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Exploration of Space as an Effective Early Screening Test for Infants with Autism

Introduction


A recent research paper by Ilan Golani (Professor Emeritus in the School of Zoology, Tel Aviv University) and colleagues, published on November 13, 2020 in Frontiers in Behavioral Neuroscience entitled, “Exploration in the Presence of Mother in Typically and Non-Typically Developing Pre-Walking Human Infants,” proposes a novel behavioral methodology for assessing the development of autism in infancy.1 The results of this study indicate that assessing an infant’s exploration of environment in relation with maternal home-base may provide an additional early assessment tool for autism. This study was conducted at the Mifne Center for the treatment of infants with autism and their whole families. I became familiar with Professor Golani’s ethological based research as well as the particular details of this study in my previous capacity as Director of Research at the Mifne Center, and am very pleased that this study – the fulfillment of intensive research – has finally been published. I consider that the publication of Exploration in the Presence of Mother is a significant event in the field of autism research. The research study applies decades of research by Golani into animal behavior to the field of infant behavior and autism. More than three decades ago, Nicholas Tinbergen, who shared the Nobel Prize for medicine together with Konrad Lorenz, applied his ethological understanding to the field of autism research.2 Since then, however, the application of ethology to understand the developmental aspects of autism has been relegated to the margins. In this blogpost I shall review some aspects of Exploration in the Presence of Mother as a means of publicizing this important research study. Besides summarizing the study, I shall focus on three important elements of it – Attachment Theory, Eshkol Wachmann Notation and Social Affordances – that have especial relevance for SomaticWell’s approach to working with infants and children with autism.


Summary of Study

Exploration in the Presence of Mother analyzed origin-related exploration in a group of five non-typically developing pre-walking boy infants treated at the Mifne Center for early signs of autism, in comparison with a control-group of seven typically developing infants, including one girl. The trial took place in a sparsely furnished treatment-room, to which the infants were exposed for the first time. In each trial the mother entered the room carrying her infant, sat on a mattress near the wall, and then seated the infant or let him or her slide down next to her. The mother was requested to remain seated and allow the infant to act freely. The infant’s exploration trajectory in relation to his mother and the environment was filmed for a maximum duration of 30 minutes. The researchers observed that leaving the infants to their own devices profoundly affected their behavior. Golani and colleagues noted that allowing the infants to explore the new space without being bombarded by social stimuli, and in close proximity to their mother enabled the “endogenous constraints” shaping the infant’s attention, perception and engagement with the physical and parental environment to be disclosed in relation with the infant’s behavior. In other words, the infant’s exposure to a novel surrounding while in the presence of the mother who was directed to sit passively, afforded the possibility of observing the infant’s exploratory behavior in relation to both the presence of the mother and the environment.

The resulting data from this study were analyzed using an arsenal of computational and statistical tools, many of them devised specifically for this kind of kinematic research analysis. Additionally, it introduces a novel phenotyping approach for assessing infant development. To this effect, it introduces kinematic movement observation in order to obtain a comparative, structural, and evolutionary phylogenetic perspective on human infant exploration.

The results of the study were striking, both at the level of natural observation and in terms of statistical analysis. The Typically Developing (TD) infants visited the furniture items frequently and persistently, invading their respective places deeply and for long durations; whereas, the Non-Typically Developing (NTD) infants visits to the furniture tended to be infrequent and shallow. Moreover, observations of the path properties of the two groups demonstrated a stark contrast in terms of what Golani and colleagues term the “modularity and partitioning” of the TD infants’ path-session into excursions from the mother and back to her, and the paucity or even absence of excursions in the behaviour of the NTD group of infants. This architecture of TD human infant exploration appears to be “homologous” to animal origin-related exploration. In other words, the movement exploration patterns in relation to home-based performed by TD infants demonstrates a behavioral structure universal among all human infants, and animal behaviour more generally. However, this behavioral modularity was demonstrated to be weak among the non-typically developing infants who came for assessment and treatment demonstrating developmental behaviours associated with autism.

The findings of this study are very suggestive for the possibility of founding a novel behavioral marker for the assessment of the development of autism, especially utilizing home videos of infants in an unforeseen natural environment and machine learning classification. The study’s authors are, however, cautious in extending their findings to the field of infant assessment of autism, while at the same time suggesting the great potential in the study’s findings, especially in terms of machine learning. This is a preliminary study with a small cohort. Validating the study’s findings requires a repeat study with a larger cohort, and later developmental assessment and autism screening.


Theory of Attachment

Exploration in the Presence of Mother extends research methodologies from the field of ethology – the study of animal behavior – as well as the closely linked theory of attachment developed by British psychoanalyst John Bowlby. Bowlby postulated that attachment behaviour may be already observable in an infant of 12 months, and consists of a number of component instinctual responses that are initially relatively independent of each other. Proximity seeking behaviours that promote attachment in the first year of life include: sucking, clinging, following, crying, and smiling.3 In developing his theory of attachment and breaking away from psychoanalytic theory of drives, Bowlby relied on the work of ethologists, particularly Konrad Lorenz, who emphasized comparatively independent physiological needs and responses promoting social interaction between members of a species.

The ethological literature has detailed extensively how many animal species from insects to mammals have a home site from which they depart and return regularly. For example, a previous paper by Golani and Eilam (1989) demonstrated how rats explore an experimental area in relation to a reference place, from which they perform excursions into the environment.4 Exploration in the Presence of Mother extends this ethological research methodology to the realm of infant behavior. In and of itself, this extension to human infant research is not novel. Golani and colleagues note that mother-related exploration has previously been described in several prior human infant studies. Child psychoanalyst Margaret Mahler developed her influential separation-individuation theory on the psychological development of the human infant through observations of infant behavior in reference to mother as a home base.5 Melanie Ainsworth, who alongside Bowlby developed attachment theory, observed that human infants use mother as a secure base for exploration.6 (Ainsworth’s “Strange Situation” test is used to evaluate the strength of an infant’s attachment to its mother or primary caregiver. It differs from Golani’s study in terms of assessing an infant’s reaction of a child to the presence of a stranger, rather than assessing infant exploration of space in the presence of mother, which provides a perhaps more indirect indication of the quality of attachment.)

All of the NTD infants in Exploration in the Presence of Mother study were treated for early signs of autism at the Mifne Center, which specializes in early autism assessment and therapeutic intervention below the age of two years. Even though research studies have not confirmed a direct relation between autism and attachment, Dr. Hanna Alonim, the Mifne Center’s director from her clinical experience considers that all infants with autism do demonstrate complicated patterns of attachment.7 The results of this study appear to confirm that complicated attachment, in terms of an infant’s relationship between exploration of environment and mother as home base, is an important element of the early development of autism.

Bowlby considered attachment behaviors to form part of an instinctual response system that when allowed to reach completion ultimately allows developing infants to become liberated from their instinctual underpinnings in developing capacity for self-directed behavior. According to this model, an infant’s atypical demonstration of exploratory behavior, as well as the repetitive behaviors characteristic of children with autism demonstrate the unfulfilled completion of development attachment behaviors. This study then affirms in a striking manner, the importance of ethology and evolutionary development for the theory of attachment and understanding of the development of autism in infancy. This phylogenetic insight undergirds its corollary therapeutic imperative: Those therapeutic interventions which emphasize social attachment with mother and other primary caregivers should be an important foundation of early therapeutic intervention for autism.


Eshkol Wachmann Notation

A key methodological element in Golani’s kinematic analysis is the application to the field of animal behavior of the Eshkol Wachman Notation (EWN) method, developed by dancer-choreographer Norah Eshkol and architect Avraham Wachman, to study elements of human movement.8

In Exploration in Presence of Mother, Golani references EWN as providing the methodology to record kinematic linkages between rigid moving body parts, but its centrality for the paper’s research methodology is somewhat understated. In another article, “The Search for Invariants in Motor Behavior,” Golani has expanded on his reliance on EWN for researching the kinematics of movement.9 He notes in this book chapter that the EWN notation provides a methodology for isolating the geometrical variables of movement, thereby providing the means to map the interaction of these movement variables for analyzing the morphogenesis of motor behavior. In other words, EWN provides an invaluable movement notation language for recording and analyzing movement, that was to some extent previously unthinkable. For example, in another study, Yaniv and Golani (2010) used the EWN to notate the social engagement behavior of two badgers in terms of the body parts of the two interactants that touched or almost touched each other.10 It is important to state that Golani’s previous application of EWN to study animal behavior was conducted primarily in terms of egocentric movements, i.e., those movements mapped in relation to an animal’s bodily self. In Exploration in Presence of Mother, Golani extends the application of EWN methodology to include an infant’s allocentric movements, in relation to the infant’s external environment. In applying EWN to the study of movement behavior, Golani’s research continues a research trajectory developed by a pioneer in the field of psychobiology, Philip Teitelbaum. Among the autism research community, Teitelbaum is known for his widely cited article Movement Analysis in Infancy, which analyzes the development of infantile reflexes for early assessment of autism.11 Teitelbaum’s study argued 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. Teitelbaum’s paper is, perhaps, the most widely cited paper referencing the relation between infantile autism and sensory motor development. Since its publication the sensory-motor approach to autism has made deeper inroads against the prevalent cognitive models of autism, exemplified by the Theory of Mind (TOM) theory of autism espoused by Simon Baron Cohen.12 It is now recognized that delayed or impaired sensory-motor development is a core sign associated with the development of autism. However, Teitelbaum’s insight regarding infantile reflexes has not become an established component of early autism assessment. This can perhaps be explained because the application of the EWN is too difficult for the average autism assessor. While sensory-motor development is a core behavior element of the prodrome of autism, it is not specific to autism alone, but is associated with many other neurodevelopmental conditions of infancy. A similar question regarding its applicability of therefore also hangs over the reception of Golani’s study in terms of providing another means of early infantile autism assessment. Applying the methodology suggested by Golani will require standardization of the features of a novel space in order for the test to be generalizable for application and validation. Nonetheless, Golani’s study deserves to become a classical study in the field of autism and infants analogous to Teitelbaum’s well-known study of developmental reflexes.


Social Affordances

While the methodology of Exploration in Presence of Mother is in terms of movement kinematics, the interest of the study, of course, extends beyond the modularity of the movements themselves to the infants’ relation to the external environment – what phenomenologist Maurice Merleau-Ponty has described as “spatiality of situation.” As philosopher Shaun Gallagher, has noted, besides egocentric and allocentric space, there exists a relation between intracorporeal space and pericentric space.13 In essence, Golani and colleagues’ study provides a study of social affordances, i.e., action possibilities that the environment offers to an animal or person (Gibson 1986).14 An environment is never simply a neutral space. How an organism makes use of, explores, or develops a niche for survival and development of the self depends intrinsically on that organism’s neural and perceptual structures. (It is worth mentioning that Katherine Loveland has also developed an ecological theory of autism based on Gibson’s concept of social affordances.15) As child developmental researchers Colywn Trevarthen & Jonathan Delafield-Butt have noted, conceptions of objects in an animal’s perceived world, or Umwelt, are created by the intentional subject’s attempts to locate and perceive “sign stimuli” detected in the environment by dedicated receptors.” They claim, furthermore, 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.” Exploration in Presence of Mother provides an elegant proof of concept of the importance of kinematic behaviors in relation with infant’s perceptual self-development. It is likely that as Trevarthen & Delafield-Butt have hypothesized, this process of developing brain networks in relation to environmental stimuli begins already in utero as “environment expectant processes of morphogenesis” and becomes solidified through experiential learning in the first two years of life.

Exploration in Presence of Mother demonstrates how infant kinematic and exploratory behavior may be utilized as an external sign of neural structure and development. This process of neurogenesis is compromised among infants with autism. Non-Typically Developing Infants appear to have deficits in their capacity for integration of egocentric and allocentric kinematic behaviors in relation with pericentric space, including relation with mother as home base. As defined by the DSM-5, autism is generally understood as a deficit of social communication and interaction. However, the importance of the environment in shaping a child’s social responsiveness is for the most part not included in this mental health perspective. Taking account of the environmental context or Umwelt is intrinsic to the ethological perspective in which this study is grounded, and makes a significant contribution to the field of autism research. At the same time, the context of autism provides a crucial link for researchers between the social affordances provided by the environment and neurobiological structures of perception.


The SomaticWell Therapeutic Conception

Exploration in Presence of Mother affirms that the analysis of movement kinematics provides a rich terrain for understanding autism and providing appropriate therapeutic intervention. The sensory-motor-perceptual conception of autism informs SomaticWell’s therapeutic approach applying Integrative Neurobiology, Feldenkrais and Play. Exploration in Presence of Mother provides important data about early assessment of autism, before the development of a child’s capacity for social intentionality. The SomaticWell therapeutic approach towards autism as a neurodevelopmental phenomenon considers that movement behaviour among infants with autism indicates what is described in phenomenological literature as “pre-reflective” intentionality. Studying pre-reflective intentionality in terms of movement kinematics provides important therapeutic material for the astute observer trained in movement observation and notation. Golani’s study provides data regarding infant’s exploration of novel space, to which they are exposed for the first time. While this is an indispensable element of the proposed assessment methodology, it also provides an important therapeutic principle. The play space as modifiable external environment is a vital element in the application of Feldenkrais and Play. The fact that the SomaticWell play space is constantly altered means that an infant’s neural pathways associated with the novel exploration of space are constantly being re-stimulated during a therapeutic session.



References:

1. https://www.frontiersin.org/articles/10.3389/fnbeh.2020.580972/full.

2. Tinbergen, N. & A. (1986). ‘Autistic’ Children: New Hope for a Cure. Unwin Hyman.

3. Bowlby, J. (1958). The Nature of the Child’s Tie to his Mother. International Journal of Psychoanalysis, 39: 350-373.

4. Eilam, D., and Golani, I. (1989). Home Base Behavior of Rats (Rattus Norvegicus) Exploring a Novel Environment. Behavioral Brain Research. 34, 199–211.

5. Mahler, M. S., Pine, F., and Bergman, A. (1975). The Psychological Birth of the Human Infant: Symbiosis and Individuation, 1st Edn. London: Routledge.

6. Ainsworth, M. S., and Bowlby, J. (1991). An Ethological Approach to Personality development. American Psychologist. 46, 333–341.

7. Alonim, A.H. (2007). Infants at risk: Early signs of autism: diagnosis and treatment. In Acquarone, S. (Ed.), Signs of autism in infants: Recognition and Early Intervention. London: Karnac Books: 118-138.

8. Eshkol, N., and Wachman, A. (1958). Movement Notation. London: Weidenfeld and Nicolson.

9. Golani, I. (1981). The search for Invariants in Motor Behavior. In K. Immelmann, G. W. Barlow, L. Petrinovich, & M. Main (Eds.), Behavioural Development: The Bielefield Interdisciplinary Project. Boston: Cambridge University Press: 372-390.

10. Yoniv, Y. & Golani, I., (2010). Superiority and Inferiority: a Morphological Analysis of Free and Stimulus Bound Behaviour in Honey Badger (Mellivora capensis) Interactions. Ethology. 74(2):89 – 116.

11. 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.

12. Baron-Cohen, S. (1995). Learning, Development, and Conceptual Change. Mindblindness: An Essay on Autism and Theory of Mind. The MIT Press.

13. Gallagher, S. (2007). The spatiality of Situation: Comment on Legrand et al. Consciousness and Cognition. 16, 700–702.

14. Gibson, J. J. (1986). The Ecological Approach to Visual Perception. Boston: Houghton Mifflin.

15. Loveland, K. (2001). Toward an ecological theory of autism. (2001.) In J. A. Burack, T. Charman, N. Yirmiya, and P.R. Zelazo (Eds.), The development of autism: Perspectives from theory and research. New Jersey: Erlbaum Press: 17 - 37.

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