January 26, 1999
Child's Movements May Offer an Early Clue to Autism
By SANDRA BLAKESLEE
The discovery that autistic children appear to have subtle abnormalities in
body movements that can be diagnosed as early as 3 months old is leading
researchers to hope for new treatments.
The findings, by Philip Teitelbaum, a psychologist at the University of
Florida in Gainesville, are preliminary. But they have generated intense
interest because for the first time, a method is being proposed for
diagnosing the condition in babies whose brains are still developing rapidly.
A warning sign in infants could allow timely treatment.
Most autism is not diagnosed in children until they are at least 3 years
old. But if there were a reliable way to diagnose autism earlier,
Teitelbaum and other researchers said, doctors might be able to devise
therapies to alleviate or eliminate the condition, when the brain is its
Autism is a disorder of the brain and behavior that affects about 5 of
every 10,000 children. While autistic children appear healthy, they may
stare into space for hours, throw tantrums, show no interest in people and
pursue repetitive activities, like head banging, with no apparent purpose.
Teitelbaum made the discovery by examining videotapes of babies who were
later found to be autistic. These infants showed a specific cluster of
movement abnormalities when rolling over, sitting up, crawling and walking,
Teitelbaum said in a telephone interview.
But, he cautioned, the results are still preliminary. Researchers need to
look at many more babies, he said, to see exactly which movement
abnormalities can predict autism and which suggest developmental disorders
like schizophrenia or attention deficit disorder.
"I think he's on to something," said Dr. Dan Geschwind, a neurogeneticist
at the University of California at Los Angeles and scientific adviser to
Cure Autism Now, an organization based in Los Angeles run by parents of
autistic children. "He's got a very intriguing piece of preliminary data
which, if it turns out to be true, will be very important."
Temple Grandin, a highly functioning autistic woman who is an assistant
professor of animal science at Colorado State University in Fort Collins
and an authority on animal behavior, said: "He's on to something really
good, and I fully support it. I like the fact that he is objectively
measuring something that is biological."
It may be, she cautioned, that Teitelbaum has discovered general problems
in the nervous system that are not unique to autism. But even that, she
said, is a benefit for doctors, parents and teachers, who now have nothing
to go on before children are 2 or 3 years old.
Anne Donnellan, a professor of rehabilitation psychology and special
education at the University of Wisconsin at Madison, said: "Teitelbaum's
work is important because it reflects a reality about autism that has been
missed. We tend to think it's a problem with the mind. But now that we are
really beginning to see how the brain works, we know that the mind is
embodied. Body is part of mind and there's no way to separate them."
Teitelbaum said he got the idea of looking at autism as a movement
disorder partly because of his work with brain-damaged animals. As they
recover, he said, they go through predictable stages, for example recovery
of movement, that reflect fundamental aspects of brain organization.
Because human babies also pass through predictable stages of development,
he theorized that defects in the brain might be reflected in early movements.
A few years ago, Teitelbaum sent out word to parents of autistic children
through various national organizations that he was looking for videotapes
of babies before their autism was diagnosed. He received 17 tapes that
showed the babies during major milestones of motor development, including
rolling over, sitting, crawling, standing and walking.
He also videotaped 15 normal infants as they passed through the same
milestones. Portions of each tape were analyzed, using a special technique,
for subtle differences in patterns of movement.
No two babies develop motor skills in exactly the same way, but the
autistic babies show a specific cluster of movement abnormalities,
Teitelbaum said. Some were subtle and others quite obvious. Normal children
may temporarily show some of the same movements.
For example, none of the autistic babies in the tapes learned to roll over
like normal children did, he said. Normal babies use a corkscrew motion to
go from back to stomach or vice versa. Starting at about 3 months old, they
first turn their pelvis to one side, followed by the trunk and finally the
shoulders and head. By 6 months, the order is reversed: the head goes first
and the rest of the body parts follow, corkscrew fashion.
Some of the autistic babies in the tapes never learned to roll over.
Others did, but in a peculiar fashion, Teitelbaum said. Starting from lying
on their sides, they rolled to their stomachs or backs by raising heads and
pelvises. Then they threw the upper legs forward and toppled over, moving
all body segments together.
And unlike healthy babies who usually learn to sit up at 6 months, even
while turning the torso or head, some of the infants whose autism was
diagnosed later on toppled easily, falling to one side "like a log" and
failing to break the falls with their hands.
Teitelbaum, who described his findings in a recent issue of the
Proceedings of the National Academy of Sciences, also noted anomalies in
the way the autistic babies in the tapes learned to crawl and walk.
Babies typically start to crawl at about the same time they begin to sit,
holding their bodies symmetrically with arms vertical at shoulder width,
palms on floor, fingers pointed forward. Thighs are vertical and hip-width
apart with knees on the ground and lower legs and feet resting on the floor
pointing backward. Weight is commonly distributed equally on all four limbs.
The autistic children in the study showed an asymmetrical lack of support
in the arms or legs, Teitelbaum said. One baby supported himself on his
forearms rather than his hands. He raised his pelvis high in the air,
bird-dog fashion, but could not move forward. Another baby crawled by
scooting his left knee on the floor but used his right foot to push himself
Teitelbaum said that every autistic child showed some degree of asymmetry
in walking. Many tended to shift their weight at the wrong moment, which
made their walking appear slightly stiff. Others kept their arms in a more
infantile position, arms extended forward. Interestingly, many autistic
children walk more slowly and with shorter steps, like Parkinson's disease
patients whose motor skills are damaged, Teitelbaum said.
Early diagnosis has long been a goal of autism researchers, who theorize
that the condition results from brain abnormalities that develop before
birth. Some researchers think the glitch occurs as early as the 20th to
24th day of gestation, long before women know they are pregnant. Others
believe the injury, which could be a mutation or environmental insult,
occurs later on, perhaps in the second trimester of pregnancy.
In any event, researchers say that in autistic people, most of the brain
forms normally but that some basic scaffolding of nerve fibers is
incomplete or improperly developed. Because the human brain grows rapidly
in the first year of life -- literally constructing circuits that will last
a lifetime -- this is the best time to intervene.
The goal of intervention would be to stimulate the baby's brain to
circumvent the bad wiring or develop connections to compensate for a
defect, Donnellan said. By correcting movements through some form of
physical therapy, it may be possible to used feedback to help correct
abnormal brain development.