Interventions For Autism We Found Useful With Our Grandchild

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BY DENIS ROGERS, MD
REMARKS FROM DR GILLIAN FORRESTER, PHD AND DR CLAUDIA GONZALEZ PHD

We have a grandchild who was diagnosed as being on the autism spectrum at around 18 months. She had seemed to develop normally up until the age of 18 months and then regressed. It was as if pathways in the brain, previously open, had become blocked.

She is now seven and has shown amazing improvement. Her “stimming” (obsessive repetitive behavior) has ceased. She now functions in school in the appropriate grade and shows continuous improvement in social integration. For us the diagnosis brought with it, as I’m sure it does for many, an initial reaction of despair and a sense of  helplessness. We desperately wanted to attempt to walk with her in her world, to help her and us, in understanding that world, to show her that she was loved, and to do something that might help.

In addition to the A.B.A. (Applied Behavioral Analysis) program, we started her on an intensive program of activities aimed at facilitating coordination and motor skills development. Eventually she was engaged in swimming, dance, acrobatics, gymnastics, ballet, skating, soccer and bike riding. She is now learning to play the violin. Initially, we got her a small indoor trampoline, which seemed to channel her “stimming” in a useful direction. When bouncing on the trampoline, she would hold our hands, smile and evince happiness and make eye contact. At those times she seemed to enter into our world, or we into hers. Now she has a larger outdoor trampoline, and is expert in cartwheels and flips!

There is evidence that language acquisition and cognitive function have a relationship with hand dominance. As a doctor, I was aware of a relationship between some developmental problems, including autism, and a failure, in some instances, to establish a definite—either right or left—hand dominance. For this reason, we also consistently encouraged her in the use of her right hand. Ethically we felt comfortable in doing this, as at the time we commenced encouraging right hand dominance, she was already showing a right hand preference. Statistically, 90 percent of people are right-handed, and also males are 20 percent more likely to be left-handed than females. Hand  dominance usually becomes established around the age of four, although a hand preference may be seen as early as in utero.

Movement of the right hand is controlled by the left hemisphere of the brain, and in over 90 percent of the  population, the speech processing center is in the left hemisphere of the brain.

In an evolutionary context, communication probably evolved from hand and facial gestures, and progressed to language, with all the complexity and nuances that are entailed in speech perception and speech production. Significantly in the brain, these two areas, the area related to hand movement and the area related to speech production, are adjacent and overlapping.

While the root cause of autism is still unknown, one result of it seems to be some abnormality of communication between the two hemispheres in the brain. With this in mind, and aware of the association between a failure to develop a strong hand dominance and developmental disorders, I wondered if facilitating a strong (in this instance) right hand dominance, might facilitate, or perhaps “wire,” pathways between the two hemispheres that would be beneficial in autism. One example (and there are many others) of the brain rewiring pathways is a treatment used for amblyopia, or lazy eye.

In amblyopia, when one eye fails to focus, the visual cortex in the brain eventually suppresses, or ceases altogether, to receive input from the lazy eye. This occurs because nerve pathways between the retina and the brain fall into disuse. One treatment is to patch the “good” eye, forcing the lazy eye to see, by reopening nerve pathways from the retina to the visual cortex in the brain. The earlier this treatment is commenced, the better the results.

Dr. Gillian Forrester, a PhD from Oxford, is involved in research in England relating to handedness and cognition. Another PhD doing similar research is Dr. Claudia Gonzalez, working in Canada. I include their comments in this article.

I realize that every child on the spectrum, as a separate individual, reacts differently to intervention. For us, however the above interventions enabled the wider family to become involved in a program that has seemed to be helpful to our grandchild, who now at seven is a joyous, engaging little girl. I do not know which of these interventions, or perhaps some combination of them, has resulted in our grandchild’s improvement but thought that perhaps this might be of interest to others with children on the spectrum. •


Dr Gillian Forrester’s Remarks On Hand Dominance

It is really interesting to hear personal accounts of motor ability in the development of children diagnosed with autism. While it is impossible to disentangle how different factors may have contributed to the attenuation of your grandchild’s autism symptoms, it is nonetheless fascinating and wonderful that she has shown such positive improvement.

I am very interested in therapeutic motor interventions and am developing a program of research that has a two-pronged strategy that aims to produce long-term cognitive benefits. The intervention includes both a motor enrichment element and a parent/carer responsiveness element. Research suggests that therapeutic interventions that require the infant/child to motivate his/her own explorative motor actions have the longest acting benefits. It has also been noted that parents/carers can support and encourage these behaviors by being extra-responsive to their child’s direction of attention, and then inviting the child to initiate his/her own motor actions towards the perceived goal state.

Stemming from my research into the evolution of human language, I have been working with a theory that considers object manipulation to have been an important catalyst for the emergence of language. Manipulating an object to achieve a goal state (e.g. simple tool use) may act like a physical proto syntax that primes the brain for language development. I believe that object manipulation may still play an extremely important role in the development of language skills in children. For example, a child learns a structured sequence of actions (e.g. pick up the spoon, dip the spoon in the porridge, bring the spoon to the mouth). When the individual motor actions of the sequence are conducted in a specific order, the goal state is obtained. This is much like a simple sentence. When the words are spoken in a specific order, the goal meaning is obtained.

When considering the human brain, it is normal for the left and right hemispheres to be dominant for different types of behaviors. This type of brain organization is thought to be more efficient than duplicating functions across both hemispheres.

For the vast majority of the population (approximately 90%), the left hemisphere controls structured sequences of actions. Since each hemisphere controls motor actions on the opposite side of the body, it is not surprising that the vast majority of the population demonstrate right-handedness for tool using activities. Interestingly, neuroimaging studies indicate that the dominant brain areas that control action sequences of actions of the hands and the mouth are overlapping and dominant in the left hemisphere. As such, the left hemisphere plays an integral role in the development of both object exploration and speech.

A growing body of evidence indicates that hand dominance (left or right) is associated with typical language  development in children. The hand dominance is a behavioral marker that suggests that the hemispheres of the brain are well lateralized for function. However, research suggests that the frequency of ambidexterity (no hand dominance) significantly rises in children with autism. Moreover, ambidexterity is associated with atypical language development.

Therefore, although we have yet to conduct systematic studies in this area, encouraging a dominant hand for object manipulation may play an important role for the typical development of expressive language abilities in children. As such, the advent of motor dominance training could become an important therapeutic intervention that builds and strengthens hemispheric dominance. Specifically, we will aim to develop interventions that employ high parent/carer responsiveness to encourage infant/child initiated motor actions. Additionally, we have come to understand that the earlier we implement therapeutic interventions, the longer-term the cognitive benefits tend to be.


Dr. Claudia Gonzalez’ Remarks

Your story is fascinating and encouraging. encouraging because basic research not always sees its translation where it matters most. My colleague Robbin Gibb (neuroscience department) and i are applying for external funding (SSHRC) for a research proposal that will investigate the possibility that encouraging right hand use for pointing and grasping will enhance language, executive function, and social competence in three- to five-year-old normally-developing children.

This proposal is based on our findings of a relationship between these functions and their specialization to the left hemisphere. We have demonstrated for example, that in typically developing four to five year olds, the greater the righthand use for picking up small objects, the greater the differentiation between the production of two sounds (/s/ and/sh/). Similarly, in five to six year olds, the stronger the right-hand preference for grasping, the better the child’s executive function (the ability to plan, set goals, and complete tasks). The proposal is for a two-year project (to begin next summer) that, if it yields positive results, we will try to implement it in children with language and executive function delays and children with ASD (autism spectrum disorder).


ABOUT THE AUTHOR:
Dr. Denis rogers is the 81-year-old grandfather of a child on the autism spectrum. Born in Ireland, he emigrated to Canada at age 19. He served in the Canadian Air Force for six years before returning to Ireland where he attended medical school, and qualified as a doctor. He returned to Canada where he practiced medicine as a G.P. for 46 years. He is now retired.
Dr Gillian Forrester obtained a BSC in Cognitive Science at the University of California San Diego and a PhD in Experimental Psychology from Oxford University. She is based at Birkbeck, University of London’s Department of Psychological Sciences. She investigates the evolutionary and developmental relationships between brain organization and naturalistic behavior. Gillian is currently investigating the developmental links between motor and cognitive abilities in children with and without neurodevelopmental disorders. She recently authored (in The Conversation): How Children’s brains develop to make them right or left handed:
https://theconversation.com/how-childrensbrains-develop-to-make-them-right-or-left-handed-55272. For more in Dr Gillian Forrester’s research, see: www.gillianforrester.com; www.researchgate.net/profile/Gillian_Forrester
Dr. Claudia Gonzalez is an Associate Professor and Canada Research Chair in the Department of Kinesiology at the University of Lethbridge. Gonzalez obtained a Bachelor in Psychology from the National Autonomous University of Mexico (UNAM) and a M.Sc and a Ph.D in Neuroscience from the University of Lethbridge. Gonzalez investigates how the brain processes and integrates sensory and motor information. In particular how vision and hapsis (touch) guide arm and hand movements for reaching and grasping. She is interested in understanding the complex interactions of the motor system with cognitive processes such as language, memory and spatial abilities.