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The boundaried sense of ego is one of the early things I've observed emerge in autistic children undergoing the Tomatis Method. The 'terrible two's' stage - where they check out the limit and boundaries. This seems emerge concurrently with reported physiologic changes, particularly in the tactile system, but also in other indicator of the body spatial awareness. As they start to feel they have a self, they start to assert it.

.......Tomatis Topics

P atterns of development we can observe in Autism.

In mimesis the act must be distinguished from the referent. You must be able to distinguish between play-acting and the event itself. This requires a boundaried sense of ego - there is a me, separate from you, and from the act. There is a me, who is performing this act to show you. (Simon Baron-Cohen in Theory of Mind noted that in the cognitive perceptual features of people with autism, that they lacked Joint attention, facial expression, and the ability to recognize that the attitudes and intentions of others might be different from their own... (Sally Anne Test.) Thinking was concrete and episodic.

The boundaried sense of ego is one of the early things I've observed emerge in autistic children undergoing the Tomatis Method. The 'terrible two's' stage - where they check out the limit and boundaries. This seems emerge concurrently with reported physiologic changes, particularly in the tactile system, but also in other indicator of the body spatial awareness. As they start to feel they have a self, they start to assert it. Pretending is also a skill that I see emerge during treatment, often following this boundaried sense of ego. This is normally almost universally absent in the autistic/PDD child. You need a sense of self in order to imagine. The ability to pretend an action or the emergence of this ability is a major prognosticator of potential or as a breakthrough in progress for the autistic child. It tells us that the child is beginning to think symbolically. Mimetic capacity in modern humans is an integral skill, coupling a variety of expressive subsystems. It might include hand singles, facial expressions, nonverbal vocalizations, and various forms of gestures.

Courschee's findings in autism indicated that it took a longer time or was at least very difficult for the autistic children to shift between modes of sensory modulation. (particularly auditory to visual.) So this area of multi-sensory processing is very difficult. Often autistic children have to look away from you in order to listen. This makes the demand for eye contact unreasonable for you to expect. Since Mimetic ability was so multi-sensory in nature the neural system sub serving it must be integrative in nature Mimetic abilities probably led to this expansion of association areas observed in human evolution.

R hythm is an integrative mimetic skill that is related to both vocal and motor mimesis. Once rhythm is established it may be played out with any motor modality. Donald call rhythm the 'quintessential mimetic skill, requiring the coordination of disparate aspects and modalities of movement.) We talk about the vestibular system influencing bilateral coordination but it also can affect rhythm and timing of movement.

Rhythm is a uniquely human skill and no other animal does it without training. Music and dance therapists use rhythm in their treatment of autistic children and know of its importance. I think the use of rhythm can have important treatment implications with this population because of its tie in with this overall mimic or practic intelligence that is the foundation for symbolically based communication.

This type of mimetic ability would have lead to an expanded conscious map or body schema in the brain. Paul Schilder, Loretta Bender and Jean Ayres all stressed the importance of a body map, or schema as a basis for praxis. The mimetic system would have superseded and encompassed the episodic system. In this way event perceptions would become event reproductions and event re-enactments (or re-presentation). And this would have lead to self-reflection. This ability allows us to look back on an event and learn from it. This ability of Self-reflection is a uniquely human function that allows us to learn and change.

Cognitive evolutionists complain that too much emphasis is placed on language and the same can be said in our diagnosis of Autism and PDD. There are so many under pinning of language that involves communication. If we take into consideration the long pre-linguistic history of mimetic thought, and Homo erectus ability to form highly evolve pre-linguistic society we can appreciated what a supportive structure these abilities provide for communication and language development. By understanding the development processes underlying speech and language we are better able to observe, document and interpret progress for the families we work with. Occupational Therapists doing Sensory Integration are working on the underlying structure that has tremendous significance but doesn't have the direct outward manifestations of the visible structure (ie speech and language) that is dependent upon it. Even though we may take this underlying structure for granted we need to systematically explain it to the families we work with. Mimetic to Symbolic Gestural Communication So the underlying question is 'What lead from mimetic thought to symbolic communication and language?' Because similar developmental processes may be observed in the delayed language development observed in autism. Donald writes that Mimetic ability evolved quickly into a system of standardized gestural signals Gestures became symbolic. This is the intermediary step between mimetic thought and symbolic language. A finger to the lips is the same to us as it is to a Kalahari Bushman. But this is different than acting out an event. In this example gestures are taking on a symbolic content. When you act out jumping it means jumping. But putting your finger to your lips to 'sh' is a symbolic gesture not a literal one. (sae Donald p221) Imagine the whole conversation you can have with another driver in another car without exchanging a word. Think of how hard it is to communicate with him if he doesn't respond. Gestures such a shrugging your shoulders, waving and smiling to greet someone, fit into this symbolic category.

A utistic and PDD children don't get the concept of waving bye-bye. Or if they once had it, it is often one of the sad indicators of regression that parents report that they used to wave bye-bye, and then they stopped. They often have trouble with the gestural aspects of peek-a-boo etc. Parents will sometimes say that their children respond to gestures but don't initiate the gesturing themselves. Understanding the symbolic intent of gesture is very important in understanding the different communication pattern of the autistic/PDD individual.

The Autistic/PDD child may lead you or your hand to the refrigerator but doesn't add the additional appropriate gestures to embellish the communication. In fact, the autistic child might pile three chairs on top of one another to get the cookie box stored on the top shelf, demonstrating excellent initiation, organization, and execution of a motor plan, rather than point to the shelf and indicated eat by pointing to their mouth. Likewise they will not say the word cookie, which we know they know from their behavioral training. It's literally easier to do it themselves than to ask for it.

In a chart review of over 200 infants and children with Autistic Spectrum Disorder, Greenspan and Wieder found that 'an impairment in complex problem-solving, gestural interaction was quite specific for autistic spectrum disorder. They found that by age two, these children were unable to 'use complex gestures involved in reciprocal interactions to negotiate a goal such as indicating that they wanted to go outside. 68% of the children couldn't. This was compared to non-autistic children who however were diagnosed with auditory processing disorder, sensory over reactivity, and motor planning problems. Only 4% of this group evidenced difficulty in purposeful gesturing.

So it is with gestural communication that we see a shift in praxis from a motor response to the environment to a more symbolic praxis that is involved in communication So it isn't just sequencing generic praxis that is implicated in autism, but more specifically the symbolic praxis that is involved in communication. Initially our gestures were tied to our emotions and all the movements of the body. Think of the game so big. Think of the whole body movements that are involved, the facial expressions, and sound effects. Etc. All of this was present before the word big. When we take the perceptual concept of seeing something big we reference it with our whole experience of 'bigness' and 'littleness' (Duel Coding) I think that is part of what underlies the full-blown tantrums we see in the autistic/PDD child. They don't have a symbolic gestural system as an intermediary ability. They can't put their hands on their hips, stomp their feet and use a variety of symbolic gestures to indicate their frustration. They go straight to 911. This can be an important area for counseling the families.

M imetic to Metaphorical: It is apparent that the use of gestures and signals to communicate became a highly developed ability in pre-linguistic Homo erectus but what led to language and speech? The big question argued by linguists, philosophers, evolutionary biologists, and who ever else thinks on these things was is it thought that drove language or vice a versa, or both. Darwin postulated that language evolved out of pre-linguistic change in primate cognition that raised the level of basic cognitive skills above those of Apes.

Once established interacted with the human capacity for thought, leading to the development of new thinking. Donald argues that language was tied to the development of integrated thought. That language was an attempt to unify formerly disconnected, time-bound snippets of information. He felt that it was the Mimetic ability to combine neural subsystems also drove the development of integrated thought. (p.215) Another way of saying this is that good sensory integration is the foundation for integrated thought. As mimetic representation became more symbolic it was pushing the cognitive envelope and a new system to express metaphorical thought was needed. Symbols require thought - symbols are mind tools (p.219) they are not important in themselves but only in the forms they represent. An ape can be taught to use a dime as a token for a reward yet the dime doesn't represent a symbolic concept of money. This is important with the autistic child because until we can bridge the symbols we expose them to in thought, the symbols will remain meaningless or ungrounded. (Engage in their preservative play. Open closing doors, on and off switches. Get these acts to become symbolic. Often their cues are so poor that we don't reinforce them.

Mimetic representation was limited to concrete episodes, by using mental symbols metaphorical thought could compare across episodes. (p215) I can see this emerge in the children as they begin to understand time. Initially I saw it as vestibular/cochlear time space awareness but also it is a more metaphorical type of thinking. We can understand 'later' as we can compare across episodes. So Donald would argue that human language developed in response to pressure to improve their conceptual apparatus. (p215) So thought developed language not vice versa. So it would seem the more we can push the autistic child to be symbolic in their non-verbal communication the more we lay the foundation for language. And I've observed this to be true. We have to put in that link between action and thought. That is how we get their motor planning to become communicative in nature.

So in evolution and again recapitulated in our development, Gestures became symbolic. This in turn pushed the cognitive envelope so to speak, in the linking this multi-sensory processing of gestural communication to the evolving metaphorical thinking. Then as we became increasingly metaphorical we needed a more efficient system to represent our thoughts and language was the answer. Language was an adaptive response to reflect our new thought structure. Just to reemphasize what Donald said He felt that it was the Mimetic ability to combine neural subsystems also drove the development of integrated thought. Again praxis is very multi-modal in nature particularly when we consider its communicative symbolic function. When our praxis is limited and particularly when it is not connected to our emotional system our thinking and language remains more concrete and less abstract or metaphorical. Again when our map is deficient so are the skills dependent upon it.

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