The Influence of Impaired Functioning of Brain Structures on the Ability to Read Emotions and Showing Empathy by People with Autism

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Krzysztof Wawrzyn

UniversityofLowerSilesia

the InfluenCe of ImPaIreD funCtIonInG of BraIn struCtures on the aBIlIty to reaD

emotIons anD showInG emPathy By PeoPle wIth autIsm

Introduction

Autism is one of the most serious disorders of neurobiological substrate�

Currently,itissaidwithabroadspectrumofautism,butneverthelesshavestillnot

beenunequivocallyestablishedthecausesofdisturbancesofthisnature�Many

researchers have indicated a number of pathomechanisms specific to autism�

Amongthem,pointout�:U�Frithontheconceptofinnatecognitivedeficittheory

B�Hermelindisturbancestalkingaboutthetransferofinformation,thetheoryof

defectivefunctioningofcentralcoherenceandtheoryofmind(TheoryofMind)

– allcitedabovemayresultfromdysfunctionofworkofcentralnervoussystem�

However,amongtheconceptsofstronglyneurobiologicalsubstratethatcanbe

cited:disruptedtheflowofsensorystimulus,brainmicro-damageormirrorneu- rondisorders�Theabovementionedcouldbeamongthemreasonsofdisordersin

communicationandsocialrelationshipsandevenwithoneself,theabilitytoread

emotionsandshowingempathytoothers�

WhileconductingtherapywithpeoplewithautismIoftenaskedmyselfthe

question:howdisturbancesinperceptionaroundtheworld,soimpairedinthe

transferofinformation,suchasinconsistenciesandapparentcentralcoherence

theoryofminddysfunction,influencetheinabilitytoaffectthereadingotherpeo- ple’semotions,atthesametimeshowingempathytoothers?

Mentalstatesaredifficulttounderstandforpeoplewithautism,ofcourse,

theyneedcloseemotionalrelationshipsandrefersuchcontacts,andfeelcompas- sion,butsometimestheyappearonlyincidentally,inaunique,socialhardshipfor

reading,understandingandacceptance�Inthefollowingtext,insimpleandshort

wayaretracedsomeoftheselectedconceptsofpsychologicalandneurobiologi- cal,tryingtofindsomeanswerstothequestionsposedatthesametimetryingto

understandthebehaviorofmypatients�

https://doi.org/10.18778/7525-795-3.17

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Central Coherence and theory of mind

Amongotherthings,amongpsychologiststherearesuggestionsthatthe“theoryofmind,aswellasotherinformationprocessingsystemsofreality,isgrowing

thankstothetrendtowardscentralcoherence,thatis,poorabilityofthecentral

coherenceinindividualswithautismcouldbetheexplanationofthetheoryof

mentaldisorders�Onemightthenconcludethatallindividualswithautismexperi- enceaweakdevelopmentofthetheoryofmind”(Kruk-Lasocka,1999,p17)�The

studiesshowthattheproblemsofcentralcoherence,socharacteristicofpeople

withautism,occurregardlessofthelevelofdevelopmentoftheoryofmind�There

was,soahypothesisthatcanfunctionindependentlyintwodifferentcognitive

deficits(Kruk-Lasocka,1999)�Inthiscasethepathogenesisofperceptionand

informationprocessingandtransferofinformationisnotdisturbedtodetermine

malfunctiontheoryofmind�Itistruethat,astheoryofmindandcentralcoher- encearemechanismsimplyingapropercommunicationandsocialfunctioning,

however,theyareworkinginseparateareas�

Letusthereforeseehowtomakethetransferofreceivedinformationfrom

theenvironment�Inahealthypersonistheintegrationofstimuliandthefluidity

ofinformationtransmission,itistrueintheinitialphaseofthemultistreamtrans- fer,butneverthelessasaresultoftheproperfunctioningofthecentralcoherence

flowingconsistently�UtaFrithlikensittotherivercollectinginformationfrom

differentsenses,accordingflowingstream(U�Frith,after:Kruk-Lasocka,1999)�

Unfortunately,peoplewithautism,“sometimesthereisaseriousdisturbancein

theabovemechanism�Incentivesreceivedbytheindividualsensorsarebonded,

anabnormalintensity,breakinthetransferofinformationorlackofmovement

ofstimuli”(Wawrzyn,2010,p179-180),whichalsocertifypeoplewithautism�

B�Randdescribinghisautisticworldusestheexpressionthat“seeingisnot

onlywhatisperceivedthroughtheeyes,buthowtheimagereachingtheeyegoes

tothebrain”�Hesaysthat“hewasrepeatedlysurprisedbydescriptionsofother

peopleforwhattheyhaveheardorseen,becauseitwasnotconsistentwithwhat

hesawandheard”(Rand,2007)�

Abnormalitiesintheperceptionoftheworldbypeoplewithautismmanifest

themselvesindifferentways�Incentivesreceivedbytheindividualsensesflowin- dependentlyofeachother(duetofaultycentralcoherence)arenotintegrallycon- nectedandreceiving–isinconsistencyofincentives,butnotalwaysandnotall

sensors,i�e�,someoftheimpetusprovidedbythedifferentsensescanbereceived

simultaneously-forexample,stimulireceivedbythesenseoftouchandhearing

maybesimultaneous,andthereceptionofstimulibysenseofsightislater�Theflow

ofstimulimaybedisruptedasaresultofvariousintensity,itmayinvolveoneor

multiplestimulus-excessivedisplay,ormuteeachofthem(Wawrzyn,2007;2008)�

Theirregularitiesintheperceptionmaybemaskingoreliminationofsome

incentives by the second� For example, the first may “come” the picture, then

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TheInfluenceofImpairedFunctionigofBrainStructures…

fades,asthe“comes”sound�ButitcanoccurinsuchawayasT�Grandinquotes:

“Nosoundisnotstuckbymyfixation�Evenasuddennoiseisnotrescuedme

frommyworld(��)�ButwhenIstayedinthe“humanworld”,Iwasverysensitive

toloudsounds(Grandin,1995,p19)�Itcanalsobefollowedbyatimedelayinthe

receiptofoneormorerelativetootherstimulisuchasfirstand“come”incentives

receivedbyareceptor(suchassightorhearing),andthenfollowsthereception

ofstimulifromanotherreceptor�Itmayalsobelossoftransmittedinformation

onthewaytothebrain-orlackofperceptionofstimulibytheCNS”(Wawrzyn,

2010,p180)�

Observationisalsoselective,captureevensmallincentives,suchasvisual

focusforautisticpeopleonverysmallobjects/itemssuchdustparticles,paying

attentiontotheshinyobject–reflectinglight,orselectivefocusingonauditory

stimuli(Delacato,1995)�Frith,quotedearlier,considersthattheconvictionofthe

child,theimportanceofdetailinasituationmaynotagreewithwhatotherscon- sidertoberelevant(after:Kruk-Lasocka,1999)�Randdescribingtheirfindings,

thereviewof“donotknowwhyhisheadchoosesthethingsonwhichitfocuses,

however,knowsthattheyarenotusuallythesamethingsthatotherpeopleare

going”(Rand,2007)�

Example presented, impaired cognition exemplifications of the material

worldaretheresultofdefectivefunctioningofcentralcoherence�Suchdefects

lead to difficulties in creating a representation of the physical/material (Frith,

2008;Kruk-Lasocka,1999;Winczura,2008),apersonsufferingfromautismlink

directlytoeachgivenstimulus,unabletogeneralizeindividualcharacteristics,

whichresultsfrominabilitytotransferintermodalinformation(comparetheory

Hermelinforimpairedtransferofinformation)(after:Kruk-Lasocka,1999)�This

factmayexplaintherigidityinbehavior,respectoffixedhabitsandritualsbypeo- plewithautism(Pisula,1999)�Suchbehaviormaybeanattempttoorganizethe

materialworldperceivedwrong,whichbecomeasourceofvariabilityofanxiety,

aggressiveand/orself-aggressivebehavior�

Thus,ifthesickpersonhasanimpairmentofperceptionofthephysicalworld

–matter,itwillalsobepresentinthementalperceptionoftheworld,especially

mentally�However,thelatterisnolongerenoughjustwell-functioningcentral

coherence,butalsoissomethingthatwillexplorethementalworldofthesame,

somethingthatwillallowthecreationoftherepresentationofintangibleassets:

emotions,desires,beliefs,orintentions–thismechanismisTheoryofMind–the- oryexplainingthementalstates(Frith,2008;Kruk-Lasocka,1999;Pisula,2000;

Winczura,2008)�Ithasbeenrecognizedbyresearchersasamajorcomponentof

thecognitiveprocess�Itisoneoftheelementsofaverycomplexnature�Isre- sponsiblefortheabilityofthinking,takingplaceatthelevelofabstractionandis

associatedwiththerepresentationofthesamemind,andoneofitsmainfeatures

istheabilitytothinkaboutthinkingortheabilitytoimaginethestateofmindof

anotherperson(U�FrithandS�Baron-Cohen,after:Winczura,2008)�Andthat

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theoryofmindenablesefficientreadingotherpeople’smentalstates,aswellas

theirownminds�Itallowsonetoapplyforthesestates,explainandpredictonthe

basisofhumanbehavior(P�Steernemanafter:Winczura,2008)�Children’stheory

ofmindenablesasmallchildunderstandingofmessagessentbyotherpeople

(inthefirstplacebyparents/guardians)-itisthroughthemessagesapersoncan

expresshisemotionsbydoing:modulationofvoice,facialexpressions,gestures,

glances(Wawrzyn,2009),non-verbalcommunicationandnon-languagecompo- nents,includingtheproto-languagevoice,butnon-verbalwaysofcommunication

(includingintensity, height, pace and rhythm sent the message) (Smyczek and

Szwiec,2000)�

Eveninfantsreacttohumanface,however,asBowlbydescribedareinnate

biologicalmechanismsofconditionalsurvival(Bobkowicz-Lewartowska,2005;

Bowlby,2007;Holmes,2007)�Achildwithsuchmechanismsrespondstothe

arrangementofelementsresemblingahumanface,cryingandlaughing(inthe

sixthweekoflife)�Atthesametimeobservedchildrenwithautism,inearlychild- hood,werestatedtohavetheirreactionssuchaslaughter,orcrying,ininfancy,

tobemoremutedthaninhealthychildrenandoccurlessfrequently(Jaklewicz,

1993)�Perhapsthesearethefirstsignsofdisturbanceinthefunctioningoftheory

ofmind,whichisdeterminedbyneurologically(Kruk-Lasocka,1999),andisan

inborncognitivemechanism(U�FrithandF�Happe,after:Winczura,2008)–re- searchersseethesymptomsofautism,includingearlychildhoodautism�

Besidestheabilityto:understandthedesires,intentions,toaskforsomeone’s

beliefs,theoryofmindallowsfor“reading”andunderstandingtheemotionsof

others(P�Steerneman,B�Huskensafter:Winczura,2008)�Thisimpliesalotof

mentalfunction: understanding,representation,abstraction,abilitytopretend�It

allowsonetocreaterepresentationsofmentalstates(U�FrithandF�Happe,after:

Winczura,2008)�Theoryofmindlargelydeterminessocialdevelopment,which

is closely related to communication skills (both verbal and non-verbal), as re- portedbymanyresearchers(L�Camaoinietal�,T�Gałkowski,M�Konstantareas

et�al�,J�Kruk-Lasocka,E�Minczakiewicz,JG�Olley,A�Pankiewicz,I�Rapin,

B�Singel,J�Surowaniec,after:Winczura,2008)�Itcouldbehypothesizedthat

deficitsimplyatheoryofmindsocharacteristicofpeoplewithautismforthe

transmissionofvoicemessages,largelywithouttheemotionalone�Theinability

orverylimitedabilityintheuseoftheautisticpeopletovoteisafunctionof

modulationbindingwiththeabilitytoreadandexpressemotions,whichisone

componentoftheoryofmind�Autisticpersondoesnotunderstandthatthrough

asystemofverbalcommunicationcanalsogiveanemotionalmessage,andthe

recipientwillbeabletoreadit�Anothercharacteristicisthesavingofgestures

andfacialexpressionsaswellaspoorinstrumentalcommunication(A�Atwood,

U�FrithandB�Hermelin,after:Winczura,2008)�Onecan,thereforeconclude

thatwithsuchalackofexpression,theautisticpersondoesnotsubstantiallyben- efitfromthefunctionofthehumanpsycheexploringtheworld,usingprimarily

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theskillstocreatearepresentationofthematerialworld�Thisdeficit,however,in

manycasescompensatesforframingthinkingaboutwhichhewritesamongother

things,T�Grandinthoseareusingphraseslike:“Icannoteventhinkthewords–

Ivividly�WhenIthinkaboutabstractconceptssuchasrelationships,useofvisual

images,suchasaglassdoor�Contactswithpeoplehavetobeextremelypolite,

becausethebargecouldbreakdownthisdoor“(Grandin,T�,1995,p100)�

Returningtotherelationshipofverbalcommunicationwithnonverbalemo- tional elements should be pointed out that one-year-old healthy children were

awareoftheimpactofcommunicationonthebehaviorofpeopleclosetothem

(Winczura,2008)�LittleChildren“indialogue”withtheparent/guardian(orother

person)usenon-verbalmeansofexpression,readthemessagesandcaller’semo- tionalstateandthemselvestransmitsuchsignals�

Amongresearchersstudyingthecommunicationproblemsofautisticchildren

weretwopositions,astowhichofthetwo–communication(Ch�Njiokiktjien,

D� Ricks, M� Rutter, L� Wing, after: Winczura, 2008) or social development

(K�Lovelandetal�,GBMesibow,E�Schopler,after:Winczura,2008)–theis

damagedfirst and thus causes damageto another� Of course, specific, limited,

orimpaireduseofverbalandnonverbalmessages,ornotusingthemleadsto

disturbancesinsocialrelations,butalsotoexploretheworldofmentaldefective,

mental,orinabilitytousethisarea,itaffectsthenormalsocialrelationshipsand

impairedfunctioninginthissphere,whichinturncausessecondarydeficitsin

languagedevelopment�Althoughtheissueisnotresolvedandthestudydidnot

indicateclearlywhichoftheparts,asoriginallydamagedisresponsibleforthe

disorder,therearestronginteractionsbetweenthem�Itisknownthatcommunica- tiondeterminesthesocialdevelopmentandviceversa�

Asindicatedabovethelevelofsocialskillsisconditionedbythedevelop- mentoftheoryofmind�ThecomponentsofTheoryofMind,whichleadtosocial

development,unfortunately,inthecaseofpeoplewithautismareoftenheavily

disturbed�Torunthe“machine”calledtheoryofmindalotoffactorshaveto

workwell�Inthefurtherprocesstheywillintersect,tieanddrive,butthatthis

mechanismwas initiatedinfant/childmust make eye contactwith a parent (or

othercloseperson)�Itmustbesupportedinmanysubsequentinteractions,which

initiatesthenextphaseofdevelopmentofeyecontact;theendresultisacon- sciousbeliefaboutthechildbeingseenbyothers(Piaget,2006;Winczura,2008)�

Ahealthychildofabout9thto18thmonthoflifethereisamechanismtoshare

observationswithothers�Attentionisdividedonaparticularobject,whichcan

alsobeaperson�Aftertakingrootofthisfunctionisenteringanother–thecentral

mechanism,whichisthe“chief”inthedevelopmentoftheoryofmind–foundin

anumberofcomponents,suchasdesires,beliefs,intentions,theabilitytosimu- lateandidentifyemotions(Pisula,2000;Winczura,2008)–Compare:Chart1�

Childthroughbeliefstakestheotherperson’spointofview,andatthesubsequent

stageacquirestheabilitytothinkaboutthinkingofotherpeople�Overtime(about

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6yearsold)developtheabilitytounderstandfalsebeliefs,wherefalsehoodand

deceitaretheirmainfeatures�Reasoningaboutfalsebeliefscanariseifthechild

understandshisownindependencebetweenknowledge,knowledgeofthepartner,

andreality�

However, the basic element and a prerequisite for the process of shaping

achild’stheoryofmindistheabilitytorecognizeemotions,whichisseenasthe

abilitytointerprethisorsomeone’sinternalstat

Krzysztof Wawrzyn

The influence of impaired functioning of brain structures on the ability to read emotions and showing empathy by people with autism.

suppositions wishes ideas preferences beliefs expectations

H. M. Wellman Desires are described As imagination

BELIEFS DESIRE INTENTION

First beliefs– recognition of thoughts and feelings of other people (app. 3/4 year of age.)

(H Wi D P )

Further beliefs - ability to think, think about thinking, recognition of motives

and intentions of other people (app. 6 year of age)

CENTRAL MECHANISM OF MIND THEORY

Unintentional action i.e mistakes Intentional

actions

Condition of development of child’s theory is ability to:

- pretending – make-believe- games (child learns it between 18th, and 24th month of age) (A.

M. Leslie),

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certainty about independence of these three elements

Empathy

Chart 1. Components of theory of mind that create the central mechanism. Own study, 2008 on the basis of: Winczura, 2008.

False beliefs (app. 6 years of age) (Steerneman, Huskens, Wimmer,

Own knowle

Knowledg e about

Knowledge about reality

Ability to identify cognitive and Simple emotions (Steerneman, Huskens)

Ability to interpret somebody’s internal state Ability to interpret own internal

state

Simple emotions:

-happiness, - sadness,

Cognitive emotions:

- surprise, - embarassement, - interest, Dreams(divided from real world

form without earlier presentation)

Chart1�Componentsoftheoryofmindthatcreatethecentralmechanism�Ownstudy,2008onthe

basisof:Winczura,2008�

Asafurtherconditiondefinestheunderstandingandtheabilitytopretend

thatthisabilityisreflectedinthechildren’s“make-believegames”�AM�Leslie

describesthismechanismastheabilitytoshareexperiencesandplayimaginary

roles� Perceived, remembered and then used combination of abstract qualities,

feelingsandeventstakingplaceinthementalsphere�Lesliedistinguishesthree

formsofpretense:thesubstitutionofobjects(usingobjectifitwereanothersub- ject), pretending to change the construction of the object (assign properties to

objectswhichtheydonothave)andtheimaginarysimulation(thisreferstothe

absentobjectasiftheywerepresentintheenvironment)�Althoughtheimag- esarecreated,however,thementalrepresentationsofpretense,anddreamsare

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separatedfromtherealworld,towhomthechilddoesnotformarepresentation

(Winczura,2008)�

Insimplifiedway,thecentralmechanismoftheoryofmindcanbepresented,

whichistheprimaryfactorinthedevelopmentofsocialskills�Thechildmust

havetheabilitytoassignhimselfandothersmentalstatesinordertounderstand,

explainandpredictbehaviorandmustunderstandandinterprettheirownandoth- ers’emotionalstates�Thisskillisneededtodevelopafeelingofempathy,which

isnotpossiblewithoutthisunderstanding�Childsympatheticinthesituationof

anotherpersongraspingherinneremotionalstate,italsofollowsbyanalogywith

thestateoftheirown,andthisisduetothepossibilityofappealtoapreviously

createdmentalrepresentation�

the emotional Brain systems and micro-damage of the Brain – the mirror neuron Disorders

Inthiswayautisticbehaviorsareexplainedbypsychologicaltheories,but

neuroscientistsandneuropsychologistssharetheopinionthattheconceptofemo- tionalstatesislargelydeterminedbyneurobiology�Theresearchhasshownthat

theabilitytoreadandunderstandotherpeople’semotionsistheresponsibility

oftherelevantareasofthebrain(Herzyk,2003;Shreeve,2005;Steuden,2008)�

“Researchers distinguish three main large systems composed of many smaller

structuresperformingspecificfunctionsintheregulationofemotion”(Herzyk,

2003,p35)�Theseinclude:thestructureofthebrainstem,limbicandcortical

areas(Herzyk,2003)�“Instudiesofbrainfunctioningsystemsgoverningemo- tionsdeterminedwaytoconnectcorticalareaswithsubcorticalstructures,located

belowandmedialinrelationtothecerebralcortex�Connectionsareverycomplex

butnotrandom,formaspecializedpathwaysconductingimpulses:theupand

down→up→down(theroadcortial-subcortial/goingupandcortial-subcortial/

goingdown)”(Herzyk,2003,p35)�Theyoperateontheprincipleofregulationof

threelevels:“(thelowestlevel-thebrainstem,themiddleone-thelimbicsystem,

thehighest-thecerebralcortex)formingtheAutonomous-functionalcircuitsthat

transmitimpulsesaccedinganddescendingpathways”�(DerryberyandTucker,

1992;LeDoux,1996;after:Herzyk,2003,p36)� Brainstemstructureslocatedbe- tweenthetrunkandthenewbark,amongotherfunctionscontrolledexcitationand

inhibition�Thelimbicsystemcontrols,butalsomodifiesresponsesdependingon

theenvironmentalstimuli(Herzyk,2003;HerzykandKrukow,2008)�“Compared

withthebrainstemofthelimbicsystemresponsesaremorevariedandspecific”

(Herzyk,2003,p35),butnevertheless,asinthecaseofreactionofthebrainstem

structures are also unconscious reactions (Herzyk, 2003; Herzyk and Krukow,

2008)�Areasofthecortexarethebasisforawarenessofemotionalexperiences

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withaparticularlyimportantroleoftheprefrontalarea,withalotofconnections

withthestructuresofthelimbicsystemandtemporalregionsandparietalcortex

(Herzyk,2003)�“Thesethreesystemsformthecircuitsconnectedtoanetwork

ofneuralpathways(ascendinganddescending),whichprovidesintegratedand

coherentactivityofthebodyasaresponsetoemotionalstimuliandsituations”�

(Herzyk,2003,p36)�Thefunctioningofthebrainmechanismsofemotionalso

playsanimportantroleinthehypothalamus-theexpressionofemotionandcer- ebralcortex–theexperienceofemotion,experiencingfeelings(accordingtothe

conceptofMcLean)(Herzyk,2003)�

Theactivityofbrainsystemscanbefollowedbyfunctionalimaging,egwith:

positronemissiontomographyormagneticresonanceimagingofthebrain�During

thisexercise,youcanobservechangesinactivatedareas(BragdonandGamon,

2006)�Comparingthebrainofahealthypersonwiththebrainofapersonwithau- tismonecanobservechangesintheregionsresponsiblefortheproperprocessing

oftheperceptionoffacialexpressionsandexpressionofemotions(Zięba,2007)�

Inthecaseoftheperceptionofanimateobjects(inhealthysubjects)isactivated:

theamygdala,fusiformanduppercurvetemporalfurrow� Theamygdalaandthe

above-mentionedstructuresareactivatedalsoinrecognizingemotionalfacialex- pressions(i�e�anger,fear,joyorsatisfaction)�Inmanystudieshaveshownthat

theamygdalaandstructuresorbital-medialfrontallobesarealsoinvolvediniden- tifyingtheemotionalsignificanceofobjects(HerzykandKrukow,2008)�“The

foreheadregionsofbrainareresponsiblefortheoryofmindtasks,forintegrating

acomplexsituationintoameaningfulwholeemotionallyandsocially�Inaddition,

theseareasareinvolvedinmanyprocessesofhumanbehaviorassessment,evalu- ationformoralbehavior”(HerzykandKrukow,2008,p342),theyalsoplayakey

roleintheevaluationoftheirconductandemotionalbehaviorofothers(Herzyk

andKrukow,2008)�

Therearealsoconductedresearchesonchildren’sbrains�Theyprovideinfor- mation,interalia,onthementalandemotionalprocessesinyoungchildrenwho

arenotyetinaperiodofspeech,andthereforearenotabletoissueanyverbal

information(fromatheoreticalpointofview,suchstudiescouldbeconducted

onautisticchildrenwithprofoundintellectualdisabilities,non-communicating)�

Thestudy(conductedinBirkbeckCentreforResearchinBrainandCognitive

DevelopmentintheU�S�)showthatthetemporalbrainareasalreadyininfantsare

veryactiveduringtherecognitionofhumanfaces(Shreeve,2005)�

Thus,individualswithautismhaveadysfunctionoccurringintheexpression

ofemotionsanddifficultiesinreadingandunderstandingtheemotionalstatesof

othersisexplainedbyimpairedactivityoftheaboveareasinthebrain�Thisis

confirmedbyfunctionalstudiesperformedusingbrainneuro-imaging(structural

studieshaveshowndifferencesini�e�,corpuscallosum)�Inthebasisstates:more

active(thannormal)withintheuppertemporalgyrus,loweractivityinthebottom

pre-centralcornerinthefrontallobeandtheloweractivityoftheamygdala�

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Neuro-imagingalsopossibletotracktheworkofmirrorneurons�Originally,

researchersattheUniversitàdegliStudidiParmafoundthat“asspecializedcir- cuitsofneuronsinthebraintostorememoriesoftheindividual,sotheteamsseem

tomirrorneuronsareencodedpatternsofindividualactions”(Rizzolatti,Fogassi,

Gallese,2006,p40)�Theresearchersfoundthatthepatternofneuronalactivity

is representation in the brain and not only motor function but the same intent

withoutinvolvingthesenseofsight,onlybyimagination�Atthesametime,“that

thereisadirectlinkbetweentheorganizationofintentionalphysicalactivityand

theabilitytounderstandothers’intentions”(Rizzolatti,Fogassi,Gallese,2006,

p43)�Thiswasconfirmedbythestudy(incollaborationwiththeUniversityof

CaliforniaatSanDiego)usingthefunctional(functional)magneticresonanceim- aging(fMRI),indicatingthat“theresponseofthemirrorneuronsystemisstrong

intentionalagents”(Rizzolatti,Fogassi,Gallese,2006,p43)�

“Insociallifeasimportantastheperceptionofintentionisunderstanding

otherpeople’semotions,theyareoftenakeyelementofthecontext,indicating

theintentiontoaction”�Thestudy,therefore,unfoldedfurtherinthedirectionto

check“whetherthemirrorneuronsystemsallowyoutounderstandnotonlywhat

othersdo,butalsowhattheyfeel” (Rizzolatti,Fogassi,Gallese,2006,p43and

44)�Theresultsshowthatthemirrorneuronnetworklocatedintheislandisac- tivatedbothwhensubjectsareexperiencingemotionsthemselvesandwhenthey

observeotherpeopleandinthecaseofexperiencingnegativeemotionsactivated

inthefrontareaoftheislandandtheanteriorcingulategyrus�

Mirrorneuronsareactivealsointheprocessofimitationand“mirrorneuron

systemifitisabridgeinthisprocessandenablestheunderstandingofhuman

actions,intentionsandemotions,perhapsinitsdevelopmenthasbecomeanim- portantelementofthehumancapacityforobservation,basedontheacquisitionof

advancedcognitiveskills”(Rizzolatti,Fogassi,Gallese,2006,p45)�

Theresearchersshowthat:“Peoplewithautismhaveareducedactivityof

mirrorneuronsinthelowerfrontcorner,i�e�,thepremotorcortexofthebrain,

whichmayexplaintheirinabilitytoassesstheintentionsofothers�Malfunctioning

mirrorneuronsinthecortexoftheislandandthefrontoftherimofthebraincan

causerelatedsymptoms,suchaslackofempathy,anddeficitsinturnleadtoangu- larlanguagedifficulties”(Ramachandran,Oberman,2006,p49)�Ramachandran

teamfromtheUniversityofCaliforniaatSanDiegotosubmitafurtherstudy

(SocietyforNeuroscience,2000),pointingattheinvolvementofmirrorneurons

intheobservationprocess,andalsolinkeditwithcommondisordersinchildren

withautism�Usingelectroencephalographstudymeasuringthebrainwavespro- ducedinμ,intheperformanceofsimplehandmovementsconscious,andthen

measure the braking waves, μ, which is the case with the analogous observa- tionofthemovementsmadebyanotherperson�Asdemonstratedabovedescribed

studies in people with autism do not wave attenuation μ is the observation of

movements performed by another person� Comparable results were obtained

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in the Helsinki University of Technology using magnetoencephalography and

UniversityofCalifornia,LosAngeles,usingfunctionalmagneticresonanceim- aging(Ramachandran,Oberman,2006,p51)–theresultsobtained,confirmthe

disturbancesintheoperationofmirrorneuronsinindividualswithautism�

Itseems,therefore,pertinenthypothesesthatmisunderstoodintentions,emo- tionsandnon-reflectingnonverbalmessages(bodylanguage,handgestures,facialexpressions,eyeexpression,modulationandpitchoftheirvoices,including:

volume,height,paceandritesentthemessage)asthecharacteristicfeaturesof

forpeoplewithautism,iscloselylinkedtomirrorneurondysfunction–problems

occurringinthecourseofobservation�Drawingonthelinguisticconceptscanbe

identifiedforsuch,accordingtowhichinterpersonalcommunicationistriggered

hand gestures and facial expressions – understanding without words, and it is

properlyfunctioningnetworkofmirrorneuronsallowmirroringofactions,inten- tionsandemotionssoneededincommunication�

Butwhatispresentedabovegiveustheconcepts,theoriesandresearchre- sults? Certainly clarify the knowledge and above all help in the selection and

conductoftherapy�

In the "arms” of autism – mary and adam

mary wastwenty-nineyearsoldwhenIstartedwithhertherapeuticwork�

Inpreschooleducation,shortlybeforethestartofthediagnosis–autism,then,in

addition–adeeplevelofintellectualdisability�

Mary’smotherclaimedthat:“the development of his daughter would be much better if provided with the appropriate therapy in childhood”�

Inadditiontobeingretardinintellectualdevelopmentshehadverysevere

behavioral,socialdevelopmentandcommunicationproblems�Thus,thebehavior

appearedinvariousformsofaggressiondirectedatinanimateobjectsandani- mate(stronghittingherheadontheheadofanotherperson,beatinganopenhand

acrosstheface–preservingsuchapatient/clientwasalsodemonstratedinre- lationtothetherapists)�Therewerealsoself-injuriousbehavior,manifestedby

bitingofthefingers,theballofhishand,hittingtheopenhandonthethighsand

theheadwithherfistsuptothestatesofvisibleinjury�Maryalsocametostere- otypes,rockinginasittingpositionaswellassniffing:items(mainlyfood),hands

andotherpeople–includingtheirface,hairandevenprivateparts�SoMary’s

socialdevelopmentwasverymuchdisturbed�Duetotheabovecitedformsof

aggressivebehaviordidnotcomewithitinprinciple,associatewithotherpeople

thanyourownimmediatefamily,andthosewereoftenlimitedtocontactwith

themother�Thewomanneverleftaloneathome,inpublicplacesdidnotcom- plywithacceptedlegally,morallyandcustomaryrulesofsocialbehavior�In the

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storesshedemolishedtheshelves,products,stealing,usuallyitemsforhaircare

andbeautyoftheir(pins,hairpinsandhairbands)–butIthinkthatunfortunately

didnotunderstandthesocialandlegaldimensions,theconceptof“stealing”–she

simplytakeofftheshelves,whatshelikedtodrawattention,orjustwhatwasat

thattimewanttoeat�Brokeoffandatethefruitfromtreesandshrubsfromthe

garden plots – mainly green immature fruits of apple and cherry� If, however,

intellectualdevelopmentdidnotallowhertounderstandtheconceptoftheftand

theconsequencesofitsactions,itshouldwouldadheretotheban:do not do that!

–However,suchprohibitionsMarydidnotrespondto�

Thewomandoesnotrespondwelltotraffic,sheenteredtheroadway,went

throughitanywherewithoutpayingattentiontopassingcarsandcausedconcern�

Parentstriedtoeliminatesuchbehaviorandaboveallanopportunitytoreduce

theirmanifestations,anddeprivesthesocialcontactMaryandisolatingitinthe

house–itseemedthatathomeitismoremutedandlessaggressive�Thema- jordifficultyininterpersonalinteractions(whichinfluencedtheestablishmentof

relationshipsandsocialdevelopment)wasalsoafailuretocommunicate(such

as verbal, nonverbal and alternate)� However, Mary’s mother claimed that her

daughtercommunicateswithher(butonlywithit)usingthecomputerkeyboard

graphicversionofdrawnoncardboard�WithMaryItriedtoholdadialoguewith

arealkeyboard,tohaveinsightonthecomputerscreeninwhatshewrites(with

someofreasonsclasseswereheldatherhome–duringtheclasshermotherwas

alwayspresent)�

BelowIplacewrittenstatement(onthebasisofforthcomingbook:Trapped by autism)�

May18,2008,the(secondmeeting)–Maryseemedtobeexcited�Hermoth- eratonepointstatedthatthedaughterwantsustoshowonyourcomputer�Atmy

request:“Marytellyourstory,leavingthehouseonthelake”,themotherreplied,

“itwasdifficultforher,pleaseaskasimplerquestion”�Iasked:“Areyoupleased

withtheweekendaway”?Marynodded�Duringseveralminutesofclasses–she

wrotethecomputerkeyboard:“goooooooawwwwwaaaaayyy”�Mary’smomsaid:

“It’suptome”�AfterleavinghismotherMarywasunabletorestrainemotionsand

self-harm,intheendshewrote:“dooooooonnn’tttwannnn”�Demonstratedmo- torstereotypesandself-injuriousbehavior–endedbecauseshewasveryaroused

emotionallyandtrytoreassurehernotyieldedresults�

June1,2008,Marywascalmandwantedtostartclassesassoonaspossible�

Isuggestedthatwetalkinthefirstplace(viacomputer),thengoforawalk�Mary’s

momadded:“Daughterpracticedplayingthekeyboardandwouldliketoplay,

andthenshouldgoforawalk”�Iasked:“Doyouwanttogoforawalk?”Mary

wrote:“yeeeeeeeeeessssssssss”�Iasked:“Howareyou?”Marywrote:“!!!!!!!!!!”

Mary’smumasked:“Areyouafraidofsomethingorsomethinghurtsyou?”Mary:

“huuurrmmmmmmmyyyyylllleeeeeeee”�Iaskedtobesure:“Doesyourleghurt

you?”Shenodded�“Whichleg?”–Iasked�Marywrote:“rgggggggggh”�Iasked

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269

thenextquestion:“Tellmewheredoyouwanttogoforawalk?”Mary’smom

said:“Wewillgoforthemeadsnearby”�Marywrote:“Itiiiiiiiiiiiiiirrrrrrrrre

dddddddd”�

ThiswasthecommunicationwithMaryandherlevel,socialrelationships

werealsospecific,continuousbehavioraldisturbances,explosions,andthestere- otypeofaself-injurytherapyishampered�

Mary,however,neverwasaggressivetowardsme�Onthecontrary,shebegan

toestablishanemotionalrelationshipandshowempathy�Thefirstattemptwas

tohelpincarryingmyheavybagwhenwewentforawalk�Mary’smothersaid:

“Shouldyouleavethisbagistooheavy”�IjokedthatMarywilldefinitelyhelp

metocarryit,andsurprisinglyshecameuptomeinprovidingassistance�Mary’s

motherwassurprisedandsaidthatitwasherfirstsuchbehaviorinrelationtoan- otherperson�Marywascryingevenaftertheendoftheday,withgood-byes,then

huggedhismother,placedherheadonhershoulderorunderherarm�

adam –twenty-three-yearoldmenwiththediagnosis–autismandprofound

intellectualdisability�

Manunabletowalkwithconductdisordermanifestingprimarilybystere- otype–swayingfromsidetosideinasittingposition,flappinghisarms,sucking

hands,constantcrying�Hecalmeddownwhengettingtosuckalollipopinthe

shapeoftheball�Hespokeonlyoneword“mom”,followedbyanoutburstfrom

himcrying�Hecriedifsomeoneelsewassaying“mom”orwhenhewasshown

picturesofhismother�Cryingwasinducedwithhimalsoinsituationswhenhe

saworheardotherchildrencrying�Motherclaimedthathersonathomeoften

criestoo,shakesandsways,thenhewantstobehuggedandcradled�Thisneed

wasalsomanifestedintheSpecialSchool,whichcameandsatisfiedwhenhe

calmeddown,stoppedcrying�However,thisbehaviortookplaceonlyforsome

people–noteveryonecouldhughimandmakehimcalmdown�

Speechdevelopmentwaslimitedonlytotheword“mom”anddifferentsyl- lablesrepeatedintheformofecholalia–akindofvocalization,waslittleunder- stoodthemessage–wasnotsupportedbyothernotverbalcommunication�

Tome,repeatedsequencesofsyllablesbyAdam,utteredwithcharacteristic

intonation expressed his good mood and enjoyment, not shown through facial

expressions� In the case of anxiety, fear and discontent he began to sway and

cry–thenneededahug(eventhoughitdemandedinothersituations)�Theword

“mom”andherimageevokedandperhapslongingforthemother–againrelieved

hugs�Inanycase,veryoftenexhibitedemotionalbehaviorandshowedagreat

needtomeettheemotionalneedsoftheirown�

Marymaintainedmentionedpassiveunderstandingofthemessagesandver- balcommandsbutmaynotreachallofit,maybenotallofthemshewantedto

receiveandrespondonlytosome�Adamunderstoodpassivespeechonlyatthe

levelsimplemessagesrelatedprimarilytothefoodintake,sometimesreactedto

hisname�Althoughthesamediagnosisastotheintellectualdevelopment,were

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among those people, they determined differences in their intellectual abilities�

Marywasunderenormousimpactherbehaviordisorders:self-injuryandstere- otypesandalackofverbalcommunicationandunwillingnesstocooperateand

executeanycommands/tasks�

AswithMaryandAdam,despitethehugedeficitsincognitiveandveryseri- ousproblems:functioning,socialdevelopmentandthedevelopmentofcommuni- cation,thereisatendencytorespondtoemotionalneeds,thereisempathy(with

Mary)andimitation(Adam–inthecaseofemotionalreactions)�

summary and Conclusions

Under current concept/theory and the available scientific data, accurate

knowledgeofthematerialworldiscloselyconnectedwiththetransferofinforma- tion,orcentralcoherence,andthedevelopmentofempathy,theabilitytounder- standtheintentionsandtheintentionsofothers,thetheoryofmindandactionof

mirrorneurons�Onthisbasis,centralcoherence,asafunctioncanbeattributedto

knowledgeofthephysicalworld/material,andthetheoryofthemind,exploring

theworldofthemental/humanpsyche�Thesetwomechanismsoperateindepend- ently:onethatistheoryofmindareneurologicallyconditioned,centralcoherence,perhapsgeneticallydetermined(Kruk-Lasocka,1995)andasmentionedby

otherresearchersinitsfunctioningdeficitsarisingfromthemicro-brain(Bragdon,

Gamon,2006)�

Peoplewithautisminadditiontodisturbancesintheknowledgeoftheworld

(suchasphysicalandmental)canbesuperimposed:hypersensitivityorlackof

sensitivityinthereceptionofstimuli,andtheremaybedisturbancesintheform

ofsignalsfromthebody(Delacato,1995)�Defendingagainstunwantedstimuli,

attemptstoorganizetheworld,tryingtoruleoverhisownbodyandtheoutside

world,amongotherthingsleadtostereotypesand/orritualofbehaviors�

Andeveniftheautisticpersonmanagestoorganizethematerialworldby

any,ritualobservance,maintenanceofconstantobjectsintheenvironmentand

stereotypedbehavior,itseemsalmostimpossibletoorganizeandunderstandthe

worldofthehumanpsyche,understandingintentionalactions,emotionalstates,

andthemanifestationofempathy,withoutdevelopmentoftheoryofmindand

properoperationofthemirrorneuronnetwork�

Somepeoplewithautismregardlessofthecognitive,thestateofknowledge

theyhaveacquiredandthelevelofpracticalskillscanbeseensometimessmall

areas of exceptionalability� Such people can be very bad in the sphere of social and/or communication, but have unique talents such as musical, technical

ormathematical�Andeventhoughtheycannotacknowledgethefactthatother

peoplethinkdifferently,whatelseisinterested,donotsharetheirtastes,anditis

difficulttoimagineastateofmindofanotherman,but,likeincaseofislettalents,

perhapstheskillsinthereceiptofthementalworld,orpartsoftheworld,may

provetobetheonlyempathyshownistheonetheywanttoshow�Currentresults

donotansweronthissubjectinaclearway(anattempttoassesstheeffectiveness

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271

oftherapiesbasedoncurrentscientificdatahas,amongothers�MSuchowierska

inpaper:Effectiveness of applied behavior analysis in working with individuals with autism and related disordersinforthcomingpublication:Time for the dia- logue! Talk so effective revalidation,2012)�

Turning,therefore,attentiontothetherapeuticdimension,onecannotstate

thattheeffectsareachievedthroughbehavioraltherapies�Indeed,therearechang- esinthefunctioning,socialrelationshipsandcommunicationbyindividualswith

autism,andthusintermsoftheircognitivedevelopment,butItaketheviewthat

alsoveryimportantarethetherapieswithemphasisontheemotionaldevelopment

ofindividualswithautism,especiallyintheemotionaldevelopmentofchildren�

Thisisindicativeofthecurrentconceptsofdisorderinthedevelopmentofthe

outlineofthatcourseofactionandtherapeuticskillsinindividualswithautismto

reademotionalmessagesanddistinguishthedegreeoftheirexpressionaswellas

sendingthemtoothersaswellasthedevelopmentofempathy�

The discovery in the field of neuroscience in the form of mirror neuron

dysfunction,impairedabilitytogivetheeffectofimitation(Rizzolatti,Fogassi,

Gallese,2006,p45)alsopointstotheneedtoexercisethisfunction�Theresultsof

theleastsensitiveandcriticalperiodsinchildren(Blakemore,Frith,2008)deter- minethemostconvenienttimetotakeaction,andtheirgreatesttherapeuticeffec- tiveness,andexampledata,neuroplasticityofthebrain(Blakemore,Frith,2008;

Domańska,Borkowska,2008;Grabowska,2008)bringsomeoptimismaboutthe

possibilitiesofthehumanbrainintheassimilationoflostfunctionsandcapabili- tiesinthefieldofneuroscience�

Obtainedresultsalsocontributetothediagnosisofdisordersinpeoplewith

autismsuchasthediscoveryofmirrorneuronactivityandinhibitionofμwavein

healthysubjectscouldbeusedasadiagnosticevenwithEEG.

Thetherapistdoesnotgetthefinalsolutiontothehandbutknowledgewhich

shouldbeprocessed,adaptedtotheneedsandabilitiesofthepatient,patiently

waitingforresultsofactionstaken�Inthecaseoftherapiesaimedatthedevelop- mentoftheemotionaleffectivenessoftheiractionsmaydependonprevailing

dysfunction,micro-orsimplythefunctionalmaturityofthefrontallobes,andit

isthey,asthelastinthebrain,“waiting”withtakingthefullrangeofactivities�

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