The DSM-5 defines autism as a neurodevelopmental disorder, characterized by persistent deficits in social communication and social interaction as well as restricted, repetitive patterns of behavior starting from early childhood.[1] Despite this tripartite definition, the overwhelming focus among clinicians and researchers is on the first two components, social communication and social interaction. The third component, restricted and repetitive patterns of behavior, has been relatively ignored. It is fair to say that movement behaviors still remain a “black box” in terms of understanding autism. The acknowledgement of autism as a neurodevelopmental disorder of childhood has also not received the attention it deserves. Behaviors associated with the later emergence of autism, the so-called prodrome of autism, may frequently be observed from 12 months of age, and even earlier in severe instances. Nonetheless, the clinical emphasis on early assessment and intervention has not yet become significantly widespread. The average age of diagnosis of autism is still around 3 years of age and older in many developed countries. In this blogpost, I discuss the movement perspective in autism, which provides a necessary corrective in conceptualizing autism as a neurodevelopmental condition associated with impaired sensory-motor development in infancy and early childhood.
Autism predominantly has been studied as a disorder of cognition, perhaps reflecting researchers own cognitivist biases. This is exemplified in the Theory of Mind (TOM) approach towards autism, which refers to the mental capacity to understand other people and their behavior by ascribing mental states to them.[2] However, in the last few years, a small, though important, group of clinicians and researchers have emphasized autism as primarily a developmental condition. Colywn Trevarthen and Jonathan Delafield-Butt (2013) note in a phrase that I love to quote, “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.” [3]
Between 2012-2015 the open access journal Frontiers in Integrative Neuroscience, published a series of 38 research articles emphasizing the movement perspective in autism. [4] For example, in her article, “Rhythm and timing in autism: learning to dance,” Pat Amos noted that, “researchers need to look at movement itself: as sensed and organized, conscious and unconscious, volitional and non-volitional, as it plays out at different levels in the peripheral nervous systems, and as these systems interface with the CNS to develop a dynamic, self-organizing map of the body in space and time.” [5] Anne Donellan and colleagues have noted that, “Individuals with the autism label often describe experiences which are not immediately obvious to the rest of us but which may well-affect our understanding of their behavior. These experiences frequently fit the definition of sensory and movement differences.” [6] Elizabeth Torres and colleagues demonstrated that variability and rates of change of micro-movements in each person can be precisely measured and statistically analyzed to provide a kinesthetic signature unique to each individual that will help address the heterogeneity of ASD. This micro-movement perspective has profound clinical and research importance in providing the potential for developing standardized assessment scales based on sophisticated statistical analyses enabling objective tracking of dyadic interactions between child with autism and caregiver. [7]
The movement perspective did not originate research into the sensory-motor component of autism. For example, already in 1998 Philip Teitelbaum and colleagues published a widely cited article “Movement Analysis in Infancy.” Teitelbaum’s study demonstrated that movement disturbances in autism can be interpreted as infantile reflexes ‘‘gone astray’’; in other words, some reflexes are not inhibited at the appropriate age in development, whereas others fail to appear when they should. Teitelbaum argued that assessment of developmental of infantile developmental reflexes could provide the basis for early autism assessment. Moreover, Teitelbaum argued that the continued persistence of Restrictive and Repetitive Behaviors above the age of mature walking is a “red flag” for ASD, or other neurodevelopmental conditions. [8]
Subsequent research has confirmed the prevalence of sensory-motor developmental disabilities in children diagnosed with autism, including for example, delays in the attainment of motor milestones, clumsiness, hyperactivity, hand flapping choreoform movement of extremities, poor balance, poor coordination, impaired finger-thumb opposition, muscle tone and reflex abnormalities, repetitive and stereotypical movements of the body, limbs and fingers, unusual gait patterns (poorly coordinated limb movements and shortened steps), poor performance of motor imitation tasks, failure to use gestures for communicative purposes, inefficient integration of sensory information and motoric timing. Moreover, abnormalities of general movements in infancy has also been shown to have strong correlations with later development of autism. [9]
In my consideration, the movement perspective in autism provides a truer conception of autism as a whole-body condition than the cognitivist understanding of autism. Additionally, the movement perspective provides a means of linking first person experience of sensory and motor behaviors associated with autism, with third person neuroscience in order to develop a neurophenomenology of autism. Most importantly, the movement perspective helps provide assessment criteria for early intervention based on normal sensory motor development. While not all infants with the presence of sensory-motor delay and repetitive behaviors will later develop autism, the presence of impaired sensory-motor development provides enough of a red flag for therapeutic programs emphasizing sensory motor development. All infants with impaired sensory-motor development will benefit from focused therapeutic intervention, which may significantly improve the outcomes in the presence of the prodrome of autism. Mayada Elsabbagh and Mark Johnson have noted that neuroanatomical abnormalities in an earlier developing structure will have consequences for later developing structures. Abnormalities in these later developing systems may then exert further atypicality on the earlier systems via feedback projections. [10] Early sensory-motor focused therapeutic intervention, may help to offset these neuroanatomical abnormalities effecting the development of these earlier and later neuroanatomical structures.
Somatic interventions provided at the SomaticWell Center, including Feldenkrais and Play, provide especially powerful therapeutic resources for working with infants with the prodrome of autism and other neurodevelopmental conditions. These therapeutic modalities address the root causes of autism as a whole-body condition through emphasizing sensory awareness, motoric and perceptual development. Additionally, they incorporate sensitivity to motivating intentionality underlying a child’s particular motor behavior and helps foster a child’s inherent spontaneity and sense of self-possibility – “I Can!”
References:
1. American Psychiatric Association (APA). (2013). Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition, DSM-5. American Psychiatric Publishing.
2. Baron-Cohen, S. (1995) Mindblindness: An Essay on Autism and Theory of Mind, Cambridge, MA: MIT Press.
3. Trevarthen C., Delafield-Butt J.T. (2013). “Autism as a developmental disorder in intentional movement and affective engagement.” Frontiers in Integrative Neuroscience, 17:49. doi:10.3389/fnint.2013.00049
5. Amos, P. (2013). “Rhythm and timing in autism: learning to dance.” Frontiers in Integrative Neuroscience, 7:27. doi.org/10.3389/fnint.2013.00027
6. Donnellan, A.M., Hill, D.A., Leary, M.R. (2012). “Rethinking autism: implications of sensory and movement differences for understanding and support.” 6:124. doi: 10.3389/fnint.2012.00124
7. Torres, E.B., Brincker, M., Isenhower, R.W., et al. (2013). “Autism: the micro-movement perspective.” Frontiers in Integrative Neuroscience, 7:32. doi.org/10.3389/fnint.2013.00032
8. Teitelbaum, P., Teitelbaum, O., Nye, J., Fryman, J., & Maurer, R. G. (1998). “Movement analysis in infancy may be useful for early diagnosis of autism.” Proceedings of the National Academy of Science U.S., 95, 13982–13987.
9. Phagava H., Muratori F., Einspieler C., Maestro S., Apicella F., Guzzetta A., et al. “General Movements in Infants with Autism Spectrum Disorders.” Georgian Medical News 156, (2008): 100-108.
10. Elsabbagh, M. & Johnson, M. H. (2007). “Infancy and autism: progress, prospects, and challenge.” Progress in Brain Research, 164, 355-383.