Part 2 of fundamental differences between behavioral and developmental approaches in Autism Spectrum Disorder.
I am currently on a 7-day course on blending attachment theory with sensory processing theory in a very practical way. I am looking at videos of children and reflecting on our kids at the center. It feels good to not be the presenter and simply taking the time to listen, reflect, and add to what I already know. To my staff’s dismay, though secretly they enjoy it, I am again thinking of changes I would like to make!
But the topic of attachment is fascinating. It starts in utero as the baby is also exposed to what the mother is exposed to. The baby starts the sense of smell quite early and listens to the mother’s voice by 5 months, though some books say 4 months. They cannot understand the language, but they can get the cadence and prosody of the mother’s voice, which conveys mostly emotional tone and this occurs with bone conduction through the spine as it ripples into the womb. Once the baby is born it is that emotional tone they seek when they burst into this sudden change from fluid to air and there the love affair visibly continues in earnest. I do not think anyone could have hardened heart when watching a mother nestle the baby’s head in that special place just under her shoulder. From this time through the entire lifespan, it is this mother that we bury deep in our subconscious no matter the environmental circumstances.
You can teach social manners, but not the complexity of social skill.
We have come a long way from believing that children on the spectrum do not share this same yearning. There is so much literature discussing the importance of the co-regulation occurring naturally between mother and baby and how this bonding keeps affecting other relationships in our lives. Some families noted the difference in their child from the first month of life; other say it happened after about 18 months, though most agree that co-regulation has always been difficult. As the child’s autonomic nervous system does not provide the adaptive response they need in order to cope, their behavior becomes difficult to read, causing the parent to feel disarmed and alarmed at their seeming own inability to follow their natural instincts. They “lose” their ideal baby to feeling dismissed, rejected and also incompetent, thinking it is about their parenting. They search for help and family members say all kinds of unhelpful things though they mean well. “Do not worry, they will grow out of it” or “I raised you this way, so you should be doing this” and other “helpful” hints. Still the mother struggles to establish a co-regulation with her baby. She visits the doctor and voices her concern about the child’s difficulty to be engaged in a co-affective behavior. Her instinct tells her something is wrong, but she is also afraid that she could possibly be to blame. The doctor states “to give it time”, “he is just a boy, they take longer to develop”. The mother feels again that maybe she is over-reacting and that she must stop feeling anxious.
If there is an emotion children on the spectrum share it is anxiety and it is this anxiety that rules their adaptive response. They also cry out for attention as other babies, but due to their difficulty adapting to the environment, the mother cannot find the right sensory pathway to assure her child of her love and care. As the mother’s anxiety rises, her child feels her anxiety quite intensely. Trewarthon gave us the term “intersubjectivity”, which considers an innate ability that seeks strength from the mother child bond. Think about when you are looking at your significant other and you know exactly what they are thinking and the look from your partner tells you they got it too. Research with one-month old babies and mothers engaged in “motherese” (that special baby talk) showed that exactly the same places in both the mother and baby brain lights up as they “talk” their own language.
Anyone working with children on the autism spectrum will know that they are keenly aware of any amount of tension in the room. They remind me of the deer I love to watch in Kruger Park. As they bend their necks to drink water, their ears are forever moving, checking the environment for danger. In their primal brain, they live in an eternal cycle of fight, flight and freeze. Children on the autism spectrum are just as vigilant of their environment as those deer. The difference is that they are supposed to grow into making sense of their environment. They should feel secure enough to mature into understanding that the environment holds no threat; that there is no danger. A loving secure base in the mother would have provided them this ability had sensory adaptive systems not gone awry. It has to feel painful to experience this disruption of such a primary “right” of development. Mothers continue to search for the answers and techniques that would allow their child to seek their loving arms.
Why am I going into this detail? If this mother-infant bond is good enough to set the stage for all typically developing children in order to grow and mature, it is no less necessary for the child on the autism spectrum. Relationship is the essence of growth and research has shown that this first bond also fosters brain growth. The child on the spectrum is as much in need of relationship as any other typical peer. Their vigilance with regards to discerning threat however, overshadow the relaxation they can find in their mother’s arms, and when sensory thresholds are over-activated, the first response is to use a short circuit to the limbic Amygdala (low road), which does not allow for logic to enter into the equation (high road). Of course there are different ranges of profiles on the spectrum, but the needs remain the same.
So this is my concern: What are we teaching children on the spectrum about relationship within the behavioral method? Is relationship about performance (the task) or is it about creating a love bond that would form the foundation of being social and developing empathy? Why are behavioral therapies so sadly lacking in developing social-emotional skills? This is a question, not an attack. This is a core deficit of Autism Spectrum Disorder and it does not appear to be enforced nor developed by behavioral techniques. The answer lies in re-establishing the mother-child bond and fostering a joy between them that can overcome the Amygdala short circuit, and build the intrinsic motivation that will create the willingness to want to be a part of our world. You can teach social manners, but not the complexity of social skill. Sadly they are not equal in attaining quality of life. To be social-emotionally skilled is to start with the bonding relationship and to use this secure base in developing the child into a fuller, more conscious person that does not have to live with fight, freeze and flight all of their lives.