autism | pre-autism | focused help | international pre-autistic network | references
Autism
Autism occurs in 1 in every 500 births.
It is the third most common developmental disability following mental retardation and cerebral palsy. A recent study in London reports that 1% of the child population in the UK has a diagnosed autistic spectrum disorder (Baird et al 2006). In the U.S. the incidence (the amount of newly diagnosed cases every year) and prevalence (the population of people with autism) are growing a rate of 10-17% per year (Autism Society of America).
Autism affects the forming of relationships.
Consequentially, it affects communication and language skills as well. Emotional development and the development of imagination also suffer. An autistic spectrum disorder is a condition which disregards borders, social class, and cultural settings, is found in every country, and reaches across ethnic, religious and economic strata.
Experts still argue about the causes.
Currently there is thought to be no medical detection, treatment or cure. In 1993, researcher Stefan
Dzikowski documented over one hundred different theories and approaches. The present debate includes a wide range of questions, such as whether this developmental disorder of early childhood is caused by brain dysfunction, genetic deficits, food allergies, vaccination damage, cognitive deficits such as lack of "theory of mind", environmental factors, a combination of some of these and many more.
The impact on family life can be devastating.
Pre-autism
We can recognize the signs of autism in infants and intervene early.
Autism is not diagnosed in the UK until a child is 2½ years old. However many parents express concerns about their child’s (un)willingness to relate to them from as early on as a few months! Evidence is coming in from around the world showing that "pre-autistic" behaviours may be detected in babies who display bonding difficulties, do not make eye contact, withdraw from touch, do not respond to their parent’s voice, or do not make babbling sounds (Danon-Bolieau 2006, Maestro et al 2002; Trevarthen 1998, 2002, 2005).
There is hope.
Intuition and psychotherapeutic work with young children with autism at The Parent Infant Clinic (the clinical arm of the School of Infant Mental Health) have encouraged a great deal of thinking about the kind of particular help that truly benefits a pre-autistic. We have been helping babies from 4 days old and we are increasingly able to demonstrate how avoidant and distant behaviour in the first months of life can be helped so that the autistic symptomatology doesn’t even get formed. This has happened if the intervention comes early enough and is well enough informed and if the early intervention is met with enough favourable potential in the child.
There's a new way to reach "distant" (pre-autistic) babies.
Beginning in the early 1980s, Stella Acqurone, PhD organised clinical research in London Health Centres and Paediatric and Child & Adolescent Departments in hospitals to pay attention to mothers who had concerns about their infants. She wanted to treat the "problem" at an early stage. Over the years, she made and supervised over 3,500 early psychoanalytic interventions and developed a process of "attuning" to babies. The major features of this process are:
• It provides psychoanalytical tools such as transference and the countertransference...and
• These non-verbal tools are deeply related to internal processes...and
• These processes are important to discover and verbalize in the mother (father) as well as for the infant.
Attuning to pre-autistic babies is the complex key to unlocking best results.
Because three percent (3%) of the population Dr Acquarone treated were babies showing early autistic behaviour, or some kind of communication disorder, she developed an "early intervention" approach to open a channel of communication to "distant" (or pre-autistic) babies. She concluded that:
• Signs of pathology can be found even in the first year of life.
• Infants treated early may resolve problem behaviour, be understood by parents and develop normally.
• Pre-autistic babies engage in a variety of puzzling, challenging or dysfunctionla behaviours.
• There is a communication in these behaviours.
• These communications can be understood in humanly meaningful ways with the help of some
psychodynamic thinking (which can be learned).
• Professionals who are not psychodynamic will not focus on babies’ individuality or deficits. Working only with the unconscious in parents’ mental representations, professionals may be deferring problems which may later lead to treatments for 3 to 5 years, 5 times a week.
Focused Help
Early intervention combines what we know with what we know that works.
The process of attunement begins by understanding the mental representation of the mother and the specific individuality of the baby. To develop this basic objective into a pragmatic and workable clinical approach that reaches the "distant" (or pre-autistic baby), Dr Acquarone combined the resources of the Parent Infant Clinic and the research and training arm of the School of Infant Mental Health to create an early intervention "laboratory" in order to observe, explore and understand these important interpersonal relationships.
An intensive early intervention has the power to change destinies.
The foundations of our "special child focus" are embedded in infant parent psychotherapy, psychoanalysis, neurobiology, infant observation and interactive time. These disciplines boost and enhance any child development expertise the parents may have already consulted.
• We work with babies to identify in what ways -- however limited -- they are in contact with the world.
• We use observation and attunment to engage and extend their motivation to relate.
• We pay attention to their sensorial, relational, behavioural and emotional development.
• We work with parents and siblings in all aspects of the treatment.
International Pre-Autistic Network
The International Pre-Autistic Network is an organisation created to provide hope and resources to those parents who are concerned about early communication and relational difficulties and guidance for the professionals who work with them.
The aims of the International Pre-Autistic Network are:
1. To facilitate early identification of pre-autistic behaviours through emotional screening in infancy
2. To develop psychoanalytically informed treatment for infants and their families
3. To promote the value of early intervention at local, national and international levels
4. To train others in our skills and methods
5. To raise funds to pay for treatment
The International Pre-Autistic Network is a UK-registered charity keen to disseminate our ideas to the professional community in order to extend the body of awareness about pre-autistic behaviours and to assist families who are concerned about their infant to access affordable treatment. We are raising funds to enable
this work and to subsidise treatments for those families unable to pay the full costs.
The International Pre-Autistic Network welcomes enquiries about our work and about available treatments and trainings both in the UK and abroad. We also welcome membership applications. To find out more, or to make a donation to support our work, please click here to visit our website: ipan-infant-autism.org
Background and References
Stella Acquarone, PhD is the initiating founder of IPAN. She introduced a psychoanalytically based technique for the treatment of preautistic infants and their families in 1980 while working in the NHS. Her "Early Signs of Alarm" checklist helps professionals detect pre-autism in infants, which facilitated the development of treatment for those infants and their parents. Her clinical practice with infants and parents has been followed for more than 20 years. Results show that after 10 to 250 hours of individual psychodynamic psychotherapy autistic-like behaviours diminish and development proceeds normally. Acquarone founded the Parent Infant Clinic in 1990 and The School of Infant Mental Health, an academic Center where professionals are trained to use her psychodynamic intervention with infants in their first year of life.
Not only is early treatment effective it is also essential. Since two-thirds of brain development occurs within the first two years of life, the earlier we can find and treat disruptions to "normal" communication, the less damage there will be to the child, the child-parent relationship
and the corresponding neurological system (Schore 1994). Research shows that the signals of autism are from birth, and if not treated, would only increase the chances of its irreversibility (Dawson, Ashman & Carver:2000). Pre-autistic behaviours are identifiable and should be treated in as soon as possible.
Acquarone (Ed) to be published in 2007 ‘Signs of Autism in Infants: recognition and early intervention‘ Karnac
Books
Acquarone, S. (2004) Infant Parent Psychotherapy: A Handbook. Karnac Publishers, London, New York.
Alonim H, (2004) ‘The Mifne method – Israel, Early Intervention in the Treatment of Autism. Journal of Child and Adolescent Mental Health 16(1):39-43
Baird et al (2006) 'Prevalence of disorders of the Autistic Spectrum in a population cohort of children in South Thames: the special needs and autism project (SNAP)' The Lancet 368:210-215
Baranek, Grace T. (2002) Efficacy of sensory and motor interventions for children with autism. Jornal Autism Dev. Disorder, 2002 Oct; 32(5):397-422.
Danon-Boileau L, (2006) Children without Language, form Dysphasia to Autism Oxford University Press
Dawson, Ashman & Carver (2000): The role of early experience in shaping behavioural and brain development and its implications for social policy. Developmental Psychopathology, 12(4): 695-712.
DiLalla, D.L. (1990): Age of symptom onset in young children with Pervasive Development Disorders. Journal of American Academy of Child and and Adolescent Psychiatry, 29: 863-872.
Greenspan & Wieder (1999) A Functional Developmental Approach to Autism spectrum Disorders. Journal of the Association for Persons with Severe Handicaps (JASH), 24: 147 -161.
Kobayashi R, Takenoshita Y, Kobayashi, Kamijo A, Funaba K, Takarabe M. (2001) Early Intervention for infants within autistic spectrum disorder in Japan. Pediatr Int. 2001 Apr: 43(2):202-8.
Maestro S, Muratori F, Cesari A (2005) ‘Course of Autism Signs in the First year of Life’ Psychopathology 38:383-96
Maestro S, Muratori F, Cavallaro MC, Pei F, Stern D, Golse B, Palacio-Espasa F: Attentionale skills during the first 6 months of age in Autism Spectrum Disorder. J Am. Acad Child
Adolescent Psychiatry 2002; 41:1239-1245
Massie, H. & Rosenthal, J. (1984) ‘Childhood Psychosis in the first four years of life’ New York: McGraw-Hill Pankseep, J.( 2001) "Babies had innate capacities and they need to relate actively to other human beings with passion and in joy, sympathy, fun and exploration.
Rhodes (2005) Mirroring, imitation and identification: The sense of Self in relation to the mother's internal world. Journal Of Child Psychoterapy, pp 52-71.
Schore A, (1994) ‘Affect Regulation and the origin of self’ Hove: Lawrence Erlbaum Ass.
Trevarthen & Hubley, (1978) Secondary intersubjectivity: confidence, confiding and acts of meaning in the first year.
In: A. Lock(Ed.) Action, gesture, and symbol (pp 183-229).
London Academic Press.
Trevarthen, C. (1998) Children with autism: Diagnosis and Interventions to Meet Their Needs. Jessica Kingsley Publishers (second edition)
Trevarthen (2005) First things first: infants make good use of the sympathetic rhythm of imitation, without reason or language. Journal of Child Psychotherapist, Vol 31, no 1 April , pp 91-113
Trevarthen & Aitken, (2001) list of clinical criteria for the early detection of the general spectrum of relational and communication disorders