Leary, Hill Revisit Evidence of Movement Disturbance in Autism

Newly published article concludes that movement study is the viable alternative to our present "socially interpreted" diagnoses of behavior

While a great many observers have recorded evidence of a vast number of movement disturbances in people diagnosed with autism -- from abnormal gait to facial grimacing to hand-flapping, rocking and spinning -- these have remained largely underinterpreted and their significance unappreciated. Martha R. Leary, MA, CCC-SLP, and her colleague David A. Hill, MA, CCC- SLP, thoroughly revisit this data in a newly-published article titled "Moving On: Autism and Movement Disturbance" (Mental Retardation, Vol. 34, No. 1, 39-53, Feb. 1996).

Leary and Hill begin their inquiry with the observation that a "cluster of socially interpreted behaviors" (p. 39) has always been used to define the syndrome of autism. While presumably offering objective definitions of symptoms, such basic diagnostic sources as the Diagnostic and Statistical Manual of Mental Disorders (DSM) in fact tend to present socially-defined interpretations or impressions of behaviors: for example, symptoms of autism are described as a child's "failure" or "preference" or "resistance" to engage in certain activities.

Despite the insistence of most experts in the field that autism is neurological in origin, many parents have complained that the very language of their child's diagnosis seemed to reinforce the Bettelheimian myth of autism as a psychological disturbance involving antisocial attitudes. As Leary and Hill put it, "Applying a social context to the behavior observed distracts from an appreciation of the possible neurological explanations for behavior." (p. 40).

The authors warn, however, that they are not proposing to add "movement disturbance" as yet another symptom of autism. They are not searching for "new areas of deficit" (p. 39) or for co-occurring conditions. (Readers will have noted numerous publications and conferences dedicated to "autism and obsessive- compulsive disorder," "autism and mental retardation," and so forth). Rather, Leary and Hill wish to inquire into the extent to which the concept of movement disturbance is useful in organizing and making neurological sense of the diverse symptoms of autism reported in the literature.

Movement disturbance is defined, for the purposes of this article, as "an interference in the efficient, effective use of movement that cannot be accounted for by paralysis or weakness." As such, it is "synonymous with a disruption in the regulation of movement." (p. 40). Leary and Hill present a chart comparing typical clinical features of movement disturbance with a wide variety of movement disturbance phenomena which they discovered through an extensive autism literature survey. These categories are also referenced to the DSM-III-R criteria for autism. The extent to which observations about people with autism, though often stated in judgmental language, actually correspond to clinical features of movement disturbance, leads Leary and Hill to speculate that even that core characteristic of autism -- difficulty communicating with and relating to others -- may have a previously unexplored relationship to movement disturbance. "Movement disturbance can clearly have a profound effect on a person's ability to regulate movement in order to effectively communicate, relate, and participate with others. Once this possibility is acknowledged, it becomes necessary to suspend absolute trust in one's intuitive interpretation of actions and intent. Behaviors may not be what they seem." (p. 44).

In making their plea for more attention to the neurological, rather than "sociological," symptoms of autism, Leary and Hill also note that this perspective would yield a more dynamic view of symptoms, helping us to understand why the performances of many people with autism are notably inconsistent and variable, and why some individuals develop additional symptoms over time (notably during adolescence). Making sense of behavior in terms of the way people diagnosed with autism actually experience it would also open the possibility of working with them to help develop practical techniques for self- regulation.