ABSTRACT
What capacities do full-term healthy neonates bring that enables the emergence of their adaptive development along the three major pathways to 1) Human relatedness and intimacy, 2) a healthy functioning body and mind–body connection, and 3) mastery of the environment? By adaptive development I mean becoming a feeling, sensing doer doing, initiating and responding, activating and taking in, modeling and innovating in a context of receptive caregivers. What capacities of a neonate evidencing autism are absent or at such variance that adaptive development does not go forward?
The ability to seek and respond affectively to a variety of stimuli
1a Responding to affectively pleasing interactions with caregivers and others to establish a category of wanting and seeking warm relationships that in time (along with smiling and sensual enjoyment) becomes encoded as a loving intimacy. In autistic infants like Anna this response pattern is not activated at birth. With Owen it was only to disappear just before his third birthday.
1b Responding to affectively unpleasant, noxious, painful interactions through the establishment of a category of aversiveness and antagonism, rage and hatred or avoidance, fear, and disdain. The response pattern leading to intimacy becomes rigidly and painfully aversive leading to a psychic wall of avoidance.
1c Responding to stimuli too high in intensity or too great a breach of expectation with confusion and withdrawal. Responding to repetitions of stimuli too low in activating interest with apathy and failure to thrive. In autism, the response pattern of facial contact is experienced as too high in intensity and too confusing about what emotional interaction is called for. In contrast, interaction with inanimate objects – Lego, machinery, maps – and other symbolic systems – math, music – may be richly activating. 135
From their experience in the intrauterine environment neonates bring a differentiated recognition of their mother’s voice, a pattern of sucking to self-soothe, and body movements to move away from noxious stimulation. For infants with autism the activation is split: self-soothing (Anna’s rhythmical rocking) and aversive withdrawal are activated, the seeking response to mother’s voice is not.
Responsiveness to a human face, preferentially to the eyes and mouth areas. Aversive and avoided.
Having a 10–12-inch visual focal point that concentrates gaze, attention, and interest on the sphere of mother infant feeding, holding, and social interchange and then gradually expands with a comparable expansion of interest to the broader environment. In autism the gaze is differentially directed away from the caregiver’s face and toward objects in the environment.
Responding to smell with a heightened sensitivity to mother’s smell that along with vision, auditory, and kinesthetic interactions contributes to a strong discriminating recognition of the primary caregiver. Not activated.
Responding positively to the human voice with a heightened reactivity to higher pitch and especially to prosody and musicality. In Dr. T’s working with Anna, the responsiveness to higher pitch and musicality went on to become an important feature but not integrated with facial communication. Gus was strongly turned on to music from an early age.
Having exquisite sensitivity to temporal features in the environment – beat, duration, and rhythm. Present outside of human interaction.
Via the rooting reflex, to seeking and responding to a nipple with sucking to reduce hunger sensation and experience fullness and relief. Sucking to reduce hunger will be activated, but in infants with autism it may or may not (as with Anna) be to the mother’s nipple. When it is, the experience will not be toward the usual full relationship. Feeding often will not take the form of close cuddling but will be more mechanical. Gus needed close proximity to his mother’s body to sleep.
Readily initiating a high percentage of interactions with a caregiver. These frequent initiatives (Winnicott’s spontaneous gestures) give the caregiver an opportunity to recognize, affirm, and validate the infant’s budding agency, his/her affects, intention, and goals. For the infant, this experience coheres into a sense of self as a doer doing with others. Rather than with a caregiver, most interactions are activated with an inanimate object. 136
When distressed and disrupted, responding to comforting with the restoration of a calm state and a return of the ability to activate interest. Children with autism are generally difficult, even resistant to comforting, preferring to be left alone to reduce tension through body movements like rocking, twitching, hopping, and an intent repetitive focus on manipulating objects.
Imitating and mimicking observed movements and gestures. No affect sharing, initiating and modeling of human interactional patterns, but movements organized to manipulate objects.
Active readiness to recognize, respond to and be affected by the emotions of caregivers. Least activated. Infants with autism have a serious inability to integrate the emotions they experience with the emotional experience of those around them.
Actively scanning for and responding with interest to changes in the environment – such as light, touch, and movement. Often activated, sometimes strongly in particular areas like weather changes and escalators with Gus and vehicles and piano keys with Anna.
Responding to repetitions of events – such as caregiver’s face approaching and receding by developing a sense of familiarity that then becomes categorized and remembered with an affective tonality. Not activated.
Recognizing the contrast between a novel stimulus and recurrent familiar experience and establishing a new category. Activated in the non-human environment.
Responding to a stimulus presented in one or more sensory modes both in that mode and in alternate (cross) modes as well – visual, auditory, taste, smell, touch, gesture, motor action. Blocked off in human interaction. Present otherwise.
Having a largely unrestricted pathway from body sensations of all types to psychic affective arousal that gradually becomes more regulated so that body sensations become less dominant factors in ordinary consciousness. In children with autism, regulation of physiological requirements may be more or less difficult but is able to be activated. Sensory hypersensitivities are common. 137
Recognizing contingencies guided by innate biases and affectively charged values especially the contingencies that involve helpful or hindering responses to the neonate’s intentions and goals. Helpfulness in dealing with desires activated in mastery of the non-human environment may be recognized and appreciated, less so with need involving attachment.
A capacity to rapidly build expectations from any repeated category of experience. Children with autism rapidly build negative expectations about human interchange and positive expectations about solitary play with objects.
