Brain development, infant communication, and empathy disorders: Intrinsic factors in child mental health

Continuity and change in neural plasticity through embryonic morphogenesis, fetal activity-dependent synaptogenesis, and infant memory consolidation

There is an apparent continuity in human neural development that can be traced to venerable themes of vertebrate morphogenesis that have shaped the evolution of the reptilian telencephalon (including both primitive three-layered cortex and basal ganglia) and then the subsequent evolution of the mammalian six-layered neocortex. In this theoretical analysis, we propose that an evolutionary-developmental analysis of these general morphogenetic themes can help to explain the embryonic development of the dual divisions of the limbic system that control the dorsal and ventral networks of the human neocortex. These include the archicortical (dorsal limbic) Papez circuits regulated by the hippocampus that organize spatial, contextual memory, as well as the paleocortical (ventral limbic) circuits that organize object memory. We review evidence that these dorsal and ventral limbic divisions are controlled by the differential actions of brainstem lemnothalamic and midbrain collothalamic arousal control systems, respectively, thereby traversing the vertebrate subcortical neuraxis. These dual control systems are first seen shaping the phyletic morphogenesis of the archicortical and paleocortical foundations of the forebrain in embryogenesis. They then provide dual modes of activity-dependent synaptic organization in the active (lemnothalamic) and quiet (collothalamic) stages of fetal sleep. Finally, these regulatory systems mature to form the major systems of memory consolidation of postnatal development, including the rapid eye movement (lemnothalamic) consolidation of implicit memory and social attachment in the first year, and then-in a subsequent stage-the non-REM (collothalamic) consolidation of explicit memory that is integral to the autonomy and individuation of the second year of life.

Towards a comprehensive approach to mentalization-based treatment for children with autism: integrating attachment, neurosciences, and mentalizing

Autism spectrum disorder (ASD) is diagnosed based on socio-communicative difficulties, which are believed to result from deficits in mentalizing, mainly evidenced by alterations in recognizing and responding to the mental states of others. In recent years, efforts have been made to develop mentalization-based treatment (MBT) models for this population. These models focus on enhancing individuals' ability to understand and reflect on their own mental states, as well as those of others. However, MBT approaches for people with ASD are limited by their existing theoretical background, which lacks a strong foundation grounded in neuroscience-based evidence properly integrated with attachment, and mentalizing. These are crucial aspects for understanding psychological processes in autism, and as such, they play a pivotal role in shaping the development of tailored and effective therapeutic strategies for this specific population. In this paper we review evidence related to the neurobiological, interpersonal, and psychological dimensions of autism and their implications for mentalizing processes. We also review previous mentalization-based frameworks on the psychosis continuum to provide a comprehensive understanding of attachment, neurobiology, and mentalization domains in therapeutic approaches for autism. After presenting a synthesis of the literature, we offer a set of clinical strategies for the work with children with autism. Finally, we provide recommendations to advance the field towards more robust models that can serve as a basis for evidence-based therapeutic strategies.

Ancestral human mother-infant interaction was an adaptation that gave rise to music and dance

Human infants are born ready to respond to affiliative signals of a caretaker's face, body, and voice. This ritualized behavior in ancestral mothers and infants was an adaptation that gave rise to music and dance as exaptations for promoting group ritual and other social bonding behaviors, arguing for an evolutionary relationship between mother and infant bonding and both music and dance.

The rise of languaging

In this paper, we turn to languaging, defined here as activity in which wordings play a part. On such a view, while activity is paramount, people also orient to acts of vocalization as wordings. These physical wordings can be used as tools that shape attending, with recourse to neither mental representations nor symbols that store and transmit information. The view is consistent with macroevolutionary continuity and will be used to challenge appeal to a major evolutionary transition to 'language'. On the languaging view, like many modern social primates, hominins have long undertaken encultured activities. Infants, human and nonhuman, act epistemically and, by so doing, align skills with objects to practice. They develop a 'stance' to pragmatic, goal-directed action. In human ontogenesis, we argue, both epistemic action and the stance-taking are extended by vocalizing. Caregiver-infant coordination enables vocalizing to be integrated with acting, attending, perceiving and managing one's attention. Infants also self-entrain vocalizing through 'babble'. Once the developmental threads unite, social reaching (Bates, 1976) favors a special stance to articulatory gestures (one that allows wordings to be made and heard). Just as in orienting to cultural tools, a child grasps a community's ways-with-wordings. The latter often express abstract relations which we can illustrate with modern non-literate use of reciprocal expressions. In Australian and Pacific languages, reciprocals sustain coordinating that, for speakers, is neither symbolic nor arbitrary. Further, cross-linguistic comparison shows the same 'patchy distribution' of reciprocals that characterizes primate tool use. Of course, we do not deny that, in many language games, people can undertake activity that makes symbolic use of wordings. In modern literate societies, abilities based on social reaching are further extended into skills that use notational practices (e.g. letters, numbers, graphics). This opens up whole new fields or domains of languaging. Yet, ostensive use of symbols is plainly a cultural invention - not a direct legacy of hominin evolution.

Prevention of Medical Trauma in Children With Early Onset Scoliosis and the Use of Mehta Casting

Despite recent emergence of information about treatment of medical trauma in children, the literature remains sparse regarding prevention of medical trauma. Health-care professionals are in an ideal position to educate about and advocate for ways to prevent the far-reaching consequences of medical trauma, yet policies remain which at times contribute to the problem. This article presents practical approaches intended to reduce the likelihood of medical trauma in children receiving serial casting for treatment of progressive infantile scoliosis (PIS). The majority of the suggestions apply not only to children being treated for PIS, but to children receiving medical treatment for many conditions. The article also provides suggestions for parents who are enduring the stress of their child undergoing repeated surgeries and hospital stays. The authors interviewed a variety of experts in the field and draw on their own experiences as clinical social workers specializing in the treatment of post-traumatic stress disorder and developmental trauma in children.

The Identification of Autism in Children Referred to a Tertiary Speech and Language Clinic and the Implications for Service Delivery

The Edinburgh Children's Hospital speech clinic is a joint paediatric and speech therapy clinic which was first established in 1950 and accepts referrals of children for whom speech and language difficulties are the principal concern. An audit was conducted for children presenting consecutively over January 1993 to January 1994 to identify what proportion of these children had autism and related disorders. The mean age of presentation of all children seen was in their final pre-school year, with 80 percent of children already being managed in the community by other professionals such as speech and language therapists and educational psychologists. Of 103 children, 22 had autism or a related disorder. A retrospective analysis of parental report and clinical assessment at the first clinic consultation confirmed that a complaint of no communication with peers coupled with temper tantrums was highly predictive for membership of this group of disorders. The audit confirmed that the contribution of autism to the children's communication difficulties had not been fully recognized and addressed prior to the speech clinic consultation. The audit has informed our practice and we intend attracting clinical psychology and child psychiatry services into the speech clinic to enhance the service we deliver and also to employ our findings to highlight consideration of autism in the young child with speech and language difficulties.

“A great moment . . . because of the music”: An exploratory study on music therapy and early interaction with children with visual impairment and their sighted caregivers

The focus of this article is on how musical interaction can contribute to bonding and early interaction. This article is based on a music therapy project in a pedagogical institution for people with visual impairment. The study is qualitative and exploratory, where children with visual impairments (aged 1–4 years) and their caregivers participated in music therapy sessions over 10 weeks. Data have been collected by participant observation, video recordings, and interviews. Moments of positive interactions in music were selected and analyzed, and the selections were triangulated by interviews with the caregivers. The data material indicates that music therapy promotes positive bonding patterns and enhances early interaction. Musical interaction facilitates elements of early interaction that can be challenging for children with visual impairments and their sighted caregivers. Both caregivers and children seemed to experience one another as a source of joyful interaction. This article discusses the findings in the broader perspective of disability studies and community music therapy and argues that music therapy promotes positive interactions and empowerment of children with visual impairment and their caregivers.

Nonverbal communication, play, and language in Greek young children with Williams syndrome

This study investigated nonverbal communicative abilities, functional play, and symbolic play in 11 toddlers with Williams syndrome (WS) during spontaneous communication. The WS group was compared with a group of typically developing (TD) children matched for linguistic abilities. Results demonstrated that children with WS exhibited significantly less spontaneous functional play and imaginary play compared to TD children. On the other hand, children with WS showed significantly more showing and giving guided by their parents than TD children. In addition, it was shown that in both groups aspects of symbolic play are correlated with expressive as well as receptive language. These findings are interpreted through the Theory of Intersubjectivity, which contrasts with the Theory of Mind and suggests that shared arbitrary purposes regarding actions on objects constitute presuppositions for the development of language.

Effects of music therapy in the treatment of children with delayed speech development - results of a pilot study

Background

Language development is one of the most significant processes of early childhood development. Children with delayed speech development are more at risk of acquiring other cognitive, social-emotional, and school-related problems. Music therapy appears to facilitate speech development in children, even within a short period of time. The aim of this pilot study is to explore the effects of music therapy in children with delayed speech development.

Methods

A total of 18 children aged 3.5 to 6 years with delayed speech development took part in this observational study in which music therapy and no treatment were compared to demonstrate effectiveness. Individual music therapy was provided on an outpatient basis. An ABAB reversal design with alternations between music therapy and no treatment with an interval of approximately eight weeks between the blocks was chosen. Before and after each study period, a speech development test, a non-verbal intelligence test for children, and music therapy assessment scales were used to evaluate the speech development of the children.

Results

Compared to the baseline, we found a positive development in the study group after receiving music therapy. Both phonological capacity and the children's understanding of speech increased under treatment, as well as their cognitive structures, action patterns, and level of intelligence. Throughout the study period, developmental age converged with their biological age. Ratings according to the Nordoff-Robbins scales showed clinically significant changes in the children, namely in the areas of client-therapist relationship and communication.

Conclusions

This study suggests that music therapy may have a measurable effect on the speech development of children through the treatment's interactions with fundamental aspects of speech development, including the ability to form and maintain relationships and prosodic abilities. Thus, music therapy may provide a basic and supportive therapy for children with delayed speech development. Further studies should be conducted to investigate the mechanisms of these interactions in greater depth.

Trial registration

The trial is registered in the German clinical trials register; Trial-No.: DRKS00000343

The experience-dependent maturation of a regulatory system in the orbital prefrontal cortex and the origin of developmental psychopathology

The maturation of corticolimbic systems that neurobiologically mediate essential affective and social regulatory functions is experience dependent. During the first and second years of life, the infant's affective experiences, especially those embedded in the relationship with the primary caregiver, elicit patterns of psychobiological alterations that influence the activity of subcortically produced trophic bioamines, peptides, and steroids that regulate the critical period growth and organization of the developing neocortex. Interactive attachment experiences of psychobiological attunemcnt, stressful misattunement, and stress-regulating repair and reattunement that maximize positive and minimize negative affect are imprinted into the orbitofrontal cortex — the hierarchical apex of the limbic system that is expanded in the early developing right hemisphere. During the critical period of maturation of thissystem, prolonged episodes of intense and unregulated interactive stress are manifest in disorganizing experiences of heightened negative affect and altered levels of stress hormones, and this chaotic biochemical alteration of the internal environment triggers an extensive apoptotic panellation of corticolimbic circuitries. In this manner less than optimal affect-regulating experiences with the primary caregiver are imprinted into the circuits of this frontolimbic system that is instrumental to attachment functions, thereby producing orbitofrontal organizations that neurobiologically express different patterns of insecure attachments. Such pathomorphogenetic outcomes result in structurally defective systems that, under stress, inefficiently regulate subcortical mechanisms that mediate the physiological processes that underlie emotion. The functional impairments of the cortical-subcortical circuitries of this prefrontal system are implicated in an enduring vulnerability to and the pathophysiology of various later forming psychiatric disorders.

Intersubjectivity, affective neuroscience, and the neurobiology of autistic spectrum disorders: a systematic review

Intersubjectivity is an approach to the study of social interaction viewed from a perspective which rejects the view that reducing any such analysis to study at the level of the individual is adequate to address the issues of social functioning. It also stresses the view that social processes cannot be reduced to cognitive ones - most of the important questions in the study of developmental psychopathology deal with issues which have commonality with many other species and are patent well before the ontological emergence of 'cognitive' abilities. In this paper we review the evidence in this area, and discuss a range of issues relevant to autistic spectrum disorders. We focus in particular on social interaction; the role of the Intrinsic Motive Formation and recent work on mirror neurons in autism; genetic and teratogenic factors in the genesis of autism; and the role of a number of biological factors in pathogenesis - tryptophan; vitamin B12; sterol metabolism; glutamate and GABA; and the Fragile-X expansion.

Concept clarification of neonatal neurobehavioural organization

AIM

This paper is a report of a concept analysis of neonatal neurobehavioural organization for healthy full-term infants.

BACKGROUND

The neonatal period is an opportune time for researchers and clinicians to assess and intervene for optimal neurobehavioural organization. Yet there is inconsistency and lack of clarity in a scientifically grounded definition of neonatal neurobehavioural organization. Clarification of the concept will strengthen research findings that influence practice for optimal infant development.

METHOD

A concept analysis of the literature between 1939 and 2007 (n = 57) was conducted using Penrod and Hupcey's principle-based concept analysis and Morse's concept clarification.

FINDINGS

The concept analysis within and across multiple disciplines revealed: (1) a view of the concept as a holistic phenomenon with multiple dimensions; (2) no agreement on the ideal instrument to operationally define the concept; and (3) consistency in implied meaning, but great variability in terminology. Neonatal neurobehavioural organization was defined as the ability of the neonate to use goal-directed states of consciousness, in reciprocal interaction with the caregiving environment, to facilitate the emergence of differentiating, hierarchical, and coordinated neurobehavioural systems, with ever-increasing resiliency and capacity to learn from complex stimuli.

CONCLUSION

A clear conceptual definition will help the international community to communicate effectively within and between disciplines and to apply evidence-based research findings. It will encourage the development of valid and reliable instruments to capture the concept's multiple dimensions and direct attention to the infant's experience, which sculpts early neurobehavioural organization.

The parent-infant dyad and the construction of the subjective self

Developmental psychology and psychopathology has in the past been more concerned with the quality of self-representation than with the development of the subjective agency which underpins our experience of feeling, thought and action, a key function of mentalisation. This review begins by contrasting a Cartesian view of pre-wired introspective subjectivity with a constructionist model based on the assumption of an innate contingency detector which orients the infant towards aspects of the social world that react congruently and in a specifically cued informative manner that expresses and facilitates the assimilation of cultural knowledge. Research on the neural mechanisms associated with mentalisation and social influences on its development are reviewed. It is suggested that the infant focuses on the attachment figure as a source of reliable information about the world. The construction of the sense of a subjective self is then an aspect of acquiring knowledge about the world through the caregiver's pedagogical communicative displays which in this context focuses on the child's thoughts and feelings. We argue that a number of possible mechanisms, including complementary activation of attachment and mentalisation, the disruptive effect of maltreatment on parent-child communication, the biobehavioural overlap of cues for learning and cues for attachment, may have a role in ensuring that the quality of relationship with the caregiver influences the development of the child's experience of thoughts and feelings.

Varieties of musical experience

In this paper, we argue that music cognition involves the use of acoustic and auditory codes to evoke a variety of conscious experiences. The variety of domains that are encompassed by music is so diverse that it is unclear whether a single domain of structure or experience is defining. Music is best understood as a form of communication in which formal codes (acoustic patterns and their auditory representations) are employed to elicit a variety of conscious experiences. After proposing our theoretical perspective we offer three prominent examples of conscious experiences elicited by the code of music: the recognition of structure itself, affect, and the experience of motion.

Love hurts: The evolution of empathic concern through the encephalization of nociceptive capacity

Empathic concern for others is an essential motive for challenges of self-regulation at all developmental stages. A child who never develops the capacity for empathic concern may become an ineffective parent, such that developmental psychopathology propagates across generations. We draw on evidence and theory by Panksepp and associates that indicates that infant-mother bonding is mediated by opiate mechanisms. We review the neural systems of pain perception and find these are closely aligned with those for attentional and cognitive self-regulation. Analysis of the limbic and neocortical representations for interpersonal reasoning suggests there are important contributions from visceral, affective, and somatic and cognitive levels. We draw on modern learning theory to propose a critical role for frustration training in development to allow the child to achieve the capacity for tolerating psychological pain that allows effective empathic concern in later relationships.

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.

Developing a diagnostic and intervention package for 2- to 3-year-olds with autism: outcomes of the frameworks for communication approach

The aim of the research was to develop and evaluate a model of good practice which would make an explicit link between diagnosis and intervention, and so give parents a very clear rationale for the autism-specific yet individualized programme that they were carrying out. It employed an action research design, which essentially is responsive to participants, thus developing a user-friendly model of service. The programme was based on the developmental perspective that the pragmatics of language are the precursors of speech itself and enable both communication and relationship between child and parents. Since these are impaired in autism they should therefore be prioritized in early intervention. Ten children aged 1:10 to 2:9 at assessment, and with a diagnosis of autism, underwent an intervention based on home visits, modelling, workshops and written information, with parents as 'therapists' in naturally occurring situations. Within 18 months all children made substantial progress in social interaction and expressive communication, including gestural and verbal communication.

Autism as a neurodevelopmental disorder affecting communication and learning in early childhood: prenatal origins, post-natal course and effective educational support

Colwyn Trevarthen, working on autism, discussed the importance of time, rhythm and temporal processing in brain function. The brains of new born infants show highly coherent and coordinated patterns of activity over time, and their rhythms are remarkably similar to those of adults. Since the cortex has not yet developed, this coordination must be subcortical in origin. The likely source is the emotional motor system. He noted that the cerebellum might regulate the intricate timing of the development and expression of emotional communication. He also pointed out that emotional and motivational factors have often been seriously neglected in psychology (largely owing to a misplaced focus on 'cognition' as some isolated entity) and emphasized the potential importance of empathetic support and music therapy in helping autistic children.

Infantile spasms: facial expression of affect before and after epilepsy surgery

This is a longitudinal study of facial expression of affect in 28 children with intractable infantile spasms who underwent epilepsy surgery. After a mean follow-up period of 1.8 years, there was a significant increase in positive affect, a significant decrease in neutral affect, and no change in negative affect during a nonverbal communication paradigm. These findings were unrelated to surgical (i. e., side of surgery, type of surgery) or seizure-related variables (i.e., seizure control, age at onset of illness, duration of illness, change in antiepileptic drugs). Comparison of affect in a subgroup of 16 patients with those of 32 normal subjects suggest a normal age-related increase in the use of positive affect. Both before and after surgery, the patients used the most positive affect while not communicating. They also used significantly more positive affect during while requesting objects or assistance rather than during social referencing. Intractable infantile spasms might be associated with reduction in the facial expression of positive affect and with impaired use during social communication.

Self-organization of mother-child instructional dyads and later attention disorder

Instructor-learner interactions are viewed from the perspective of dynamically self-organizing, coordinated systems. Mothers were asked to instruct their preterm and full-term 24-month-old children to sort blocks according to size and color (a challenging task for children of this age). Dyads were observed for their ability to find a mutual and stable instructional relationship. Dyads in which the child was later identified as having attention-deficit/hyperactivity disorder (ADHD) were marked by significantly less stable organization, less mutuality, and greater perturbations in the system. Mothers of children later found to have ADHD tended to apply stronger constraints than those whose children grew up to have no identified school problems. Implications are drawn for optimal instruction of children who are at risk for central nervous system disorders.

Imitation in eight young infants with Down's syndrome

Imitation of tongue protrusion and mouth opening was studied in eight infants with Down's syndrome. Five of the children were observed at approximately 1 mo, seven around 3 mo, and seven at 4 mo. The only significant group result revealed imitation of tongue protrusion at 1 mo. In addition, a descriptive analysis of each child's response pattern during the presentation period showed that all five children observed at 1 mo imitated tongue protrusion and that four of them also seemed to imitate mouth opening. The result for the 3-mo observation was some-what inconsistent. All but one of the infants increased their response rates of both tongue protrusion and mouth opening when mouth opening was modeled. At 4 mo imitation seems to disappear. Overall, the findings are in agreement with what is known from typically developing children.

The concept of transcortical cell assemblies: a key to the understanding of cortical lateralization and interhemispheric interaction

According to Hebb, elements of higher cognitive processes, such as concepts, words and mental images, are realized in the brain as cortical cell assemblies, i.e. large and strongly connected neuron populations that form functional units. Neurons belonging to such assemblies may be scattered over wide cortical areas, and some cell assemblies may even comprise neurons of both hemispheres (transcortical assemblies). If full activation (ignition) of an assembly leads to fast circulation of neuronal activity in the assembly, this process should be visible in high-frequency cortical responses. Some evidence will be reviewed that cell assembly ignition indeed leads to changes in high-frequency cortical responses which can be recorded in the EEG and MEG. Within the cell assembly-framework, the question of cortical laterality translates into the question of how neurons of transcortical assemblies are balanced between the hemispheres. This approach allows for different degrees of laterality. Recent evidence is summarized that the degree of laterality indeed differs between language units. For example, the cortical representation of certain words appears to be strongly lateralized to the left hemisphere while those of others are less lateralized. If neurons of both hemispheres are part of one assembly bihemispheric processing should lead to a processing advantage compared to processing in the dominant hemisphere alone. The latter appears to be the case for lexical processing, as revealed by recent behavioral studies. In conclusion, the cell assembly-framework suggests a more fine-grained description of the issue of cortical laterality; it is not appropriate to ask whether "modules" supporting higher cortical functions are located either in the left or right hemisphere. Rather, it appears fruitful to ask how the neurons of transcortical cell assemblies are balanced between the hemispheres.

Lateral asymmetries in infancy: implications for the development of the hemispheres

Cerebral asymmetry of cognitive processing of stimulus information is commonly viewed as a neocortical phenomenon. However, a number of lines of evidence give innate asymmetry of brainstem motivating systems, which anticipate experience, a key role. Spontaneous asymmetries of gesture and emotion can be observed in infants, who entirely lack language and visuo-constructive skills. Motives for communication in early life may direct subsequent development of complementary cognitive systems in left and right hemispheres. In split-brain monkeys, lateralized motive sets, intentions for manipulation by one hand, can determine which hemisphere will see and learn. Evolutionary antecedents of cerebral asymmetry appear to affect motivation, social signalling and bimanual coordination, with secondary effect in perceptual processing and learning. The hemispheres of adult humans differ in links with neurochemical system that regulate motor initiatives, exploration and attention, and the approach/withdrawal balance in social encounters. Asymmetries in emotional and communicative behaviour in infancy support evidence that an Intrinsic Motive Formation emerging in the embryo human brain stem regulates asymmetries in development and in functioning of the cerebral cortex.

Epilepsy in early development: the lesson from surgery for early intractable seizures

This report examines the impact on development and the problems involved in assessing development in very young children with early-onset intractable seizures, particularly infantile spasms. A review of studies on medically and surgically treated children with infantile spasms underscores the relationship between seizure control and developmental outcome. About 50% of children with markedly intractable infantile spasms attained seizure control and significant improvement in the use of nonverbal communication, a developmental measure that has been used in other populations of developmentally delayed children. With the exception of duration of illness, clinical measures of age of onset of infantile spasms, type of surgery, and side of surgery did not appear to be related to the postoperative change in nonverbal communication. The neuropathology findings of surgically treated children with infantile spasms suggest that the underlying pathology occurs early in brain development. In conclusion, the cumulative effect of uncontrolled seizures and the underlying pathology might impact the early development of children with intractable infantile spasms.