Part 6 Listening to movement, including the perspective of autistic adults

Caroline Whyatt and Cathy Craig Sensory-motor problems in Autism: Frontiers in Integrative NeuroScience July 2013 Volume 7 Article 21

Professor Cathy Craig is Head of the Department of Psychology at Queens University Belfast and Director of Research, Perception Action Communication Cluster:-

“We will present sample studies that explore the role of timing and perception-action coupling in children with ASD who experience motor difficulties. These findings will then be discussed in light of the development of coherent movement control and its impact on social and cognitive ability, highlighting the potential role of a Theory of Sensory-motor control in ASD.
If sensory-motor problems are to be considered a fundamental symptom of ASD, the nature of persistent motor problems specific to ASD must be identified.

Although largely taken for granted, perception-action coupling is honed through maturity and experience, and is dependent on the gradual filtering of sensory information to identify sensory invariants to facilitate the establishment of coherent motor control. Delayed sensorimotor skill acquisition in ASD (Teitelbaum et al., 1998; Zwaigenbaum et al., 2005), may therefore suggest specific a fundamental problem with perception-action coupling as a consequence of impaired perceptual attunement. Combined, this evidence implies a fundamental difficultly with sensory-motor development in Autism Spectrum Disorders, which may precede later social and cognitive symptoms. Indeed, sensory-motor difficulties may even underline classical symptoms of ASD such as cognition, socialization, and communication (Leary and Hill, 1996; Von Hofsten, 2007; Haswell et al., 2009). Whilst, a poor internal sense of time in ASD (Boucher, 2001) and variable temporal production may extend to difficulties with the social “dance” such as turn taking and eye contact (Leary and Hill, 1996; Wimpory, 2002). Moreover, growing evidence for substantial links between motor ability and intensity of classical ASD symptoms (Dewey et al., 2007; Freitag et al., 2007; Hilton et al., 2007; Fuentes and Bastian, 2009) further suggest sensory-motor difficulties are potentially a fundamental, core symptom of ASD, which are currently being overlooked.”

Caroline P. Whyatt and Cathy M. Craig: Motor Skills in Children Aged 7-10 Years Diagnosed with Autism Spectrum Disorder Journal of Autism Development Disorders 2012 42: 1799-1809

“Impairment on both the peg-board and balance board tasks also mirror results from Green et al. (2009), who highlight the explicit use of timing in the scoring of both tasks. Test performance on each task is scored according to performance accuracy and age related time limits. The concept of being timed and understanding the principle of achieving maximal temporal performance may not have been understood by the children with ASD, or the children may have been simply indifferent to this test requirement.

Alternatively it may suggest children with autism have an underlying difficulty with complex tasks which require the coupling of both speed and accuracy, indicating impaired perception–action coupling, crucial in the production of coherent, meaningful goal directed movement (von Hofsten 2007), identified in (1954) by Paul Fitts, Fitts Law is now widely accepted as a universal law of movement control, specifying a direct relationship between spatial and temporal characteristics of a movement. This law stipulates that levels of spatial accuracy required in a movement will be directly reflected in the kinematic profile of the movement. However it may be that children with autism have specific difficulties with this, leading to an inevitable trade off in maintaining an artificially low speed to attain high levels of accuracy. Such a trade off would therefore artificially lower performance scores on both the peg-board (ManDex1) and balance board (Balance1) tasks, which are both scored according to speed and accuracy.

This study reports new results that suggest specific motor deficits in children with autism. Teasing apart levels of performance on a standardised test, whilst controlling for facets of IQ by providing two distinct, well-matched groups of typically developing children has helped reveal a comprehensive profile of motor ability specific to autism. Consideration of the pattern of results may indicate significant underlying deficits in perception–action coupling, vital for the production of coherent, controlled movement.

Jodi Robledo, Anne M. Donnellan and Karen Strandt-Conroy: An exploration of sensory and movement differences from the perspective of individuals with autism. Frontiers in Integrative Neuroscience November 2012 Volume 6 Article 107

Anne M. Donnellan Professor Emerita at San Diego University A long time researcher, advocate and teacher, she founded one of the first programs in the English-speaking world for autistic children in San Diego in 1970. For over 20 years, Dr. Donnellan and her students and colleagues have been writing books and articles emphasizing the importance of studying movement differences in order to understand and support autistic people. Today the Special Research Topic in Frontiers on “Autism: The Movement Perspective” strongly supports this view with over 30 scientific research articles from top research institutions world-wide. Dr. Donnellan co-edited the Frontier’s issue and edited the three papers of Dr. Torres and colleagues from Rutgers and Indiana that document and measure those movement differences. She and her colleagues and students have two research papers in the issue as well (Donnellan, Hill & Leary; Robledo, Donnellan & Strandt-Conroy). The collective works of all these researchers are expected to transform autism by shifting the focus of research and treatments to the individual on the spectrum in ways that are more objective as well as more personalized.

“In the absence of a clear understanding of cause or symptoms, many definitions and theories about autism have been developed. Most often the descriptions offered by the professionals pay little attention to the experience of people who live with autism. It leaves out a long and rich history of writing and research which suggests that individuals with a variety of disabilities or disorders may, in fact, be experiencing differences in their sensory, motor, perceptual, and other systems, which confound and confuse the picture (e.g., Kahlbaum, 1874/1973; Bleuler, 1911/1950). Even in the more recent research that studies the body (motor differences) and autism, there is little understanding of the potential affect of these differences on social, communication, and behavioral functioning (see Leary and Donnellan, 2012).

Typically, the word ‘movement’ refers to observable actions, such as posture, muscle tone, head and eye movements, facial expression, vocalization, speech, whole body movements, reaching, gesturing, running, and walking. Here, the use of the word movement is consistent with research that considers internal mental processes of sensory perceptions (touch, taste, smell, vision, hearing, and proprioception), language, thoughts, and emotions as aspects of human movement.

A review of published first-hand accounts of autism and research studies with participants with autism revealed numerous references to sensory and movement differences in the areas of perception, action, emotion, communication, and cognition.

Perceptual differences, such as differences in hearing, vision, smell, taste, proprioception, and synesthesia were all noted in numerous published first-hand accounts (e.g., White and White, 1987; Cesaroni, 1990; Barron and Barron, 1992; Grandin, 1992, 1995; Williams, 1992, 1994; McKean, 1994; Blackman, 1999; Mukhopadhyay, 2000; Rubin, in Biklen, 2005).

First-hand accounts of autism also revealed challenges with controlling, executing, and combining action or movements (Volkmar and Cohen, 1985; Cesaroni, 1990; Grandin, 1992; Williams, 1992, 1994; McKean, 1994; Hale and Hale, 1999; Mukhopadhyay, 2000; Frugone, in Biklen, 2005; Mukhopadhyay, in Biklen, 2005; Goddard and Goddard, 2012). Alberto Frugone described his challenges with action and movements: “Right from the beginning of an action, I was conscious of my inability to access motor planning and I was lost in an unacceptable motor silence” (Frugone, in Biklen, 2005, p. 190).

Charles Hale described his difficulty with actions and movements: I think my movement disorder is most apparent in the fact that I am unable to respond to someone or something, when my intelligence would tell me to respond in an appropriate manner. For instance, when I should be smiling, sometimes I know that I am not smiling but may be even frowning. This causes me a great deal of pain and makes me look as though I am not comprehending when, in fact, I am trying to respond in an appropriate manner.” (Hale and Hale, 1999, p. 32).

Another individual with autism, Therese Jolliffe commented: ‘It [stress] occurs at any time, but always when I know I have to go somewhere stressful. Sometimes the pain is so bad that my whole body becomes stiff and then I am unable to move.’  Jolliffe et al., 1992, p. 14).

It is essential that the exploration of autism include sensory and movement differences and involve the people who experience autism first-hand for a number of reasons: (1) professionals investigating autism from a perspective that separates mind and body may have overlooked sensory and movement differences, and/or their possible effect on behavior; (2) published first-hand accounts of autism suggest that this is a fruitful area for investigation; (3) in studying autism we need to elicit information from one of the most valuable resources—people with the label of autism.

One of the patients in the study Barbara summed it up well: I want to stop doing anything that doesn’t look normal. But if I am feeling really bad inside, I want people to see the distress signals for what they are. I want people to understand I don’t want to hide the urges if I’m feeling really bad. I want people to let me be. I’ve had all kinds of people who thought they were helping me stop doing things. I have been endlessly criticized about how different I looked, criticized about all kinds of tiny differences in my behavior. There’s a point where you say to hell with it, its impossible to please you people…. No one ever tried to really understand what it was like to be me…. I wish they had accepted some of my behaviors I didn’t have any control over. You don’t criticize people with cerebral palsy.

Summary

This review of recent literature on what Anne. M. Donnellan calls:  ‘Sensory and Movement Differences’  demonstrates that these differences are both a cause and a consequence of ASD. In both cases a movement based therapy is a necessary addition to the armamentarium.

VIDEO BIBLIOGRAPHY

Kennedy Krieger Institute sticky mittens video:

Esther Thelen Motor Development – Baby Body Sense

Elizabeth Torres discusses her research – Click here for her Vimeo presentation. Total time 1hr 2 mins

The Rubber Hand Illusion Horizon.  BBC. How sensory coupling works

Elizabeth Torres Video of children on the spectrum and Reinforcement Learning Interface Therapy

Linda B. Smith (Indiana U.) – “Grounding Toddler Learning in Sensory Motor Dynamics”

Karen Adolph The Baby Human – Specificity of Motor Learning

Interview with Prof. Colwyn Trevarthen: Stories of Connection

Interview with Dr Jonathan Delafield Butt: Stories of Connection

Next month’s blog will focus on Neuroplasticity and Neural-Darwinism as brain-based explanatory frameworks for understanding the Waldon Approach.

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autismadmin99

Walter Solomon is the father of Robert, the autistic boy who is the first subject of the book. He was educated at St Paul’s School, London and has a Masters degree in economics from Cambridge. He is a passionate advocate of the Waldon Approach, works with developmentally delayed children and adults in three different locations in Israel. He lives in Zur Hadassah a small town in a beautiful wine growing area in the Jerusalem hills.