Movement Differences Among Some People with Autism: an Impetus to Re-Examine Behavioral Issues



Beliefs, attitudes, and old information about autism appear to need constant re-examination as new concepts, information, and treatment approaches continuously become available. In recent years professionals and parents have reflected about concepts such as inclusion and theory of mind and interventions ranging from holding therapy to manual signing. Movement differences has become a contemporary topic in the area of autism in the 1990's, although the neurobehavioral construct itself is referenced in pre-1990's medical chronicles. Present discussion of the topic with regard to individuals with autism represents a broadening of application and reflection beyond the original documented disability groups. The significant questions and possibilities presented by the topic of movement differences compel people with an interest in autism to engage in some personal re-assessment. This paper presents some basic information regarding the nature of movement differences and provides suggestions as to its functional application. Readers are urged to read full text discussions by Donnellan & Leary (1995), and Leary & Hill (1996), and to remember that movement difference is a construct and not a new disability category.

Recent widespread awareness of selected aspects of movement differences began with the publications and trainings of Rosemary Crossley (1980) and Doug Biklen (1990) on the technique of facilitated communication. The need for an assisted movement/emotional support technique (i.e., facilitated communication) arose from supposition. Later, direct confirmation occurred when selective nonverbal individuals indicated that they did indeed have difficulty initiating or sustaining independent coordinated motor movements. Controversy still surrounds the use of the facilitated communication technique in terms of consistent authentic authorship of messages. As part of the controversy, there has been speculation that many nonverbal individuals who were introduced to the facilitated technique may not have had a movement difference or a disturbance of the magnitude that prevented them from using more conventional and independently accessed augmentative means of communication (e.g., Liberator™, DynaVox®, non-commercial manual communication boards). There is no significant data to support or refute the prediction about prevalence. In comparison to dialogues and disagreements about facilitation as a technique, discussion about the more broadly defined construct of movement ability or difference has been less provocative. If anything, the new information has encouraged others to notice potential movement differences in individuals with autism that had been previously overlooked and to engage in pondering about new interpretations of human behavior.

The reframing of observations that derived from the facilitated communication movement, however, proved to be just the tip of the iceberg in the topic area of movement differences. Many neurologically based disorders such as Parkinson's and Tourette's appear to share symptoms that are also found in some individuals with autism. The neurobiological basis for autism per se, however, is not considered to be the causal agent for the movement difference symptoms that have been noted but there does seem to be some relationship. Selective examples of shared characteristics or symptoms include the following: repetitive movements, abnormal gait, abnormalities in muscle tone, lack of imitation, self injurious behavior, echolalia, and difficulty initiating, stopping or switching actions (Donnellan & Leary, 1995).

On a semantic basis one would guess that movement differences literally referred to observable motor movement patterns. Instead, movement differences, as described by Donnellan and Leary, and others, has a more figurative meaning. While the construct does include movement patterns or actions, it also encompasses posture, speech, perception, thought, attention, consciousness, motivation, memories, and emotion. Overlaid on each of these is the issue of volitional or voluntary control (Donnellan & Leary, 1995; Leary & Hill, 1996). The more figurative or metaphorical nature is evidenced by discussions of someone's internal mobility to cease thinking about a particular thought, to switch a perceptual focus, or to combine memories with new thoughts. Both Leary and Donnellan define movement differences through visual information displays and examples rather than through an exact dictionary-type of definition.

Recognizing Possible Instances of Movement Differences

Recognition of movement differences as a factor in observed behavior certainly will force rethinking in the area of behavioral analysis. It will no longer be possible to only hypothesize about the probable purpose or motivation for a given behavior. Since specific actions may not be under the individual's volitional control, there may be a mismatch between personal motivation and the action observable by others. There also may be a mismatch between a service provider's hypothesis about the intent or benefit of an action and the actual intent of the person with a movement difference. The mismatches can best be illustrated by some common examples. Movement differences may be a co- occurring factor or the sole factor behind the observed behavior in any of the illustrations and the hypothesized intent of the behaviors.

Examples of Real Situations

John paces the perimeter of the kitchen in an intense manner; he ignores directives to find something else to do.

Possible function of the behavior:
John is anxious about an upcoming event or he has the need to relieve built up tension.

Possible movement difference:
John has difficulty ceasing the motor behavior, switching his thoughts to an internal activities option menu, and initiating body movement to begin the selected activity.

Brian is told to get ready for gym class; he begins screaming.

Possible function of the behavior:
Brian is sound sensitive and he is avoiding the transition to a noisy environment.

Possible movement difference:
Brian is unable to execute all of the motor steps or sequence involved in getting ready for gym class, (i.e., putting away his pencil, returning a book to the library shelf, getting his jacket, lining up with his classmates to transition to another building for gym). Shifting his thoughts regarding what he must do with his body at each step may be difficult. The movement difficulties may be instigated or compounded by the challenge of transitioning to an environment that is aversive to a sound sensitive individual.

Sarah enjoys assembling puzzles. She reaches to insert a puzzle piece but appears to stop for a minute before moving on to insert the piece.

Possible function of the behavior:
Sarah was waiting for a verbal cue to continue the action which also would have resulted in a brief social interchange with her favorite staff member. Second, she could have been distracted by the shininess of the table upon which she was assembling the puzzle. As a third option, Sarah could have had a seizure.

Possible movement difference:
Sarah experienced a freezing or blockage in her ability to smoothly execute a volitional motor plan.

Gary periodically bites his hand and makes sounds as he tries to manipulate his shirt buttons while dressing in the morning.

Possible function of the behavior:
Gary is expressing his frustration with the difficulty level of the task.

Possible movement difference:
Gary is unable to execute the complex movements involved in buttoning his shirt. He finds it difficult to shift his thoughts from memories of past difficulties and frustration with the present episode.

Tim takes a long time to think of what he wants to say. By then the relevant moment for a response is gone. Usually his second grade teacher and classmates are talking about a different aspect of the topic when he contributes what appears to be an off task comment. He gets angry when the other students laugh at what appear to be non sequitur comments.

Possible function of the behavior:
Tim is protesting that the other students laughed at his contribution to the class discussion. He has experienced an affront to his dignity.

Possible movement difference:
Tim is unable to quickly move from thought to thought, to sift the important aspects, and then combine those thoughts while executing a motor movement plan.