Вы находитесь на странице: 1из 5

Psychological Medicine, 1976, 6, 545-549

The aetiology of childhood autism: a criticism of the


Tinbergens' theory: a rejoinder
E. A. TINBERGEN AND N. TINBERGEN

The Editor has kindly offered us space for how to remain unnoticed) influences the children
replying to the paper by Wing and Ricks, in far less than a person who subjects them to tests.
which they reject, and advise their readers to This is important because, if ever there is a sub-
discard, our views on early childhood autism. ject prone to observer interference, it is an
Rather than using this space for a 'counter autistic child. Tests, whether psychological,
refutation' we prefer to call attention in this physiological, or biochemical, have not only the
journal to what, after careful study of Wing's drawback of almost invariably distressing the
and Ricks' criticism, we still consider a poten- child, but they also tend, by their very nature,
tially fruitful approach to the problems posed to concentrate on isolated aspects of the syn-
by the autistic deviation. We take this course drome, which makes their results difficult to
because we feel that our critics have missed the place in an overall, comprehensive, causal
point of our publications. As we see it, the picture. Finally, the kind of observation we
disagreement is not so much a matter of facts recommend and apply ourselves is not merely
per se as one of how to look at the problems. non-interfering; it is also characterized by the
The primary aim of what we have written (as special attention that is paid to what Darwin
was indicated, for instance, in the subtitle of our has called the 'expressions of the emotions'. It
joint paper of 1972) has been to sketch a method is the recognition and interpretation of expres-
of approach, to illustrate its potential, and to sive behaviour that can be of great help towards
advocate the application of this approach in understanding a subject's motivational condition.
child psychiatry. The method has been developed A second aspect of our approach is that we
in studies of animal behaviour, where it has led compare the behaviour of autistic children with
lo valuable insights. But we have not simply that of normal children. It may be thought that
extrapolated the results of animal studies. We the normal picture is sufficiently well known. It
have looked at certain details in the behaviour may be argued that the science of human be-
of the children themselves. When we applied haviour development is or will be providing the
this 'ethological' approach to autistic behaviour, necessary information. We have great admira-
we arrived at certain, naturally tentative con- tion for what the students of human behaviour
clusions which seemed, and still seem to us, to development are doing, but they will be the
have the merit of being plausible interpretations first to agree that their science is still in its
of quite a number of hitherto puzzling parts of beginning and shows many gaps even at the
the syndrome. descriptive level. Anyone who cares to look
intently at normal children in their 'natural
The proposed approach has three main aspects. environment' can collect a wealth of evidence
First, we advocate, both in the study of autistic that has a bearing on our understanding of
children and in their treatment, a more intensive autism - evidence, incidentally, so rich and so
use of non-experimental observation of their varied that as yet it defies neat tabulation. New
facts are being discovered, or are seen in new
behaviour. Of all aspects of the syndrome the
contexts, all the time, so that the picture is
overt behaviour is more readily observable
steadily being enriched. However, psychiatrists
than whatever happens inside the body. Further,
have not generally been trained to apply this
a skilled observer (particularly one who knows
method, and so often fail to see the relevance of
1
Address for correspondence: Dr N. Tinbergen, many details of behaviour. Tn our opinion the
Lonsdale Road, Oxford 0X2 7ER.
545
Downloaded from https://www.cambridge.org/core. Universite Pantheon Sorbonne Paris 1, on 19 Apr 2020 at 09:28:22, subject to the Cambridge Core terms of use,
available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S003329170001816X
546 E. A. Tinbergen and N. Tinbergen

rejection of the notion that there are numerous 'poaching on the territory of the psychiatrist' (as
intermediates between 'normal' and 'autistic'- one psychiatrist put it, with strong disapproval)
a fact of great significance - has a lot to do carries with it a number of dangers, including,
with this lack of knowledge of normal child among others, that of semantic misunderstand-
behaviour. ings and, of course insufficient factual scaffold-
The third aspect of our approach is that the ing. But if scientists were to reject all unfamiliar
fluctuations in the behaviour of both autists and ideas because they are not yet fully substan-
normal children are observed in relation to tiated (and on the advice of authorities rather
changes in the environment. When doing this, than on the basis of their own experience),
one begins by seeing that apparent, isolated interdisciplinary exercises would be futile and
coincidences tend to repeat themselves, and this progress would be needlessly slow.
makes one discern regular correlations between Our views concern three more or less distinct
behaviour changes and outside events. Then, as problems: that of the nature of the autis-
one begins to notice that the outside events often tic state, of being autistic; that of its genesis
precede the behaviour changes (in what we like or development; and that of treatment or
to call 'natural experiments') one suspects that prevention.
the behaviour change is actually a consequence As to the nature of the autistic state, we claim
of the change in the environment. Finally, one that it is characterized by an emotional im-
can test and either strengthen or refute this balance, in which fear, anxiety, or apprehension
conviction by studying the effects of controlled dominates and suppresses many forms of social
manipulation of the environment. This proce- and exploratory behaviour. In our experience
dure, so simple and yet so difficult to apply many autistic behaviour patterns can be recog-
critically, can literally bombard one with eye- nized as either withdrawal from, or defence
opening experiences, of which we have given a against unfamiliar situations, or as incomplete,
few examples in our paper of 1972. Of course inhibited attempts at socializing or exploration,
most workers notice this connection between or as so-called 'conflict movements', or as a
outside events and behaviour changes, but only mixture of the three. Many of these movements
with regard to very conspicuous, major changes, become habits and tend to be performed in a
and even then without realizing their informative stereotyped way, which makes it difficult to
value. Careful observation of both behaviour discern their origin. We have described the
and environment reveals how extremely sensitive rationale of the interpretation of such behaviours
even young children are to seemingly minute in our joint paper, and will not repeat ourselves
changes in their environment, and how subtle here. But we maintain that if this rationale is
their response can be. This is as much true of applied to autistic behaviour, more and more
autists as of normal children; in fact autists examples of 'bizarre' behaviour become in-
respond by withdrawal to many slight stimuli telligible. For instance, excessive distance keep-
that are ignored by a normal child. But the signs ing, hugging the wall, 'spinning', walking on
by which they reveal their alertness to such tiptoe, gaze aversion or a 'blank' eye expression,
stimuli may be so unobtrusive that they are acoustical cut-off, hunched shoulders, many
easily overlooked. And even when such signs are stereotypies, panic tantrums in response to
noticed, their significance is often not appreci- social or physical intrusion, overall muscular
ated. Yet they can be seen very often and in tension and a host of other behaviours can be
many differeni forms, in tests and in teaching recognized as exaggerated and often rigidified
situations as well as in everyday life. To ignore forms of the behaviour categories mentioned
them is lo throw away a great deal of relevant above. But this is possible only if one is familiar
information. with the expressive behaviour of normal children,
and only if one takes into account the fluctua-
When we began to look at autists and autistic tions in the external situation. Despite the
behaviour in these ways, we were led to the growing literature on normal behaviour de-
views that Wing and Ricks urge their colleagues velopment, the recognition and identification of
to discard. We know only too well that our this type of behaviours is still hampered by gaps

Downloaded from https://www.cambridge.org/core. Universite Pantheon Sorbonne Paris 1, on 19 Apr 2020 at 09:28:22, subject to the Cambridge Core terms of use,
available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S003329170001816X
Criticism of the Tinbergens' theory: a rejoinder 547

in our knowledge. To mention only one example : that it accommodates a larger number of facts
many are familiar with a frequently observable, in an internally consistent scheme.
curiously rigid hand position of many autists, Quite apart from the interpretation of the
in which the hand is held rigidly pulled-back, autistic state, we have also expressed a view of
while the fingers are bent in an almost clawlike what can make children autistic. We should
position. We have not yet met one person who like to stress that these are two separate prob-
recognized that this hand position is common in lems, and that it is our views on this second
young children when they want to approach and problem that have met with most resistance.
seize something, yet hesitate to do so. The main Having found such clear signs of short-term
obstacles to recognizing this as such are that effects of external conditions on autistic be-
autists may do this very often, for long periods, haviour, and having noticed that many autists
and in some cases up to or beyond the age of are almost continuously exposed to influences
ten, while in normal children the hand position that make them withdraw, we naturally recon-
is seen only momentarily, and only at the toddler sidered whether the genesis might not after all
stage. be, more than is often assumed, a long-term
This brings us to another general aspect of response to external conditions. This touches on
autistic behaviour that is always mentioned but two issues: that of 'nature' versus 'nurture',
as far as we know not satisfactorily explained: and that of 'organic' versus 'psychogenic'.
the fact that in so many behaviours autistic With regard to the first issue: while develop-
children are more or less, often severely re- mental processes are of course always the result
tarded. Although most test results give an of interactions between 'nature' (i.e. genetic
exaggerated picture of this (due to the children's endowment) and 'nurture', developmental devia-
dread of being tested) this retardation cannot of tions could of course be due either to genetic
course be denied. The observant ethologist sees abnormalities, or to an unusual environment,
numerous, hitherto not recognized signs of this, or to both. With regard to autism we claim that
for instance in the retention of 'babyish' there is no evidence pointing to a purely genetic
behaviour by children even of ten and older, defect. Of course some children are genetically
and in general in a lag in the development of more vulnerable to external disturbance than
many behaviour systems. This retardation can others and so more predisposed to illness. With
in our opinion best be seen, and is in fact to be regard to the organic-psychogenic issue we had
expected, as a secondary consequence of the at the time overstressed the psychogenic, non-
inhibition of social and exploratory behaviour, organic influences. Without withdrawing any-
from which normal children learn so much, but thing we said about the importance of psycho-
from which the autist cuts himself off. The genic agents, we do agree that we have previously
impairment, non-appearance, or regression of underrated possible influences of an organic
speech can in our opinion best be understood nature. New evidence either shows or suggests
as an aspect of this retardation, due to defective that rubella and other illnesses contracted by the
socialization. In this context it seems to us mother during pregnancy may be predisposing
highly significant that the 'islands of good per- conditions ; we think also of the possibility that
formance' always concern solitary activities a difficult delivery may have harmful effects; we
(including listening to speech from a distance also accept that unsuitable food is likely to be a
without engaging in it, from which many contributing influence (but we should like to
autists derive their astonishing understanding point out that all such agents must be considered
of what is said). environmental). With regard to both issues it is
We cannot possibly here develop this inter- of course not a matter of either-or; of course,
pretation fully and systematically, but we remain organic and psychogenic influences can act
of the opinion that thinking along these lines together, and the same is of course true of
does lead to the hypothesis mentioned above, genetic and environmental agents. In neither
and that this view of the autistic state as due to case are the notions mutually incompatible.
an anxiety-dominated emotional imbalance com- It is relevant here to come back to the question
pares favourably with other interpretations in of intermediates between normal and autistic

Downloaded from https://www.cambridge.org/core. Universite Pantheon Sorbonne Paris 1, on 19 Apr 2020 at 09:28:22, subject to the Cambridge Core terms of use,
available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S003329170001816X
548 E. A. Tinbergen and N. Tinbergen

children. Our conviction that there is in principle should avoid eliciting withdrawal or defence.
a continuum between the two is based on the (This does not of course mean that autists
fact that the autistic bouts of normal but appre- should not be subject to any discipline.) Since
hensive children overlap considerably with the autists are so easily intimidated, much is in-
more normal bouts of autists. This overlap goes trusive that is not so, and can even be helpful,
so far that normal children can at times show all to normal children. Autists usually withdraw
the behaviours typical of autists and that, con- into their shells when being looked at, being
versely, if a young autist is left alone in his addressed, being prodded, however gently, and
favourite surroundings he can shed many of his even when being encouraged. The prediction
peculiarities and behave surprisingly normally. based on our interpretation would be that treat-
Needless to say that such more normal behaviour ment 'at the emotional level', aiming at reducing
does not appear during a visit to the psychia- anxiety, would allow social and exploratory
trist's clinic. Even so, many do not deny the learning to play their part in the development of
existence of this overlap, but argue that there skills even without specific instruction; and
remains an enormous gap between 'real' conversely that even slightly intrusive specific
autists and normal children. The idea of a sharp treatments, even when they lead to some desir-
dichotomy seems to be supported by the fact able behaviour modifications, will not improve
that a number of autists are reported to have and might even aggravate the child's overall
been 'odd from birth'. But we must not forget condition if the restoring of a mood of security
that there is really very little reliable information is not given priority. We stress once more that
about what proportion of the autistic popula- these views about treatment, though originally
tion have been odd from birth or how odd they derived from our interpretation of the autistic
have been. We believe that it is most likely that state, are being tried out in more than one place.
the continuum will be found to exist in young So far the results seem to confirm the prediction.
children but that, as they grow up, they sort Although we are not ourselves in charge of a
themselves out into those who enter into a school for autists, we do have opportunities for
downward spiral and those who overcome their assessing the results of different regimes. What
initial handicap. That the issue is still so con- we have seen and heard so far has strengthened
troversial is, we think, mainly due to the fact us in the conviction that, where teachers con-
that there are degrees of 'oddness' at birth; to centrate on skill teaching, overall progress is
the fact that most parents do not become less good than in those (relatively rare) schools
aware of signs of abnormal development until and individual programmes which concentrate
the downward spiral is already well on its way, less on instruction and aim primarily at reduc-
so that they can hardly ever report retrospec- tion of anxiety. We also have heard personally
tively and reliably about the first weeks or from quite a number of psychiatrists and
months; and also to the fact that clinical psy- teachers of autistic children, not only in Britain,
chiatrists see mainly the most advanced, most but also on the Continent and overseas,
extreme cases. that they found our views and our suggestions
Our views on treatment and education of helpful.
autists were derived in part from our interpreta- Naturally, we cannot say more about the
tion of what in the autistic syndrome is primary results of treatments that we have mentioned in
and what are secondary consequences, but in our papers as showing promise. For one thing,
part also from what we have seen and heard of the data are not our property, nor can we claim
the effects of the many different procedures that credit for what is being achieved. For another,
are being tried out. The notion that an anxiety- the treatments have not yet run their full course.
dominated emotional conflict is somehow cen- We hope and trust that, when the time is ripe,
tral leads naturally to the view that a reduction the professionals concerned will publish full
of this anxiety should be the primary objective reports. In the meantime, let us not forget that
of any educational programme, and that in- education even of normal children is still largely
struction in specific skills and treatment of based on a mixture of convention and intuitively
specific defects should be 'non-intrusive', i.e. guided trial and error, nor that the success

Downloaded from https://www.cambridge.org/core. Universite Pantheon Sorbonne Paris 1, on 19 Apr 2020 at 09:28:22, subject to the Cambridge Core terms of use,
available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S003329170001816X
Criticism of the Tinbergens' theory: a rejoinder 549

achieved so far in the education of autists has our views with all the facts that are regarded as
been disappointingly poor, so that further established. But even at this early stage the
experimentation with educational regimes is ur- approach has shown so much promise that it
gently needed. We feel that there are very good should not be totally rejected, but instead be
reasons for believing that many autists are far followed up. We know that many colleagues
from 'uneducable'. react far more positively to our ideas than Wing
Concluding, we want to repeat that we and Ricks; we also know that treatments com-
'poached on the territory of the child psychia- patible with our views are being tried out in
trists' for no other reason than to alert them to several places; and above all, we see striking
the potential of an approach with which they signs of improvement in the children so treated.
are not familiar. We may have done this clum- It is for the sake of the children and their families
sily and in a provoking way; we were and are that we urge those working in this field to con-
not even now able to substantiate fully the sider our approach and our interpretation with-
views to which our approach had led us; it may out prejudice.
even at the moment seem impossible to reconcile

Downloaded from https://www.cambridge.org/core. Universite Pantheon Sorbonne Paris 1, on 19 Apr 2020 at 09:28:22, subject to the Cambridge Core terms of use,
available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S003329170001816X

Вам также может понравиться