Stability and Continuity in Mental Development: Behavioral and Biological Perspectives


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As shown in Figure 2 , non-significant parameters among the latent constructs were removed. The raw and estimated i. Multivariate growth curve models relating early and later intellectual development. As seen in Figure 2 , the high degree of stability in cognitive and intellectual functioning is found mostly in the relationships among the level factors. However, the rate of change in early cognition was also positively related to the rate of change in the Nonverbal factor.

This pattern of dynamic influence suggests that young children who make more rapid gains in early cognition also show more rapid growth in the Nonverbal factor across the early childhood years; this pattern was not evidenced for the Verbal factor. For the Verbal factor, mean levels did change over time, but there was no significant variability in the rates of change consistent with the higher levels of stability for this construct depicted in Figure 1. Here, the individual differences in the intra-individual change patterns for verbal ability are restricted to the initial levels of verbal ability measured at 30 months of age.

The current analyses provide a rigorous and summary examination of this rich and extensive database. The fundamental message to emerge from this endeavor is that intellectual function shows striking continuity from 12 through 48 months of age. Like infancy, the period from toddlerhood through preschool age has been suspected to be a period of discontinuity and reorganization. Although a careful look at the extant data provide some hints that continuity exists, both the structural analyses and the level analyses from growth curve modeling reported in this paper show clear and strong evidence of continuity within and between instruments.

The transition from the BSID II MDI to the factors gleaned from the SB4E and the PPVT III shows no evidence of tumult or reorganization, and the findings are quite consistent with the conclusions of Humphreys and Davey in their first examination of this age period nearly two decades ago; a simplex model featuring a high level of continuity is quite adequate to describe intellectual development from the end of infancy forward. A second finding of interest from the growth curve modeling is that the trajectory of change for the early-cognition factor computed from the BSID II MDI during the second year is related to growth in nonverbal — but not verbal — abilities during the second and third years.

Thus, the trajectory of growth in the MDI is predictive of the trajectory of nonverbal skills during the preschool period. We would reiterate here that the MDI level of performance during year 2 was highly predictive of level of performance in both Verbal and Nonverbal factors in years 3 and 4. A final contribution of the current data set is the observation that early vocabulary production as measured by the MBCDI , did not cohere strongly with the early cognition factor during the second year, and contributed relatively little to the continuity that we observed here.

We very much suspected that early vocabulary growth during the second year would carry much of the continuity we expected to see in the preschool period, but this was not the case. This finding implies that early expressive word acquisition is not the sole factor, and is probably not the predominant factor, in driving the development of intellectual function in the second year of life see also Reznick et al. These findings do not detract in any way from the probable importance of early language in cognitive development. The emphasis on vocabulary during this time is reflected in the shifting of items on most infant tests at and shortly after the first birthday to represent it fully in the assessment domains.

Not coincidentally, that is when age-to-age correlations for infant tests and the predictive validity of infant tests to later childhood McCall, , show dramatic improvement. Thus, we presumed that we would find some reorganization and discontinuity in these models, and that this discontinuity would be resolved by the emergence of vocabulary. These observed models, however, instead show considerable stability in individual scores from the earliest ages tested that is apparently independent of the contribution of early vocabulary growth.

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Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Otilia M. Blaga, The University of Kansas. Jill Shaddy, The University of Kansas. Christa J. Anderson, The University of Kansas.

Kathleen N. Kannass, Loyola University of Chicago. Todd D. Little, University of Kansas. John Colombo, University of Kansas. Europe PMC requires Javascript to function effectively. Recent Activity. The snippet could not be located in the article text. This may be because the snippet appears in a figure legend, contains special characters or spans different sections of the article. Author manuscript; available in PMC Jan 1. PMID: Blaga , D. Jill Shaddy , Christa J. Anderson , Kathleen N.

Stability and Continuity in Mental Development: Behavioral and Biological - Google Books

Kannass , Todd D. Little , and John Colombo. Jill Shaddy. Blaga, The University of Kansas;. Correspondence regarding this article should be addressed to John Colombo ude. Copyright notice. See other articles in PMC that cite the published article. Method Participants The primary sample consisted of healthy children from the metropolitan and suburban areas of Kansas City, KS see Colombo et al. Table 1 Mean, standard deviation, skewness, and kurtosis of each study constructs.

Open in a separate window. Table 2 Loadings, standard errors, and communality from the longitudinal CFA. Structural Analysis Given the acceptable fit of the CFA model, we conducted a longitudinal structural analysis to examine the ability of the measures taken during early childhood to predict later standardized measures of intellectual functioning.

Figure 1. Latent Growth Curve Analysis We also examined the structural relations among these constructs by way of growth curve analysis. Figure 2. Discussion The current analyses provide a rigorous and summary examination of this rich and extensive database. Contributor Information Otilia M. References Aylward GP. Presidential address.

Prediction of function from infancy to early childhood: Implications for pediatric psychology. Journal of Pediatric Psychology. Factors influencing the growth of intelligence in young children. In: Whipple GM, editor. Part II, Original studies and experiments. Bayley N. Birns B, Golden M. Prediction of intellectual performance at 3 years from infant tests and personality measures. Merrill Palmer Quarterly. Stability in cognition across early childhood: A developmental cascade.

Psychological Science. Continuity in mental development from infancy. Child Development. Infant development: Recent advances. Colombo J. Infant cognition: Predicting later intellectual functioning. Belmont, CA: Sage Publications; Colombo J, Cheatham C. The emergence of endogenous attention in infancy and early childhood.

In: Kail R, editor. Advances in child development and behavior. New York: Elsevier; Recent advances and issues in the study of preverbal intelligence. In: Anderson M, editor. The development of intelligence. Maternal DHA and the development of attention in infancy and toddlerhood. The developmental course of habituation in infancy and preschool outcome. Cognition through the lifespan: Mechanisms of change. Trends in Cognitive Sciences. Prediction of Bayley and Stanford-Binet scores with a group of very low birthweight children. Child: Care, Health and Development.

Discontinuity and instability in early development: Implications for assessment. Topics in Early Childhood Special Education. Infant recognition memory as a measure of intelligence. Advances in Infancy Research. Variability in early communicative development. Monographs for the Society for Research in Child Development. Individual and developmental differences in disengagement of fixation in early infancy.

Effects of repeated assessment on standardized test performance by infants. American Journal of Mental Deficiency. Missing data estimation in longitudinal studies. Modeling contextual effects in longitudinal studies. Mahwah, NJ: Erlbaum; Honzik MP. Value and limitation of infant tests: An overview. In: Lewis M, editor. Origins of intelligence.

New York: Plenum; Continuity in intellectual growth from 12 months to 9 years. Hunt JMcV. The psychological basis for using preschool enrichment as an antidote for cultural deprivation in the disadvantaged child. In: Hellmuth J, editor. The disadvantaged child.

Stability and Continuity in Mental Development - Behavioral and Biological Perspectives (Hardcover)

Explorations into patterns of mental development and prediction from the Bayley Scales of Infant Development. In: Hill JP, editor. Minnesota symposia on child psychology. The synchronization of rhythms allows tuning and adaptation to the external environment. The role of melatonin in the ontogenetic establishment of circadian rhythms and the synchronization of the circadian clocks network suggests that this hormone might be also involved in the synchrony of motor, emotional, and interpersonal rhythms.

Autism provides a challenging model of physiological and behavioral rhythm disturbances and their possible effects on the development of social communication impairments and repetitive behaviors and interests. This article situates autism as a disorder of biological and behavioral rhythms and reviews the recent literature on the role of rhythmicity and synchrony of rhythms in child development. Finally, the hypothesis is developed that an integrated approach focusing on biological, motor, emotional, and interpersonal rhythms may open interesting therapeutic perspectives for children with autism.

More specifically, promising avenues are discussed for potential therapeutic benefits in autism spectrum disorder of melatonin combined with developmental behavioral interventions that emphasize synchrony, such as the Early Start Denver Model. Endogenous physiological variations involved in biological rhythms reflect adaptation to the environment. Thus, the sleep—wake rhythm associated with biological circadian rhythms can be viewed as an adaptation to the day—night cycle.

Circadian rhythms allow temporal organization of biological functions in relation to environmental changes 1. The periodicity of activities applies to all biological, physiological, and psychological functions; recently, the science of biological rhythms, chronobiology, has emerged with its own theory, science, and education 2. Furthermore, recent studies in the field of cognitive and developmental psychology have highlighted the importance of rhythmicity and synchrony of motor, emotional, and relational rhythms in early development of social communication.

Given the major role of the sleep hormone melatonin in the ontogenetic establishment of diurnal rhythms, the synchronization of peripheral oscillators also termed clocks and the regulation of human circadian rhythms 1 , melatonin might be involved in the synchrony of motor, emotional, and relational rhythms. Indeed, relationships might exist, based on the hypothesis of ergodicity 3 , between cellular communication networks involving a cellular synchrony synchronization of cellular oscillations by melatonin and early social communication development involving a synchrony of motor, emotional, and interpersonal rhythms.

Autism spectrum disorder ASD — a developmental disorder characterized by social communication impairments associated with repetitive interests and behaviors — provides an interesting and challenging model of abnormal melatonin production in early developmental disorders and its possible relationship with autistic behavioral impairments. This article proposes a central role of rhythmicity and synchrony of rhythms in typical child development and offers a new integrative approach, which considers autism as a disorder of biological and behavioral rhythms.

In this perspective, promising avenues will be discussed in this article for potential therapeutic benefits in ASD of melatonin and developmental behavioral interventions that emphasize rhythms and synchronization, such as the Early Start Denver Model ESDM. Alterations in circadian sleep—wake rhythm have frequently been reported in autism 4 , 5. More specifically, reduced total sleep and longer sleep latency as well as nocturnal and early morning awakenings are often observed in individuals with ASD 6 — Furthermore, prior studies on melatonin in autism have all reported abnormalities in melatonin secretion see Table 1.

In addition, abnormalities in cortisol circadian rhythm have also been reported in autism [for a review, see Tordjman et al. In particular, significantly higher frequency of absence of circadian variation in melatonin and cortisol levels was observed in individuals with autism compared to typically developing controls.

Golombek et al. More specifically, abnormally low daytime and nighttime melatonin secretion was associated with an absence of melatonin circadian variation in some individuals with autism 18 , 19 , which in turn, given the role of synchronizer of melatonin, also has consequences on the circadian rhythms network, including the cortisol circadian rhythm 13 , Table 1.

Studies of melatonin levels in individuals with autism. This blunted circadian rhythmicity with no or little variability might be related to the difficulties in adapting to changes typically observed in individuals with autism. Thus, children with autism who are confronted with physiological continuity due to absent circadian rhythms may have difficulties adapting to changes in either their external or their internal environment Similarly, blunted circadian rhythmicity may explain the difficulty observed in many children with autism in adapting to changes in rhythms of their external and internal environment.

Thus, rapid rhythms of sensory stimuli in their external environment e. Interestingly, EEG changes tended to be correlated with an abnormal rhythm of melatonin in young adults with autism Furthermore, some parents have reported that their daughters with autism experience epileptic seizures toward the 14th day of their menstrual cycle, which is when luteinizing hormone LH levels peak Tordjman, personal communication , suggesting quite tentatively that individuals with autism may have difficulties adapting to periodic hormonal changes in their internal environment.

We can state the following hypothesis: a change in rhythm associated with excessive environmental stimuli might strongly increase arousal and lead to physiological stress which, for some individuals with autism, can disturb the rhythmic activity of a particular brain area, leading it to fall out of sync with the rest of the brain and causing its population of neurons to fire depolarization and occurrence of an epileptic seizure.

This underlines the importance of stable physiological rhythms. Finally, significant relationships have been found between lower nocturnal melatonin excretion and increased severity of autistic social communication impairments, especially for verbal communication and social imitative play 18 , These findings are in agreement with studies suggesting an association between reduced melatonin production and language impairment 22 , Along the same line, the systemic administration in the animal model of Zebra Finch of a melatonin-1B receptor antagonist at the beginning of the night shortens the song and motif length and affects the song syllable lengths produced the next day It is noteworthy that deficiency in oxytocin [oxytocin is considered a bonding hormone 32 , 33 ] has also been reported in autism 34 , 35 and bonding is involved in the development of very early social interaction in infants.

Interestingly, the release of oxytocin by the posterior pituitary gland follows a robust circadian rhythm in mammals. Further studies are needed to better understand the underlying mechanisms of oxytocin anomalies in autism and to explore, in particular, possible oxytocin rhythm disturbances in ASD. The importance of the synchrony of rhythms in the development of social interaction and communication is detailed in the next section.

Several studies, based on animal models and human perinatal development, suggest that stable patterns of repeated stimuli in the form of maternal physiological rhythms, involving cross-modal perception such as regular cardiac rhythm, which provides the fetus with auditory and vibratory stimuli, allow the fetus to integrate sensory information facilitating prenatal perceptual learning and develop a coherent representation of his or her internal and external environment 36 — As previously emphasized 38 , very early mother—infant relations provide a secure environment based on the repetition of invariants, while at the same time promoting adaptation to change through the presence of variants.

It is through the regular repetition of identical sequences of discontinuity, such as circadian rhythms, that a continuum is constructed associated with the development of adaptation to changes. Cortisol a stress and arousal neurohormone crosses the placental barrier.

Historical Origins

The cortisol circadian rhythm, as well as the melatonin circadian rhythm in the fetus and infant after birth, are those of maternal cortisol and melatonin. Interestingly, this period coincides in typical development with the emergence of social smiling by the second month of life 43 , the advent of mirror self-recognition at around 3 months of age 44 , and increased brain activation to speech occurring between 3 and 4 months of age At birth, the human immaturity of the cerebral cortex allows initial learning to influence the neural architecture through perceptual-action mapping 46 , Social synchrony can be defined as the dynamic and reciprocal adaptation of the temporal structure of behaviors between interactive partners In typically developing children, the quality of social interaction depends on an active dialog between the parent and the infant 50 , Numerous studies have been emphasizing the importance of parent—infant synchrony and the construction of shared timing in social communication development Also, biological markers were associated with relational synchrony.

First, oxytocin administration to parent enhances infant physiological and behavioral readiness for social engagement and parallels an oxytocin increase in infants Second, neural correlates were found using hyper-scanning recordings of EEG brain activity and measures of neural synchronization between distant brain regions of interacting individuals through a free imitation task Eleven same-sex pairs were scanned.

Developmental psychologists now study interaction not only as the addition of two behaviors but also as a global phenomenon in which synchrony is considered as social per se. To describe the dialog between two partners engaged in behavioral and affective exchange, developmental psychologists more and more take into consideration rhythm and temporal course of both behavior and affect, regarded as key expressions of adaptation during interaction 49 , It appears appropriate in the field of autism to consider the combined domain of social communication, as the most recent version of the ADOS scale does, as well as the recently released DSM-5 American classification.

Methods to investigate this issue include studies using early home videos 54 , parental interviews focusing on early abnormalities 55 , and prospective assessment of children at risk of ASD e. Studies have revealed a pervasive developmental course in infants who were later diagnosed with ASD. Thus, the first signs were abnormalities in eye contact, imitation, disengagement, joint attention, orienting to name, and body language.

Also, these behaviors are important precursors of later-developing symptoms. However, whether these first signs impair early infant—parent interactions and whether they reflect already autistic behavioral impairments in the infant remain to be explored. In two related studies based on home movies of children later diagnosed with autism, Saint-Georges et al. In addition, parents experienced weaker interactive responsiveness from their children and increasingly tried to compensate this perceived deficit by soliciting behaviors through touching the infant. This was particularly observed after 12 months of age for the fathers of infants who were later diagnosed with autism.

This is what humans do through rhythmic finger or foot taping, dancing, singing, and drumming in synchrony with others Xavier et al. From birth, a child has a predisposition to engage, intersubjectively, with the rhytmic actions and awareness of other persons, and to move in synchrony with them 44 , Synchronic imitation is an important preverbal way to communicate among peers 64 , This reciprocal experience concerns two children able and motivated to coordinate their behavior with the non-ritualized behavior of the other, in both form and timing and to alternate turns between model and imitator The impression of fluidity in the coordination of movements between partners is underlined by mutual attention, engagement, continuous adaptation, and turn taking This rhythmic process made of ludic spontaneous imitation reveals moments of discontinuity occurring in a background of continuity.

Neural bases of this coupling activity are constituted by the neuron mirrors system 68 , with the same evidence showing that the neuronal structures involved when a mental state is experienced, are also recruited during the observation of others. Guionnet et al.

2. Behavioral Evolution

Their results agree with those previously evidenced 70 , 71 concerning the core circuit of imitation, but they found different activations between the situation of imitating and that of being imitated. A special quality of temporal imitation is the ability to use different motor movements in order to communicate. Although animals and humans can perceive rhythms and produce rhythmic motor patterns, only humans can adapt their rhythmic movements to external rhythms 72 [with the exception of the cockatoo 73 ]. The ability to be rhythmically synchronized with the environment appears important for infant development in the emotional, cognitive, social, and sensorimotor realms 44 , It has been demonstrated that the human fetus and newborn already have the capacity to perceive and produce rhythms The ability to produce temporally adapted motor patterns comes later and depends on the specific motor system involved and the relationship between the beat presented and the spontaneously occurring motor tempo of the infant 76 , It should be fruitful to longitudinally examine children with autism in terms of ability to adapt their own rhythm to external rhythms.

Interestingly, clinical observations suggest that some children with autism are able to respond to an external rhythmic vocalization by a similar rhythmic motor pattern such as hand flapping Tordjman, personal communication. However, previous studies reported disorganized rhythms, stereotypies, and poor synchrony in most of these children 78 , which might be related to the low melatonin levels reported to be associated in autism with the severity of verbal communication and social imitative play impairments 18 , Interestingly, in a study of social smiling in infants 79 , there was no difference in frequency of smiling between 2- and 5-month-old infants with and without ASD during infant—caregiver face-to-face interactions.

However, whereas typically developing infants showed a significant increase in smiling rate when caregivers were smiling, smiling in infants later diagnosed with ASD was not synchronized with smiling in caregivers and was not contingent upon caregiver behavior caregiver facial expressions and vocalizations. Repetitive behaviors and interests are defined, according to DSM-5 criteria 81 , as a repetition of identical sequences of behaviors for motor stereotypies motor stereotypies involve repetitive maladaptive movements or thoughts for restrictive patterns of interests restrictive and repetitive interests involve fixated interests, adherence to routines, or ritualized and rigid thinking patterns.

Thus, repetitive behaviors and interests can be viewed as behavioral responses to the need to create discontinuity that is repeated at regular intervals, which could have been fundamentally lacking in the physiological development of children with autism due to the melatonin deficit reported in autism. Our finding 18 observed in a sample of 43 adolescents and young adults with autism nocturnal excretion of 6-SM was significantly negatively correlated with repetitive use of objects , taken together with improvement of stereotyped behaviors following administration of melatonin in 24 children and adolescents with ASD 82 , supports this hypothesis.

From this perspective, stereotyped behaviors and interests can be seen as offering to children with autism rhythmic forms providing rhythmicity and discontinuity through the creation of repeated identical patterns. Albert Goldbeter 83 , director of the Chronobiology Unit at the Brussels Sciences University, underlines that life is rhythm. It is noteworthy that the word pineal comes from pine cone that is a Mesopotamian symbol representing the source of life and the power of regeneration. In Asia, the pineal gland is considered as the 7th chakra and represents the location of the soul and the highest level of consciousness.

We can nevertheless hypothesize, as we did in the previous section and in a prior article 26 , that this internalization process starts far earlier, in the womb, through maternal physiological rhythms; conversely, based on clinical observations in autism, children with autism create discontinuity out of continuity. However, the relationships between stereotyped behaviors and stress responses or anxiety need to be clarified given discrepant results reported in some studies 85 , Finally, it should be noted that several studies have also recently opened new behavioral, neurobiological, and pharmacological perspectives on autistic repetitive behaviors, especially on self-injurious behaviors [for a review, see Adler et al.

Thus, research on potential therapeutic effects for repetitive behaviors and interests should investigate benefits of melatonin in ASD see next section but should not be limited to the administration of melatonin. Published melatonin treatment studies in autism are presented in Table 2. Many have been most concerned with effects of melatonin on sleep.

Reviews, commentaries, and meta analyses of melatonin treatment studies are presented in Table 3. These two tables come from a prior article of our team Table 2. Studies on potential therapeutic benefits of melatonin in autism. Table 3. Review, meta-analysis, and discussion of therapeutic uses of melatonin in autism.


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As previously discussed 26 , the treatment studies have a number of limitations. In some studies individuals covering a wide age range were included with pre-pubertal, pubertal, and post-pubertal individuals being studied , , Reported differences in pineal melatonin secretion according to age and pubertal stage, coupled with the clearly developmental nature of autism, suggests that therapeutic effects of melatonin might vary considerably with age and pubertal status Studies have also been limited by small sample sizes 90 — 93 , 95 , 96 , 98 , , In larger studies, heterogeneous groups are often examined and have included blind individuals and individuals with various neurological disabilities with concomitant intellectual disability.

In such studies, often results seen for the autism subgroup are not separately presented 97 , , — The specificity and interpretation of the results with respect to autism are often unclear. However, it should be pointed out that in our studies 18 , 23 , lower melatonin excretion was significantly associated with social communication impairments rather than with sleep problems. Future studies of melatonin in ASD should simultaneously examine melatonin levels, sleep problems, autistic behavioral impairments, and level of functioning so that a more complete picture can emerge.

It is worth noting that just a few of the therapeutic trials of melatonin have assessed effects on autistic behavioral impairments. These include reports of improved communication , reduced social withdrawal 82 , 99 , decreased stereotyped behaviors and rigidity 82 , , and reduced anxiety 99 , Furthermore, at time the improvements noted were not sufficiently detailed. For example, Wright et al.

To reiterate, there is a real need for further studies on the therapeutic effects of melatonin that are conducted on large, relatively homogeneous samples and that employ validated behavioral assessments. Although there is a growing interest in the role of motor, emotional, and interpersonal rhythms in autism, there have been only a few attempts to focus on behavioral synchronization of social communication during therapeutic and educational intervention in autism.

The ESDM, developed by Sally Rogers and Geraldine Dawson , , is a comprehensive behavioral and developmental early intervention approach designed for delivery to to month-old children. The model uses the knowledge of how typical infants, toddlers, and pre-schoolers develop, in addition to knowledge of the ways in which autism affects early development, in order to facilitate an appropriate developmental trajectory in young children with autism beginning at the earliest ages. In order to do so, there is a strong focus on interpersonal engagement marked by synchrony and reciprocity during teaching, as research demonstrates that these are closely tied to successful developmental outcomes — Within the ESDM, the therapist and child work together to develop and sustain coordinated, synchronous activity routines into which teaching opportunities are embedded.

The ESDM reflects an understanding of the importance of synchrony of motor, emotional, and relational rhythms for the early development of young children with autism. For example, if the child uses an object with a rhythmic motor pattern, the therapist will reproduce this behavior with exactly the same rhythmic pattern. Furthermore, the ESDM requires the program to be implemented in different environments such as home, school, and caregiver settings , which also contributes to the introduction of variants. The ESDM is both a curriculum and a set of teaching practices. A specific developmental curriculum, administered every 3 months in typical practice, defines the skills to be taught at any given time.

In addition, a manual of teaching practices outlines the ways in which these skills are to be taught. Embedded within both the curriculum and the set of teaching practices is a focus on rhythms and synchrony. In other words, when therapists are working within the model, a focus on rhythms permeates both what they teach and how they teach it.

The ESDM curriculum outlines skills to be taught in multiple areas, including cognitive, social—emotional, and language domains. The curriculum focuses heavily upon the teaching of skills that promote engagement with other people in a synchronous, rhythmic way.

Many young children with autism enter an ESDM program with weaknesses in these skills, such as imitation, joint attention, orienting to name, and eye contact, and these have broad influences upon the manner in which these children can engage with others. It is well recognized that learning occurs within a social context and that social skills, such as imitation and shared attention, provide a foundation for many aspects of learning, including language, cognitive, and social—emotional abilities. Thus, the ESDM focuses heavily on the development of social engagement and interactional synchrony early on in order to further support learning of a wide range of skills.

One area of focus within the ESDM, which is closely tied to the concept of rhythmicity, is imitation. Spontaneous and appropriate imitation of others is typically rhythmic and marked by mutual attention, continuous adaptation, and turn taking. The beginning stages of facilitating imitation and social engagement often start with imitating the child, thereby entering into a rhythmic interaction with the child. Rhythmicity is also involved in the way teaching occurs within the ESDM upon multiple levels, from the basic structure of each interactive routine to the ways in which adults engage with children during interaction.

Social communication is about sharing moments of synchrony with others, and the ESDM supports the emergence of interactional synchrony. The therapist facilitates the occurrence of synchronous moments and strings them together into routines into which the therapist can naturally embed teaching opportunities. The primary vehicle through which all teaching is accomplished in this model is the joint activity routine, which is permeated by moments of rhythmic, synchronous interaction, and enriched with positive affect.

The joint activity routine, although flexible and naturalistic, adheres to a four-part structure: 1 opening, 2 theme, 3 elaboration, and 4 closing. This structure provides a set of invariants, against which multiple variants can occur at differing levels. For example, perhaps a child finds a toy drum and begins banging on it with his hand.

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This would be considered the opening phase of the joint activity routine. Next, the child and adult would develop a theme. This can be considered a continuation of the rhythm introduced during the opening phase — in our example, banging a drum slowly with hands. The adult and child would take turns doing so, each leading and each following. The skillful adult would embed teaching opportunities into these turns — perhaps a focus on eye contact during dyadic engagement, or on imitation of actions on objects, or on giving and taking objects with eye contact. Both partners then play within this rhythm for a while, until one introduces a variant, or elaboration.

In the ESDM, elaboration occurs by introducing a change into the joint activity routine, a change in the rhythm which often allows different teaching targets to be practiced. In this example, the child and adult might start to play peek-a-boo behind the drums. A new rhythm would need to be established, and both partners would work together in order to do so.

An elaboration of this sort is a rhythmic fluctuation occurring against a background of invariants e. The fourth stage of the joint activity routine — the closing — is the last part of the joint activity routine. Adult and child might help one another clean up the materials, and then both partners would begin an entirely new joint activity routine. This could often involve a change in location, activity level, or teaching domain, and an entirely new set of coordinated interactions would be developed.

Within the joint activity routine, synchrony pervades within several different levels and in several different areas. Adult and child are attuned to one another and responsive to one another in terms of sensory input and output, motor actions, and emotions.


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  • Coordinated dyadic engagement, well-balanced in terms of leader and follower, pervades a high-quality joint activity routine. It is quite natural to view this ever-present synchrony in terms of a focus on shared nuanced rhythms. There is also a focus on rhythmicity within some of the broader teaching practices of the ESDM; for example, in the way in which a teaching session is constructed. As mentioned above, teaching is delivered within joint activity routines. For a therapist-delivered session, these routines are strung together within a session to occupy a full 1- or 2-h time period.

    Within that time period, therapist and child move around to occupy several spaces. In a well-coordinated way, they engage together in a joint activity routine at the table, and then may move onto the floor for the next. They may sit together, then they may stand or walk or run. All of these changes occur against a stable background, as the session is marked by stability and continuity, with the introduction of variants when appropriate.

    The ESDM, a comprehensive, behavioral, and developmental early intervention designed for infants and toddlers with autism, is rooted within a sense of and appreciation for rhythmicity and synchrony at multiple levels, ranging from the specific skills that are taught to how those skills are taught, woven together and supported by a broader structure focused on maintaining a well-coordinated, synchronous set of dyadic interactions.

    Taken all together, ASD could be seen as a disorder of rhythmicity with, more specifically, impairments in the synchrony of rhythms. Alternatively, such asynchrony might play an important role in a possibly large subgroup of individuals that forms part of the heterogeneous ASD category. In this article, we proposed an integrative approach to study desynchronization in biological and psychological rhythms in ASD and develop an etiopathogenic hypothesis as well as therapeutic perspectives for ASD based on this integrative approach.

    Indeed, this integrated physiological and psychological approach opens important therapeutic perspectives for ASD based on regulation of physiological rhythms in particular, through the use of chronobiotics such as melatonin, and also through light exposure, use of regularly scheduled bedtime, wake up, meals, or activities combined with synchronization of motor, emotional, and relational rhythms through developmental behavioral intervention such as the ESDM. Further studies are required to better ascertain the underlying mechanisms of physiological alterations induced by temporal desynchronization and to better understand the role of biological rhythms and rhythmicity in the development of social communication, repetitive behaviors, and interests or adaptation to changes, and therefore in the development of autism involving impairments in these domains.

    The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Pevet P, Challet E. Melatonin: both master clock output and internal time-giver in the circadian clocks network.

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      Stability and Continuity in Mental Development: Behavioral and Biological Perspectives Stability and Continuity in Mental Development: Behavioral and Biological Perspectives
      Stability and Continuity in Mental Development: Behavioral and Biological Perspectives Stability and Continuity in Mental Development: Behavioral and Biological Perspectives
      Stability and Continuity in Mental Development: Behavioral and Biological Perspectives Stability and Continuity in Mental Development: Behavioral and Biological Perspectives
      Stability and Continuity in Mental Development: Behavioral and Biological Perspectives Stability and Continuity in Mental Development: Behavioral and Biological Perspectives
      Stability and Continuity in Mental Development: Behavioral and Biological Perspectives Stability and Continuity in Mental Development: Behavioral and Biological Perspectives
      Stability and Continuity in Mental Development: Behavioral and Biological Perspectives Stability and Continuity in Mental Development: Behavioral and Biological Perspectives

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