Time to Re-think Treatment Techniques?


Last week, at Bessel van der Kolk’s Annual Trauma Conference, the number of references to autism intrigued me.  While one would not necessarily expect to find those two words together in a conference, some of the underlying neurobiology found in trauma may be similar to children with autism, including weak or disconnected neural links from the limbic system (part of the brain that manages threat detection) to the pre-frontal cortex (part of the brain that manages reasoning). This may explain, in part, why anxiety is seen so often in children on the spectrum.   Stephen Porges, researcher and neuroscientist, hypothesizes that the set point for threat detection may be much lower in individuals with ASD. Specifically, the amygdala, think of it as a smoke detector for danger, may be over reactive, sensing threat rather than safety.  He surmises that the reason children on the spectrum look at the lower part of the face, (mouths) rather than the eyes or the whole face, is that looking at the mouth sets up an adaptation for protection (a mouth could bite or strike out), while looking at the eyes and whole face is more intrinsically trusting and social.  If children on the spectrum have a biological set point in self-protection, forcing eye contact as an isolated behavior could cause additional stress responses in the central nervous system.  As clinicians, we really need to consider the work of pioneers like Steven Porges outside our field of ASD treatment and wonder if our treatment methods are neurodevelopmentally appropriate, and if not, have the potential for iatrogenisis.

Mona M. Delahooke, Ph.D.



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