Part 3 The Movement Perspective of Atypical Development: The View from Psychobiology

Colwyn Trevarthen and Jonathan Delafield-Butt: Autism as a developmental disorder in intentional movement and affective engagement. Frontiers in Integrative Neuroscience July 2013 Volume 7 Article 49

Colwyn Trevarthen is Emeritus Professor of Child Psychology and Psychobiology at the University of Edinburgh:-

“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.

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.
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.

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 sensory-motor and affective integration errors and poorly regulated motor intentions. These compensations are elaborated mainly by cortical systems that grow after birth.

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).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).

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).

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’, 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).

This natural history of human movement at a stage of development when the sensory-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).

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).

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).

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).”

Jonathan Delafield-Butt and Nivedita Gangopadhyay: Sensorimotor Intentionality: The origins of intentionality in prospective agent action. Developmental Review 2013 33 (4) pp. 399-425 smith

Jonathan Delafield-Butt a Senior Lecturer in Early Years at the University of Strathclyde:-

“An essential property of all animal actions, complex or single, is their prospectivity or future directedness (von Hofsten, 2004). Externally oriented animal action carried out through the activities of its skeletomusculature in movements of the limbs, body, and head are rarely just reactive reflex responses, they are an expensive activity of the animal’s vital energy resources and neuromotor system that work to move the animal forward in space and time to a new point in experience with a new set of possibilities. And to do this economically and with adaptive effect, they must be guided by prospective perceptual control (von Hofsten, 1993). Even a single simple action, like a rotation of the head, must be guided ‘ahead in time’ in order that the forces of momenta generated do not over-turn the head, potentially causing damage, and do not under-turn the head, failing to make effective action. Information originating from the muscles and tendons of the neck integrated with the distance senses of sight and hearing enable the agent to move from ‘where it is’ to ‘where it wants to be’, situated within an environment of possible action (Lee, 2005, 2009). Even the spontaneous actions of new-borns, repeated over and over again, enable exploration of the action systems of one’s developing body, their possibilities, and their consequential effects (Piaget 1953)

However, prospective sensorimotor control is not limited to visuomotor action; it can employ all modalities of sense – sound, touch, and smell being particularly important cues in early life – with their varied spatial and temporal properties (Lee, 2009; Lee, Simmons, Saillant, & Bouffard, 1995). Especially important is proprioceptive control of movements and postural compositions of the body (Witherington et al., 2002).

From the beginning of life post-partum, the infant’s engagement with the world depends on its capacity for prospectively controlling sensorimotor activity, and this capacity increases rapidly over the first months with improved goal-directed motor coordination of tasks such as reach-to-grasp and standing (von Hofsten, 2004, 2005). More complex tasks requiring serial ordering of several actions, such as manual manipulation of objects, begins to develop significantly only once upright posture is established at about ten months (Trevarthen, 1986), and expands in capacity throughout early childhood as memory and action planning begin to enable abstract reasoning (Piaget, 1954), but their prospective orientation is a feature that remains invariant, no matter their degree of immediacy or complexity.

An infant’s intelligence depends on anticipation of the consequences of an action or serially organised project of actions. Abstract intelligence involving complex memories and plans can anticipate more complex and distant futures. In terms of motor logic, the problem of serial organisation is the problem of serial assembly of single action units that each deliver sensory consequences with new sets of action affordances. Developing knowledge of these and capacity to organise simple action units into projects with greater distal reach expands sensorimotor intelligence to guide the action in the present moment for future gain. Thus, sensorimotor intentions are at first simple and proximal, and later become complex with greater distal purpose.

Any intelligence, no matter how well developed, abstract, and imaginative, must always be fed back through a motor logic to generate its effect in the world. Sperry (1952) reminds us ‘the sole product of brain function is motor coordination’ (p. 297). And it is in the serial organisation of motor acts that intentions and intelligences are developed and expressed, ‘‘… all skilled acts seem to involve the same problems of serial ordering, even down to the temporal coordination of muscular contractions in such a movement as reaching and grasping.”

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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.