Disorganized rhythm and synchrony: Early signs of autism and Rett syndrome

doi:10.1016/j.braindev.2005.03.016

Brain and Development

Volume 27, Supplement 1, November 2005, Pages S25-S34

https://doi.org/10.1016/j.braindev.2005.03.016 Get rights and content

Abstract

We interpret early age-related developments in intentions and socially responsive behaviour with data from home videos of infants who later develop autism or Rett syndrome. Detailed evidence is given from a micro-analytic study of videos of monozygotic twin girls at 11 months, one of whom became autistic in the second year. Changes in this twin's attention, motor tonus, initiative and emotion reduce her prospective control of movements and her anticipations in awareness compared to her sister. These changes were reflected in the child's asynchronous social behaviour, which frustrated the father's attempts to support her attempts to walk, share toys, or play a game, confusing his anticipations, and this further reduced mutual attention and joint activity. Observations of the development of girls with Rett syndrome in the first year reveal changes in motor coordination, attention and communicative initiative, indicative of a failure of intrinsic core brain regulations of neural development and conscious activity. Notwithstanding that the two conditions show clear differences in both brain growth and early development of skills and sociability, the first signs of autism and Rett syndrome have important similarities. We conclude with recommendations for an approach to early diagnosis and treatment, applicable for the whole range of developmental brain disorders, including Rett syndrome and autism, that attempts to identify residual capacities for sympathetic motivation and collaborative learning—an approach that deliberately tries to support weakened rhythmic impulses for motor, perceptual and communicative functions in the growing infant brain.

Section snippets

Age-Related developments in brain systems for action, awareness and communication in infancy

In early weeks, the mother can be described as an ‘external regulator’ for a baby's vital functions and state of arousal [1], but this is not all. She helps the baby be at ease with a brain and a body that, while growing rapidly, are seeking to engage the world and other people with prospective awareness. From the start a young human seeks playful ‘intersubjective’ communication of purposes and interests. He or she gains pleasure, encouragement and stimulation for development from reciprocating

Changes in self-awareness, disturbed movements, and detachment from other people

Autism affects how a developing person moves and responds in the environment—both the physical one of objects, events and places, and the interpersonal or social one. It disturbs the development of interpersonal sympathy and collaborative action, and interferes with cultural learning and with sharing ‘common sense’ of the world, in community [17], [18], [19], [20], [21].

Kanner [17] identified the age of appearance of ‘infantile’ autism as ‘before 30 months’. This is a crucial stage in a child's

Different rhythms: the case of two monozygotic twin girls, one of whom later develops an autistic disorder

Home video recordings of two 11-month-old monozygotic twin sisters were subjected to micro-analysis. Twin A was later diagnosed as autistic at age 18 months according to ICD-10, while Twin B had a normal development.

Comparison with Rett syndrome

“Although the deficits of higher cortical functions in Rett syndrome seem most obvious and severe, the problems with the brainstem may be primary, and should be the focus of our research efforts.” [49, p. 57].

Early stages of Rett's syndrome resemble those of autism. At around 9 months, a baby, who at 6 months was thought to be normal, but who probably was already defective in attention, initiative and motor coordination, shows distracted attention, weak posture, and poor coordination of limb

Implications for parenting and therapy

We have presented evidence from home movies made by the mother that a father's natural affectionate behaviour, responding with intuitive sympathy to the reduced motor capacities and uncertain social feedback of an 11-month-old infant developing autism, is confused by abnormal withdrawal or detachment in the infant. The autistic baby, unlike her twin sister who was unaffected by autism, did not have the regulatory motive abilities to escape this situation. If the ‘normal’, but unhelpful,

Acknowledgements

We thank the parents for their generosity in allowing us to study their family vidoes, and for their interest in the research; Dr Kenneth Aitken, who put us in contact with the twins’ family; and especially Catherine St Clair who collaborated in the selection of video clips, the planning and execution of the micro analyses and the preparation of the graphs.

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Original articleDisorganized rhythm and synchrony: Early signs of autism and Rett syndrome

Abstract

Section snippets

Age-Related developments in brain systems for action, awareness and communication in infancy

Changes in self-awareness, disturbed movements, and detachment from other people

Different rhythms: the case of two monozygotic twin girls, one of whom later develops an autistic disorder

Other videos showing developments in movements and attention

Comparison with Rett syndrome

Implications for parenting and therapy

Acknowledgements

Prostoglandins Leukot Essent Fatty Acids

Cognition

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

Brain Dev

Hidden regulators in attachment, separation and loss

Self-other organization in human psychological development

Dev Psychopathol

Fetal and neonatal psychology: intrinsic motives and learning behaviour

Infant intersubjectivity: Research, theory, and clinical applications

J Child Psychol Psychiatry

Musical rsponsiveness in Rett disorder

Evoking communication in Rett syndrome: Comparisons with conversations and games in mother-infant interaction

Eur Child Adolesc Psychiatry

Early clinical signs in the Rett disorder

Neuropediatrics

Regulation of brain development and age-related changes in infants’ motives: The developmental function of “regressive” periods

Intrinsic motives for companionship in understanding: Their origin, development and significance for infant mental health

Infant Ment Health J

The neurobiology of early communication: intersubjective regulations in human brain development

Brain development, infant communication, and empathy disorders: intrinsic factors in child mental health

Dev Psychopath

Brain development

Affective neuroscience: The foundations of human and animal emotions

Autistic disturbances of affective contact

Nerv Child

Autism and asperger syndrome

The Emanuel Miller memorial lecture: autism and autistic-like conditions: subclasses among disorders of empathy

J Child Psychol Psychiatry

Autism and medical disorders: a review of the literature

Dev Med Child Neurol

Executive functions and developmental psychopathology

J Child Psychol Psychiatry

Defining the broader phenotype of autism: Genetic, brain, and behavioral perspectives

Dev Psychopath

Autism, Psychology

Practice parameters: The screening and diagnosis of autistic spectrum disorders

J Autism Dev Disord

Early recognition of 1-year-old infants with autism spectrum disorder versus mental retardation

Dev Psychopath

Original article
Disorganized rhythm and synchrony: Early signs of autism and Rett syndrome