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The Theoretical Principles of the Body-Centered Therapy to Promote Affective Attunement in Children with Autism Spectrum Disorder

Authors:
  • Independent Researcher

Abstract

The roots of autism spectrum disorders become evident in first attunement mechanisms between mother and child that allow a first level of mentalizing. Neurosciences and current developmental theories confirm the existence of defensive mechanisms related to body and affectivity that psychodynamic theories had already highlighted. Reading child’s behavior not only by administering tests but also through careful clinical observations allows a better understanding of the communication and social difficulties present in autistic children. The identification of the zone of proximal development can promote a therapeutic intervention that respects the individuality of the child and the specificity of his relational approach to the world. Conclusion: The paper presents the theoretical principles of a bodycentered therapy to promote the attunement processes necessary to activate cognitive resources.
Journal of Behavioral and Brain Science, 2017, 7, 545-556
http://www.scirp.org/journal/jbbs
ISSN Online: 2160-5874
ISSN Print: 2160-5866
DOI:
10.4236/jbbs.2017.712039 Nov. 22, 2017 545 Journal of Behavioral and Brain Science
The Theoretical Principles of the
Body-Centered Therapy to Promote
Affective Attunement in Children with
Autism Spectrum Disorder
Magda Di Renzo
Institute of Ortofonologia (IdO), Rome, Italy
Abstract
Background:
The roots of autism spectrum disorders become evident in first
attunement mechanisms between mother and child that allow a first level of
mentalizing. Neurosciences and current developmental theories confirm the
existence of defensive mechanisms related to body and affectivity that psy
-
chodynamic theories had already highlighted. Reading childs behavio
r not
only by administering tests but also through careful clinical observations
allows a better understanding of the communication and social difficulties
present in autistic children. The identification of the zone of proximal
development can promote a therapeutic intervention that respects the indi
-
viduality of the child and the specificity of his relational approach to the
world.
Conclusion:
The paper presents the theoretical principles of a body
-
centered therapy
to promote the attunement processes necessary to activate
cognitive resources.
Keywords
Autism Spectrum Disorders, Body-Centered Therapy, Affective Attunement,
Mentalizing, Clinical Observation
1. Introduction
As it is well known, a number of changes were made to pervasive developmental
disorders (PDDs) in the recently released Diagnostic and Statistical Manual of
Mental Disorders, 5th edition [1]. The proposed DSM-5 criteria for autism spec-
trum disorders have been reduced so that the ASD symptoms are best represented
How to cite this paper:
Di Renzo, M.
(201
7)
The Theoretical Principles of the
Body
-Centered Therapy to Promote Affec-
tive Attunement in Children with Autism
Spectrum Disorder
.
Journal of Behavioral
and Brain Science
,
7
, 545-556.
https://doi.org/10.4236/jbbs.2017.712039
Received:
September 26, 2017
Accepted:
November 19, 2017
Published:
November 22, 2017
Copyright © 201
7 by author and
Scientific
Research Publishing Inc.
This work is
licensed under the Creative
Commons Attribution International
License (CC BY
4.0).
http://creativecommons.org/licenses/by/4.0/
Open Access
M. Di Renzo
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10.4236/jbbs.2017.712039 546 Journal of Behavioral and Brain Science
in a two-domain model of social-communication deficits and restricted and re-
petitive interests/behaviors (RRB). Aiming towards a dimensional approach, the
DSM-5 emphasizes the concept of spectrum to reflect a continuum that defines
more accurate and descriptive specifiers
(Severity level; Co-existing conditions
and genetic or medical diagnoses; Intellectual functioning; Language level) that
need a thorough clinical evaluation. The definition of diagnostic specifiers, in
fact, requires the professional, in addition to the use of standardized tests, even a
good expertise in collecting clinical and anamnestic data for being integrated
with the direct observation of the child. The latter, in fact, can never be replaced
by the exclusive use of scores obtained in the assessment process.
It seems clear, in this perspective, the competence that the clinician must have
regard to development and its facets. Otherwise, the risk is to define a diagnostic
framework only for the presence of symptomatic behaviors, without considering
a causal elaboration for each behavior, without highlighting the potential present
and without a precise definition of the areas that need intervention in terms of
priority in the genesis of the disorder.
The observation must then consider the different ways in which the autistic
child expresses his atypia in cognitive, language, behavioral and emotional areas,
to be able to place the therapeutic intervention in the zone of proximal devel-
opment indicated by Vygotskij [2].
In this perspective, the developmental approach, which takes into account all
the components that come into play during growth, can provide the right tools
to deal with the diagnostic and therapeutic process with full respect for the indi-
viduality of each child. The developmental model gives importance to the childs
motivation to learn and the naturalness of the context in facilitating those nor-
mal tuning processes that form the basis of relationships and therefore of com-
munication [3]-[15].
2. Main Context
This article aims to highlight the importance of adopting a developmental ap-
proach which defines the zone of proximal development so considering the body
dimension as an essential basis to activate the resources of the child and help
him in that attunement process he lacks. This could stimulate a motivating
communication in the child.
The latest developmental and neuroscientific researches show that knowledge
is the result of a process that starts from the bodily-affective area to arrive slow-
ly, and through required steps, to the mental dimension.
Apart from ethiopathogenesis, what we can find in the autistic child is an ar-
rest in the attunement development that determines a serious failure in the imi-
tation processes, a distortion in sensory and emotional processing and, as a re-
sult, a deficit in the cognitive dimension.
The authors of psychodynamic approach, interested in the phenomenology of
the disorder, showed different defensive mechanisms that all refer to a peculiar
M. Di Renzo
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way of experiencing and living the body dimension.
Frances Tustin pointed out that when the autistic child experiences the sepa-
ration from the mother before he has developed the transitional activity de-
scribed by Winnicott, he starts to generate pathological auto-sensuous reactions
instead of expected fantasy, imagination, thought and play [16] [17] [18] [19]
[20].
In the typical early childhood development autistic objects are normal and
gradually give way to the creation of fantasies and illusions and finally to the
thought. In autistic children who instead do not accept the separateness from the
mother, these objects are manipulated in a stereotypical, over-materialized, only
bodily way because these children have never learned to “tolerate” the world as it
is and then to adjust to it. Autistic sensation objects [17] are, therefore, material
objects, “protections” (used in place of the parents and not to evoke their ab-
sence) and are opposed to the development of thought.
The auto-sensuous reactions, as opposed to what normally happens in the
early stages of a childs life, do not allow to define a bodily boundary because
they are kept alive to divert the attention of the autistic child from everyday ex-
periences. Autistic sensation shapes [18], acting as bodily traces of previous
pleasant experiences, allow the child to console and defend himself from the
sense of loss or abuse of the outside world stimuli.
In recent years Smith [21], with his empathy imbalance hypothesis, argued
that autistic behaviors and stereotypic patterns are defenses the children with
autism develop to manage the excess of feelings and emotions that are not ad-
dressed in the relationship. In this view, the autistic behavior is an adaptive re-
sponse to empathic imbalance. Avoidance behavior, obsessive interests, and in-
sistence on routines may regulate the stress that stems from living among people
whose behavior is difficult to comprehend but whose emotions are all too readily
sensed.
Donald Meltzer [22] described the defensive mechanisms related to the body
through the concepts of sensory dismantling and adhesive identification stress-
ing that the autistic child has a form of primitive permeability which makes him
extremely vulnerable to the outside world. According to the author, autistic
children have a particular speed in mental processes that makes them prone to
perceive stimuli from the outside world as a sort of bombardment.
Through the dismantling, autistic children fragment the experience so to no
longer perceive it as dangerous because this form of segmentation makes im-
possible any form of integration. Since the dismantling is a defensive mechanism
earlier than the splitting, it allows the parceling of the experience which occurs
through the passive attitude of the child and that constantly diverts him from the
relationship with the object. Thanks to the underlying mechanism that is the
adhesive identification, the child is able to adhere completely to the surface of
objects avoiding to perceive the three-dimensionality which gives them depth, so
eluding the experience of limit that anticipates the sense of separateness.
The adhesive identification also provides an explanation of the preference that
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autistic children have for the proximal senses than distal.
The sense of touch, for example, promotes the experience of merging, the ba-
by seeks, whereas hearing or sight confront him with that distance that he would
cancel and that are thus weakened. Fordham [23], considers the autism as a dis-
order of the Self, as a distorted state of integration, owing its persistence to fail-
ure of the Self to deintegrate. Fordham proposed the term deintegration as a
property of the Self behind the ego formation. The Self deintegration is therefore
understood as a normal stage of development in which the child is able to recog-
nize objects as different from the Self (through the physiological process of inte-
gration and deintegration that allows the differentiation of the original psycho-
somatic unity). Reconnecting to immunological researches that discovered the
existence of defensive reactions carried out to cancel or reject the not self-ob-
jects, Fordham assumed that only the objects assimilable from the Self can pro-
mote vital biochemical processes and, in the case of autism, a functional disinte-
gration occurs to hold off the not self-objects, that is a kind of auto-immune
disease that prevents vital processes.
Damasio [24], more recently, showed that the Self
is built in stages, is con-
structed starting from the meeting of the body with the outside world objects,
according to primordial feelings. These are spontaneous reflections of the state
of the living body which form the basis of cognitive processes. The Self comes to
mind from the sensations belonging to the brain stem, which represents, in his
opinion, not a mere conduit for signals, but a first decisional location, a center of
information processing.
The protoself
is an integrated collection of separate
neural patterns that map, moment by moment, the most stable aspects of the
organism’s physical structure, it is a sort of deep root that cannot be alienated.
The knowledge that makes conscious our mind must be built according to a
bottom-up mode, from body to brain. The conscious mind emerges from a link
between the body and the object of knowledge. Primordial feelings, produced by
the protoself, precede all other feelings and uniquely refer to the living body that
is interconnected with its specific brain stem.
According to Damasio [25], in brief, in the cognitive process we can distin-
guish the following steps: 1) an object involves the body when it is looked at,
touched or heard from a specific perspective, 2) the involvement induces a
change in the body, 3) the object’s presence is felt, 4) the object has been made
prominent, 5) the object becomes part of the childs knowledge and settles in the
memory. The Self, therefore, comes to mind in the form of images that narrate,
without interruption, the story of these entanglements.
What these authors have shown, in physiological or pathological sense, it is
the centrality of the body in child development, hypothesis also supported by
Stern’s studies about inter-subjectivity which highlighted the importance of the
affective attunement. The mechanisms underlying it are the amodal properties
of experience (intensity, time, shape, movement and number) that allow the in-
terchangeability of sensory modes for the different behavioral expressions. What
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characterizes the attunement, distinguishing it from other mechanisms, is its
ability to respond not only to affective categories but also to vital affections such
as the increasing and decreasing of excitement. This possibility guarantees the
continuity of the mother-child experience and allows, in the developmental
process, to experience the vital affections in the form of dynamic changes in
ourselves or in others.
The affective attunement assumes the presence of imitation and contagion
which both express an exclusive interest in overt behavior and which are both
interfered in the autistic children. The child, according to this perspective, is not
able to get the mirroring nor can respond to the variations on a theme that
mother provides him [9] (Stern 1985) because the imitation, already lacking,
cannot favor an adequate affective attunement. Gaddini [26] highlighted the fact
that in the first weeks of life the child perceives through bodily modifications
respect to the object and that the differentiation of perception and memory sys-
tems starts from this early communion of perception and physical imitation.
What Gaddini stressed so bright is the fact that the first manifestations of the
imitation process have to do with being and not with having, so that the imita-
tive conducts can be considered as precursors of the ego adaptation processes.
In this perspective, the autistic disorder consists of a lack or a significant defi-
ciency in the imitation processes that can be defined as a difficulty to pass from
the stage of imitate to perceive to the stage of imitate to be. This is a child’s dif-
ficulty in getting hold, in the sense of Winnicott [27] [28] [29] from the emo-
tional dimension of the mother which is predominantly expressed by bodily di-
mension through the modulation of muscle tone intended as an essential ele-
ment for the transition to the imitate to be.
The tonic dialogue [30] between mother and child, as well as forming the basis
for the future development of empathy, also allows the construction of a plot for
the semantic processing of the contents carried in the relationship. Without the
hug that holds and that allows the child to recognize himself as a separate indi-
vidual there can be no exploration in the world nor the ability to respond to the
other.
More recently Reddy [13], commenting on the imitation studies of Nadel [12],
emphasized the interpersonal dimension already present from the first days of
life with regard to imitation, showing that emotional involvement is essential al-
so for the repetition of those simple gestures, such as tongue protrusion, that
before were seen only through an intra-individual perspective. Many authors
confirmed this hypothesis by moving more and more attention also to the gesta-
tional period as the beginning of possible attunement, so that Trevarthen [5]
coined the term sinus rythm to refer to the existing dialogue between mother
and baby during pregnancy.
Neuroscience highlighted the fact that the inter-subjective characteristic of
first experiences, as well as outlined until now, in the brain is sustained by the
presence of mirror neurons.
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Through the embodied simulation [31] it is possible to experience and then
understand the tactile and painful experience of other people simply observing
them, because even the only others’ observation activates the same neural cir-
cuits that are responsible for others’ feeling. The word simulation is to be un-
derstood as an attempt to mimic the characteristics of a process in order to assi-
milate its essence and is expressed as a modeling mechanism. In this sense it dif-
fers from the process proposed by the “simulation theory” (as a result of a deli-
berate act of will) because it is characterized as an automatic process, not con-
scious and predeclarative.
The classical cognitive approach, which expresses the vision of a fully disem-
bodied human mind, in the sense that the ability to understand others’ inten-
tions would simply be due to met are presentations, appears, in light of this,
simplistic and inadequate to the complexity of the situation [32]. Through the
mechanism of embodied simulation, which enables two different bodies to share
a functional state, the “objectual other” becomes “another self” and thanks to
this it is possible to build the foundations for social intelligence. In this sense the
body, simultaneously perceived as a place of subjective and objective experience,
allows the structuring of that perception of the personality experience that can
be attributed also to the others. The same sensory-motor circuits that control
body movements and perception, in fact, give structure to abstract thought too
[33] [34]. This identity relation, which is transversal to all the forms of interper-
sonal relationships, is defined by Gallese [32] as shared manifold hypothesis and
promotes, as already underlined, the intersubjectivity and the attribution of in-
tentionality to the others. The impossibility of building a we-centric space, as a
basis for establishing a connection with the intentional relations of others, does
not allow the development of a resonance able to favor anticipations of the be-
havior of others. Experimental data on postural attitudes show that autistic
children are not able to use feed-forward mechanisms but essentially use the da-
ta coming from the sensory periphery, unable to adopt anticipatory postural at-
titudes. Experiments with high-functioning autistic subjects showed that recog-
nition and imitation of other people’s emotions occurs through different strate-
gies from those used by normal subjects (there is an absence of the premotor
mirror circuit, underactivation of insula and amygdala and a hyperactivity of the
visual cortex). The lack of embodied simulation does not allow, in this case, to
give an experiential content to the emotions of others and access to the other
would remain limited to the cognitive interpretation of sensory conveyed by an
external event.
In the Italian developmental approach called Turtle Project [35] the focus of
the intervention is constituted from the body’s relationship with the child that
also involves parents in individual and/or group settings. The fundamental ob-
jective is to help parents to interpret the atypia of the child for creating a shared
care that could form the basis for a first form of communication. Meet the need
of the child, as mothers know usually do, is quite different from helping the
child to mentalizing his need. To make this happen it is necessary that adult does
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not refuse the child’s dysfunctional behaviors, as occurs with the use of behavior
modification techniques, but that accept and transform them to kick off that
kind of dance [9] which allows to bring within the context variations on a theme.
Only starting from such tuning can be activate the imitation mechanism that al-
lows the child to imitate to be rather than imitate to perceive.
The reverie capacity [36] [37] of the mother may in fact be reactivated if the
therapist is able to make interpretable for her the childs behavior and, only in
this case, the mother can start to put in place that hypothesis of semantic nature
[38] [39] [40] which founds other’s mind. The communication starts from the
format [41] that is established within the context when the mother, regardless of
the intention of the child, can give a meaning to his actions because it is only the
mind of the other which can found in the autistic child a mental state that makes
him a talking of his native language.
In Turtle Project [35] dyadic therapy is privileged just to allow a new form of
relationship that helps the child to live the dependence in a new form and to
learn new patterns of communication. Unlike what happens in other approach-
es, the therapist is an active part in the interaction, a living companion [42] act-
ing as a facilitator for communication and as a model to be imitated by parents
who do not yet know how to respond and interpret the mainly bodily child’s
messages. The therapist is there, as Winnicott would say [43] [44], where the
child can meet him, and helps the mother-child pair to tolerate the inevitable
frustrations that arise from the difficulties in finding an attunement. An attune-
ment which applies only to that child who is in relationship with his mother, and
not to a couple in an abstract sense, because every relationship is unique, and
each individual is what becomes according to the personal patrimony and in
reference to the stimuli received from the environment. Learn to tolerate the in-
evitable frustrations necessary to find the same significance to the events is what
founds the profound sense of language and that allows the learning of meanings
shared by the community.
In a general sense the aim of the developmental approach of Turtle Project is
to create natural settings in which to support, through a bodily intervention, the
developmental trajectories of each child, helping him to integrate the various
senses and to meet the body of other people without being afraid of.
In this sense, besides the dyadic therapy, group interventions are proposed to
enable the embodied simulation with peers in motivating contexts where the
mirroring of dysfunctional behaviors acts as a further stimulus to attune. In the
peer group supported by therapists (at least 2 professionals to 4 children) the
child find a natural framework in which give shape, that is format [41] contents
not yet integrated and where, at least initially, also the dysfunctionality can be-
come an adaptive form if the others can understand or share it. The objectives,
calibrated for the single group, are gradually modified to allow more structured
communication layers and the expansion of language occurs as the childs need
to exchange and not for imposition from outside. In this way, also the modeling
that the therapist puts in place to improve the linguistic expression is accepted as
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main driver of the relationship and not as incomprehensible claim for a perfor-
mance.
Once the child is able to find a good level of attunement with the outside
world, it is possible to propose him more structured interventions that support
the cognitive development with modalities more advanced than those necessary
to be present to the other in an affective relationship.
To demonstrate how the bodily-affective dimension is crucial in the structur-
ing of the autistic disorder and how it takes priority over the cognitive dishar-
mony some studies [45] [46] [47] [48] highlighted, through the evaluation pro-
tocol called T.U.L.I.P.1, how a sample of 49 children, regardless of the ADOS
score [49], showed a better ability to understand intentions and emotions of the
others. By monitoring the group during 4 years of Turtle Project therapy [35]
there was evidence that the results were significantly better as early as the end of
the second year of therapy, compared with children who had a worse outcome at
the T.U.L.I.P. protocol testing. As well as allowing the identification of the zone
of proximal development, the T.U.L.I.P. protocol clearly shows that the main
obstacle to the development is determined by the lack of those basic attunement
mechanisms that are highlighted through the UOI and the TCE [47].
This approach requires, as can be seen from the above reflections, a therapist
competence both in the field of the development theories to calibrate the inter-
vention according to the developmental level of the child, both in the relational
area in order to contain the anxieties, the frustrations, the attacks on linking
[36], the atypical behavioral that dot the intervention with parents too. That is
why in Turtle Project approach there are psychotherapists of developmental age
and professionals with specialized developmental relationship training.
3. Conclusions
This theoretical and clinical framework allows to elaborate also the emerging
difficult emotional dynamics. The knowledge of the technique itself is not suffi-
cient to guarantee the capacity to hold child’s and own’s reactions, because the
risk is to put in place aggressive behaviors to evade the sense of impotence felt.
The rigidity of some methods colludes with the persistence of the child to pro-
tect himself from the outside and amplifies his obsessive behaviors giving rise to
an unsuccessful escalation which can be transformed only if profoundly elabo-
rated by the therapist. It is not useful to answer the segmentation with a symme-
trical behavior because the primary goal is to encourage a possible integration.
On the other hand, the indispensable premise of the intervention is starting from
the child and not from the symptoms present, this to ensure, besides the change,
also his right to childhood. The starting point is always the body as a place of
primordial feelings that need to be gathered, accepted and elaborated from the-
1The
T.U.L.I.P
. protocol investigates the autism severity through the ADOS, the IQ through the Le
i-
ter-R, the ability to understand the intentions of others through the Understanding of Other Inte
n-
tion (UOI) test and the
presence of emotional contagion through the Emotional Contagion Test
(TCE).
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rapist’s mind in order to share and mentalize experiences.
It appears necessary, especially in the early stages of therapy, that the inter-
vention is not fragmented among different operators and disciplines because this
would collude with the already existing fragmentation of the child and his con-
text while therapists must act as facilitators in all directions. Multiple operators
may work in the Turtle Project approach because they all perform the living
companion function. This activates the existing resources by channeling the
energies of the child towards the next stage of development without having to
distinguish too early the psychomotor intervention from the speech therapy, be-
cause the child needs to integrate his knowledges at the time when he lives them,
so the words acquire their deep meaning if they arise from the action and if are
shared in the play. The ludic dimension, that is to play and do not play games, is
what should characterize all interventions so that enjoyment and motivation
could activate the cognitive functions. To get involved is what promotes the ac-
tivation of the ludic area that should never be confused with the use of games for
educational purposes but is constituted by shared action that generates pleasure
and encourages to look for the other, in order to avoid those self-stimulations
which, in absence of other, allow the child to experience few moments of rest. In
a research conducted to assess the efficacy of the developmental approach [35],
in a sample of 80 autistic children, significant improvements were founds in all
developmental areas: significant change was found on Cognitive abilities (F2, 78
= 32.06, p < 0.001;
η
2 = 0.29); on ADOS score (F2, 78 = 65.15; p < 0.001,
η
2 =
0.45); on Stereotyped behaviors (Wilks’ lambda: 0.76; p < 0.001,
η
2 = 0.24). In
fact, after 4 years of therapy, 31 children (39%) came out from the ADOS diag-
nostic category of autism, and 14 children (15%) changed ADOS diagnosis from
autism to spectrum. The other children, although remaining in the same ADOS
diagnostic classification, showed a decrease in the ADOS score and consequently
also in the autistic symptomatology for all the areas taken into account (com-
munication, reciprocal social interaction, play, restricted and repetitive beha-
viors). Another significant finding emerged from the research in question, was
the increase in IQ score in the most of the children (%) which showed that lo-
wering the defenses and growing the relational opening, if realized through an
intervention that uses the body in the rehabilitative relationship with the child,
make it possible a better use of the cognitive potential.
In light of the foregoing, it would be advisable that the bodily dimension was
more considered in the treatment of children in the autistic spectrum and that it
was given greater importance to the psychomotor area during the assessment
and naturally during the therapeutic process.
The future perspective of therapies for children with autism spectrum disorder
should therefore be to promote more and more the attunement processes that
involve the body as a place of primordial affection and feelings. The inter-
changeability of sensory modes, activated by the attunement processes, in fact,
supports behavioral expressions paving the way for the structuring of cognitive
processes. If the child has been able to experience the various sensory elements,
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learning how to adjust depending on interaction with each other, he will have
the tools needed for solving the problems that world experience requires.
Cognitive maturity, as Bruner points out [50], depends on the relationship of
enactive, iconic and symbolic systems of representation.
Compliance with Ethical Standards
All procedures performed in studies involving human participants were in
accordance with the ethical standards of the institutional and/or national research
committee and with the 1964 Helsinki declaration and its later amendments or
comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in our
previous studies and citated in this paper.
References
[1] American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental
Disorders (DSM-5). Washington DC.
[2] Vygotskjy, L.S. (1934) Thought and Language. MIT Press, Cambridge.
[3] Trevarthen, C. (1977) Descriptive Analyses of Infant Communicative Behavior. In:
Schaffer, H.R., Ed.,
Studies in Mother-Infant Interaction
, Academic Press, London,
227-270.
[4] Trevarthen, C. (1998) The Concept and Foundations of Infant Intersubjectivity. In:
Braten, S., Ed.,
Intersubjective Communication and Emotion in Early Ontogeny
,
University Press, Cambridge, 15-46.
[5] Trevarthen, C. (2001) Infant Intersubjectivity: Research, Theory, and Clinical Appli-
cations.
Journal of Child Psychology and Psychiatry
, 42, 3-48.
https://doi.org/10.1111/1469-7610.00701
[6] Schore, A. (2003) Affect Dysregulation and Disorders of the Self. Norton, New
York.
[7] Schore, A. (2012) The Science of the Art of Psychotherapy. Norton, New York.
[8] Tronick, E. (2007) The Neurobehavioral and Social-Emotional Development of In-
fants and Children. Norton, New York.
[9] Stern, D. (1985) The Interpersonal World of the Infant. Basic Books, New York.
[10] Stern, D. (1995) The Motherhood Constellation: A Unified View of Parent-Infant
Psychotherapy. Basic Books, New York.
[11] Stern, D. (2004) The Present Moment in Psychotherapy and Everyday Life. Norton,
New York.
[12] Nadel, J. (2014) How Imitation Boosts Development in Infancy and Autism
Spectrum Disorder. Oxford University Press, Oxford.
[13] Reddy, V. (2008) How Infants Know Minds. Harvard University Press, Cambridge.
[14] Eisenberg, N. (1995) Social Development. Sage Publications, Thousand Oaks.
[15] Feldman, R. (2007) Parent-Infant Synchrony and the Construction of Shared Tim-
ing: Physiological Precursors, Developmental Outcomes, and Risk Conditions.
Journal of Child Psychology and Psychiatry
, 48, 329-354.
M. Di Renzo
DOI:
10.4236/jbbs.2017.712039 555 Journal of Behavioral and Brain Science
https://doi.org/10.1111/j.1469-7610.2006.01701.x
[16] Tustin, F. (1972) Autism and Childhood Psychosis. Hogarth, London.
[17] Tustin, F. (1981) Autistic States in Children. Routledge, London.
[18] Tustin, F. (1986) Autistic Barriers in Neurotic Patients. Karnac Books, London.
[19] Tustin, F. (1990) The Protective Shell in Children and Adults. Karnac Books, Lon-
don.
[20] Tustin, F. (2013). Autistic States in Children. Revised Edition, Routledge, London.
[21] Smith, A. (2009) The Empathy Imbalance Hypothesis of Autism: A Theoretical Ap-
proach to Cognitive and Emotional Empathy in Autistic Development.
The Psycho-
logical Record
, 59, 489-510. https://doi.org/10.1007/BF03395675
[22] Meltzer, D. (1975) Explorations in Autism: A Psychoanalytical Study. Clunie Press,
Perthshire.
[23] Fordham, M. (1976) The Self and Autism. Medical Books, London.
[24] Damasio, A. and Carvalho, G.B. (2013) The Nature of Feelings: Evolutionary and
Neurobiological Origins. Nature Reviews.
Neuroscience
, 14, 143-152.
[25] Damasio, A. (2010) Self Comes to Mind: Constructing the Conscious Brain. Pan-
theon Books, New York.
[26] Gaddini, E. (1969) On Imitation.
International Journal of Psycho-Analysis
, 50,
475-484.
[27] Winnicott, D.W. (1965) The Family and Individual Development. Tavistock, Lon-
don,
[28] Winnicott, D.W. (1965) Maturational Processes and the Facilitating Environment:
Studies in the Theory of Emotional Development. Hogarth Press, London.
[29] Winnicott, D.W. (1974) Fear of Breakdown.
International Review of Psychoanalysis
,
1, 103-107.
[30] Wallon, G. (1947) Les origines de la penseè chez lenfant. [The Origins of Thinking
in Children.] Presses Universitairesde France, Paris.
[31] Gallese, V. (2001) The “Shared Manifold” Hypothesis: from Mirror Neurons to
Empathy.
Journal of Consciousness Studies
, 8, 33-50.
[32] Gallese, V. (2003) The Roots of Empathy: The Shared Manifold Hypothesis and the
Neural Basis of Intersubjectivity.
Psychopathology
, 4, 24-47.
https://doi.org/10.1007/BF03395675
[33] Gallese, V. and Lakoff, G. (2005) The Brains Concepts: The Role of the Sensory-Motor
System in Conceptual Knowledge.
Cognitive Neuropsychology
, 22, 455-479.
https://doi.org/10.1080/02643290442000310
[34] Hobson, R.P. and Lee, A. (1999) Imitation and Identification in Autism.
Journal of
Child Psychology and Psychiatry
, 40, 649-659.
https://doi.org/10.1111/1469-7610.00481
[35] Di Renzo, M., Bianchi di Castelbianco, F., Vanadia, E., Petrillo, M., Racinaro, L. and
Rea, M. (2016) From the Emotional Integration to the Cognitive Construction: The
Developmental Approach of Turtle Project in Children with Autism Spectrum Dis-
order.
Autism Open Access
, 6, 160.
[36] Bion, W.R. (1962) Learning from Experience. William Heinemann, London.
[37] Bion, W.R. (1967) Second thOughts. William Heinemann, London.
[38] Bruner, J.S. (1973) The Relevance of Education. Norton, New York.
[39] Bruner, J.S. (1991) Self-Making and World-Making.
Journal of Aesthetic Education
,
M. Di Renzo
DOI:
10.4236/jbbs.2017.712039 556 Journal of Behavioral and Brain Science
25, 67-78. https://doi.org/10.2307/3333092
[40] Bruner, J.S. (1999) The Intentionality of Referring. In: Zelazo, P.D., Astington, J.W.
and Olson, D., Eds.,
Developing Theories of Intention
:
Social Understanding and
Self-Control
, Mahwah, Erlbaum, 329-339.
[41] Bruner, J.S. (1983) Childs Talk: Learning to Use Language. Norton, New York.
[42] Alvarez, A. (2012) The Thinking Heart: Three Levels of Psychoanalytic Therapy
with Disturbed Children. Routledge, Hove.
[43] Winnicott, D.W. (1971) Playing and Reality. Tavistock, London.
[44] Winnicott, D.W. (1989) Psychoanalytic Explorations. Karnac Books, London.
[45] Di Renzo, M., Bianchi di Castelbianco, F., Petrillo, M., Racinaro, L. and Rea, M.
(2015) Assessment of a Long-Term Developmental Relationship-Based Approach in
Children with Autism Spectrum Disorder.
Psychological Reports
, 117, 26-49.
https://doi.org/10.2466/15.10.PR0.117c15z8
[46] Di Renzo, M., Bianchi di Castelbianco, F., Vanadia, E., Petrillo, M., Racinaro, L. and
Rea, M. (2016) Assessment of Executive Functions in Preschool-Aged Children with
Autism Spectrum Disorders: Usefulness and Limitation of BRIEF-P in Clinical
Practice.
Journal of Child and Adolescent Behavior
, 4, 313.
https://doi.org/10.4172/2375-4494.1000313
[47] Di Renzo, M., Bianchi di Castelbianco, F., Vanadia, E., Petrillo, M., Racinaro, L. and
Rea, M. (2016) T.U.L.I.P. Protocol (TCE, UOI, Leiter-R as Indicators of Predictivity)
for the Assessment of the Developmental Potential in Children with Autism Spec-
trum Disorders.
Autism Open Access
, 6, 188.
https://doi.org/10.4172/2165-7890.1000188
[48] Di Renzo, M., Bianchi Di Castelbianco, F., Petrillo, M., Racinaro, L., Donaera, F.
and Rea, M. (2016) The Emotional Contagion in Children with Autism Spectrum
Disorder.
Austin Journal Autism & Related Disability
, 2, 1020.
[49] Lord C., Rutter M., Di Lavore P.C. and Risi S. (2005). ADOSAutism Diagnostic
Observation Schedule. O.S. Organizzazioni Speciali, Firenze.
[50] Bruner, J.S. (1966) Toward a Theory of Instruction. Harvard University Press,
Cambridge, Mass.
Abbreviation Note List
Pervasive Developmental Disorders (PDDs)
Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)
Restricted and Repetitive Behaviors (RRB)
Emotional Contagion Test (TCE)
Understanding of Other Intention (UOI)
Leiter International Performance Scale-Revised (LEITER-R)
Autism Diagnostic Observation Schedule (ADOS)
TCE, UOI, Leiter-R as Indicators of Predictivity (T.U.L.I.P.)
... As children with ASD often show specific difficulties in processing experiences, responding to social interactions and using symbolic play as well as engaging in unusual behaviors and reactions, to be attuned with their children may represent a particular challenge for parents [3,31]. During infant-parent interactions, infants are able to form mental representations mainly based on emotional and somatic components, hereafter referred to as the affective-bodily dimension [32]. To better understand the interactions with their children with ASD, parents should mostly consider the affective-bodily dimension of individuals with ASD in different life situations [33]. ...
... The "dynamic forms of vitality" are perceptual motor gestalt conveying vital affects or the affective exchanges between mother and child. During infant-parent interactions, infants are able to form mental representations mainly based on emotional and somatic components or the affective-bodily dimension [32]. ...
... Subsequent studies have shown that lower levels of emotional attunement and synchrony in parents during naturalistic play are associated with higher ASD symptomatology [38] and that mothers who accept their child's diagnosis are more likely to be sensitive to their children while playing [39]. A 2018 study [32] was conducted with a sample of 11 fathers of children with ASD using a narrative methodology and the fathers' play interactions with their children were investigated. The data showed that parents who were more attuned and capable of accepting their children's play interests and who showed less adherence to the social norms of the play were also more accepting during the play narratives. ...
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Parents of children with autism spectrum disorder (ASD) have to address various challenges mainly due to their children’s atypia related to communication, emotion regulation and behaviors, arising also within the relationship with their caregivers. Several studies have pointed out that children with ASD can exhibit many difficulties regarding initiating and maintaining meaningful relationships with others. To date, little research has explored the interactions between children with ASD and their fathers, focusing more on mothers. In the context of parent–child interactions in the presence of autism, recent studies have highlighted the importance of parental attunement but there is little research considering solely the affective-bodily dimension. Therefore, the aim of the present study was to explore the parental attunement in fathers of children with ASD observed during play interactions and to investigate the relationship between paternal attunement and the perception of their psychological characteristics related to care relationships. The results highlight that fathers who describe themselves as better in affective care and sensitivity toward others more likely have an absence of paternal attunement during play interactions. The data presented are discussed in the light of intervention hypotheses, aimed at improving the relationship between fathers and children with autism.
... In this context, a developmental atypia of the first affective attunement in children with autism spectrum disorder could be related to alterations of that functional mechanism of our brain that allows us to understand the sense of motor behavior of others, using our own states or mental process, that is the embodied simulation (Gallese, 2006). The difficulty of giving an experiential content to others' emotions and in developing imitative processes represent central elements in the autistic organization and consequently should be considered primary targets of therapy (Di Renzo, 2017). Smith (2009) suggested the presence of an imbalance between cognitive and emotional strategies, consequently, the child with ASD may experience an emotional overload when managing internal states. ...
... For many years, The Institute of Ortofonologia (IdO) has based its diagnostic and therapeutic processes for children with ASD, or at specific risk, on an integrated, multi-professional, developmentalrelationship-body mediated approach which is represented by the DERBBI method and Turtle Project (Di Renzo et al, 2016a;Di Renzo, 2017). This approach considers both of the interrelated cognitive and affective components (Alvarez, 2012;Bion, 1967;Freud, 1965;Stern, 2004;Winnicott, 1989). ...
... It involves therapeutic interventions that consider the child's individual profile, defines the areas of deficit, and enhances the emotional-relational and cognitive potential (Schore, 2003(Schore, , 2012Stern, 2004). The therapeutic project for this developmental stage is centered on bodily dimensions and on the adequate attunement of the mother-child dyad (Anzieu et al., 1987;Di Renzo et al., 2017;Trevarthen, 2001). The difference between this intervention in relation to other developmental models, both interactive and behavioral (i.e., DIR, TED, ESDM), is the use of the therapist's body as a communication tool. ...
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Autism spectrum disorder (ASD) is a neurodevelopmental disorder displaying individual impairments in social interaction, communication skills, interest and behaviours. In the last decade several studies have been published on the approaches that can be used with ASD children. This study illustrated the therapeutic approach of the DERBBI method, defined as a relational and body based intervention. The research described the symptoms and emotional development outcomes of ASD children aged 21–66 months, after 2 of the 4 years of planned therapy; the study group included both children who had received a diagnosis of autism and children (under 30 months) who had a risk of developing symptoms. Approximately 78% of the children with a more severe ASD symptomatology after two years of therapy maintained this diagnosis, instead, among children with a less severe ASD symptomatology, about the 67% after two years of therapy no longer fulfilled the ADOS-2 criteria for autism. Among the children who were at risk of developing the autistic symptomatology, about the 42% no longer showed this risk after 2 years of therapy. The improvements that the children showed in their ability to understand the intentions of others and to contact the emotions of others were also investigated. The findings of this study have underlined the importance of early positive indicators which, among the Autisms, could be defined a specific subpopulation that get better benefits from such a type of intervention.
... As mentioned above, the debate on attunement is still open and the authors vary in their formulation of this construct (Mesman and Emmen, 2013). The tool we used for the assessment of the parental attunement, which is currently being validated, was specifically b u i lt f o r a s s essing interaction within parent and child with autism, guided by our theoretical basis and specific t herapeutic i ntervention, f ocused o n children body and sensory processing to promote the ability to be responsive to others' signals, understanding them and replying to them appropriately (Di Renzo, 2017). To overcome these limitations, future studies should involve a larger and less heterogeneous sample and include additional measurements of parental attunement. ...
... The importance of starting and supporting a process of acceptance relating to the child diagnosis (Guerriero et al., 2017a,b;Guerriero and Di Folco, 2017;Freda et al., 2019;Waizbard-Bartov et al., 2019) and parental insightfulness could support the relational experiences that determine the child "way of being" that is strongly connected to the non-verbal aspects of parental communication, especially parental attunement (Di Renzo, 2017). According to Trevarthen and Delafield-Butt (2013), responsive and attuned communication and a pattern of timed and sensitive actions can compensate for children experiencing repetition of uncertain and anxious attempts, when psychomotor attunement with perceptive and motor experiences become confused (LaGasse and Hardy, 2013). ...
Article
Full-text available
Early parent–child relationships are an important factor influencing many domains of child development, even in the presence of autism. In this study, we investigated the associations between parent–child attunement during play, parental insightfulness, and parental acceptance of their child’s diagnosis of an autism spectrum disorder. A sample of 50 parents (26 mothers and 24 fathers) of 26 children aged between 24 and 58 months were videotaped during parent–child play interactions and then interviewed about what they thought had gone through their child’s head during the play interaction, and about their feelings and thoughts about their child’s diagnosis. Play interactions were evaluated using a coding protocol to assess parental attunement. The results showed that parents who were more able to accept their child’s diagnosis and to see things from their child’s perspective were more likely to also be attuned during play interactions with their children. These findings highlight the importance of studying the parental ability of insightfulness and acceptance of their child diagnosis of ASD for the implementation of intervention programs for supporting parental attunement and improving the interactions between the parents and the children with autism spectrum disorders.
... It is through the tonic dialog (Toledo, 2009) between mother and child that the child will develop a series of skills. Emotional involvement in the dyad is also fundamental to the repetition of those simple gestures, such as the protrusion of the tongue, which were previously only seen through an intraindividual perspective (Di Renzo, 2017). But this pas de deux, as other studies on prenatal life point out, is nothing more than the continuation of a rhythm already established during pregnancy. ...
Article
Full-text available
A baby’s first year of life is a time of immense development and cerebral plasticity. Following today’s research and clinical observation, the period of the first year of life provides a new challenge inasmuch it is presently clear that it is possible to identify developmental anomalies in this window of time. Effecting early screening procedures could prove very useful, especially where we find genetic vulnerabilities in brothers and sisters of autistic subjects. Interventions of this kind, already practiced by some Public Health systems, can mean taking early action and primary protective measures with significant impacts not only on the subjects (babies and family members) concerned, but also on the public purse. It is, therefore, essential to provide for specific professionalized procedures for psychologists, pediatricians and neuropsychologists to be introduced through personnel highly specialized in interventions during the first year of life.
... Dopo la conferma della diagnosi, tutti i bambini, in entrambe le regioni di residenza, sono inseriti nello stesso progetto terapeutico riabilitativo per il disturbo dello spettro autistico (modello DERBBI -Developmental, Emotional Regulation and Body-Based Intervention) (Di Renzo, 2017;. Tale modello di intervento si focalizza sulla rimodulazione delle interazioni comunicative dei bambini attraverso la psicocorporeità. ...
Article
Full-text available
I disturbi dello spettro autistico sono caratterizzati da difficoltà nell'interazione socio-comunicativa, dalla presenza di comportamenti e interessi ristretti e ripetitivi. In determinate circostanze, ad esempio durante un periodo di lockdown, quando l'isolamento sociale e il distanziamento diventano obbligatori per tutti, in particolare per le famiglie con un bambino con disturbo dello spettro l'interruzione delle routine quotidiane (scuola, terapia, tempo libero) rischia di minare il lavoro terapeutico e i progressi che faticosamente le famiglie avevano raggiunto fino a quel momento. In questo studio abbiamo monitorato 81 famiglie di bambini con disturbo dello spettro, valutandole prima dell'inizio della pandemia e circa 4 mesi dopo, per verificare quali comportamenti dei bambini fossero peggiorati e quali invece fossero rimasti stabili o anche migliorati. Le famiglie sono state intervistate, a febbraio e luglio 2020, attraverso rating scale standardizzate e i risultati hanno evidenziato un intensificarsi nei bambini di irrequietezza motoria, difficoltà nella regolazione del sonno, mentre non sono emersi peggioramenti nelle condotte autolesive o etero-aggressive, né nelle autonomie personali. Va considerato che tutte le famiglie coinvolte nella presente ricerca erano inserite in percorsi terapeutici e non hanno interrotto il percorso di supporto psicologico (online), con lo specifico obiettivo di sostenerli nel loro ruolo genitoriale nelle fasi più critiche vissute dai bambini, e nel renderli sempre più attivi nei processi di consolidamento delle competenze acquisite dai bambini.
... Regarding the IQ, although the ASD-OO children had higher initial scores than the ASD-ASD group, the children in both groups showed improvements over time in cognitive functions (IQ) regardless of the chronological age factor and the initial autism severity score. This increase can be interpreted as the emergence of previously unexpressed potential [36]; meaning that, when symptomatology decreases, planning and organization skills can emerge more easily [25]. It should also be noted that the children included in this study followed a rehabilitation path based on a developmental approach [12] that focuses its intervention on mainly psycho-physical rather than cognitive activities, so the improvement in cognitive functioning is not a consequence of specific enhancements. ...
Article
Full-text available
Background: Autism spectrum disorder is a complex condition with wide variation in type and severity that involves persistent challenges in social interaction, speech and nonverbal communication, restricted/repetitive behaviours and adaptive behaviours. In recent years, research has deepened the study of the predictive factors of optimal outcome, intended as indicators of positive trajectory in children with a previous diagnosis of autism who, after a therapeutic path, show a significant reduction in the “core” symptoms of autism and a positive evolution in social, adaptive, affective, and relational skills. Methods: The study included 40 children aged 21 to 66 months, enrolled between 2015 and 2016 for an autism spectrum disorder clinical suspicious. Children were re-evaluated after at least 2 years of therapy and they were divided into two groups: the ASD-ASD group included children with a confirmed diagnosis of ASD, and the ASD-OO comparison group included children who no longer met the criteria for an autism classification. The aim of this retrospective study was to investigate the presence of cognitive, emotional and relational predictors capable of predicting the presence of optimal outcome in with a diagnosis of autism; the predictors taken into consideration were the intelligence quotient, the play, the emotional contagion and the understanding of other’s intentions. In this way, it is possible to support clinicians in defining a more complete diagnostic framework of autism, using assessment tools that can be administered quickly and therefore suitable for short observation sessions in paediatric patients. Results: The findings showed that 15 out of 40 children, after at least for 2 years, no longer fell into the diagnostic ASD category based on the ADOS-2, DSM-5 and clinical criteria. The children in the ASD-OO group initially had a higher IQ than those in the ASD-ASD group, lower severity of autistic symptoms, greater understanding of intentions, more emotional contagion, and better quality of play. The results suggest that the initial coexistence of skills in these areas at the time of the first diagnostic assessment may allow us to predict the possibility of achieving optimal outcome after 2 years of therapy. Conclusions The data of this study highlight the importance of considering, during assessment, intelligence quotient, play, emotional contagion, and understanding of the intentions of others as potential prognostic predictors that can become useful tools for clinicians and paediatricians. This allows us to focus attention, in both the diagnostic and prognostic phases, on emotional-relational variables that can support the clinician in defining a more complete diagnostic framework and in planning a more personalized therapeutic path.
... The Turtle Project is an example of a program that both reflects and contributes to the evidence base of autism interventions, through various studies that have shown an assessment protocol useful for capturing the complexity and the uniqueness of every child [114,116,117]. Furthermore, the studies deepening the effectiveness of the Turtle Project highlighted the protective factors identified during the diagnostic assessment and useful in predicting children's developmental trajectories and children for whom this type of treatment could lead to a greater improvement in symptoms [113,114,118,119]. Third, recent papers have brought new reflections on the need to customize the intervention according to the characteristics not only of the autistic disorder but above all of the child and his/her family. ...
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Developmental approaches characterized interventions based on the typical sequences of the child's development, paying particular attention to the linguistic, motor and socio-emotional aspects, within a relational perspective. The purpose of this paper was to identify developmental interventions for children with Autism Spectrum Disorders (ASD) aged between 0 and 12 years old. A literature review was carried out searching on MEDLINE, PsycINFO, and PsycARTICLES and manually on key journals and reference lists of key articles [...] This review highlights the need for improved research on intervention programs and the important service needs for families and children with Autism Spectrum Disorders.
Article
Full-text available
This study examined the effectiveness of a theraplay-based program that incorporated music as a rhythm-mediated component to facilitate attunement among children in 2 age groups. A total of 15 children, with 7 in the younger group (aged around 4 years) and 8 in the older group (aged around 6 years), participated in an 11-week program conducted in a group format. Data were collected before and immediately after the program. The children were evaluated using a questionnaire on social responsiveness as well as a performance-based rhythm matching task on attunement. The results indicated significant changes in children’s responsiveness to others. The effect size, particularly for the younger group, was also large. The qualitative data indicated stronger progress among children in the younger group. Despite the use of a small sample, the results of this study suggest a promising effect of rhythm and music in a theraplay-based program for facilitating children’s synchronization and ability to establish connections. Limitations of the study and future directions are described.
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This study examines the context of executive functioning in preschool children with Autism Spectrum Disorders (ASDs) and verifies the degree of agreement between the compilation of the Behavior Rating Inventory of Executive Functions-Preschool Version (BRIEF-P) by parents and therapists. To this end, parents and professionals of 46 ASD children aged between 24 and 71 months completed the BRIEF-P in order to highlight the level of agreement between these two different evaluators and then investigate the correlations between executive functions impairment, the degree of autistic symptomatology, the level of cognitive development, the chronological age and the therapy duration. The results showed that parents tend to underestimate the impairment of executive functions in ASD children compared to what estimated by specialized operators. A low level of agreement was found between the two evaluators. Moreover, both for parents and professionals, the EF impairment was not related to the severity of autistic symptoms, assessed with the ADOS-2, while it was correlated to cognitive development in professional evaluations, and to chronological age and therapy duration in parental evaluations. These results indicate that, even if among the pathogenic assumptions about ASDs there has been included also that of the EF impairment, this, if present, does not correlate with the severity of autistic symptoms. With regard to cognitive development, the greater correlation between cognitive and executive impairment seems to be rather obvious. The use of the BRIEF-P completed by parents allows them a greater awareness but does not add clinical data to the diagnosis.
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The article aims to highlight some predictive indicators of improvement in ADOS scores in a group of 49 children with Autism Spectrum Disorders. For this purpose we created a specific protocol named T.U.L.I.P. that, using the Fluid Reasoning of the Leiter-R, the presence of Emotional Contagion (TCE) and the ability to understand the intentions of the others (UOI) as predictive indicators, can identify a category of autistic children who positively respond to treatment and improves the autistic symptomatology. The children who at the intake had predictive indicators of Emerging or Present UOI and TCE improved their autistic symptomatology with therapy and some of them (those with Present indicators) positively changed their ADOS diagnosis. In pre-school children, or in the first year of their schooling, the assessment of cognitive and social components shows that relational skills have a greater importance in predicting the decrease of the ADOS scores. The presence of predictive indicators, especially on the emotional response and the ability to understand the intentions of the others, also helps to work through a developmental- relational approach that activates in children their existing potentialities to get improvements even in the cognitive functioning. The Social Affection component of the ADOS correlates with predictive indicators and accounts for an intervention targeted to the emotional dimension.
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The author addresses the field of infant mental health. He draws on his experience - in both the lab and the clinic - to present an integrated model of treatment for both infants and their parents.
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There has been a widely held belief that people with autism spectrum disorders lack empathy. This article examines the empathy imbalance hypothesis (EIH) of autism. According to this account, people with autism have a deficit of cognitive empathy but a surfeit of emotional empathy. The behavioral characteristics of autism might be generated by this imbalance and a susceptibility to empathic overarousal. The EIH builds on the theory of mind account and provides an alternative to the extreme-male-brain theory of autism. Empathy surfeit is a recurrent theme in autistic narratives, and empirical evidence for the EIH is growing. A modification of the pictorial emotional Stroop paradigm could facilitate an experimental test of the EIH.