sleep, and substance P is notable for causing pain (Sunshine et al., 1997). Thus, when people are deprived of deep sleep they may have less somatostatin and increased substance P, which resuits in greater pain. One of the leading theories for the pain associated with fibromyalgia syndrome, for example, is the production of substance P due to deep sleep deprivation (Sunshine et al., 1997). One of the possible reasons the participants with fibromyalgia syndrome in the Sunshine et al. study experienced less pain following the massage therapy treatment period is because they were experiencing less sleep disturbance. Reducing Neuromuscular Problems Multiple Sclerosis Ambulation is a significant problem for patients with multiple sclerosis. Because massage therapy involves deep manipulation of muscles and can increase range of motion, it might be expected to improve ambulation. In a recent study, 24 adults (M age = 48 years) diagnosed with multiple sclerosis and requiring unilateral support to walk were assigned to a massage therapy or a control group (Hernandez-Reif, Field, Theakston, & Field, 1998). The massage therapy group received 30-minute massages twice a week for five weeks. The effects of the massage were assessed immediately after the massage using self-reports on stress levels and grip strength tests, and longer-term effects were assessed at the end of the study using self-reports on body image, self-esteem, depression, and functional activities including ambulation. Although both groups reported being less anxious after the first and last day of the study, only the massage group reported less depressed mood. In 1274 December 1998 • American Psychologist addition, by the end of the study, the massage group's social lifestyle and functional activity status had improved significantly. However, grip strength was unaffected, and ambulation was only marginally improved. Spinal Cord Injury Two major problems for spinal cord injury patients are restricted range of motion and muscle atrophy in the unaffected areas. Massage therapy might be expected to alleviate at least the range of motion problem, as it did in the lower back pain study just reviewed. Twenty patients with spinal cord injury at the C5-C7 spinal cord level were assigned to a massage therapy or a control group (Diego et al., 1998). The massage therapy group received 30-minute massages twice a week for five weeks. The massages focused on participants' shoulders, arms, hands, and back muscles. The effects of the massage were assessed immediately after the session using self-reports on anxiety and mood, and the longer term effects were assessed at the end of the study by physical therapists (unaware of group assignments) who evaluated activities of dally living, passive and active range of motion, and muscle activity. Participants in the massage group reported less anxiety and better mood following the five-week study. In addition, significant improvement occurred on functional living activities and in wrist and elbow range of motion. A series of studies have addressed the effects of massage therapy on the Hoffmann reflex (H-reflex) amplitude in persons with a spinal cord injury. The studies, conducted by Morelli and colleagues (Morelli, Seaborne, & Sullivan, 1990, 1991; Sullivan, Williams, Seaborne, & Morelli, 1991), are considered among the best controlled massage therapy studies in the literature because of their reliance on the more objective neurophysiological measures. The purpose of this group of studies was to investigate the effects of massage therapy on neuromuscular excitability as measured by changes in the H-reflex. A reduction in the H-reflex amplitude is critical to the comfort of spinal cord injury patients for reducing cramps and spasms. In these studies, the H-reflex peak-to-peak amplitude was measured during and following a three-minute massage to the triceps muscle. Typically a 60%-80% decrease in the H-reflex amplitude was observed during the massage followed by a return to baseline levels immediately following the termination of the massage. In contrast to the activation of cutaneous receptors by light fingertip pressure, this stimulation of deep tissue receptors by tendon pressure muscle vibration inhibits activities along the reflex pathway as measured by the H-reflex. This suggests that deep lying receptors override the influences exercised by superficial cutaneous receptors. Enhancing Attentiveness Attention Deficits Autism. One of the most salient problems of children with autism is their inattentiveness. Although they have also been anecdotally described as being extremely sensitive to touch and as typically disliking being touched, they showed surprisingly little resistance to being massaged in a recent study (Field, Lasko, et al., 1997). Massage may not have been aversive to them because it is predictable, unlike the social stimulation they frequently resist, and because it involves pressure. The children who were massaged as opposed to the children who were held by their teachers and shown objects showed a decrease in their off-task behavior in the classroom following a 10-day period of massage. Their "social relatedness" to their teachers also improved, and they showed fewer autistic behaviors (orienting to sounds and stereotypic behaviors; Field, Lasko, et al., 1997). Attention Deficit Hyperacthn'ty Disorder (ADHD).