Disorganized rhythm and synchrony: Early signs of autism and Rett syndrome


      We interpret early age-related developments in intentions and socially responsive behaviour with data from home videos of infants who later develop autism or Rett syndrome. Detailed evidence is given from a micro-analytic study of videos of monozygotic twin girls at 11 months, one of whom became autistic in the second year. Changes in this twin's attention, motor tonus, initiative and emotion reduce her prospective control of movements and her anticipations in awareness compared to her sister. These changes were reflected in the child's asynchronous social behaviour, which frustrated the father's attempts to support her attempts to walk, share toys, or play a game, confusing his anticipations, and this further reduced mutual attention and joint activity. Observations of the development of girls with Rett syndrome in the first year reveal changes in motor coordination, attention and communicative initiative, indicative of a failure of intrinsic core brain regulations of neural development and conscious activity. Notwithstanding that the two conditions show clear differences in both brain growth and early development of skills and sociability, the first signs of autism and Rett syndrome have important similarities. We conclude with recommendations for an approach to early diagnosis and treatment, applicable for the whole range of developmental brain disorders, including Rett syndrome and autism, that attempts to identify residual capacities for sympathetic motivation and collaborative learning—an approach that deliberately tries to support weakened rhythmic impulses for motor, perceptual and communicative functions in the growing infant brain.


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        • Hofer M.A.
        Hidden regulators in attachment, separation and loss.
        in: Fox N.A. The development of emotion regulation: biological and behavioral considerations. Monographs of the society for research in child development. vol. 59. 1994: 192-207
        • Aitken K.J.
        • Trevarthen C.
        Self-other organization in human psychological development.
        Dev Psychopathol. 1997; 9: 651-675
        • Trevarthen C.
        Fetal and neonatal psychology: intrinsic motives and learning behaviour.
        in: Cockburn F. Advances in perinatal medicine. Parthenon, New York1997: 282-291
        • Trevarthen C.
        • Aitken K.J.
        Infant intersubjectivity: Research, theory, and clinical applications.
        J Child Psychol Psychiatry. 2001; 421: 3-48
      1. Trevarthen C. Stepping away from the mirror: pride and shame in adventures of companionship: reflections on the nature and emotional needs of infant intersubjectivity. In: Carter CS, Ahnert L et al., editors. Attachment and bonding: a new synthesis. Dahlem Workshop Report 92. Cambridge, MA: The MIT Press 2005; in press.

        • Merker B.
        • Wallin N.L.
        Musical rsponsiveness in Rett disorder.
        in: Kerr A. Witt-Engerstrom I. Rett disorder and the developing brain. Oxford University Press, Oxford2001: 327-338
        • Burford B.
        • Trevarthen C.
        Evoking communication in Rett syndrome: Comparisons with conversations and games in mother-infant interaction.
        Eur Child Adolesc Psychiatry. 1997; 6: 1-5
      2. B. Hagberg, J. Aicardi, K. Dias, O. Ramos. A progressive syndrome of autism, dementia, and loss of purposeful hand use in girls: Rett syndrome: a report of 35 cases. Ann Neurol 1983;14:471–479

        • Kerr A.M.
        Early clinical signs in the Rett disorder.
        Neuropediatrics. 1995; 26: 67-71
      3. Kerr A. Witt-Engerstrom I. Rett disorder and the developing brain. Oxford University Press, Oxford2001
        • Trevarthen C.
        • Aitken K.J.
        Regulation of brain development and age-related changes in infants’ motives: The developmental function of “regressive” periods.
        in: Heimann M. Regression periods in human infancy. Erlbaum, Mahwah2003: 107-184
        • Trevarthen C.
        Intrinsic motives for companionship in understanding: Their origin, development and significance for infant mental health.
        Infant Ment Health J. 2001; 22: 95-131
        • Trevarthen C.
        The neurobiology of early communication: intersubjective regulations in human brain development.
        in: Kalverboer A.F. Gramsbergen A. Handbook on brain and behavior in human development. Kluwer, Dordrecht2001: 841-882
        • Trevarthen C.
        • Aitken K.J.
        Brain development, infant communication, and empathy disorders: intrinsic factors in child mental health.
        Dev Psychopath. 1994; 6: 597-633
        • Trevarthen C.
        Brain development.
        in: Gregory R.L. Oxford companion to the mind. 2nd ed. Oxford University Press, Oxford2004 (p. 116–127)
        • Panksepp J.
        Affective neuroscience: The foundations of human and animal emotions. Oxford University Press, New York1998
        • Kanner L.
        Autistic disturbances of affective contact.
        Nerv Child. 1943; 2: 217-250
        • Frith U.
        Autism and asperger syndrome. Cambridge University Press, Cambridge1991
        • Gillberg C.
        The Emanuel Miller memorial lecture: autism and autistic-like conditions: subclasses among disorders of empathy.
        J Child Psychol Psychiatry. 1991; 33: 813-842
        • Trevarthen C.
        • Aitken K.J.
        • Papoudi C.
        • Robarts J.Z.
        Children with autism: diagnosis and interventions to meet their needs. 2nd ed. Jessica Kingsley, London1998
        • Trevarthen C.
        Autism as a neurodevelopmental disorder affecting communication and learning in early childhood: prenatal origins, post-natal course and effective educational support.
        Prostoglandins Leukot Essent Fatty Acids. 2000; 63: 41-46
        • Frith U.
        • Happé F.
        Autism: beyond ‘theory of mind’.
        Cognition. 1994; 50: 115-132
        • Gillberg C.
        • Coleman M.
        Autism and medical disorders: a review of the literature.
        Dev Med Child Neurol. 1996; 38: 191-202
        • Pennington B.
        • Ozonoff S.
        Executive functions and developmental psychopathology.
        J Child Psychol Psychiatry. 1996; 36: 459-474
        • Dawson G.
        • Webb S.
        • Schellenberg G.D.
        • Dager S.
        • Friedman S.
        • Aylward E.
        • et al.
        Defining the broader phenotype of autism: Genetic, brain, and behavioral perspectives.
        Dev Psychopath. 2002; 14: 581-611
        • Jarrold C.
        • Happé F.
        Autism, Psychology.
        in: Nadel L. Encyclopedia of cognitive science. Macmillan, London2003: 283-286
        • Filipek P.A.
        • Accardo P.J.
        • Baranek G.T.
        • Cook E.H.
        • Dawson G.
        • Gordon B.
        • et al.
        Practice parameters: The screening and diagnosis of autistic spectrum disorders.
        J Autism Dev Disord. 1999; 29: 439-484
        • Osterling J.A.
        • Dawson G.
        • Munson J.A.
        Early recognition of 1-year-old infants with autism spectrum disorder versus mental retardation.
        Dev Psychopath. 2002; 14: 239-251
      4. Werner E, Dawson G, Osterling J, Dinno N. Brief report: recognition of autism spectrum disorder before one year of age: a retrospective study based on home videotapes. J Autism Dev Disord 2000;30:157–62.

        • Rapin I.
        Autistic children: diagnosis and clinical features.
        Pediatrics. 1991; 87: 751-760
        • Teitelbaum P.
        • Teitelbaum O.
        • Nye J.
        • Fryman J.
        • Maurer R.G.
        Movement analysis in infancy may be useful for early diagnosis in autism.
        Proc Nat Acad Sci USA. 1998; 95: 13982-13987
        • Baron-Cohen S.
        • Allen J.
        • Gillberg C.
        Can autism be detected at 18 months?, The needle, the haystack, and the CHAT.
        Br J Psychiatry. 1992; 161: 839-843
        • Baron-Cohen S.
        • Cox A.
        • Baird G.
        • Swettenham J.
        • Nightingale N.
        • Morgan K.
        • et al.
        Psychological markers in the detection of autism in infancy in a large population.
        Br J Psychiatry. 1996; 168: 1-6
        • Baird G.
        • Charman T.
        • Baron-Cohen S.
        • Cox A.
        • Swettenham J.
        • Wheelwright S.
        • et al.
        A screening instrument for autism at 18 months of age: a 6-year follow-up study.
        J Am Acad Child Adolesc Psychiatry. 2000; 39: 694-702
        • Kubicek L.F.
        Organisation in two mother-infant interactions involving a normal infant and his fraternal twin brother who was later diagnosed as autistic.
        in: Field T. Goldberg S. Stein D. Sostek A. High risk infants and children: adult and peer interactions. Academic Press, New York1980
        • Adrien J.L.
        • Lenoir P.
        • Martineau J.
        • Perrot Haumery L.
        • Larmande C.
        • Sauvage D.
        Blind ratings of early symptoms of autism based upon family home movies.
        J Am Acad Child Adolesc Psychiatry. 1993; 32: 617-626
        • Osterling J.A.
        • Dawson G.
        Early recognition of children with autism: a study of first birthday home videotapes.
        J Autism Dev Disord. 1994; 24: 247-257
        • Maestro S.
        • Casella C.
        • Milone A.
        • Muratori F.
        • Palacio-Espasa F.
        Study of the onset of autism through home-movies.
        Psychopathology. 1999; 32: 292-300
        • Maestro S.
        • Muratori F.
        • Barbieri F.
        • Casella C.
        • Cattaneo V.
        • Cavallaro M.C.
        • et al.
        Early Behavioural development in autistic children: the first 2 years of life through home movies.
        Psychopathology. 2001; 34: 147-152
        • Maestro S.
        • Muratori F.
        • Cavallaro M.C.
        • Pei F.
        • Stern D.
        • Golse B.
        • et al.
        Attentional skills during the first 6 months of age in autism spectrum disorder.
        J Am Acad Child Adolesc Psychiatry. 2002; 41: 1239-1245
      5. Maestro S, Muratori F, Cavallaro MC. et al. How young children with autism treat objects and people: a longitudinal study of the first year of life through home movies. 2004, in preparation.

        • Baranek G.
        Austim during infancy: a retrospective video analysis of sensory-motor and social behaviors at 9–12 months of age.
        J Autism Dev Disord. 1999; 29: 213-224
        • Haag G.
        Encounter with Francis Tustin.
        in: Mitriani T. Mitriani J.L. Encounters with autistic states: A memorial tribute to Frances Tustin, Northvale. Jason Aronson, London1997: 355-396
        • Brazelton T.B.
        • Koslowski B.
        • Main M.
        The origins of reciprocity: the early mother-infant interaction.
        in: Lewis M. Rosenblum L.A. The effect of the infant on its caregiver. Wiley, New York1974: 49-76
      6. Trevarthen C, Marwick H. Cooperative understanding in infants. Project report to the Spencer Foundation of Chicago. Department of Psychology, The University of Edinburgh; 1982.

        • Stern D.N.
        The first relationship: infant and mother. Harvard University Press, Cambridge1977
        • Piontelli A.
        Twins: from fetus to child. Routledge, London2002
        • Trevarthen C.
        • Marwick H.
        Signs of motivation for speech in infants, and the nature of a mother's support for development of language.
        in: Lindblom B. Zetterstrom R. Precursors of early speech. Macmillan, Basingstoke1986: 279-308
        • Armstrong D.
        • Kinney H.C.
        The neuropathology of Rett disorder.
        in: Kerr A. Witt-Engerstrom I. Rett disorder and the developing brain. Oxford University Press, Oxford2001: 57-84
        • Kerr A.M.
        • Stephenson J.B.P.
        A study of the natural history of Rett's syndrome in 23 girls.
        Am J Med Genet. 1986; 1: 77-83
        • Kerr A.M.
        • Montague J.
        • Stephenson J.B.P.
        The hands and the mind, pre- and post-regression, in Rett syndrome.
        Brain Dev. 1987; 95: 487-490
        • Nomura Y.
        • Segawa M.
        The monoamine hypothesis in Rett syndrome.
        in: Kerr A. Witt-Engerstrom I. Rett disorder and the developing brain. Oxford University Press, Oxford2001: 205-225
        • Wigram A.
        • De Backer J.
        Clinical applications of music therapy in developmental disability, paediatrics and neurology. Jessica Kingsley, London1999
        • Elefant C.
        Speechless yet communicative: Revealing the person behind the disability of Rett syndrome through clinical research on songs in music therapy.
        in: Aldridge D. Di Franco G. Ruud E. Wigram T. Music therapy in Europe. ISMEZ, Rome2001
        • Trevarthen C.
        • Burford B.
        Early infant intelligence and Rett syndrome.
        in: Kerr A. Witt-Engerstrom I. Rett disorder and the developing brain. Oxford University Press, Oxford2001: 303-326
        • Leonard H.
        • Bower C.
        Is the girl with Rett syndrome normal at birth?.
        Dev Med Child Neurol. 1998; 40: 115-121
      7. Garreau B, Carmagnat C, Suavage D. Rett syndrome and autism: a comparative study with home movies. Research report, Département de Psychopathologie de l'Enfant et de Neurophysiologie du Développement, C.H.U. Brettonneau, 37044. Tours Cedex:France; 1996.

        • Swettenham J.
        • Baron-Cohen S.
        • Charman T.
        • Cox A.
        • Baird G.
        • Drew A.
        • et al.
        The frequency and distribution of spontaneous shifts of attention between social and non-social stimuli in autistic, typically developing, and non-autistic developmentally delayed infants.
        J Child Psychol Psychiatry. 1998; 395: 747-753
        • Trevarthen C.
        Autism sympathy of motives and music therapy.
        Enfance. 2001; 1: 86-99
        • Gutstein S.E.
        • Sheely R.K.
        Relationship development intervention with young children.
        Social and emotional development activities for asperger syndrome, autism, PDD and NLD. Jessica Kingsley, London2002
        • Sigman M.
        • Capps L.
        Children with autism: a developmental perspective. Harvard University Press, Cambridge1997
        • Schore A.N.
        Affect regulation and the repair of the self. Norton, New York2003
        • Tiergerman E.
        • Primavera L.
        Imitating the autistic child: Facilitating communicative gaze behaviour.
        J Autism Dev Disord. 1984; 14: 27-38
        • Nadel J.
        • Pezé A.
        Immediate imitation as a basis for primary communication in toddlers and autistic children.
        in: Nadel J. Camioni L. New perspectives in early communicative development. Routledge, London1993: 139-156
        • von Tetzchner S.
        Facilitated, automatic and false communication: current issues in the use of facilitating techniques.
        Eur J Spec Needs Edu. 1996; 111: 151-166
        • Lovaas O.I.
        • Smith T.
        Intensive behavioral treatment for young autistic children.
        in: Lahey B.B. Kazdin A. Advances in clinical child psychology. vol. II. Plenum, New York1988: 285-324
        • Schopler E.
        • Mesibov G.B.
        • Shigley R.H.
        • Bashford A.
        Helping autistic children through their parents: The TEACCH model.
        in: Schopler E. Mesibov G.B. The effects of autism on the family. Plenum Press, New York1984: 65-81