Movement disorders in autism
A recent article in the New York Times ("Movement may offer early clue to autism," Science Times, January 26, 1999, p D3) by Sandra Blakeslee reports studies done on infants by Dr. Philip Teitelbaum suggesting that abnormal patterns of movement can be discerned in young infants later diagnosed with autism. Home videotapes were reviewed showing that infants with unsuspected autism have atypical ways of rolling over, sitting up, crawling, and walking. It is suggested that movement analysis may provide a means for identification of autism earlier than is now possible by the usual diagnostic methods.
Although I have long had the impression that some persons with autism seem to have an odd gait and that other motor activities are not always fluid and coordinated, I am not convinced that this observation is central to the core social deficits in autism. It may be more of an epiphenomenon. As I have mentioned in another commentary, I view autism as a lack of the biological drive to "latch on" to other persons in a reciprocally-satisfying relationship. However, areas in the brain concerned with social cognition may well have subtle motor components since certain kinds of movement are central to nonverbal communication. I refer to this as "social kinesiology" and this has been studied for many years in different cultures by anthropologists. Moreover, in view of the difficulty that individuals with autism have in imitating models of motoric behavior, it is also not surprising that they are unable to accurately copy "templates" of relatively fluid, motor activity that are modeled for them by other persons. This problem in "social kinesthetic" behavior might include impaired "motor planning." Moreover, it is even possible that the basic brain aberration in autism spills over into certain kinesthetic mini-modules (or "neural automata") that fail to become properly "hard-wired."
Can persons with autism "kiss?"
A good example of impaired social kinesthetic behavior is the inability of a person with autism to kiss in a typical way. Now, I know that some parents claim that their children with autism are able to "kiss" but I have never seen one who can do a real honest-to-goodness pucker up and smacking of the lips. Rather, what I have seen is a stereotypical, robotic planting of the lips on a cheek, without the pucker, smacking of the lips, or affective component of a typical affection-laden kiss. Some might say that this is indicative of a problem in "motor planning" or a "movement disorder." To my mind this is evidence that one of several mini-modules concerned with social gesture and motor aspects of affiliative behavior is missing in autism. In this instance the "kiss mini-module," which represents the neural substrate for both the social-affective and the motoric components of "the kiss" may not have been laid down during the early neurodevelopmental sequence as a "hard-wired" circuit. That this may represent a "neural automata" is suggested by the observation that even nonhuman primates have facial displays of social significance including a probable precursor of what later became the more highly refined kiss of typical humans.
Another example is the impaired ability by a person with autism to wave goodbye in a "neurotypical" way. This may also reflect a problem in building an internal image of a socially-motivated motor sequence.
In my opinion, this evidence of a "movement disorder" in autism does not lie at the core of autism but lies at the periphery as a manifestation of impaired social kinesthetic behavior.
The study by Teitelbaum et al, ("Movement analysis in infancy may be useful for early diagnosis of autism") was published in Proc. Natl. Acad. Sci., 1998(Nov); 95:13982-13987 (Proceedings National Academy of Sciences).
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