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Aromatherapy and autism
By Jane Ellwood
While working in a Special School, I was asked by a Teacher to direct a series of Aromatherapy sessions with a small group of severely autistic children during the autumn term of September to December 1999. Essential oils were already being used in the school in other classes but not in any structured way.
How autism affects sensory perception is a very complex issue and I was interested to learn how autistic children would react to touch and fragrance, and whether or not it could be used to help with learning experiences. Working with autism can present particular problems for the Aromatherapist: some authors describe autism as a disorder of the senses rather than a social dysfunction, where each sense operates in isolation, the brain unable to organise the stimuli in any meaningful way (Hatch-Rasmussen 1995, p1). The brain relies on information gathered by various sensory receptors such as touch, smell, taste, hearing and sight in order to make sense of our environment. The disruption caused by a sensory disorder as to how the information is organised in the brain can have a devastating effect on how a situation is perceived and understood (Siegel 1996, p79). The author Donna Williams, herself autistic, makes many references to what she calls sensory shutdown, which occurs when an autistic individual is subjected to too much sensory stimuli and the brain cannot cope (Williams 1996, p126). Many people with autism will experience hypersensitivity to certain stimuli resulting in actual physical pain of sensory over-load (Waterhouse 1995, p19). Therefore I knew that I would have to plan my sessions carefully in order not to cause any undue anxiety with my group of children.
The group was a small class of 6 junior aged children, all severely autistic and non-verbal. The class comprised of a mixture of learning styles: 'Alan' was mono-sensory, only able to use one sense at a time; 'Michael' and 'Jon' being very tactile defensive children, usually resistant to any form of physical contact; 'Rod', a severely hyperactive child with obvious attention deficit, unable to sit still for longer than a few seconds at a time; 'Gary' was probably the most able of the group, a kinaesthetic learner and always very inquisitive: the remaining child 'James', solely a functional learner who chose isolation and was often very difficult and aggressive.
Before starting the sessions, I got permission from parents to use essential oils with the children. I also asked the parents to indicate specific medical needs and talked to the School Nurse about medications the children were on and to help identify any specific difficulties. One of the children was epileptic which contraindicated the use of essential oils associated with seizures (Aniseed, Fennel, Hyssop, Sage (Sanderson et al. 1997, p113, and possibly Rosemary (Price et al. 1999, p342). There were no other contraindications with the group.
To ensure quality I got permission to purchase oils from an Aromatherapy Trade Council approved supplier. As an additional precaution, I conducted a risk assessment to identify possible hazards of using and storing essential oils in the workplace. As a result of the interest in my work, I was asked by the School to produce an Essential oils Policy and also to help organise staff training to address Health and Safety aspects of use and storage of aromatherapy product on the school premises.
To satisfy the requirements of the National Curriculum, I had to relate the Aromatherapy sessions to components of the curriculum. I also had to make lesson plans for the sessions listing targets for each individual child, and whether or not they had been achieved. To relate the sessions to the Curriculum, I needed to adapt Longhorn's (1993) core curriculum subjects (English, Mathematics, Science, History, Personal and Social Development) to suit the specific client group and reflect recent changes to Key Stages 1 and 2 of the National Curriculum as outlined in the Department for Education (1995) Guidelines.
It was decided that the Curriculum subject should be Science, working towards specific goals which included exploration of the environment, cause and effect, discriminating and associating, turn taking, attention/concentration, and participation. The sessions would take place in a 'low arousal' setting: free from excessive noise, bright lighting, and other distractions. Autistic children concentrate better in low arousal environments and are more able to focus and process external sensory stimulation.
I selected 5 different essential oils to use throughout the sessions chosen for their safe use with children, contrasting scents to stimulate the sense of smell, and for their therapeutic properties. I needed stimulating oils to use during experimental exploration sessions and calming oils for massage and relaxation sessions. I also wanted to see if I would be able to observe any emotional effect the oils may have with an autistic client group. I planned to use massage with and without essential oils, and other different tactile sensations to explore their reactions. The aim was to then channel their responses to work towards positive communication and social goals outlined in the National Curriculum.
The essential oils I selected to use were:
Peppermint (Mentha piperita): a neuro-stimulating oil (Price et al. 1999, p333) to help concentration. Peppermint also had the advantage of being familiar to the group through taste and smell (they all ate mints). I intended to make use of its cooling effect on the skin as an additional sensory experience.
Neroli (Citrus aurantium): chosen for its non-irritant properties even on cracked or damaged skin (Tisserand 1999, p262). Neroli is a sedating oil (Price et al. 1999, p320) and I intended to use it for massage, needing the children to be calm and receptive. Worwood (1995) also recommends using it for obsessive behaviour, one of the characteristics of autism (National Autistic Society 2000, p8-9).
Eucalyptus (Eucalyptus radiata): selected for having no known contraindications and its suitability for use with children (Price et al. 1999, p326), but particularly for the mucolytic effect of its high cineole content as a different sensory experience for the group.
Roman chamomile (Chamaemelum nobile): to impregnate wheat cushions and other sensory objects. Selected for its safe use and calming effect (Price et al. 1999, p317). I also wanted to observe its use with autism: Tisserand (1999, p199) supporting its use for over-sensitiveness (hypersensitivity) and Worwood (1995) suggesting its use with aggression (p136).
Sandalwood (Santalum album): Chosen as a contrast to the other oils. Safe and non-irritating (Price et al. 1999, p344). Also to observe its calming and meditative properties (Price et al. 1999, p344) and its use with obsessive and aggressive behaviour (Worwood 1995, p136, 137, and 192). Sandalwood also blends extremely well with Neroli and would give me flexibility to create a new fragrance if required.
I chose Peppermint (Mentha piperita) as a familiar fragrance for the first session - I had already slowly introduced it over the previous few days using an electric diffuser in the classroom with no adverse reactions observed. I was pleasantly surprised to observe positive responses in all but one of the children (Rod) to a dilute Peppermint (1.5%) essential oil in water being sprayed into the air, letting the droplets settle on their hands, arms and legs. 3 of the children (Gary, Jon and Alan) were obviously interested and indicated for me to repeat the experience. Alan in particular kept smelling his hands and laughing, unable to smell and look at his hands at the same time. Normally he found the process of having to suddenly switch off one sense in order to use another quite difficult, which would result in frustration and sometime self-harm. As the sessions progressed, he learnt to shut his eyes in order to block out visual stimuli while he smelt his hands. More surprisingly was the interest shown by Michael (one of the tactile defensive children) in a small pillowcase that I had filled with dried cracked wheat impregnated with Roman chamomile essential oil, heated in a microwave until warm. The bag was floppy and heavy and he immediately placed it on the back of his neck, remaining motionless for the rest of the session. Usually Michael was quite fidgety, always trying to place himself in a particular position in order to feel safe and comfortable.
A further session of hand massage with Neroli was enjoyed by most of the children - particularly James (the functional learner) whose need to self-stimulate would include the antisocial practice of spitting on his hands and 'rubbing it in'. As a more acceptable alternative to spitting on his hands, I poured the massage oil onto them and mirrored his action of rubbing the oil into his hands - this allowed him to indulge his desire to self-stimulate, but was still participating in the group session. He was able to remain calm and interested in what was going on around him, and over the next few sessions, learned to gesture for me to use more oil, indicating a preference for which hand to be massaged. After several more sessions, he learned to sit at the table unprompted and would patiently wait his turn, something he would not do very often in other circumstances.
After a few weeks, the more able and inquisitive child (Gary) began to massage Jon's hands - an enormous step forward for both children, particularly as Jon was one of the children normally resistant to touch. The other tactile defensive child (Michael) continued his interest in the heat cushion until I decided to give him an ice pack (the type normally used for sports injuries), immediately this took preference, placing it carefully on the back of his neck. While the ice pack was in place, he was totally passive to a staff helper who was able to put their hands on his shoulder and massage his hands. Normally he would have screamed and moved away. Over the weeks I introduced other objects (wooden shaped, fabric sample books, brushes, sponges, fur) impregnated with Roman chamomile, each with a different texture to help stimulate learning through tactile exploration.
The only sessions Rod (the hyperactive child) chose to participate in were foot massages. I used a neutral carrier oil to massage his feet because I felt that to stimulate both touch and smell at the same time would have been too overloading. Initially he resisted, but after about 5 seconds of perseverance, he lay on his back with his hands behind his head and placed both his feet in my lap. He then lay still; enjoying a 2-3 minute foot massage, which was the longest, we had ever known him to be still. In subsequent sessions I introduced a blend of Sandalwood and Neroli into the carrier oil and staff helpers used foot massage to gain his attention in order to introduce new learning opportunities such as singing and counting games.
Aware of the often-negative effects of excessive sensory stimulation to those affected by autism, I had not expected the positive way the Aromatherapy sessions were received. For all of the children, the experience has led to new opportunities for interaction and communication. Working with the children also gave me the opportunity to start to document the therapeutic use of specific essential oils with autism and their use with sensory dysfunction. Evaluating the effectiveness of the different essential oils was difficult because it was based solely on observing the children's behaviour and reactions. The reactions were as I would have expected: interest and activity for the stimulating oils (Peppermint, Eucalyptus), receptiveness and calm with the more relaxing oils (Neroli, Sandalwood, Roman Chamomile), but these apparent effects could also have been due to the different activities I chose to associate with each oil.
As the sessions progressed, the opportunities for interaction became more frequent, leading to valuable opportunities to communicate with some very difficult children. Gary and Alan responded so well to the sessions that I continued to work with them separately after the autumn term.
Staff found a new way in which to calm the hyperactive child (Rod) and gain his attention. The children I had particularly expected to resist massage and touch (Michael and Jon) were very accepting, one of them allowing close physical contact for the first time. The child whom I thought would most resist the new smells (Alan) was the most fascinated and amused by the experience. Because of his obvious enjoyment, he was highly motivated to find ways to regulate incoming sensory stimulation by switching off one sense while receiving another, a skill that could be adapted for use in other situations. The most receptive and brightest child (Gary) used the sessions to start to interact with his peers, a positive move forward in his social development. For the most difficult and aggressive child (James), the sessions were a legitimate way to satisfy a constant need to self stimulate, yet still being able to practice the valuable social skills of sitting in a group and turn-taking without feeling the need to become aggressive or disruptive.
I also found having to produce a risk assessment and Essential Oils Policy for the school a valuable exercise in identifying the potential hazards associated with using oils with such a vulnerable client group, and the potential for harm through misuse. The Policy also served to give more structure and credence to what had previously been practiced in a haphazard way by untrained staff.
References
DEPARTMENT FOR EDUCATION (1995) Key Stages 1 and 2 of the National Curriculum London: The Stationary Office
HATCH-RASMUSSEN C (1995) Sensory Integration http://www.autism.org/si.html
LONGHORN F (1993) Planning a multi-sensory massage programme for very special people London: Catalyst Education Resources Limited
PRICE S,. PRICE L (1999) Aromatherapy for Health Professionals (Second edition) London: Churchill Livingstone
SANDERSON H,. HARRISON J,. PRICE S (1991) Aromatherapy and massage for people with learning difficulties Birmingham Hands On Publishing Limited
SEIGAL B (1996) The world of the autistic child: understanding and treating autistic spectrum disorders Oxford: Oxford University Press
TISSERAND R (1999) The Art of Aromatherapy (Nineteenth Edition) Saffron Walden: The C W Daniel Company Limited
WATERHOUSE S (1995) Sensory overload Special Children January (80) pp19-21
WILLIAMS D (1996) Autism: An Inside - Out Approach London:Jessica Kingsley Publishers
WORWOOD V A (1995) The Fragrant Mind: Aromatherapy for personality, mind, mood and emotion London: Bantam Paperbacks
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