Prologue: The Interpersonal World of the Autistic Infant, Part 2: Modes of Treatment

“A good developmental theory must encompass all outcomes, individual and atypical as well as universal and typical.”

— Esther Thelen, 2005

This issue marks the second of a two-part issue exploring “The Interpersonal World of the Autistic Infant,” a project that reconsiders autism from a Sternian point of view. The first issue foregrounded the role of the implicit, embodied and relational dimensions of autistic development. This second issue examines the treatment implications of this emerging perspective. The relevance of Stern seemed apposite for a number of reasons: For one, psychoanalytic-adjacent developmentalists are increasingly putting autism under the “social microscope” (Beebe, 2018) of video microanalysis to examine early autistic development at the “local level.” Stern’s empirical-phenomenological approach – which posits the primacy of movement in early development – is proving indispensable in the search for a more clinically plausible autistic baby. His interdisciplinary construct of dynamic forms of vitality, in particular, has become an important bridging concept in contemporary research into autism, connecting the sensory-motor and the psychological realms and giving us an experience-near appreciation of how in-born autistic differences in intentional movement and holistic perception, i.e. in the expression and apprehension of dynamic forms of vitality, cascade in butterfly-like fashion to shape the broad developmental trajectory of the autistic infant. Moreover, just as Stern’s early research debunked the myth of an autistic phase in normal development, his colleagues’ work has chipped away at some of the myths that still inhere in depictions of infantile autism: in particular, paraphrasing Biklen and Biklen (2005), “the myth of the child alone”: As several papers in the first issue show, we can now appreciate that autistic infants demonstrate an intrinsic intersubjective inclination to engage in reciprocal, joyful interactions. It is the subtle impairments in the “pre-autistic” infants’ capacity to use her body communicatively – and not some static deficit in “social motivation” – that gradually disrupts the dance of relationship. Retrospective analysis of home videos allow us to see how this unfolds at the micro level: Bids for social interaction become harder to discern and the rhythms of relating become increasingly confusing for caregiver and infant alike. What starts out as a tango turns into a chase and dodge, and eventually, a two-step. Moreover, sensory-motor impairment in ASD affects intersubjective coordination both in real-time, preventing autistic infants from collaborating with their caregivers during routine interactions and in developmental time, interfering with the elaboration of the “mini-narratives” (Lichtenberg & Thielst, 2018) that underpin capacities typically accrued in the course of everyday interactions in infancy. These latter relate to the domain of implicit know-how, such as how close to stand to someone during conversation, when to make and when to break eye contact, how to take turns during play and so on. All of these implicit skills rely on time-locked sensory-motor coordination – both to learn in the first-place and to implement in everyday life.

The first issue also considers the development of the autistic self in terms of how autistic interests diverge from the neurotypical early on. The work of Muratori and others illustrates how, as interactional synchrony becomes insidiously elusive, the “pre-autistic” infant develops a precocious interest in the object world and a concomitant drop-off in responsiveness to faces and bids for social interaction. Why does this occur? Shaun Gallagher and his co-authors posit an enactive view which understands perception in terms of social and pragmatic “affordances.” That is, we perceive others – and objects – in terms of how we can interact with them. From this perspective we can understand that autistic challenges to a-modal/dynamic perception (facial expression, spoken language) and the relative salience of modal/non-dynamic aspects of the social surround (e.g., vocal pitch, objects, written language) will make affordances for social interaction harder to detect – and affordances for interacting with more static aspects of the surround (books, media, toys) more inviting. This view helps illuminate why autistic perceptual development appears to gradually coalesce into a distinct “interest system” culminating in the familiar autistic phenotype of childhood – one characterized by both challenges, e.g., to cognitive flexibility and social understanding, as well as unique strengths, e.g., a capacity for joyful, or in current parlance, “monotropic” (Murray, Lesser & Lawson, 2005) immersion in specific interests. It also creates the possibility of a non-essentializing discourse around what autistic people can and can’t do since – as the contributors to this issue show – the capacity to detect social affordances can be softly assembled under the right circumstances.

This enactive picture of the intra and interpersonal world of the autistic infant – contra many traditional developmental models – foregrounds the intrinsic coherence of autistic subjective experience. Previous theories, especially those privileging cognitivist models of the mind have tended to dismiss much autistic behavior as meaningless or defensive. An enactive, sense-making psychology extends the range of our empathic understanding of autistic experience: We can appreciate that even the child who flicks his fingers in front his eyes, or raptly opens and closes doors is, among other things, exploring self-contingencies and thus, in Sternian terms, shoring up a “sense of an emergent self.” To a neuro-typical observer this sort of behavior may seem purposeless (or dismissed as mere “stimming”) but when considered through an enactive lens it partakes of its own internal coherence. Indeed many autistic traits – such as the drive to systematize (Baron-Cohen et al., 2003), the proclivity for organizing memory in one sensory mode at a time, even the peculiar “stance” to the present moment of experience¹ (the fluctuating awareness of self-with-other, the relative salience of the trees over the forest of social stimuli) can be appreciated – with empathy – in sense-making terms, as lending a measure of self-synchrony or felt coherence to moment-to-moment experience. The autistic memoirist (Williams, 2005) explains her habit of blinking compulsively: “To slow things down and make them seem like a more detached, and therefore less frightening, frame-by-frame film.” Temple Grandin famously describes “thinking in pictures.” Each’s preference for mono-channel sense-making is what we’d expect of an individual with challenges to a-modal perception – i.e. the capacity for chunking time-locked features from the sensory array into neurotypically-sized perceptual gestalts. A broad range of classically autistic traits may more profitably be seen as compensations of this sort, from the preference for sameness and routines to the now well-established superior capacity for “local processing” (Mottron et al., 2006). And increasingly these sense-making preferences are considered not only as disabling but in terms of representing perceptual neuro-divergent strengths. On this view, the autistic self is not merely undrawn (Alvarez, 2016) or, as classical psychoanalytic models contended, withdrawn, but rather differently drawn. In other words, autism is more than just a disability: it is also a different way of being in the world. This view aligns with the work of autistic researchers and self-advocates who posit that autistic self-experience can – and should – be understood on its own terms and not solely in terms of how it differs from that of neurotypicals. Accordingly, a new wave of research has begun framing relational breakdowns among autistic-neurotypical pairs as a mutual affair, redescribing these in terms of “the double empathy problem” or “mismatched salience” (Milton, 2012). After all, it takes two to botch a tango.

Implications for treatment

“The global subjective world of emerging organization is and remains the fundamental domain of human subjectivity … It operates out of awareness as the experiential matrix from which thoughts and perceived forms and identifiable acts and verbalized feelings will later arise. It also acts as the source for ongoing affective appraisals of events. Finally, It is the ultimate reservoir that can be dipped into for all creative process.” (Stern, 1985, p. 67).

The turn to a more embodied, dynamic, relational picture of the interpersonal world of the autistic infant is creating new avenues for discourse among disparate stakeholders long estranged by the prevailing medical model of prior eras. Where autism had been conceptualized in essentialist, individualistic terms, as a static, brain-based deficit in social motivation or a traumatic defense of psychogenic origin, it is increasingly viewed – by developmentalists, neurodiversity researchers and a growing array of practitioners, parents and educators – as a dynamic, life-long difference in the pre-reflective/embodied/relational self (cf. Stern’s “sense of an emergent self.”) Long-held assumptions about autistic children’s motivations and capacities for imagination, theory-of-mind, learning and relating are being considered anew. Take the example of “special interests.” Ordinarily these have been considered as either impediments to therapy or instrumentalized as reinforcers to enhance engagement with formal treatment. But – from a Sternian perspective – autistic “enthusiasms” (Prizant & Field-Meyers, 2015) may be important clues to the dynamic forms of vitality that animate an autistic child’s sense of an emergent self and can inform the clinicians’ direction – and style – of play or inquiry. As Life Animated, Ron Suskind’s remarkable memoir illustrates, many seemingly “perseverative” autistic children may be up to something more purposeful and meaning-making than previously assumed when they put classic films under the “social microscope” of their DVRs: By pausing, playing and re-playing movies it is as if – in a sort of autistic twist on video microanalysis – they are self-adjusting the dynamic forms of vitality of film to the speed of autistic processing. Characters, intentions and situations that seem obscure at the speed of everyday social interaction emerge as graspable gestalts. Suskind captures something very Sternian in his description of what can occur when he and his son Owen play out scenarios around an evocative Disney scene:

It’s as though his whole being snaps in coherence. The clinical term is he’s integrated, both in his senses and importantly, his emotional core. And now he’s ready for a wide-ranging discussion, first about when the movie is set—“in the future, I think, but kind of a past and future both,” he says. (Suskind, 2014)

Building on this observation, Lichtenberg in his book, From Autism and Mutism to an Enlivened Self, argues for the potential value of supporting this need in autistic children to “borrow narrative and conversational skills from cartoon characters.” Instead of counseling parents to avoid the world of their child’s “affinities” (Suskind, 2014), he presciently suggests they join in the “re-animation” of their child’s sense of an emergent self as co-participants.

Similarly, empirical research (Pickles et al., 2016) is also welcoming parents back to the treatment fold, leveraging video-guided feedback approaches (Beebe & Steele, 2013) to help caregivers identify and amplify intentional bidirectional communications at the “local level” of everyday interactions. For decades autism has been conceptualized in terms of either parental failure (the “refrigerator mother” hypothesis), or as such an impenetrable “enigma” that parents – and the naturalistic environment – were sidelined altogether. Accordingly, the treatment system has been comprised of a hydra-headed mix of behavioral, play and other specialized therapies – where clinical care takes place – often with a medicalized sense of urgency – outside of the confines of the child’s everyday life. The reigning axiom of autism treatment has been that autistics cannot spontaneously develop social understanding and know-how. They will need to get there some other way – via discrete social skills training, or through professionally-mediated therapies that “teach” pretend play. The emerging embodied/relational turn views autistic development – and its care – as proceeding from the same foundation of ongoing collaboration between a response-seeking child apprentice and a mindful adult guide as typical development. This view, which follows from Stern’s developmental scheme, involves the elaboration of a series of self-discoveries that occur in the campus of everyday life. Contrary to popular belief, autistic children can develop proficiency at navigating the “hidden curriculum” of social interactions – not by obviating the developmental prerequisites that underpin it but by sensitively accommodating the very dance of relationship that makes the whole landscape of social meaning discoverable in the first place. From research into parent-mediated approaches we are learning that the botched tango in autism – the loss of the “rhythmic third” in contemporary psychoanalytic parlance – results in a characteristic relational perturbation to the dyad: after too many failed attempts at sustaining what Stern terms a “shared feeling voyage,” the parents pick up the intentional slack as it were and wind up doing much of the work of sustaining engagement. Paradoxically, this prevents the autistic child from learning how to become a “do-er doing” (Lichtenberg et al., 2016) in the dance of relationship. They miss out on opportunities to self-discover their capacity to regulate interactions, detect social affordances and elaborate the early “embodied narratives” that set the stage for the development of what Stern called “the sense of a narrated self.” By grounding their interventions in “rhythmic relating” (Daniel et al., 2022) clinicians, parents and teachers are increasingly focused on catalyzing the sort of authentic shared feeling journeys that can restore this process, regardless of age, and – as we will see – irrespective of milieu.

Finally, the notion that non-verbal therapies (e.g., music, dance, occupational, art) are merely adjunctive – and that clinical progress should be measured exclusively in terms of the child’s capacity to “climb the symbolic ladder” (Wieder & Greenspan, 2003) by engaging in more normative forms of play – with the prized end goal of developing some approximation of neurotypical social cognition – seems increasingly questionable. In the first issue Trevarthen and Delafield-Butt, writing in collaboration with an autistic adult, the creative artist and advocate Penelope (“Pum”) Dunbar, draw on Winnicott to remind us of the risks to “the source of a True Self” of approaches that privilege “social skills” and verbal-relating:

In childhood learning, Pum was instructed how to understand and use social verbal language. And she worked hard to learn speech, reading, and writing through copying particular demonstrations of these, and with obsessive attention to detail of politeness and needs of others. This led to an unintegrated sense of self, which was eventually expressed in mental health symptoms of chronic anorexia and depression. It was only many years later in adult life, after ongoing therapy and some decades of self-reflection and analysis that she came to understand that she had developed a disjunction between what we now know as her Core Self – her core affective, perceptual, and embodied Self – and her more artificial, rational, and reflective Tertiary Self.

Here, as in Stern’s scheme, the embodied, pre-narrative, sense-of-an-emergent self comes first. Its disruption in autism can cause profound challenges for the development of social and cultural learning. But to ignore, or work around it places the True Self at risk: For the sense of an emergent self is the wellspring of self-organizing creativity – and thwarting it may set the autistic individual up for a life of “masking” and mental distress. The path to catalyzing self-development must go through the sense of an emergent self.

Pum’s case thus refreshes and complicates our picture of the potentials and pitfalls of therapy for autistics. For one, it calls into question many of the hierarchical binaries that place, e.g., verbal above non-verbal, symbolic above non-symbolic, treatment above accommodation. A Sternian view of the interpersonal world of autism clearly vitiates these binaries and levels the hierarchies. If autism is underpinned by disruption to the sense of an emergent self – the domain of sensory-motor intentionality and a-modal perception – than how can it be treated without first accommodating these very differences and accounting for their accumulated impact on the autistic person’s repertoire of implicit relational knowing and narrative competence? It also complicates our ideas about the ends of treatment: In so far as autism is a discrete condition that somebody “has” – then is the goal to treat the autism itself or – as Pum’s experience might indicate – to attend to the mental health consequences of living with a developmental difference/disability? If it is an identity – a different way of being in the world – then is autism disabling only in so far as proper access to needed supports is lacking? Might certain well-meaning interventions even iatrogenically introduce mental health problems by imposing a procrustean neurotypical developmental scheme on the care of “differently wired” individuals? On the other hand, if treatment doesn’t address autistic challenges in cognitive flexibility and dynamic thinking, then how does it promote autonomy and well-being?

Here too Stern may be of help. His embodied/relational approach – and that of developmentalists like Trevarthen, Beebe, Tronick and others – has helped blur the boundary between the verbal and the somatic, pointing to the shared implicit factors that underpin development and therapeutic process. As he writes in The Present Moment in Psychotherapy and Everyday Life,

At this point in time, no one can claim a royal road to the unconscious. The dream, free association, the present moment, body sensations or expression, and actions are all, if not royal, still good enough routes into the mind, including the unconscious and the implicit.

This ecumenical view seems especially helpful for framing clinical work with autistic children. It has the virtue of holding some of the fraught dialectics around treatment discourse in creative tension: As we will see, all the authors in this second issue, in keeping with the Sternian focus, were invited to share their expertise employing dynamic, relational and implicit approaches in their clinical work; but they hail from a variety of disciplines and backgrounds, make judicious and variable use of verbal/explicit techniques and take up very different positions on the methods and goals of clinical care. Their approaches run the gamut from intervention to accommodation: Some hew to a medical model where remediation of autistic impairments is foregrounded and progress is measured in terms of the relative integration of the affected individual into the neurotypical community. Others emphasize accommodation where inclusion is framed as a two-way street. Most more or less agree that order to enhance autonomy, the environment needs to be made more responsive to the autistic individual’s particular needs and interests. Sometimes that environment is a person, sometimes a family, sometimes a school system. Featuring contributions from empirical researchers (both neurotypical and autistic), family systems and music therapists, as well as a well-known parent/practitioner and independent researcher – the contributions represent a diverse array of stakeholders in the autism treatment community creating a productive discourse around how to care for and support the True Self of our autistic patients.

The issue begins with a pair of articles that – taken together – give a comprehensive overview of a psychoanalytic-adjacent family systems approach called Relational Developmental Intervention (RDI). The first, by RDI founders Gutstein and Sheely, outlines the rationale and theoretical underpinnings of this model; the second, by Fionnuala Larkin, Lynne Hollaway, Mary Garlington, and Jessica Hobson presents an empirical study showing its efficacy in elementary school-aged children.

For background: the Relational Development Intervention (RDI) model was developed in the 1990s as an antidote to the monolithic behaviorism (i.e. Applied Behavioral Analysis or ABA) that remains – to this day – the predominant approach to “early intervention” in autism. ABA, which relies on reinforcement-based learning, presumes that autistic children lack social or growth-seeking motivation. According to Gutstein and Sheely, this is a pernicious myth – and accounts for the relative lack of progress in the treatment of autism. By parceling out reward-based treatment for purported deficits in high-order domains (e.g., theory of mind, capacity for pretend play) clinical-researchers have left too many autistic children “prompt dependent” and reliant on the sort of “static” skills that do not translate into real-world know-how. In their view, clinical researchers into autism treatment have failed to address the key question for the field: How to explain the well-known and confounding disparity between what an autistic child can do explicitly – or “off-line” – and what they are able to execute implicitly or “on-line” in the complex dynamic system of everyday life? How to explain the grim disparity in outcomes – i.e. quality of life, employment, relationship – for IQ-matched autistic and neurotypical individuals? Although they are agnostic about the etiology of autism, Gutstein and Sheely trace its origins to the first year of life which, like the Baby Watchers, they view in terms of a “dynamic experience-guiding relationship” between a response-seeking infant apprentice and a more skilled parent-guide. In this view, the engine of early development is marked by the gradual emergence of a “dynamic growth-seeking mindset” where the infant provides the “’thrust’ needed for ‘liftoff’” and the parents serve as a ”guidance regulatory system” by harnessing the infant’s exploratory drive, while also making sure “the engine doesn’t ‘overheat.’” Babies, they remind us, are not born with a taste for variety. Initially, for the first 2–3 months of life, a “stability-maintaining” mind-set predominates. Infants seek out invariants in their experience of self and other. In Stern’s terms they are shoring up the “sense of a core self.” Only when this becomes consolidated, and the infant becomes increasingly habituated to everyday routines, does she begin to push the dance of relationship into a decisively more dynamic register. Drawing on her growing capacity to communicate through gaze, body orientation, and vocalization she can now both regulate arousal to a manageable level and make her intentions and ideas discernible to her parent/guide. This permits interactions to become co-regulated. In Gutstein and Sheely’s view, this transition doesn’t occur in autism. The infant remains arrested in a stability-maintaining mind-set and the parents cease to function as guides. Without specialized supports, the guided-participant relationship derails and the infant’s capacity to develop a “dynamic growth-seeking mindset” remains un-developed. In order to re-store this process, parents are encouraged to adjust their guiding style to the rhythms of autistic processing, expanding the bandwidth of intersubjective communication to where co-regulation, experience-sharing, and shared problem-solving become possible. Gradually this leads to the emergence of what they term “dynamic intelligence,” i.e. the “knowledge, mental skills, intrinsic motivation, beliefs and habits” that permit for true autonomy, real-world know-how and ultimately – as they report in the qualitative structured interview section that concludes their paper – improved quality of life and well-being.

Larkin et al.’s article provides empirical support for Gutstein and Sheely’s approach, reminding us of the Vygotskian roots of the guided participant model of development, whereby parents scaffold the child’s emerging capacities so that they can become “competent in practices that are socially and personally meaningful practices of everyday life in a culture.” Drawing on their own empirical research they review evidence that autism severity can be directly correlated to the strength of the guided participant relationship, as measured by the Dyadic Coding Scales (DCS). The DCS, they note, was originally developed by attachment researchers to assess “the smoothness and fluidity of the goal-corrected partnership” by quantifying “social coordination, communication, appropriate role assumption, emotional expression, responsivity/sensitivity, tension/relaxation, mood, and enjoyment.” Their study demonstrates its utility for measuring the guided participation relationship in ASD by examining the effect of an RDI intervention in school-aged children with and without autism. According to their findings, children with ASD showed lower DCS on initial assessment and a statistically significant improvement in DCS scores over the year-long course of RDI. Pointedly, they remark that “the parents of children with autism were not less sensitive guides” than parents of non-autistic children.” But, “it takes two to tango and there were challenges to the guided-participant relationship.”

The next two articles pivot to a less medicalized view of treatment, exploring the nature, relevance and possibilities of autistic play on its own terms. The first, by the well-known parent-practitioner Pat Amos, considers play from the perspective of dynamic systems theory where autism is re-framed as a “movement difference that can interrupt the complex coordination involved in social interactions, communication, and exploration.” Amos sets out to “promote recovery, not from autism, but from our sense of being privileged interpreters … of individuals who have acquired this label.” Drawing on her own first-person experience of raising an autistic son, she pushes back on the still-prevailing assumption that autistic play and imagination is either absent or irrelevant – due to purported deficits in cognition or empathy. On the contrary, she notes, autism, is more like an “intense world” marked by a characteristic hypersensitivity to interactions that can disrupt sensory-motor agency in ways that fly under the radar of even the well-meaning neurotypical observer. For children with “delicately-balanced” and unreliable sensory-motor systems, traditional forms of play “can be a minefield” with their “loud noises … fast pace … and simultaneous demands placed on multiple sensory systems.”

Competitive play, which might seem inviting to a neurotypical child, “may drive a child with autism into behavior considered deliberately antisocial.” But, she contends, it would be more profitable to appreciate such relational breakdowns as attempts at self-regulation by a person with “a body that has a mind of its own.” When we “see movement” we can appreciate and accommodate autistic interests and intentions by rhythmically-scaffolding playful interactions. In a series of poignant illustrations and vignettes, Amos concludes by showing how engaging autistic interests directly “allows us to become more in sync with their rhythms of play, exploration and development.” Given enough time, and the right partner, autistics can organize their delicate and highly unpredictable sensory-motor systems to self-discover affordances for play and interaction. “If one idea runs like a thread through these reflections on autism and play,” she writes, “it is the importance of respecting the integrity and context of each individual’s experience and of working with them, not on them.”

The second, a collaboration between a neurotypical researcher, Pamela Wolfberg and her autistic doctoral student, Gesean Lewis Woods, considers play through the lens of neurodiversity, bringing equity, social justice and inclusion to the fore to interrogate “so-called” autistic impairments in play. Historically, they note, autistic differences in symbolic and social play have been framed in pathological terms. Accordingly treatment has been delivered in professional contexts where progress is measured by neurotypical standards of play behavior. Apart from the ethical dubiousness of such an enterprise (the authors remind us that “teaching autistic children to behave in non-autistic ways may have serious repercussions that impact social functioning and psychological well-being over the lifespan”) these approaches fail to foster true “play culture.” In an authentic play culture, “peers perform a distinct role by scaffolding development and socialization in ways that cannot be duplicated by adults.” Wolfberg and Lewis-Woods proceed to outline an alternative approach, the Integrated Play Group (IPG) model, which re-repurposes Vygotsky from the perspective of neurodiversity. The IPG approach involves the facilitation of guided-participation play interactions between neurotypical guides and autistic apprentices “where each player (neurotypical and neurodivergent) is dependent on the other.” Initially, participation may be asymmetric, but with sufficient support, all the participants come to discover meaningful roles and actions. “For instance, a child with an affinity for banging objects may take the role of a drummer with the other children who are pretending to be in a rock band.” Through “mutual socialization” both autistic and neurotypical children are supported in “co-creating a play culture” in which “neurodivergent ways of communicating, relating, learning and creating become embedded.”

The final article, by Birnbaum, Kandler, Aslan, Hoi Yan Fu, and Turry – all members of the Nordhoff-Robbins Center for Music Therapy at NYU – returns us to the Sternian realm of emergent self-experience, focusing on “the value of improvisational music therapy in cultivating intersubjective states between autistic clients and therapists.” Drawing on Trevarthen, Malloch and others – they remind us that though “many autistic children struggle to understand the elements of non-verbal communication that take place in the neurotypical world,” they still possess “innate musicality,” – that is, the capacity to discern the communicative intentions of others as these are expressed through the non-verbal exchange of dynamic forms of vitality. “By being attuned to and joined musically,” they write, “the child experiences relatedness in a way that may be difficult to do otherwise.” Like the dance of relationship of early development, music therapy can catalyze the development of a sense of an emergent self, enhancing the capacity for “emotional regulation, flexibility and cooperative relatedness, both inside and outside of therapy.” In a series of evocative, fine-grained clinical vignettes, the authors capture how this unfolds in moment-to-moment negotiation of embodied intersubjectivity that occur in “musical dialogue.”

Daniel S. Posner, M.D.

Issue Editor

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This article has been republished with minor changes. These changes do not impact the academic content of the article.

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Notes on contributors

Daniel S. Posner

Daniel S. Posner, M.D., is assistant clinical professor of psychiatry in the Icahn School of Medicine at Mount Sinai Hospital System in New York City where he teaches and supervises residents in psychodynamic psychotherapy. He has published in the Journal of Autism and Developmental Disorders and Psychoanalysis, Self and Context and Psychoanalytic Inquiry. He maintains a private practice in Manhattan.

Notes

¹ There is a need for a Sternian phenomenology of “the present moment” (Stern, 2004) in everyday autistic experience. Amos (2017), a parent/practitioner (and contributor to this issue) has speculated that many autistic children, lacking reliable self-feeling-in-movement, might live in a sort of permanent present,“struggling with information that is processed in the “ here and now”… that is, with neurological systems that treat specific tasks as new whenever they are presented. Like the GPS in my car, they are constantly “recalculating.”