Child Myths

Straight talk about child development.

Holding Therapy and Autism

Autism cannot be treated effectively by "holding therapy."

An excellent resource for parents and community members interested in autism is Paul Offit's book, "Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure." Offit describes various physical treatments that have been falsely claimed as cures for autism, including chelation and the use of Lupron, both of which I mentioned in a post a couple of weeks ago. The very real dangers of chelation treatment and of Lupron, and the fact that these treatments have received much publicity, certainly justifies the emphasis Dr. Offit has placed on them. However, I'd like to add to the list of inappropriate autism treatments one which is not mentioned in "Autism's False Prophets": "holding therapy".

"Holding therapy" is not nearly as intrusive as the pharmaceutical treatments Dr. Offit describes, but it has its own dangers (there have been fatalities), it has no supportive evidence basis, and it shares with the pharmaceutical treatments the problem that parents who seek these alternative approaches may not make use of the safe methods for which there is some scientific evidence. The ‘holding" treatment involves physical restraint of a child, attempts to force eye contact between the child and the holding adult(s), and may also include painful poking and prodding of the child's torso and armpits-- termed "tactile stimulation" by advocates of this approach. This treatment may be used for children with various emotional disturbances, with equal ineffectiveness, but there was a period of time during which its advocates suggested its use with autistic children.

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Practitioners of "holding therapy" for autistic children made two major claims, neither of which is supported by empirical evidence. The first was that autism results from a disturbance of the relationship between infant and mother, that is, a disorder of attachment. The second was that attachment could be created or repaired by causing the child to experience and acknowledge the control and authority of an adult.

In fact, autistic children do not seem to be unusual in their attachments to their mothers, although their limited communicative behavior makes it more difficult to see evidence of the attachment. The idea that the relationship with the mother causes autism appears to be a throwback to the post-World-War-II assumptions that autism was caused by "refrigerator mothers" who did not want their children to exist and did not create an attachment relationship with their children. The information we have today suggests that autism causes relationship difficulties rather than relationship problems causing autism, just as autism causes differences in eye contact rather than a lack of eye contact causing autism.

As for the second assumption, that attachment could be caused by physical restraint and restrictive treatment, this idea was once suggested by Bruno Bettelheim after observing what he considered to be personality changes in concentration camp prisoners. But Bettelheim himself dropped this idea and proposed instead to use nurturing techniques as treatment for disturbed children. Wilhelm Reich, who eventually went to prison for selling machines falsely claimed to treat cancer, also contributed to the idea that the physical pain of being prodded and grabbed would cure problems of early experience and relationships. Neither Bettelheim's nor Reich's views have been supported by later research.

Another factor in the development of "holding therapy" for autistic children was a report by the very high-functioning autistic professor and author, Temple Grandin, in her book "Thinking in Pictures", that as a child she had been comforted by physical pressure. She had constructed what she called a "squeeze machine" which would give her the experience of pressure without any necessity for being touched by human beings, which she much disliked. Some proponents of "holding therapy" for autistic children held that their treatment was parallel to Grandin's squeeze machine, but of course they were quite different. The squeeze machine was completely under Grandin's control and involved no direct touch from other people, whereas "holding therapy" is by definition under the control of others, whose task is to convey their authority and power to the child through their use of sometimes-painful touch.

While it is difficult to know which was the chicken and which the egg, "holding therapy" for autistic children and others appears to have developed in parallel with a treatment called Sensory Integration Therapy. This treatment method, which is used with autistic children among others, involves the use of pressure, weight, and movement techniques to alter the children's experiences. For example, swings, trampoline jumping, and the wearing of weighted vests may be used. (The recent "Dateline" program on autism showed a brief glimpse of what appeared to be SI treatment at Andrew Wakefield's Texas facility.) Sensory integration concepts have broadened to include similar treatment for many childhood problems; one treatment is the Body Sock overall-pressure garment which caused much disturbance when used at a public school in Tampa, FL several years ago. Treatments of this type have not been clearly supported by research evidence.

Some aspects of "holding" or the use of pressure or movement in treatment of autism have some degree of plausibility, although they are not supported by evidence. Others are not even plausible, but their practitioners continue to sell them to concerned families.


Jean Mercer is a developmental psychologist with a special interest in parent-infant relationships.


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