Autism is a puzzling and distressing state which affects a
considerable number of children world-wide. Autistic children
display a range of deficiencies and often present bizarre
patterns of behaviour. There is no consensus about the causes or
treatment of autism. There may be a genetic element and autism
may be a manifestation of errors in the programming of neural
development pre- and post-natally. One of the central and most
discussed aspects of autism is deficiencies in speech
development; absence or distortion of the use of words and of
syntax make communication difficult for autistic children.
Coupled with their notable lack of social empathy, this
intensifies the isolation from which the children suffer. No
clearly successful treatment for their language or other
difficulties has as yet emerged. Given this, it seems desirable
to examine whether the different ideas about the origin and
functioning of language offered by the motor theory may be
relevant in understanding the nature of autism or suggesting ways
in which these unfortunate children might be helped, in tackling
their language deficiencies or more widely.
The motivation for this paper came from seeing what a significant
part language deficiency and language peculiarities play in the
development of autistic children, particularly as illustrated by
that very careful and perceptive book The Siege (Clara Claiborne
Park 1967). This led to a closer examination of the specific
features of the autistic language deficiency: the difficulty in
acquiring words, the peculiar misuse of pronouns, defects in
pronunciation, formality of syntax, as described by many authors
in a surprisingly uniform way. Other deficiencies in autistic
children, in movement, gesture, pointing, go along with the
deficiencies in language. Autism in children is a distressing and
strange experience both for the child and for the parent. It
seems as though there is something which has gone wrong - and
that what is wrong is not necessarily irretrievable. There is a
question how far all the deficiencies may be the result of a
single developmental fault. A tremendous amount of work is
currently done to help autistic children and their parents. Many
different forms of treatment and many different theories of what
is wrong in autistic children have been tried - none has proved
remarkably successful. Because of the major part played by
language-deficiency in autism, and because defects in language
have such a crippling effect on the life of the autistic child,
it seems right to see whether the different approach to the
origin and nature of language proposed in the motor theory might
have some relevance for the origin or possible treatment of
autism. Are there any practical conclusions both for the nature
of the autistic syndrome and for the treatment of autistic
children ?
What is autism?
The short answer is : no one really knows but there have been
many excellent accounts of manifestations of autism in children
by experts such as Lorna Wing, Frances Tustin, Uta Frith,
Patricia Howlin and many others. The following
account draws directly upon their descriptions of autism and upon
the summary of the features of autism by the National Autistic
Society.
Autism is a disorder affecting cognition and language
development. They have problems in understanding and using any
form of communication, non-verbal as well as verbal. Some
autistic children do not develop any useful language at all or
else use only stereotyped words or phrases that have little or no
meaning. There are also cognitive difficulties. Although they can
remember experiences, autistic children seem unable to imbue them
with significance beyond the immediate, literal meaning, or to
classify such events so that they fit into a gradually
developing, coherent mental picture of the world. There is a
strange combination of marked abnormality and yet relatively
intact abilities together with normal physiognomy and an
apparently intelligent expression. The highly unusual patterning
of skills and deficits has given rise to the notion that,
somehow, if only the right key could be found, the solution to
all the child's handicaps could be discovered but no such key has
been found.
The autistic child has no sense of 'me' and 'not-me' except
in fleeting moments of awareness. Such a child lives mostly in
terms of the outlines of shapes. Touch seems to be the
predominant mode of experience and seeing, hearing and even
smelling are felt to be tactile experiences. People are treated
as things which are extensions of the child's own bodily
'things'. The handicap is in its nature more similar to blindness
or deafness than to, say, shyness. Autistic children have an
obsessive desire for sameness.
Bizarre behaviours appear in a child who looks perfectly
normal, physically attractive, unusually serious. The many
strange aspects of behaviour include abnormal bodily movements,
such as grimacing, arm flapping, jumping and springing back and
forth, one foot to another. There are abnormalities of visual
inspection and eye contact. They use peripheral rather than
central visual fields (responding to movement and outline rather
than to details), looking past rather than at people and things;
looking at people and things with brief rapid glances rather than
a steady gaze. They may show a lack of dizziness after spinning
round. There will be problems of motor imitation: difficulty in
copying skilled movements (the child learns best if his limbs are
moved through the necessary motions). Autistic children are
unable to use gesture, miming, facial expression, vocal
intonation, bodily posture etc. to convey information; the only
gesture may be grabbing someone's hand and pulling them towards a
desired object) using the adult or an adult's hands as a tool.
Expressive gesture of the kind that accompanies speech is
lacking. With this lack of gesturing by the children goes poor
comprehension of the information conveyed by gesture, miming,
facial expression, bodily posture, vocal intonation, etc. They
may become insistent that other people take part in their
routines. For example, they may try to insist that everyone in a
group of adults sit with their feet pointing in a particular
direction.
Perhaps more difficult to explain are the unusual responses
to sensory stimuli. Oversensitivity to certain sounds,
fascination with bright lights or objects that spin, and
indifference to pain, heat or cold may all occur in young
autistic children. The way these children cover their ears to
shut out or modify sound is often remarked upon. Often there are
paradoxical responses to sensations (e.g. covering eyes in
response to a sound, or ears in response to a visual stimulus).
Play is ritualistic and lacking in imagination, most noticeably
in those autistic children with the most severe language
impairments.
Autistic children are incapable of understanding emotion in
others. All autistic children suffer a severe lack of empathy -
the ability to put themselves in the place of another person.
They are indifferent to others' distress. They seem to lack the
normal child's awareness of other human beings.
Who are the autistic children?
It has been calculated that there are approaching 5000
autistic children in England and Wales, slightly more than the
number of blind and partially sighted children and slightly less
than the number of deaf children. The sex ratio, male to female,
increases with increased ability. At the lowest levels, the ratio
is 2 : 1. At the highest ability levels the ratio rises
remarkably to 15 : 1. About three fifths of autistic individuals
remain severely handicapped, with only about one in six likely to
make a sufficiently good social adjustment to live independently.
These 'shell-type children' are as alike as peas in a pod both in
their appearance, the kind of parents they have and their early
developmental history (Tustin, 1980: 28), remarkably similar even
if they come from different countries and communities. Often they
belong to families of superior socio-economic status
Besides descriptions of autistic children by psychologists
and other professionals, there have been some accounts of the
autistic experience by parents and by the sufferers themselves.
One at age 31 recorded his recollection of autistic childhood as
continual confusion and terror; everything was unpredictable and
strange. A very recent account by someone who eventually was
diagnosed as autistic, and later, remarkably, took a degree in
psychology while still remaining autistic, shows close agreement
with the general picture of autistic children's behaviour and
experience. A few extracts:
When people didn't touch me I never experienced this as
neglect. I experienced it as respect and understanding. Love and
kindness, affection and sympathy were my greatest fears.
Staring into space ... spinning ... A means of losing
awareness of self...Hurting oneself ... To test as to whether one
is actually real.
Head banging To fight tension and provide a thudding rhythm
in my head when my mind was screaming too loud ...Staring past
things ... Looking at things directly often robbed them of all
their impact and meaning.
I heard speech as only patterns of sound ... As an echolalic
child, I did not understand the use of words.
any one or combination of the senses can become extremely
sharp. For me this made some high-pitched sounds intolerable,
bright light became either intolerable or mesmerising, and touch
was always intolerable.
From the earliest age I can remember I found my only
dependable security in losing all awareness of the things usually
considered real. I rejected all contact because this robbed me of
the security I found in my ability to lose myself through colour,
sound, pattern and rhythm. I learned eventually to lose myself in
anything I desired- the patterns on the wallpaper or the carpet,
the sound of something over and over again, the repetitive hollow
sound I'd get from tapping my chin. Even people became no
problem. Their words became a mumbling jumble, their voices a
pattern of sounds.
For language to have any meaning one must be able to relate
to it. For me, when the directness of relating is too great, the
walls go up. ... the comprehension of the meaning of words drops
away leaving the listener lost as to both concepts and
significance. At worst, the stress of direct emotionally loaded
communication blocks the brain's ability to retrieve all or any
of the words for speaking a fluent sentence, or won't allow the
articulation process to get into action, leaving the words
echoing within the speaker's head. (Williams, 1992: 186-188)
The most systematic and comprehensive account by a parent of
the progress (or lack of progress) of an autistic child is Clara
Claiborne Park's book The Siege about her autistic daughter,
Elly, from which the following extracts are taken::
She could look right through a person. She usually did. It
was impossible by gesture to get her to look at an thing at a
distance. ... her imperviousness to visual stimuli of all sorts.
A car would draw up within three feet of where she was playing.
She would not look at it. A dog ran past. She seemed to register
nothing. She was over three before she looked up and saw a bird.
But there were things she did not ignore:- colours, abstract
shapes. The abstract meaningless, shapes seemed to have an
intrinsic importance for her. That Elly wanted nothing was worst
of all ... the child in the glass ball ... her overwhelming
unwillingness to affect the environment. "Elly's signal lack of
interest in future experience.For her out of sight is out of
mind". (Park, 1972: 257)
Language peculiarities
More has been written on the language of autistic children
than on any other of their psychological disabilities.
Abnormalities of language are frequently reported by parents as
being the first problem to give concern. The babbling sounds made
by autistic infants are rarely as extensive in range as those
made by normal babies. The speech cadences that usually develop
by the age of 9 to 12 months do not appear. The National Autistic
Society comment that it is virtually impossible to over-emphasise
the importance of language to the developing child. A pictorial
mind is completely inadequate and until one has a label for an
object, one sees but does not remember it, so that in effect it
does not really exist. Similarly Luria, in his study of
language-retarded twins (1971 [1956]), said that the word has a
basic function not only because it indicates a corresponding
object in the external world, but also because it abstracts,
isolates, the necessary signal, generalises perceived signals and
relates them to certain categories."the acquisition of speech
allowed man to rise above direct visual perception to analysis of
its data, to the relation of perceived objects to certain
categories, so enabling him to organise his behaviour, not
according to the visually perceived situation, but according to a
deeper 'categorised' reflection of the world".(Luria, 1971: 23)
In autistic children there may be a complete absence of
speech or, in those children who do speak, immediate echolalia [a
parrot-like repetition of words the child has just heard spoken -
'Say hello Bob' - 'Say hello Bob'] or delayed echolalia,
repetition of words or phrases heard in the past (often in the
accent of the original speaker). There may be repetitive
stereotyped, inflexible and often idiosyncratic use of words and
phrases, immaturity of grammatical structure of spontaneous (not
echoed) speech, problems in sequencing and in understanding
meaning, a muddling of the sequence of letters and words -'What
that say word' -, confusion of words of similar sound or related
meaning; use of 'you' or 'he' instead of 'I'; problems with
prepositions and other words that change their meaning with the
context. When the child does start to talk he sounds as though he
is deaf, the voice is often monotonous and flat and as if speech
is unnatural. Repetitive and stereotyped utterances take the
place of novel and creative ones; abnormal and eccentric use of
language almost as if the autistic person was speaking a foreign
language. They seem to have to acquire language intellectually as
one would have to learn Russian or Chinese. Conversation with an
autistic child may be a matter of ritualistic questions and
answers, with the child insisting on the mother asking a specific
set of questions; if the mother varies, even in the minutest
detail, the way in which she asks the question, the child may
respond with a severe and prolonged tantrum. Autistic children
display apparent difficulties in producing certain sounds. They
are excessively literal; for example: "Steven was very upset by
the use of metaphors and similes. 'It is raining cats and dogs'
resulted in his sitting by the window all day screaming 'Where's
the cats, where's the dogs? it's raining water'".(Howlin and
Rutter, 1987: 64)
Autistic children find differing degrees of difficulty in
learning words belonging to different grammatical categories.
Nouns are easiest to teach, easily demonstrated. Concrete verbs
can be taught fairly easily too, most of them can be acted.The
same can be done with words such as 'under', 'over', 'behind',
'in front', 'top', 'bottom', 'long', 'short', etc... The
difficulty is with abstract words, and function words such as
'to', 'for', 'or', 'unless', 'until', 'while', 'as', etc. Even a
child who has learnt to speak fairly well may ask what 'and' or
'the' means. 'Who', 'what', 'why', 'where', 'when', 'how',
'which', are difficult to teach. Most autistic children learn the
word 'No' long before 'Yes'. An autistic child who is not
echolalic will still have trouble with pronouns. This often leads
to reversals: 'you' instead of 'I'. In spite, or perhaps because
of, their language handicap these children are very interested in
words... They may be quite ingenious in inventing an appropriate
name for a thing if they cannot remember the real one, such as
'doggie-bunny' for kangaroo.
All these peculiarities of language in autistic children were
illustrated in "The Siege".The following paragraphs brings
together points relating to language:
At under two-years old, at any given time Elly has a one-word
vocabulary. Aged two she spoke her name clearly but it was two
years at least until she spoke her name again. She did not use
words to communicate. She had no idea of language as a tool that
could cause things to happen. Elly learned 'milk' and 'pin' at
two and lost them by two and a half. She asked the first question
[with a rising intonation] at four and a half. She never
pronounced a final consonant and often the initial consonants
were ambiguous or wrong. Anything she could see she could
remember and identify - from aardvark to zebra. 'Friend' and
'stranger' are beyond her today (at years old). What she could
not understand were relational terms. She acquired the word 'man'
a year before she learned the name of any specific man. She had
difficulties with personal pronouns; she was six before she used
any pronouns at all. In any statement, 'you' is the equivalent of
'I' or 'me'. Elly thinks her name is 'you ... 'I like that' means
... that her interlocutor does, "I have come to wonder how it is
that ordinary two-year-olds can grasp anything so subtle [as] the
correct use of the first- and second-person pronouns. Such nearly
undefinable words as 'have' 'put' 'take' and 'get' are only now
coming into use and their boundaries overlap in distorted
ways:'Daddy give temperature hundred'. She had never spoken the
word 'is' until she was seven. She forms no plurals and inflects
no verbs because she will not pronounce a final 's' or 'd'. As
late as six and a half Elly comprehended no prepositions and of
course used none. Adverbs, articles and conjunctions: but, if,
whether, maybe, because, soon, when. yet, like, except. The words
seem unimportant until you try to imagine doing without them, and
simple until you try to find ways to teach them. Teach them? No
one teaches such words - the small child seems to draw them out
of the air. But Elly did not even pick up 'and'... Who can draw
'if' or 'when'? Who can draw 'but' itself ?" The almost total
absence of articles, conjunctions, prepositions, verb-inflections
for tense or person, and the verb 'to be'. "She may say 'table on
a hat'. It was not until she was seven that we taught her to
answer 'yes'. The powerful word 'Why? Elly cannot comprehend; we
cannot ask her 'What do you want?' or 'What's the matter?(Park,
1972: 205 ff.)
Non-verbal communication of the autistic
child
The understanding of non-verbal cues used by other people,
such as gestures and facial expression, is severely affected.
There is poor comprehension of the information conveyed by
gesture, miming, facial expression, bodily posture, vocal
intonation, etc. The strangeness and poverty of gestures in
autistic children is noticeable, with absence of expressive
gestures of the kind that usually accompany speech. Even very
simple gestures, such as pointing, may be lacking. "Elly did not
point. Nor did she try to get objects which were not within her
reach; Elly is eight years old now. I have still never seen her
point". (Park, 1972:12)
The following account is drawn almost wholly from Rita Jordan
(1985). The use of signing with autistic children has been
growing consistently since the early 70's. In 1983 half of the
fourteen schools in Britain for autistic children were using some
form of sign system. The hope is that the 'easier' sign language
will provide a structure from which English can develop as a
second language. The reasons why signing is 'easier' are probably
multiple. The neurophysiological findings suggest that there may
be differential disturbance of left-hemisphere brain functions in
autistic children and there is some evidence that signing may be
processed in the right hemisphere of the brain. Sign language is
also more iconic than speech; autistic children learn iconic
signs faster and retain them more readily than non-iconic ones.
Signs are promptable - they can be physically guided. It is
easier to make individual signs distinct than to separate
individual words from the stream of speech. In the light of the
'failure' of speech programmes, signing may be presented as a new
activity - free from association with that experience of failure.
All the studies report an increase in social awareness and a
decrease in tantrums following the development of a system of
communication. It is hoped that the child will learn to code his
or her experiences and thus build up cognitive structures which
are the basis for much later learning.
The most interesting aspect of the use of signing has been
that often along with increasing ability to use signs has gone
improvement in vocalisation and the ability to use words. So in
the case of Gary, a three year old boy, who made a few sounds but
who could copy simple gestures fairly readily, imitation of
gestures was systematically encouraged until he could use such
signs spontaneously to indicate his wishes. At the same time he
began to vocalise more when using these signs although the
vocalisations were generally rather indistinct.
Work by Creedon with 30 autistic children in America(see
Jordan, 1985: 1) was very influential in that it offered hope
that through signing a proportion of them at least would acquire
speech. Along with overall progress in signing, some children
developed spontaneous speech which gradually was produced more
and more clearly. There has been the repeated observation that
spontaneous vocalisations are often produced in conjunction with
signs. While learning to sign many children produce closer and
closer approaches to the spoken word. According to Luria (quoted
by Fay and Schuler, 1980: 160),body movements, particularly hand
movements, facilitate speech production otherwise hampered by
various types of brain damage . Such a facilitation effect may be
related to the neural overlap that supposedly exists between oral
and manual activities (Kimura and Archibald 1974). Activities of
one neural region might trigger related action in adjoining
areas. But such a triggering effect has not been limited to
signs. The spontaneous emergence of vocalisations that accompany
hand movements was also noted by Carrier(1976) and Bonvillian and Nelson(1976). One might
speculate that motor action might allow the formation of a
representational framework for other action and thus reinforce
the acquisition of meaning.(Tustin) The boy's progress [being
taught signs] suggests that autism is a disorder of cross-modal
perception rather than of symbolic functioning. (Fulwiler and
Fouts 1976)
Reading by autistic children
This relation between speech and a non-articulatory system of
communication is paralleled by an equally interesting relation
between reading and the acquisition of language. What is
surprising is that a sizable proportion of autistic children
learn to read very effectively just as well [often] as
non-autistic children of the same mental age. Some of these
children learn to read early sometimes before they can talk; on
hearing a new one word they may ask for it to be written or
spelled and in this way it is unlikely to be forgotten again.
Park similarly observed "I cannot explain the strange reversal of
the natural order of events in which a child learns speech
through the written word. The configuration of letters itself
seems to crystallise the word, makes it possible to hear its
pronunciation, and renders its spelling an inseparable part of
its identity. The look of a word could be used to help correct
the indistinctness of her [Elly's] pronunciation. She could learn
the look of a new word overnight; the job was not to retain the
word itself, but its meaning".(Park 1972: 213 ff., 237)
Trevarthen(1990: 350) in his studies of child development has
noted that the same progress also appears when deaf,
hearing-impaired or hearing children are given early instruction
in reading, an apparently more artificial form of communication,
that, nevertheless, can start as a natural language at the middle
of the second year; that is, as soon as a child can be expected
to speak, or sign, single words, that same child, or one who is
partially or profoundly deaf, can learn to read single words.
The motor theory summarised
Language is the capacity of one individual to alter, through
structured sound emission, the mental organisation of another
individual. Language is more than speech just as perception is
more than the structure and functioning of the eye. In both cases
we have also to be concerned with the neural organisation
underlying the functions of speech and visual perception. The
theory is that language was constructed on the basis of a
previously existing complex system, the neural motor system. The
programs and procedures which evolved for the construction and
execution of simple and sequential motor movements formed the
basis of the programs and procedures going to form language.
A principal theme is the mosaic evolution of language, the
fitting together of a whole array of elements, anatomical, neural
and behavioural. Many elements necessary for mosaic evolution of
the language capacity can be found in the anatomical and
behavioural repertoires of birds and other animals. If these
animals have behavioural elements involved in the evolution of
human language capacity, they must also have the neural
structures required to produce the behaviours, and in particular
the neural motor programs required. A mechanism for the
development or acquisition of the elements, in evolutionary
terms, must have existed. In humans, the evolution of language
would have had a major survival value, particularly for the group
which acquired language.
Two important behavioural elements for language are imitation
and the categorical perception of speech sound - both abilities
found in some animals. Imitation, of speech or other sound or
bodily movement, involves a remarkable and complex linking of
perception and motor organisation. The capacity to discriminate
categorically between human speech sounds, has surprisingly also
been found in a variety of animals - and in extremely young human
infants. These and other behavioural prerequisites for language
depend on the intimate involvement of the motor control system
and the existence of cross-modal processes. Development of the
language capacity has resulted from the progressive establishment
of new cross-modal or trans-functional neural linkages, cerebral
reorganisation in the sense that the interconnectedness of
different brain regions concerned with what are usually
considered distinct functions has substantially increased. This
extensive relation between language and the motor system is what
one might reasonably expect, given the central role of the motor
system in all behaviour and the essentially motor character of
speech production. The next step is systematic examination of the
relation between each aspect of language and corresponding
features of motor activity and the motor system. However, given
the close relation between the use and content of language on the
one hand and perception on the other, the examination naturally
extends also to the relation between the motor system and
perception in all its forms. The motor system forms the
indispensable mediator between language and perception.
The essential additional hypothesis is that the motor system,
prior to the development of language, was built up from a limited
number of primitive elements - units of motor action - which
could be formed into more extended motor programs. If this is so,
then one can look for a direct correspondence between the
primitive motor elements and the fundamental elements of spoken
language, the phonemic system. The processes of word- formation
and syntactic rules for constructing word-sequences would then be
derived from the neural rules governing the union of motor
elements into simple and more complex actions. If language is in
this way derived from the motor system, there is no reason to
believe that any aspect of language - sound-elements, words or
syntactic structure -is necessarily arbitrary. There is strong
experimental evidence that the phonemic system is not arbitrary,
and suggestive evidence that word-forms are not arbitrary but are
expressive or appropriate to their meaning. There is also
considerable evidence for a fundamental relation between the
syntax of language and physiological syntax, the syntaxes of
action and perception.
Recent research bears on the proposition that motor activity
depends on a set of primitive motor elements. It supports the
concept of motor programs and motor subprograms as real and not
merely formal or theoretical bases for the organisation of
action. Common general principles have evolved in neural control
of movement in a wide range of animals. The experimental results
suggest that the elementary motor programs may well be innate,
part of standard human (and even vertebrate) neural structure.
The elementary programs may form part of fixed action programs or
be formed by a central motor program into novel action-sequences.
In humans, research into motor programming bears directly on the
relation between arm and head movements and speech.
The relation between motor programming and speech programming
can be examined at the phonemic, lexical and syntactic levels.
For phonemes, this leads to the idea of an invariant program for
each phoneme, or 'auditory targeting', a motor-alphabet
underlying speech, related to the elementary motor-patterns
underlying other forms of action. Research on categorical speech
perception has a direct bearing on this. A range of animals and
very young infants have displayed the ability to categorise
speech-sounds, natural or synthesised, in ways which match the
category boundaries in adult speech; very young infants have been
shown to discriminate categorically speech-sounds not found in
their mother language.
On the motor theory, the categorisation of speech-sounds is
derived from organisation prior to language, and specifically
from the categorisation of motor programs used in constructing
and executing all forms of bodily action. What the rhesus monkey,
or the chinchilla, share with the young human infant is very
similar skeletal and muscular organisation. The specificity of
the phoneme is the accidental result of the application of the
different elementary motor subprograms to the muscles which went
to the form the articulatory system.
The link between the motor system and the formation of words
follows. The hierarchical structure of the motor system is built
on the basis of a limited set of motor elements. These are
combined in an unlimited number of ways (motor-words). Words in
speech are a read-out of neural structures in the same way as
actions or facial expressions. A word, as a neural structure, can
be formed from the co-activation of the motor subprograms for
phonemes which are then melded or shingled together to form a
distinct neural program for the whole word. Experimental
approaches with the creation of artificial words have suggested
that there can be a lawful relation between speech-sounds and
auditory or visual percepts. Research into sound-symbolism
suggests that there is an isomorphism at the motor level between
speech and the contents of perception. The object seen produces a
motor-pattern which is readily transferable as a motor-program to
the articulatory system and so becomes the associated word for
the thing. The neuromuscular sequences which are the immediate
motor programs underlying words are derived from the integration
of the neural structures underlying perception in all its forms
(visual, auditory, tactile etc.) and motor organisation. It is of
interest that in a recent book Hockett has commented on the
relation between motor organisation and speech perception.
"Although listeners obviously cannot have kinaesthetic feedback
from someone else's articulation, they interpret what they hear
by implicit motor- matching; actual movements of the organs of
speech become unnecessary; the appropriate pattern of impulses
within the central nervous system is enough".(Hockett 1987 39)
If, as the motor theory proposes, phonemes and word-forms are
derived from the motor system, then there must also be a close
relation between the structuring of motor activity, motor syntax,
and the organisation of language, speech syntax. One looks for
evidence of this particularly in word-order.
Motor theory: features possibly relevant
for autism
If autism is primarily a disorder of communication, or at the
very least deficiencies in communication are one of the most
grievous effects of autism, a number of aspects of the motor
theory may be relevant.
Neural organisation The role of language is to produce changes
in the mind (changes in the brain) of the hearer which
structurally resemble those in the mind (brain) of the speaker.
This would apply to other systems of communication, gesture, sign
languages, facial expression, and to instances where
communication is mediated in space or time e.g. written language.
The content of all utterances, messages of any kind, ultimately
will be represented by changes in synaptic strengths,
establishment of new excitatory or inhibitory connections,
dendritic growth.
Crossmodal processes Any utterance, any message however
delivered, looks for a response, which may be immediate action,
or delayed action.For the action to take place. there must be the
necessary crossmodal links between different brain functions.
Equally there must be the crossmodal links for the production of
any utterance, gestural message etc.
Motor system centrality All behaviour in evolutionary terms is
a matter of motor primacy, and all types of communication in
relation to the autistic child should be examined from this
perspective.
Primitive motor elements (programs) Because of the limitations
of the human (and other) brains - there cannot be preformed
neural programs to provide for every possible sentence or every
possible action - and the demands of an unpredictable
environment, communication systems have to be open-ended, relying
on a limited set of primitive elements which can be combined to
meet the needs of any situation. How far do autistic children
possess. or have effective use of, such a system of primitive
elements?
Categorical perception Production and perception of spoken
language and other forms of communication must have evolved
together. In the normal case,there must be provision for
extracting primitive elements or combinations of the elements
reliably from the incoming utterance or message.
Non-arbitrariness Insofar as the motor elements are the
product of evolution of neural organisation, language rests
ultimately on a non- arbitrary basis; the same is probably true
for other forms of communication, gestures, facial expression
etc..
Hierarchical pattern of system Motor control is a hierarchical
process, with relevant parameters being fed in at the appropriate
level. This is a necessary organisational economy.The primitive
elements must be capable of being melded together to form
higher-level structures, to provide a "lexicon" to match the
multiplicity of objects or actions.
Derivation of second-level patterns from the structure of
perception The particular structure of words is derived from the
structure of the perception or action to which the words refer.
This link between language and perception may be of particular
importance in considering the communication problems of autistic
children.
Extended sequences The syntax of spoken language is based on
motor syntax. Motor syntax may also be a source for the
organisation of extended sequences in other forms of
communication. In the autistic child is normal motor syntax
deficient, or is the relation between speech syntax and motor
syntax lacking?
Causes and treatment
So far the underlying condition of autism has been
untreatable though many meliorative forms of treatment have been
tried, with limited success. There is no consensus about the
fundamental causes of autism. It is more clear what autism is not
rather than what it is. Autism is not just a variety of mental
retardation or a form of childhood schizophrenia. There are three
principal theories, competing but not necessarily mutually
incompatible. The first is that autism is the product of faulty
emotional attachment between the parent and the infant. Treatment
flowing from this approach concentrates on breaking down
parent/child emotional barriers. This approach is not accepted by
most of those working professionally with autistic children
insofar as it implies that parents are to blame for their
children's autism. The second theory is that there is an
important genetic component - this indeed seems likely but does
not go far to explain the character of autism or to indicate how
it should be treated. The third theory is that there are faults
in pre-natal and post-natal neural development, in the maturation
of the brain. Neural connections which make possible the transfer
of experience from one sensory modality to another are not made
or are not functional. In the absence of the normal translation
of sensations into percepts and concepts, the autistic child is
unable to organise appropriate response to the outside world. It
has been suggested that the faulty brain development may be due
to excessive neurone proliferation; in post-mortem examination of
autistic patients, increased neurone density has been found. This
could reflect abnormality in the process of selective cell death,
by which the appropriate pattern of connections is established.
Some practical treatment is based on this; it takes the form of
controlled patterning of the movements of autistic children in
the hope that this will establish the neural connections that
should have resulted from normal development.
The plausibility of this developmental view of autism depends
on the extent to which it is coherent with current theory of
normal pre-natal and post- natal cerebral development. Some of
the most valuable work on this has been by Trevarthen(1990), from
whom the following account is largely derived. In normal
development the child acquires before birth an array of
communication capabilities, for imitation, motor control,
response to facial expression, systematic links between vision
and action. These capabilities are essential for maturation of
the infant's brain through interaction with the parent; the
infant's communication abilities are matched to those of the
parent. Applied to autism, this account would bring together the
concept of autism as a developmental neural failure and autism as
related to emotional communication between parent and child; the
parent is not the cause of the child's autism but is the agent
responsible for normal development. The autistic child, for
genetic or other reasons, lacks the neural connections which
would enable it to take part in co-ordinated communication with
the parent.
The failure of development in autism can be contrasted with
what is known or hypothesised about normal pre-natal and
post-natal cerebral development. A brain that is already very
elaborate soon after birth, reaches full maturity with
exceptional slowness. After a maximum rate of growth from the
mid-fetal stage, the human brain continues a rapid size increase
for one and one-half years after birth. Between birth and one
year, it more than doubles in weight, by three it reaches 80 per
cent of the adult brain size Other processes proceed almost as if
birth had never happened: proliferation of synapses, branching of
dendrites, changes in the density of dendritic spines, changes in
connectivity.
Trevarthen (1984: 253 ff.) says that the neural basis for
empathic response would underlie imitation in both directions.
Although infants do learn by imitation, the structural
foundations for the imitative movements cannot be learned. It is
necessary to assume an innate structure that at least partly
matches the structure of the adult models to explain both
imitation and more complex reciprocal or complementary
interactions which are characteristic of communication between
child and adult from immediately after birth. This theory would
explain transmission of culture in terms of a specific and highly
active epigenetic program for brain growth that needs brain-
brain interaction, a companionship formed by emotions,in the
context of an intimate relationship between infant and mother:
immature brains and mature brains entering into a long program of
emotion-guided communication. Before a baby gains postural
stability, it has refined awareness of other persons and their
emotions. By the end of the first month, a full-term infant can
join in a 'proto-conversation' looking at the mother intently.
The evidence indicates that infants are born with a considerable
part of the neural structures that will coordinate the functional
patterns of muscle activity in adults,
How does this kind of approach relate to, have points of
contact with what the motor theory proposes? For language, the
theory suggests, there must be the development of neural
connections linking perception, motor control and language. Only
if this happens will the child find it easy, natural, to acquire
the phonemes of whatever happens to be the mother-language. Only
if these neural connections are made will there be an easy and
natural relation between the structures of words and the visual
(or other) percepts or actions to which the words relate. Only if
the necessary neural connections between neural motor sequencing
and language sequencing will the infant be able easily and
naturally to acquire grammatical features,, the concept of
word-order, the use of function-words, etc. The emphasis laid by
the motor theory on the cross-modal aspects of language, on
language in use as a continual neural restructuring, on the vital
importance of the primitive motor-elements, seems to have very
direct relevance.
Practical suggestions flowing from the
motor theory
But where does this lead in practical terms? This depends on
some hypotheses about what may have gone wrong, what may be
missing in the autistic infant's patterns of neural connectivity.
At the worst there might be lack of the primitive motor programs
- if that were the case then the child would be spastic, and
autistic children are not spastic. Typically, they can move, see
and hear. Or the link between articulation and perception and the
primitive motor programs may not have been made. The
peculiarities of vision, the tendency to use others' hands rather
than their own, the curious lack of dizziness in spinning round,
do suggest that there may be something wrong in the relation
between the motor aspects of vision and central perception. Or
there may be a lack, a distortion, of the relation between the
primitive motor programs and the patterning of articulation. This
would explain both the defects in the production of speech sounds
and the absence or difficulty in the perception of speech sounds.
Or there may be deficiency in the neural links between motor
sequencing and speech sequencing, which would explain confusion
in word- order as well as confusion in the ordering of phonemes
in a word.
What might be done by way of treatment, or training, in the
light of this? That motor methods may be practically useful has
been shown by the relative (though still limited) success of
treatment developed by Doman and Delcato.(Doman 1974) This
involves physically moulding the pattern of movement of the
children so that they perform the same motions in the same stages
as those which normal children go through in, for example,
learning to walk. How the theory of the motor basis of language
might be translated into practical forms of treatment is
speculative but some possibilities seem to be:
1. Emphasis on improving the autistic child's motor abilities.
A number of forms of treatment (besides the Doman-Delcato
approach) already do this. Some autistic children, as they get
older, in fact demonstrate skilled motor control in piano
playing, drawing etc.
2. Emphasis on the strengthening in every way possible of
cross-modal links: gesture and speech-training should be linked
together. The characteristic attention of autistic children to
abstract shapes should be exploited - maybe the curious ability
with which they can use written letters and learn to read is a
manifestation of this. They should be encouraged as early as
possible to associate the shapes of letters with speech-sounds,
the shapes of words with pictures of the things to which the
words relate; associate appropriate hand and arm movements with
reading a word describing the movement.
3. The link between basic motor programs and the patterning of
articulation is of critical importance. There should be a
systematic linking of bodily movement and the production and
perception of speech sounds. They should be taught to correlate a
pattern of arm movements with an ordered set of speech sounds.
4. For improving retention of words and their meanings, use
iconic gestures and associate the sound of the word with the
gesture. It does not matter much whether the gesture is part of
an established sign language (ASL or BSL) but the more iconic,
even pantomimic, the better. Do not rely only on imitation of the
gesture by the child; form the movement for the child, following
the Doman approach. Accompany a word describing action with the
action to which it refers e.g. jump with 'Jump' - hit with 'Hit'.
5. Try to develop a direct relation between action-syntax and
speech- syntax. The child should be encouraged ( or the child's
movement directly patterned) to match specific actions with
specific word-orders: "I give the cup to Mary " etc.
6. Pronouns are directly derived from deictic gestures. The
pronouns should be associated with these gestures. It is very
important that the child should be encouraged to point, to
himself or to others or to things. Associate pointing (forming
the child's arm position) with the pronouns: YOU with pointing to
someone else and ME with the hand pointing to the child's chest.
Conclusion
The main idea of the motor theory is that the structures of
language, (phonological, lexical and syntactic) derive from and
are modelled on neural patterning for motor control. Motor
programs for the control of bodily action, by a growth in neural
connectivity, became extended to the control of articulation so
producing the restricted and specific range of speech sounds
found in all human languages; the structures of words were
derived from the motor patterning involved in the perception of
objects in the external world and from the motor patterning of
the actions to which words refer, and syntactic organisation of
language reflects 'syntactic' processes in the planning and
execution of bodily action. The aspect of the motor theory of
language origin and function which may be particularly relevant
for autism is this: perception and motor control in the normal
individual are, and must be, intimately linked (so that we can,
for example, see an object and stretch out our hand to pick it
up). If language is derived from and closely associated with the
patterning of motor control, then perception, motor control and
language must in neural terms be locked together. For language to
develop normally, the neural connections with the motor system
must develop at the appropriate time. If they do not, then even
if the relation between perception and motor control is normal,
the link between the object perceived (scanned by eye-movements)
or the action executed or perceived and the word structurally
related to the object or action cannot be established. Without
the necessary and natural link between word and object or word
and action, all the potentialities of higher-level mental
functioning, the manipulation of concepts, rational thought,
imagination, planning, would be crippled. Meaningful gesture, a
motor activity intimately related to speech and seen by many as
an integral aspect of speech production, would be defective or
absent.
The autistic child lacks language, or has only severely
defective language; at the same time the autistic child is
abnormal emotionally, both in the lack of empathy with others and
in its heightened sensitivity: as Donna Williams describes it, a
hyper-emotional response to everything from the outside world. In
autistic behaviour, what are causes and what are effects? Does
the abnormal emotional response cause the failure to acquire or
use language normally, or does the lack of normal language create
the hyper- sensitivity, the abnormal emotionality? The autistic
child appears to lack the step in cerebral reorganisation (neural
connectivity) which made language possible; this is a critical
loss. Language, vision and motor control all go together;
language is the supreme medium of empathy and language almost
certainly plays the major role in making possible consciousness,
self-awareness; language allows one to construct a model of one's
world, to create rational expectancies, particularly about the
behaviour of others. For someone with no reliable pattern of
expectation about the 'world', every moment of life becomes like
wandering through a Chamber of Horrors, unknown and unexpected
horrors. Is that soft and furry thing a rat - or a bedroom
slipper? Is that unfamiliar noise an attacker - or someone
coughing? Is that cold breeze a ghost - or a window left open? Is
that bright light an explosion or a fire - or a fluorescent tube
lighting up? It can be unpleasant when we hear too sharply,
birds, the wind, a creaking door etc. Emotions are normally
softened by familiarity and expectation. Without these, emotions
may go into over-drive, are stirred all the time, too strongly.
Not emotionally-crippled but not sufficiently emotionally
de-sensitised.
Attention, that is, directed expectancies, not only make what
is attended to more salient - it also makes everything not
attended to less salient. What is expected does not surprise. The
unexpected surprises: e.g. something empty that is expected to be
full, something full that is expected to be empty (we judge, or
misjudge, the likely weight of everything we handle). The sharp
sound that comes upon us with no prior context alarms. So: if we
have no, or a faulty, updated model of our 'world', our
environment, (even of ourselves ?), everything may become sudden,
unexpected, alarming. All the senses may become over-sharp, over-
acute. Every noise, every bright light, every touch, becomes an
acute (perhaps unbearable) experience.
Perception is perception of change in the environment. To
perceive change, the perceiver must have retained the pattern of
the normal,the stable, the usual, the expected. The source of any
change may be the inanimate environment (wind, rain, cloud), the
animate environment (conspecific or other specific), the
individual human environment, or the social environment. Language
is both itself perceived change in the human environment and the
means for controlling, categorising change. To make possible the
perception of change, there must be appropriate neural
organisation, a neural record of the expected environment. The
perceptual capacity of the perceiver derives from the model it
retains of its environment and of itself as acting within that
environment. Our brains must be structured in terms of the usual
or expected environment and perception is the result of
interaction, or matching between the expected environment and the
current environment by which change is detected. There must then
be restructuring in response to the perceived change, possibly
not as a separate process - the awareness of the perception may
in fact be the restructuring. Perception would then be a direct
reflection, an internal representation of reality, internal
ordering guided by external ordering. Language would be the
instrument for controlling rather than being controlled by
perceived change. The autistic child's hyper- emotionality,
hyper-sensitivity, would be the result of the lack of language,
of all means of social communication. If this is right, then any
approach, any treatment, that reduces, even if it does not cure,
the deficiencies of language, should carry with it the prospect
of general gains in behaviour, in sociability, in emotional
control.
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