Moving Together Along the Spectrum: Toward an Empathic Dialogue with Autistic Children and Their Families

ABSTRACT

The role of sensory-motor impairment as a factor in autistic development is increasingly recognized but there remains a dearth of synthetic models that bridge autism’s psychobiological origins in perinatal development with its later manifestation as a disruption to agency, intersubjective engagement, and social interaction. This article expands on the work of Daniel Stern and the Boston Change Process Study Group on the primacy of embodied intersubjectivity in development, applying recent findings on Autism-specific impairments in intentional movement and dynamic vitality form perception to posit an embodied developmental-relational framework for Autism Spectrum Disorders. In this view, deficits in the regulation and timing of movement subsystems dampen inter-personal kinesthetic and affective bodily resonance during early dyadic interactions, reducing the frequency of “moments of meeting” in the first year of life, with “knock on” effects on implicit relational knowing and later cognitive development. In relational terms, autistic infants and adults face challenges with the “intention unfolding process,” in “mutual sensing,” and with “moving through and being moved by” the other in sustained engagement.

KEYWORDS:

• Autism
• embodiment
• dynamic forms of vitality
• primary intersubjectivity

Notes

¹ A recent landmark study published in Lancet (Pickles et al., 2016) reports on a longitudinal investigation of a parent-mediated relational intervention in an autistic toddler population where “Interactional synchrony” was the chief mediating variable. The results showed a greater impact—at 6 years follow-up—on adaptive functioning–as measured by the Vineland Adaptive Behavior Scale–than any prior study in the autism literature.

² As BCPSG note, the mirror neuron system mediates our micro-apprehensions of others affective experience, permitting us to resonate with them non-consciously, thereby expanding the creative possibilities of the intersubjective field. Interestingly, new research (Rochat & Gallese, 2018) shows that vitality form perception is handled by its own dedicated brain substrate in the insular cortex. Where mirror neurons mediate action understanding (“what is this person intending”), the insula appears to mediate affective understanding (“how is this person intending”).

³ In Stern’s view (2004) sense-making is constrained by how an individual “chunks” the sensory array of the present moment into a perceptual gestalt. The well-known autistic preference for local detail—often dismissed as “context-blindness”—may represent a different way of chunking sensory experience where non-temporal, i.e., visual and melodic aspects of the array have more salience.

Additional information

Notes on contributors

Daniel S. Posner

Daniel S. Posner, M.D. is assistant clinical professor of psychiatry in the Icahn School of Medicine @ Mount Sinai Hospital System in NYC where he teaches and supervises residents in psychodynamic psychotherapy. He has published in the Journal of Autism and Developmental Disorders and is a member of the editorial board of Psychoanalytic Inquiry. He maintains a private practice in Manhattan.