Research for RDI principles

01B. Research Summaries. Lack of Differences at 6-7 months

In an early prospective study, Bryson and colleagues (Bryson et al. 2007), described future ASD infants as demonstrating a consistent pattern of  typical social responsiveness, shared enjoyment and appropriate eye gaze at 6months, followed by reduced social engagement, shared enjoyment and non-verbal communication by age 12 months.

Young and colleagues (Young et al., 2009), found that at six months of age, future ASD infants engaged in typical patterns of gazing at their mother’s face.  

Rozga and colleagues (Rozga et al. 2011) found that at 6 months, future ASD infants showed typical rates of social smiling, social vocalizations and direction of looks, smiles and vocalizations toward their mothers during non structured interaction. Contrary to predictions, there was actually a trend for future ASD infants to show greater amounts of gaze to their mother’s faces.

Wan and colleagues (Wan et al., 2012) reported that, while infants diagnosed with ASD at 36 months showed reduced attentiveness to their mother during naturalistic interaction at 12 months, there were no significant differences found at  6 months.

In a similar finding, Clifford and colleagues (Clifford et al., 2013) found that infants diagnosed with ASD at 36 months were rated by their parents as less cuddly and less likely to smile during care taking and play at 14 and 24 months relative to low risk infants. However these differences were not apparent at seven onths of age.  

As in prior studies, Jones and Klin (2013) could find no significant differences in gaze or affect towards mother in the future ASD infants they studied at six-months-of-age, compared to their typically developing peers. 

Ozonoff and colleagues reviewing the results of their two major longitudinal studies (Ozonoff et al. 2010; 2014) found evidence to support a progressive pattern of declining social engagement between 6 and 24 months, including decreased social smiling and facial gazing  They observed that the greatest decline in ASD infant’s social engagement was observed by 12 months and continued to become more pronounced over time.

In reporting the results of  another longitudinal study, Filliter and colleagues (Filliter  et al., 2014) focusing on the display of emotion found that future ASD infants showed significantly less affect at 12 months, but not at 6 months, thus support the accumulating evidence of relationship disengagement occurring during the latter part of the first year.

01C. Are There Earlier Differences?

While most researchers have  been unable to demonstrate future ASD infant’s disengagement until somewhere around the end of their first year, there is some reason to believe that this is actually beginning to occur earlier in their development. Research groups that have taken a more qualitative approach to studying the early infant-parent relationship have consistently demonstrated an ability to differentiate future ASD infants from their typically-developing counterparts at an earlier age. 

  • Yirmiya and colleagues (Yirmiya et al, 2006)  found that a significant proportion of 4 month old future ASD infants had less synchronous interactions that their typically developing peers. At four months of age not one dyad with a typically developing infant exhibited low synchrony, whereas 5 dyads with an ASD infant (24%) did.
  • In a similar fashion, Muratori’s Italian group, have consistently been able to detect difference by six months of age. For example, Muratori and colleagues reported that during the second half of their first year, infants with autism showed a reduced rate & duration of maintaining social engagement In addition, orienting to name (turning toward and looking at the person who has called within a few seconds) significantly differentiated ASD from TD infants between 6 and 12 months (Muratori et al. 2011). 
  • In a rigorously conducted recent study, Elsabbagh and colleagues (Elsabbagh et al., 2015) found that they could detect significant differences in infant ‘responsiveness’ as early as 7 months.

There are some major gaps in the ASD infant research that must be addressed if we are to understand what actually goes on between 6 and 12 months. Researchers have not studied what parents of future ASD infants have to do  to obtain the smiles and vocalizations of future ASD infants. Additionally, there has been no longitudinal research studying whether the parent-infant relationship continue to adapt and evolve as in typical development, or whether it remains static by 6 or 7 months. Are parents of future ASD infants limited to repeating a few static routines or are they able to gradually expand and increase the complexity of their engagements during the latter part of the first year. 

In addition, findings such as those presented above, lead to the possibility that some of the attentional, motor, neural and other delays and differences researchers have found in future ASD infants prior to 12 months, may not be congenital, but rather due to their early inability to obtain the benefits of parent guiding. Studies have demonstrated that parental guiding plays a major role in infant’s attention, motor and emotion regulating ability during the first year. Because of this possibility, it becomes quite difficult if not impossible to differentiate between early vulnerabilities that may contribute to future ASD infant’s lack of growth-seeking and development that fails to occur in a normal fashion, due to not obtaining the benefits of a Guiding Relationship.  

Failing to Take Advantage of Opportunities to Develop Imaginative-Pretend Play

The Typical Development of Pretense & Imagination

During the beginning of their 2nd year, infants start to show indications of  make-believe play. For example, they may act as if an ordinary piece of cloth were their special bedtime pillow, while giggling in a playful fashion. By 18 months, many show signs of tracking rather elaborate games of pretense initiated by others—for instance, being able to identify which of two dolls that have been ‘washed’ by an adult experimenter is ‘still wet’ and engaging in the requisite ‘drying’ activity. At this age, toddlers are also able to reliably tell, based on behavioral cues alone, whether a series of actions are genuine or merely pretend

Lillard (2006) has written extensively on how parents guide their children to develop pretense and imagination. According to Lillard, children are just starting to pretend, between 12 and 24 months of age, their ability to represent what is not there depends heavily on the support from a skilled partner and benefits from the use of familiar scripts and routines. Parents provide toddlers who are not yet skilled pretenders with specific, reliable behavioral cues signifying “this is play,” thereby distinguishing pretend actions from real, goal-directed acts for the toddler who is not yet proficient in doing so independently. When pretend acts are components of familiar routines such as eating or grooming, the “not real” is more easily distinguished from the real. Moreover, parents’ communications about the not real are more accessible and meaningful, further contributing to toddlers’ comprehension of play signals. Interestingly, parents’ use of the word pretend does not facilitate the very young child’s pretense


Research Results: Impaired Development of Imaginative-Pretend Play in ASD

Research aimed at studying the development of imaginative-pretend play in ASD infants and toddlers has been extremely limited. The few studies conducted have documented how ASD toddlers are unable to benefit from parental guidance to develop more sophisticated functional and symbolic/pretend modes of play: 

Christensen and colleagues (Christensen et al., 2010) observed free-play in high risk 18 month-old’s to assess functional and imaginary-symbolic play. They found that 18-month-old ASD toddlers showed fewer functional and more non-functional repetitive play than typically developing peers during a play session that included dolls, blocks and kitchen equipment..  

Pierce (2009) studied the play of young ASD, developmentally delayed & typically developing toddlers. He found that ASD toddlers engaged in lower proportions and rates of functional and symbolic play than typically developing and developmentally disabled children. 

Poon & colleagues (Poon, Watson, Baranek & Poe, 2012) obtained similar results with a younger group of ASD infants and toddlers ranging from 9-18 months of age. As a result of their findings, they express a strong concern about the developmental consequences of this early disruption in play development, 

 “infants and toddlers who are not engaged in play have fewer learning opportunities from experiences acting on objects, and fewer social-communicative learning opportunities from others joining in play and talking about the infant’s interests and actions.” 

Failure to participate with guides in developing empathic foundations

Research on the Typical Development of Empathy

Brophy-Herb and colleagues (Brophy-Herb et al., 2011) studied the relationship between mothers emotion-socialization practices and their toddlers empathy and emotional competence. Mothers demonstration of encouragement, forgiveness & emotion coaching was highly related to toddlers emotional competence and empathy.

“Maternal contingent responsiveness provides not only a model for desirable social behaviors, but also opportunities for toddlers to learn and practice new skills during parent-child interactions. These experiences may contribute to toddler’s growing sense of mastery and competence in more enriched play experiences.”

Brownell and colleagues (Brownell et al., 2014) studied 18, 24 and 30 month old children who were sharing a picture book with parents to learn more about parents role in young children’s development of empathy. The authors point out that during the second year of life,

 “The dawning awareness of the subjectivity of emotions, desires, and intentions during the second year of life transforms early social behavior, permitting the emergence of ability to respond to another’s plight.”

The authors found that the bulk of parents’ emotion-related talk was devoted to labeling and commenting on emotions, as would be expected at these young ages when emotion understanding is undergoing such pronounced development and emotion words are still being acquired. Nevertheless, it was parents’ efforts to engage the children themselves in labeling and explaining the characters’ emotions that were associated with sharing and helping. Children who helped and shared more quickly and more often, especially in tasks that required more complex emotion understanding, had parents who more often asked them to label and explain the emotions depicted in the books. Moreover, it was parents’ elicitation of children’s talk about emotions rather than parents’ own production of emotion labels and explanations that explained children’s prosocial behavior, even after controlling for age.  Thus, it is the quality, not the quantity, of parents’ talk about emotions with their toddlers that matters for early prosocial behavior.

Clark & Ladd (2000) found that parent-child conversational connectedness was correlated with five-year-old children’s socio-emotional orientation, number of mutual friendships, and peer acceptance.

Similarly, Flanagan (2001) found that the frequency of Mother-Son discussions about their peer relationships was significantly related to ratings of peer acceptance.

Drummond and colleagues (Drummond et al., 2008) found that conversations about emotions and mental states were most effective in developing early prosocial actions when parents asked children themselves to think about and explain others’ emotions. 

In a latter study, Drummond and co-workers (Drummond et al., 2014) examined how parents’ emotion and mental state talk (EMST) with their toddlers (aged 18-30 months) predicted to toddlers’ helping actions and how these associations varied during two everyday contexts –  joint book ready and joint play with toys –  that are natural settings for mental state and emotion-related discussion. The authors point to the critical nature of conversations beginning in late infancy, where children learn to use these conversations to gradually construct a more complete understanding of emotions and mental states. In their research they found that children who tended to help others in distress more quickly had parents who, labeled emotion and mental states more often during joint play. The authors point out that parent- child interaction provides many opportunities for discussing emotions and mental states beginning very early in life. The structure and tone of these interactions vary widely, but each conversation offers the child a context in which to explore and begin to understand the complexities of subjective states.

“Developmentally sensitive discourse about emotions and mental states provides children a framework within which to objectify and reflect on abstract subjective concepts, as well as recognize their role in motivating behavior. Beginning in late infancy, children use these conversations to gradually construct a more complete understanding of emotions and mental states. “

Dunn, Bretherton & Munn (1997) found that parents’ use of guiding and socializing language when discussing emotions with their 18 and 24-month old children (e.g., “You really made me sad that time. I wish you wouldn’t scream like that” or “Big kids don’t cry so much”) was related to children’s later social functioning including levels of children’ s positive reactions to peers’ emotions and teacher-rated social competence, as well as children’s internalizing emotion (e.g., sadness, fear, tension) in the classroom & conciliatory behavior with siblings.  On the other hand the frequency of discussion of emotion and parental attempts to explain or clarify the causes or consequences of feeling states generally were not related to children’s social functioning.  The authors point out that the critical distinction may be whether parents use emotion language simply to clarify and teach children about emotions or to try to modify children’s inappropriate behavior. If parents are trying to remediate children’ s socio-emotional deficits, there will be a negative association between parental use of socializing emotion language and children’s socio-emotional functioning.

Eisenberg Cumberland & Spinrad (1998) found that parental conversations about emotion were linked not only to children’s use of emotion language, but also to their awareness and understanding of emotion. The authors concluded that emotion-related discussion in the family may not only communicate support, but also sharpen the child’s awareness of emotional states and promote the development of an emotion-related conceptual system.

“Whether children come to view their emotions as threatening, something to be controlled, or in contrast something to enjoy and that can enhance relationships, or as a deterrent to rational thinking emerges from the way their families and the surrounding culture deal with emotion, and children’s fit on this dimension within their family and culture.”

Farrant and colleagues (Farrant, Devine, Maybery & Fletcher, 2012) investigated whether more em­pathic mothers are more likely to encourage their child to take the perspective of others and whether this would be associated with increased child empathy and prosocial behaviour. They found that mothers who more regularly take the cognitive perspective of others are more likely to encourage their children to do the same, and this facilitates children’s abilities to take the cognitive perspective of others

Recchia and colleagues (Recchia et al., 2014) found that mother–child conversations about children’s helpful behavior uniquely serve to support children’s understanding of their own agency in help situations. By highlighting children’s own and others’ internal experience (motivations, cognitions, and emotions), parents help children to further their understandings of themselves and others as psychological beings with unique perspectives on events. 

The authors reported a strong relationship between mother–child conversations about children’s helpful behavior uniquely served to support children’s understanding of their own agency in help situations. Mothers’ contributions to conversations about help focused on aspects of experiences that serve to facilitate, encourage, and reinforce children’s sense of themselves as prosocial moral agents capable of deriving satisfaction and personal fulfillment from their own responsiveness to the needs of others. In addition to discussing the positive consequences of help for others, conversations focused frequently on positive emotional/psychological consequences for self (e.g., feelings of pride). Mothers also frequently emphasized evaluations and insights that underscored the child’s positive moral characteristics (e.g., I’m so proud of you; you’re such a compassionate person). Conversations about harm appeared to provide opportunities for children to further their understandings of both their own and others’ moral agency, albeit in different ways than those evident in discussions of help


Research on the development of empathic foundations by children with ASD

Charman and colleagues (Charman et al., 1997) examined the empathic responding of very young children diagnosed with autism (20 months). All of the children in the comparison groups (including typically developing children and children with developmental delays) paid attention to the person in distress; however, less than half of the autism group looked to the distressed adult. Strikingly, none of the children in the autism group showed signs of facial concern (e.g., brow furrowing), in comparison to approximately half of the children in the other groups.

Dissanayake and colleagues (Dissanayake et al., 1996) conducted a longitudinal investigation of the stability of young children with autism’s responses to an examiner’s distress between preschool age and a follow-up time point 5 years later. Children’s empathy ratings from preschool age predicted their later empathic responding to similar emotional displays 5 years later.

 In an important prospective study, Hutman and colleagues (Hutman et al., 2010) sought to determine whether response to another person’s distress differentiates infants subsequently diagnosed with autism from high- and low-risk infants who were not on the autism spectrum at 36 months of age. The authors describe how at ten months, typically developing infants consistently orient toward another person’s distress  and, at 12 months, they are more responsive to maternal displays of negative emotional expression than to pleasant or ambiguous displays of emotion.

In contrast, they found that infants subsequently diagnosed with ASD paid less attention and showed less affective response to another person’s distress at every time point from 12 to 36 months and across time points. They concluded that the emotional value of the information appeared to be less salient for infants later diagnosed with autism and that,

“The inability to decipher emotional messages or indifference to them is likely to interfere with social learning, social interaction, and the formation of close relationships. ” 

McDonald & Messinger (2012), in another prospective study, found that toddlers who were later diagnosed with an ASD showed less expressed concern, and tended to show less bodily arousal, in response to their distressed parent than children who did not receive a diagnosis. Importantly, children with lower levels of global empathic responding at 24 and 30 months of age exhibited higher levels of autism symptomatology at 30 months of age. They concluded that, “Overall, an emerging literature provides evidence for the significance of empathy difficulties in emerging ASD.” 

Failure to take advantage of the guiding relationship to prepare for peer relationships

Typical Development of  Collaborative Ability

“The development of joint action in the form of active, coordinated engagement around common objects, to which the infant actively contributes, is an extended process that occurs under the tutelage of adults, with the first evidence of autonomy and mastery occurring toward the end of the second year. Although children participate in joint action from very early in life, they only gradually become autonomous contributors to it.  Active coordination of joint activity around toys and other objects, even with familiar, attentive, cooperative adults is not a regular occurrence until much later in the second year.” Brownell, 2011

Towards the end of their first year, infants show increasing desire to take responsibility to coordinate their actions with parent guides. Early games become a critical developmental lab. Infants learn to  recognize recurrent patterns amidst variation, anticipate future events, and master the rhythm of reciprocal social interaction. 

In the following passage, Fantasia and colleagues (Fantasia, De Jaegher & Fasulo, 2014) describe the importance of these early cooperative activities,

“By  participating in shared cooperative interactions, infants practice their ability to make sense of & coordinate their actions with those of their parents in order become increasingly skilled in social participation … Participation in scaffolded cooperative activities enables infants to build up their competence on a moment-by-moment basis, by learning to make ongoing relational adjustments.” 

By the end of their first year, infants see themselves as active interpersonal agents when engaging in familiar activities with their guides. They rapidly adapt to new variations. They take &  reverse a variety of simple activity roles. 

During the second year, guides respond to increasing infant competence by decreasing the structure of activity frameworks, thus providing opportunities for infants to make more creative, improvised contributions. In the following passage, Dr. Kelley Brownell describes the enormous growth of collaborative competence during this period.

“Exchanges with adults form the foundation for dramatic growth in joint action during the second year of life, culminating in the child’s ability to contribute autonomously to novel goal-directed joint action by the end of that year. Without the structure and scaffolding provided by the expert adult partner, 1-year-old children are unable to generate and sustain joint action with each other in the service of an external goal. [Parental guidance] makes it possible for older toddlers and preschoolers to participate broadly in joint action across multiple social contexts and partners, and to generate and sustain goal-directed joint activity independent of adult direction.”

Drs. Aureli & Presaghi (2010), in discussing their research on how children begin learning to become competent collaborators during their second year, take a similar position:

“Social play occurring in the second year of life evolves from episodes when only the mother is sensitive to the infant, by directing her attention to and acting on the object of the infant’s focus, to episodes where both partners are mutually involved and influence each other continuously. Becoming an effective partner in collaborative interaction is a gradual process.

Infants are initially relatively incompetent: 12- to 18-month-olds involved in social games do not go beyond ritualized interactions and 14-month-old infants fail to coordinate their actions with those of another person in problem-solving tasks Social play in the second year of life evolves from episodes when only [parents are] sensitive to the infant, by directing their attention to and acting on the object of the infant’s focus, to episodes where both partners are mutually involved and influence each other continuously.”


Research on the collaborative development of children with ASD

The few studies that have been conducted to study ASD infant and toddler interaction with parents and other caregivers clearly demonstrate that they do not take advantage of available support to learn to function in a more coordinated and collaborative manner – a critical foundation for future peer interaction. 

Alisa Richmond (Richmond, 2010), as part of her dissertation work, conducted a series of home observations to study the natural day-to-day pattern of joint engagement between toddlers at high risk for ASD (17-34 months of age) and parents. She found that as expected the high-risk toddlers spent the vast majority of their time in solo activities with objects and rarely participated in supported or coordinated joint engagements, despite the availability and willingness of their caregivers.

Bottema-Beutel and colleagues (Bottema-Beutel et al., 2014), observing ASD infants low level of joint engagement with parents, concluded that,

  “ASD infants are not able to take advantage of their parents support during joint engagements They may be unaware of the adult as a source of collaboration and potential communication partner.”

Adamson and colleagues conducted two carefully conducted studies of the joint engagement of ASD toddlers in comparison to toddlers with Down Syndrome and typically developing peers (Adamson et al., 2009; Adamson, Decker & Bakeman, 2010).  In discussing the results obtained from observing the three groups of toddlers engaging with parents, the authors concluded that,

 “Compared to Down Syndrome and typically developing peers, young children with autism rarely coordinated their attention to a shared object and their partner, a deficit that was no less marked in children who had acquired relatively large vocabularies. “

In addition to studying the toddlers with their parents, the authors investigated the manner in which the children interacted with a very engaging but unfamiliar adult they refer to as a ‘play director’. They note that while all of the typically developing toddlers observed displayed considerable interest in the play director, the toddlers with ASD paid significantly less heed to the adult, and in a sizable minority of observations, they did not display any interest in her despite her significant attempts to greet & engage with  them. Based on the results of their two studies, the authors concluded the following,

“Autism but not Down Syndrome selectively disrupts coordinated joint engagement such that young children with autism rarely enter and sustain this state even when interacting with responsive caregivers.” 

They offer the following possible explanation for their findings,

 “There are a myriad of reasons why young children with autism might have difficulty sustaining periods of coordinated joint engagement even when interacting with a caregiver who was trying to facilitate communication. The child may appear uninterested in the partner  or fail to orient to her and be affectively unresponsive.  Highly restricted or idiosyncratic object interests may also make it difficult to locate a topic for sustained shared attention and conversation.”

Failure to use parents for Social Referencing

Typical Development of Social Referencing

An important step in an infant’s development of self-regulation takes place during the end of the first year, as infants develop the capacity to engage in social referencing, should the results of their studying fail to sufficiently reduce their uncertainty (The prototype of self-referencing typically emerges between 9 and 12 months of age). The onset of social referencing is important is an indication of significant neural and mental development.

Social referencing, when employed as a secondary response to studying a novel stimulus or ambiguous situation, tells us that the child has developed a top-down PFC mediated response to the experience of uncertainty and requires the integration of self and self-other neural circuitry and the ability to shift between the self and self-other focus when needed. 

Social referencing helps infants resolve a new developmental dilemma brought about by their emerging mobility. Infants wish to use their mobility to explore their environment, but also want to retain an emotional connection with caregivers. As they autonomously explore their environment, infants experience states of uncertainty when encountering situations that surpass their current level of assessment about whether to engage or not to engage with a particular stimuli. Social referencing provides a means to manage their uncertainty without having to disengage or withdraw from the stimulus.

In such instances, infants treat adults as a reliable source of information about external entities. Consequently they regulate their reaction to a novel object or event in a differentiated manner (e.g. approaching/avoiding, manipulating/not manipulating) based on their guide’s emotional state  (e.g. relaxed/anxious).

During the second year, social referencing transforms from the automatic, conditioned response of  nine-month-old, to a part of a more deliberate, inference-based decision-making process; checking to see how an adult reacts to actions the child intends to take, assessing the impact of our behavior on others, as well obtaining judgments and appraisals when experiencing uncertainty.

By 24 months social referencing has evolved into a more deliberate process of studying the subjective reactions of valued partners. The child deliberately “borrows” the guides valuation of stimuli (in an important/not important/maybe important manner) and uses the guide’s help in making appraisals, for example appraising the impact of changes, to differentiate insignificant from significant changes in tasks.   At this time, children begin employing social referencing for a number of new purposes:

 Social Referencing in ASD: Research Results

While research has focused almost exclusively on replicating ASD infants striking lack of communication for co-experiencing, several research groups have studied other ways in which ASD infants fail to benefit from by expanding the functions of their relationship with parents.

A few recent studies have observed that ASD infants and toddlers fail to engage in social referencing – defined as seeking out and using information and feedback from parents to aid them in solving problems and attaining clarification in ambiguous situations.

Shic and colleagues (Shic et al, 2011) found that toddlers with ASD showed less attention to the activities of others and focused more on background objects (e.g. toys). In addition, while all groups spent the same time overall looking at people, toddlers with ASD looked less at people’s heads and more at their bodies. The authors conclude that,  “… monitoring of the social activities of others is disrupted early in the developmental progression of autism, limiting future avenues for observational learning.” 

Cornew and colleagues (Cornew et al., 2012), in a prospective study of social referencing with 18-month-olds at high risk for autism, concluded that, “Infants at high risk for ASD do not appear to be affected by feedback based on parents’ facial expressions. Unlike typically developing infants they are not more likely to approach a toy following positive facial and vocal expressions, or to withdraw from a toy following negative expressions.” 

Bedford and colleagues(Bedford et al., 2013) found that the ASD toddlers they observed did not make use of their mother’s availability and feedback while working on a task. They noted that the ASD toddlers, “either ignored socially conveyed information, or did not appreciate the feedback they received”. The authors, in trying to explain why high-risk ASD toddlers did not benefit from feedback during learning as did their typically developing peers, posited that, “… toddlers at high risk for ASD might give less weight to information gained from others and either ignored the socially conveyed information, or did not appreciate the certainty value of the feedback they received regarding their choices.”


Why Would ASD Infants and Toddlers Fail to Take Advantage of Social Referencing? A Possible Explanation

Infants often look to their caregivers, in situations of uncertainty, to decide how to respond. Is the stranger friend or foe? Is the new toy funny or scary? Is the unfamiliar room inviting or threatening? Parents’ social signals can tell infants whether to approach or avoid a new person, novel object, or questionable situation.

The concept of uncertainty is central to studies of social referencing because infants should only seek social information or defer to unsolicited advice when self-generated perceptual information is insufficient  When risk is not uncertain (i.e., the situation is clearly safe or impossible), then infants should instead rely on perceptual information from their own exploratory activity.

The function of social referencing is to aid the infant to more easily manage their experience of uncertainty to determine:

  • Whether to engage with an unfamiliar, ambiguous stimulus  
  • How they should engage with the stimulus

Social referencing is thus a response that occurs several links down the chain of encountering a new stimulus. The chain goes like this:

  • First the infant must differentiate feelings of uncertainty from those of threat
  • Secondly the infant must act in a mediated manner & inhibit any immediate impulse to withdraw
  • Third the infant must try to manage feelings of uncertainty by attempting  to ‘study’ its source, in an autonomous manner
  • Finally, the infant should engage in social referencing if his or her own efforts to resolve the uncertainty fail to provide sufficient resolution

ASD infants never get to the point where social referencing is needed. In almost all cases they avoid or withdraw much earlier in the process When would you have the opportunity to engage in social referencing when you avoid or withdraw, prior to ever experiencing uncertainty?

Restricted development of communicative functions & means

Researchers have noted that ASD infants and toddlers are severely limited in their development of both communicative functions and means.

Limited Communicative Functions

A number of studies have concluded that once ASD infants do begin to communicate in their second year, their communication is limited to ‘instrumental’ rather than co-experiencing functions, a pattern which was the exact opposite of their typically developing and developmentally disabled peers (Barbaro & Dissanayake, 2012; Meirsschaut, Warreyn and Roeyers, 2011; Shumway & Wetherby, 2009).  

Barbaro & Dissanayake (2012) note that,“Once ASD infants acquire the ability to communicate, they limit communication primarily for the purpose of requesting rather than sharing experiences.”

Shumway & Wetherby (2009) found that By 18 to 24 months of age, children later diagnosed with ASD showed a unique profile of communication, with core deficits in communication rate, joint attention, and communicative gestures. They concluded that young children with ASD do communicate, but communicate predominantly for behavior regulation rather than for the purpose of commenting or sharing attention on an object or event of interest

Meirsschaut, Roeyers & Warreyn (2010), conducting an analysis of the proportion of declarative, imperative and neutral initiatives revealed that young children with ASD used significantly more imperative initiatives while non-ASD children used significantly more declarative initiatives during play interaction. In addition, they reacted significantly less responsively to declaratives initiatives than to imperative initiatives.


Impoverished Communication Means

Given the limited functions for which they apply communication, it is not surprising that researchers have found significant differences in the quality of ASD infant and toddler communication. Several recent studies have pointed out that ASD infants and toddlers possess ‘impoverished’ and limited means of communication. 

Watson and colleagues (Watson, et al., 2013) have reported that ASD infants develop an extremely limited repertoire of gestures.

Similarly, Parlade (2012) concluded that, “The communicative system of ASD infants exhibits a lack of behavioral variability and flexibility”.

In contrast to typically developing peers, several studies have found that ASD infants do not communicate in a multimodal manner (e.g. integrating gesture, vocalization and facial communication) than their typically developing peers (Parlade & Iverson, 2015; Talbot, Nelson & Tager-Flusberg, 2013; Winder et al., 2013). 

For example, Snowden and colleagues (Snowden et al., 2013) found that co-speech gestures  were  either absent or rare in ASD young children, “our findings suggest that children with ASD do not make use of the facilitating communicative effects of gesture in the same way as typically developing children.”

This series of findings has important implications for parents ability to function as effective guides. As Hudry and colleagues (Hudry et al,. 2014) point out, “ … parents of ASD infants are at a strong disadvantage because children with ASD present few leads for parents to follow and their weak/poorly timed signals are easily missed.”

Developmental Cascades and Cumulative Risk Models

In the child development literature, the process by which the effects of one early domain of functioning or set of constraints influence other domains of functioning in the system over time has been examined using the construct of Developmental Cascades. Various terms have been used to represent the notion of a developmental cascade, such as chain reactions and snowball effects.

Thelen & Smith (2006) point out that, “The stable regularities we see in developed organisms—the phenomena we seek as psychologists to explain,might not have specific causes that can be demarcated and isolated but rather may be understood only as a dynamic cascade of many processes operating over time.”

Cascading effects involve interactions between different factors during early development, while the brain is still highly plastic, that lead to a non-linear change. 

Meek et al. (2014) coming from the genetics perspective discussed how initial genetically-based conditions can  influence environmental exposure and how environmental exposure can further reinforce the initial behavior of interest, to perpetually affect development. Specifically in relation to the genetics of ASD, they make the following proposal:

“… risky genetic variants contribute to social impairments and low social motivation early in life, which may lead to decreased frequency of social initiations and social reciprocity from communication partners. To continue this hypothesis over time they consider that ”…  as children develop and become more influential in forming their own environments, difficulty with social skills and low social motivation may lead children with ASD to self-select to spend their time engaged in nonsocial activities, .. children with autism may be left further and further behind in what can be labeled a “snowball effect”.

Lewis (1997) introduced the concept of ‘Cascading Constraints’’ in which they propose that initial developmental limitations (constraints) produce more limitations:

” … constraints beget more constraints over time as the system becomes more organized and less variable. … It is likely that preexisting constraints (e.g., a specific genetic condition that impairs prenatal development) have their developmental effects through the influence of cascading constraints (e.g., the emergence of a narrower range of early behavioral competencies of the child related to the specific neurogenetic condition and a correspondingly narrower range of potential caregiver–child behavior patterns)“

 
Gliga et al. (2014) have proposed that ASD may be best understood from either a  ‘Cumulative’ or ‘Multiplicative’ Risk’ model. Cumulative Risk models consider how a number of different factors can combine in different ways to exceed a particular threshold’ thus producing a degree of ‘cumulative risk’  and altering the infant’s development in a common manner.  According to cumulative accounts of autism, the number of  vulnerabilities during infancy will be related to the severity of the outcome. Different factors could contribute more or less to predicting an outcome. While cumulative models assume that the number of initial vulnerability “hits” determines outcome, multiplicative models account for the dynamic nature of  development by assuming that a few initial factors interact and amplify each others’ effects during development. While they differ in emphasis, both of these models are consistent with the idea that their may be multiple routes to ASD pathogenesis.

Evidence for Lack of Growth Seeking: Limited Exploration, Restricted Actions & Circumscribed Interests

Strangely, while psychologists and educators have for decades agreed that the early activation of a growth-promoting motivation is a critical factor in development, it has received little if any attention from ASD researchers. In the section below we provide brief summaries documenting the abnormal and limited ways that infants later diagnosed with ASD and young ASD children seek to explore objects and their environment, as well as, from a very young age, restricting their involvement to very limited objects and circumscribed interests.

Exploration

Baranek (1999), in an early study of ASD infants, reported that, “Children who were later diagnosed ith autism looked at objects and manipulated them less often.” 

Ozonoff and colleagues (Ozonoff et al., 2008), as part of their  longitudinal study of a small group of high-risk infants, concluded that, “unusual visual exploration may be a particularly distinctive feature of the early autism phenotype, with seven of nine subjects displaying very high rates of unusual (primary stimulation vs. meaning) behavior such as  rotating or spinning.”

de Campos and colleagues (De Campos et al., 2012) found that High-Risk infants exhibited early (at 6 and 9 months) delays in the visual and oral exploration of objects relative to their Low-Risk peers. They conclude emphasizing the potential consequences of reduced exploration, “ there is reason to suggest that even relatively small perturbations in early-appearing exploratory behaviors may have far-reaching, cascading effects on the emergence of subsequent skills in other domains.”

Elison and colleagues examined patterns of stereotyped motor mannerisms and repetitive manipulation of objects over several time periods with initial observations at 12months. They found that ASD infants showed significantly more repetitive object manipulation than their typically developing comparison group. The authors reported that compared to children who were developing typically, toddlers with ASD explored fewer images overall, perseverated to a greater degree on the few images they did explore, and were more detail-oriented in their inspection of individual images.  Additionally, they found that the developmental difference for visual exploration was most pronounced with respect to the exploration of those images conveying. nonsocial information. The authors  conclude that their results indicated how  abnormal exploratory behavior not only occurs very early in the development of ASD, but persists and appears to increase with age with the ASD children engaging in dramatically less productive visual exploration than their typically developing peers. In emphasizing that such differences can have profound implications for development the authors discuss how,  “… extended experience with certain categories of information (i.e., nonsocial information) over time is likely to have effects on brain development and the specialization of dedicated neural circuitry.”

Koterba and colleagues (Koterba, Leezenbaum & Iverson, 2014) investigated the exploratory behavior of high-risk ASD infants during their first year found that exploratory activity in children with autism differed from that of their typically developing peers from the first year of life, both in terms of intensity of exploration and distribution of particular forms of exploratory behavior. ASD infants demonstrated a much lower rate of environmental exploration.

Adamson, Decker & Bakeman (2010), in a series of home observations, compared the exploratory play of ASD, Downs Syndrome and Typically Developing Toddlers,. They found that toddlers in the ASD group displayed less interest in unfamiliar than familiar objects while children in both the typically developing and Down syndrome samples displayed more interest in unfamiliar objects than in familiar ones.

Kawa & Pisula (2013), studying young ASD children, found that they engaged in significantly less complex object manipulation than their typically developing peers.

Restricted Actions and Circumscribed Interests

In respect to early restricted behavior and circumscribed interests, Sasson and colleagues (Sasson et al., 2011) found that the ASD children between the ages of 2 and 5 exhibited greater perseverative attention to objects related to their circumscribed interests than did typically developing children.

Wolf and colleagues (Wolff et al., 2014) found that as early as 12 months of age, a broad range of repetitive behaviors are highly elevated in children who go on to develop ASD. While some degree of repetitive behavior is elemental to typical early development, the extent of these behaviors among children who develop ASD appeared highly atypical.

Harrop and colleagues (Harrop et al., 2015) documented the presence of restricted and repetitive behaviors in 85 toddlers with autism spectrum disorder as they interacted with their caregiver in a play interaction.  The most common child restricted and repetitive behavior was repetitive object use with 72 children displaying at least one instance of this category of restricted and repetitive behavior. Overall, caregivers responded to fewer than half of their child’s restricted and repetitive behaviors.

Early Impairments in Social Information Processing

Studies of ASD infant’s social information processing have focused on two main areas:

  • The manner in which infants process facial information – focusing mainly on the time spent by ASD and typically developing infants in processing facial information presented in different ways
  • Infant’s development of gaze-following – shifting their attention based on changes in the gaze of their caregivers

In both areas, results have been confusing and in some cases contradictory. 

Face Processing

Elsabbagh and colleagues (Elsabbagh et al., 2013) found that 7-month-old ASD infants spent proportionally more time looking at faces relative to other objects than low-risk controls. They concluded that longer proportional looking at the face in the ASD group appeared to reflect early face-processing difficulties.  However, in a related study, the authors (Elsabbagh et al., 2013a) examined modulation of gaze while infants saw videos of people playing peek-a-boo. They found that at both 7 and 14 months, infants diagnosed with ASD at 36 months showed normal patterns of gaze modulation.

Webb and colleagues (Webb et al., 2014)  reported that ASD toddlers spent more time than typically developing peers gaze at faces, which they also attributed to the ASD toddlers having increased difficulty in processing the facial information. To support this conclusion, they reported slower face learning was correlated with poorer social-communicative skills.

Key and Stone (2012) examined whether, on average, nine-month-old ASD infants processed facial features (eyes, mouth) differently than their typically developing peers and whether such differences were related to the infants’ social and communicative skills. They found differences in brain measures of activation, but not in any behavioral indices.

Kay and co-workers (Kay et al., 2014) found that group differences were most pronounced for subtle facial expressions. Compared to the high-risk ASD group, the low-risk group exhibited relatively longer processing and greater attention resource allocation to small smiles relative to neutral expressions.

In contrast to the above findings, de Klerk and colleagues (de Klerk et al. 2013) found that toddlers who went on to develop ASD spent less time looking at faces. They concluded that this lack of experience with faces has detrimental effects on their face-processing abilities later in life. In explaining their results, the authors concluded that ASD infants did not lack an attraction to or actively avoid faces, but rather seem to experience difficulties with processing faces from early in life resulting their being less motivated to attend to facial information.

Gaze Following

Jones and colleagues (Jones et al. 2014) have hypothesized that ASD infant’s difficulty in processing gaze cues may reduce their interest in eye gaze over time, because these infants do not receive the reinforcement of identifying the gaze referent.

Bedford and colleagues (Bedford et al. 2012) found that gaze-following at 7 and 13 months was not impaired in infants at risk for autism. However, having followed gaze correctly, the ASD at-risk infants allocated less attention to the object  of their gaze following. They concluded that the problem was that they did not understand what was significant about attending to the same object as their adult guide.

Elsabbagh and colleagues (Elsabbagh et al. 2014) examined the neural correlates of infant’s observing an adult either directing or averting their gaze towards a stimulus. They found that, in contrast to typically developing infants, who showed no differences in their reactions to both types of gaze, ASD infants responded much faster to averted than to direct gaze.

Failure to ‘Privilege’ Attention to Social Information

There has been a good deal of support for the idea that infants who go on to be diagnosed with ASD are born without an innate preference to attend to socially-based vs. non-social information. There is substantial evidence that neural systems that bias attention towards human faces or eyes are functional from the first months of life in typical development. These mechanisms are actually most useful very early on, when limited attentional abilities make it difficult to select relevant information to attend to.

Generally those supporting this model hypothesize that diminished exploration of social information could initiate a developmental sequence that contributes to the emergent social deficits characteristic of autism. For example, Gliga and colleagues (Gliga et al., 2014) in their review of the ASD infant literature concluded that, “One could expect that, if generalized across modalities, decreased orienting [to persons] would have multiple and wide-­‐ranging consequences on all aspects of development that require learning from people and about people.”

Ellison and colleagues (Elison et al., 2012) discussing finding on longitudinal studies of ASD infant and childhood attention concluded that an early attentional bias for nonsocial information may be a primary feature of autism,

 “ASD may involve a difference in the balance of attention between social and nonsocial aspects of everyday experience which may over time manifest behaviorally as excessive nonsocial interests and behaviors coupled with diminished social interests and behaviors. Disproportionate visual attention to certain nonsocial objects relative to social stimuli in ASD spanned from early to late childhood, and thus may represent both an early and a persistent characteristic of the disorder.

Greene and co-workers, (Greene et al., 2011) studied the way that the brains of children with ASD and their neurotypical peers process social and non social information and provide evidence that the neural circuitry involved in social orienting is disrupted in ASD. They found that when attention was directed by social cues compared to nonsocial cues, the typically developing group showed increased activity in higher level attentional and information processing networks whereas the ASD group only showed much more limited and ‘lower level’ neural activation. As a result of their work, they concluded, “In the autistic brain, social cues are not assigned the same privileged status as they are in the typically developing brain.”

In another study comparing neural responses to social information, Luyster and co-workers (Luyster et al. 2014) found that infants at high risk for ASD did not differentiate between familiar and unfamiliar social stimuli at 12 months of age in terms of their neural response.

In their study of  7-month-old ASD infants Chawarska, Macari & Shic (2013) found that ASD infants paid significantly less spontaneous attention to social scenes  (less time spent in monitoring social scenes) than non-ASD peers.  In the following passage they describe the potential consequences of this early impairment. Based on their results they developed the following preliminary model.

” In typically developing infants, an early attunement to people facilitates access to a range of highly socially relevant experiences and, consequently, the development of a more fine-tuned ability to spontaneously attend to people, their facial expressions, and gestures. These skills are necessary for participation in complex dyadic routines (e.g., peek-a-boo game) and later in infancy, triadic interactions (e.g., joint attention).  Infants later diagnosed with ASD present with a different picture, characterized by the continuity of social attention impairments’ which progress, ”from a limited attunement to people in general toward more specific impairments in attention toward their bids for social interaction and communication. Difficulty in processing social information could over time result in a decrease in social reward and orientation as infants struggle to deal with incoming information.

 In the postnatal period many brain regions are poorly specialized but undergo fine tuning to more specific classes of stimuli in an experience-dependent fashion. Initial difficulties in processing social information, along with the limited salience of social stimuli observed [in at risk infants] at 6 months, and possibly manifesting even earlier, may hinder the cortical specialization process that rapidly advances in non-affected infants. This will have important implications for emerging patterns of parent-child interactions, and thus are potentially highly clinically relevant to the outcomes in high-risk infants.”

Sasson and colleagues (Sasson et al., 2012), presented a model in which beginning at birth, the neural reward system of ASD infants is biased away from social information in favor of nonsocial aspects of the environment. 

“Greater affective responses evoked by certain nonsocial aspects of the environment relative to social stimuli may result in the experiential prioritization of a restricted range of environmental input.  If present from early in life, such processes could have important developmental repercussions.” 

Social Attention or Information Processing: Can it be both and does it matter?

A growing number of researchers are coming to the conclusion that it may not be possible, or worthwhile  to try and separate ASD infant’s  social attention and  information processing. They argue that a lack of attentional prioritization could lead to less experience and thus impaired social information processing and accompanying neural specialization. For example, Chawarska, Macari & Shic (2013) have pointed out that difficulty in processing social information could over time will result in a decrease in social reward and orientation as infants struggle to deal with incoming information. In contrast, it is just as likely that difficulty in processing social information might lead infants to eventually reduce their preference for attending to social information.

In the following passage, Jones & Klin (2009) describe the potential consequences of early social impairments, whether they are due to attentional abnormalities or impaired social information processing

 ”  blockage of the normative social adaptive trajectories and thus biasing the child to forms of learning that are not grounded in social interaction.  In typical development, success in social adaptive tasks prompts further development in an iterative process that builds on older structures to generate new ones. This process is ever ongoing, resulting in successively more complex social cognitive development. In this fashion, ontogeny typically realizes phylogenetic predispositions through the rapid movement of the child through universal social adaptive tasks, jerry-building successful social and communicative babies. However, if this process is derailed, we expect that the earlier the disruption, the greater will be the developmental consequences. “A child with autism is learning from a world dominated by physical rather than social events, and this experience is likely to bring about increasing divergence in processes having an impact on brain development,” 

02. Early Impairments in Disengaging & Shifting Attention

During the first months of life, infant attention-orienting is rigid, primarily controlled by external sensory factors and marked by the inability to flexibly shift attention. Towards the latter part of the first year, development of the frontal cortex allows the infant to exert increasing volitional control over visual orienting. In typical development the disengage mechanism becomes operative at 3-4 months. Ease of disengagement is found from 4-6 mos. Prior to 4 months, infants can selectively focus attention but have difficulty disengaging and remain somewhat rigidly fixated.  

Several recent studies have presented compelling evidence that ASD infants are impaired, or significantly delayed in their ability to disengage and shift attention:

  • Elison and colleagues (Elison et al., 2013) reported that disengagement of attention at 6 months of age was slower in infants who met criteria for autism at 2 years of age.
     
  • Elsabbagh and colleagues (Elsabbagh et al. 2012) found that relative to typically developing peers,  ASD infants at 9 & 10 months of age were slower to disengage their fixation from a central stimulus to orient toward a peripheral distractor. They concluded that current results support the conclusion that reduced flexibility in the control of visual attention is among the first  early emerging features of autism.
     
  • Bryson and colleagues Bryson et al. 2013), studying 12-month-olds’, found that ASD infants  ASD infants took longer to disengage that non ASD siblings and controls. In addition they found that ASD infants failed to disengage at al  on 20% of trials.

Development of the ability to volitionally disengage their attention provides infants with their first experience of personal agency. It also allows infants to withdraw attention from distressing events and thereby regulate their emotional state. Infants attentional disengagement is associated with more positive emotion, less distress and enhanced ability to be soothed.

Keehn, Tager-Flusberg & Nelson (2013) have presented a model in which the inability to disengage attention may lead ASD infants to withdraw from engagements with others. They posit that, because typically developing infants learn to use attentional disengagement to manage their state of arousal, the failure to disengage attention during interaction could lead to ASD infants to associate their engagements with caregivers as over-arousing. They speculate that following repeated instances of over-arousal during early social interactions, social information would become aversive. In addition, they discuss how early difficulties disengaging attention would curtail ASD infant’s capacity for participating in experience-sharing engagements with caregivers 

Bedford and colleagues (Bedford et al., 2013) have presented evidence that supports adoption of an ‘additive model’ of attentional impairment in which both the lack of preference for social information along with the difficulty in disengaging attention both independently predicted ASD outcome and when combined significantly increased the power to predict future ASD diagnosis

03. Early Impairments in Perceptual Processing

While there has been little actual research involving infants who go on to be diagnosed with ASD, there has been much discussion of the potential impact of early perceptual processing impairments with two major themes dominating discussion:

  1. Efficiency models in which ASD infants are unable to use top-down neural functioning to integrate perceptual stimuli into single ‘chunks‘ as well as to contextually filter out non-significant information
     
  2. Synchronization models involving impairments in intermodal perception  – temporally synchronizing multi-sensory input so that it is perceived as a single multi-modal unit

Mottron and colleagues (Mottron, et al., 2014) have presented a model in which autism results from a [genetically induced] plastic reaction targeting the most variable cortical regions. According to the authors, 

“… this plastic reaction may create a cascade effect yielding the particular pattern of strengths and weaknesses of each autistic individual. The “hijacking” of a region typically dedicated to a certain type of informational input by another neurological function, may result in enhanced perceptual or verbal performance in autistic individuals.”

Amos and colleagues (Amos et al., 2014) have presented a model in which sensory driven activity present at early stages of development may influence existing organization, and fundamentally alter the organization of the cortex, its connectivity and its function, resulting in enhanced perceptual functioning in autism, and poor mastering of social interactions, speech, or motor coordination. In addition, competition with other cortical allocations may result in the neglect of non-targeted functions, leading to autistic “negative” social behaviors.

The results of a study conducted by Collignon (2012), showed that persons with ASD receive reduced benefit from multi-sensory information. The present study demonstrates that ASD individuals do not benefit from the presence of a typically temporally relevant tone during a demanding visual search task. The absence of this pip and pop effect in the autism group is suggestive of atypical integration of low-level, non-social perceptual cues originating from different sensory modalities. 

Kwakye and co-workers (Kwakye et al., 2011) reported  that the temporal  processing of auditory and multisensory stimuli is disrupted in ASD,

“A disruption in the temporal precision with which a multisensory perception is created from its component  unisensory parts is likely to be compounded at  subsequent  processing stages and to lead to more pronounced disruptions in the understanding of complex stimuli. Numerous auditory and visual stimuli involved in the interaction (e.g., subtle changes in tone of voice, facial expression, and body language) must be integrated seamlessly for social interaction to be successful. Altered experiences with multisensory processing from early ages may have detrimental effects on subsequent development of complex social abilities such as empathy and reciprocity.“

Lloyd-Fox and colleagues (Lloyd-Fox et al. 2013) investigating the neural correlates of inter-modal perception concluded that,

“A pattern of results is emerging that supports the view that the rapid temporal processing required by dynamic stimuli is affected in infants at risk and/or those who go on to a later diagnosis. A characteristic of interactions with other humans is that it is dynamic and probabilistic, and it may be these features that lead to greater deficits in social perception and cognition than in understanding of the physical world.“

04. Motor, Movement & Postural (‘Embodied’) Abnormalities\

In recent years a number of ASD researchers have hypothesized that early motor impairments may play a role in the emergence of ASD (Apicella et al. 2013; Sacrey et al. 2014; Trevarthen & Delafield-Butt, 2013; Whyatt & Craig, 2013).

  • Zwaigenbaum and colleagues (Zwaigenbaum et al., 2013), in their review of ASD Infant Research, reported that motor functioning scores distinguished infants with ASD from other HR infants at 12 and 18, but not 6 months.
     
  • Bhat, Landa and Galloway (2011) reported that motor delays at 18 months of age were highly predictive of an ASD diagnosis  at 3 years of age .

Several studies have reported finding postural abnormalities in ASD infants that appear to be related to their later diagnosis. 

  • Bhat and colleagues (Bhat et al., 2011) concluded that ASD infants appear to have poor postural control, as reflected in lack of head holding and rolling at 3 months and lack of pivoting and side-prop postures at 6 months. Additionally they spent less time in advanced postures used in sitting and crawling and more time in less-advanced postures such as prone play than age-matched infants who were developing typically.
     
  • Nickel and colleagues (Nickel et al., 2013) reported that ASD infants were slower to develop skill in sitting and standing postures. They exhibited substantial delays in the emergence of more advanced postures and initiated fewer posture changes. The ASD group exhibited delays in the achievement of new postures, had more restricted posture repertoires, and spent more time in developmentally less advanced postures (e.g., Lying at 9 months; Sitting at 12 and 14 months) relative to comparison infants. Thus, for example, at 9 months, ASD infants spent roughly a third of the observation in Lying postures (prone or supine).

While research confirms some association between early motor problems and later ASD diagnosis, the specific role of motor impairments in ASD emergence is far from clear. 

  • Trevarthen & Delafield-Butt (2013) considered that a primary deficit in the capacity to perceive and move the body in a planned way would impact infant communication and social understanding.
  • Apicella and colleagues (Apicella et al., 2013) speculated that an early lack of motor activity jeopardized the child’s ability to initiate and respond to interactive exchanges, making infant-parent interaction more difficult and compromising the development of reciprocity.
  • Marsh and colleagues (Marsh et al., 2009; 2013) hypothesized that deficiencies in “the social grounding of ASD children’s movements” play a major role in their ability to function as a “socially connected unit with others.”
     
  • Isenhower and colleagues (Isenhower et al., 2012) pointed out that, “if an individual cannot coordinate their own limbs, how can they possibly coordinate with their physical and social environment?”
  • Whyatt and Craig (2013) concluded that ASD infants may have a central underlying  ‘perception-action coupling’  impairment which interferes with their ability to “adapt the temporal characteristics of their movement to conform to external spatial constraints” and create difficulties for ASD infants in participating in ‘the social dance”.
  •  Sacrey and colleagues (Sacrey et al. 2014) describe the potential impact of an early impairment in the ‘timing’ of motor actions, “The idea is, when a person is unable to respond to another’s action in a timely fashion, he/she will miss the positive reinforcement associated with interpersonal interactions.  A child’s experiences throughout development may be drastically altered if, at an early age, he/she is unable to remain involved in social interaction, and as a result, may withdrawal from social activities.”

In contrast to the above findings, Leonard and colleagues (Leonard et al., 2014) expressed caution in assuming that motor problems found in ASD infants were unique to the disorder.

“Fine-motor delay did have some degree of discriminative value at 7 months However, results indicate that poor motor skills may not be ASD-specific. Rather, they may be a more general indicator of atypical development as well as, in some cases, showing an association with the social and communication difficulties.”

Summary of Findings re. Early Functional Abnormalities

Dinstein and colleagues (Dinstein et al., 2011) found that, compared with language-delayed and control toddlers, toddlers with autism exhibited significantly weaker inter-hemispheric synchronization. They report that,

” … the fact that poor synchronization was found in the language system of toddlers with autism, and not in toddlers with language delay (both groups exhibited similarly low expressive language scores, suggests that reduced synchronization may reflect the existence of a specific pathophysiological mechanism that is unique to autism Our results suggest that reduced neural synchronization is a notable characteristic of autism, evident at very early stages of autism development. Compared with language-delayed and control toddlers, toddlers with autism exhibited significantly weaker inter-hemispheric synchronization …”

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Fishman and colleagues (Fishman et al., 2014) reported finding atypical connectivity of and between ToM and MNS networks in adolescents with ASD, predominantly reflected in overconnectivity. They reported that, in contrast to previous findings of predominantly reduced connectivity in ASD detected at rest in other functional networks, a mixed pattern of both over- and underconnectivity was observed in the Theory of Mind (TofM) network. Moreover, the extent of atypical connectivity was correlated with greater social dysfunction, suggesting that abnormal neural connections involving the mentalizing and mirror neuron systems are related to the social impairments observed in ASD

Keown and colleagues (Keown, et al., 2013), studying connectivity in ASD teens, found that whereas both TD and ASD groups showed overall patterns of local connectivity consistent with previous results for healthy adults, significant group differences were detected, which overwhelmingly reflected increases of local connectivity in the ASD group. They conclude that, “The functional and developmental significance of our findings may lie in what appears to be an atypical gradient of local connectivity abnormalities from mild anterior underconnectivity to robust posterior overconnectivity in ASD.”

Lewis and colleagues (Lewis et al., 2014) found that cortico-cortical organization was deficient in infants with significant symptoms of ASD in terms of both the long-range connectivity that provides for rapid integration of information between different brain regions, and the spatial clustering that provides for efficient processing for subtasks. They concluded with the following passage,

“… [Neural] organization is deficient in [ASD infants] in terms of both long-range connectivity that provides for rapid integration of information between different brain regions & their spatial clustering that provides for efficient processing for subtasks [specialization]. [These] Brain-based abnormalities are likely to contribute to a developmental cascade of behavioral and neural abnormalities … neural networks [must] balance global efficiency with local efficiency –  strong local clustering mixed with sufficient long-range connectivity to allow rapid communication between distant nodes.” “To function effectively our brains must develop in a manner that maintains an optimal balance of strong local clustering mixed with sufficient long-range connectivity   Networks with a high degree of spatially local connectivity, but with few or no  long-range connections, that is, shortcuts, will have high local efficiency [but] low global efficiency  Networks with a high degree of long-range connectivity, but which lack spatially local clustering, [will] have high global efficiency [but] low local efficiency,”

Lloyd-Fox and colleagues (Lloyd-Fox et al., 2013) concluded that,

“… a pattern of results is emerging that supports the view that the rapid temporal processing required by dynamic stimuli is affected in infants at risk and/or those who go on to a later diagnosis. A characteristic of interactions with other humans is that it is dynamic and probabilistic, and it may be these features that lead to greater deficits in social perception and cognition than in understanding of the physical world.”

Maximo, Cadena and Kana (2014), as a result of their comprehensive review, concluded that  a better way to characterize connection abnormalities in autism may be in terms of disrupted connectivity, which would encompass the wide array of findings involving increased and decreased connectivity. They conclude that, 

“… inefficient connectivity may be the hallmark of ASD, with possibly overabundant connectivity between ‘non-essential’ regions, allowing for low-level cross talk resulting in increased noise in the system. They postulate that this may also relate to findings of early brain overgrowth in children with ASD. Impaired synaptic pruning, important for brain organization and network specialization in typical development may also play a role in creating enhanced connections. ASD is associated with the inability of the brain to maintain an optimal balance between functional ‘specialization’ & network ‘integration resulting in an “Inefficient allocation of neural resources”. 

Menon (2011) in a research review, argued that, of all networks examined, the connectivity patterns of the Salience Network show the highest classification accuracy between children with autism and typically developing children and its functional organization predicted restricted and repetitive behavior scores, one of the core symptoms of autism.

“Identification of the Salience Network, as a particular locus of aberrant connectivity is consistent with the hypothesis that inappropriate assignment of saliency to external stimuli or internal mental events by the SN plays a prominent role in autism.”

Misic and colleagues (Misic et al., 2014) concluded that their findings demonstrated network disorders in children with ASD that affect how distributed regions communicate and generate information at multiple time scales.

“These results indicate that ASD involves disrupted temporal organization of the networks required to integrate information for flexible cognitive control, rendering them less effective. Our data demonstrate that ASD does not affect any one region or pathway, but ensembles of regions, supporting the view that disruptions of integrated network functions may play an important role in the pathophysiology of ASD. In particular, ASD affects the temporal organization of these networks, perturbing the global interactions required to perform specific cognitive tasks.”

Orekhova and colleagues (Orekhova, et al., 2014) conducted a study that provided the first EEG evidence of functional brain hyper-connectivity in infants who later go on to ASD. They concluded that the hyper-connectivity the found might may reflect white matter abnormalities previously found in infants, toddlers, and young children with ASD.

Perez-Velazquez & Galan (2013) proposed that the excessive production of information in the absence of relevant sensory stimuli or attention to external cues underlies the cognitive differences between individuals with and without autism. They conclude that the information gain in the brain’s resting state provides quantitative evidence for perhaps the most typical characteristic in autism: withdrawal into one’s inner world.’ 

Righi and colleagues (Righi et al., 2014) found that by 12 months of age, infants at high-risk of developing ASD displayed significantly lower functional connectivity between frontal and parietal sites compared to infants at low-risk for ASD. They concluded that ASD is broadly characterized by differences in neural integration that emerge during the first year of life

Schipul and colleagues (Schipul et al., 2012) obtained results that supported a model of neural inefficiency. They found that as  the control group became more proficient at the task, they appeared to reduce the use of nonessential processes in these areas involved in higher level cognition. This decrease in activation was consistent with previous findings of increasing neural efficiency in neurotypical individuals as they receive more practice.  The autism participants, however, did not show evidence of such increased neural efficiency, “Unlike the control group, the autism group was unable to implement a more economical way to perform this task due to decreased communication between frontal and posterior areas.”

Uddin and colleagues (Uddin et al., 2014) concluded that unlike their typically developing peers, children with ASD did not exhibit significant changes in connectivity patterns between task-evoked processing and resting states.  They conclude by stating that,

“This finding is in line with the hypothesis that autism may be characterized by “undifferentiated brain states” …  this within-network intrinsic hyperconnectivity in ASD may result in “network isolation” during task-evoked states, limiting dynamic interactions between brain networks that are necessary for flexible and adaptive cognition and behavior.”

Washington and colleagues (Washington et al., 2014), studying 6-9 year-olds’ with ASD, concluded that connectivity deficits in ASD within the Default Network resulted from a lack of developmental strengthening of connectivity within this network.

Zikopoulos & Barbas (2013), in their review of research, concluded that findings from a variety of functional and structural imaging studies suggest that the breakdown in neural communication in autism involves local overconnectivity and long distance disconnection, especially in pathways that include the frontal lobe.“

Support for an early impairment in ‘Neural Efficiency’

Maximo, Cadena & Kana (2014) proposed that, considering  findings of both overconnectivity and underconnectivity in ASD, perhaps a better way to characterize connection abnormalities in autism may be in terms of disrupted connectivity, which would encompass the wide array of findings involving increased and decreased connectivity and lead to a non-optimal balance. They conclude that inefficient connectivity may be the hallmark of ASD, with possibly overabundant connectivity between ‘non-essential’ regions, allowing for low-level cross talk resulting in increased noise in the system. They describe their model of neural inefficiency in the following passage

“Cognitive processes are computationally demanding, and hence require effective allocation of the brain’s resources. Optimal functioning of different brain areas, is guided by two fundamental principles of brain organization: functional specialization and  functional integration.  Functional specialization suggests that different areas in the brain are specialized for different cognitive functions.  Functional integration involves the coordination among brain areas to accomplish a task. The balance between segregation and integration is essential for the operation of distributed networks underlying cognitive functions.”

Lewis and colleagues (Lewis et al., 2014) found that the neural functioning of ASD toddlers was characterized by both ineffectiveness and inefficiency at 24 months. Specifically, they found abnormalities in both the long-range connectivity that provides for rapid integration of information between different brain regions and the spatial clustering that provides for efficient processing for sub-tasks. In response to their findings, the authors presented a model in which the emergence of ASD may be related to the poor development of neural networks,

Networks with a high degree of spatially local connectivity, but with few or no long-range connections, that is, shortcuts, have high local efficiency and low global efficiency; networks with a high degree of long-range connectivity, but which lack spatially local clustering, have high global efficiency and low local efficiency. Biological systems in general, and neural networks in particular, reliably balance global efficiency with local efficiency, having strong local clustering mixed with sufficient long-range connectivity to allow rapid communication between distant nodes; these have been dubbed ‘small-world’ properties.”

Dickstein and colleagues (Dickstein et al., 2013), have hypothesized that growth profiles in autism may not support an appropriate balance between maturation and experience, and thus function inefficiently, due to abnormal neural “pruning”. They point out that, whereas normal pruning could help eliminate faulty connections and optimize coordinated neural functioning, compromised pruning might fail to do so, possibly resulting in some degree of anatomical “overconnectivity” that decreases the efficiency of communication among cortical regions.

Dinstein and colleagues (Dinstein et. al., 2011) proposed that reduced neural synchronization be considered a central characteristic of autism, evident at very early stages of development. In support of their hypothesis, they presented findings indicating that poor synchronization was found in the language system of toddlers with autism, and not in toddlers with language delay (both groups exhibited similarly low expressive language scores), suggesting that reduced synchronization may reflect the existence of a specific pathophysiological mechanism that is unique to autism.

Rudie and colleagues (Rudie et al., 2013) found alterations in community organization of functional networks, as well as in the balance of local and global efficiency within and between structural and functional networks in children and adolescents with ASD relative to their typically-developing counterparts. They detected robust reductions in positive functional connectivity within major functional systems (i.e., functional integration) in individuals with ASD.  They conclude that the pattern of altered connectivity they observed, suggest that ASD is characterized by reduced functional integration and segregation of large-scale brain networks.

Righi and colleagues (Righi et al., 2014) proposed that ASD can be characterized by differences in neural integration that emerge during the first year of life. They present findings that by 12 months of age, infants at high-risk of developing ASD display significantly lower functional connectivity between frontal and parietal sites compared to infants at low-risk for ASD.  Second, infants at high-risk for ASD showed lower functional connectivity compared to low-risk infants, irrespective of ASD outcome. Third, coherence appears to be lowest in those high-risk infants who go on to develop ASD, compared to high-risk infants who do not.

04. Implications of ASD Infant Research for RDI

As a result of ASD infant research we have significant new evidence to bolster our belief that the impairments found to be most debilitating for individuals with ASD are the result of their loss of access to a Guiding Relationship and thus do not have to be considered as permanent.


What in the past was regarded as the ‘sine qua non’ of autism, universal social, self and information processing impairments distinguishing individuals from ASD from others, can now be viewed as the inevitable consequence of losing access, from an early age, to essential growth-promoting opportunities. 

Their impairments are not  things persons with ASD are born and must therefore learn to ‘live with.’ 

If this is indeed the case, as we know it to be, then by providing access to similar types of learning opportunities through a Mindful Guiding Relationship, we can provide a route for remediation and a pathway for achieving a quality of life for persons with ASD.

  • Intact ‘abstract’ social knowledge but impaired application in real-world settings

What we have learned from research is that persons with ASD may demonstrate some facility in multiple areas in laboratory settings. However, these same abilities may appear quite impaired in more naturalistic ‘real-world’ environments.

What some researchers are beginning to realize is that, when abilities of persons with ASD are measured in controlled, more static lab conditions, integrated, dynamic processing is not needed. In such relatively static environments, where rapid contextually-based adaptation is not required, some ASD persons may tend to do as well as their NT peers.

However, such controlled conditions tend to obscure the very impairments that characterize ASD.

Researchers are starting to recognize that ASD deficits can most clearly be seen when operating in more challenging ComplexUnpredictable and Stress-Producing environments:

  • When there is a requirement for integration, efficiency and agility.
  • When there is a need to match and mine prior experience to benefit your future
  • When there is a need to dynamically balance  past-present-future emphasis, self and others, now and later, multiple priorities and limited resources.

 Early Work: Raising the Question

In an early paper, Uta Frith (1989) posited that, for adults with milder forms of autism, compensatory learning may lead to the acquisition of ToM*, and since this acquired knowledge is a consciously held, theoretical knowledge, it lacks automaticity and its use in everyday life will be slow and not quite sufficient for normal social communication

Williams & Happe (2009) posited that individuals with ASD might be atypical in ‘solving’ theory of mind problems through the application of a kind of rule-bound, cognitively-acquired modality, rather than through an affective system/capacity.

Under these circumstances, it may be more or less difficult to apply one’s (partial) knowledge (of beliefs) to the case of self or others. Rule-governed knowledge might be more easily acquired and/or applied to the case of others’ mental states than to one’s own. After all, there would seem to be many more opportunities to observe the behaviour of others, and thereby learn ‘behaviour rules’ to predict their actions, than there are opportunities to observe one’s own behaviour and acquire such rules in relation to oneself. This is not to say that there are no modes of first-person experience available to individuals with ASD that could provide relevant information about their own behaviour. It is just that these forms of self-experience appear insufficient for acquiring a theory of (one’s own or another’s) mind.”

De Jaegher (2012), pointed to a possible connection between high reasoning capacities and good scores on Theory of Mind (ToM) tests in people with autism, because they can calculate ToM-like inferences and explanations of behavior. Despite this, such calculations seem to have a limited effect since teaching people with autism about the “rules” of social interaction and perception does not necessarily lead to greater social fluency.


Looking for Answers

Peterson and colleagues, (Peterson, et al., 2009) reported that parents reported everyday TofM problems in their child with ASD, even when the child succeeded on first-order ToM tasks.

Moran and colleagues (Moran et al., 2011) sought to understand the real-world – lab discrepancy in social findings. They wondered why high-functioning ASD individuals clearly demonstrated  real-life difficulties in social interaction. However, when administered ‘laboratory tests’ requiring  an understanding of another person’s beliefs and intentions many of the same individuals could not be distinguished from matched neurotypical peers. As a result of their research they concluded the following,

“ASD individuals develop atypical compensatory mechanisms for solving simple false belief tasks, which do not easily encompass the more subtle demands of judgment. On average, the ASD group weighed beliefs and intentions less than the typical control group—a difference that could lead to a difficulty for ASD individuals in their everyday interactions with other people.”

Senju  and colleagues (Senju et al., 2012) have distinguished what they refer to as ‘spontaneous’ theory of mind from the more deliberative form that is studied in most lab experiments. They point out that spontaneous TofM  is critical not only for infants, but also for adults. The following is a summary of their findings and conclusions:

“Unlike experiments, the real social world is fluid and rapidly changing. We have to process socially relevant information rapidly, spontaneously and on-line, in order to achieve day-to-day social interaction.   To achieve good social interaction with your partner, you have to detect all the relevant information (e.g. her facial expression, gaze and utterances), predict her behaviour (e.g. looking for the chocolate in the cupboard), and act quickly. All these cognitive operations need to be conducted spontaneously, as in daily social interaction it is highly unlikely that you will be offered explicit information about another person’s mental state. For example, you wouldn’t expect your partner to ask “Where do you think I will look for the chocolate?”. Thus the absence of spontaneous theory of mind would cause difficulty in social interaction and communication, even in adults with high verbal and cognitive skills.

Our study demonstrates that adults with Asperger syndrome do not spontaneously anticipate others’ actions in a nonverbal task, closely modelled on the standard false belief test which they pass with ease. In particular, the contrast with Neurotypical 2-year-olds who showed spontaneous looking to the correct location on the same task is quite notable. Our results are consistent with previous findings that high-functioning individuals with ASD, who show difficulties in social communication in real life despite performing fairly well in a well-controlled experimental or training context. They are also consistent with findings that training on false belief tests does not  improve social adaptation in ASD. 

The capacity for false belief attribution may not be sufficient to deal with its spontaneous use in a fluid and rapidly changing “real” social world. Unlike experiments, the real social world is fluid and rapidly changing. We have to process socially relevant information rapidly, spontaneously and on-line, in order to achieve day-to-day social interaction.”

In another recent study, Scheeren and colleagues, (Scheeren, de Rosnay, Koot, & Begeer, 2013) concluded that some ASD individuals seem to master the concept of theory of mind without mastering the ability to use such insight in the service of their ongoing social interactions. In their conclusion, they provide an important caution:

 “Despite their ultimate success on  ToM tasks, children and adolescents with ASD still experience profound difficulties understanding others’ thoughts and intentions in everyday life.  This apparent discrepancy may be due to the complexity of everyday social interactions compared with the simplistic social situations used in research studies.”

Finally, Hagenmuller and colleagues  (Hagenmuller et al. (2014) reported results indicating that individuals with ASD may use explicitly acquired intellectual strategies whereas individuals with typical development can rely on intuitive processes for social responsivity

 *TofM = Theory of Mind

Theory of mind classically refers to the ability to ascribe mental states to people and to explain and predict their behavior in terms of underlying mental states

02.   Social Motivation

Social Motivation Models of ASD posit that early-onset impairments in social attention set in motion developmental processes that ultimately deprive the child of adequate social learning experiences and that the resulting imbalance in attending to social and non-social stimuli further disrupts social skill and social cognition development. 

Chevallier and colleagues,  (Chevallier et al., 2012), in their review of the ‘Social Motivation theory of ASD’ concluded that  ASD could be seen as an extreme case of early-onset diminished social motivation

“Diminished social orienting, social reward and social maintaining, are all found in autism and can account for a range of behaviors, including cascading effects on the development of mature social cognitive skills. Social motivation models of ASD posit that early-onset impairments in social attention set in motion developmental processes that ultimately deprive the child of adequate social learning experiences and that the resulting imbalance in attending to social and non-social stimuli further disrupts social skill and social cognition development.”

Anthony and colleagues (Anthony et al. 2012) in their study of adults with ASD found that, contrary to their predictions, ASD adults did do not have fewer interests than do Neurotypical individuals. Rather, they found that the intensity of their interests were greater, and their interest areas were less likely to be socially oriented (e.g., interaction with others) and more likely to be object or sensory oriented.

Adamson, Decker & Bakeman (2010) studied the social interest of three groups of toddlers – those with ASD, Downs Syndrome & typically developing peers. They concluded that autism had a strong effect on how children negotiate the common social situation of greeting and casual interaction with a friendly adult.’

The average ratings for the autism group on the variables that measured interest in the play’s director and that compared interest in familiar objects and the director were almost a full standard deviation less than those for either the typically developing and Down syndrome groups. All of the typically developing toddlers observed displayed considerable interest in the play director when she entered the room for the intermission between scenes. Then, in half of the observations, they rapidly turned their attention elsewhere and in half they either sustained or strengthened interest in her.  In contrast, the children with autism paid significantly less heed to the adult, and in a sizable minority of observations, they did not display interest in her at any point throughout the interval, despite her attempts to greet.

03.   Understanding Others’ Feelings

 

As the following passage illustrates, Gaigg (2012) has presented a powerful argument that a central problem for individuals with ASD lies in productively employing emotional information,

 “For autistic individuals, the unpredictable nature of the social environment appears to remain to a large extent impenetrable. Encounters with other people are associated with a whole range of emotional experiences. One moment the adult smiles, the next he scolds and after that he may look puzzled, indifferent, or surprised. One moment a smile indicates the imminent arrival of food, the next the playful withdrawal of a preferred toy and the next it is a simple sign of affection that relates to nothing in the external environment at all.  And if this were not complex enough, the same face that produces smiles in a dozen different contexts is also the source of a multitude of other, mutually incompatible emotional signals that occasionally occur in the same context as the smile (e.g., a playful frown whilst withdrawing the preferred toy).”

In research with adults Mathersul and colleagues  (Mathersul et al. 2013), found that individuals with ASD demonstrated specific deficits in comprehending the beliefs, intentions, and meaning of non-literal expressions. They also had significantly lower cognitive and affective empathy.


Empathic Impairments in Young Children with ASD

 Charman and colleagues  (Charman et al. 1997) examined the empathic responding of very young children diagnosed with autism (20 months). All of the children in the comparison groups (including typically developing children and children with developmental delays) paid attention to the person in distress; however, less than half of the autism group looked to the distressed adult. Strikingly, none of the children in the autism group showed signs of facial concern (e.g., brow furrowing), in comparison to approximately half of the children in the other groups.

 Dissanayake and colleagues (Dissanayake et al. 1996) conducted a longitudinal investigation of the stability of young children with autism’s responses to an examiner’s distress between preschool age and a follow-up time point 5 years later. Children’s empathy ratings from preschool age predicted their later empathic responding to similar emotional displays 5 years later.

 In an important research study, Hutman and colleagues sought to determine whether response to another person’s distress differentiates infants subsequently diagnosed with autism from high- and low-risk infants who were not on the autism spectrum at 36 months of age. 

The authors describe how at ten months, typically developing infants consistently orient toward another person’s distress  and, at 12 months, they are more responsive to maternal displays of negative emotional expression than to pleasant or ambiguous displays of emotion. In contrast, they found that infants subsequently diagnosed with ASD paid less attention and showed less affective response to another person’s distress at every time point from 12 to 36 months and across time points. They concluded that,

“… the emotional value of the information appeared to be less salient for infants later diagnosed with autism and that the, “Inability to decipher emotional messages or indifference to them is likely to interfere with social learning, social interaction, and the formation of close relationships. ” 

McDonald & Messinger  (2012) found that toddlers who were later diagnosed with an ASD showed less expressed concern, and tended to show less bodily arousal, in response to their distressed parent than children who did not receive a diagnosis. Importantly, children with lower levels of global empathic responding at 24 and 30 months of age exhibited higher levels of autism symptomatology at 30 months of age. They concluded that, “Overall, an emerging literature provides evidence for the significance of empathy difficulties in emerging ASD.”

A Common Self & Self-Other Impairment?

 


Williams (2010) concluded that the best explanation of the self-awareness deficits seen amongst individuals with autism implicates impairment of a single theory of mind mechanism, which is responsible for detecting mental states in both self and others.

 Williams and Happe (2010) concluded that impairments in representing mental states in self are at least as profound as impairments in representing the mental states of other people.  individuals with ASD have as much difficulty recognizing their own mental states as they do recognizing others’ mental states. In addition to difficulties with representing false beliefs, individuals with ASD also show deficits in recognizing their own and others’ intentions.


Lai, Lombardo & Baron-Cohen (2013) concluded that the social deficits of individuals with ASD are not only about problems with processing  information about other people, but also about processing self-referential information. They hypothesized that individuals with ASD are unable to use the self as a ‘proxy’ to understand the social world .

“Historically, the domain of mentalizing has been largely centered on others, but self-referential cognition and its neural substrates are also atypical in autism. Therefore, deficits in the social domain are not only about diculties in the processing of information about other people, but also about processing of self-referential information, the relationship that self has in a social context, and the potential for using self as a proxy to understand the social world.”


Henderson & Mundy (2012) have pointed out how the results of recent neuroimaging studies provide converging evidence of an association between an under-elaborated self-system and social functioning in individuals with ASD. 

They describe how the failure to develop an elaborate self concept  likely impairs the ability to quickly and effortlessly use ASD children’s understanding of self to scaffold the understanding of others

In a recent study, Pfeiffer and colleagues (Pfeiffer et al. 2013) supported Henderson and Mundy’s hypothesis by documenting ‘hypo-activation’ of the Ventral-Medial Pre-Frontal Cortex, an area that has been assumed to play a central role in  self-other differentiation, during the process of making self-appraisals in children and adolescents with ASD.

Failure to Manage Multiple Perspectives: The Absence of Self-Dialogue in ASD

 

What is Self Dialogue?

Self-Dialogue is an internal ‘conversation’ that we conduct with ourselves. The basic doubling structure of self-dialogue (speaker–listener) enables the speaker to reflect on his or her motives and to understand self while exiting the temporal framework of here and now into the domain of timelessness. Self dialogue is sometimes referred to as ‘private speech’ and ‘self-talk’. However, as you will soon see, there are some important distinctions between the former and latter terms.

Fernyhough (2008) outlines the following as unique characteristics of mental dialogue:

  • Thinking involves a conversation with oneself – a mental dialogue.
  • Mental dialogues involve the simultaneous accommodation of multiple perspectives on reality.
  • Mental dialogues involve interplay between equally ‘correct’ versions of reality or possible future reality.
  • Our mental dialogue is activated whenever it is necessary to ‘view’ the same element of reality in different ways at the same time.
  • An  individual who has acquired the capacity to conduct internalized mental dialogues will  be  able to operate with a  range  of often contradictory perspectives, without necessarily  being  committed to any of them as beliefs. 

How does Self Dialogue typically develop?

Fernyhough (2008) has presented the most coherent model for the development of internal self dialogue.  In his model, self-dialogue has its origins in the hundreds of dialogues conducted with parental guides in which multiple perspectives are portrayed and validated. The process of simultaneously presenting and validating multiple perspectives, not the actual content of conversations,  is gradually internalized and becomes a self-process.

Fernyhough’s core premise, that our ability to consider multiple perspectives emerges out of early parent-child conversations has been supported by a good deal of research. A number of studies have reported that parent-child conversations that emphasize different perspectives, for example that contrast the child’s and other people’s mental states (e.g., “you know where the key is, but John doesn’t”) play a central role in teaching children to appreciate the subjective nature of mental-states  (Dunn et al. 1991; Bartsch & Wellman, 1995; Fivush, Haden & Reese, 2006; Slaughter et al., 2007). 


Fernyhough also presents a four-level model for self-dialogue development:

  • Level 1 (external dialogue): Overt dialogue  between children and parents displays the characteristic give-and-take  structure  of conversation.
  • Level 2 (private speech): Children begin to conduct these  dialogues in their own overt (and  then gradually  sub-vocalized)  speech-for-self. At this stage, the earlier contributions of parents as, for  example, in the transcript below, where  the child both generates the  question and answers it herself.
  • Level 3 (expanded inner dialogue): The  give-and-take  structure of external dialogue  is manifested internally  as a process of talking  silently  to oneself.
  • Level 4 (condensed  inner dialogue):  Inner  speech becomes a  dialogic interplay  between alternative perspectives which bears little  structural relation to the external dialogue  from which it  was derived.

Example of a three-year-old’s level 2 self dialogue

  • Child: (Looks at  model, places purple  piece  at correct location.)  “That  goes there, does it?”  (Sees other purple piece  already  placed incorrectly.)  Ah…  (Looks at  model.)  “That  shouldn’t go there, should  it? Who put that  there? Not  me.”  (Removes incorrectly  placed purple piece.)
  • Child:   (looking at model)  “Help… where’s the  orange  bit?”  (Points to model. Finds orange piece.)  “There!”  (Places orange piece  at correct location.)  “Goes… in  the  corner.”   (Points to a  gap where  a cargo piece  should go.)  “What  goes there, then, Mummy?” (Looks at  model.) “White!”  
  • Mother: “You tell me.” (simultaneously)

Fernyhough points out how at several places the child appears to be  asking  questions of herself and then answering  them. For  example, in making the utterance  ―That shouldn’t go there, should it?, the child adopts  an alternative, adult  perspective on the task and represents it for  herself in overt speech while a  response can be generated.


 Self Dialogue Development in ASD

Fernyhough (2008) makes a powerful argument for the power of his dialogic thinking model to explain the emerging findings that children and adults with ASD are deficient in their ability to use internal self-dialogues. 

In his model, the ability to carry on productive self-dialogue emerges from the gradual internalization of numerous experiences of participating in supported dialogues with caregivers. Without engaging in such dialogues he argues, it is not surprising that persons with ASD would not have developed the capacity for the type of flexible, multiple-perspective forms of thinking that are enacted through self-dialogue.

Shopen (2014), in a recent paper goes even further than Fernyhough by arguing  that rather than considering impaired private speech as one of many symptoms of persons with ASD. we should instead consider that it may provide a key to understanding the ‘essence of autism’ which he believes to be related to the difficulties of people with ASD to turn ‘consciousness towards the self’.


ASD Research Studies

Frawley (2008) in one of the first studies of self-dialogue in ASD, found that private speech was absent or dramatically reduced for the children in his sample with ASD. Additionally, he noted that when private speech did appear, the ASD children were unable to use it productively to guide their problem-solving efforts.

In a more recent study, Russell-Smith and colleagues (Russell-Smith et al., 2014), presented data that support Frawley’s earlier conclusions.

They found that children with ASD do not appear to utilize self-talk to aid in managing challenging tasks. Specifically, they found that being asked suppress self-talk while working on a challenging task, lowered typically-developing children’s performance, but not that of ASD children, while asking children to employ self talk helped the typically developing children but not the ASD children


Williams, Bowler & Jarrold (2012)  provided strong support for Fernyhough’s thesis. They found that in contrast to monologic inner speech which appeared intact, dialogic inner speech appeared to be missing in persons with ASD. 

The authors echoing Fernyhough’s earlier arguments, described dialogic inner speech as a kind of conversation between different aspects of self/perspectives held by self and is an ideal medium for accommodating multiple, alternative perspectives upon a topic of thought. They point out that

“It is this ability to hold in mind and move flexibly between different perspectives on a situation that arguably facilitates efficient problem solving in situations where one might otherwise become “stuck in set.”

Again, similar to Fernyhough, the authors argue that the absence of dialogic inner speech is due to the lack of opportunities by persons with ASD to participate in the types of regular parent-child conversational dialogues from which it emerges. They point out that, in contrast ‘monologic’ inner speech might not be as reliant on dialogic interaction. The authors conclude by stating the following:

“The message from Vygotskian theory is clear: individuals who are poor at conversing with others will be poor at conversing with self.”

Over-Reliance on ‘detail’ vs ‘global’ processing

There is a strong and growing body of evidence that persons with ASD are characterized by superior performance on tasks requiring detail-focused processing. Whether this superiority is achieved at the cost of normal global processing is less clear, and the weak coherence account has moved towards an emphasis on superiority in local processing rather than deficit in global processing. The deficit may also be related to difficulties shifting between detailed and global/gist processing when most optimal, rather than an overall inability to do either.

Happe and Frith (2006) in their most recent revision of their ‘central coherence’ model, hypothesized that weak central coherence is associated with:

  • Difficulty perceiving the gist or big picture
  • Tendency to over-rely on local, ‘bottom-up’ vs. global ‘top-down’ processing
  • Difficulty selecting optimal responses in relation to complex contexts (environments) or adapting responses when there are significant changes
  • Difficulty with generalization
  • Difficulty with ‘Experience Matching’ If people with ASD remember each exemplar rather than extracting prototypes, this would render recognition of situations that are ‘’alike’’ problematic: only if a situation shares the key detail(s) with a previous experience, will generalization of skills occur.

Research Support

Scherf and colleagues (Scherf et al., 2008) focused on evaluating developmental changes in the ability to group local elements in the service of perceiving the global shape of an object. They came to the following conclusions,

  “… in autism the full process of garnering shape information from perceptual grouping, which is essential for the ability to do fast and efficient object recognition and identification never matures, and this is especially evident in adolescence when this ability begins to improve in TD individuals. Adolescents with ASD fail to acquire mature global shape perception.”

Liu and colleagues (Liu et al. 2011) found neural evidence supporting a natural inclination for local vs. global processing. They concluded that

“Accumulating behavioral evidence has demonstrated that individuals with autism are less hindered by interference from task-irrelevant global information.” .

 Koldewyn and colleagues, (Koldewyn et al. 2013) hypothesized that persons with ASD may be able to conduct global processing but at a much higher ‘cognitive load’ cost. Their results indicated that children with ASD had no impairment in processing global information, only a “disinclination to report global information”  They concluded that,

 “Differences in local/global processing in autism reflect differences in default preference, not differences in ability. When given a choice, children with ASD were less likely to report global information than typical children were, but when explicitly instructed to report global information they performed similarly to typical children.”

In their conclusion, they  posited that this ‘disinclination’ may have serious consequences.

“Lacking a typically global processing style may cause significant problems when an individual with ASD interacts with others who automatically process and understand the ‘’gist’’, even if it does not cause problems when he/she is told what aspect of a scene to focus on.”

Lind, Williams, Bowler & Peel (2014), in reporting on their observation that individuals with ASD had significant impairment in ‘scene construction’, concluded that this difficulty is also consistent with the notion that perceptual processing among people with this disorder tends to be characterized by weak central coherence.

 “In the current study, spatial coherence scores were significantly lower among ASD than comparison participants, indicating greater fragmentation and less coherence of mental representations. That people with ASD have difficulty binding together elements of a scene in their mind might well be related to a corresponding difficulty with binding together elements of a scene in the environment”

Olu-Lafe, Liederman & Tager-Flusberg, (2014) studied the performance of ASD adolescents and adults  in a simple silhouette-to-shape matching task and a higher-order shape integration task. ASD participants were disproportionally slower than comparisons on shape-integration (twice as slow). This relative slowing correlated with symptom severity. Their findings supported the hypothesis that integrating local information is significantly more challenging for people with ASD. 

1.   What Experts Have to Say About the Guiding Relationship

Parents are the architects and managers of their children’s development, [providing] the
fundamental foundations that determine  whether or not children will be able to derive maximum benefit from their future experiences.” 
(Neitzel & Stright, 2003)

As the preceding passage illustrates, Drs. Neitzel & Stright are among a host of psychologists, educators and other experts who make a strong case that parents play the primary role in children’s mental, self and neural development.

Drs. Brownell & Kopp have referred to parent-child interaction as,  “… the fundamental context for development.” (Brownell & Kopp, 2007)

Drs. Young & Hauser-Cram have long supported the same position,  “Research has consistently pointed to the parent-child relationship as central both to children’s learning of self-regulation and future cognitive competence.” (Young & Hauser-Cram, 2008)

Noted expert, Dr. Barbara Rogoff has referred for many years to the general consensus in the scientific community, that children’s development of thinking and problem-solving is primarily the result of hundreds of transactions that involve,

 “…transformations in the nature of the sharing of meaning between parents and children.” (Rogoff, 1991)

In a similar vein, Dr. Peter Hobson has convincingly argued that higher level thinking can only be acquired by having mental processes, ‘pass through the minds of others’, 

Through others the child gains a vantage-point from which to relate to her own attitudes and actions. … she can begin to sort out what It is to have one perspective among many.” (Hobson, 2002)

A number of noted psychologists have discussed the critical role of what may seem like ‘routine’ parent-child conversations – reminiscing about prior events, providing perspectives on current events and preparing for future events – in developing children’s mental awareness & sense of self:

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Dr. Katherine Nelson has described how learning how to establish a past that can be travelled through [in one’s mind] depends on child and parent’s shared remembering experiences. 

“The result of this learning is the establishment of a store of memories [..] forming a personal history that has its own value independent of the general memory function of prediction and preparation.” (Nelson, 1988)

children come to understand their memories as representations, and themselves as having unique perspectives on their past.”(Fivush & Nelson, 2006)

Hoerl has discussed how, through joint reminiscence, children develop the motivation and means to save memories, not as a temporary store but as having meaning in and of themselves. 

“Talking about experienced events with parents who scaffold children’s narratives and provide coherence and organization, not only provides a means for organizing them for future recall but also for how to organize saved representations in relation to others by understanding how they ‘fit’ into the child’s historical life, including how they link with other events.” (Hoerl, 2007). 

More recently, Fivush described how joint reminiscing with parents not only creates an individual history; it also creates a shared history. 

“Through reminiscing with others about shared events, one creates an autobiography intertwined with others. We are bonded together in the present because of what we have shared in the past. Thus mother – child reminiscing is critical for creating and maintaining emotional bonds.” (Fivush, 2011) 

Typically developing children rely on the Guiding Relationship to provide them with a safe yet challenging learning environment for mental & self growth.   In the course of development, children, their parents and other  caregivers participate together in thousands of daily tasks, conversations, playful encounters and problems.  While on the surface these interactions may seem to be about one thing, such as mutual enjoyment, or getting a chore done, they actually have a much more important function..

Scores of studies have pointed to the Guiding Relationship as the primary pathway for mental and self development.   The following is a partial list of mental  tools whose development has been strongly associated with the Guiding Relationship:

  •  Self-reflective and mental Inferencing abilities needed to accurately understand our own and others intentions, motivations and feelings.
  • Metacognitive skills, such as the ability to find  and exploit ‘matches’ between our prior and current experience are an essential component of effectively managing difficult decisions, perplexing problems and tough tasks.
      
  • Sophisticated ‘executive’ abilities such as self-monitoring are needed to manage our internal world including our attention, emotions, motivation and thoughts.
  •  Self-directed language is an essential tool in many applications .  This includes  self-regulating speech  and productive mental dialogues – internal self-debates –  where we  mentally compare multiple perspectives , consider the meaning  of  differing experiences and  decide how to allocate our limited mental resources.
      
  • A variety of mental tools provide the means employ  to ‘widen’ our perspectives, including mental simulation and hypothetical, speculative, and divergent thinking .
      
  • The means for effective experiential learning include the knowledge, habits motivations and skills needed to  effectively select, save and organize representative samples of our  past experience. It also entails learning how to make judgments based on multiple experiences, to construct, evaluate and adapt our expectations and explanations.
      
  • Reflective  experience tools  play an invaluable role in allow us to re-experience and ‘replay’ prior experiences, as well as trying out possible alternate versions.
     
  • Prospective  experience tools such as previewing, pre-experiencing and mentally rehearsing,  allow us to project ourselves into multiple possible future experiences and are essential for planning and preparing.

Along with the above mental tools, researchers have pointed to the central role played by the  Guiding Relationship in developing critical mental resources – the knowledge, motivation mindsets and habits that are essential for ongoing growth and real-world application.

 Along with mental development, the Guiding Relationship has been found to play an essential role in promoting the growth of  the Apprentice’s experience of ‘self’. This includes developing self-reflective consciousness, a sense of ‘self-agency’, learning to acquire self-knowledge and developing a facility for experiencing oneself in a ‘temporally extended manner – “capturing, storing and re-experiencing” critical episodes and  “pre-experiencing” possible future ‘selves’.  

Finally, the Guiding Relationship has been shown to provide a unique setting where guides can gradually ‘simulate’ real-world conditions, adding additional ‘application complexity’ based on the student’s progress, to prepare children to successfully engage with the complex, unpredictable, stress-producing situations they will face, as they come to fully participate in their culture. 

The resources that follow in this section represents just a small portion of the hundreds of papers and research findings published over the past 40 years,  demonstrating the central role of the Guiding Relationship in children’s mental and self development.

 Theoretical Perspectives

Reddy (2010) points out that knowing one’s own, as well as another person’s, mind can only take place through engagement with other minds. Mentalizing emerges through the infants ongoing relationships. We come to know of other minds only through interacting with them and by observing their responses to us and through our responses to them.

Tronick (2004) has described how mental awareness emerges out of successful mutual regulation between the partners. According to Tronick, parents imbue infants with a sense that their actions are motivated by mental states and therefore meaningful; that they are agents and owners of their body and actions; that mental states, positive and negative, can be shared with others; and that other people can and want to communicate with them on a mentalistic level.

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 Research Reports

Emotional Understanding

Dunn and colleagues found that children who participated in family conversations about different emotions and their causes at age 3 were better at explaining the feelings and actions of a character 3 years later than children whose families did not engage in these conversations as frequently (Dunn et al., 1991).

Shipman & Zeman found that parents who engaged their children in conversations about their feelings when in situations that evoked particular emotions, tended to have children with higher levels of emotion understanding ( Shipman & Zeman, 1999).

Several studies have found that mothers’ references to causal links between mental states and behavior during conversations (e.g., “Sally is happy because she is going to the park today”; “Sallie is going to the park because she thinks it is open today”) are a particularly strong predictor of children’s emotional and mental-state understanding (Denham et al. 1994; Dunn et al.1991; Garner et al. 1997; Peterson and Slaughter 2003; Slaughter et al. 2007).

Strong associations have been found between the overall frequency of conversations about emotions and desires and children’s later emotional understanding (Raikes and Thompson 2006; Taumoepeau and Ruffman 2006).

Denham et al. (2010) found  significant results when analyzing expressive balance (positive minus negative expressiveness scores) and fathers’ and mothers’ contributions separately. Mothers’ expressive balance negatively predicted children’s emotion knowledge, whereas fathers’ balance positively predicted children’s emotion knowledge. The researchers suggest that this difference may be due to the fact that fathers and mothers usually assume different roles in the socialization of emotions. Fathers are “loving playmates”, safeguarding an emotional basis for children, whereas mothers act as “emotional gatekeepers”, and expose children to a wide range of emotions that enrich their emotional knowledge.

In their extensive review of joint reminiscence, Fivush & Nelson, (2006) refer to a number of studies that have confirmed that parents who talk more about emotion during reminiscing with their preschool children have children who include more emotion in these co-constructed narratives. For example, longitudinal research has demonstrated that mothers who talk more about emotion during shared reminiscing early in the preschool years have children who include more emotion in their personal narratives later in the preschool years In addition, mothers’ use of narrative evaluation that includes emotional reactions and feelings during early mother–child reminiscing (e.g. ‘wasn’t that fun?’ and ‘that was neat!’) predicts children’s later use of evaluation in their own independent personal narratives.

Mental-State Understanding

A number of studies have reported that parent-child conversations that emphasize different perspectives, for example that contrast the child’s and other people’s mental states (e.g., “you know where the key is, but John doesn’t”) play a central role in teaching children to appreciate the subjective nature of mental-states  (Dunn et al. 1991; Bartsch & Wellman, 1995; Fivush, Haden & Reese, 2006; Slaughter et al. 2007).

Bartsch & Wellman (1995) reported that parental discourse and language about mental states was related to young children’s abilities to understand mental states 

Lundy (2013) found that parent mental state references during conversations with their children were positively correlated with children’s Theory of Mind performance (Lundy, 2013).

Ruffman, Slade, & Crowe (2002) found that mothers’ mental state utterances consistently correlated with young children’s understanding of theory of mind.

Several studies have found that Mothers’ references to mental states (e.g., thinking, knowing) when describing pictures to their 3- to 5-year-old children predicted their understanding of false beliefs (Adrian et al. 2005; Racine et al. 2007; Ruffman et al., 2002, 2006).

A number of studies have found that mothers’ references to causal links between mental states and behavior during conversations (e.g., “Sally is happy because she is going to the park today”; “Sallie is going to the park because she thinks it is open today”) are a particularly strong predictor of children’s emotional and mental-state understanding (Denham et al. 1994; Dunn et al.1991; Garner et al. 1997; Peterson and Slaughter 2003; Slaughter et al. 2007).

Joint Engagement 

Nelson, Adamson & Bakeman (2008) reported on a longitudinal study that demonstrated how the quality of early parent-toddler parent-child joint engagements played a critical role in the child’s development of a theory of mind when they reached pre-school age. Specifically they found that variations in the amount and form of toddlers’ joint engagement with their mothers influenced the emergence of false belief understanding, In addition, they found that different aspects of joint experiences seemed particularly influential at different points along the developmental pathway.

For example, by the middle of the third year, attention to symbolic communication rather than explicit attention to the partner seemed particularly beneficial to theory of mind development. Since the relationship between the amount of symbol-infused joint engagement and false belief understanding was moderately strong and statistically significant, after differences in receptive language were controlled, it is unlikely that this association merely reflects the effect of language skill on theory of mind tasks. Instead, it draws attention to how conversations between toddlers and caregivers about shared objects may lead to an understanding not only about events but also about another person’s experience of them.

They conclude that, “… by observing their partner’s actions on and reactions to shared objects during periods of coordinated joint engagement and discussing shared objects during symbol-infused joint engagement, young children have the opportunity to obtain, “[…[ vital information about other people’s mental states.” 

Ruffman and colleagues (Ruffman et al., 2006) studied 2 measures of child theory of mind (task performance and mental state talk), and 4 measures of conflict/cooperation. Children were tested once when they were around 3 years and then again around 4 years. At each time point, children were given a task in which mothers helped the child and a friend draw items with a drawing toy.

The authors found that early mother mental state talk was uniquely related to both later theory of mind measures and 2 of 4 later conflict/cooperation measures. Mother parenting style (warmth) was uniquely related only to 1 later child conflict/cooperation measure. The authors concluded that it seems to be only what mothers say (their mental state talk) that relates to child theory of mind, and both what they say and what they do (their warmth) that relates to child conflict/cooperation.

References to mental states during joint storybook reading. Adrian, Clemente & Villanueva
Adrian, Clemente & Villanueva (2007) studied the impact of parent’s reference to mental states during joint reading with their children (ages 3-7). The authors point out that during joint reading, mothers refer to the characters’ mental states during reading, but they also refer to their own mental states, for instance, when interpreting and extending the characters’ actions and behaviors. This could be especially true in picture-based stories, since the complex mental states of characters may not be so easy to depict. Additionally, mothers routinely ask about the children’s mental states, for instance, when they try to check children’s comprehension. The authors found two factors that appeared related to parent effectiveness:

  1. Parents attempt to build a shared state of knowledge or shared meaning: This includes references to both the children’s and parents own mental states, in addition to those of others. It was achieved (primarily) by asking questions and other functions (mainly reflections from the reading) and by using (primarily) all categories of cognitive verbs except ‘‘think’’ terms.  Thus, parents tried to monitor (e.g., by asking questions) and to expand (e.g., by reflections on the reading) their children’s current state of knowledge and comprehension while reading the book. But since their own mental states are included in such a process, the mothers appeared to monitor and expand the children’s understanding by means of a continuing exchange between the children’s points of views and their own.
  2. Parent reference to the mental states of story characters: This involves story reading that deals with what happens to the characters and involves mothers’ references to the characters’ mental states by means of (primarily) explanations of the characters’ thoughts and actions from reading and using (primarily) ‘‘think’’ terms. A strong correlation was found between mothers’ references to the mental states of others (the characters of the story)  during storybook reading with their 3-7 year-old children, and the child’s later understanding of mental states.

3.   The Guiding Relationship’s role in pro-social functioning & Empathy: Research Findings

Ayoub, Bartlett & Swartz (2014) in a recent study,  found that parents who talk about feelings and conflicts tend to have children who develop a better understanding of emotion. Those who encourage appropriate expression of negative emotions have children who tend to be more sympathetic and socially competent.

Brophy-Herb and colleagues (Brophy-Herb et al. 2011) studied the relationship between mothers emotion-socialization practices and their toddlers empathy and emotional competence. Mothers demonstration of encouragement, forgiveness & emotion coaching was highly related to toddlers’ emotional competence and empathy.

“Maternal contingent responsiveness provides not only a model for desirable social behaviors, but also opportunities for toddlers to learn and practice new skills during parent-child interactions. These experiences may contribute to toddler’s growing sense of mastery and competence in more enriched play experiences.”

In another recent study, Brownell and colleagues (Brownell et al., 2014) studied 18, 24 and 30 month old children who were sharing a picture book with parents, to learn more about parents role in young children’s development of empathy. The authors point out that during the second year of life,

 “The dawning awareness of the subjectivity of emotions, desires, and intentions during the second year of life transforms early social behavior, permitting the emergence of ability to respond to another’s plight.”

The authors found that the bulk of parents’ emotion-related talk was devoted to labeling and commenting on emotions, as would be expected at these young ages when emotion understanding is undergoing such pronounced development and emotion words are still being acquired. Nevertheless, it was parents’ efforts to engage the children themselves in labeling and explaining the characters’ emotions that were associated with sharing and helping. Children who helped and shared more quickly and more often, especially in tasks that required more complex emotion understanding, had parents who more often asked them to label and explain the emotions depicted in the books. Moreover, it was parents’ elicitation of children’s talk about emotions rather than parents’ own production of emotion labels and explanations that explained children’s prosocial behavior, even after controlling for age.  Thus, it is the quality, not the quantity, of parents’ talk about emotions with their toddlers that matters for early prosocial behavior.

Clark & Ladd (2000) found that parent-child conversational connectedness was correlated with five-year-old children’s socio-emotional orientation, number of mutual friendships, and peer acceptance.

Similarly, Flanagan (2001) found that the frequency of mother-son discussions about their peer relationships was significantly related to ratings of peer acceptance.

Drummond and colleagues (Drummond et al. 2008) found that conversations about emotions and mental states were most effective in developing early prosocial actions when parents asked children themselves to think about and explain others’ emotions. 

In a latter study, Drummond and co-workers (Drummond et al., 2014) examined how parents’ emotion and mental state talk with their toddlers (aged 18-30 months) predicted to toddlers’ helping actions and how these associations varied during two everyday contexts –  joint book ready and joint play with toys –  that are natural settings for mental state and emotion-related discussion. The authors point to the critical nature of conversations beginning in late infancy, where children learn to use these conversations to gradually construct a more complete understanding of emotions and mental states.  In their research they found that children who tended to help others in distress more quickly had parents who,  labeled emotion and mental states more often during joint play. The authors point out that, parent- child interaction provides many opportunities for discussing emotions and mental states beginning very early in life. The structure and tone of these interactions vary widely, but each conversation offers the child a context in which to explore and begin to understand the complexities of subjective states.

“Developmentally sensitive discourse about emotions and mental states provides children a framework within which to objectify and reflect on abstract subjective concepts, as well as recognize their role in motivating behavior. Beginning in late infancy, children use these conversations to gradually construct a more complete understanding of emotions and mental states. “

Dunn, Bretherton & Munn (1997) found that parents’ use of guiding and socializing language when discussing emotions with their 18 and 24-month old children (e.g., “You really made me sad that time. I wish you wouldn’t scream like that” or “Big kids don’t cry so much”) was related to children’s later social functioning including levels of children’ s positive reactions to peers’ emotions and teacher-rated social competence, as well as children’s internalizing emotion (e.g., sadness, fear, tension) in the classroom & conciliatory behavior with siblings. On the other hand the frequency of discussion of emotion and parental attempts to explain or clarify the causes or consequences of feeling states generally were not related to children’s social functioning. The authors point out that the critical distinction may be whether parents use emotion language simply to clarify and teach children about emotions or to try to modify children’s inappropriate behavior. If parents are trying to remediate children’ s socio-emotional deficits, there will be a negative association between parental use of socializing emotion language and children’s socio-emotional functioning

Eisenberg Cumberland & Spinrad (1998) found that parental conversations about emotion were linked not only to children’s use of emotion language, but also to their awareness and understanding of emotion. The authors concluded that emotion-related discussion in the family may not only communicate support, but also sharpen the child’s awareness of emotional states and promote the development of an emotion-related conceptual system.

“Whether children come to view their emotions as threatening, something to be controlled, or in contrast something to enjoy and that can enhance relationships, or as a deterrent to rational thinking emerges from the way their families and the surrounding culture deal with emotion, and children’s fit on this dimension within their family and culture.”

Farrant and colleagues (Farrant, Devine, Maybery & Fletcher, 2012) investigated whether more em­pathic mothers are more likely to encourage their child to take the perspective of others and whether this would be associated with increased child empathy and prosocial behaviour. They found that mothers who more regularly take the cognitive perspective of others are more likely to encourage their children to do the same, and this facilitates children’s abilities to take the cognitive perspective of others

Recchia and colleagues (Recchia et al., 2014) found that mother–child conversations about children’s helpful behavior uniquely serve to support children’s understanding of their own agency in help situations. By highlighting children’s own and others’ internal experience (motivations, cognitions, and emotions), parents help children to further their understandings of themselves and others as psychological beings with unique perspectives on events. 

The authors reported a strong relationship between mother–child conversations about children’s helpful behavior uniquely served to support children’s understanding of their own agency in help situations. Mothers’ contributions to conversations about help focused on aspects of experiences that serve to facilitate, encourage, and reinforce children’s sense of themselves as prosocial moral agents capable of deriving satisfaction and personal fulfillment from their own responsiveness to the needs of others. In addition to discussing the positive consequences of help for others, conversations focused frequently on positive emotional/psychological consequences for self (e.g., feelings of pride).  Mothers also frequently emphasized evaluations and insights that underscored the child’s positive moral characteristics (e.g., I’m so proud of you; you’re such a compassionate person). Conversations about harm appeared to provide opportunities for children to further their understandings of both their own and others’ moral agency, albeit in different ways than those evident in discussions of help

Taumoepeau & Ruffman (2008) found that actively engaging a child in conversation about emotions appears to provide especially fertile opportunities for the child to attend to mental states. Parental discourse with young children about others’ emotions is a formative influence in the development of prosocial behavior even for toddlers who are only beginning to understand and talk about emotions.

Taylor and colleagues (Taylor et al., 2013) studied a variable they term “Expressive Encouragement’ which reflects the degree to which parents encourage children to express negative affect or the degree to which they validate children’s negative emotional states (e.g., “If my child fell down and scraped himself while trying to get a favorite toy, I would tell my child it’s okay to cry”), found that children who were encouraged to express their emotions when distressed at 18 months were more likely to demonstrate empathy at 6 years. The authors conclude that, “Parents encouragement of their child’s emotional expression may provide these children with  opportunities to learn and understand their own emotions, which in turn allows them to better understand and empathize with others’ emotions.”

The Guiding Relationship and Dynamic Neural Development


”…[the brain] does not develop through the simple addition of new structures but primarily in terms of changes in the complexity of organization, with increasing integration among components. … the emergence of new, more elaborated and differentiated pathways characterizes much of postnatal brain development.
Dr. Alan Sroufe

This much we now know: The brain learns best when it is trying to “make sense;” when it is building on what it already knows; when it is working in complex, situated circumstances; when it accepts the significance of what it is doing; when it is exercising in highly challenging but low-threat environments.“  
– 21st Century Learning Initiative

When we employ Dynamic Intelligence, we are asking our brain to call upon many different neural processing centers that must come ‘online’ rapidly and then proceed to operate in a collaborative, integrated and highly flexible manner, managed by our pre-frontal cortex. One hallmark of a brain that provides for Dynamic Intelligence is the ability to form relationships between different processing centers that can be called upon as needed. This allows us to take multiple perspectives for any single problem, setting or encounter and to forge new pathways when prior solutions no longer suffice.

Dynamic Intelligence requires a neural system that is highly responsive to processing change and variation. It is a system that must be able to continually seek out opportunities for enhancement, innovation and growth.

The human brain possesses relatively little capacity for such flexible neural collaboration at birth. Dynamic neural development does not occur in an automatic fashion. It will not happen on its own. It will only come about if the child is spending most of his waking hours actively engaging in a challenging manner with people and things in his world. Our brain is experience dependent

We believe, along with the vast majority of developmental theorists and researchers, that our brain is programmed from birth to move towards greater complexity, integration and flexibility. However, scientists have learned that the brain will only become more dynamic if provided with the right learning opportunities.

We can increase the brain’s productive networking capacity, and similarly our mental functioning, but only if children are provided with the proper learning experiences. It is the quality, not the quantity, of experience that determines how the brain will develop. Our primary responsibility is not to ‘fill up,’ but rather to shape, the actual development of the brain..

 Our brains are ‘lazy.’ That is, the brain will find a way to do any job in a manner that creates the least amount of fatigue. It is mentally and physically tiring for brains to grow in a dynamic fashion. Dynamic neural development will not occur if existing neural complexity is sufficient to ‘get by.’ The brain will not develop in a more dynamic, integrated manner unless it is ‘stretched’ by problems that pose challenges to existing dynamic information processing. This requires thousands of hours of productive ‘struggling’ with challenging decisions and problems, new feelings and uncertain, unfamiliar situations.

Children must encounter thousands of carefully-constructed mental challenges, so that the existing neural networking is not quite sufficient to solve the problem or fully understand the new information, but not so challenging that they present an insurmountable obstacle leading to helplessness or discouragement.

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