Self-injurious behaviors, clumsiness, motor stereotypies, faulty facial recognition, the bothersome nature of change, joint attention and theory of mind in autism: putting it all together

I will always remember seeing Mel Kaplan examine autistic patients for a prism lens study that was being conducted at my laboratory. One young participant, despite having his parents around, became unruly and rather uncooperative. I thought for sure this would be the end of his participation in our study. I was surprised, however, when Mel took out a small bean bag from a box he was carrying and placed it on top of the young boy’s head. A short time later, the young boy was behaving normally and complying with the behavioral demands of the study. The change in his overall demeanor was truly amazing, especially when considering that it became evident after only a few minutes. I had no mechanistic explanation for the observed effect and had never seen anybody use the technique before. Upon asking Mel about his action he said that the irritability exhibited by the patient was possibly the result of “having lost the sense of his body in space”. Mel’s explanation really intrigued me and piqued my curiosity.

In my experience as a clinician and researcher I have only witnessed such a drastic change in behavior in a handful of occasions. One of these experiences happened a few years ago with my own grandson, Bertrand, as we were taking him to his weekly physical/occupation therapy. He dreaded the appointment as he was being desensitized to touch and the therapists massaged his extremities for many minutes at a time. Bertrand can’t stand being touched, especially the face. The problem is that I love kissing him on the cheeks thus making everything worse. Having broken his routine in order to take him to the hospital, Bertrand was in the midst of a major tantrum, that is, a full-blown autistic tantrum. He was certainly showing that he had healthy lungs and was flinging his extremities around. I thought that given Bertrand’s state of mind any efforts on part of the therapist were going to be a waste of time. I knew from my previous attempts at trying to comfort him that anything that I did only served to agitate him even more… and then, the most amazing thing happened! The therapist took Bertrand to a full body swing. The same was big enough to fit both the therapist and Bertrand. It was like flipping a toggle switch, one second Bertrand was vocally blasting the acoustic ceiling tiles out of their support and the next he was calm and relaxed- a dramatic change to say the least.

My experience with Bertrand made me a great believer of full body swings, especially the ones that can be hung inside the house, for the purpose of treating autism. I have suggested having them near places where I expect some tantrums, e.g. dental clinics. It may be that swings as well as hug machines (squeeze boxes) and pressurized jacket all act the same way. As Mel would say, pressure against the body may help the individual gain a sense of his/her own body in space.

Although I am not a believer in psychological theories trying to explain autism (see http://bit.ly/1eAH70s ), I do believe that a faulty body (and world) schema may help explain many findings in autism including irritability, problems with face recognition, theory of mind, etc. An abnormality of feature maps in autism was proposed by Gustafsson (1997) as a core deficit of autism, modeling the same after columnar abnormalities, as we have described neuropathologically in the literature. Gustafsson’s model uses Kohonen’s map with Hebbian learning that has a columnar structure as an essential feature. Gustafsson defined features as “characteristic of classes of objects that are useful for distinguishing the objects within a class”. He proposed that proper self-organization of feature maps does not take place in autism. Gustafson did not expand on how his theory would explain diverse clinical features of autism, e.g. face recognition, motor sterotypies.

A faulty feature map (perception) of the world does seem to explain many clinical features of autism spectrum disorders. I have always believed that the rocking behavior of autistic individuals resembles the wobbling of a pigeon walking as well as the bobbing of its head. We now know that this behavior in pigeons is a way of stabilizing their visual surroundings. Normally humans do this by moving their eyes, but whenever the eyes can’t catch to their surroundings, we similarly resort to moving our body repeatedly (note: have you seen the wobbling head motion of somebody who is blind?). Likewise, although many reasons may underlie self-injurious behaviors (e.g., GI upset, migraines, seizures), pain may serve to recall body parts seemingly lost to our sensory senses (e.g.., proprioception, touch, pain).

Perception and emotion go hand in hand. Our ability to see emotions in others allows them to perceive emotions in us. This is due in part by gestures in our face. An inability to recognize facial expressions and even posture would make it difficult to understand the state of mind of a person. Gestures themselves may be an evolutionary way of communicating. We make a fearful face as a way of warning others about a potential strike. We are able to do these complicated actions because certain specialized cells within our cerebral cortex respond to combinations of stimuli. We recognize a face only if the features are embedded within an oval, a body schema. Feature maps and/or body schematas are therefore essential towards recognizing faces.

We pick up tidbit is what people say in order to infer what they are thinking. This type of perception is not different than trying to predict the future from data available in the present. It may be that autistic individuals may have the same difficulty in trying to predict the future as in reading the mental state of other people. Catching a ball is a small exercise in predicting the future. Where our eyes direct their gaze is also a way of predicting the future. This is important for learning (joint attention). Without joint attention the ability to lie is also diminished. This is not ESP. It is based on the intactness of feature maps. Without this ability change is a bad thing, it shatters our perception of the world.

Our laboratory has already provided many preliminary findings that would help explain an abnormal feature map or schema of the body and surrounding world in autism. We have made many studies in regards to minicolumnarity of the cerebral cortex that imply a biased corticocortical connectivity (see http://bit.ly/XzE8us ). We have also done a good number of physiological studies based on gamma frequencies, that is, the way we bind a perceptual whole in our minds (see http://bit.ly/11KrMEl ).

The findings from our laboratory have predictive significance. It could be easy to assume that autistic individuals with a defect in feature maps of both their body and immediate surrounding would have difficulties in seeing the special effects of a 3D movie. They would fail to properly interpret illusory figures, such as the Ames room. They would also have difficulties in categorization and differentiation (why are two dogs that differ markedly in size and shape still considered dogs?).

Ames room

Figure: The Ames room.

illusory tringle

Figure:  Illusory triangle figure.

The findings of our laboratory also have significance for patient treatment. Self-injurious behavior based on a faulty body schema could be treatable by using a hug machine or a pressurized vest. Swimming should have remarkable positive effects in the disposition of ASD individuals (given the pressure of the water around their bodies). Transcranial magnetic stimulation which has been proven to improve gamma binding in ASD should also be beneficial (see http://bit.ly/WgGkGB ).

The principle of parsimony asks us to try to explain different phenomena with the least number of suppositions. That explanation which contains the least number of variables is likely to be closest to the truth. In autism, the possibility of faulty feature maps (schematas of the body and surrounding world) confers explanatory powers to a host of clinical findings. More importantly it can guide us as to ways to intervene in a positive way when prompted by behavioral demands of the patient.

References

Gustafsson L. Inadequate cortical feature maps: a neural circuit theory of autism. Biol Psychiatry 42:1138-1147, 1997.

3 responses to “Self-injurious behaviors, clumsiness, motor stereotypies, faulty facial recognition, the bothersome nature of change, joint attention and theory of mind in autism: putting it all together

  1. Excellent review that is consistent with Martha Hebert and Michael Rutter’s concept of autism being a system wide problem and that the brain, the mind and the body are interconnected in many ways with multiple co-occurring problems each of which should be addressed with unique therapies.

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  2. Thanks. I am not sure when joint attention stops and theory of mind begins. As you say, most of the problems in autism appear to be heavily interconnected. Thankfully we are gaining a better appreciation of this fact.

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    • Regarding the many problems that are interconneted, Rutter has argued that the term ‘comorbidity’, (a) implies unsubstantiated presumption of independent etiologies and (b) discrete categories do not exist in real life.. Common genetic variants associated with ASD risk are also associated with general population risk for SLI, Dyslexia, ADHD, depression, social anxiety, eating disorders, immune deficiencies gastrointestinal problems, bi-polar disorder, developmental language delay, intellectual disability etc., many or most of which can co-occur in any individual with general developmental problems associated with the same common polymorphisms. For example the MET (7q31) gene region harbors a polymorphism, the MET promoter variant rs1858830 allele “C” that is present in 47% of the general population and is associated with risk for autism, immune function, gastrointestinal repair, neuronal growth and development all of which can co-occur in any single individual when normal gene function is disrupted via environmental and/or epigenetic factors when present.

      Reference

      Randolph-Gips M. Srinivasan P. (2012). Modeling Autism: A systems biology approach. J Clin Bioinforma. 2012; 2: 17.

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3507704/

      Like

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