Monday, 23 April 2012

More on reflex integration in autism

As a result of my two last blogposts, there has been some interesting discussion about how impaired reflex integration may contribute to the child with autism not being able to give the parent the feedback that is necessary for the parent to know where to pitch the tiny interpersonal engagement-related challenges that are so key to development of thinking in the very early stages of baby-hood.

It is the breakdown in this crucial feedback loop that prevents the guided participation relationship from acting (via interpersonal relatedness) as the 'cradle of thought'.

I’m including here some further observations by Kimberly and Claire on how reflex integration may contribute to the breakdown in the guided participation relationship.

First, over to Kimberly:

Our discussion has made me think differently about remediation. It makes sense to me to start with the reflexes first, make sure that they are firmly in place and work up the brain stem just how it happens in normal development. In normal infant development it is movement that integrates the reflexes.

Take a look at just one movement - the belly crawl. Just some of the things it can do for the infant: stimulates horizontal eye tracking, early head movement helps the skull to round out, stimulates the nerves that go to the muscles that pull the eyes into correct alignment (in the case of crossed eyes or over convergence), helps with heel to coccyx alignment, strengthens the arches in the feet, promotes cervical and lumbar spine stability, and neck strength, so helps the development of the mature s curve from the infant c curve, makes the child aware of the genital area through ventral stimulation, and helps with on time toilet training, stabilises the hip sockets, helps with the supination and pronation of the lower arm, helps the hands to open out from the grasp reflex to eventual cortical control, creates a feeling of vertical throughness which helps the child to feel grounded, is the first self determined movement, seems to be connected with brain stem development, and functions that ensure survival: accurate perception of pain, heat, cold and hunger, builds a sense of self, and is the basis for development of empathy and compassion. You can deduce the implications of missing out on building these foundations (source Bette Lamont Developmental Movement Center, Seattle).

I'm trying to put together a website with all this information and my thoughts on remediation after doing everything wrong & backwards, but here are a few of my favourites. There's a chart on Goodchild's (Neurological Reorganization) website gives you a basic idea of the brain stages and how it affects sensory and motor development:
http://www.activehealing.org/HTML/howitworks_ontogeny.htm.

I love Sally Goddard's book (INPP) "Reflexes, Learning and Behavior" for a more thorough explaination. A quick overview can be found at Sonia Story's (Rythmic Movement Therapy & Brain Gym?) website http://moveplaythrive.com/images/pdf/integrating_reflexes.pdf and Svetlana Musgatova (MNRI) has some ways to learn more at http://masgutovamethod.com/learn-more.

There's a lot of information out there even though it comes from different camps and there are even more out there. It really makes sense to me. It's just hard finding people who really know thoroughly about all this near me. We have been doing NR for a little over a year. It is so slow. It is not uncommon for kids to take 3 years in the program with the average being 18 months. I have seen minor improvements but I stick with it because I often hear from NR graduates that sometimes it just clicks one day. I might have chosen the slowest method, but for right now it is the cheapest. So RDI is technically on hold until NR is finished but as always we continue the RDI lifestyle and higher level skills.

For my son to be fully remediated we will need to get the vision piece down and I thought if I am going to work on one area I should make sure all are solid. I was surprised to find that out of 9 basic reflexes, 8 were not fully integrated/developed. I think it is amazing how far he has come having to work extra hard to compensate. Our kids are amazing! -Kimberly

Kimberly, I’m really looking forward to your web site, and thanks so much for your insightful contributions to this discussion.

Now, over to Claire:

Hi Kimberley

I think Dr Gutstein used to refer to “obstacles” that impeded the progress of RDI programmes.  Issues such as you describe clearly fall into that category. 
I agree with you that RDI works principally at the cortical level of the brain and that neuronal connections in the cortex are made at a developmentally later stage. As you suggest, reflex development is involved in the development of the “lower” parts of the brain – including the brainstem and cerebellum and limbic system.  These systems are involved in getting on with what should be “automatic” functions like balance, co-ordination, sensory modulation, emotional regulation.

Just to give a couple of examples to illustrate – though please bear in mind that it is always somewhat artificial when you extract elements from a complex, interdependent system!   Firstly you mentioned your son’s problems with vision.  Reflex development is directly associated with the development of all the visual skills I wrote about previously – fixating, tracking, shifting from near to far vision etc.  For instance if the Moro reflex is not inhibited at the typical age of 2 to 4 months the infant will continue to be drawn to movement and light in his/her peripheral vision.  If the ATNR reflex is not inhibited by about 6 months tracking across the midline will be very difficult.  IF the STNR reflex is not inhibited to allow the infant to crawl properly accommodation (switching from near to far vision) will not be learned as it should.

As a second example – returning to the Moro reflex – if this is not inhibited at the appropriate stage then light and movement in peripheral vision (amongst other stimuli) will continue to cause a startle reaction.  The infant may develop all sorts of coping strategies.  You may see “body armouring” – ie being rigid and tense to prevent responding physically to constant stimuli that startles.  In your son it may be that – and this is just one suggestion – that he has learned to narrow his field of vision because he is so distracted and disturbed by his peripheral vision.  In other words he is trying to reduce his exposure to the anxiety caused by specific visual stimuli that triggers the startle reaction.  The startle reaction involved in the moro reflex is very different to the adult startle reflex.  In the adult something causes them to startle but then they pause, orientate to assess the significance of the stimuli (ie is it dangerous, unpleasant, important) then either ignore it or take appropriate action.  In young infants or people where the moro is still active the reaction is an emotional one.  The cortex does not immediately  kick in and say I don’t’ need to worry about that its not important.  Clearly, in autistic children, the cortex often/always kicks in later but it is too late as the intense emotional response (and sometimes “impulsive” or automatic response) has already taken place and the memory laid down that that stimuli creates a very unpleasant response that is to be avoided at all costs. 
If you look up Joseph le Doux who writes about the “emotional brain” he essentially summarises mental wellbeing (like “emotional regulation” in autism) as being about the connection between the cortex (thinking brain) and the lower parts of the brain (like the amygdala).  In a healthy well regulated system sensory stimuli is sent to the cortex for analysis so that the emotional response and the course of action taken is in proportion to the significance of the sensory stimuli.  In our children the connection from lower to higher brain is too weak and/or too slow – so you get an unregulated emotional response and an impulsive course of action.  Hence you can see how important it is that reflex development enables the lower brain to function automatically, thus putting in place the foundations for the development of the cortical brain and the effective interaction between the two.

Thank you Claire and Kimberly.  I have learned so much from this exchange via my blog. 
Reflex integration is definitely something I now want to explore more through school www.brightfuturesschool.co.uk and school will be commissioning Claire to come over and do assessments on those of our pupils who will find it easiest to engage in the assessment and subsequent exercises.  I think also that between us, me and Claire might think about blogging here about what the findings are, what treatment/exercises are recommended and what our progress is.

Watch this space!

4 comments:

  1. Involuntary reactions to stimulus resulting with instantaneous movement are called reflexes. Reflexes are apparent from birth including blinking and sneezing. There are many types of reflexes in a healthy person. A pain receptor in the skin is an example of a sensory neuron. The sensory neuron detects the pain and sends a signal that is intercepted by a motor neuron, which results in the withdrawal reflex. Since only one interaction occurs this is called a monosynaptic reflex. More complex reflexes, known as polysnaptic reflexes, involve interneurons and may be integrated through the brainstem, cerebrum or spinal cord.

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  2. Many people are familiar with the idea that crawling in infancy is important for future learning. There are also many other movement patterns, beginning in the womb, that are important for future learning read more , emotional and social skills.

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  3. Reflexes are a fascinating set of automatic movements that every human being is designed with from the womb on. From infancy, the reflexes are vitally important for proper development of the brain, nervous system, body and sensory systems.read more

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