Understanding Movement and Sensory Regulation
How our perception of movement and sensory differences can change our perception of people diagnosed with autism/PDD, mental retardation, and related disabilities
What is a movement disturbance/difference?
This term refers to an interference in the efficient, effective use of movement which is not caused by paralysis or weakness, but by difficulties in the regulation of movement. Modern models of neuroscience include sensory perception in the term movement because the regulation of movement depends on sensory perception, and vice versa.
The word "difference" is included as a reminder that these regulatory challenges are not necessarily disturbing for the person who experiences them; problems may ensue when others have difficulty interpreting or responding to a person who moves differently, or when others are intolerant and unaccepting of differences.
Why do movement differences occur? What is their connection to sensory regulation and perception?
The basis for the overlapping lists of behaviors labeled "autism" and "mental retardation" may be found in the brain's regulating or tracking systems for predicting sensory consequences of all types, and for relaying useful predictions to motor and other output systems. For example, when these tracking systems are not working reliably the person may be unable to correctly estimate the "trajectory" of a stimulus and regulate an efficient response:
o When these off-the-mark estimates are relayed to the body's motor systems they produce movements which undershoot or overshoot the target, as well as disrupt the coordination of movement involved in social interaction. (This complex synchrony of body language and timing is often referred to as "the dance of relationships.")
o When skewed estimates of a stimulus are relayed to the systems that regulate sensations, they produce analogous "undershoots" and "overshoots" (e.g. hyper- or hypo-sensitive hearing, vision, smell, touch; overreactions of "fight or flight"). Since action cannot be separated from perception, sensory regulatory problems also have a profound effect on the production and coordination of movements crucial to social interaction and communication.
What is the significance of movement in rethinking labels such as autism/Pervasive Developmental Disorder and retardation?
Neuroscientists consider movement regulation and sensory regulation to be "two sides of the same coin." In fact it is not hard to imagine why individuals with movement disturbances would be seen to have difficulties in social communication and interaction, where even a small difference in behavior can have an enormous effect. Smiling too much or too little or at the wrong time, grimacing when you mean to grin, taking ten seconds rather than the expected two seconds to respond, all can give an erroneous impression. If these problems begin early in life, obviously they will interrupt the person's ability to participate in "the dance of relationships." This interruption will further narrow the range of available learning experiences.
Focussing on symptoms of movement disturbance is not a way of adding a new label or adding new "deficits" to the lengthy lists already used to define disabilities such as autism and mental retardation. It is a way of moving beyond the judgmental, socially-defined elements of these lists and labels toward an understanding and appreciation of the nature of each person's experience.
What sorts of movement differences have been associated with people diagnosed with autism/PDD or mental retardation?
Movement differences are manifested in a wide range of behaviors, including the more easily-identifiable activities such as unusual gait and posture, constant physical movement, or repetitive rocking. Other movement differences tend to become evident at transition points. Among these are:
Starting -- difficulty initiating; Executing -- difficulty with the rate, rhythm, target, etc. of movement; Continuing -- difficulty "staying on track," not taking alternative paths, etc.; Stopping -- difficulty terminating a movement; the tendency to "perseverate"; getting "stuck" in one sensory mode like staring into space; Combining -- difficulty adding a sensory mode or a movement, e.g. listening to someone speak while watching their gestures and facial expression, doing two things at once, etc.; Switching -- difficulty "letting go" of one perception or movement and initiating a new one.
When there is an imbalance in the systems regulating movement, there may be a tendency for disruptions in other systems such as perception, emotion, and thought. These may include:
Difficulty "calling up" an emotion or finding the motivation needed for an action; Having one's attention repeatedly drawn to some insignificant detail or event; Not being able to initiate a request until someone else mentions it; Getting stuck on a repetitive thought; Difficulty in maintaining or letting go of a topic of conversation.
These difficulties often become evident during interactions where synchrony of movement, thought and emotion form the basis of relationship.
What does an understanding of movement and sensory regulation help us to do differently?
In the words of the legendary quality consultant W. Edwards Deming, "The more we do what we always did, the more we'll get what we always got." The current track record for positive, satisfying outcomes in the lives of people labeled with autism/PDD and retardation suggests that it is time for a new approach, and there's a lot we can do to make change happen:
1. THINK IN TERMS OF DYNAMICS AND DEVELOPMENT RATHER THAN LABELS AND TRAITS. We can no longer think of autism or retardation as a "thing" a person "has." We can no longer view people's lives in terms of separate "genetic vs. environmental" influences. We can no longer credit static measures of cognition and performance such as I.Q. scores. Instead, we must learn to pay attention to the different and ever-evolving ways that people perceive and connect with the world, and think in terms of how we can facilitate the natural processes of human development.
2. CONSIDER DISABILITY AND DEVELOPMENT AS THE PRODUCT OF LARGER SYSTEMS OF RELATIONSHIPS, NOT AS THINGS THAT HAPPEN "IN THE HEAD." The development or disablement of a child can no longer be considered a "given" at birth or at diagnosis. Instead, we can recognize that these are processes played out in a larger context over which we all have influence. When children experience movement differences due to perceptual/regulatory problems in their nervous systems, these differences make it difficult for them to connect successfully with the people and objects that make up their environment, and their world may become very narrow. The nature, quality, and developmental appropriateness of the interactions which we help them to experience becomes of vital importance, since these interactions will establish a system of feedback for their emotional and cognitive development, which in turn will enhance their ability to make future connections.
3. FOCUS ON ADAPTATIONS AND ACCOMMODATIONS, NOT COSMETICS OR CURES. Emotional and cognitive development is a tightly-integrated, individual process which every child and adult must "own" -- that is, it can be facilitated but not forced. Interactions with the environment must make sense to the developing child, rather than being taught as a collection of isolated skills or rote performances. This process takes time: we can appreciate that there are no quick fixes and that undue attention to surface appearances (looking "normal") may have little developmental significance for the person with movement differences. The presence of a symptom is not just cause for deciding to eliminate it. Instead, decisions about intervention should be based on factors such as individual choice and safety. It is far more productive in the long run to adapt the environment and adjust our interactions to accommodate the person with movement differences.
4. INTERPRET BEHAVIOR WITH CAUTION AND IN CONTEXT. Knowing that someone experiences movement differences can protect us from that most common and dangerous movement disorder: jumping to conclusions. A person with movement differences may not stand still and look you in the eye, or may not register a facial expression that is clear to you, but that is no reason to assume that he or she is being avoidant, is asocial, or lacks interest and concern. The movement approach steers us away from subjective interpretations of other people's motives and intent, demonstrating that there are different body languages which must be interpreted by different rules.
How can I learn more?
The following books and articles, written from a wide assortment of backgrounds and perspectives, offer well- balanced food for thought. Many of the books are available through the Autism National Committee Bookstore, TEL 1-800-378-0386 for list and order form.
Damasio, Antonio R. (1994) Descartes' Error: Emotion, Reason and the Human Brain. New York: G. P. Putnam's Sons.
Donnellan, Anne. M., and Martha R. Leary. (1995) Movement Differences and Diversity in Autism/Mental Retardation: Appreciating and Accomodating People with Communication and Behavior Challenges. DRI Press, P.O. Box 5202, Madison, WI 53705.
Edelman, Gerald M. (1992) Bright Air, Brilliant Fire. New York: Basic Books.
Grandin, Temple. (1995) Thinking in Pictures and Other Reports from My Life with Autism. New York: Doubleday.
Greenspan, Stanley. (1995) The Challenging Child. New York: Addison-Wesley Publishing.
Leary, Martha R. and David A. Hill. (1996) "Moving On: Autism and Movement Disturbance," in Mental Retardation, Vol. 34, No. 1, pp. 39-53.
Lovett, Herb. (1996) Learning to Listen: Positive Approaches and People with Difficult Behavior. Baltimore, MD: Paul Brookes.
Maurer, Ralph. (1995) "Autism and the Cerebellum: A Neurological Basis for Intervention." Unpublished "work in progress." Send a SASE to the Publications Editor, Autism National Committee, 635 Ardmore Avenue, Ardmore, PA 19003.
Thelen, Esther, and L. B. Smith. (1994) A Dynamic Systems Approach to the Development of Cognition and Action. Cambridge, MA: MIT Press/Bradford Books.
Williams, Donna. (1992) Nobody Nowhere. London: Doubleday.
Williams, Donna. (1994) Somebody Somewhere. New York: Times Books.
This brochure was developed by Pat Amos (editor); Anne Donnellan, PhD; Mary Lapos; Martha Leary, MA CCC/SLP; Kathy Lissner-Grant; Ralph Maurer, MD; and Barbara Moran.
Published by the Autism National Committee (AUTCOM). AUTCOM was founded in 1990 to protect and advance the human rights and civil rights of all persons with autism, Pervasive Developmental Disorder, and related differences of communication and behavior, and to support positive and respectful research into the nature of movement and sensory differences.