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AUTISM AS A DEVELOPMENTAL
DISORDER IN INTENTIONAL MOVEMENT AND AFFECTIVE ENGAGEMENT
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by
Colwyn Trevarthen1 and Jonathan T. Delafield-Butt2
|
|
1 Department of Psychology, College of
Humanities and Social Sciences, University of Edinburgh, Edinburgh,
UK
2 Early Years, School of Education,
Faculty of Humanities and Social Sciences, University of Strathclyde,
Glasgow, UK
This
article has been originally published in "Frontiers in
Integrative Neuroscience"(2013) (Open Access),
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INTRODUCTION
TO A DIFFERENT, PSYCHOBIOLOGICAL APPROACH
"Generality
of the problem of Syntax:
Not only speech, but all skilled acts seem to involve the same
problems of serial ordering .
. . Analysis of the nervous
mechanisms underlying order in the more primitive acts, may contribute
ultimately to the resolution even of the physiology of logic." (Lashley,
1951, pp. 121–122)
"A
Different Approach to the Problem: In
so far as an organism perceives a given object, it is prepared to
respond with reference to it. This preparation-to-respond is absent in
an organism that has failed to perceive." (Sperry, 1952, p.
296)
Lashley
(1951) and Sperry (1952) observed that perception, intelligent action
and thinking depend upon impulses that move the body purposefully. The
animal brain contributes systematic and serial organization, in time
and space, to muscle activity under expectant perceptual and emotional
control. It is always active, not passively reactive to stimuli. Nor
is the human brain ever animated by thoughts of external events alone.
All mental and behavioral skills depend on preparation to respond with
serial ordering of acts. "The sole product of brain function is
motor coordination" (Sperry, 1952, p. 297). This is a
psychobiological theory of motives and affects in the mind, clearly
articulated before the advent of the "cognitive revolution"
that divorced mind from vital body in the 1960’s (Miller, 2003). The
motor theory of consciousness was inspired by the research of Charles
Sherrington (1906) on "the integrative action of the nervous
system." It has support from developmental neurobiology and
neuroembryology (Trevarthen, 1986a; Prechtl, 2001), from ethology of
the adaptive action patterns of animals and how they communicate
emotional evaluations for social cooperation (Gallistel, 1980; Marler,
1984; Fentress and Gadbois, 2001; Panksepp, 2005), and from infant
psychology and communication (Trevarthen, 1986b, 2001a, 2009a; Stern,
2000, 2010). Research focused on cognitive disorders of perceptual
information processing, selective awareness, and representational
thinking articulated in language, all of which skills develop after
infancy—disregards the developmental foundations of experience in
motor coordination, and in the expression of vital states as emotions
for regulation of social life. In an animal’s perceived world, its
"Umwelt" (von Uexküll, 1957), conceptions of objects are
created by the intentional subject’s attempts to locate and perceive
"sign stimuli" detected in the environment by dedicated
receptors (Buchanan, 2008; Berthoz and Christen, 2009). Self-regulation
of knowing, with emotional assessments of risks and benefits, becomes
in humans the source of cultural sign systems of social cooperation—for
sustaining health, for reproduction and for learning how to use
environmental resources collaboratively (Sebeok, 1990; Trevarthen,
1990; Stern, 2010; Porges and Furman, 2011). We relate autistic
disturbance of cognitive functions to growth errors in creative agency
attributable to events in brain development of embryo, fetus and
infant (Trevarthen et al., 1998, 2006; Trevarthen, 2000; Trevarthen
and Daniel, 2005; St. Clair et al., 2007).We address development of
the autopoetic subcortical neurobiology that makes possible
manifestations of intentions and emotions before birth (Delafield-Butt
and Trevarthen, 2013), and the cooperation of movements after birth
within an intimate infant-parent intentional system (Sander, 2008),
which sustains itself by the primary emotional processes of
consciousness (Solms and Panksepp, 2012). The motivation of the
developing human organism is environment expectant, ready for sharing
agency and emotions in movement, but this sharing is "anoetic";
that is, not dependent on acquired categorical knowledge of the
structure and uses of the environment (Vandekerckhove and Panksepp,
2011). The infant is adapted physically and motivated psychologically
to receive not only vital care in attachment to the mother, but also
"companionship" for the young mind’s growing purposes in
imaginative movement and the uptake of new experience (Trevarthen,
2005, 2013). Shared health and meaning are created in human awareness
by primary processes of joint agency and emotional sympathy between
the movements of human bodies (Trevarthen, 1986b, 2012; Reddy, 2008;
Stuart, 2010). We need to have a clear conception of the nature of
animal movement and its affective sociability if we wish to understand
how children with autism fail to organize and time their movements
effectively, hesitate to become affectively engaged with their parents
as infants (Muratori and Maestro, 2007), and fall behind their peers
in learning how to share and use knowledge of the human world
playfully (Reddy et al., 2002). Based on evidence of early neural
growth errors in core brainstem systems during fetal ontogenesis, and
on new evidence of disturbance of primary prospective motor control
of expressive action, we present the following hypothesis on the
etiology of autism for testing and argument:
(1)
A primary cause of autism spectrum disorders is an error in early
growth of intrinsic motive and motor systems of the brainstem during
prenatal ontogenesis.
(2)
This interferes with efficient integration of sensory information with
motor timing, and is accompanied by disturbance of autonomic functions,
disrupting timing and control of prospective sensory perception in
movement as well as vital regulation of functions within the body. All
these disorders become most obvious in early childhood, when a toddler
normally gains many new powers of movement in engagement with the
environment, including speech.
(3)
Social isolation, socio-emotional and cognitive delay, and language
disorder in children and adults with autism are secondary
consequences developed within socio-emotional systems as
experience-dependent compensations for primary sensori-motor and
affective integration errors and poorly regulated motor intentions.
These compensations are elaborated mainly by cortical systems that
grow after birth.
AUTISM
IS A DISORDER OF SELF-RELATED MOTOR-AFFECTIVE PROCESSES,WHICH CONTROL
DEVELOPMENT OF SHARED COGNITIVE REPRESENTATIONS
People
diagnosed as autistic exhibit disabilities in regulation of the order
and timing of moving, in the feelings of their bodies and emotional
control, in selective expectation of objects for experience, in
attention to other persons expressions, in the playfulness and humor
of their social engagements, and in collaborative learning (Baron-Cohen
et al., 2000; Reddy et al., 2002, 2010; Rogers and Williams, 2006;
Mundy et al., 2009; Hobson and Hobson, 2011; Torres, 2013). Cognitive
disabilities attributed to failure in special modular mental functions
of perceptual selection, of conceptual grouping, or of a capacity to
conceive and think about the emotions behind other persons' face
expressions, orientations and practical actions, or to imagine the
representational contents of their minds (Baron- Cohen et al., 1985;
Frith, 1989/2003; Morton, 2004), may only be identified after infancy.
Similarly, definition of autistic disturbance by reference to
neuropsychological tests that identify faults in praxis, gnosis,
reasoning and language in adults after local brain injury ignores the
large transformations in brain function and behavior that take place
during psychological development (Karmiloff-Smith, 2009; Thomas and
Karmiloff-Smith, 2002; Karmiloff-Smith, 2009). We propose that faults
in higher mind functions of persons with autism arise out of disorder
in the early development of primary, non-reflective sensori-motor
factors that regulate moving-with-awareness of an integrated Self.
These affect vitality dynamics, the qualities of motor control that
express essential expectancies of action and enable communication of
emotion in purposes (Stern, 2010; Gowen, 2012; Gowen and Hamilton,
2013; Rochat et al., 2013). The primary processes of mental agency do
not require conceptual representation or explicit reference to
external events; they are primary conscious experience (Vandekerckhove
and Panksepp, 2011). Growth errors found in formation of brain stem
motor control and emotional systems of the embryo and fetus (Prechtl,
2001; Rodier and Arndt, 2005), interfere with the maturation of
sensory-motor skills at significant periods in a child’s early life,
impairing cultural learning mediated in postnatal elaborations of the
neocortex and dependent on creative emotional engagement with human
company (Trevarthen et al., 2006). Interpreting autism in these terms
requires attention to the environment–expectant processes of
morphogenesis by which human bodies and brains are formed in utero,
with special adaptations for intersubjective communication (Trevarthen,
2001a,b), and information on how additional brain networks grow and
learn after birth (Thomas and Karmiloff- Smith, 2002). This is a
"developmental psychobiology," not a "developmental
cognitive neuroscience" based on the neuropsychological
definition of disorders inferred retrospectively from effects of
damage to parts of the adult brain (Baron-Cohen et al., 2000).
Psychological theory must also explain how individuals with
high-functioning autism and Asperger’s disorder perform certain
feats of perception or action with remarkable precision, but with
inadequate awareness of the context, or "weak central coherence,"
in their self-related conceptions and plans for action (Frith,
1989/2003; Rinehart et al., 2001). No single genetic, neurobiological
or environmental factor has been identified as the cause of autism,
which is also not attributable to the loss of a single cerebral
function or capacity (Bauman and Kemper, 2005; Aitken, 2010). The
complex and varied cognitive problems of people with autism, and the
abnormalities in habits of action and of social response or use of
language, are consequences of core disabilities, manifestations of
which might be recognized, and compensated for, in infancy, before the
development at the end of the first year of "joint attention"
(Trevarthen, 2000). A new scientific recognition of these core
disabilities in autism, and their relationship to imagination for
action and to qualities of movement, is emerging from attention to the
emotions that evaluate other persons actions (Hobson, 1993, 2002/04;
Reddy et al., 2002, 2010; Reddy, 2008; Hobson and Hobson, 2011), and
from a brain science of intentions in movement and the intersubjective
sharing of their dynamics of expression (Gallese, 2006; Stern, 2010;
Gowen, 2012; Gallese and Rochat, 2013; Rochat et al., 2013).
AUTISM
COMPROMISES AFFECTIVE SHARING, AND REQUIRES CREATIVE RESPONSE TO THIS
When
Leo Kanner (Kanner, 1943) distinguished "autistic disturbances of
affective contact" in 1943, he accentuated that the disorder is
emotional. Hobson and Hobson (2011) quote examples from Kanner’s
sensitive case studies that identify a difficulty in engagement with
other person’s intentions, experiences and feelings. Kanner also
recorded that parents of these children were often concerned from the
first year about their child’s detachment or aloneness. Reddy (2008,
2011) cites a large number of studies that prove normally developing
infants "know minds" and learn complex cooperative
activities by deliberately engaging playfully and inquisitively with
the way other persons display their interests, experiences and
feelings. This eagerness for enjoyment of shared experience, a
sympathetic activity, which goes beyond "joint attention to
objects," is weakened in autism. The cognitive deficiencies of
autism measured by tests of perceptual recognition, rational choice,
and language are skills that must be gained by learned accommodation
to objective experience, and normally depend on deliberate adult
instruction. But all can be attributed to deep subjective causes that
impair imaginative moving, the pleasures of the body in explorative
action, and a motivation to deliberately share this "seeking"
in inventive and playful, assimilatory, communication, going
"beyond the infor-mation given" (Bruner, 1974). It appears
likely that autism results from disorders of imaginative and sociable
playfulness itself, for which the motives and emotions are apparent
from birth. Such disorders can be traced back to creative developments
of movement and awareness in body and mind before birth (Trevarthen
and Delafield-Butt, 2013), to disorders of sensory-motor circular
reactions that become the tools for mastery of engagement with the
world (Piaget, 1951, 1954) and for the development of shared cultural
understanding (Baldwin, 1902). Though some medical treatments lead to
improvements in associated conditions, there is no drug or surgical
intervention for autism.
A prescribed course of training or instruction in behaviors, cognitive
abilities or communication by learned symbolic language may help, but
can have adverse consequences, increasing the subject’s anxiety,
isolation and dependency (Trevarthen et al., 1998). Moreover, the
activity, cognitive capacities, relationships and emotional well-being
of a child or older person with autism can be improved by a variety of
non-verbal, non-cognitive activities in which a therapist, who engages
sensitively with the individuality of their impulses and felt
experiences, accompanies the autistic person in the emotions of
intimate engagement to more productive and less defensive states of
activity and awareness. This type of relational and creative
"art" therapy, which responds to and guides the primary
actions, interests and feelings of individuals with autism, much as
mother engages her affections with her animated infant from birth, can
benefit language learning and both social and practical education (Malloch
and Trevarthen, 2009; Stern, 2010). Evidence that autistic behaviors
express abnormalities of pre-natal development of the brainstem (Rodier
and Arndt, 2005) relate to evidence that early postnatal communication,
if it is to support social and cognitive development, must be ready to
protect the infant against autonomic reactions of protective
withdrawal and depression, as well as to support positive initiatives
promoting advances in social communication (Panksepp and Sahley, 1987;
Panksepp and Watt, 2011; Porges, 2011; Porges and Furman, 2011).
Infant psychology and paediatric practice have been transformed by
abundant confirmation that precise coordination of well-formed
intentions, interests and feeling may occur within the child and
between the child and an attentive and affectionate adult from the
neonate stage (Brazelton andNugent, 1995; Trevarthen, 1977, 1998,
2009a; Stern, 2000; Sander, 2008; Nagy, 2011). This is the arena in
which we must be alert for weaknesses in developing human sense and
for special support it may need from the parental and social
environment (Narvaez et al., 2013).
PSYCHOBIOLOGY
OF HUMAN MENTAL FUNCTIONS DEVELOPMENTAL NEUROBIOLOGY OF SELF-CONSCIOUS
INTENTIONS WITH EMBODIED FEELINGS, AND SOCIAL AWARENESS
Evidence
concerning the generation of animate intentions, awareness and emotion
in deep processes of the brain (Panksepp and Biven, 2012) questions
the "thalamo-cortico-centric" theory of conscious awareness,
thought and memory, which focuses on abilities that depend on learned
definition of objects from information picked up outside
the body, on the routines of fine articulate skills for
using the environment, and on educated conventions of representation
and reflective thought about objective information. Functional brain
research shows that the primate neocortex is excited to regulate motor
activities prospectively in reference to their goals, seeking
perceptual confirmation by imaginatively simulating the completion of
the action within an established context of multimodal information (Fogassi
et al., 2005; Pezzulo et al., 2008; Pezzulo and Castelfranchi, 2009;
Hesslow, 2012; Gallese and Rochat, 2013). The process of intending to
act in a particular way is not a consequence of backward coupling of
frontal cortex "executive functioning" to recollections of
the past objects and events mediated impersonally in the temporal lobe.
It is the product of a forward-looking creative imagination that builds
an episodic memory of past events related to an intentional personal
self (Tulving, 2002), with an autopoetic imagination equipped from the
start with "implicit experiential and procedural memory processes
that generate non-reflective qualia" (Vandekerckhove and Panksepp,
2011, p. 7). These animating functions of the primate brain mediate
intersubjective coordination of self-related experiences in intimate
direct communication of purposes and feelings with others. The
anticipations of experience are charged with emotional values linked
in the brainstem with autonomic regulation of vitality within the body
(Damasio, 2010; Solms and Panksepp, 2012), and these affections are
communicated between subjects by a reciprocal sympathetic
cooperation of purposes and experiences (not a one way
imitation or shadowing of emotional processes now commonly called
"empathy"). Human relationships and mutual awareness depend
on relational emotions that promote social cooperation in performance
of creative actions and thinking, to increase collective well-being (Stern,
1993; Hobson, 1993, 2002/04; Trevarthen, 2009a). The well-coordinated
performances and expressions of affect of newborn infants in expectant
orientation to real or imagined objects, and to persons (Trevarthen,
1984, 1986b; Nagy, 2011), the development of intentional movements and
rhythmic emotional expressions of fetuses (Trevarthen and
Delafield-Butt, 2013), and the behaviors of anencephalic children (Merker,
2007) support phylogenetic evidence that primary conscious states and
emotional evaluations, which are essential regulations in all goal
directed consciousness, are indeed first generated and regulated
sub-cortically (Solms and Panksepp, 2012), without neocortical
involvement. These motor-emotional systems are elaborated in the
orbito-frontal cortex and the temporal lobe of human beings, which
continue to develop to adult stages (Schore, 1994, 2005). Before these
developments they play a central role in maternal care, and in the
repair of emotional disorders (Schore, 2003). Affective
self-regulation and emotional communication to regulate engagement
with other individuals have evolved in vertebrates by elaboration of
intrinsic neurochemical systems in the brainstem linked to the
hypothalamus (Trevarthen et al., 2006). Regulation by the vagal nerve
of essential self-related vital processes of heart activity,
respiration and feeding is adapted for intersubjective coordination in
the primate social brain by means of communication employing
expressive movements of eyes, face, and vocalization. Throughout
development of a child, from the time of maternal support of the
infant through birth and nursing, there is a dynamic process that
balances changes in self-regulation against the need for collaborative
regulations of relationships with other persons in various degrees of
intimacy (Porges and Furman, 2011; Carter and Porges, 2013). These
have particular significance for identifying and explaining autism (Patriquin
et al., 2013). The importance of rhythmic emotionally expressive hand
gestures in human communication from infancy (Trevarthen, 1986b;
Trevarthen et al., 2011), indicates that forebrain systems for guiding
action of the hands in complex manipulations have been recruited into
the brain stem and limbic systems for assisting autonomic regulations
by self-touching or holding and further adapted to the service of
social coordination. Hands are part of the human emotional motor
system (Holstege et al., 1996).
Indeed,
movements of "mimesis" for social celebration in dance and
song, appears likely to have preceded evolution of speech and
contributed to its power to communicate thoughts as Homo
sapiens sapiens evolved (Donald, 2001; McNeill, 2005;
Mithen, 2009; Gillespie-Lynch et al., 2013). The roots of this human
talent for expressive gestural mimicry is apparent in infancy and an
essential contributor to the intimacy of parental care (Trevarthen,
1999, 2013; Dissanayake, 2000). Both gestural and linguistic languages
develop in intense interpersonal communication mediated by vitality
dynamics and expressions of emotional investment that provide a basis
for the transmission of more differentiated semantic references by
symbols (Stern, 2010; Lüdtke, 2012). Dynamic communications carried
by consistent innate measures of moving in time (Pöppel and Wittmann,
1999), over intervals from fractions of a second to minutes and longer,
are cultivated in all human societies in the arts of music, dance and
theatre. They begin as a universal human regulation of rhythms of the
mind or "biochronology," active before birth and elaborated
in the communicative musicality and rhythmic action games parents play
with infants in the middle of the first year (Trevarthen, 1999, 2009b;
Malloch and Trevarthen, 2009). Autistic children show abnormalities in
production and reception of communication by both speech and gesture,
and in writing (Rapin and Allen, 1983).
THE
NEUROLOGY OF COMMUNICATION BY TRANSFER OF THE DYNAMICS AND FORM OF
INTENTIONS AND FEELINGS IN MOVEMENT
New
data from social neuroscience confirm the "common sense"
that we are aware of other person’s states of mind by immediate or
direct engagement with the Other’s motor
intentions, by whatever modality or movement these
intentions are expressed, matching them by instantaneous "affect
attunement" (Stern, 1993, 2010) to the animation by which we
generate intentions of our own Self (Gallese, 2006; Bråten, 2009).
Sensitivity for the intentions, interests and feelings of other
individuals, for the social affordances of their behaviors, must
depend upon matching regulatory processes that govern the rhythm or
pulse and expressive tonality or quality of movements of the human
body as well as by "mirroring" their body-related form (Trevarthen,
1986b, 1999; Stern, 2010). Regions in the adult cerebral hemispheres
of a monkey or human being that are sensitive to organism-object
relations, and that respond selectively to perceived capacities
for action of the self, also respond to the possible
actions available to, and enacted by others (Gallese, 2007). The same
neural system is responsible for perceiving one’s own possibilities
for action and the
possibilities for action of another. Direct intra-personal
neural resonance within the "mirror neuron
system," reflecting the Self, gives one individual direct inter-personal
access in "felt immediacy" (Bråten, 2009) with
intentions in the mind of an Other made manifest in their body
movement, in "intersubjectivity" (Trevarthen, 1979, 1998;
Trevarthen and Aitken, 2001). Further, data from imaging of brain
activities show there exists substantial overlap in activity of this
system for awareness of actions with activity excited by merely thinking
about an intentional act (Decety and Grezes, 2006).
Direct
resonance between preparation, execution, observation and thought in
action depends on "motor images" (Bernstein, 1967), which
underpin perception, observation, and planning of goal-directed
action, and also integrate Self-related experience (Llinàs, 2001;
Northoff and Panksepp, 2008). An amodal perception-action system is
also the means by which complex embodied human intentions may be
communicated between agents across many channels of expression, in a
"consensuality," which, when further elaborated and mediated
by language, becomes a tool for sharing abstract concepts and plans (Maturana
et al., 1995). Disruption of the neural systems of motor planning in
time and space, by epigenetic dysregulation of early development in
the brainstem, or by environmental insult to the growing brain, will
have pervasive effects in maturation of consciousness, behavior and
social engagement, such as occurs in autism (Aitken and Trevarthen,
1997; Trevarthen et al., 1998; Trevarthen, 2000).
PRENATAL
GENESIS OF AUTISM
We
have described the coordinative mechanisms in the brain as an "intrinsic
motive formation" (IMF), "ready at birth to share emotion
with caregivers for regulation of the child’s cortical development,
upon which cultural cognition and learning depend. .
. . many psychological disorders of childhood can be traced to
faults in early stages of brain development when core motive systems
form." (Trevarthen and Aitken, 1994, p. 597). The IMF, laid out
in development of the fetus, is a core component of all of the
sensory-motor mechanism of human communication—by gesture and dance,
speech and song, or by writing, playing musical instruments and other
manual or digital media (Trevarthen, 2001a,b). Rodier and Arndt (2005)
relate autistic behaviors that limit expressive movements of the eyes,
face and vocal productions, and anticipatory attention to expressive
movements of other persons, to malformation in the embryo of core
regulatory systems in the midbrain, the brain stemvisceral efferent
and afferent nuclei, and the olivary nuclei and cerebellum. They
conclude, "there is no region but the brainstem for which so many
lines of evidence indicate a role in autism" (Rodier and Arndt,
2005, p. 146).
IMAGINATIVE
INTENTIONS AND EMOTIONS OF THE PRIMARY SELF
There
has been, in the last two decades, a highly significant re-evaluation
of the relationship between emotion and cognition, and their
functional inseparability in human experience and in communication at
all stages of development (Damasio, 2010; Panksepp and Biven, 2012).
Comparative studies of the mammalian emotional system demonstrates
that an affective core
sense of the Self (Northoff and Panksepp, 2008; Solms and Panksepp,
2012) does not depend on learned conceptual knowing. This "anoetic"
consciousness of a live body (Vandekerckhove and Panksepp, 2011)
develops before a child becomes familiar with the external world
through practice of intention and testing of actions which explore the
affordances of situations and objects. At all stages of the
development of human conscious intelligence this mobile
self-with-feelings remains active, generating an innate
spatio-temporal context for the arousal of movements to engage with
the environment, and affective values for sustaining core vitality (Stern,
2010). From mid gestation through infancy the developing self is
sensitive to other persons’ responses to its activities and vitality,
first showing signs of vital state to achieve shared "amphoteronomic"
regulation of its own autonomics with those of the mother. After birth
the infant signals its own rhythmically intended and affectively
measured acts in responsive ways that lead to the "synrhythmic"
communication for cooperative learning and cultural development (Maturana
et al., 1995; Donald, 2001; Trevarthen et al., 2006; Malloch and
Trevarthen, 2009; Porges and Furman, 2011).
DEVELOPMENT
OF HUMAN AGENCY IN INFANCY, AND BEFORE BIRTH MEASURES OF INFANT
SENSORY-MOTOR INTELLIGENCE, SELF-REGULATION AND SOCIABILITY
Movements
of a baby under 2 months old are coordinated and integrated within a
rhythmic awareness of a single intentional subjectivity (Trevarthen,
1979, 1984). These movements were described by Prechtl (2001) and
Einspieler and Prechtl (2005) as "general movements" (GM),
which, "involve the whole body in a variable sequence of arm, leg,
neck, and trunk movements. They wax and wane in intensity, force and
speed, and they have a gradual beginning and end. Rotations along the
axis of the limbs and slight changes in the direction of movements
make them fluent and elegant and create the impression of complexity
and variability. If the nervous system is impaired, GMs loose their
complex and variable character and become monotonous and poor." (Einspieler
and Prechtl, 2005, p. 61). General movements are not precisely focused,
intentional and directed by discrimination of discrete objects, but
they can orient head, eyes and limbs to external events in coordinated
sequences within a body-related space (Trevarthen, 1984). Visually
directed reaching in newborns compensates for changes in the "load"
of a limb, which proves the responsiveness of this non-reflex
imaginative coordination to proprioceptive reafference, or "body
self awareness" (Van der Meer et al., 1996). A newborn infant’s
movements are especially sensitive to sight, hearing and touch of an
attentive the mother in face-to-face engagement, and they can take a
creative part in a shared narrative of expressive action (Trevarthen
and Delafield-Butt, 2013). Her voice was learned in
utero (DeCasper and Fifer, 1980) and its sound motivates
rapid visual learning of her face. Imitation tests, made with care to
allow the infant to focus attention and regulate a state of responsive
arousal, prove that a newborn can initiate eye-movements, face
expressions, vocal sound patterns and hand gestures of another person
(Meltzoff and Moore, 1977; Maratos, 1982; Field et al., 1983; Heimann
et al., 1989; Kugiumutzakis, 1999; Nagy and Molnar, 2004; Nagy, 2011).
These behaviors signaling a "second person other-awareness"
are adapted for sharing curiosity for others’ mental states of
interest and affective appraisal (Reddy, 2011). At 2 months, after a
period of rapid maturation of sub-cortical and cortical visual-motor
regulations of foveal sight (Trevarthen, 1986a), the infant’s
precisely timed responses of looking, smiling, and vocalization give
evidence of preparation for sharing ritual practices and language (Bateson,
1979). Electroencephalic data on the activity of a 9-week-old infant’s
brain when looking at the photograph of a woman’s face (Tzourio-Mazoyer
et al., 2002) confirmed that complementary neocortical areas in left
and right brain, which 2 years later will become involved in a child’s
learning of expression and reception of spoken language, are already
components in cerebral regulation of interpersonal contact by a
"social brain," long before the training of a "social
intelligence" by life with other persons (Frith and Frith, 1999).
The subcortical visual and auditory systems that mature from the early
fetal period show an asymmetry related to differences in left and
right parts of the brainstem that mediate in complementary autonomic
regulations (Trevarthen, 1996). Schore (1994, 2005) proposes that the
early developing right brain motivates shared learning of perception
and articulation of meaning in language when the left cerebral
hemisphere shows an acceleration of growth in the second and third
year, the period when diagnosis of autism becomes possible.
Developments around 3–5 months correlate with more differentiated
movements of the baby’s extremities when new neo-cortical
sensory-motor functions are developing. Einspieler and Prechtl, label
these subtle gestures "fidgety," and describe them as,
"small movements of moderate speed with variable acceleration of
neck, trunk, and limbs in all directions" (Einspieler and Prechtl,
2005, p. 61). They lead the infant to make more discriminating
orientations of head, eyes and hands intending to reach for and touch
or take hold of objects at a distance from the body, and are
accompanied by a fall in attention to the mother. This incites the
mother to be more animated and playful, and to incorporate the baby’s
selective interest in objects into "person-person-object"
games (Hubley and Trevarthen, 1979; Reddy, 2011).
PROGRAMMED
DEVELOPMENT OF THE INFANT-PARENT SYSTEM
Longitudinal
studies of developments in actions, perception and communication in
the first two years, with information on internally regulated brain
growth changes, confirm that there are transformations in the motives
and emotions of the child for collaboration with parental care (Trevarthen
and Aitken, 2003). Sander’s studies of infants with their mothers
from birth over the first 36 months showed that growth of a human life
is sustained by a series of stages of adjustment within a system of
human-to-human engagement (Sander, 2008). Both mother and child are
significant actors, but in the creative process of development the
child must normally set the pace and the times of important advance.
Brazelton extended Sander’s system approach to an interpersonal
paediatrics accepting the conscious and personal powers of the newborn,
and defining "touch points" in the developing life with
parents and in the community (Brazelton and Nugent, 1995; Brazelton
and Sparrow, 2006). Periods of change in developing powers that are
both sensitive and significant, are symptoms of advances in motivation
for learning and for communication (Johnson, 2005). Their consequences
depend on collaboration with parents who are "attuned" to
the infant (Stern, 2000), and both intimate and playful in their
accommodation to the child’s impulses. Data from a review of the
literature on changes in the child’s psychology and brain over the
first 18 months (Trevarthen and Aitken, 2003) point to natural
emergence in the child of new levels of mastery of action and
awareness at around 6 weeks, 4 months, 7 months, 9 months, and between
15 and 18 months. These agree with longitudinal studies of infant’s
capacity to take initiative in joint activities (Trevarthen, 1977;
Hubley and Trevarthen, 1979; Reddy, 2011). These five advances in
adaptive processes correlate with temperamental changes commonly
referred to as "regressions." They adapt to cultural
differences in the frequency of parental initiatives or directives (Reddy
et al., 2012). They are products of the active system of "intent
participation" in the environment with companions that drive
cultural learning (Trevarthen, 2013).
SENSORI-MOTOR
INTENTIONALITY BEFORE BIRTH: GENESIS OF PRIMARY SELF-CONSCIOUSNESS AND
THE FIRST INTERSUBJECTIVITY
Spontaneous
movements develop in the late embryo and fetus, showing increased
sensory awareness of their purposes (Delafield-Butt and Trevarthen,
2013). The first integrative actions of the nervous system are to move
the body, and the first nerve tracts in the central nervous system are
those that will activate movements to express different orientations
and emotional states (Trevarthen, 1986a). After 8 weeks the core
neurochemical systems of the subcortical brain that will link motor
centers and select and evaluate experiences throughout life make their
appearance. At this stage the fetus makes the general movements of
Prechtl (2001). These become increasingly differentiated and
controlled with the benefit of re-afference from sensory systems that
grow in the following weeks. Detailed studies of by real-time
ultrasonography demonstrate a fetus’s exploratory sensation-testing
to touch their own body, their face, the placenta, umbilicus, and the
uterine wall with their hands at 11 weeks. They make jaw movements and
swallow amniotic fluid, expressing pleasure or disapproval at tastes,
sucking and smiling or grimacing with disgust. Complex movements of
trunk, arms, and legs position the body, and may react to movements of
the mother’s body and to the contractions of the muscles of her
uterus (Lecanuet et al., 1995; Trevarthen et al., 2006; Piontelli,
2010). In weeks 10–14 fetal movements become differentiated into
individual, isolate actions with increasing goal-direction to
particular parts of the body (Prechtl, 2001; Piontelli, 2010). The
arms and hands "test" sensitive zones of the body,
especially to the face and head, exploring the border of sensory
innervation on the top of the head (Piontelli, 2010, p. 61–67). In
singleton pregnancies motor planning of action patterns adapted for
different goals is evident before 22 weeks gestational age (Zoia et
al., 2007). In twin pregnancies, movements directed by one twin to the
other are "carefully" slowed, even by 18 weeks, which the
researchers interpret as evidence of a primary "social awareness"
(Castiello et al., 2010). At this time the motor centers of the
brainstem and spinal cord are directing the coordinated behavior of
the fetus (Okado, 1980). Neocotical cells do not develop dendrites
until after 26 weeks of gestation (Hevner, 2000). This natural history
of human movement at a stage of development when the sensori-motor
environment can only be the properties of an organized body itself
appears to support Lashley’s conclusion that propositional thought
may depend on, and indeed be derived from, the spontaneous syntactic
ordering of movement sequences (Lashley, 1951, p. 122). The fetus has
an imaginative "motor intelligence" and can formulate
orderly projects without neocortical skills. Expressions in fetuses,
in addition to twisting movements of distress and tentative
exploration by touch, give evidence of emotions—of discomfort,
curiosity or pleasure, adapted for communication of interests and
feelings. In the third trimester, movements of the face visualized by
4D ultrasound develop into complexes that define a "cry face
gestalt" or a "laughter gestalt," expressing emotions
that will communicate powerfully immediately after birth in the
regulation of parental care (Reissland et al., 2011). Maternal hunger
with depletion of energy supply to the fetus drives "anxious"
patterns of fetal movement. The mother and the fetus are already
affectively connected. These discoveries prompt a revolution in
psychological theory and medical ethics. There is a consensus in
modern paediatrics that by 24 weeks the fetus should be considered a
conscious agent deserving the same standard of sympathetic medical
care as adults (Royal College of Obstetricians and Gynaecologists,
2010).
READINESS
FOR SUPPORT OF THE BODY IN RHYTHMS OF MOVEMENT, AWARE OF SURROUNDINGS,
AND ATTENTIVE TO HUMAN COMPANY IN MOVEMENT
Infants
demonstrate the regulations of an innate time for life in movement.
Research on their dynamics and coordination with a parent’s
movements have led to a natural science of human "musicality"
(Trehub, 1990; Papoušek, 1996; Malloch, 1999; Malloch and Trevarthen,
2009). Inspired by discoveries of precise analysis of films, revealing
self-synchrony of movements of individual actors and inter-synchrony
between actors in conversations (Birdwhistell, 1970; Jaffe and
Felstein, 1970; Condon and Ogston, 1971) researchers found that
infants and adults share matching rhythms (Condon and Sander, 1974;
Beebe et al., 1985; Jaffe et al., 2001). One remarkable video
recording made by Saskia van Rees of a 2 month premature infant in
precisely timed coordination of dialogue of simple "coo"
sounds vividly demonstrates how this shared sense of time for
combining syllables in phrases may lead to a narrative in wordless
dialogue (Trevarthen, 1999). Two bands of time are shown to be
fundamental in dialogues, games and songs between young infants and
their parents (Trevarthen, 1999, 2009b). Faster rhythms of syllables
and phrases in speech and song, or dancing steps and gestures,
correspond with arm and hand grasping for object manipulation, or of
the head and eye rotations that perform visual inspection. These range
from the median syllable frequency of 1.5–3 per second— the same
as a running or fast stepping, a glance or eyebrow rise, a laugh or a
hand wave—to every 3–5 s for a visual scan, a manipulative
sequence, a phrase of speaking or song, and a cycle of deep breathing.
These are somato-motor coordinations that achieve use of the
environment and pickup of information for perception, or of a
communicative message, in the "psychological present," the
"here and now" of consciousness in action. Slower periods of
sensed vitality, as expressed in the "extended present" of
an episode in a story, a verse of singing or a stanza of poetry,
occupy 10–25 s. Longer times of imagined activity and narrations
form natural elements of 25–50 s in the rhythmic verses, playful or
calming, of baby songs in all languages. These slower events are
identified with autonomic events that regulate arousal, hunger and
wakefulness throughout life, and regulation of the rate of heartbeat
and breathing by the vagal nerve (Delamont et al., 1999). They are
accompanied by bursts of electrical activity in the cerebral cortex
that have a role in the fluctuating experiences of dreaming. They link
the imagination with the economy of life energy in the body, and with
the expressive arts. Stern (1993, 2000, 2010) called the cycles of
arousal or variations in vitality dynamics in mother-infant play
"emotional narratives" expressing "implicit relational
knowing." Malloch analysed the controlled patterns of change in
voice qualities and pitch of the voices of mothers and infants in
dialogues and baby songs as "narratives" that, "allow
two persons to share a sense of passing time, and to create and share
the emotional envelopes that evolve through this shared time. They
express innate motives for sharing emotion and experience with other
persons and for creating meaning in joint activity." (Malloch,
1999, p. 45). These shared "routines" are identified by
Bruner (1999) as the medium for reference in language. We have
recently been finding evidence of the same "narrative"
cycles of arousal in the "general movements" of newborn
infants, which may be shared with a sensitive mother who coordinates
with her baby by modulated vocal sounds, touches or rocking. They
participate in tides of consciousness of being together that later
will regulate the changes of meaning in a story or the recollections
of episodic memory (Delafield-Butt and Trevarthen, 2013; Trevarthen
and Delafield-Butt, 2013).
SENSORI-MOTOR
DIS-COORDINATION IN AUTISM, FROM INFANCY DEFICIT IN PROSPECTIVE MOTOR
CONTROL IN AUTISM AND ITS CONSEQUENCES FOR DEVELOPING INTENTIONALITY
AND LEARNING
The
complex disorder of childhood autism, and how it has serious effects
on a young child’s life, may be described as follows:
"By
about one to two years after birth .
. . at a time when infants usually become acutely aware of
other people and what they are doing, full of playful imagination and
eager for new experiences, these babies became strangely
self-contained or isolated in their own world and increasingly
unresponsive or irritable, and difficult to understand; their
vocalizations movements often seemed repetitious and pointless, and
their gestures and postures were also odd. Throughout their childhood
they continued to express themselves in ways that made parents,
teachers and other children feel unable to make contact. As
pre-schoolers, the children are not insensitive to others or
unaffectionate, and they can show strong likes and dislikes for
particular people. Sometimes they imitate or seek to interact, but
never in a free and easy way, and sometimes with a peculiar
ritualistic insistence, and remarkable inattention to their effects on
other people. Strange postures and movements and a need for sameness,
combined with obsessive interest in certain objects and experiences,
cut them off from others. At times they seem to be in a trance, "floating
off," "looking" or "listening" when nothing
is there, often with strange flapping of the hands, or an enigmatic
smile, and they only make unintelligible baby-like vocalizations. They
may get into inexplicable panics and seem very distressed, anxious or
terrified, especially when forced to have close contact with people or
in strange environments. In general they do not like, or fear,
unfamiliar places or routines. They protest at irregularities in their
world and repeat seemingly trivial actions for their own interest.
Some, in panicky states or anger,may injure themselves.Most of the
time, however, they seem content to amuse themselves, often performing
favorite actions over and over. Their behaviors can be frightening and
distressing to parents who need help to understand what is wrong and
how to cope with a child who looks healthy enough, but who won’t
respond." (Trevarthen et al., 1998, p. 1–2).
Odd
behaviors like these are seen in children who do not have autism, but
they are momentary and easily regulated by the child’s playful
resourcefulness or by affectionate attentions of parents, and in
shared enjoyment with other children. The autistic child has
persistent problems in both self-regulated actions and emotions, and
in awareness of other person’s intentions, interests and feelings.
There are conflicting ideas on the causes of these problems and how to
respond, especially for the early stages. Disorders of movement in
children with autism particularly affect expressive movements in
communication (Ricks and Wing, 1975; Damasio and Maurer, 1978;
Gillberg and Coleman, 1992; Frith and Frith, 1999; Oller et al.,
2010). These have lead to an interpretation in terms of a deficit in
"executive functioning" (Rumsey, 1985) attributed to a
developmental fault in the frontal lobes that manifests itself in the
second year. Recent data point to a more basic and probably earlier
developing deficit in prospective control of movements (Mari et al.,
2003; Rinehart et al., 2006a; Dowd et al., 2012; Gowen and Hamilton,
2013). For example, in an automated vocal analysis of a large body of
data recorded from natural expressive behavior of infants 10–50
months of age, Oller et al. (2010) identified massive delay in
development of movements of vocal articulation in children developing
autism or language delay. Such disorders affecting communication
behavior can be explained as originating as faults in the timing and
integration capacities of the brainstem sensorimotor system, which
develops prenatally and affords prospective control for later
developments in psychological functions. Failure in cognitive
strategies of "action planning" and "action execution"
(e.g., Rinehart et al., 2001; Nazarali et al., 2009) attributable to
change in mirror neuron systems (e.g., Cattaneo et al., 2007;
Fabbri-Destro et al., 2009), require higher-order cortical processing,
which develops after birth. Children with ASD differ from typically
developing children in the efficiency of three types of prospective
motor control:
(i)
Generation of single actions,
such as when extending the hand to touch, or indicate, an object of
interest;
(ii)
Organization of a series of
actions to perform more complex tasks or projects,
including speaking,
and
(iii) Simultaneous coordination
of multiple action units to achieve coherent purpose, as in
postural accommodations when standing or walking.
Simple
"action units" and serially organized "action chains"
both require precise coordination of muscle actions that are conceived
or imagined "ahead-in-time" so that they achieve a desired
future effect efficiently (Bernstein, 1967; von Hofsten, 1993; Lee,
2009). And an integrative control of movement is a necessary
foundation for learning more advanced and complex tasks, such as
speaking and reading (von Hofsten, 2004, 2007). Awareness of others’
intentions requires detecting prospective control in their movements,
and this is apparent in how infants participate in dialogue and games
(Trevarthen, 1986b). Failure to time movements prospectively and meet
expectation in movement will thwart efficient goal acquisition,
confuse awareness and frustrate a sense of success, causing negative
emotions of self-protection and avoidance (Bower et al., 1970;
Rovee-Collier et al., 1978).
(i)
Evidence for disturbance in prospective control of single action units.
Autistic persons exhibit significant differences in the
timing and patterning of single movements (Rinehart et al., 2001,
2006a; Mari et al., 2003; Nazarali et al., 2009; Dowd et al., 2012).
The type of disturbance varies with the task and the sub-group
examined. For example, in a reach-to-grasp task individuals with ASD
grouped by low or average to high intellectual ability, with
full-scale I.Q. scores below and above 80, exhibited different
kinematics, and both groups acted significantly less efficiently than
typically developing children (Mari et al., 2003). Differences between
ASD groups were thought to reflect different compensatory coping
strategies for a primary deficit in motor planning. The autistic
individuals also failed to coordinate the two sub-actions in the
reach-to-grasp task, i.e., reaching of the arm and the opening of the
fingers. They performed one act and then the other separately. Typical
children coordinate the sequence of arm and hand actions in "pre-reaching"
and gesturing fluently from early infancy (Trevarthen, 1984;
Rönnqvist and von Hofsten, 1994; Prechtl, 2001).
(ii)
Evidence for disturbance in serial organization of multiple action
units. The progressive planning of "action chains"
communicate intentions. When we see someone grasping a bottle, for
example, the initial reaching movement of the arm differs depending on
whether the goal is to shelve it or to serve some wine (Jeannerod,
1999). The postural preparation of the body and extension of the arm,
with shifts of gaze, are adjusted from the start in different ways
depending on the final goal. Children with ASD have deficits in this
preparatory coordination for motor sequencing or action chaining (Cattaneo
et al., 2007; Fabbri-Destro et al., 2009). Typically developing
children, when asked to perform an object manipulation task, such as
turning an upside-down drinking glass right-side up, adjust their body
posture at the start of the action so that their final posture is
comfortable (Rosenbaum et al., 1990). Children with autism begin with
a comfortable posture and conclude it in an uncomfortable one,
suggesting a deficit of motor "knowledge" of how the action
will proceed. Cattaneo and colleagues (2007) used electromyographic
recordings of the mylohyoid muscle movements that lower the jaw and
raise the tongue for reaching-to-grasp-to-eat, and they compared this
sequence with the muscle activity during a movement of
reaching-to-grasp-to-place. They found that typically developing
children anticipated eating the food with mylohyoid activation
beginning well before their hand had grasped the piece of food. In
contrast, this activation did not start in children with ASD until the
food was already grasped in the hand and traveling toward their mouth,
demonstrating a failure to couple the action chains efficiently. This
lack of anticipation was also evident when the children were asked to
watch another person perform the reach-to-grasp-to-eat action. The
mylohyoid activation occurred in typically-developing children at the
onset of the other’s movement toward the food, but in autistic
individuals there was no mylohyoid activation at all.
(iii)
Evidence for failure in simultaneous integration of multiple action
units. Measurements of children’s postural adjustments
and muscle tensions during load shifting shows that prospective
control of whole-body posture and perception of body-space goals,
which require synchronizing and co-ordinating action units through-out
the body in shifts of the legs, chest, back, and arms, are also
disrupted in autism (Schmitz et al., 2003). Disturbances of
prospective control for the whole body are confirmed by data on gait
differences in individuals with autism, showing an increase stride
length and variability of the width of stride, but also significant
differences in postural adjustments of the upper-body to maintain
balance (Hallett et al., 1993; Vernazza-Martin et al., 2005; Rinehart
et al., 2006b; Calhoun et al., 2011; Nayate et al., 2011). They also
have difficulties in perceiving the environmental context for their
movements (Gowen and Hamilton, 2013).
DIFFERENCES
IN PROSPECTIVE MOTOR TIMING AFFECT SOCIAL EXPECTATION AND
UNDERSTANDING
The
subtle deficits in prospective motor control of children with ASD must
be involved in the symptoms of social isolation and emotional distress
that they show. They have difficulties in communicating their
intention in gestural acts, and in sensing the dynamics of another’s
intentions from their movements (Cattaneo et al., 2007; Zalla et al.,
2010; Gowen, 2012). Imitation-based or interaction therapies for ASD
employing sensitive response to signs of intended movement are able to
assist because they facilitate both anticipation of actions and
psychological and emotional connection (Escalona et al., 2002; Nadel,
2006; Zeedyk, 2008; Field et al., 2011; Solomon et al., 2012). The
therapist acts to excite anticipation, which simplifies and supports
the performance of desired actions. It also explains why insistence on
evidence from repeated measures of performance in tasks to test
perceptual preferences or cognitive mastery can fail to detect or
explain the cause of failure (Wigram and Gold, 2012). Such external
measures, focusing on achievement of goals or response to facts,
neglect the temporo-spatial phenomena of prospective motor control
within the subject. Problems of intentionality and its perceptual
guidance in autism, and pathological defense against sensory overload
(Rosenhall et al., 1999; Foxton et al., 2003), may be due to faults in
motor regulations of sense organs; of the inner ear to adjust the
sensitivity of hearing, and of head and eye movements to control
selection of detail by foveal fixation which is guided by pick-up of
global information from the ambient field. Hearing and production of
speech sounds, which autism impairs in differing degrees, is
particularly demanding, requiring detection and control of affective
expression transmitted by small modulations in the timbre, pitch and
loudness of vowel sounds, and their constraint by consonants produced
in rapid sequences to articulate intelligible words in
information-rich phrases. Autism, however, interferes not only with
the motor controls of selective hearing and seeing, but with attention
to all the expressive movements of other persons. In high functioning
persons with autism, exceptional abilities in detecting, separating
and combining visual details or pitches of sounds (O’Riordan et al.,
2001; Bonnel et al., 2003; Mottron et al., 2006) may be a consequence
of compensatory hypertrophy in higher cortical sensory systems driven
by a bias to detect affective self-related feedback or support.
Ockleford’s experience with supporting exceptional performative
talents in autistic children who cannot speak suggest that pleasure
from control of pitch in sounds from musical instruments activates a
primary reward system different from that which discriminates speech
components (Ockleford, 2012, 2013). In confrontation with another, a
person with autism avoids looking at the eyes, directing attention to
the mouth (Senju and Johnson, 2009). Given that rapid movements of the
eyes transmit important information about the direction and intensity
of interest, in
preparation for shifts in locomotion, posture or reaching by hand, as
well as selective attention to individuals in a group, they implicate
tracking of sequences of intended action to engage with others’
prospective control in thought and action (Bal et al., 2010). Lower
face expressions and mouth movements express affect
and are essential for emotional sympathy. They attract
attention of an observer for judging another person’s feelings.
Failure to appreciate playful teasing and humor and avoidant or
defensive reaction to strangers, as well as preference for familiar
surroundings and consistency in placement of objects or execution of
routines, characteristics of ASD, all point to a disturbance of
imaginative curiosity for prospects of action. They are as much
disorders of self-regulation of pleasurable movement-with-awareness as
of affective other-awareness, and they impair intentional and
emotional engagement (Hobson and Hobson, 2011; Reddy, 2011)
DISORDERS
OF AUTISM IN THE FIRST YEAR
Teitelbaum
and colleagues (1998, 2002), studying home movies of infants later
diagnosed as autistic, made a comparative analysis of the
developmental stages of turning over, crawling, sitting, standing and
walking, which infants typically master in the first year. Using the
Eshkol-Wachman Movement Notation for temporal and spatial parameters
of human body movement they showed deficits in whole body control and
sequencing of the movements of trunk, head and limbs to control
balance and posture changes, which were interpreted as disordered
sensory-motor reflexes. These detailed observations have been helpful
for parents who suspect their infant may be developing autism,
assisting them to engage the attention of medical specialists and
therapists (Teitelbaum and Teitelbaum, 2008). Similar disturbance of
anticipatory regulations of whole body postures were found by
Danon-Boileau (2007) in films made of two sisters while they were
being bathed by their mother; one, at five months, who later developed
autism, and the other who developed normally, at 3 months. The films
show the anxiety and awkwardness of the first girl who scarcely looked
at her mother, and an analysis of the mother’s speech shows she was
not "in contact" and was using her voice with a detached
tone, to draw response. With the normally developing sister the mother’s
speech is lively and addressed to the child as person seeking to share
the experience. This infant keeps eye contact with the mother and
reacts expressively. Similar observations were made in an analysis of
home movies of identical twin girls at 10 months, when their father
was helping them to walk or playing a game with them in the family
living room (Trevarthen and Daniel, 2005; St. Clair et al., 2007). One
girl later diagnosed as autistic, and who did not speak until the age
of 3, showed clear delay in motor coordination for stepping and for
regulation of her sitting posture. She lacked attention to other
persons’ eyes and made fleeting smiles and she could not participate
in a teasing game with her father that required anticipation of his
rhythmically phrased behaviors and speech. The rhythms and expressions
in response to teasing and tickling with the father were different
from those of the typically developing twin, and the father was unable
to reciprocate, creating confusion in games and interactions. Her
sister who had a mild retardation at school age, developed normally
through the first years showing no evidence of autism. The lack of
responsive attention by the infant developing autism to her father’s
attempts to play caused him to become irregular and insistent in his
solicitations, which afterwards he could see only confused the child.
The same transformation of parents’ responses to avoidant or
disengaged behavior of an infant developing autism have been noted in
other studies of home movies and in prospective studies of siblings of
autistic children, i.e., a change to a more insistent and monotonous
mode that tries to excite a response (Baranek, 1999; Saint-Georges et
al., 2010, 2011). For example, there is a lack of the affective
modulation of the parent’s voice in speech to an infant who later
develops autism (Mahdhaoui et al., 2011). Disorder in development of
the child’s vocal control on the way to mastery of speech, such as
that demonstrated by Oller et al. (2010) for the crucial period from 1–4
years, will affect the parents ability to share talking, and prompt
them to use stimulating or coercive ways of engaging with the child.
Two research strategies have been used to search for evidence of
abnormal development before medical diagnosis is possible: prospective
study of the infant siblings of older children with autism. The two
procedures confirm important conclusions about manifestations of
autistic disorder that are developing in the first 18 months after
birth (Zwaigenbaum et al., 2005; Saint-Georges et al., 2010). They
highlight effects of the "flatness" and lack of seeking for
engagement and also changes associated with the phases of motor
development which were recorded by Teitelbaum (Teitelbaum et al.,
1998, 2002), and the development of interest in objects. Attention to
objects was normal in the first six months in infants developing
autism when their attention to social engagement was significantly low
(Maestro et al., 2002). There is a specific loss of interest in other
persons' expressions early in infancy (Muratori and Maestro, 2007).
Expression of intentions and affects is achieved with crossmodal
fluency between voice and gesture that promotes sympathetic action and
shared experience with "affect attunement" (Trevarthen,
1986b, 2009a; Tronick, 1989; Stern, 2000; Reddy, 2008). Expressive
acts, like all goal-directed voluntary movement, require prospective
control, and by assimilation of the form and flow of the movements of
the body and voice of one subject states of intention, affect, arousal
and interest are conveyed to the awareness of the other in "felt
immediacy" (Bråten, 2009; Stern, 2010; Trevarthen et al., 2011).
If predictive control of the timing and harmonization of these
expressive body movements are disrupted, then psycho-motor attunement
with the perceptual and motor experiences of others will be confused.
Magnetic resonance imaging of the brains of autistic children indicate
reduction in size of the brainstem and midbrain at birth, a loss of
tissue more than compensated for by excessive growth of the brain as a
whole postnatally (Hashimoto et al., 1995). Detailed neuroanatomical
investigation of brains from children with ASD also indicate limbic
midbrain structures and brainstem regions are affected (Rodier and
Arndt, 2005). Of particular note is an abnormality in the inferior
olivary nucleus, a prominent lower brainstem nucleus known to be
involved in perceiving and controlling of the timing of movement (Welsh
et al., 1995), indicating a likely primary site of disruption
underpinning ASD motor deficit (Welsh et al., 2005). The data on motor
impairments in ASD and their early manifestation in infancy confirm a
primary deficit in the capacity to perceive and move the body in a
planned way, which limits the capacity to control the timing of
actions of the body and their perceptual consequences, and thence
impairs the communication of intentions and ideas.
AN
INTERACTIVE RELATIONAL APPROACH TO THERAPY AND TEACHING, NURTURING
INTIMACY AND CREATIVEY OF MOVEMENT
"Musical
structure in improvisation can provide a framework for creative
development, and . . . more creative skills may well-emerge given a
structure than one might see from a purely free form of improvisation—where
a lack of direction and model may leave the "non-musician"
client struggling to find out how they can "create"
music.... Creativity is a key process in improvisational music therapy,
and demands substantial skill and flexibility in the therapists to
nurture in clients for therapeutic benefit." (Wigram,
2006).
Interactive
music therapy for both diagnosis and treatment of autism indicates
that the aim of a therapist or teacher is to provide support for
creativity, and that this requires both a "direction and
model" and "skill and flexibility." It requires a guide
that protects the learner from "struggling to find out how they
can create." And it requires descriptive evidence from single
case studies (Wigram and Gold, 2012). In the controversial field of
therapy for children with autism there is a bewildering range of
theories and advice for procedures, which range from strict teaching
of skills to control disordered actions and feelings and to coax
communication, to permissive environments where possible distractions
are eliminated and attempts are made to give comfort (Trevarthen et
al., 1998; Teitelbaumand Teitelbaum, 2008). Given the evidence that
the core deficit in autism concerns prospective sensori-motor control
and affective self-regulation, especially for activities of
communication, we focus our final comments on evidence that intimate
or intensive engagement with the impulses of affected children in ways
that bring pleasure from control of actions and mutual recognition may
bring benefit for creative learning of practical skills and artificial
rituals of shared experience, including language. Finely measured
pulse, form and flow of the enactments of the sensuous body and voice
convey psychological states of intention, affect, arousal, and
interest (Trevarthen, 1986a,b; Stern, 2010; Trevarthen et al., 2011;
Hardy and Blythe LaGasse, 2013). Gestures made in communication are
controlled and directed in body-space and by selecting transitory
goals with precise timing of muscular energies that display affective
content in "narrative" sequences (Schögler et al., 2008;
Trevarthen and Delafield-Butt, 2013). It follows that, if the common
control of body movements is disrupted, then the individual will have
difficulty finding psycho-motor attunement with the perceptual and
motor experiences of typical others. Understanding of the fundamental
and deeply felt disorder in autism as failure of integrative brain
activity for carrying out sensori-motor intentions with ease and
creativity, that it is a disorder that also affects communicative
expression and perceiving the motor intentions of others, may help
explain how intensive, imitation-based therapies attentive to emotions
may be effective and may foster enjoyable response and interest (Nind,
1999; Field et al., 2002, 2011; Nadel, 2006; Nordoff and Robbins,
2007; Zeedyk, 2008; Caldwell, 2010; Frank and Trevarthen, 2012;
Lüdtke, 2012; Solomon et al., 2012). By consciously "attuning"
to the motor acts of the autistic patient and feeling their affective
and intentional content in "intense interaction," before
re-enacting creative collaborations with adaptation to responses, the
therapist provides an exterior pattern of actions that are timed and
directed sensitively to compensate for repetition of uncertain,
anxious attempts (Hardy and Blythe LaGasse, 2013). A responsive,
"listening" makes communication possible, as well as
progress to new self-confident and joyful experience, which may free
an exceptional talent (Ockleford, 2013). Sensorimotor attunement in
therapy embodies mental/ affective components as much as it does the
motor expression, and in so doing is able to open up a co-regulation
of arousals, interests, and intentions in a person otherwise
unavailable and isolated. All movements are considered valid
expressions of purposeful states, and even stereotypies are regarded
as affective sensori-motor acts capable of initiating communication,
not disregarded an unintentional, non-mental motor acts. As the
therapist attends to the movements of the person, attuning to them
with her own body movements, so they begin to generate an implicit,
affective, and inter-subjective psycho-motor connection. Such therapy
can aid not only the autistic child to achieve communication, but can
be of great help to a parent. It may bring an autistic person of any
age and to more self-confident and articulate participation in an
intimate community of knowledge (Frank and Trevarthen, 2012; Lüdtke,
2012). It is the experience of any therapist who works with persons
suffering from autism that a conscious care must be taken to
"stand back" and allow any impulse the child or adult may
show to take its course, indeed shadowing or mirroring it to aid its
motivation. This is the principle put into the practice of interactive
music therapy (Robarts, 1998; Wigram and Gold, 2006; Nordoff and
Robbins, 2007; Wigram and Elefant, 2009; Ockleford, 2013). A more
explicit standing back, called "asocial," is practiced by
the method developed by the paediatric neurologist Waldon to assist
persons with a wide range of disabilities in acting and thinking. The
therapist places him or herself behind the client, holding the arms to
guide the hands in performance of tasks to move objects in such a way
that a goal or project is completed bringing a sense of satisfaction.
This method has proved effective in helping young children overcome
the confusion and isolation of autism in a way that makes productive
and progressive motor learning possible (Solomon et al., 2012).
|
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