Wednesday, 28 August 2013

Why is mastery of key developmental milestones absent or delayed in autism?

If you've been following the blog recently, you'll know that Sue and I have been having some lively discussions in the comments of the previous blogpost that related to autism and loneliness.  One of the questions Sue asked me was why I thought mastery of key developmental milestones is absent or delayed in autism.
I undertook to answer this by quoting from an article I wrote that was published in the UK journal 'Good Autism Practice'.  The citation for the full article in case anyone wants to read it is: 'Why a developmental approach is crucial in supporting children and adults with autism: using the principles and practice of Relationship Development Intervention within an alternative school setting' Good Autism Practice Volume 14, issue 1, May 2013.
Here is the excerpt:
'In autism, something interferes with brain development early in life which derails the typical developmental process.  In typical development, parents establish patterns which the baby comes to rely on: e.g. right after birth: the pattern of feed, rock, sleep, change; after a few weeks: the pattern of feed, rock, sleep, change, play.  The baby comes to know that when s/he cries, the parent will come and take whatever action is appropriate to sooth him and/or provide him with stimulation.  In this way, the baby learns to trust the pattern and the associated adult.  Parents adjust their response in relation to the feedback they get from the baby.  If the baby is still unhappy when she has been fed, the parent tries winding her to see if this will settle her.  If this doesn’t work, the parent tries rocking her, playing with her etc. until she settles. 
These patterns also set the stage for emotional self-regulation: the baby learns that if s/he is upset, the adult will provide comfort.  Emotional regulation is a process that starts out as a shared activity between two or more people (co-regulation) and becomes internalised as the child develops.
Even before talking develops, the toddler has become a master at reading and responding to non-verbal communication such as facial expression, gesture and prosody.  Through hours of play and experimentation with the parent, the toddler has already learned to reference the adult’s emotional expression for information, including information about what to do when s/he is faced with uncertainty.
This can be seen clearly in the ‘visual cliff’ experiment where the baby is unsure whether or not to cross what looks like a steep drop to obtain a colourful toy.
To help decide what to do, the baby references her mother (looks to her for information). When greeted with an anxious face, the baby withdraws, but when greeted with a positive, cheerful face, the baby proceeds to cross the visual cliff.
Children with autism fail to develop this experience-sharing type of referencing because they have veered away from the typical path of development where interpersonal engagement acts as the ‘cradle’ for the development of higher-level ‘dynamic intelligence’ thinking skills.  This explains why children with autism avoid change and uncertainty and why change and uncertainty lead to such high levels of anxiety in autism. 
In early development, the adult is the ‘guide’ to the child’s ‘apprentice’ in a process called ‘guided participation’ (Rogoff, 1990).  Guided participation enables the child to collaborate in a learning relationship with close adults which is:
‘…..carried out day after day, without much deliberation or conscious awareness. Children participate alongside family and community members in authentic activities as apprentices, actively seeking to appropriate meaning and expertise from adult guides who provide opportunities for the apprentice to safely encounter cognitive challenges.’
In babyhood and more so as the baby matures into a toddler, parents pitch small challenges just at their child’s current edge of competence: Vygotsky’s ‘zone of proximal development’.  The toddler’s feedback enables the parent to decide whether the challenge has been pitched at the right level.  If it is too great, the parent will scaffold the activity to make it easier.  The toddler then successfully completes the activity and, in experiencing success (which is usually spotlighted by the parent with a comment such as ‘wow – you did it!’ and a big smile), lays down an episodic memory of competence. 
In typical development, success that is spotlighted by the guide leads to an episodic memory (a personal, autobiographical memory) being encoded.  These special memories of competence build up in a memory bank to be used again when we are faced with another uncertainty.  For instance, I have a condition called ‘topographical agnosia’ which basically means I can’t navigate my way out of a paper bag.  I quite often have to drive to places I don’t know, which causes me anxiety.  However, I am not daunted by this because I can draw on my memories of previous success in similar uncertain situations.  I can remember successfully using my satnav, stopping to ask people directions, phoning my husband to ask him to look at the map and tell me where to go next.  These memories have built my resilience, which enables me to cope and to manage my anxiety, so also helping me to regulate myself.
The crucial points here are that typically developing children safely encounter cognitive challenges during their interaction with the adult guide and that they lay down episodic memories of competence thanks to the interpersonal engagement that takes place within the guided participation relationship.  The experience (and memory) of success in overcoming a challenge is partly what motivates them to continue being curious.  The child is successful because the challenge is taking place within the interpersonal relatedness that is the cornerstone of the guided participation relationship – so if the child apprentice starts to falter, the adult guide intuitively picks up the signals and scaffolds the activity to make it easier for the child to master the challenge successfully.
Children with autism do not have the safety net of their communication partner’s perspective to use as a point of reference when faced with uncertainty.  Autism has interfered with the child’s development, so the child neither references for information nor gives feedback to the parent.  The parent is then unable to take their role as the guide and consequently the child lays down few episodic memories of competence in their ‘resilience repository’.   For children with autism, their experiences are more often those of failure, causing frustration, distress, withdrawal and sometimes ‘meltdown’'.
To summarise: humans are hard-wired to be social.  The evolutionary advantage of being social is that interpersonal relatedness within the guided participation relationship is the vehicle that enables the development of higher level thinking skills. Autism interferes with typical brain development (with the hard-wiring to be social).  The feedback loop between parent/caregiver and child breaks down, the guided participation relationship is not in place and so the interpersonal relatedness that leads to the development of higher level thinking skills via mastery of key developmental milestones (referencing, joint attention, co-regulation, self-regulation....and many more) cannot take place.


  1. This comment has been removed by a blog administrator.

  2. Hi Zoe

    Thanks for posting this. It has made your perspective clearer. Although I agree that what you describe is what happens in a typical developmental trajectory, I take a very different view of child development and would question some of your explanations for what happens.I’ve responded in two parts.

    I get the impression that you view child development not just as *involving* social interaction, but *in terms* of it. You refer, for example, to patterns of parental behavior, non-verbal communication and Vygotsky’s ‘zone of proximal development’. Each of these factors certainly plays a part in child development, but there’s an awful lot more going on that you don’t mention.

    Typical development can be derailed by other things; genes, physiology, sensory input, toxins, infections, injury etc. The baby’s anatomy and physiology are just as important as its social interaction - more so, in fact, since the baby relies on its anatomy and physiology to be able to interact socially at all. When looking for possible causes for derailment of typical development, all factors need to be taken into account. If you see child development solely in terms of social interaction, then you kind of have to conclude that social development is hard-wired, because your model includes nothing else that could explain where it came from.


  3. 2/2
    Next, I’d like to pick up on some of the specific points you mention.

    First, emotional regulation. If you haven’t read Bowlby’s chapter on feeling and emotion in 'Attachment', I’d strongly recommend that you do. I think he gets to the heart of the knotty problem of ‘what is emotion?’ Where I think Bowlby goes wrong is that he assumes that feelings, like blood pressure, temperature and heartrate, have to maintain homeostasis. I can’t see that they do. People’s emotions fluctuate wildly. It’s obviously not good for people to be permanently consumed by grief or anger, but most of us actually seek emotional arousal quite a bit, whereas we don’t try to raise or lower our blood pressure or body temperature. I’ve critiqued the emotional regulation concept in more detail on my blog here

    Second, the derailment implicated in autism. You say

    “Children with autism fail to develop this experience-sharing type of referencing because they have veered away from the typical path of development where interpersonal engagement acts as the ‘cradle’ for the development of higher-level ‘dynamic intelligence’ thinking skills. This explains why children with autism avoid change and uncertainty and why change and uncertainty lead to such high levels of anxiety in autism.”

    It’s certainly one explanation. But there are others that you don’t mention. Fluctuations in neurotransmitter levels that result in intermittent changes in sensory input, or delayed sensory processing or heightened functioning of parts of the amygdala would also account for high anxiety levels and would royally screw up one's dynamic intelligence thinking skills.

    Third, episodic memory. You’re quite right that episodic memories of competence can boost confidence and encourage curiosity. Unfortunately they have to compete against the much stronger effect of episodic memories of incompetence - there’s an asymmetry throughout the animal kingdom in terms of positive and negative reinforcement. Episodic memory is often overridden by subconscious memory of previous negative outcomes.

    In addition, episodic memories of competence aren’t sufficient to overcome lack of capacity. You've found that you can bypass your topographical agnosia by recalling and using previously successful alternative strategies. But you can bypass your agnosia. If it was so severe you couldn’t bypass it, you wouldn’t have memories of competence to fall back on.

    Lastly, you finish by saying ‘humans are hard-wired to be social’. What you’ve said in the section of the article you’ve quoted certainly demonstrates that social factors play a part in human development, but it contains no evidence to support a hard-wiring hypothesis.

    If your model of child development makes this assumption, then yes, you can couch the difficulties with social interaction we call ‘autism’ in terms of missing key (social) milestones. But what about other milestones, like crawling, walking, talking, bladder and bowel control, fine motor skills and balance that are often also delayed (or absent) in children with autism? How does a social model of child development explain them?

    Thanks again for posting.