Social touch and disordered development: autism

Following on from my previous Blog on 5th September ('Social touch and human development' ... an interesting paper) reporting on the paper 'Social touch and human development' by Cascio, Moore, & McGlone, in this Blog I will focus on one important aspect, this being 'Social touch and disordered development: autism'.

What the authors say about touch and how it more specifically relates to people with autism is I think highly significant. They make the following points:

• The impact of social touch on the developing brain and the consequences of its altered trajectory in childhood are indicated as being 'highly relevant for autism spectrum disorder'. 

• Children with autism 'exhibit aberrant behavioral responses to touch which are strongly linked both with the core clinical symptoms [of Autism] ... and genetic variants that increase serotonin transporter function'. 

• 'Experimenter-delivered affective (pleasant and unpleasant) touch to children with autism elicits defensive reactions that are more severe in CT-innervated somatotopic regions [i.e. touching their face or arms] than in non-CT-innervated regions [e.g. touch to their palms]' - which is an interesting finding, if it is generalisable to the more general autistic population! 

• 'Taken together, these results indicate that social touch is altered in autism', although the authors do say that it isn't yet clear how this impacts on individuals with autism who experience specific forms of 'hyper-responsiveness and hypo-responsiveness'. 

• The authors also go on to say that: 'Both hypo-responsiveness and hyper-responsiveness to social touch may result in reduced input (occurring naturally or resulting from defensive/avoiding behaviors) that alters the trajectory of the developing social brain starting in infancy'.  

• Then perhaps most importantly the authors state that: 'Given the fundamental importance of social touch for infant’s formation of secure attachment, cognitive and linguistic development, social reward, and emotion regulation, these differences are likely to have far-reaching effects'. 

The authors finally sum up with the vitally important statement that: 

'A better understanding of these sensory-social developmental sequelae (i.e. the developmental consequences of the altered touch related neural responses of individuals with autism) holds great promise for developing and refining early intervention approaches based on sensory features'.

The sooner the better I would suggest.

Intensive Interaction: 'A tool for communication', OTnews article (May 2019).

My blog for this week is shamelessly referencing (or mainly copied from) a recent article in OTnews (the official monthly magazine of the Royal College of Occupational Therapists). In this article, 'A tool for communication', Rebecca Haythorne (an Occupational Therapist at Leeds & York Partnership NHS Trust), discusses the role of Intensive Interaction in facilitating meaningful engagement for one of her NHS service users with a learning disability and autism.

Below I sample some of her article in the hope of giving an Occupational Therapy view of using Intensive Interaction integrated into aspects of their own case work:

'John, a 26 year old man with learning disability and autism, lives at home ... and receives care 5 days a week to support engagement in activities of daily living and meaningful occupations ... He was referred for occupational therapy input after concerns were raised that he was finding it difficult to engage with his care team and was spending a significant amount of time in his bedroom area'.

'After an initial assessment of needs, it was agreed that the Occupational Therapist would work with John and his support team to explore a range of interventions and approaches to support his care team to engage him more positively in purposeful and meaningful occupations ...'

'The Occupational Therapist worked with John and his care team over a period of five months, and during this assessment period it was identified that Intensive Interaction was a positive and key approach in supporting him to engage in both domestic and leisure activities in and outside of the family home'.

'One of the key objectives of exploring the Intensive Interaction approach with John’s care team during times of intervention was to identify and demonstrate the value and importance of engaging John in less demanding activities that occupy his time, as opposed to more physical observable and measurable ones'.

During the assessment process 'the Occupational Therapist observed that John was sat in the window seat at his home and was refusing attempts made by his care team to engage in activity. The Occupation Therapist noticed that John was occupying his time by watching the council maintaining trees. This was seemingly a purposeful activity for John, and through carrying out Intensive Interaction techniques of sitting with John, mirroring his actions when he communicated interested, and letting John lead the activity, the Occupational Therapist was able to reduce the demands that his care givers were placing on him to do an activity that they thought was more purposeful'. 

'Through reducing the demand being placed on John and following his lead and pace the Occupational Therapist was able to support John from moving on from this activity into the next activity of his choice in a timely manner'. 

'To conclude, Intensive Interaction can be a positive tool to support occupational therapy interventions to increase engagement in meaningful occupations and activities for individuals with complex needs ... In this case, the Occupational Therapist used Intensive Interaction approaches to emphasise to his care team that engagement in ‘activity’ should not be based on one action after another to keep him physically active, which can often cause a demand overload. Instead it should be measured by the quality of the intervention offered to occupy the service user’s mind in something that he finds purposeful'.

'Social touch and human development' ... an interesting paper.

I would like to thank my most estimable colleague Lynnette Menzies for pointing me to an interesting paper on: 'Social touch and human development' by Cascio, C., Moore, D. & McGlone, F. in the journal Developmental Cognitive Neuroscience, (2019, vol 35, p.5-11).

In this paper the authors talk about how sociable physical contact 'is a powerful force in human development, shaping social reward, attachment, cognitive, communication, and emotional regulation from infancy and throughout life'. So, already I am interested, although this claim probably sounds very plausible (bleeding obvious) to most of the people reading this blog. 

However, when getting into the main part of the paper the authors go on to discuss issues such as there being two different touch systems (or 'sub-modalities' of touch) that mediate between 'affective touch' and 'discriminative touch', and how 'factors such as culture, personal relationships, setting, gender, and other contextual influences are also important in defining and interpreting social touch'. They also note how touch can be 'associated with immediate reductions in both behavioural and psychological response to stress'.

Without copying (or 'referencing' as I like to call it) the entire paper, I thought I might point to some of the issues accounted for in the paper's conclusions, where the authors state that:

• The 'developmental nature' of social touch is 'dynamic, integrative, and firmly rooted in reward learning processes that shape the developing brain and ultimately adult behaviour'.

• 'The landscape that defines social touch changes qualitatively from an intense and primary mode for associative learning and affiliative connection in the earliest stages of pre- and neonatal life, to part of a multisensory integrated environment throughout the lifespan'.

• The 'perceptual experience' of social touch 'is in and of itself the product of several overlapping integrative processes ... [and] is paired repeatedly over time with physiological and psychological processes that invoke feelings of comfort, security, and satisfaction' (- my underlining for the purpose of extra emphasis). 

• Such overlapping, integrative neural processes 'in the central nervous system are effectors of broader neurobiological systems including oxytocin and mu-opioid systems mediating the reinforcing properties of simple and more complex social bonding' (- again, my underlining for extra emphasis). 

• Finally the authors state that these integrated 'social touch' neurobiological systems 'all interact with top-down contextual factors, including the nature of the relationships, culture, and social context, to create a highly complex, flexible platform in which the rich affective information conveyed through the skin exerts a powerful impact on behaviour ... over a lifetime' (and again, my underlining for extra emphasis).

I am sure we've* been saying much the same thing (although maybe not using all the same words like 'innervation' or 'myelinated' or 'somatosensory') for years now! 

So remember, the next time someone asks you about your use of touch as part of your Intensive Interaction practices, you can tell them all about how: 'the overlapping integrative processes ... in the central nervous system are effectors of broader neurobiological systems, including oxytocin and mu-opioid systems, mediating the reinforcing properties of simple and more complex social bonding' ... or you can just say it is one naturalistic element of the now well established Intensive interaction 'social' communication approach (see *Nind & Hewett, 1994, 'Access to Communication' p.24 - again, my underlining for extra emphasis).