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The compensation of autistic features during a little boy’s second year: overcoming pain through the development of attachment (continuation)

Some technical details of the ethological observations

My attention was concentrated on the following insufficiently developed attachment behaviour patterns, which may be assessed as autistic-like patterns (Tinbergen & Tinbergen, 1983; Lebedinskaia and Nikolskaia, 1991; Lord 1985):

1. the disturbance of the baby’s proper moulding of his body to the adult’s body when being embraced or being picked up

2. the incompleteness, weakness or severe irregularity of basic coordination of contact in different sensory modalities, and the deficient use of individual modalities in the service of establishing

3. the deficit of early greeting behaviour, expressed by irregular smiling at a familiar face and voice, and later by the ambivalent response to an adult; peculiarities of stranger separation anxieties

4. the inability to use the adult’s emotional signals or responses for behavioural regulation while exploring the environment. This leads to

5. the inhibition/distortion of exploratory behaviour.

I used video recordings to supplement my write-ups of observations. This made it possible to capture subtler links between the adult’s and Serioja’s emotional expressions, which were of key significance in making, sustaining or breaking off emotional contact. Video recordings also allowed me to pick up minute traces of attachment behaviour or of its extremely incomplete forms, and to follow oscillations between these and autistic behaviour patterns.

2. Infant observation

I also observed Serioja once a week using Esther Bick’s method, between the ages of eleven and twenty-five months. As I hope to show, this filled in and enriched the results from the ethological observation of the development of behaviour patterns, since it provided material for understanding the deeper and more complex levels of internal emotional states and of the links between them.

Early developmental history

Serioja was born of an alcoholic mother who ‘gave him up’. At the age of twelve days, he went from hospital to orphanage, with a diagnosis of early damage to the central nervous system (‘hypertensive-hydrocephalic syndrome’ at the stage of compensation, and ‘vegetative-visceral dysfunction syndrome’). These early diagnoses were typical for the babies I observed at the orphanage.

From the medical notes, it appears that the most difficult part of Serioja’s development took place during the early months of his life: he was extremely irritable, would cry for long periods of time, and could not be comforted. He did not babble, and was thought to be deaf as he did not react to carers’ attempts to involve him in an emotional contact. His motor development was severely delayed (for instance, he could not support his head at the age of five months).

During his first year, Serioja underwent four hospitalisations, lasting from six days to three weeks.

The first signs of progress only appeared in the second half of his first year, two months after his transfer from the isolation unit to a group of children in the orphanage. While there remained an absence of eye contact, repeated prolonged episodes of inconsolable crying, a continuing sleep disturbance, and some belching, there was also a normalisation of muscular tone. Serioja now had clear intervals during which he would allow an adult to approach him. He started to smile and to laugh in his seventh month, and to babble in his eighth month. He became interested in toys, and his motor skills developed rapidly.

It is worth noting that Serioja’s progress in sensory-motor development and exploratory behaviour was more noticeable and stable than the development of his attachment behaviour or his ability to communicate with adults.

The first part of the observation: primary suffering

This covered the period of Serioja’s life between the ages of eleven months and fourteen months and three weeks, when the first, unsuccessful, attempt was made to transfer him to a group of older children.

When I began to observe him, Serioja was at the beginning of his painful emotional awakening. He was just starting to differentiate between familiar and unfamiliar adults, developing his first stereotypes of interactions with them and reacting with panic if these were disturbed. He was learning to walk, often falling and crying. His cheeks were red and encrusted; his nose usually leaking mucus. When he approached an adult, Serioja screwed up his eyes, and his face expressed a mixture of fear and ecstasy.

During all of this first period, Serioja made desperate efforts to establish close contact with the observer, or with a student participating in the research. At each attempt, however, the painful quality of the emotional experience increased so rapidly that it made any more or less harmonious contact with an adult impossible. This experience of pain during intimate contact with an adult seemed to be the primary emotional deficit that Serioja was suffering from — primary not in terms of aetiology, but in terms of the structure of his condition. I mean here the distortion in the way he perceived a human caress, gaze or voice, so that the inborn evaluation of these as soothing, attractive and promising gave way to a painful and repellent experience. The reason for such a distortion may be an interaction between the child’s emotional deprivation and the biological weakness of his nervous system, which is closely connected with perception of the environment. We are probably witnessing the distortion of the oldest form of sensitivity, ‘protopathic sensitivity’, which is responsible for the preliminary assessment of any perception in terms of whether it is pleasant or unpleasant. This kind of sensitivity is distinct from modal perception and precedes it (Lebedinsky 1985). The contribution of emotional deprivation to this primary deficit becomes clear if we bear in mind the selectivity of the distortion: it manifests itself mostly in relation to adults (not in relation to children or the inanimate environment).

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