistic child's behavior directly addresses concerns
regarding the safety and efficacy of biofeedback for autism, highlighting the need
for further investigation into its potential risks and benefits.
Ultimately, biofeedback for autism emerges as an alternative psychotherapy
lacking a robust evidence base. Within the framework of the National Center for
Complementary and Alternative Medicine (NCCAM) categories, it falls within the
manipulative class, underscoring the need for cautious interpretation of its
purported therapeutic benefits within the realm of autism treatment.
Le packing, an unconventional treatment method, involves enveloping
autistic children in chilled, wet sheets while leaving their heads exposed, all the
while conducting psychoanalytic therapy sessions that can last up to six hours.
This technique is predominantly utilized for self-harming autistic children and
those exhibiting psychotic symptoms, and occasionally for individuals with eating
disorders, as noted by Spinney.
Originating primarily in France, le packing has garnered significant
controversy due to its lack of empirical evidence supporting its efficacy and the
psychoanalytic rationale underpinning its use. In 1996, the French National
Consultative Ethics Committee for Health and Life Sciences explicitly stated that
there was no substantiated evidence for the effectiveness of le packing or the
psychoanalytic interpretation of autism.
While le packing remains largely confined to French clinical practice, efforts
have been made to introduce it to the English-speaking world. A lecture held at
the prestigious Tavistock Institute in London served as a platform for its
dissemination, sparking widespread condemnation from various quarters.
Notably, a group of renowned autism researchers collectively issued a consensus
statement rejecting the use of le packing, citing its lack of empirical support and
potential for harm.

21

In response to mounting criticism, a team comprising Goeb, Bonelli, Jardri,
Kechid, and L’enfant announced the initiation of a randomized controlled trial to
evaluate the efficacy of le packing. This trial, reportedly funded by the French
government, aimed to provide empirical evidence regarding the treatment's
effectiveness. However, despite the announcement of this trial, the present
author has been unable to locate any published results, leaving the efficacy and
safety of le packing unresolved and subject to ongoing debate within the autism
community.
Le packing's origins in France have often been attributed to the American
psychiatrist Michael Woodbury, yet historical accounts trace similar practices of
"wet packs" for mental illness treatment back to the 1940s in the United States.
Moreover, the broader tradition of hydrotherapy, encompassing baths, wraps,
and water consumption, dates back to the nineteenth century, where it was
embraced as a therapeutic regimen offering both relaxation and treatment
benefits akin to those of European spas. Interestingly, hydrotherapy was not
exclusive to adults but extended to children as well, underscoring its historical
relevance in the realm of pediatric care.
But is le packing a plausible treatment approach? Its adoption aligns closely
with the French psychoanalytic perspective on autism, which posits that the
disorder arises from early-life relational disturbances, particularly within the
mother-child dynamic, leading to the development of profound defensive
behaviors and social withdrawal. However, this viewpoint stands in stark contrast
to prevailing evidence linking autism to genetic factors rather than solely
environmental influences. Additionally, studies indicate that parents of autistic
children do not exhibit significantly higher levels of dysfunctionality than can be
attributed to the inherent stressors of caring for children with atypical
development.
Despite the proposed theoretical underpinnings, the efficacy of le packing
remains uncertain, with the much-discussed randomized controlled trial led by
Goeb et al. yet to be published. Consequently, the absence of published data
makes it impossible to ascertain whether adverse events were associated with le
packing or if proper monitoring for such events was conducted. While the
presence of therapists during the procedure may mitigate the risk of severe

22

physical harm, concerns persist regarding the emotional toll on the child
undergoing the treatment. As Linden aptly noted, this ethical dilemma is
compounded by the lack of concrete evidence supporting the treatment's
efficacy, rendering le packing ethically questionable in its current state.
In terms of the National Center for Complementary and Alternative
Medicine (NCCAM) categories, le packing can be considered a manipulative
approach, albeit one that incorporates a psychoanalytic dimension not typically
found in other manipulative treatments. Nonetheless, the ethical and practical
concerns surrounding its use underscore the need for rigorous evaluation and
scrutiny before its widespread adoption in clinical practice.
Dolphin Assisted Therapy stands as one among several animal-assisted
interventions aimed at addressing the multifaceted needs of children grappling
with severe disabilities. These disabilities encompass a spectrum of challenges
spanning physical impairments, emotional disturbances, and cognitive limitations.
Drawing inspiration from the pioneering research of John Lilly on dolphin
communication, Dolphin Assisted Therapy often entails facilitating interactions
between children and dolphins, with activities ranging from swimming alongside
these marine mammals to engaging with them from a platform in the water. The
underlying premise hinges on the belief that dolphins, renowned for their
sociable nature and purportedly heightened sensitivity to human needs, will forge
a special bond with disabled children, thereby serving as a catalyst for their
improvement across various domains.
Notably, proponents of Dolphin Assisted Therapy have advanced
speculative claims regarding the therapeutic potential of dolphin communication.
It is suggested that the unique sounds emitted by dolphins through their
echolocation system possess the remarkable ability to modulate human brain
waves, promoting relaxation and bolstering the body's immune defenses.
However, despite these assertions, robust empirical evidence substantiating the
effectiveness of Dolphin Assisted Therapy in ameliorating developmental
disabilities or other challenges remains conspicuously lacking.
In fact, concerns have been raised regarding the safety and ethical
implications of Dolphin Assisted Therapy. Captive dolphins, subject to the
confines of artificial environments, may exhibit signs of distress or aggression,

23

posing potential risks to participants. Moreover, the absence of standardized
regulations or professional credentialing systems governing the practice of
Dolphin Assisted Therapy raises additional qualms about its legitimacy and
accountability.
Although Dolphin Assisted Therapy may incorporate the expertise of
speech, physical, or occupational therapists as part of its treatment regimen, it
operates within a regulatory vacuum, lacking robust oversight mechanisms to
ensure adherence to ethical standards and best practices. As such, while
proponents tout its potential benefits, the dearth of empirical support and the
presence of potential hazards underscore the need for cautious appraisal and
further research into the efficacy and safety of this intervention.
Dolphin Assisted Therapy (DAT) is undoubtedly categorized as an alternative
treatment, a designation supported by various factors. Firstly, the notion that
dolphins possess a special affinity for humans is dubious, as such relationships are
typically observed only among certain domesticated animals, conditioned by
positive human interaction over time. Additionally, while it is acknowledged that
sound and light patterns can temporarily alter brain waves, there is scant
evidence to suggest that dolphin echolocation sounds yield such effects, let alone
promote relaxation or boost immunity.
Even if one were to entertain the hypothetical possibility of these
outcomes, questions persist regarding their relevance to addressing
developmental disabilities. For instance, how would relaxation impact conditions
predominantly characterized by cognitive or neurological impairments? Similarly,
what role would enhanced immune responses play in conditions not primarily
associated with infections?
Furthermore, DAT lacks empirical evidence supporting its effectiveness and
raises concerns about potential harm, both directly and indirectly. Notably, the
allocation of resources towards DAT may divert families from pursuing
conventional treatments with established efficacy, exacerbating the burden of
disability management.
Practitioners of DAT typically receive training in informal settings and lack
recognized credentials endorsed by established professional bodies. Instead of

24

aligning with mainstream medical practices, DAT seems to draw inspiration from
Romanticism and Idealism, philosophies extolling the power and beauty of nature
and privileging spontaneous animal life over human limitations. In embracing
these foundational beliefs, DAT aligns with the ethos of many alternative
psychotherapies, although not all.
Given its philosophical underpinnings and unconventional approach,
categorizing DAT within the framework of the National Center for Complementary
and Alternative Medicine (NCCAM) proves challenging, with its transcendental
nature suggesting a departure from conventional therapeutic paradigms. As such,
DAT remains a subject of debate, necessitating further scrutiny to clarify its
efficacy, safety, and philosophical orientation within the landscape of alternative
therapies.
The selection of treatments for psychological disorders is often influenced
by prevailing beliefs about the causes of these conditions. In the case of autism,
there has been a notable evolution in perspectives on its etiology, ranging from
early attributions to parenting factors, as proposed by Kanner, to contemporary
genetic explanations. Alternative psychotherapies for autism, some of which
originated decades ago, may have been conceived in alignment with earlier
beliefs but are now incongruent with current understandings and empirical
evidence.
Moreover, treatment decisions are shaped by assumptions regarding the
nature and manifestations of the disorder itself. A retrospective analysis of
editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM)
reveals shifting conceptualizations of autism since its initial inclusion in 1980.
Initially, affective disturbances were emphasized, later evolving to encompass
considerations of attachment deficits, and more recent editions incorporating
cognitive and language anomalies. Furthermore, while earlier iterations of the
DSM tended to depict autism as a uniform disorder with consistent symptoms
across cases, contemporary perspectives acknowledge a broad spectrum of
symptoms, with individual presentations likely to vary.
The landscape of therapy options for autistic disorders presents a unique
scenario. While Applied Behavior Analysis (ABA) is widely considered the
conventional and established treatment, its evidence base has been questioned

25

despite its theoretically plausible framework. On the other hand, DIR/Floortime,
an increasingly popular alternative, lacks robust research support, though
ongoing studies hold promise, albeit without published findings thus far.
However, certain aspects of the DIR theoretical framework have raised doubts.
Regrettably, a plethora of therapies offered for autism treatment fall under
the category of alternative psychotherapies. These interventions typically suffer
from weak or nonexistent empirical support and questionable plausibility.
Moreover, some of these therapies carry the risk of direct harm to clients,
although there has been insufficient exploration of adverse events. Additionally,
the pursuit of such therapies has the potential to deplete family resources,
indirectly contributing to harm. Thus, careful consideration of the efficacy, safety,
and alignment with current scientific understanding is imperative when
evaluating therapy options for autistic disorders.

26

Chapter 2: Techniques for Auditory Training

The treatments discussed in preceding chapters of this book predominantly
address mental illness, which conventionally encompasses disturbances in
emotional well-being, with or without accompanying cognitive, behavioral, or
physical impairments. While psychotherapies are typically regarded as
interventions for mental health issues across all age groups, certain psychological
treatments are specifically tailored to address cognitive and behavioral
challenges. These treatments are particularly targeted towards school-aged
children with special needs or older individuals whose life functioning is hindered
by developmental disabilities such as autism. In terms of the National Center for
Complementary and Alternative Medicine (NCCAM) classifications, alternative
interventions for such issues may encompass both biologically based and
manipulative approaches, or may utilize the "Veritable" form of energy therapies.
Psychological interventions for individuals with special needs aim to
enhance their ability to engage effectively in educational settings. These
interventions may target improvements in physical functioning, behavior
management, sensory processing, cognitive skills, or social interaction. It's
noteworthy that educational methods, by their very nature, could be regarded as
psychological treatments. Given their close association with educational
requirements, these interventions are often selected or administered by school
personnel. They are commonly integrated into the realm of "special education," a
broad term encompassing diverse treatments tailored to individuals with varying
degrees of developmental challenges, ranging from specific disabilities like visual
impairments to more pervasive developmental disorders.
The link between psychological treatments for educational difficulties and
school environments may appear self-evident, but it merits discussion due to its
implications for the likelihood of encountering alternative interventions. The field
of education, particularly special education, has been identified as uniquely
susceptible to trends and fads. A fad is characterized by its rapid adoption in the
absence of substantial research validation, widespread popularity or recognition,

27

and subsequent decline—often in response to contradictory research findings or
the emergence of new trends. Fads are often propelled by ideological beliefs
rather than empirical evidence, and may be championed by professional groups
with vested interests or influenced by the personal anecdotes of advocates.
Therefore, the association between psychological treatments in education and
the potential for encountering alternative approaches underscores the
importance of critically evaluating interventions based on their empirical support
and alignment with evidence-based practices.
An illustrative instance of a fad within the realm of special education is the
adoption of Facilitated Communication (FC), a method purported to aid non-
speaking individuals in communicating through the assistance of a facilitator
using an alphabet board or keyboard. Originating in Australia during the 1980s as
a means to facilitate communication for children with cerebral palsy, FC quickly
gained traction globally and was subsequently extended for use by autistic
children and individuals with other developmental disabilities. Despite evidence
indicating that adult facilitators were the actual source of communications and
that false allegations of abuse, including sexual abuse, were made through this
method, FC continued to be endorsed and taught by various agencies and
universities well into the early 2000s. However, its popularity plummeted
dramatically following revelations regarding its efficacy and the risks associated
with its use.
In addition to short-lived fads, the landscape of special education has also
been characterized by the prolonged utilization of treatments lacking plausibility
or empirical support. This poses challenges when attempting to categorize these
interventions as "alternative," as they often enjoy widespread acceptance and
frequent usage within the field, rendering them more conventional than
unconventional. Paradoxically, it seems commonplace to gravitate towards
unvalidated methods in special education, while advocating for plausible and
evidence-based techniques is viewed as unconventional.
As a consequence of this inclination towards questionable treatments, the
special education arena presents numerous options for scrutiny in this text. The
following chapter will delve into a select few techniques that have endured over
time and have garnered an air of orthodoxy within the field. These encompass

28

Sensory Integration Therapy, interventions involving altered auditory experiences,
and non-physical treatments for autism spectrum disorders. Each treatment will
be examined in detail, exploring its alignment with established knowledge and
evidence of its efficacy. Furthermore, a section within the chapter will delve into
the historical context surrounding these treatment modalities.
Objectives and Techniques in Sensory Integration Therapy
Sensory Integration Therapy (SIT) comprises a repertoire of approaches
developed and predominantly administered by occupational therapists. While
predominantly rooted in physical interventions, SIT is categorized as a
psychological treatment due to its overarching objectives aimed at fostering
psychological and behavioral transformations conducive to educational
advancement. Although commonly attributed to the pioneering work of
occupational therapist A. Jean Ayres, the foundational principles of SIT trace back
much further, as elucidated later in this chapter.
Ayres delineated the concept of "sensory integration" as the neurological
process responsible for organizing sensory inputs from both the body and the
external environment, thereby facilitating effective utilization of the body within
its surroundings. For instance, deficits in sensory integration could manifest as
challenges in accurately reaching or kicking towards visually perceived targets, or
in gripping a crayon with the appropriate force to maintain control without
inadvertently damaging it. According to Ayres, sensory integration or processing
disorders—terms not formally recognized in diagnostic manuals such as DSM-5—
stemmed from cortical dysfunctions impeding the harmonization of central and
peripheral nervous system activities, as well as the modulation of both excitatory
and inhibitory processes. It was postulated that such imbalances were implicated
in various conditions including cerebral palsy, learning disorders, attention
deficits, and autism.
Sensory Integration Therapy (SIT) employs a repertoire of techniques
centered around engaging in full-body movements that aim to provide vestibular,
proprioceptive, and tactile stimulation. It is believed that such stimulation
enhances the functioning of the relevant sensory organs. Activities such as
swinging, balancing, limb movement, and exposure to various tactile experiences
are thought to induce changes in sensory capacities, ultimately improving the

29

brain's ability to process and organize sensory information effectively.
Additionally, SIT practitioners emphasize the importance of implementing an
appropriate "sensory diet" tailored to manage a child's arousal levels and
attention to the environment. This sensory regimen may involve adjustments in
illumination or sound levels to either calm or stimulate children. Moreover, the
sensory diet may incorporate techniques such as deep pressure application, skin
brushing, textured toys, weighted vest usage, or envelopment in a "body sock."
The anticipated outcomes of these interventions include enhancing a child's
attention span, observational skills, and memory retention, consequently
facilitating learning within classroom settings.
While SIT methods are highly personalized to meet individual needs, they
are grounded in several core principles. Firstly, the principle of the Just Right
Challenge dictates that activities should present noticeable challenges to children
while ensuring that they consistently achieve success. Secondly, the principle of
the Adaptive Response posits that when children are appropriately challenged,
they will develop novel and beneficial behavioral and cognitive strategies. Thirdly,
the principle of Active Engagement underscores the importance of therapists
actively engaging children in play rather than merely entertaining them. Lastly, SIT
adheres to the principle of Child-Directedness, wherein therapists prioritize
following the child's cues, suggestions, and areas of interest and attention.
Sensory Integration Therapy (SIT) techniques have been integrated into the
individual educational plans (IEPs) of many children in school settings as part of
their treatment for learning disabilities or other developmental and educational
challenges. These IEPs are comprehensive documents tailored to meet the
specific needs of each child. Children recommended for SIT intervention often
exhibit a range of characteristics, including clumsiness, impulsivity, distractibility,
difficulties with transitions, sensory sensitivities (either over- or under-sensitivity
to touch, sound, or movement), as well as speech or other developmental delays.
In some cases, children may undergo screening using tools such as the Sensory
Integration and Praxis Test, although its reliability has been called into question
due to inconsistent scores across different administrations.
Interestingly, some practitioners employ treatments that closely resemble
SIT techniques without explicitly referencing SIT-related materials. For instance,

30

the Swedish Vestibularis Institute offers "sensorimotor therapy" to children and
adolescents experiencing challenges such as clumsiness, attention difficulties, and
academic underachievement. This therapy involves engaging in movement
patterns reminiscent of those observed in young infants, providing vestibular
stimulation through the use of a rotating chair, administering auditory stimulation
primarily to the right ear, applying tactile stimulation through techniques like
squeezing and brushing various body parts, and facilitating the practice of specific
athletic or play skills such as skipping rope. Despite not directly citing SIT, these
interventions share similarities with SIT principles and aim to address similar
underlying sensory and motor challenges.
Upon closer examination of Sensory Integration Therapy (SIT) through the
lens of established principles of perception and child development, it becomes
evident that this treatment lacks congruence with accepted understandings of
vestibular functioning, perceptual adaptation, and neural plasticity. Consequently,
its plausibility is brought into question. While it is widely acknowledged that
sensory information must be integrated and contextualized for optimal
functioning, the claims made by proponents of SIT appear dubious.
An important aspect of evaluating SIT is considering its alignment with the
ontogenetic schedule of sensory development. Advocates of SIT, such as Ayres
and her followers, argue that the significance of a sensory modality for overall
functioning is reflected in its chronological emergence during development. They
contend that vestibular and tactile sensitivities, which develop prenatally and
precede auditory and visual functioning, are foundational for later cognitive and
perceptual abilities. However, empirical evidence contradicts this assertion.
Individuals who experience impairment in vestibular or tactile sensitivity due to
nerve damage or nervous system deficits still demonstrate proficient cognitive
and perceptual processing skills, such as reading and language comprehension.
Furthermore, astronauts adapting to zero gravity, which drastically alters
vestibular experiences, exhibit no significant impairment in perceptual judgment
or cognitive performance. This resilience suggests that factors beyond sensory
inputs, such as memory and visual dominance, play a crucial role in sensory
processing and calibration. Therefore, the purported primacy of vestibular and
tactile senses in SIT's framework appears unsubstantiated in light of empirical
findings.

31

While the argument presented in the previous paragraph does not
definitively disprove the notion that touch and vestibular information play crucial
roles in early development, as asserted by proponents of Sensory Integration
Therapy (SIT), it does offer converging evidence against the plausibility of the SIT
theory. The absence of empirical support for the SIT perspective further weakens
its credibility. Moreover, there is a notable lack of evidence concerning
proprioception and kinesthesis, senses that SIT advocates deem significant but
are challenging to assess in infants and young children.
A fundamental premise of SIT is the assumption that stimulating a sense
enhances its effectiveness. While sensory experiences undoubtedly influence the
interpretation of sensory input, such as blind individuals learning to interpret
echoes to navigate their surroundings, the notion that sensory stimulation
universally improves sensitivity lacks empirical support. For instance, experiences
with language phonemes during infancy shape the categorization and response to
speech sounds. However, except for olfaction, where experiences can indeed
enhance detection and responsiveness, sensory experiences typically do not
decrease thresholds or enhance sensitivity. Nevertheless, sensory experiences
may exert broader effects, such as promoting the growth rate of preterm infants
through additional touch stimulation.
In essence, while sensory experiences undoubtedly shape perceptual
processes and behaviors, the assumption that sensory stimulation universally
enhances sensory functioning, as posited by SIT, lacks empirical substantiation.
This underscores the need for rigorous research to evaluate the validity of SIT
principles and their implications for developmental interventions.
Furthermore, the assertion that sensory stimulation universally enhances
sensory function is challenged by the lack of known effects of such stimulation on
sensory thresholds. It is difficult to conceive of circumstances in which a child
would not experience substantial touch and vestibular stimulation, even within a
relatively short lifespan. Touch is omnipresent, occurring both prenatally and
postnatally as body parts come into contact with each other and as the skin
interacts with surfaces due to gravitational forces. Similarly, vestibular stimulation
is inherent in fetal development as the mother moves, and in infant care activities
such as carrying, feeding, bathing, diapering, and dressing, which involve various

32

body movements. Caregivers instinctively respond to infant distress with rocking,
jiggling, and swinging movements, providing ample vestibular stimulation. The
near absence of vestibular stimulation would imply a severe lack of adult care,
endangering the infant's survival.
Moreover, advocates of Sensory Integration Therapy (SIT) seem to overlook
the concept of perceptual adaptation, which involves the adjustment of
perceptual responses following prolonged stimulation. Adaptation to touch, for
instance, results in decreased awareness of tactile sensations until a change in
touch occurs. Similarly, adaptation to limb position or visual stimuli leads to
systematic alterations in perception, albeit temporary ones. Notably, repeated
vestibular stimulation induces a reduction in reactivity, as evidenced by the
training regimen of astronauts preparing for zero-gravity environments.
However, conducting research to evaluate the effectiveness of SIT, as
defined by Ayres and others, poses significant challenges. The issues experienced
by children undergoing SIT are multifaceted and nebulous, encompassing
phenomena such as sensitivity fluctuations, distractibility, social and emotional
difficulties, and impulsivity. Consequently, determining which children should
participate in research studies and identifying appropriate outcome measures
presents a formidable hurdle.
If Ayres's proposition regarding vestibular disorders as the underlying cause
of various symptoms associated with learning disabilities were supported by
evidence, evaluating the efficacy of Sensory Integration Therapy (SIT) could
involve measuring vestibular responses. Vestibular stimulation, such as rotation in
a chair or warm water infusion into the ear, typically elicits predictable changes in
posture and involuntary eye movements known as nystagmus. Ayres argued that
children with learning disabilities, particularly those exhibiting abnormally short
or long durations of nystagmus following vestibular stimulation, would benefit
most from SIT. However, assessing nystagmus measurements as conducted by
Ayres and her colleagues poses several challenges, including the lack of reliability
between trials. Moreover, Ayres's method involved conducting tests in
illuminated environments, creating a conflict between vestibular and visual cues,
which could influence the results. Despite instructions to avoid fixating on
stationary objects post-rotation, children tested by Ayres may not have fully

33

understood or complied with the directions. Additionally, subsequent research
failed to validate the Ayres test as an accurate measure of vestibular functions.
The aforementioned challenges underscore the complexity of designing a
robust study to evaluate SIT. Despite extensive research in this area, meta-
analyses and systematic reviews have consistently yielded similar conclusions
over the years, finding no empirical support for the effectiveness of SIT. As early
as 1988, a critique questioned the efficacy of SIT, while by 1994, Hoehn and
Baumeister went further to declare it demonstrably ineffective. Subsequent
reviews, such as the 2009 study by Hyatt, Stephenson, and Carter, echoed these
findings, highlighting the absence of evidence supporting SIT despite two decades
of investigation. Notably, a recent study examining a treatment akin to SIT
reported overall positive outcomes but noted instances of "regressive" behavior
attributed to the treatment. This highlights the persistence of attempts to assert
the effectiveness of SIT despite contradictory evidence and acknowledged gaps in
knowledge.
Temple Grandin, a prominent high-functioning autistic professor of animal
husbandry, has lent support to the concept of sensory issues in autism, drawing
parallels between SIT techniques and her childhood use of a "squeeze machine"
she constructed for self-compression. In certain circles, Grandin's perspective,
influenced by the "wounded warrior" belief that individuals afflicted with a
disorder possess unique insight into its treatment, has garnered significant
attention.
In NCCAM terminology, SIT can be categorized as a manipulative treatment
method.
Numerous treatments targeting cognitive, emotional, and learning
disorders bear resemblance to Sensory Integration Therapy (SIT) in their
underlying principles but pivot towards auditory rather than vestibular and tactile
stimulation. These auditory training methods operate under the premise that the
regulation and modulation of auditory experiences can induce changes in sensory
and neural processes, thereby enhancing the performance of individuals with
developmental disabilities. Among these methods, two major categories emerge:
Auditory Integration Therapy (AIT) and Computer-Based Auditory Training (CBAT).

34

AIT entails exposing patients to electronically filtered and modified music,
aiming to address a spectrum of disorders including attention-
deficit/hyperactivity disorder (ADHD), autism, dyslexia, learning disorders, and
depression, with the majority of patients being children or adolescents. One
prominent method within AIT originated in the 1970s under the direction of
French otolaryngologist Guy Berard. Berard's approach involves conducting
auditory assessments to identify areas of hyperacuity, where patients exhibit
heightened sensitivity to specific sound frequencies. Subsequently, music is
filtered to attenuate the intensity of these frequencies during a total of ten hours
of exposure, distributed across two thirty-minute sessions daily over ten days.
Popular music is channeled through specialized devices such as the
Audiokinetron, Audio Tone Enhancer/Trainer, or EARS Education and Retraining
System. These devices employ frequency modulation techniques, randomly
clipping frequencies above or below 1000 Hz for varying durations ranging from
0.25 seconds to 2 seconds. However, the United States Food and Drug
Administration (FDA) prohibited the importation of the Audiokinetron in 1993
due to its production of sound exceeding 130 dB, surpassing the intensity limits
mandated by the Occupational Safety and Health Administration (OSHA) for
exposure exceeding one hour daily.
Another French otolaryngologist, Alfred Tomatis, devised a similar auditory
intervention aimed at treating autism and related conditions. Tomatis's method
involves exposing children to music through a device known as the Electronic Ear,
which progressively filters out low frequencies. Additionally, the intensity of
sound directed to the left ear is diminished to foster the dominance of the right
ear. Children undergoing this treatment also engage in speaking and singing into a
microphone to listen to their altered voices. Concurrently, they interact with toys
designed to provide tactile and vestibular stimulation, akin to techniques
employed in Sensory Integration Therapy (SIT).
Both Berard and Tomatis failed to establish a solid research-based
foundation for their respective treatments. One proponent of the Tomatis
method has asserted that auditory stimulation leads to myelination of the
auditory pathways, enhancing processing speed, citing this claim to personal
communication. However, it is essential to note that hearing is functional even in
utero, and myelination primarily occurs due to maturational factors rather than

35

external stimulation. While the auditory system does exhibit some plasticity,
particularly in functions like sound localization, which necessitates adjustment as
the infant's head grows, this is not primarily driven by external auditory
stimulation.
Berard characterized areas of hyperacute hearing as "traumatizing
frequencies," a notion at odds with conventional understanding of auditory
processing. He likened AIT to physical therapy, suggesting that reducing intensity
was akin to gradually increasing the range of motion in a stiff joint. However,
Berard offered limited explanation regarding the mechanisms underlying
improvement. More recently, proponents of AIT, now referred to as Digital
Auditory Aerobics (DAA), have posited that the treatment exercises the muscles
controlling the ossicles in the middle ear. These muscles reflexively act to dampen
movement in response to excessively intense sounds.
Despite claims made by proponents, neither the Berard nor the Tomatis
method has garnered support from research evidence. The positive reception of
AIT has largely stemmed from a book penned by the mother of a child Berard
deemed completely cured of autism. Additionally, autism researcher Bernard
Rimland's endorsement played a significant role in popularizing AIT. Rimland and
Edelson reported "sufficiently promising" outcomes from 445 autistic children
whose parents paid $1,000 each for treatment in Oregon. However, the study
design lacked a placebo-treated comparison group. Subsequent attempts to
replicate these findings, including those by Mudford et al., proved unsuccessful. A
meta-analysis examining the efficacy of the Tomatis treatment yielded cautiously
supportive results, yet the overall study designs were deemed weak. In a more
recent series of case studies, only five out of eleven autistic children were
reported to experience significant benefits from the treatment.
While AIT methods are constrained in their ability to manipulate sound
stimulation and lack compelling incentives to capture attention, computer-based
techniques offer a diverse range of options that can readily engage individuals.
These methods leverage game formats, which are particularly effective in piquing
children's interest and enhancing motivation. Currently, various proprietary
software options are available, including Fast ForWord, Earobics, and Laureate
Learning Systems software. Much of the research and development in this

36

domain has been centered around Fast ForWord and its parent company,
Scientific Learning Corporation.
Computer-based auditory training methods primarily target phonological
awareness, which entails the capacity to discern between the intricate sound
structures inherent in speech. Fast ForWord, for instance, comprises seven
computer games that blend sound stimuli with captivating visual presentations.
Among these games, three focus on memory retention for phonemes (i.e., speech
sound units), while the remaining four address vocabulary, syntax, and
morphology. Initially, the games employ acoustic modifications to simplify the
tasks, gradually transitioning towards more natural speech patterns. During
treatment, children engage in these games for one hundred minutes per day, five
days a week, spanning up to six weeks or until predefined proficiency levels are
attained. The efficacy of these games hinges on improvements in phonological
awareness, such as swift discrimination between syllables like "BA" and "DA".
All computer-based methods for auditory training offer a distinct advantage
over ambient music techniques utilized by Berard and Tomatis: they excel in
enhancing children's motivation and attention to the delivered sounds.
Furthermore, the theoretical framework underpinning Fast ForWord is highly
plausible. Proficient language use, particularly in reading, relies heavily on skills
such as comparing sounds, associating them with visual patterns, and possessing
strong phonological awareness. These foundational skills are intricately linked to
auditory processing abilities. Effective auditory processing demands rapidity, as
the defining characteristics of speech sounds are contingent upon minute,
sequential alterations within sound patterns; failure to detect even a single micro-
change can impede speech sound recognition. It stands to reason that any
intervention capable of accelerating auditory processing and bolstering
phonological awareness would likely contribute to the enhancement of higher-
level language skills. Nonetheless, the redundancies inherent in language may
mitigate the necessity for ultra-fine discriminations.
Regrettably, despite reports suggesting that techniques akin to Fast
ForWord enhance children’s capacity to identify swift sequences of speech and
non-speech sounds, the evidence supporting its efficacy in fostering language
skills and reading comprehension remains scant. While numerous children have

37

undergone treatment with Fast ForWord and analogous methods, data collection
under controlled conditions has been infrequent, and meticulous monitoring of
intervention fidelity or formal assessment of language difficulties has been
lacking. A randomized trial comparing the effects of Fast ForWord with
nonspecific treatments failed to demonstrate any advantage for Fast ForWord.
Similarly, a review encompassing sixteen studies on Fast ForWord and similar
interventions revealed improvements in phonological awareness but little impact
on language proficiency, spelling, or reading competence.
Assessing the efficacy of Fast ForWord is further complicated by various
factors. Impulsive children may exhibit a propensity to disengage prematurely
from the games, necessitating the presence of an adult monitor as recommended
by Scientific Learning Corporation, the proprietor of Fast ForWord. Such monitors
are advised to employ strategies like praise, relaxation breaks, and supportive
feedback to sustain children's engagement, particularly in cases where multiple
children are participating simultaneously or where attention or learning
difficulties are present. Active attention is deemed crucial for the success of the
treatment.
Auditory integration therapies may be categorized as manipulative within
the framework of NCCAM classifications.
Sensory integration and auditory integration techniques have found
application in treating autism spectrum disorder (ASD) as well as a diverse array
of childhood developmental issues necessitating specialized education. However,
despite their widespread use, the effectiveness of these techniques remains
uncertain, as highlighted earlier in this chapter. In contrast, Chapter 1 delved into
the discussion surrounding two prominent therapies for autism: Applied Behavior
Analysis (ABA) and Developmental, Individual-differences, Relationship-based
therapy (DIR), also known as Floor Time.
Both ABA and DIR boast plausible theoretical underpinnings. ABA draws
upon the principles of operant conditioning elucidated by B. F. Skinner. Its primary
objective is not to address the core deficits of autism but rather to modify
behavior patterns, particularly those linked to social and communicative
behaviors, through reinforcement techniques. On the other hand, DIR is
grounded in a synthesis of established concepts proposed by Piaget and Freud.

38

As previously explored, ABA enjoys a robust evidential foundation, although
subsequent replications have not consistently replicated the strong effects
observed in initial studies, which were marred by certain methodological flaws. In
contrast, DIR has garnered only limited empirical support, with proponents
displaying minimal enthusiasm for bolstering its evidentiary basis.
Furthermore, this chapter has also touched upon other unconventional
treatments for autism, albeit less commonly employed within the context of
special education or developmental disabilities. Attachment Therapy, once
considered a viable approach for autism treatment, has been discussed in some
circles. Additionally, strategies like rejecting vaccination in attempts to prevent
autism, as well as interventions involving chelation or hyperbaric methods, fall
beyond the purview of the current chapter.
The therapy known as "patterning," or Doman-Delcato patterning therapy,
originated in the 1970s under the direction of physical therapist Glenn Doman.
Initially conceived as a treatment primarily aimed at children with cerebral palsy
or other physical impairments, Doman's 1994 book expanded the scope of
patterning to encompass mental retardation, hyperactivity, and autism,
positioning it as a potential psychotherapy. Like many alternative
psychotherapies, patterning hinges on the notion that regression to infantile
experiences can somehow replicate or stimulate developmental progress.
Proponents of patterning attribute cognitive and behavioral issues to deficiencies
in brain development. They posit that by repeating infant movement patterns, it
is possible to rebuild an injured brain and foster typical development in both
brain function and behavior.
However, as noted by Hines in a comprehensive review, the plausibility of
patterning therapy is dubious in light of our current understanding of brain
function. Furthermore, the evidence supporting its effectiveness is exceedingly
weak, and there exists the potential for indirect harm stemming from patterning
treatment. The American Academy of Pediatrics has taken a firm stance against
this therapy, passing resolutions rejecting its use.
Despite this, patterning therapy continues to be practiced, particularly by
occupational therapists, a professional group often employed by schools and
institutions focused on developmental disabilities. In European contexts, physical

39

manipulation methods similar to patterning have been utilized by occupational
therapists in countries like Germany and the Czech Republic. For instance, the KIT
method from Germany has been described as exerting control over the child
through physical and emotional means. Another method, Vojta therapy, involves
repeating infantile reflex movements akin to the patterning approach. Advocates
of the Vojta method claim various benefits, including improved language skills.
However, a demonstration available on YouTube suggests that the Vojta
treatment can be distressing for the child involved.
The Vojta website attempts to normalize the child's crying during
treatment, attributing it to a natural newborn reaction rather than pain. However,
this may inadvertently mislead parents into believing their child is experiencing
distress. Both the KIT method and Vojta therapy lack substantial evidence
supporting their efficacy, and they carry the potential to inflict emotional burdens
on children. Overall, these manipulative methods for children remain implausible
and warrant skepticism in their application.
Historical Context of Interventions for Developmental
Disabilities
While contemporary treatments like SIT, AIT, ABA, DIR, and others may
appear to be modern innovations emerging in the latter half of the twentieth
century, their fundamental principles and even certain techniques can be traced
back to much earlier periods, including the era of the French Revolution and
preceding it. There exists a clear lineage from philosophers such as Locke,
Condillac, and their intellectual successors to the therapeutic approaches
commonly employed today.
Despite their association with psychology and medicine, the historical roots
of special education treatments diverge significantly from those of other
therapeutic modalities discussed in this discourse. Instead, the history of
education serves as the primary wellspring of ideas informing the treatment of
developmental disabilities. A notable disparity between educational philosophies
and those of psychology or medicine lies in the absence of vitalistic themes within
educational approaches. While alternative psychological treatments often
incorporate notions of vitalism, educational strategies tend to eschew such
concepts. However, it's worth noting that families with children with disabilities

40

may sometimes harbor beliefs in the paranormal or perceive their children's
conditions as endowing them with paranormal abilities.
Educators historically have shown relatively little inclination to embrace the
ideas of Descartes and Kant, who postulated the existence of innate knowledge or
knowledge acquired through means other than sensory experience. Instead,
educational thought has predominantly adhered to some variant of
sensationalism, which posits that knowledge is derived exclusively from sensory
input, and intellectual capacity is built upon this foundation of sensory
information. The appeal of sensory experiences, which can be meticulously
planned and orchestrated by educators, may have outweighed the appeal of
notions concerning innate knowledge or processes that lie beyond direct
educational intervention.
John Locke's seminal work, "An Essay Concerning Human Understanding,"
positioned sensory information as paramount in the formation of knowledge, yet
he also acknowledged the role of innate processes such as reflection and
association in shaping this sensory material into coherent understanding. Building
upon Locke's foundation, George Berkeley's "An Essay Towards a New Theory of
Vision" emphasized the centrality of sensory experience, even in seemingly
inherent abilities like depth perception. However, it was Étienne Bonnot de
Condillac who fervently championed sensationalism, proposing a comprehensive
system that dismissed the influence of innate factors on human cognition.
In his groundbreaking treatise "Traité des Sensations," Condillac delved into
the origins of human knowledge through the allegorical depiction of a statue
devoid of any prior sensory impressions. This metaphorical statue, endowed
solely with the sense of smell, served as Condillac's canvas to illustrate his theory.
He argued persuasively that from this solitary sensory modality, all mental
operations could spring forth. Consciousness of smell, he posited, was equivalent
to the faculty of attention, while the hedonic experiences of pleasure or pain
associated with smells provided a foundational motivational principle.
Furthermore, Condillac elucidated how the lingering impressions of scents
formed the rudimentary substrate of memory, enabling the comparison of past
and present experiences. In his framework, imagination was depicted as the
faculty that could amalgamate these impressions, albeit potentially in a disorderly

41

manner—a concern echoed in the caution against excessive daydreaming or
indulgence in fantastical literature, which might blur the boundaries between
reality and fiction.
For Condillac and his adherents, the complete explanation of human
abilities necessitated no appeal to innate characteristics. Instead, individual
differences were ascribed to variations in exposure to sensory experiences, thus
underscoring the crucial role of education in providing a diverse array of pertinent
sensory stimuli. Of particular significance in this regard was the tactile sense,
deemed by Condillac to be an indispensable fount of information.
Philippe Pinel, a notable French physician and psychiatrist, embraced
Condillac's sensationalist perspective in his professional endeavors and
discussions with the ideologues, the intellectual leaders of the Revolutionary
period who advocated for a "science of ideas." Pinel's focus extended particularly
to the intricate workings of imagination and its potential role in both precipitating
and alleviating mental illnesses. In one poignant case recounted by Pinel, known
as the "guilty tailor," a patient plagued by an illusionary sense of guilt found
temporary relief through a simulated trial that proclaimed his innocence.
Pinel's utilization of imaginative interventions was not unique; indeed, such
theatrical methodologies mirrored the spirit and purpose of certain civic
commemorations during the Revolution. Organizers of these events fervently
believed in the persuasive power of sensory stimuli, especially visual imagery, to
imprint ideas onto the receptive "soft wax" of the mind. Their objective was to
forge a profound imaginative link between the concept of the republic and an
aura of opulent abundance, convinced that such associations would foster
unwavering political allegiance and indomitable courage among the populace.
While a purely sensationalist viewpoint might suggest that individuals with
developmental disabilities could be cured through immersive sensory
experiences, Pinel dissented from such a simplistic notion. He contended that
structural brain damage or other physical impairments could render recovery
unattainable, regardless of the therapeutic interventions employed. This stance
became particularly apparent in his assessment of the "wild boy" of Aveyron, a
seemingly feral and mute child discovered in 1798. Despite widespread

42

speculation, Pinel stood nearly alone in his somber conclusion that a cure for the
child's condition was unattainable.
Jean-Marc-Gaspard Itard, a protege of Philippe Pinel and a distinguished
scholar specializing in the study of the deaf and mute, embarked on a bold
journey inspired by the principles of sensationalism in his endeavor to rehabilitate
the enigmatic "wild boy" known as Victor. Over the course of several years, Itard
meticulously devised and executed a meticulously planned regimen, drawing
upon the insights of Condillac's sensory-based philosophy. With unwavering
determination, Itard set out to systematically exercise and enhance each of
Victor's sensory faculties, firmly believing in the transformative potential of
sensory stimulation.
Focusing on the premise that hearing constituted the linchpin of intellectual
development, Itard orchestrated treatment sessions meticulously tailored to
engage Victor's auditory faculties. Employing a methodical approach, he would
blindfold Victor to heighten his concentration on auditory stimuli, utilizing various
auditory cues such as the resonating chime of a bell or the rhythmic beat of a
drum. Through repetitive exercises, Itard endeavored to train Victor to replicate
these sounds, progressively refining his ability to discriminate between
increasingly subtle auditory nuances.
As Victor's auditory acumen advanced, Itard introduced more complex
challenges, transitioning to the realm of linguistic comprehension. Drawing
parallels between wind instruments and the human larynx, Itard guided Victor
through exercises aimed at deciphering the nuances of speech intonations.
Despite encountering setbacks, such as the difficulty in associating vowel sounds
with specific finger movements, Itard persisted, recognizing the incremental
progress made by Victor in discerning distinct speech patterns and emotional
nuances.
Although Victor never attained the ability to vocalize his thoughts, Itard's
exhaustive efforts bore fruit in other aspects. Through his diligent tutelage, Victor
exhibited a heightened sensitivity to speech inflections, demonstrating a
discerning ability to decipher emotions conveyed through intonation, ranging
from reproach and anger to sadness, scorn, and friendship. Itard's enduring
commitment to Victor's rehabilitation, grounded in the principles of

43

sensationalism, not only enriched the understanding of sensory-based
interventions but also underscored the profound complexities inherent in human
cognition and communication.
Edouard Seguin, a pioneering figure in the field of childhood disabilities,
took inspiration from Jean-Marc-Gaspard Itard's sensationalist methodologies
and brought them across the Atlantic to the United States. Upon establishing
institutions, notably in Cleveland, Ohio, Seguin applied Itard's principles within his
own framework, known as the "physiological method." This approach centered
on sensory training, with a particular emphasis on tactile sensation, facilitated
through specially crafted materials designed to stimulate the senses.
Unlike Itard, Seguin expanded the scope of intervention beyond sensory
training to incorporate motor skills development and a diverse array of age-
appropriate activities. Recognizing the importance of maintaining engagement
and motivation, Seguin advocated for frequent changes in activities to sustain
interest and foster progress. His innovative methods were epitomized by the
obituary in the New York Times, which lauded his groundbreaking treatment of
individuals with intellectual disabilities. Seguin's approach aimed at awakening
dormant intellects and nurturing stunted brains through a combination of manual
and optical training, challenging prevailing notions by suggesting that complex
ideas and sentiments could originate from peripheral nerves rather than solely
from the brain.
During Seguin's era, American practitioners avidly studied French
methodologies for working with handicapped children, leading to the
establishment of specialized institutions such as the Perkins Institute for the
Blind. These endeavors were characterized by a quest for innovative solutions to
address the needs of severely disabled individuals. One such remarkable case was
that of Laura Bridgman, a deaf and blind girl taken under the care of Samuel
Howe in the late 1830s. Howe, following in the footsteps of Itard and Seguin,
viewed Laura's condition as an opportunity to dissect various facets of human
nature. His endeavors to teach Laura to communicate through sign language and
familiar noises underscored his curiosity about the development of religious
beliefs in the absence of formal instruction.

44

Seguin's legacy endured as his methods continued to influence the evolving
landscape of special education, inspiring practitioners to explore novel
approaches in the quest to unlock the potential of individuals with disabilities.
Maria Montessori, a pioneering figure in the realm of childhood education,
drew upon the sensationalist methodologies championed by Edouard Seguin as
she embarked on her work with mentally deficient children in Rome. Mirroring
Seguin's approach, Montessori conducted a comparative study, contrasting the
development of older children with atypical trajectories with that of young,
typically developing children. Through her meticulous observations and analyses,
Montessori arrived at a profound insight: methods proven effective with one
group of children could indeed be extrapolated to benefit the other.
Central to Montessori's pedagogical philosophy was the belief in the innate
unfolding of each child's individuality, rejecting the notion of children as mere
"blank slates" awaiting inscription. Nevertheless, her educational methodologies
resonated strongly with a sensationalist perspective, placing a premium on
sensory experiences as catalysts for learning and development. For instance,
Montessori classrooms abound with manipulatives—tactile materials designed to
be arranged and rearranged, facilitating not only touch but also visual
experiences. These materials, carefully curated to isolate specific sensory
encounters, exemplify Montessori's commitment to providing holistic and
multisensory learning opportunities. Take, for example, the use of blocks varying
in size yet uniform in color, inviting children to engage both tactile and visual
faculties in their exploration and manipulation.
Montessori's educational paradigm, rooted in the principles of
sensationalism, quickly gained traction and popularity in the United States,
particularly within progressive educational circles. Its enduring appeal lies not
only in its efficacy but also in its alignment with the evolving understanding of
child development and learning.
Furthermore, Montessori's influence extended beyond her immediate
sphere, shaping the intellectual landscape in unexpected ways. Her
methodologies resonated with Jean Piaget, a luminary in developmental
psychology, who served as the president of the Swiss Montessori Society in the
1930s. Piaget, while advancing a complex constructivist theory and delving into

45

the depths of epistemology, remained anchored in a sensationalist framework,
emphasizing the crucial role of sensorimotor learning in intellectual growth.
According to Piaget, sensory experiences served as the wellspring of new
concepts, undergoing assimilation and accommodation as individuals interacted
with their environment.
Although Piaget's groundbreaking work initially gained little traction in
English-speaking countries, its eventual translation in the 1950s sparked a seismic
shift in educational paradigms worldwide. Piaget's emphasis on sensory factors as
pivotal in intellectual development reverberated across curricula designed for
both typically and atypically developing children, underscoring the enduring
legacy of sensationalist thought in the realm of education.
Contemporary iterations of sensory integration (SI) and auditory integration
methods maintain continuity with the foundational principles of sensationalism
that originated in pre-Revolutionary France and subsequently migrated to the
United States and other industrialized nations under the influence of figures like
Seguin and Montessori. Both past and present approaches share a fundamental
belief in the rehabilitative potential of sensory development, operating on the
premise that disabilities can be effectively addressed through the nurturing and
refinement of sensory capacities. Moreover, they espouse the notion that sensory
experiences serve as catalysts for strengthening and enhancing the respective
senses.
In the realm of sensory integration therapy (SIT), a profound influence is
exerted by the ontogenetic theory, which posits that senses emerging early in an
individual's development wield significant influence over subsequent
developmental trajectories. This theoretical framework, although not explicitly
inherent in the work of Ernst Haeckel, the renowned German biologist, finds
resonance in his seminal concept of "ontogeny recapitulates phylogeny." Within
the context of SIT, this theory underscores the pivotal role played by tactile and
vestibular senses, deemed paramount due to their early emergence in
developmental sequences. Proponents of SIT adhere to the notion that, under
appropriate conditions, ontogeny can mirror previous ontogenetic stages, thereby
shaping therapeutic interventions that leverage experiences associated with early
sensory development.

46

However, it is noteworthy that the utilization of touch and vestibular
stimulation predates the formulation of Haeckel's ontogenetic theory. Massage
therapy, for instance, has been ingrained in cultural traditions as a means of
alleviating physical discomfort for centuries. Even in the pioneering work of Itard
with Victor, tactile stimulation was integral to his overarching strategy aimed at
cultivating attentiveness by exposing the senses to vivid impressions. Victor's
regimen, which included extended hot baths and "dry frictions" of the spine
alongside tactile sensations like tickling, exemplifies the historical precedence of
incorporating sensory experiences into therapeutic interventions. Thus, while
contemporary methodologies draw inspiration from theoretical frameworks such
as the ontogenetic theory, they are deeply rooted in a rich historical tapestry of
sensory-based interventions aimed at fostering holistic development and well-
being.
While Itard and other proponents of sensationalist methodologies may not
have explicitly incorporated vestibular stimulation into their treatment regimens,
historical records indicate that such stimulation had been utilized for
psychological disorders as early as the eighteenth century. The understanding of
vestibular functions had been evolving over time, with notable contributions from
figures such as William Charles Wells, who conducted extensive studies on
phenomena like "giddiness," visual illusions, and involuntary eye movements like
nystagmus and ocular torsion. This evolving comprehension culminated in the
identification of Meniere's disease in 1861, elucidating the connection between
vestibular dysfunction and symptoms such as dizziness and nausea.
The therapeutic potential of vestibular stimulation gained traction with the
pioneering insights of Erasmus Darwin, who proposed the use of rotational
movements as a means to induce sleep—a notion expounded upon in his seminal
work, Zoonomia. Darwin's conceptualization laid the groundwork for the
development of practical interventions, such as the rotating chair constructed by
Joseph Mann Cox, designed specifically for this purpose. Cox's innovation found
practical application in the early 1800s, notably in the lunatic asylum of Cork,
where it was employed as a therapeutic tool for patients grappling with mental
illness.

47

Across Europe, similar endeavors emerged, with Cox's rotating chair finding
use in Germany, Denmark, and Sweden. While its precise therapeutic efficacy may
have been debated, anecdotal accounts suggest its utility in both correctional and
therapeutic contexts. For instance, a Swedish physician of the era recounted
instances where patients exhibiting irrational or aggressive behavior were placed
on the rotating chair until they either exhibited signs of contrition and promise
for improvement or succumbed to nausea-induced vomiting.
Simultaneously, across the Atlantic, American physician Benjamin Rush
explored the tranquilizing potential of vestibular stimulation, employing rotating
chairs for similar therapeutic ends. These historical precedents underscore the
multifaceted nature of vestibular stimulation as a therapeutic modality, with its
emergence likely influenced by a confluence of factors including ontogenetic
principles and pragmatic considerations stemming from the quest for effective
treatments for psychological disorders.
The sensationalist perspective on human development diverges from
nativist ideologies, embracing an empiricist approach that underscores the
paramount importance of experience, nurture, and education in shaping
individual developmental trajectories. This nurturing orientation gained further
momentum in the twentieth century with the ascendancy of behaviorism during
the 1920s, followed by the groundbreaking research on operant conditioning
spearheaded by B. F. Skinner and his cohorts. Their investigations delved into the
intricate mechanisms of reinforcement and how these principles could be
harnessed for educational purposes, heralding a new era of empirically driven
pedagogy.
The aftermath of World War II witnessed a heightened emphasis on the
utilization of propaganda and persuasion techniques to mold attitudes, reflecting
a growing awareness of the power of environmental influences in shaping societal
dynamics. Concurrently, concerns about the roots of totalitarianism spurred
inquiries into the environmental determinants of social behavior, catalyzing a
series of conferences sponsored by the Josiah Macy Jr. Foundation. These
gatherings delved into the realm of cybernetics and nurturist theories of
schizophrenia, exploring the intricate interplay between environmental factors
and developmental outcomes.

48

In the pre-1950s landscape, comprehension of biological underpinnings in
mental and behavioral functioning remained rudimentary, amplifying the appeal
of the optimistic outlook associated with nurture-oriented paradigms. Against the
backdrop of a world reeling from the ravages of war, the prospect of social
amelioration through nurturing interventions offered a glimmer of hope for a
brighter future.
Within this nurturing framework, the emergence and delineation of autism
took center stage, epitomized by Leo Kanner's seminal description in 1943.
However, antecedents of autistic behavior had been observed in the annals of
history, with figures like Edouard Seguin drawing attention to peculiar
manifestations of mental eclipse juxtaposed with exceptional prowess in specific
domains, such as music or mathematics. Despite such historical observations, the
distinctiveness of autism remained elusive, confounded by challenges in
discriminating it from childhood schizophrenia or sensory impairments,
particularly deafness, which share overlapping characteristics with autism,
including speech deficits.
In essence, the nurturing paradigm that permeated scholarly discourse
during this era underscored the pivotal role of environmental influences in
shaping developmental trajectories, laying the groundwork for nuanced
understandings of complex neurodevelopmental conditions such as autism within
the broader context of special education.
Leo Kanner is widely recognized as the first to provide a comprehensive
published account of autism, delineating what came to be known as "Kanner's
syndrome" and distinguishing it from childhood schizophrenia in his seminal 1943
work. Within this groundbreaking publication, Kanner meticulously documented
eleven cases afflicted by what he termed "autistic disturbance," thereby laying
the groundwork for subsequent research and diagnostic criteria in the field of
developmental psychology.
However, the later misinterpretation of Kanner's observations as attributing
autism to maternal coldness—the infamous "refrigerator mother" hypothesis—
was largely drawn from selective snippets of his work. While Kanner did make
passing remarks about certain mothers exhibiting obsessive tendencies, the
broader cultural milieu of the time, which placed a heavy emphasis on

49

environmental factors in shaping individual differences, likely contributed to the
emergence of this misguided interpretation. It is worth noting that Kanner's own
focus was not exclusively on maternal influences, as he speculated more broadly
about family dynamics and parental preoccupations with intellectual pursuits.
Contrary to the prevailing pessimism regarding autism and early nurturing
failures, Kanner's outlook remained relatively optimistic. He posited that schools
could potentially play a pivotal role in fostering the development of children who
faced rejection and alienation within their familial environments. Decades later,
Kanner revisited the cases he had initially documented, reporting that many of
these individuals had achieved remarkable outcomes—living independently,
attaining higher education, and securing gainful employment. This optimistic
prognosis, perhaps, contributed to the initial exclusion of autism as a distinct
disorder in the Diagnostic and Statistical Manual of Mental Disorders by the
American Psychiatric Association in its early editions. It was only with the
subsequent recognition of autism's clinical significance that it was formally listed
in the DSM-III in 1980, marking a significant milestone in the acknowledgment
and understanding of this complex condition.
The parallels between autism and other conditions addressed within the
realm of special education, coupled with the perspectives espoused by influential
figures like Leo Kanner, may have fostered a prevailing belief in the potential
efficacy of educational interventions in ameliorating autism. This viewpoint
gained traction during the post-war era, marked by a pervasive emphasis on
environmental factors as both the causes and remedies for a myriad of
conditions—ranging from medical ailments to political ideologies and social
biases. Against this backdrop, which was conducive to the adoption of teaching
methods rooted in B. F. Skinner's operant conditioning framework, the
groundwork for the groundbreaking work on discrete trial learning, later evolving
into Applied Behavior Analysis (ABA), was laid in the 1960s under the guidance of
Lovaas.
As time progressed, autism underwent a conceptual shift, transitioning
from being perceived as a psychological ailment to being recognized as a
developmental disorder. This paradigmatic shift implied that fostering
developmental progress became the primary approach to addressing the

50

challenges associated with autism. Reflecting this evolution, the erstwhile Journal
of Autism and Childhood Schizophrenia underwent a transformation, reborn as
the Journal of Autism and Developmental Disorders. Consequently, the
responsibility for treating autism shifted to special education classes, assuming a
role once reserved for addressing emotional concerns.
In a noteworthy convergence of perspectives, recent scholarship has
proposed a neuroconstructivist model of autism that resonates with both
Condillac's sensationalist framework and contemporary educational paradigms.
This model posits that peripheral sensory abnormalities disrupt the intricate
processes of synaptogenesis, synaptic pruning, and myelination, consequently
manifesting as autistic behaviors. Such a perspective underscores the
multifaceted nature of autism, highlighting the interplay between sensory
processing difficulties and the intricate neural processes underpinning cognitive
and behavioral manifestations.

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