Practical suggestions flowing from the motor theory

But where does this lead in practical terms? This depends on some hypotheses about what may have gone wrong, what may be missing in the autistic infant's patterns of neural connectivity. At the worst there might be lack of the primitive motor programs - if that were the case then the child would be spastic, and autistic children are not spastic. Typically, they can move, see and hear. Or the link between articulation and perception and the primitive motor programs may not have been made. The peculiarities of vision, the tendency to use others' hands rather than their own, the curious lack of dizziness in spinning round, do suggest that there may be something wrong in the relation between the motor aspects of vision and central perception. Or there may be a lack, a distortion, of the relation between the primitive motor programs and the patterning of articulation. This would explain both the defects in the production of speech sounds and the absence or difficulty in the perception of speech sounds. Or there may be deficiency in the neural links between motor sequencing and speech sequencing, which would explain confusion in word- order as well as confusion in the ordering of phonemes in a word.
What might be done by way of treatment, or training, in the light of this? That motor methods may be practically useful has been shown by the relative (though still limited) success of treatment developed by Doman and Delcato.(Doman 1974) This involves physically moulding the pattern of movement of the children so that they perform the same motions in the same stages as those which normal children go through in, for example, learning to walk. How the theory of the motor basis of language might be translated into practical forms of treatment is speculative but some possibilities seem to be:
1. Emphasis on improving the autistic child's motor abilities. A number of forms of treatment (besides the Doman-Delcato approach) already do this. Some autistic children, as they get older, in fact demonstrate skilled motor control in piano playing, drawing etc.
2. Emphasis on the strengthening in every way possible of cross-modal links: gesture and speech-training should be linked together. The characteristic attention of autistic children to abstract shapes should be exploited - maybe the curious ability with which they can use written letters and learn to read is a manifestation of this. They should be encouraged as early as possible to associate the shapes of letters with speech-sounds, the shapes of words with pictures of the things to which the words relate; associate appropriate hand and arm movements with reading a word describing the movement.
3. The link between basic motor programs and the patterning of articulation is of critical importance. There should be a systematic linking of bodily movement and the production and perception of speech sounds. They should be taught to correlate a pattern of arm movements with an ordered set of speech sounds.
4. For improving retention of words and their meanings, use iconic gestures and associate the sound of the word with the gesture. It does not matter much whether the gesture is part of an established sign language (ASL or BSL) but the more iconic, even pantomimic, the better. Do not rely only on imitation of the gesture by the child; form the movement for the child, following the Doman approach. Accompany a word describing action with the action to which it refers e.g. jump with 'Jump' - hit with 'Hit'.
5. Try to develop a direct relation between action-syntax and speech- syntax. The child should be encouraged ( or the child's movement directly patterned) to match specific actions with specific word-orders: "I give the cup to Mary " etc.
6. Pronouns are directly derived from deictic gestures. The pronouns should be associated with these gestures. It is very important that the child should be encouraged to point, to himself or to others or to things. Associate pointing (forming the child's arm position) with the pronouns: YOU with pointing to someone else and ME with the hand pointing to the child's chest.

Conclusion

The main idea of the motor theory is that the structures of language, (phonological, lexical and syntactic) derive from and are modelled on neural patterning for motor control. Motor programs for the control of bodily action, by a growth in neural connectivity, became extended to the control of articulation so producing the restricted and specific range of speech sounds found in all human languages; the structures of words were derived from the motor patterning involved in the perception of objects in the external world and from the motor patterning of the actions to which words refer, and syntactic organisation of language reflects 'syntactic' processes in the planning and execution of bodily action. The aspect of the motor theory of language origin and function which may be particularly relevant for autism is this: perception and motor control in the normal individual are, and must be, intimately linked (so that we can, for example, see an object and stretch out our hand to pick it up). If language is derived from and closely associated with the patterning of motor control, then perception, motor control and language must in neural terms be locked together. For language to develop normally, the neural connections with the motor system must develop at the appropriate time. If they do not, then even if the relation between perception and motor control is normal, the link between the object perceived (scanned by eye-movements) or the action executed or perceived and the word structurally related to the object or action cannot be established. Without the necessary and natural link between word and object or word and action, all the potentialities of higher-level mental functioning, the manipulation of concepts, rational thought, imagination, planning, would be crippled. Meaningful gesture, a motor activity intimately related to speech and seen by many as an integral aspect of speech production, would be defective or absent.
The autistic child lacks language, or has only severely defective language; at the same time the autistic child is abnormal emotionally, both in the lack of empathy with others and in its heightened sensitivity: as Donna Williams describes it, a hyper-emotional response to everything from the outside world. In autistic behaviour, what are causes and what are effects? Does the abnormal emotional response cause the failure to acquire or use language normally, or does the lack of normal language create the hyper- sensitivity, the abnormal emotionality? The autistic child appears to lack the step in cerebral reorganisation (neural connectivity) which made language possible; this is a critical loss. Language, vision and motor control all go together; language is the supreme medium of empathy and language almost certainly plays the major role in making possible consciousness, self-awareness; language allows one to construct a model of one's world, to create rational expectancies, particularly about the behaviour of others. For someone with no reliable pattern of expectation about the 'world', every moment of life becomes like wandering through a Chamber of Horrors, unknown and unexpected horrors. Is that soft and furry thing a rat - or a bedroom slipper? Is that unfamiliar noise an attacker - or someone coughing? Is that cold breeze a ghost - or a window left open? Is that bright light an explosion or a fire - or a fluorescent tube lighting up? It can be unpleasant when we hear too sharply, birds, the wind, a creaking door etc. Emotions are normally softened by familiarity and expectation. Without these, emotions may go into over-drive, are stirred all the time, too strongly. Not emotionally-crippled but not sufficiently emotionally de-sensitised.
Attention, that is, directed expectancies, not only make what is attended to more salient - it also makes everything not attended to less salient. What is expected does not surprise. The unexpected surprises: e.g. something empty that is expected to be full, something full that is expected to be empty (we judge, or misjudge, the likely weight of everything we handle). The sharp sound that comes upon us with no prior context alarms. So: if we have no, or a faulty, updated model of our 'world', our environment, (even of ourselves ?), everything may become sudden, unexpected, alarming. All the senses may become over-sharp, over- acute. Every noise, every bright light, every touch, becomes an acute (perhaps unbearable) experience.
Perception is perception of change in the environment. To perceive change, the perceiver must have retained the pattern of the normal,the stable, the usual, the expected. The source of any change may be the inanimate environment (wind, rain, cloud), the animate environment (conspecific or other specific), the individual human environment, or the social environment. Language is both itself perceived change in the human environment and the means for controlling, categorising change. To make possible the perception of change, there must be appropriate neural organisation, a neural record of the expected environment. The perceptual capacity of the perceiver derives from the model it retains of its environment and of itself as acting within that environment. Our brains must be structured in terms of the usual or expected environment and perception is the result of interaction, or matching between the expected environment and the current environment by which change is detected. There must then be restructuring in response to the perceived change, possibly not as a separate process - the awareness of the perception may in fact be the restructuring. Perception would then be a direct reflection, an internal representation of reality, internal ordering guided by external ordering. Language would be the instrument for controlling rather than being controlled by perceived change. The autistic child's hyper- emotionality, hyper-sensitivity, would be the result of the lack of language, of all means of social communication. If this is right, then any approach, any treatment, that reduces, even if it does not cure, the deficiencies of language, should carry with it the prospect of general gains in behaviour, in sociability, in emotional control.

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