The following case study presents the experience of Adya, an autistic child who, with the help of yoga, learns to deal with chronic disease by getting in touch with her self and her physical and emotional planes.
In February 1999, I walked into a circle of expectant faces in the sun soaked room of a special school for my yoga session, when I noticed her. Adya, a girl of about 12 years, pale and silent, with the shuttered look so characteristic of autistic individuals, seemed frail and vulnerable. Later I learned from her mother that she suffered from chronic anaemia and from a sepranayama rious lung condition, which left her with very little energy to play or engage in activities with other children. Chronic colds and coughs, together with repeated attacks of fever, left Adya easily breathless, fatigued and exhausted.
Adyas mother was sceptical about the efficacy of yoga in dealing with such conditions, yet, with hope in her heart, she requested me to take Adya as a student. That was the beginning of a very special association. The insights I gained during that time have helped me in yoga therapy applications for children with special needs.
Autism is a little understood phenomenon. It is a developmental disorder of brain functions, now attributed to biological factors. The exact causes are currently under investigation by researchers. Recent advances in modes of intervention have resulted in a greater percentage of autistic children able to attend school with normal children, and to live more or less independently in community settings. However, the majority remain severely handicapped in their ability to communicate and socialize with other people.
Prior to the 1990s autism occurred in about 5 children per 10,000 live births. Since then the rate has increased enormously, with figures as high as 60 per 10,000. According to Bernard Rimland, founder of the Autism Society of America (ASA), autism is serious and world wide.*1
Michael Goldberg, MD, Dept of Neurology, UCSF Medical Center, Santiago, USA, considers autism as a syndrome rather than a disease.*2 It is probably a state of dysfunction induced in the brain by a dysregulated immune system, thought to affect central nervous system functions and the language and social skills area of the brain.
The syndrome possibly occurs in children with a genetic predisposition and is triggered by various stresses placed on the immune system. Children suffering from autistic syndrome appear normal in the first 1518 months of life, achieving normal motor milestones on schedule, appearing to have above average intelligence, and are affectionate until the onset of the problem. Then, without warning, in their pre-school years they cease to progress or begin to regress, becoming withdrawn and displaying various abnormal behaviours, often including soft signs of neurological impairment.
At the age of 3 years 10 months, Adya had shown signs of regression such as learning difficulties, problems communicating with other children, and laughing and grimacing to herself. The diagnosis was autism with delay in language development, basic conceptual mastery, and mild delay in motor coordination. Treatment/therapy involved special education, play, dance and other activities to progressively stimulate her physical development. Despite these efforts Adya seemed hypersensitive and frustrated. She was unable to express feelings, respond appropriately to other children or handle even mildly challenging situations such as boisterous talk or teasing, and would withdraw hurt. Although interested in art and music and craving participation, group involvement was difficult for her.
When Adya began yoga therapy in February 1999, aged 12, she was undergoing treatment for Auto Immune Haemolytic Anaemia (AIHA), detected at 6 years, and B/L Bronchiectasis, which developed in the 8th year. AIHA is a severe life threatening condition. Clinical features are pallor, and jaundice with enlargement of the spleen. Corticosteroid therapy and splenectomy constitute some of the modalities for treatment.*3 Bronchiectasis is a chronic disease of the lung. Symptoms are chronic cough and anorexia, failure to thrive and weight loss. Management is with antibiotics and postural drainage by physiotherapy. As the disease is irreversible, this treatment can only control infection and prevent further damage. Surgical removal of the affected lobe is recommended in severe cases.*4 All the above clinical features were present in Adyas case.
Adyas main treatment was postural drainage, steam inhalation, plus antibiotics and steroids, as well as regular monthly tests, which in January 1999 and on 19 February indicated severe anaemia. Jaundice had set in, appetite was poor, and Adya complained of pains in the legs and arms and general weakness. Surgery had been recommended for removal of the bronchiectasic lobe.
On 23 February 1999, yoga intervention began with a basic program focusing on respiratory functions. Within a month changes were noted. The haemolysis was in check from February. A gradual improvement in the respiratory condition was noted by the mother from March. At the end of March the worst attack lasting two days was reduced with a higher dosage of antibiotics but without steroids.
In the second week of April 1999 surgery for removal of the bronchiectasic lobe was scheduled. The yoga program was reviewed and shatkarmas included. The focus was on cleansing, draining the lungs and improving ventilation through postures, movement, breathing, and guided imagery.
Adya was admitted for surgery on 27 June 1999. However, on 3 July, after treatment with antibiotics and steroids, she was discharged without surgery. On the basis of test reports and scans taken as a preliminary to the scheduled surgery, the attending surgeon opined that there was no longer evidence to warrant surgery. A suggestion to carry out a splenectomy was rejected by Adyas parents. Steroids were administered for one month.
Her mother observed that within the next three weeks Adyas health stabilized, her appetite improved, and she looked healthy. By the beginning of September, Adya was eating a more varied diet, which she could not do earlier due to dietary restrictions. She experienced greater tolerance for exertion with no fatigue in the mornings. Antibiotics were reduced by 50%. There was improvement in communication abilities, an increased interest in academics, dance and music, and she appeared more confident.
From 2nd September 1999 until the end of December 2000, Adyas yoga program focused on strengthening immunity and preventing respiratory infections; improving blood circulation to the brain and increasing energy levels; toning the liver and spleen; dealing with emotions and improving communication, speech and listening skills; as well as deepening self-awareness.
Adya has attained normal physical development. Her condition continues to be stable with respect to haemolysis and bronchiectasis with no major episodes of illness. The frequency of medication (antibiotics) has reduced. No steroids have been given since December 1999. This young girl is now able to deal with haemolysis on her own, without medication. Yoga has become a regular part of her daily life, while pursuing functional academic skills at a special school along with art and vocational training. Her interests and activities have grown in scope and depth. Her moods are sunnier and friends more conspicuous.
It is apparent that Adya succeeded in managing conditions that were chronic, severe and debilitating to the extent that there was no evidence of worsening and surgery was avoided, a feat considered sensational by her medical team and family. After this initial success with disease and exhaustion, she continues to progress towards a state of well-being and growth.
We may never fully unravel the truth that underlies the processes and mechanics of healing, but it is clear that Adyas yoga program released forces that contributed to her healing. Although I cannot say with certainty, I believe that Adyas guided visualization practice, a modified form of yoga nidra as taught by the Bihar School of Yoga, was the key to her healing process as it opened a door to the source of her difficulties, autism.
While Adyas autoimmune dysfunction might be related to autistic syndrome, her emotional condition was intrinsic to it. Her inability to convey feelings or respond appropriately to emotional stimuli, especially when provoked to anger, led to depression and to introversion which in turn would reduce her immunity, worsen the infection in the lungs and trigger haemolysis. Her psycho-social difficulties aggravated her frustration.
In this discussion the focus is on the possible benefits that Adya might have derived from specific practices and the yoga program as a whole. The observations presented are based on a systematic daily record of Adyas daily yoga practice and variations in her condition that were closely monitored by her mother. The practice program was evaluated periodically, varying from twice a week to once a month, according to the severity of the problem and need for intervention. Its effectiveness was assessed in terms of relief from symptoms of lung infection, anorexia, pallor and jaundice; and improvement in general health indicators such as appetite and digestion, growth, bowel movement, sleep, emotional state, stamina and exertion tolerance.
In the initial stages when Adyas condition was acute, clinical tests gave an indication of the changes happening. Later, self-assessment by the child, subjective information by the parents, as well as my own observations contributed to a more complete understanding of Adyas progress.
The yoga practices taught were based mainly on the teachings of Bihar School of Yoga, Munger, Bihar,*5 with a few exceptions (e.g. nikunjasana) from the teachings of Yogacharya Janakiraman, a student of Swami Gitananda of Anand Ashram, Pondicherry. Whenever required, the practices were slightly modified to suit her needs and capacity. I believe that all the practices contributed to the relief she gained from the severity of her original condition. Listed below are some of the practices considered to be most effective in bringing about her significant improvement.
Laghoo shankhaprakshalana toned the digestive organs, particularly the liver, regularized bowel movements and improved appetite. After this practice Adya slept well and was inclined to be more peaceful and relaxed. Initially it was practised daily for one week, then later, when the condition was stable, once every weekend.
Kunjal induced strong muscular contractions of the diaphragm and the chest walls, eliminating infected secretions and mucus from the lungs. As the basal lobes of the lungs were affected, kunjal was very helpful in improving drainage, reducing the severity of the initial infection and in preventing further aggravation of bronchiectasis. By eliminating excess bile and toning the liver and spleen, jaundice was controlled. Initially practised daily for about ten days, now it is practised whenever the condition is aggravated, or once every ten days. Kunjal might have been one of the most important practices instrumental in releasing the pent up feelings of hurt and anger underlying Adyas frustration and depression.
Neti, along with kunjal, was helpful in reducing and controlling the infection. Colds were arrested at the start of infection, which helped to prevent infection in the lungs from worsening, thus awakening the potential for improvements in Adyas respiratory condition.
After the initial phase of intense shatkarma practices, she seemed more energetic and found it easier to pursue the other yoga practices.
Vajrasana strengthened and corrected weaknesses in the lower limbs and general body posture; and improved digestion. Pranamasana increased circulation to the brain, induced calm and was helpful in reducing anxiety. Ushtrasana stretched the abdominal organs and opened up the chest. Together with abdominal breathing, this facilitated rhythmic expansion and contraction of the lower lobes of the lungs, giving the added beneficial effects of deep abdominal breathing. Both postures were useful in improving drainage and ventilation of the lungs, and digestive functions.
Although yogic breathing was learnt and practised, it appeared that Adya did not understand the concept and found it difficult to do satisfactorily lying down. It was easier for her to use yogic breathing in other positions, such as vajrasana.
Nikunjasana was found to be very effective in draining the upper lobes of the lungs, easing congestion and providing immediate relief when breathing became difficult. In combination with pranamasana it brought about significant improvement in Adyas condition even when the infection was severe. It was much appreciated by physiotherapists during her hospitalization.
Surya namaskara postures combined with breath awareness improved motor coordination and general awareness. It was particularly effective in improving digestive functions, toning the liver and spleen, increasing appetite, reducing fatigue and building up stamina and tolerance for exertion. After commencing this practice, marked physiological changes were noted and Adyas resistance to infections improved significantly, possibly as a result of more balanced endocrine functions. It can be surmised surya namaskara served as a mood elevator extricating her from depressive states.
Vipareeta karani mudra: While it is difficult to ascribe particular changes, this inverted practice was significant from the point of view of improving circulation to the brain, restoring balance to the endocrine system, stimulating the parathyroid, facilitating normal development of bones, relieving anxiety and encouraging abdominal breathing.
Simhagarjanasana relieved tension from the throat, chest and abdominal region, thus aiding deep breathing. It was a good method of teaching Adya to let go and vocalize her feelings, and it may have contributed to the improvement in clarity of speech and verbal expression.
Bhastrika pranayama was taught to increase metabolic activity, tone and detoxify the liver, to eliminate secretions from the lungs and to strengthen respiratory functions through the action of the diaphragm.
Nadi shodhana (without kumbhaka) has become Adyas way of relieving fatigue during illness and moments of stress. This practice has clearly helped her to relieve anxiety and to increase and balance her energy levels.
Guided imagery in shavasana. Adyas response to visualization or guided imagery (based on yoga nidra) was in many ways quite astonishing. Little did I expect that she would be able to actually follow purely verbal instructions and conjure up vivid images as her difficulties lay in language and the ability to conceptualize. It was unmistakable from her statements and behaviour that guided visualization practices increased her self-awareness, her ability to surrender to the forces of life and to express emotions burdening her heart.
Perhaps the most momentous experience of her life was the cancellation of lung surgery. Guided imagery was the mainstay of her practice in the days immediately preceding and during hospitalization. It appears the vision of a golden light spreading an aura of protection saw her through the crises. She continues to draw sustenance from that cocoon of light even today. We do not know whether Adya was always a visual thinker, but through this incident we glimpsed how appropriate techniques could unearth unrecognized potential.
The yoga sadhana as a whole appeared to reduce her vulnerability to extraneous forces such as the behaviour or responses of other children. An inward movement of consciousness empowered her to initiate and direct the healing. It enabled her to take charge of herself and be responsive in ways that seemed to make a change to her physical, mental and emotional health. Her parents, particularly her mother, encouraged and aided this growth from the depths of their being.
It is my belief that management of stress, a positive mental/emotional state and endocrinal balance kept the haemolysis in check. Against a background of relative stability of the immune system, practices for improving blood circulation, lung functions and increasing energy levels were more effective, resulting in a general health improvement so essential for managing bronchiectasis. Can this be construed as a movement towards restoration of a modicum of balance to the derailed immune system? Only a systematic enquiry into more such cases can tell.
The insights I have gained from Adya indicate the potential for a wider application of yoga practices. The science of yoga may well contribute to a fresh approach to rehabilitation of autistic individuals, especially children.
It is heartening to note that researchers are now discussing and recommending measures that yogic practices are designed to achieve. Michael Goldberg cautions that medications to calm the brain further shut down these areas implying that alternative measures for improving blood flow and function are needed. According to him, clinical research is currently focusing on areas of dysfunction amenable to self-help therapy, indicative of a shift in approach to rehabilitation.*6
Stephen M. Edelson states that vigorous exercise is a most under-utilized yet effective treatment for autistic individuals and recommends it as a healthful alternative to drugs.*7 Studies have shown it to be one of the best treatments for the depression and stereotypic behaviours of autistic children as it reduces stress and anxiety as well as improving sleep, reaction time and memory.
Temple Grandin, Ph.D., Assistant Professor, Colorado State University Fort Collins, Colorado, USA, shares her own experiences as an autistic individual, highlighting the importance of sensory stimulation and presents a most remarkable description of her visual thinking, which was like playing different tapes in a video cassette recorder in my imagination.*8
The therapeutic benefits of visualization practices in yoga nidra are substantiated by scientific investigations reported in the book Yoga Nidra by Swami Satyananda Saraswati.*9
My subsequent experiences with other children suffering from autism and neuro-cognitive disorders are in consonance with the belief that visual language is suited to some individuals with neuro-cognitive disorders. The results of a recent pilot study conducted for the Spastic Society of Karnataka, Bangalore, lends credence to this view.*10
Further scientific investigations into the effect of yoga nidra and guided imagery on developmental disabilities may pave the way for wider applications of this yoga practice for therapeutic purposes.
Although constrained by her condition, Adya appears to be moving towards a more balanced state, more accepting of her-selfand the world, more adept at handling stress and better equipped for directing her life. Occasionally I do see her hover above the path in the garden of her mind space, not quite grounded. But there have been times when she has retraced her own footprints back to where she began.
As Adyas journey continues on from one layer of unfoldment to the next, from a diseased state to one of growth and enrichment, our understanding of the special needs of autistic individuals also continues to unfold.
*1. Bernard Rimland, Keynote address at the 36th annual conference of ASA, San Diego, California, July 19, 2001. http://autism.com/ari/contents.html#editorials
*2. Michael Goldberg, Frontal and Temporal Lobe Dysfunction in Autism and Other Related Disorders: ADHD and OCD. Alasbimn Journal, 1(4), July 1999. Web site: http://www.alasbimnjournal.cl/revistas/4/goldberg.htm.
*3. IAP Text Book of Paediatrics, Editor-in-chief A. Parthasarathy, 1st edn, Jaypee Brothers, Medical Publishers (P) Ltd, New Delhi, 1999.
*4. IAP Text Book of Paediatrics, op. cit.
*5. Swami Satyananda Saraswati, Asana Pranayama Mudra Bandha, 3rd edn, Yoga Publications Trust, Munger, Bihar, 2002.
*6. Michael Goldberg, op. cit.
*7. Stephen M. Edelson, Web site: http://www.autism.org/contents.html#interven
*8. Temple Grandin, My Experiences with Visual Thinking Sensory Problems and Communication Difficulties. Web site: http://www.autism.org/temple/ref.html
*9. Swami Satyananda Saraswati, Yoga Nidra, 6th edn Yoga Publications Trust, Munger, Bihar, 2001.
*10. Rama Ranee, The Effectiveness of Yoga on Developmental Disabilities, Unpublished report of pilot study by the Diagnostic and Research Centre, Spastic Society of Karnataka, Bangalore, March 2004.