Infant intersubjectivity: research, theory, and clinical applications.

We review research evidence on the emergence and development of active "self-and-other" awareness in infancy, and examine the importance of its motives and emotions to mental health practice with children. This relates to how communication begins and develops in infancy, how it influences the individual subject's movement, perception, and learning, and how the infant's biologically grounded self-regulation of internal state and self-conscious purposefulness is sustained through active engagement with sympathetic others. Mutual self-other-consciousness is found to play the lead role in developing a child's cooperative intelligence for cultural learning and language. A variety of preconceptions have animated rival research traditions investigating infant communication and cognition. We distinguish the concept of "intersubjectivity", and outline the history of its use in developmental research. The transforming body and brain of a human individual grows in active engagement with an environment of human factors--organic at first, then psychological or inter-mental. Adaptive, human-responsive processes are generated first by interneuronal activity within the developing brain as formation of the human embryo is regulated in a support-system of maternal tissues. Neural structures are further elaborated with the benefit of intra-uterine stimuli in the foetus, then supported in the rapidly growing forebrain and cerebellum of the young child by experience of the intuitive responses of parents and other human companions. We focus particularly on intrinsic patterns and processes in pre-natal and post-natal brain maturation that anticipate psychosocial support in infancy. The operation of an intrinsic motive formation (IMF) that developed in the core of the brain before birth is evident in the tightly integrated intermodal sensory-motor coordination of a newborn infant's orienting to stimuli and preferential learning of human signals, by the temporal coherence and intrinsic rhythms of infant behaviour, especially in communication, and neonates' extraordinary capacities for reactive and evocative imitation. The correct functioning of this integrated neural motivating system is found to be essential to the development of both the infant's purposeful consciousness and his or her ability to cooperate with other persons' actions and interests, and to learn from them. The relevance of infants' inherent intersubjectivity to major child mental health issues is highlighted by examining selected areas of clinical concern. We review recent findings on postnatal depression, prematurity, autism, ADHD, specific language impairments, and central auditory processing deficits, and comment on the efficacy of interventions that aim to support intrinsic motives for intersubjective communication when these are not developing normally.

Autism as a neurodevelopmental disorder affecting communication and learning in early childhood: prenatal origins, post-natal course and effective educational support.

Colwyn Trevarthen, working on autism, discussed the importance of time, rhythm and temporal processing in brain function. The brains of new born infants show highly coherent and coordinated patterns of activity over time, and their rhythms are remarkably similar to those of adults. Since the cortex has not yet developed, this coordination must be subcortical in origin. The likely source is the emotional motor system. He noted that the cerebellum might regulate the intricate timing of the development and expression of emotional communication. He also pointed out that emotional and motivational factors have often been seriously neglected in psychology (largely owing to a misplaced focus on 'cognition' as some isolated entity) and emphasized the potential importance of empathetic support and music therapy in helping autistic children.

Evoking communication in Rett syndrome: comparisons with conversations and games in mother-infant interaction.

Girls with Rett syndrome retain a responsiveness with care-givers that corresponds in many respects with the preverbal communication observed with normal infants. This has characteristic rhythmic patterns and phrases, mutual imitation, reciprocal emotional phases and rudimentary oral, vocal and gestural expressions. After individuals with Rett syndrome have passed the critical stage in dissolution of their attention, co-ordination and voluntary control, they retain positive orientation to human faces and eyes with smiling. Video analyses show that they can engage with rhythms and phrases of conversation, sometimes showing a sense of humour and sensitivity to playful teasing. They respond to repeated patterns of expression in rhythmic/prosodic play and to certain forms in music. It is suggested that sensitive and appropriately attuned support for the rudimentary motives for human contact that survive in Rett syndrome can help stabilisation of self-regulatory states, alleviate panic and confusion and facilitate learning. The effects of the disorder may be a consequence of a genetic fault in the elaboration of an Intrinsic Motive Formation in the reticular core of the embryo brain, leading to dysregulation of differentiation in higher cognitive systems and learning, but leaving partially intact motive principles for human intersubjective response.

Self/other organization in human psychological development.

Evidence from the evolution of human cultural behavior and learning, embryology and genetics of the brain, and the behavior of human infants indicates that the critical and uniquely human motives for cooperative imagination and joint interest in objects and tasks are determined by expression of genes and epigenetic neural systems elaboration long before birth, along with essential peripheral organs of perception and motor expression that will serve in communication by rhythmic facial, vocal, gestural, and body movement signals. These cerebral motives continue to exercise their influence on neural development and behavior throughout life, transforming the behaviors of the developing individual through a succession of phases to which other individuals and cultural institutions are constrained to adapt. We discuss the theory of innate intersubjectivity and relate it to the hypothesis of an Innate Motive Formation that emerges in brain development as regulator of morphogenesis in neural systems, and that continues to function, postnatally, as generator of motives and emotions by which human contacts and relationships are regulated. We suggest that differentiates of the primary motive formation in the embryo brain later serve to generate intelligent exploration of the objective environment and the emergence of an additional dialogic mechanism that represents the self-subject as a partner for an other-subject, intersubjectively. Intersubjective communication in infancy leads, through systematic age-related transformations of the brain and behavior, to preverbal mimetic negotiation of cooperative awareness and joint task performance. Finally we discuss, in relation to this theory, interpretations of faulty communication and development at different stages of the life cycle that result from maternal postnatal depression, autism, premature birth and schizophrenia.

Lateral asymmetries in infancy: implications for the development of the hemispheres.

Cerebral asymmetry of cognitive processing of stimulus information is commonly viewed as a neocortical phenomenon. However, a number of lines of evidence give innate asymmetry of brainstem motivating systems, which anticipate experience, a key role. Spontaneous asymmetries of gesture and emotion can be observed in infants, who entirely lack language and visuo-constructive skills. Motives for communication in early life may direct subsequent development of complementary cognitive systems in left and right hemispheres. In split-brain monkeys, lateralized motive sets, intentions for manipulation by one hand, can determine which hemisphere will see and learn. Evolutionary antecedents of cerebral asymmetry appear to affect motivation, social signalling and bimanual coordination, with secondary effect in perceptual processing and learning. The hemispheres of adult humans differ in links with neurochemical system that regulate motor initiatives, exploration and attention, and the approach/withdrawal balance in social encounters. Asymmetries in emotional and communicative behaviour in infancy support evidence that an Intrinsic Motive Formation emerging in the embryo human brain stem regulates asymmetries in development and in functioning of the cerebral cortex.

Voluntary emotional facial expressions in patients with focal cerebral lesions.

This study investigates the voluntary production of emotional facial expressions in 43 brain-damaged and 9 control subjects. The expressions of right- and left-hemisphere lesion groups did not differ significantly, but those of the anterior lesion group were impoverished relative to the posterior lesion and control groups. Deficits of voluntary expression were dissociable from impairments in "non-emotional" facial-motor functions, dysphasia, and unilateral neglect.

A musical assessment of psychiatric states in adults.

In music therapy, joint musical improvisation of therapist and subject provides the framework for a spontaneous and intimate, non-verbal interaction. This study shows that such an interaction can be used to reveal the subject's capacity for emotional contact with another person, the nature of this contact and how well it is sustained. We examine the musical interaction in first music therapy sessions using a model of analysis specially developed for this study. A comparison between 15 schizophrenics, 15 depressed patients and 15 clinically normal controls revealed significant differences. The findings, which take into account subjects' musical background and perceptual functioning, have implications for the diagnostic use of music therapy in adult psychiatry.

Reactions of patients with focal cerebral lesions to success or failure.

Multiple measures were used to investigate emotional reactions to card sorting in patients with focal cerebral lesions and in matched non-brain-injured controls. Spontaneous facial expressions of patients with anterior lesions were impoverished, relative to the posterior group, on a quantitative index of facial movement. This deficit did not appear to be attributable to group differences on lesion variables, or degree of cognitive deficit. There were also indications that a "non-emotional" facial-motor deficit was not the primary cause. The marked anterior deficit for facial movement was not, however, associated with equally pronounced deficits on qualitative, self-report and heart rate indices of emotional response. Right hemisphere patients differed from left hemisphere patients on only one qualitative measure of emotional reaction, but this may have been due to the stronger negative reactions of dysphasic patients. Left unilateral neglect was not associated with reduced emotional response.

Facial expressions of emotion in mother-infant interaction.

Face movements of infants 2 months of age when they are interacting with their mothers give evidence both for innate representation of the mother as a partner in communication and for an emotional system that evaluates her expressions and regulates their interpersonal contact. Although the facial neuro-motor system is immature in infancy, it can generate many expressions that compare closely with those by which adults transmit emotions and control engagements and relationships. It also expresses rudiments of special motivation for speaking. Even newborns show clear evidence of organized facial expressions defining distinct communicative states that respond to maternal care. Emotional communication is multimodal; as infants gain in perceptuo-motor and cognitive powers, they both express and respond to simultaneous signals of affect in multiple channels of voice, gesture and postural change. Face expressions form but part of a stream of motor evidence of central affective state and its changes. Mothers present to infants a form of expressive activity (baby talk) that has clearly marked synchronous visible and audible features. The precocious expressive capacities and sensitivities of infants and maternal fostering of them would appear to be a human adaptation to facilitate development of observational learning and language. Developments in the first year expand the scope of communication and play without changing the fundamental emotional code by which infant and familiar caretakers construct and defend their special relationships.

The tasks of consciousness: how could the brain do them?

According to Darwin's theory of evolution by natural selection, the existence of mental operations proves their usefulness. Darwin called himself a mental materialist. This is one scientific theory of consciousness. Human consciousness has three useful aspects: awareness, intentionality and sharing with others. All have simple equivalents in animals. The latter two are neglected in neurophysiology and experimental psychology. Developmental, neuroanatomical and neuropsychological evidence shows that the human brain has innate structures of awareness, intentionality and interpersonal sharing. Human life depends on interpersonal cooperation. We may have a conscious self, but consciousness of others is essential in us. Studies of commissurotomy patients demonstrate the elaborate interconnected neural organization of consciousness and provide evidence of underlying and necessary levels of motivation, perception and motor integration below consciousness. Additionally, they show that awareness may be split into two different modes. These regulate one another during development and are complementary in culturally sophisticated adult life. One hemisphere, usually the left, has responsibility for expressing ideas and purposes in language. The other responds to the phenomenal context and the subjective situation. Both have human experiences and purposes. Both still collaborate in a unified intentional system after commissurotomy. Infant studies reveal that language develops out of an interpersonal mental process. This seems to control development of thinking. Thus notions of the newborn as an isolated amoral id, and of the infant as an egocentric discoverer of the object concept, must be rejected. Cultivation of moral awareness and a sense of purpose guided by meanings and values depends on innate organization of the human brain for interpersonal consciousness.

Perceptual, semantic and phonetic aspects of elementary language processes in split-brain patients.

Patients with total forebrain commissurotomy were examined on three tests of elementary linguistic ability. We found that the right hemisphere was dominant for the visual recognition of words when no semantic or phonetic decoding was required. The left hemisphere assumed control of behaviour when written words had to be matched semantically to pictures, though the right hemisphere was also competent at this task. On a test of rhyming, the left hemisphere was not only dominant, but was vastly superior to the right which displayed little, if any, ability. We suggest that the two hemispheres are basically differentiated with respect to their generative, constructive capacities in language, as in other functions of intelligence.

Metacontrol of hemispheric function in human split-brain patients.

Four commissurotomy patients were tested for ability to match tachistoscopically presented stimuli with pictures in free vision, according to either structural appearance or functional/conceptual category. Patients were given ambiguous, structural, or functional instructions on any given run to trials with simultaneous double stimulus input to the two cerebral hemispheres. With ambiguous instructions, appearance and function matches were performed by the right and left hemispheres, respectively. When instructions were specific, appearance instructions tended to elicit appearance matches and right-hemisphere control. When function instructions were given, left-hemisphere control and function matches tended to be elicited. In three of the four patients, however, there was a significant number of dissociations between controlling hemisphere and strategy of matching.