Early Signs of Autism

Transcription

1 10/7/14 Early Signs of Autism From Developmental Research to Practice Barbara Kalmanson, Ph.D. DIR / Floortime Coalition of California Lafayette, CA October 10, What are we looking for in the first year of life that could indicate the earliest signs of Autism Spectrum Disorder? 3 1

2 We have no definitive diagnostic signs in the first year of life If parents are concerned we should be too The earlier the intervention, the sooner baby and parents are back on track Research suggests the best outcomes with early intervention 4 Where should we be looking for signs? Objective measures of which behavior baby exhibits: orient to name point joint attention Interactional Synchrony: communication of subjective inner states how a behavior is performed in dyadic context 5 Autism researchers identify higher risk in infant sibs Most study measurable instances of baby behavior Most promising studies of eye tracking show areas of concern: reduced looking time at people and faces visual orienting disengagement of attention 6 2

3 Eye tracking studies are performed under experimental conditions 6 month old babies look at videos with social content Predictive eye movements develop typically between 2-4 months (this refers to the ability to keep up with external events) 7 Infant Start : A pilot study of autism intervention in the first year of life Looking at infants 7 15 months abnormal fixations repetitive motions decreased eye contact Parental training intervention: draw infant attention to parent s face and voice parent imitation of infant sounds and actions use of toys to support attention to social cues enjoyable activities 8 From an intervention perspective Would the best early indicators be found in looking for interactional synchrony? DIR model : shared attention, engagement, circles of communication Infant interaction research: inter-subjectivity, forms of vitality, affect attunement, implicit relational knowing Look to the work of: Greenspan, Stern, Trevarthen, Tronick, Beebe, Sander, Brazelton, Feldman 9 3

4 Affect Attunement Infants have innate cross modal perception they receive information from one sensory modality and translate it to another Parental attunement produces more gazing and positive vocalizing than maternal imitation 10 Synchrony and the Interactive Flow Rhythmic repetitions Ongoing matching of affective states Mirroring infant communicative signals Temporal aspects of intensity, shape and rhythm 11 Dyadic systems All interactions are based on simultaneous self and interactive regulation Each form of regulation affects the other 12 4

5 Co-construction of the interactive process The individual and the dyad form the organization of experience and behavior Locate the difficulties and the repair in the relationship rather than in one partner Each partner makes moment to moment adjustments to the other s shifts in behavior 13 We can use a dyadic systems view and the DIR model Early choreography of interactional synchrony Observable components of shared attention and engagement

6 Shared Attention Between birth and 3 months the baby attends to multi-sensory affective experiences While organizing a calm and regulated state. 16 Shared Attention Looking at people look/ look away cycle Looking at objects though preferring faces Orienting visually to voice Smiling at people match mismatch repair a b 17 Shared Attention Postural attunement Synchrony to voice Adjusts posture to people holding him Fluidity of motion Vocalizes when talked to Seeking contact with people Initiates or vetoes through gaze Quiets to being held or seeing faces Develops rhythm for being with partner 18 6

7 Engagement & Reciprocity The infant from 3-5 months shows evidence of affective preference and pleasure with caregivers 19 Engagement & Reciprocity Follows the movement of caregiver with gazebegins to understand the intention of others Laughs and joyful smiles at caregiver Affectionate reaching, touching Reciprocal social smiling, cooing, vocal play Adjusts posture to caregivers movement or holding 20 Engagement & Reciprocity Shows recognition of special care givers Shows anticipation Vocalizes to initiate socializing Stops crying when talked to 21 7

8 Vitality aspects of shared attention and engagement Affect cueing Pacing of interactions Temporal sequences Rhythmicity 22 Vitality aspects of shared attention and engagement Use of space Intensity of affect and movement Intention Integration cross modal responses 23 Thank You 24 8