Infant Intersubjectivity: Research, Theory, and Clinical Applications

J. Child Psychol. Psychiat. Vol. 42, No. 1, pp. 3–48, 2001

Cambridge University Press

' 2001 Association for Child Psychology and Psychiatry

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Infant Intersubjectivity : Research, Theory, and Clinical Applications

Colwyn Trevarthen and Kenneth J. Aitken

The University of Edinburgh, U.K.

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 mentalhealth practice with children. This relates to how communication begins and develops ininfancy, how it influences the individual subject’s movement, perception, and learning, andhow the infant’s biologically grounded self-regulation of internal state and self-consciouspurposefulness is sustained through active engagement with sympathetic others. Mutual self-other-consciousness is found to play the lead role in developing a child’s cooperativeintelligence for cultural learning and language. A variety of preconceptions have animatedrival research traditions investigating infant communication and cognition. We distinguishthe concept of ‘‘ intersubjectivity ’’, and outline the history of its use in developmentalresearch.

The transformingbodyandbrainofahuman individual grows inactive engagementwithanenvironment of human factors—organic at first, then psychological or inter-mental.Adaptive, human-responsive processes are generated first by interneuronal activity withinthe developing brain as formation of the human embryo is regulated in a support-system ofmaternal tissues. Neural structures are further elaborated with the benefit of intra-uterinestimuli in the foetus, then supported in the rapidly growing forebrain and cerebellum of theyoung 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 brainmaturation that anticipate psychosocial support in infancy. The operation of an intrinsicmotive formation (IMF) that developed in the core of the brain before birth is evident in thetightly integrated intermodal sensory-motor coordination of a newborn infant’s orienting tostimuli and preferential learning of human signals, by the temporal coherence and intrinsicrhythms of infant behaviour, especially in communication, and neonates’ extraordinarycapacities for reactive and evocative imitation. The correct functioning of this integratedneural motivating system is found to be essential to the development of both the infant’spurposeful consciousness and his or her ability to cooperate with other persons’ actions andinterests, and to learn from them.

The relevance of infants’ inherent intersubjectivity to major child mental health issues ishighlighted by examining selected areas of clinical concern. We review recent findings onpostnatal depression, prematurity, autism, ADHD, specific language impairments, andcentral auditory processing deficits, and comment on the efficacy of interventions that aimto support intrinsicmotives for intersubjective communicationwhen these are not developingnormally.

Keywords: Infant intersubjectivity, parent-infant communication, developmental disorders,pathologies of empathy, therapies.

Abbreviations: ADS: adult-directed speech; DTV: double video link; F0: fundamentalfrequency; IDS: infant-directed speech; IMF: intrinsic motive formation; IMP: intrinsicmotive pulse ; PDD: Pervasive Disintegrative Disorder; PRC: period of rapid change.

Introduction

This is the first Annual Research Review on infancyresearch for the JCPP. The time is ripe for an examinationof changing conceptions of first steps in human psycho-social growth.

The idea that normal human sensitivity for psycho-logical impulses in other persons may have a basis ininherent cognitive and emotional systems of the brainspecialised for this function has received attention inpsychology recently, much of it sceptical. Given thepredominance of individualist, constructivist, and cog-

Requests for reprints to: Professor Colwyn Trevarthen, De-partment of Psychology, University of Edinburgh, 7 GeorgeSquare, Edinburgh EH8 9JZ, U.K.

nitive theory in empirical psychology, this is hardlysurprising. The central problem in early development ofthe mind has been taken to be object awareness, notperson awareness. Nevertheless, there is evidence thateven newborn infants, with their very immature thoughelaborate brains, limited cognitions, and weak bodies, arespecifically motivated, beyond instinctive behaviours thatattract parental care for immediate biological needs, tocommunicate intricately with the expressive forms andrhythms of interest and feeling displayed by otherhumans. This evidence of purposeful intersubjectivity, oran initial psychosocial state, must be fundamental for ourunderstanding of human mental development. It will alsobe crucial for accurate interpretations of the influencesof nature and nurture in the baffling spectrum of psycho-social pathologies in children, as for the development of

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4 C. TREVARTHEN and K. J. AITKEN

effective treatment strategies, be they therapeutic oreducational.

Observation and experimentation in the motor, sen-sory, and cognitive developments in early childhood hasgrown spectacularly since the 1960s, stimulating modelsof developmental change in perceptual discriminationand representation, operational thinking, skills and mem-ory, and attempts to relate these achievements to braindevelopment, as well as to the design of artificial neuralnets that simulate cognition and learning. With thesuccess of precise experimental methods developed tomeasure infant object-perception and cognition in con-trolled conditions, the everyday social-interpersonal fac-tors of development and the intrinsic motives thatnormally regulate them, for which new evidence wasobtained in the 1970s by micro-descriptive studies, havebeen less regarded. Or they have been explained inreduced physicalistic terms as secondary effects of socialcontingencies, or as the outcome of some kind of acquiredintellectual process that can ‘‘read’’ others’ minds. Nowresearch on infants’ special awareness of persons, andtheir active influence over caregivers’ behaviour, is havinga comeback, along with a renewed interest in the motivesand emotions that animate consciousness and self-awareness in humans and animals.

We believe that the existence of specialised innate‘‘human-environment-expectant ’’ social regulatory andintersubjective functions in the infant mind has beenfirmly established, and argue that the correspondinganticipatory motives constitute an essential frameworkfor the regulation of all human cognitive development;guiding, limiting, extending, and evaluating what theindividual can discover inside and outside his or herbody. Related, though psychologically simpler, processesof intersubjective regulation appear in all animal speciesthat are both highly social and at first dependent onintelligent parental care. The human case is unique in itsadaptations, which guide children through dialogic ex-change of emotive and referential narratives in body-mimesis to language and learning of a cultural accumu-lation of well-reasoned knowledge and strategic technicalskills. The emotional investment of the child in this‘‘ learning how to mean’’ is of primary importance inclinical work with children, as well as in their education.

A cognitive description of psychological developmentin the individual human baby, focusing on the processesthat take in perceptual information about objects and thephysical situation, is certainly possible.However, it wouldappear to be a logical category error to infer thatinteraction between subjects can be explained by decom-posing their behaviours and perceptual discriminationsinto cognitive components that are adapted to guide oneagent in engagement with things that have no psycho-logical anticipation and no adaptive behaviour.

The social intelligence of the infant is evidently aspecific human talent—an inherent, intrinsic, psycho-biological capacity that integrates perceptual informationfrom many modalities to serve motive states. Moreover,this capacity is a necessary prerequisite, although not initself a sufficient cause, for a child to go throughpsychological development of the kind that leads to anddepends on cultural learning. Such a premise leads to adifferent research agenda in clinical psychology from onethat views the cerebral mechanisms of social behaviour,and the emotions that regulate it, as a product ofemerging, or constructed, modular components ofgeneral representation, or of processing in cognition

(Karmiloff-Smith, 1992; Piaget, 1954; Rutkowska, 1993,1997; Spelke, 1991), or uni-modal perceptual pattern-recognising mechanisms (Bremner, Slater, & Butter-worth, 1997; Johnson & Morton, 1991). We believe thatthe prevailing logic needs to be reversed; that objectcognition and rational intelligence in infants, andtheir perceptual preferences, should be viewed as theoutcomes of a process that seeks guidance by person-perception and through communication with equivalentprocesses, of cognition-with-intention-and-emotion, inother persons.

Evidence will be given from a number of clinical areasfor the effects of early difficulties in interpersonal func-tions that degrade subsequent developments, includingthose rational, experience-dependent skilful, and moreutilitarian aspects of conscious life subsumed under thetitles of ‘‘social cognition’’, ‘‘ theory of mind’’, and‘‘pragmatics ’’ of speech and language.

Normal Intersubjectivity in Early Infancy

The Discovery of Innate Intersubjectivity in Proto-conversations and Games with Young Infants

The theory of innate intersubjectivity—that the infantis born with awareness specifically receptive to subjectivestates in other persons—was put forward 25 years ago toaccount for observations made descriptively or etho-logically from films of the behaviours of infants in naturalinteraction with their mothers, who were attempting toengage the infants in face-to-face chat, or playing gameswith them (Trevarthen, 1974, 1979, 1998a). In the 1970s,researchers in different fields reported the findings of filmstudies of live interactions between adults and infants afew months old (Bateson, 1971, 1979; Brazelton, Kos-lowski, & Main, 1974; Stern, 1971, 1974, 1977; Tronick,Als, & Adamson, 1979). They were impressed with thesimilarities of timing and expression between thesesimplest, intuitive human encounters and informal con-versations between adults. The techniques of conver-sational analysis, with accurate measurement of thetiming of the contributions by adult and infant, broughtstatistical confirmation of this similarity (Beebe, 1982;Beebe, Jaffe, Feldstein, Mays, & Alson, 1985; Beebe,Stern, & Jaffe, 1979; Feldstein et al., 1993; Fogel, 1977,1985a; Stern, 1971). It was M. C. Bateson (1971, 1975,1979) who termed the mother-infant interactions proto-conversations.

Further study revealed that this natural sociability ofinfants, engaging the interest, purposes, and feelings ofwilling and affectionate parents, serves to intrinsicallymotivate companionship, or cooperative awareness, lead-ing the infant towards development of ‘‘confidence,confiding and acts of meaning’’, and, eventually, tolanguage (Trevarthen, 1980, 1982, 1987, 1988, 1990a;Trevarthen & Hubley, 1978; Trevarthen, Murray, &Hubley, 1981). The infant’s communicative motivation,and the intuitive parenting that fosters it, have beenidentified with the special human aptitude for culturallearning, including language learning (Adamson & Bake-man, 1991; Bakeman & Adamson, 1984; Bruner, 1976,1983; Butterworth & Grover, 1988; Eckerman, Whatley,& McGee, 1979; Halliday, 1975; Locke, 1993; H.Papousek & Bornstein, 1992; H. Papousek & Papousek,1977, 1987; Rommetveit, 1979, 1998; Ryan, 1974;Tomasello, 1988; Tomasello & Farrar, 1986; Tomasello,Kruger, & Ratner, 1993; Vygotsky, 1978). The infant’s

5INFANT INTERSUBJECTIVITY

need for communication animates the initial self-otherawareness and reception of motives and emotions in theintersubjective messages that underlie all language—a‘‘human sense ’’, as Donaldson (1978) called it, thatemerges in progressively more powerful forms throughthe course of infancy (Bra/ ten, 1998;Reddy,Hay,Murray,& Trevarthen, 1997; Rommetveit, 1998; Ryan, 1974).The earliest meanings are conveyed to the infant ortoddler nonverbally or paralinguistically by vocal andgestural expression in natural social situations, at thesame time as language is being used by older interactantsto convey referential information and to specify purposes,experiences, thoughts, and recollections. Regulation ofthis primary human communication depends on an innate‘‘virtual other ’’ process in the infant’s mind (Bra/ ten,1988a, b, 1998).

Researchers found that as early as 2 months, infantsand mothers, while they were looking at and listening toeach other, were mutually regulating one another’sinterests and feelings in intricate, rhythmic patterns,exchanging multimodal signals and imitations of vocal,facial, and gestural expression (M. C. Bateson, 1975,1979; Beebe et al., 1979, 1985; Brazelton, Tronick,Adamson, Als, & Wise, 1975; Fogel, 1977, 1985a, b,1993a, b; Fogel & Hannan, 1985; Fogel & Thelen, 1987;Mayer & Tronick, 1985; Stern, Beebe, Jaffe, & Bennett,1977; Stern, Jaffe, Beebe, & Bennett, 1975; Tronick, Als,& Brazelton, 1980; Weinberg & Tronick, 1994). Mothersand fathers were behaving in an intensely sympatheticand highly expressive way that absorbed the attention ofthe infants and led to intricate, mutually regulatedinterchanges with turns of displaying and attending. Theinfant was thus proved to possess an active and im-mediately responsive conscious appreciation of theadult’s communicative intentions. This is what was calledprimary intersubjectivity (Trevarthen, 1979). The dis-tinction between subjectivity and intersubjectivity in earlyinfancy was defined as follows:

Subjectivity and intersubjectivity: a definition of terms

Human beings understand one another intimatelyand at many levels. To analyse this ability of personsto act together and to share experience in harmony,we have first to view communication in relation tothe private activities of conscious, purposeful action.All voluntary actions are performed in such a waythat their effects can be anticipated by the actor andthen adjusted within the perceived situation to meetcriteria set in advance. Interpersonal communicationis controlled by feedback of information, as in allvoluntary behaviour. But there is an essential differ-ence between a person doing things in relation tothe physical world and the control of communicationbetween persons. Two persons can share control,each can predict what the other will know and do.Physical objects cannot predict intentions and theyhave no social relationships.

For infants to share mental control with otherpersons they must have two skills. First, they mustbe able to exhibit to others at least the rudiments ofindividual consciousness and intentionality. Thisattribute of acting agents I call subjectivity. In orderto communicate, infants must also be able to adaptor fit this subjective control to the subjectivity ofothers : they must also demonstrate intersubjectivity.By subjectivity I mean the ability to show bycoordinated acts that purposes are being consciously

regulated. Subjectivity implies that infants masterthe difficulties of relating objects and situations tothemselves and predict consequences, not merely inhidden cognitive processes but in manifest, intel-ligible actions (Trevarthen, 1979, pp. 321–322).

Perturbation tests, by the still or blank face or doubletelevision replay procedures, discussed below, furtherdemonstrated that a 2- to 3-month-old infant was emo-tionally aware of a mother’s contingent and emotion-ally appropriate behaviour, and actively engaging with it(Murray & Trevarthen, 1985, 1986; Trevarthen,1993a, b; Trevarthen et al., 1981; Tronick, 1989;Tronick, Als, Adamson, Wise, & Brazelton, 1978), andthese findings are confirmed by more recent investigations(Nadel,Carchon,Kervella,Marcelli,&Re! serbat-Plantey,1999).

Longitudinal film study of behaviours recorded insemicontrolled lab}studio conditions that favoured closeobservation revealed an orderly age-related transform-ation of the infant’s motives through the middle of thefirst year, toward increasingly intricate, precise, andselective coordination with the mother’s richly inflected,rhythmically patterned, and repetitive expressions ofcommunication and dramatised actions of play (Beebe etal., 1979, 1985; Bruner & Sherwood, 1975; Fogel, 1977;Jasnow & Feldstein, 1986; Mayer & Tronick, 1985;Ratner & Bruner, 1978; Stern, 1971; Stern et al., 1977;Stern & Gibbon, 1980). The baby’s increasing interest inobjects was observed to grow in some competition withthe earlier developed motives for protoconversationalplay, and led, around the middle of the first year, to theelaboration of more lively games with objects. Just beforethe end of the first year, there was a rather suddendevelopment of joint interest of mother and infant in theirsurroundings, triggered by the infant’s emerging curiosityabout the timing and direction and focus of attentionsand intentions of the mother (Hubley & Trevarthen,1979; Pecheux, Ruel, & Findji, in press). This change ininfants’ experience, and acceptance of joint attention tothe world, clearly has momentous consequences insubsequent learning, and profound effects on the waysmothers act with and speak to their infants.

Parallel study of the development of younger infants’orientations—activities aimed to engage objects andphysical events (tracking and reaching, grasping, andmanipulating)—clarified the differences between sub-jective motives that led them to experience, for themselves,the sensations and affordances of their own bodies and ofthings, and the intersubjective motives that were drawingthem into games and self-other regulations of a strictlyinterpersonal kind, in which the babies had to reactalertly to the expressions of purpose and emotion in theirpartners (Trevarthen et al., 1981). It was confirmed thatthe differing motives for these two kinds of objective—forobject awareness or doing with things, and for person-awareness and communicating with persons (seeTrevarthen, 1998a)—were, indeed, undergoing divergentand periodically competing development during the firstyear, leading, at around 9 months after the infant’s birth,to integration in the new form of cooperative inter-subjectivity (person-person-object awareness), which wasnamed secondary intersubjectivity (Trevarthen & Hubley,1978).

It is significant that the evidence for ‘‘person aware-ness ’’ and a capacity for intersubjectivity came fromdescription in detail, from frame-by-frame analysis with


accurate measurement of the timing, of how infantsmoved their bodies, especially their expressive organs, inresponses, both contingent and provocative, to theexpressions of another person. Importantly, the be-haviours selected to define the infant’s intersubjec-tivity—the ways the infants look, express their feelings inface and voice, how they gesture and move in rhythmiccycles to accept or reject contact—were homologous withbehaviours that are essential to the elaborate inter-subjectivity of all collaborative intentional activity inadult society, including live conversational language.They are regulated and negotiated purposefully andemotionally, by expressive and receptive processes en-gaging many modalities simultaneously (Bra/ ten, 1998;Dore, 1983; Fernald, 1989; Jaffe, Stern, & Peery, 1973;Kuhl & Meltzoff, 1982; Murray & Trevarthen, 1985;Stern, 1974; Stern et al., 1977; Stern, Hofer, Haft, &Dore, 1985; Trevarthen, 1978, 1984a, 1993a, b;Trevarthen, Kokkinaki, & Fiamenghi, 1999; Weinberg &Tronick, 1994).

By 1 year a baby can not only communicate directlywith human expression without language, but can alsoenergetically share complex arbitrary experiences, boldlydisplaying to familiar persons an individual, sociallyadapted personality. The baby attends to and imitatesconventional vocalisations and gestures, as well as mak-ing orientations to and handling objects that otherpersons use, imitating their actions (Adamson & Bake-man, 1991; Bakeman & Adamson, 1984; Bates, 1979;Bretherton, McNew, & Beeghly-Smith, 1981; Bruner,1976, 1983; Butterworth, 1999; Butterworth & Grover,1988; Eckerman et al., 1979; Halliday, 1975, 1979;Hubley & Trevarthen, 1979; Locke, 1993; Ryan, 1974;Tomasello, 1986; Tomasello & Farrar, 1986; Trevarthen,1987, 1988, 1990a, 1992; Trevarthen & Hubley, 1978;Trevarthen & Logotheti, 1987; Trevarthen et al., 1981;Uzgiris, 1981, 1999). Motivation to regulate fluent‘‘person-person-object ’’ awareness, joint attention, andmutually adjusted intentionality, all at once, is comingto the fore at this age (Trevarthen & Hubley, 1978).

Details of the expression of the developing motives thatdrive the earliest communications of humans are sum-marised as follows. In the gentle, intimate, affectionate,and rhythmically regulated playful exchanges of proto-conversation, 2-month-old infants look at the eyes andmouth of the person addressing them while listening tothe voice. In measured and predictable cycles of responseto regular time patterns in the adult’s behaviour, theinfant moves its face, which it cannot see or hear, andreacts with movements of face, hands, or vocal system tomodified patterns of adult vocal expression that it isincapable of mimicking, and that have not been availablein that form in utero. The communicatively active handsof young infants may make expressive movements inrhythmic coordination with a person’s speech (as was firstnoted by Condon & Sander in 1974), and this can occurwhen the baby has been blind from birth, and thus neverseen its hands, or anyone else’s hands (Tønsberg &Hauge, 1996; Trevarthen, 1999a). Thus we may concludethat the infant has a coherent psychoneural organisationthat specifies the timing and form of body movements.This organisation can react with appropriate dynamicchanges to another person’s dynamic expressions, match-ing their rhythms and accents. Evidently the responses ofthe infant are made expressive by internally generatedmotives and emotions that resemble those carried in theadult expressions. Infant and adult can, for a time,

sympathise closely and apparently equally with oneanother’s motive states, using similar melodic or prosodicforms of utterance and similar rhythms of gesture. Thisentails an absorption of the adult’s motivations into anaffectionate intuitive parenting mode that tends to mimicthe infant and that releases in the adult a specialised,emotionally coordinated ‘‘musicality ’’ of voicing, withanimated but sympathetic and joyful facial expressionsand dance like postural, gestural movements that matchvocal expressions, and affectionate and playful touchingand moving of the infant’s hands, face, or body (H.Papousek & Papousek, 1977, 1987; Stern, 1974, 1985,1993).

Intersubjectivity of Neonates and Foetuses

It has been assumed in medical science and psychologythat a human newborn, lacking coherence of psycho-logical representation even of itself as a subject, cannot‘‘distance’’ itself perceptually or conceptually from theadult who cares for it. That, consequently, the relation-ship with the mother is one of ‘‘symbiotic fusion’’, to usethe term employed by Mahler, Pine, and Bergman (1975).In the same way, the British Object Relations School ofpsychoanalysis, while developing a framework for ap-preciating the emotional needs of infants, took it asevident that newborn is confluent emotionally with themother, and emerging to self-awareness within herrational consciousness in a growing attachment to herperson (Stern, 1985). With the exception of Fairbairn(Grotstein & Rinsley, 1994), object relations theory(Bion, 1962; Guntrip, 1971; Klein, 1952; Winnicott,1965) holds that the young baby has no consciousness, noseparate ego, no representation of self distinct from theother. These ideas recall ancient philosophical inferencesabout the primacy of reason, the role of learning byimitation, and the opposition of reason and emotion(Kugiumutzakis, 1998, p. 88).

In fact, while neonates are undoubtedly endowed withreflex ‘‘panic ’’ responses that serve physiological main-tenance and survival (Panksepp, 1998a), if a newborn isalert, rested, free of stress, and responded to sympath-etically, voluntary behaviours appear that are well-coordinated, perceptive, and specifically adapted to exciteand regulate an engagement with the autonomous expres-sions of interest and emotion of another person, all ofwhich makes the behaviours intensely rewarding for anew mother or father, who feel they are interacting witha human person (Murray & Andrews, 2000; Van Rees,Limburg, Smulders, & Kloosterman, 1992). The express-ive behaviours in affectionate chat and play have noimmediate role in the regulation of the neonate’s physio-logical state, comfort, or survival. They are distinct frommaternal breast-feeding, stroking, holding, rocking, vocalcomforting, and the like. The caregiver responds toneonatal signals that are very different from appetitivemovements, distress cries, or gestural signs of fear, anger,or fatigue. The interactions are calm, enjoyable, anddependent upon sustained mutual attention and rhythmicsynchrony of short ‘‘utterances ’’ which include, besidevocalisations, touching and showing the face and hands,all these expressions being performed with regulatedreciprocity and turn-taking. Newborn and adult spon-taneously display a mutually satisfying intersubjectivity(Kugiumutzakis, 1998; Trevarthen et al., 1999).

A comparable intimacy with mutual imitation can be


seen in interspecies communication between a humanadult and a newborn chimpanzee (Bard, 1998; Bard &Russell, 1999), which proves that face-to-face trans-mission of the basic intersubjective motives is notrestricted to humans. The state-regulating communi-cative behaviours and reactions of infants resemble theneeds for parental attention shown by the helpless youngof many other mammals (Blass, 1994, 1996; Carter,Lederhendler, & Kirkpatrick, 1997; Hofer, 1990; Mc-Kenna & Mosko, 1994; Panksepp, 1998a; Panksepp,Nelson, & Bekkedal, 1997; Panksepp, Nelson, & Siviy,1994; Rosenblatt, 1994; Schore, 1994; Suomi, 1997).

By recording changes in their heartbeat with attentionto novel events, where they chose to look, or by causingtheir head rotations, leg movements, or sucking to triggerstimuli, it has been possible to show in experimentalsituations that newborns are sensitive to expressions ofemotion in body movements and touching, voice, orfacial movements (Bower, 1982; DeCasper & Carstens,1981; Eisenberg, 1976; Jusczyk, 1985; Lipsett, 1967; H.Papousek, 1967). However, the most striking evidence foran innate protoconversational readiness comes fromintended imitations and provocations of newborns inclose reciprocal interaction with adults who are seekingto make their behaviours interesting for, and contingentwith, the infant’s signs of attending. Infants only a fewhours old are capable of expressing communicativecapacities adapted for psychological self-other regulation(Aitken & Trevarthen, 1997; Als, 1995; Blass, 1999;Brazelton, 1984; Brazelton et al., 1974, 1975; DeCasper& Carstens, 1981; DeCasper & Fifer, 1980; Heimann,1998; Kugiumutzakis, 1998, 1999; Meltzoff, 1985a;Meltzoff & Moore, 1977, 1994, 1997, 1998; Nagy &Molna! r, 1994; Reissland, 1988; Trevarthen, 1979, 1997a;Trevarthen et al., 1999; Zeifman, Delaney, & Blass,1996). The infants act assertively or apprehensively inappropriate coordination with the assertive phases orwatchful apprehensive states of a sympathetic partner(Trevarthen et al., 1999). This active involvement incommunication of rudimentary intentions and feelingsconfirms that the human mind is, from the start,motivated not only to elicit, guide, and learn frommaternal physical care to benefit regulation of the infant’sinternal biological states, but also for cooperative psycho-logical learning—the mastery of socially or inter-personally contrived meaning specified in intelligentreciprocal social engagements (M. C. Bateson, 1979;Bra/ ten, 1998; Dore, 1983; Halliday, 1975, 1979; Hubley& Trevarthen, 1979; Newson, 1979; H. Papousek &Papousek, 1977; Ratner & Bruner, 1978; Ryan, 1974;Tomasello et al., 1993; Trevarthen, 1980, 1987,1988, 1994; Trevarthen & Hubley, 1978; Trevarthen &Logotheti, 1987; Trevarthen & Marwick, 1986).

In short, infant survival and development depends oncommunication with a caregiver to service the baby’sneeds for an emotional attachment, but also to maintainand develop an intimate emotionally expressed com-panionship in changing purposes and conscious ex-periences (Trevarthen, 1998d, in press). The infant’smind andbodyhas special functions adapted to anticipatethis development of the imagination of meaning (seeFig. 2).

Even an infant born more than 2 months before termcan begin to share dynamic protoconversational motivesin precisely regulated rhythms of purposeful movementand investigative awareness by exchanging facial ex-pressions, vocalisations, and gestures of the hands with a

sympathetic partner (Trevarthen et al., 1999; Van Rees &DeLeeuw, 1993). Learning tests that examine preferentialorienting or autonomic regulations of newborns provethat perceiving the mother’s rhythmic vocal expressionsof motive state from her speech can begin in utero, manyweeks before birth (DeCasper & Spence, 1986; Fifer &Moon, 1995; Hepper, 1995; Lecanuet, 1996). Her charac-teristic patterns of speech can be identified by hernewborn immediately. Recognition of the visible ap-pearance of the mother’s face is acquired within hours offull-term birth, aided by the newborn’s coherent orintegrated capacity for interest in interaction with thefeelings behind the other person’s facial expressions andvocalisations (Bushnell, Sai, & Mullin, 1989; Field,Cohen, Garcia, & Greenberg, 1984; Field et al., 1983;Field, Woodson, Greenberg, & Cohen, 1982; Goren,Sarty, & Wu, 1975; Heimann, 1989, 1998; Heimann,Nelson, & Schaller, 1989; Heimann & Schaller, 1985;Kugiumutzakis, 1993, 1998, 1999; Maratos, 1982;Meltzoff, 1985a; Meltzoff & Moore, 1977, 1994; Nagy &Molna! r, 1994; Reissland, 1988; Zeifman et al., 1996).

The complex adaptive structure of the foetal humanbrain, and notably the peripheral organs and neuralsystems of social or interpersonal perception and ex-pression, determine directions and limits to future ac-quisition of skills or knowledge by a child (Als, 1995).Although it has been shown that prematurely born infantscan imitate facial expressions (Field et al., 1983; Kugiu-mutzakis, 1985, 1998), it appears likely that the auditorylearning of foetuses and the vocal imitations of prematurenewborns may be related to the precocity of the auditorysense and its special reception of other persons’ ex-pressions (Mehler et al., 1988). Development of auditionmay be inhibited after birth by the sudden acceleration ofdevelopment of the visual system that occurs in earlymonths (Lecours, 1982). Longitudinal data (Kugiu-mutzakis, 1999, pp. 42, 44, 48) indicate that vocalimitations may be declining immediately after birth, asimitations of seen mouth movements increase, and thenvocal imitations pick up after 2 months.

Imitation by infants is not mere reproduction orrepetition of movements made by another individual, andit serves interpersonal functions, not just acquisition ofmotor skills and expression (Kugiumutzakis, 1993, 1998,1999; Uzgiris, 1981, 1984). It is, even for newborns, anemotionally charged mutual influence of motive states inwhich certain salient expressive actions of the other areidentified and repeated to further an ongoing communi-cation (Nagy & Molna! r, 1994, 1997). Imitative responsesoccur at a moment in the stream of interaction where theycan act as affirmations, acceptances, or commentarieswith respect to accentuated displays of the other person(Trevarthen et al., 1999). Older infants and toddlersimitate to display and reinforce friendship or affiliation,showing great sensitivity to pleasure and praise shown byfamiliar companions. But even in young infants, imi-tations serve to qualify an attachment relationship(Meltzoff & Moore, 1994), possibly to identify anindividual person as an object of heightened affect—i.e.of love or admiration.

The manner of imitating proves the natural complexityand specificity of the infant’s motives for human contactand communication. The imitative reactions recognisecommunication, as a hand-shake or a head-nod doesbetween adults in conversation, and they have a furtherpeculiar feature. An inventory of the actions that neo-nates can imitate reveals a rather bizarre set : e.g. large


tongue protrusions, exaggerated opening of the mouth oreyes, looking back over the head, holding up a hand,extension of one finger or two fingers, single vocal sounds(vowels) emitted in a rhythmic burst. All these appear tobe forced or emphatically marked innovations, notnormal spontaneous currency in mutual affective regu-lation, such as ordinary smiles, staring, crying, orfrowning. The imitations are emitted after prolongedattention and with effort, and they show improvement inaccuracy over a series of repeated attempts. Where it hasbeen found that neonates imitate expressions of emotion(Field et al., 1982), these have been responses to theexaggerated performances of an actress, not normalcontingent responses in reciprocal communication. Thisappears to indicate that, even at this age, imitation is partof a motivation specialised for purposeful negotiationand learning of new or arbitrary social habits or con-ventions, in the form of behaviours that have beenisolated and given emphasis in the stream of engagement.Further research on the timing of neonatal imitations isneeded to establish this curious point.

Intuitive Parenting and Maternal Speech:Sympathetic Emotions Evoked by the Infant’sExpressions of Feeling, Initiative, and Curiosity

The very distinctive manner of an affectionate adult’svocalisations to a young baby has now been analysed indetail. ‘‘Motherese ’’ or infant directed speech (IDS) hasdefined rhythmic and melodic features as well as voicingqualities. It is organised in repeated phrases, and tends tocreate slowly changing, cyclic narratives of emotion. Thesimilarity of this speech and vocal play to music and tothe rhythmic and rhyming forms, phrases, and verses ofpoetry has drawn researchers’ attention, and led to aconcept of preverbal or subverbal ‘‘musicality ’’ as afundamental basis for communication of motives andfeelings (Malloch, 1999; H. Papousek, 1996). Infantshave been found to have astonishing powers of discrimin-ation for subtle features of musical sounds and melodicforms, especially as these are represented in the inflectionsof a mother’s voice (see below). These features are evi-dently manifestations of a fundamentally innate pro-cess of emotional physiology, by expression of which aprimary level of intermental communication is estab-lished between human subjects.

The dynamic narrative envelopes of a mother’s utter-ances, their pitch contours, and other dynamic qualities,have been identified as necessary alimentation for theinfant’s developing self-awareness and consciousness ofagency (Beebe & Lachmann, 1988; H. Papousek &Papousek, 1977, 1987, 1989; Stern, 1974, 1985, 1993). Onthe other hand, the extraordinary precision of the infant’smirroring, even with a restricted vocal repertoire, hasbeen taken as further evidence for an innate capacityfor such ‘‘on-line’’ communication (Beebe et al., 1985;Stern & Gibbon, 1980; Stern et al., 1975, 1977, 1985;Trevarthen et al., 1999). Infants, even newborns, canexactly synchronise with certain salient moments in theadult’s message by gesture or utterance, and the vocalemissions can be matched in pitch and quality (timbre)(Malloch, 1999). There clearly is a sensitive two-waymirroring of the emotional values of expression in spite ofthe great difference in maturity between the participants.

Speech directed to infants with concern for their

interest, like speech addressed sympathetically to pets(Burnham, 1998), or to very old people who often thinkslowly and are hard of hearing, has exaggerated, butmodulated, expressivity. It clarifies the feelings, interests,and intentions of the speaker, and it minimises theremembering of meanings of words. This talk is under-standable as effective communication only if it is acceptedthat even young infants are as sensitive to the feelingsbehind consciously regulated well-motivated utterancesas an old person or a cat. As Bateson, an anthropologistand linguist, pointed out, it is a form of human com-munication that is related not only to education inthe forms and meanings of language, but also to therhythms and melodies of religious ritual and communion,and traditional healing practices (M. C. Bateson, 1979,pp. 74–76).

Comparison of parents’ speech to young infants indifferent languages confirms that there are universalrhythmic and prosodic features in the expression ofhuman feelings and sympathetic interest (Fernald, 1992a;Fernald & Simon, 1984; Fernald et al., 1989; Grieser &Kuhl, 1988; M. Papousek, Papousek, & Symmes, 1991;Stern, MacKain, & Spieker, 1982). Thus, for example,motherese or IDS in both a tonal language (Mandarin)and in a nontonal language (English or German), com-pared to adult-directed speech (ADS) in either language,has higher pitch (fundamental frequency, F0), larger F0range, shorter utterances and longer pauses, fewer syl-lables per phrase, and less phrase time}sample time(Grieser & Kuhl, 1988; M. Papousek et al., 1991).Thanavisnuth and Luksaneeyanawin (1998) report simi-lar features in Thai mothers’ speech to their infants.Rising contours, used by parents to elicit infant attention(Stern, Spieker, Barnett, & MacKain, 1983), are similarin English and Mandarin (M. Papousek et al., 1991), andthis form of utterance is more effective in eliciting andmaintaining infant attention than falling pitch (Sullivan& Horowitz, 1983). Infants prefer approving rather thandisapproving intonation (M. Papousek, Bornstein,Nuzzo, Papousek, & Symmes, 1990) ; they show morepositive affect to this way of speaking (Fernald, 1993) andare more interactive, interested, and emotionally positiveto IDS (Werker & McLeod, 1989). Adults, too, judgerole-play better from speech in the IDS register.

Maternal speech has often been studied as if it were justan instructive register of language, an aid for the infant topick up words and sentence grammar. But cats pre-sumably do not understand words, and nor do 2-month-olds. With toddlers or the aged, linguistic communicationmay also be part of the effective function of this way ofuttering, but its obvious attractiveness and regulatoryeffects with the youngest infants can have little to do withthe grammatical or semantic purposes of language. Vocalcommunication addressed to infants is, for the infant andlargely for the adult too, nonreferential, in the sense thatit does not matter that it may specify any reality or objectoutside the human contact itself. It is intersubjective at afundamental level. It serves to respond to or affirm theinfant’s eagerness to become involved in proto-conversation, which is a nonverbal discourse regulated bydynamic relational affects, and a ‘‘narrative ’’ sense oftransforming feelings.

Research on IDS, at first reacting to the theory of aninnate language acquisition device, which argued thatlanguage input to infants is so linguistically impoverishedthat it couldn’t possibly teach grammar (Chomsky, 1965),sought to demonstrate that mothers do provide a graded


instruction in features of language (Snow & Ferguson,1977). Then acoustic speech analysis led to the dem-onstration that speech to infants has higher pitch, widerpitch excursions, slower tempo, shorter utterances, andlonger pauses (Cruttenden, 1994; Fernald&Simon, 1984;Stern et al., 1982), and it was claimed that the trainingwas perceptual rather than linguistic. But infantsclearly already have perceptual biases and attentionalpreferences that favour awareness of parental speech(R. P. Cooper & Aslin, 1990; Fernald, 1985; Gleitman,Gleitman, Landau, & Wanner, 1988; Pegg, Werker, &McLeod, 1992; Werker & McLeod, 1989). Thus threedifferent functions have been attributed to the wayadults talk to infants : this speech engages attention(M. Papousek et al., 1991; Stern et al., 1982; Sullivan& Horowitz, 1983), communicates affect, facilitatingsocial interaction (Fernald, 1989, 1992a; Kitamura &Burnham, 1996, 1998a; M. Papousek et al., 1990;Werker & McLeod, 1989), and facilitates language acqui-sition (Fernald & Mazzie, 1991; Hirsh-Pasek et al.,1987).

Experimental Tests of Infants’ Emotions inProtoconversation

The motives and emotions of protoconversation withinfants under 3 months of age have been tested byperturbation experiments, situations that have been con-trived to obstruct or distort the rhythmic traffic ofexpressive signals and contingent and sympatheticresponses between infant and adult. Two procedures havegiven valuable evidence on what infants expect from thebehaviour of a conversational partner, and how they actwhen the adult fails to meet these requirements. Theyconfirm that the interaction is generated by coregulation,coconsciousness, and contingent and reafferent mutualregulation in a complex dynamic system wherein theexact course of events is emergent or not defined inadvance (Fogel, 1993a, b; Fogel & Thelen, 1987; Tronick& Weinberg, 1997). They also show that the young infanthas expectations of the emotional quality of the en-gagement and the normal contingencies of a sympath-etic adult response, and that these emotions changein ways that affect the adult, regulating positivelytowards a happy encounter, and defending against fail-ure of contact, by appealing with negative emotionalexpressions for appropriate remedial action to repaircommunication.

The still or blank face test (Murray, 1980; Murray &Trevarthen, 1985; Trevarthen et al., 1981; Tronick et al.,1978) requires a mother who has established a proto-conversational interaction with her infant to arrest hermovements on a signal from the experimenter, and simplylook at the infant without any reaction to what the infantdoes. This commonly results in the infant showing asuccession of appeals for communication by smiling,vocalising, and gesturing, punctuated by increasinglysober staring at the mother, then emission of signs ofavoidance of eye-contact and distress. The behaviour hasbeen charted by micro-description and proved by stat-istical analysis and to be a coherent emotional reactionthat shows the infant is disturbed or made unhappy bythe mother’s unresponsiveness. Indeed, the infant’s be-haviour assumes the configuration and interpersonaltiming of an expression of sad avoidance, an expressionwhich, in an older person, we would not hesitate to call

distressed embarrassment or shame (see below for adiscussion of the ‘‘nonbasic emotions’’ of infants).

A second experiment was designed to deal with theobjection that the infant was simply affected by themother’s sober face and inactivity (Murray, 1980;Murray & Trevarthen, 1985; Trevarthen et al., 1981). Adouble video (DTV) link was set up so that infant subjectsa few weeks old (less than 3 months) and their motherscould see each other and communicate by seeing oneanother’s face expressions and hearing vocalisations live.Once good, happy communication was obtained, aportion of the recording of the mother approximately 1minute in length from an animated and playful period ofthe encounter was rewound and replayed to the infant.The projection of the mother’s behaviour to the infantwas exactly as before, but the physical recording was not,in any reliable way, reacting contingently to what thebaby was expressing at any moment. Here infants showedoccasional accidental interaction with the taped behav-iour of the mother, confusion when she failed to respondin time and appropriately, then prolonged distress andavoidance as in the still face experiment. It takes time forthe infant to recover from this perturbation when themother resumes normal sympathetic communication, oris on-line again, as was the case in the still face experiment(Weinberg & Tronick, 1996). Replay of the infant’sbehaviour to the mother in the DTV apparatus causes herto feel something is wrong, and different mothers ex-perience different emotions and make different verbalevaluations, all uncomfortable, when the infant appearsnot to connect.

Replication of this DTV replay experiment confirmsthat 2-month-olds are highly sensitive to the timing andemotion of a mother’s expressions in communication(Nadel, Carchon, et al., 1999). Evidently the infant, at 6to 12 weeks of age, is able to anticipate and join asympathetic ‘‘conversation’’, and is distressed by mis-timed maternal expressions, no matter how joyful andplayful they may be. As we shall explain, this finding isresolutely contested by proponents of the view thatinfants under 3 or 4 months (or even much older) lack(have not yet constructed) a coherent, intentional ‘‘ self ’’,and therefore do not perceive agency in another person,and cannot be sensitive to the purposeful contingency ofanother person’s communicative responses (Rochat,Neisser, & Marian, 1998). According to this theory, theself-awareness required for awareness of the other as anagent is a product of acquired social cognition (Lewis,1999)

Research on the effects of maternal postnatal de-pression, which causes the mother to express herselfwithout pleasure, with flat affect, and with erratic timingof behaviours that do not engage with the infant’sbehaviours, leads to the same conclusion as the per-turbation experiments, as is discussed further below.Young infants seeking communication from a depressedmother are affected by unsympathetic and inappro-priately timed maternal behaviour (Breznitz & Sherman,1987; Field, 1992; Lundy et al., 1996; H. Papousek &Papousek, 1997; Tronick & Weinberg, 1997), themother’s self-referred, unresponsive state (Murray,Kempton, Woolgar, & Hooper, 1993) and the quality ofspeaking that lacks ‘‘musicality ’’ (Robb, 1999). Theybecome distressed and avoidant and may develop alasting depressed state that affects communication withpersons other than the mother (Field, 1992; Lundy et al.,1996).


Changes in older infants’ reactions to the two per-turbation tests show that a capacity to withstand dis-engagement of a conversational game without distressincreases with the infant’s increasing alertness and curi-osity for the environment at large. Infants over 4 monthseasily engage in agile visual investigation of surroundings,and they can use this new interest to escape an unres-ponsive mother’s gaze. Whereas the 2-month-olds appearto be trapped in the stressful encounter and usuallybecome seriously disturbed, the older infants are muchless concerned by brief unresponsiveness of the mother(Biglow, MacLean, & MacDonald, 1996; Hains & Muir,1996) ; they simply avoid looking at her (Muir & Hains,1999; Trevarthen, 1984a, 1990a). Further age-relatedchanges in infants’ resistance to distress and separationwill affect how they behave in any situation where themother’s responses are unusual, and when they are olderthan 6 months infants often regard the still face test as anentertaining game (Trevarthen, 1998a, p. 40). The testswith 2-month-olds engage the protoconversationalmotives that are active in ‘‘primary intersubjectivity ’’,before motives for investigative looking and manipu-lating have become strong, and before the infant hasdeveloped a robust self-confidence in game playing,teasing, and showing off.

Developments of Intersubjectivity in the FirstYear : Age-related Events and Changing Parental

Responses

Perceptuomotor Maturation in Infancy: IncreasingBody Awareness and Transitions in Motive andEmotion

Infants consistently show conspicuous age-relatedchanges, not only in their physical size, acuity ofperception, and motor strength, but in the coordinationof their movements for different purposes, their per-ceptual discrimination and attentional preferences, andtheir affectionate and cooperative engagements withcaregivers. These changes are reflections of trans-formations in brain function that have intrinsic causes.They are clearly also consequences of experience andlearning, about the body and of the world and objects,and therefore dependent on the kind and quantity ofexperiential input. Infants learn recognition of humansignals from before birth, and at all ages they reactstrongly to the emotional support they receive from otherpersons, and the attentions given to their interests andactions. But they also have their own powerful internalimpulses andmotivations, and these are always importantfactors in development of the infants’ awareness andmotor coordination, and in their responses to self-generated experience, as well as to care or teaching.

Figure 1 summarises the evidence we have concerningage-related changes in infants’ behaviour. These appearto express periods of rapid change (PRCs) in infants’psychological motives and capacities for action, cog-nition, and communication (Trevarthen, Aitken, &Plooij, 2000). Four main epochs can be defined, and theseappear to reflect changing balance in three principle kindsof intrinsic motive: (a) ergotropic, for attending to theexternal world with the aid of motor adjustments of thebody and selective use of the senses ; (b) trophotropic, forregulation of the internal autonomic or visceral state ; and(c) communicative, this last being effective in regulating

both attachment, serving the developing infant’s tropho-tropic needs, and companionship, by which experiencesand skilful actions directed to the environment are sharedand learned socially (Trevarthen, 2000; and see Fig. 2).The ergotropic}trophotropic distinction in animal motiv-ations was first made by Hess (1954) on the basis ofphysiological effects of brain stimulation. For modernevidence on motive systems of the mammalian brain seePanksepp (1998a).

Experimental cognitive psychology has focused prin-cipally on the ergotropic, environment-assimilating func-tions of the infant as an individual perceiver and actor,exploring and using objects, observing events, and ac-quiring skills of perceiving and acting. Consequentlyprimary importance has been given, first, to the veryconspicuous changes in visual focus at 4 to 6 weeks, thenin attention and manipulation with advances of posturalcontrol, visual orienting, and discrimination, and reach-ing and grasping around 3 and 4 months (e.g. Rochat &Striano, 1999). A second major change in cognitioncomes toward the end of the first year as the infant, on thethreshold of independent locomotion, shows more de-liberate interest in pursuing the kind of purposes whichadults see as intentional and becomes more capable ofsolving problems of the ways objects interact and can beused together.

These changes, at these three ages, have been taken bydevelopmental authorities as the beginnings of variousfunctions of consciousness, object concepts, volition, andself-awareness. The program of developments in objectcognition has been assumed to set the pace and strategyfor ‘‘social cognition’’, a product that must incorporatethe capacity for relational emotions, empathy, andintersubjectivity (e.g. Bahrick & Watson, 1985; Baron-Cohen, 1994; Gergeley & Watson, 1999; Izard, 1978,1994; Lewis & Brooks-Gunn, 1979; Mahler et al., 1975;Piaget, 1954, 1962; Rochat & Striano, 1999; Rothbart,1994; Schore, 1991; Sroufe, 1996; Stern, 1985; Toma-sello, 1993; Yarrow et al., 1984; Zahn-Waxler, Radke-Yarrow, Wagner, & Chapman, 1992). An alternativeview holds that self-awareness and emotional maturitycomes principally with language and social training, afterinfancy (Dunn, 1994; Lewis, 1987, 1992, 1993). Suchconclusions can only be supported if the ways in whichyounger infants, including newborns, react purposefullyand emotionally to the environment are disregarded, andtheir reactions to the communicative signals from otherpersons are explained as reflexive or ‘‘mindless ’’. Webelieve that the changes through the first and second yearor childhood are more accurately seen as developmentaltransformations in prenatally drafted motives that areadapted for intelligent life in the company of othersubjects, not the first appearance of the adaptive be-haviours.

Research on the social development of infants focusedon the supposed dependence of communication oncognitive development, or on the dependence of the childfor emotional development on parental regulation, and,on imitation, takes the child’s self-awareness to be aconstruct built of experiences acquired concerning howother persons react to what the child does, inferringpurposes where they did not exist (Kaye, 1982). Theincreasing self-consciousness of the infant in the second 6months of life has been taken as evidence for thebeginning of a representation of other individuals’ inten-tions, or intersubjectivity. Advances in the dynamics ofinteraction and in social signalling are supposed to reflect


Regulation of sleep, feeding and breathing. Innate “pre-reaching”.Imitation of expressions. Smiles to voice.

Fixates eyes with smiling. Protoconversations. Mouth and tongue imitationsgive way to vocal and gestural imitations. Distressed by “still face” test.

“Person-Person” games, mirror recognition.Smooth visual tracking, strong head support. Reaching and catching.

Imitation of clapping and pointing. “Person-Person-Object” games. Accurate reach and grasp.Binocular stereopsis. Manipulative play with objects. Interest in surroundings increases.

Playful, self-aware imitating. Showing off. Stranger fear. Persistent manipulation.Babbling and rhythmic banging of objects. Crawling and sitting, pulling up to stand.

Cooperation in tasks; follows pointing. Declarations with joint attention. Proto-language.Clowning. Combines objects, executive thinking. Categorises experiences. Walking.

Self-feeding with hand. Beginning of mimesis of puposeful actions,uses of tools and cultural learning. May use first words.

A

B

C

D

E

F

GFigure 1. Top : In protoconversation, a two-month-old infant and a mother communicate by many modalities of perception andexpression, transmitting information about intrinsic motive rhythms and emotions, principally by eye-to-eye contact, voice, facialexpression and gesture. Middle : In the first 18 months of life there are marked changes in the infant’s consciousness of other personsand in their motives for communication, without language. Several major transitions can be observed in self-and-other awareness atparticular ages. These lead the child toward cooperative interest in actions and objects, and cultural learning. Below : Research studiesthat have made detailed longitudinal observations at sufficiently frequent intervals have found evidence for major periods of rapidchange (PRCs) in motor coordination, perceptual abilities, and communication. All may be described as elaborations of the meansby which the initial purposeful, consciously regulated, and intersubjective motives of the newborn infant may be employed to further

learning. The sources of the data on which this summary is based are cited in Trevarthen, Aitken, and Plooij (2000).


change to the social ‘‘ scaffolding’’ offered to the infant asparents are more playful, presenting game routines, withthe infant’s initiative in these changes of communicationbeing regarded as consequences of perceptual and mo-toric developments. The infant’s realisation that otherpersons are ‘‘ like me’’ (Mead, 1934) is taken to come asa consequence of acquired contemplative or metacog-nitive functions (Leslie, 1987), developing expectationsregarding the dynamic vitality features of other persons,and, especially, an emerging sense of variable contingencyin their responses (Bahrick & Watson, 1985; Gergeley &Watson, 1999; Watson, 1984).

While not denying the importance of learned regu-lations in the management and recollection of experi-ences, and the influence parents may play through theirinterpretation of infant’s expressions of emotion and‘‘behavioural responses ’’, we see the conspicuous de-velopments in infant’s self-consciousness and sociabilityin this ‘‘period of games’’ as continuous with, and de-veloping from, the rhythmically patterned intersubjectivemotives that were present and active in the newborn. Webelieve that development is fostered best when parentsrespond with perceptive sympathy to the motives andfeelings infants express to them.

As the infant gains in alertness, discriminative aware-ness, and power of movement in the early weeks, turningmore to explore the environment and manipulate objects,exchanges with parents become more lively (Trevarthen,1990a, 1998a; Trevarthen & Hubley, 1978). After 3months protoconversations give way to body games,nonsense rhymes, nursery chants, and songs and to ritualplay routines involving body bouncing, hand-clapping,tickling, ‘‘peek-a-boo’’, and the like (Bruner & Sher-wood, 1975). These are always strongly rhythmic, withregular phrasing and highly predictable repetitions andresolutions of emotional energy or excitement (Tre-varthen, 1999a). They involve the easy substitution andmatching of forms of expression in different modalities(hand gestures, voice sounds, face expressions, looks, andhead orientations), which Daniel Stern called ‘‘ inter-modal fluency’’, in the emotional complementation thathe describes as ‘‘affect attunement’’ (Stern et al., 1985).By 4 months or so, infants are clearly interested in andresponsive to the adults’ changing mood and expressionsof excitement, surprise, pleasure, or displeasure, and,with familiar persons, they can appreciate complexteasing games (Nakano & Kanaya, 1993). Imitationgames between infants and their mothers and fathers, orbetween infants, are emotional, and usually very pleasur-able (Fiamenghi, 1997; Reddy et al., 1997; Trevarthen etal., 1999). Older infants, when they are caught inunfamiliar circumstances, orient purposefully to checktheirmothers’ emotions (Klinnert, Campos, Sorce, Emde,& Svejda, 1983). It follows that any implication that theparent is giving organisation to the infant by ‘‘scaf-folding’’ an erection of immature moves should bequalified by the observation that the adult is oftenassiduously tracking the infant’s varying mood withimitations, and that the infant can take the role ofprovocateur or teaser (Reddy, 1991). The infant can bethe one who attunes to and accompanies the parent withnicely synchronous gestures or vocalisation, even show-ing anticipation of salient events, such as the prolongedvowel at the end of a phrase or stanza (Malloch, 1999;Trevarthen et al., 1999). As in protoconversation, thereare frequent occasions in games or songs when the infanttakes the role of leader, while the mother responds.

Communicative Musicality in The First Year

The subtleties of early preverbal interaction are beingstudied in detail by methods for objectively assessing theprosody and melody of infant-directed vocalisations andmusical sounds, and recording infants’ orientations andpreferences to such sounds. The evidence is that infantsare selectively attracted to the emotional narrativescarried in the human voice, and that they are excited toparticipate in a shared performance that respects acommon pulse, phrasing, and expressive development.Infants respond with synchronous rhythmic patterns ofvocalisations, body movements, and gestures to match orcomplement the musical}poetic feelings expressed by themother. As infants become more energetic and alert,mothers’ songs and games become more lively. Theydevelop ritual forms which are often repeated, to thegreat satisfaction of infant and parent. The mood of themother’s performance changes with the state of alertnessand humour of the baby, and reacts with a soothing,calming mode when the infant is tired or distressed. Thesongs can modulate the emotional state of the infant andthe extent to which he or she engages in communication.

By 6 months of age, in laboratory discrimination tests,infants respond differently to play songs and lullabies,types of song that are easily recognised by adults. Playsongs are associated with increased alertness to theexternal world and joint attention, whereas lullabiesresult in more self-focused infant behaviours (Rock,Trainor, & Addison, 1999). These developments parallel,or accompany, changes in the ways parents talk to olderinfants, conspicuous changes occurring in both musicalforms of play and in the affective and directive forms ofspeech in different languages, first towards 3 months, andthen between 9 and 12 months (Kitamura & Burnham,2000; Thanavisnuth & Luksaneeyanawin, 1998; Tre-varthen & Marwick, 1986). There are interesting sexdifferences in these developments, indicating not onlythat females may be developing slightly ahead of boys incommunication, but that they are more responsive of andstimulating to both affective and directive functions ofmother’s speech after 9 months (Kitamura & Burnham,2000; Masur, 1987; Papaeliou, 1998; Thanavisnuth &Luksaneeyanawin, 1998).

Just as infant-directed speech and singing tends to behigher-pitched, slower in tempo, and more repetitious incontent than talk addressed to older children or adults(Trainor, 1996; Trehub et al., 1997), infants’ responses tofemale singers confirm that parents’ propensity to interactwith infants using a higher vocal range is paralleled by theinfants’ preference for higher-pitched singing (Trainor &Zacharias, 1998). However, further investigation hasshown that infants are not interested so much in the pitchof singing per se. They are perceiving and mirroring thenarratives of emotion in the voice, as we explain below.

The intuitive time-patterns and motive contours ofprotoconversation and mother-infant games can be car-ried by any means of sensory-motor contact. A recentstudy focused on the importance of variations in maternaltouch and hand gestures during interaction with infants(Stack & Arnold, 1998). Sixty mothers were videotapedwith their 5"

#-month-old infants during four phases of

interaction. At certain times they were instructed to useonly touch and gesture, at others to attend to the infant’sface, and at others to engage in normal interaction withtheir infants using vocalisation as well. Mothers were ableto engage successfully with their infants using touch and


gesture alone. This is in accord with studies of therhythmic tactile forms of communication that familiarand experienced partners use to make contact withprofoundly mentally handicapped children or youngadults (Burford, 1988, 1993; Burford&Trevarthen, 1997;Trevarthen & Burford, in press), as well as the findings ofresearch into the most effective ways of supporting self-regulation, communication, and cognitive developmentin infants and children with sensory loss, including thoseboth deaf and blind (Tønsberg & Hauge, 1996).

Research on infant’s attentions and preferences bringsevidence that the essential features of what we may callthe intrinsic motive pulse (IMP) of musicality (Trevar-then, 1999a) are possessed by infants—they are shown inplay with adults, or when infants are responding toartificial fragments of musical sound in laboratory tests.Infants listen with perceptive preferences to the melodiesof speech, singing, and music, and songs and music makethem move in rhythm and register interest and happiness(Baruch & Drake, 1997; Demany, 1979; Fassbender,1996; Fridman, 1980; Lynch, Short, & Chua, 1995; H.Papousek, 1996; M. Papousek, 1994, 1996; M. Papousek& Papousek, 1981; Stern, 1971, 1974, 1993; Stern et al.,1977; Trehub, 1987, 1990; Trehub, Trainor, & Unyk,1993; Trehub, Schellenberg, & Hill, 1997; Trevarthen,1986a, 1987; Trevarthen et al., 1999; Zentner & Kagan,1996).

Twenty-five years ago, Condon and Sander (1974)reported ‘‘entrainment’’ of newborn arm movements tothe syllabic rhythms of adult speech in any language.Since the infant can generate the same arm rhythmswithout any external guide (Trevarthen, 1974, 1984b, c ;Von Hofsten, 1983), this coordination is evidently not apassive locking-on of the infant to the adult ‘‘pace-maker ’’, but a sympathetic and flexible cross-modal, oramodal (aud6itory to proprioceptive, and possibly tovisual) monitoring of actively generated impulses ininfant and adult (Trevarthen, 1986a; Trevarthen et al.,1999). In early protoconversations, when the infant is 6weeks old, alternation or turn taking on a slow adagio(1 beat in 900 milliseconds or 70}minute) is set up. Withina month or two, in animated games, the beat of sharedvocal play with an infant accelerates to andante(1}700 milliseconds; 90}minute) or moderato (1}500milliseconds; 120}minute). Different qualities of engage-ment are determined by shared emotions organisedmutually in the communications. Homologous feelingsand changes in affect of infant and caretaker generateharmony, sympathy, support, comfort, restraint, orantagonism.

In the first 6 months, the emotions become strungtogether in increasingly impassioned ‘‘plots ’’, in whichprotagonists play expressive parts to each other. Sterndescribes feeling qualities transmitted with distinctiveactivation contours, which are ‘‘captured by such kineticterms as ‘crescendo, ’ ‘decrescendo, ’ ‘ fading, ’ ‘explod-ing, ’ ‘bursting, ’ ‘elongated, ’ ‘fleeting, ’ ‘pulsing, ’‘wavering, ’ ‘effortful, ’ ‘easy, ’ and so on’’ (Stern, 1993,p. 206). In Stern’s terms, these give ‘‘vitality forms’’ tothe emotions (vitality affects), which would seem to behomologous with the ‘‘sentic forms’’ described in musicalexpression of feelings by Manfred Clynes (Clynes, 1980,1983; Clynes & Nettheim, 1982). The intuitive parentingbehaviour of a father or mother at play with an infantshows that the adult is sensitive to the infant’s emotionand unconsciously skilled in giving the right level ofemotionally coloured contingent responses (H. Papousek

& Bornstein, 1992; H. Papousek & Papousek, 1987; M.Papousek, 1996; Stern, 1971, 1974, 1992, 1999).

Laboratory tests have proved that, by the middle of thefirst year, infants hear musical parameters amazingly well(Demany, 1982; Trehub, 1987; Trehub et al., 1993, 1997;Zentner & Kagan, 1996), and they show preferences forthese same parameters in the vocal productions ofmothers (DeCasper & Fifer, 1980; Trehub, 1990; Fass-bender, 1996; M. Papousek, 1994, 1996). It seems that theinfants’ acute ability to hear musical elements in amother’s voice is important for state regulation by themother’s sympathetic response to the infant’s expressionsof arousal, fretfulness, tiredness, playfulness, joy, etc. (M.Papousek & Papousek, 1981). But the infant is not justresponding to the mother’s signals with a reflex statechange, and the adult is responding to the rhythms andemotional quality of the infant’s expressions in a joint,two-way ‘‘performance’’. They are ‘‘musicking’’ per-formance and listening together (Small, 1998). Themother is attuning to musicality in the infant’s ex-pressions and communicating with the infant (M. Pap-ousek, 1994, 1996; H. Papousek & Papousek, 1987; M.Papousek & Papousek, 1981, 1989; Stern, 1993, 1999;Stern et al., 1985).

Sustained orienting of the baby’s head towards aloudspeaker that is presenting preferred sounds has beenused to show that infants 4 to 8 months old candiscriminate melodic patterns independent of pitch, andmelodic contours with variation of intervals (Chang &Trehub, 1977a; Trehub, Bull, & Thorpe, 1984; Trehub,Thorpe, & Morrongiello, 1985, 1987; for a synthesis, seeTrehub et al., 1995). Trehub (1990) concludes that‘‘ infants’ representation of melodies is abstract and adult-like’’ (p. 437). It has been shown that infants candistinguish pairs of notes separated by one semi-tone, andthey can recall a melody based on the tones of the majortriad better than one that is atonal. Other tests dem-onstrate that infants are sensitive to tempo and torhythmic sequences independent of tempo (Trehub &Thorpe, 1989), and that they experience Gestalt ‘‘group-ing’’ effects like adults (Chang & Trehub, 1977b;Demany, 1982; Demany, McKenzie, & Vurpillot, 1977;Fassbender, 1993; Me! len, 1999a, b; Thorpe & Trehub,1989; Thorpe, Trehub, Morrongiello, & Bull, 1988).They respond to fundamental pitch independent of tonalcomposition (Clarkson & Clifton, 1985), perceiving andcategorising differences in timbre of nonspeech tones(Clarkson & Clifton, 1985; Clarkson, Clifton, & Perris,1988; Trehub, Endman, & Thorpe, 1990). They aresensitive to differences in timbre between vowels [a] and[i], in spite of variations in fundamental frequency,duration, and intensity (Kuhl, 1985).

Trehub argues from her data and observations onhuman voices that ‘‘ the design features of infant musicshould embody pitch levels in the vicinity of the octavebeginning with middle C (262 Hz), simple contours thatare unidirectional or that have few changes in pitchdirection (e.g., rise-fall), slow tempos (approximately 2±5notes}sec), and simple rhythms’’ (Trehub, 1990, p. 443).These predictions match well the vocal patterns infantsproduce in song-like play, the prosodic patterns parentsuse to excite or calm their infants, and the songs thatadults sing to infants (Fernald, 1992a; H. Papousek,1996; M. Papousek, 1996; M. Papousek & Papousek,1981; Stern, 1999; Stern et al., 1977, 1983, 1985; Trainor,1996; Trehub, Schellenberg, & Hill, 1997; Trehub, Unyk,et al., 1997).


Self-awareness and Self-other Awareness : Showingoff, Stranger Fear, and Privileged Relationships forEmotional Attachment, and for Companionship inExperience

Two-month-old infants may show coyness when en-countering their own reflection in a mirror (Reddy, 2000).Older infants play with the fun and deceit of interactionsin teasing games (Nakano, 1994; Nakano & Kanaya,1993; Reddy, 1991; Reddy et al., 1997). When they playwith reactive mobiles, this seems not simply a response tocontingency of physical motion, as Watson (1972, 1984;Bahrick & Watson, 1985; Gergeley & Watson, 1999) hasproposed, nor just another kind of exploration of theembodied, proprioceptive self (Rochat, 1998). Rather it isan imaginative variant of the capacity for intersubjectivenegotiation, as H. Papousek (1967) demonstrated whenhe showed that 4-month-olds made communicativelyappropriate emotional reactions to success or failure inpredicting the behaviour of a reactive physical system,showing their motivation in a human way. Play is morelively and more satisfying for the infant with a partnerwho is not merely moving with mechanical contingency,but also varying the contingency and qualifying themoves of self and other with mock expressions of surprise,anxiety, joy, etc. The emotions communicated are es-sential to thefull game between two humans. An infantplaying with a reactive mobile is ‘‘as if ’’ with anotherperson—he or she being other-aware, as much as a kittenbatting after a paper ball is chasing prey (Hall, 1998).

Stern’s dynamic affects describe transforming statesthat continuously and rhythmically synchronise andregulate the flow of play (Stern, 1993). They givecommunicative meaning to the discrete action patternsshown in photographs of the climax facial expressions(Ekman, 1993) representing the categorical affects ofanger, joy, sadness, disgust, fear, and surprise. Suchvisible and static forms of emotion punctuate a dynamicmusic-like expression of interpersonal feelings in thevoice, and the ‘‘dance’’ in body movement and handgestures. Even in newborns, expressions of emotion incommunication are blends, and the succession of chang-ing expressions is a central component of the message(Oster, 1978; Oster & Ekman, 1978). Analysis of DTVrecordings, and the effects of replay, clarify this point(Murray & Trevarthen, 1985; Trevarthen, 1993a, b;Nadel, Carchon, et al., 1999).

Alternations of address and reply, of asserting andapprehending or attending (Trevarthen et al., 1999),between the infant and an adult in a conversation game,are animated by continuously changing and contingentlyexchanged expressions of mixed relational emotions—smiles and laughter signalling joy in sharing, bold andmock-angry threats as self-assertion, looks away andfrowns of impatience reacting to intrusions, fear to signalthe impact of strange and startling events, pouts and criesof anger with fatigue or when self-actions are frustrated,tears of sadness conveying loneliness or pain, and so on.None of these constellations of emotion are easilydescribed by combining the classical discrete categories ofemotion. They are coherent, so-called non-basic emotionswith immediate interpersonal value, as discussed below.

Mutual attunement of dynamic feelings and imitationof actions and expressions regulates sharing, or rejection,of purposes. The infant can imitate, reply to, or ignore apartner, or show decisive avoidance. The adult’s playoften seems designed to challenge the assertive inde-

pendence of an infant. Parental teasing games, charac-teristic of good relationships, demonstrate this nego-tiation. Infants, also, tease their companions, especiallyafter 3 months, and this behaviour, with early demon-strations of coyness (Reddy, 2000), proves that infantsalready have an expectation of and interest in what theother may perceive and do, an other-awareness (Draghi-Lorenz, Reddy, & Morris, 2000; Reddy, 1991, 2000;Reddy et al., 1997).

Infants may react to others’ attention with self-testinggestures and display, creating socially conscious manner-isms or bearing, which Wallon (1928) called, in French,prestance : i.e., offering the self to others by assuming aceremonial posture or manner, acknowledging a publicand their formal or intuitive appreciation. Six-month-olds often show off, making exaggerated postures orgrimaces, displaying imitated ‘‘ trick’’ behaviours, suchas head shaking, bouncing, hand-clapping, silly faces,shouting, theatrically coughing or squealing, and theyrepeat appreciated behaviours to amuse themselves orfamiliar companions (Reddy, 1991; Trevarthen, 1990a,1998a). Infants also turn these display behaviours to facea mirror, examining themselves with amusement anddisplaying lively postures and hand gestures, whichindicates that this kind of self-consciousness is part of theawareness of others (Fiamenghi, 1997; Reddy, 2000;Reddy et al., 1997; Trevarthen, 1986b, 1990a; Tre-varthen et al., 1999). Siblings, and adults, take up thedeveloping sense of fun to make the infant laugh withmock attacks and exaggerated comments, and thisevidently can assist development of the infant’s socialunderstanding and social expression (Dunn, 1994; Nadel& Tremblay-Leveau, 1999). Expressions of these subtlekinds gain value in the more intricate negotiations oftriads, such as mother-father-infant interactions (Fivaz-Depeursinge & Corboz-Warnery, 1999) or those betweenan adult and two infants (Nadel & Tremblay-Leveau,1999).

Infants also develop, at about 7 or 8 months, bothstronger attachment to the mother and increased‘‘stranger fear ’’ (Ainsworth & Bell, 1970; Sroufe, 1977,1996). These developments, viewed in the whole contextof infants’ social behaviours at this age, appear to beelaborations of motives that prepare for cooperativelearning in specific relationships, i.e. of conventionalbehaviours and symbols that are meaningful with knowncompanions (Trevarthen & Logotheti, 1987). First mean-ings make sense only in the restricted culture of thefamily, and an infant’s learned tricks and mannerisms arelikely to be misunderstood by unfamiliar persons, whomay, quite sensibly, be regarded with suspicion. In thelast months of the first year imitated behaviours arereadily incorporated in delayed reproductions (Meltzoff,1995; Meltzoff & Moore, 1999; Trevarthen, 1990a),which proves their role in the development of arbitrarysymbolic representations (Akhtar & Tomasello, 1996;Nadel & Butterworth, 1999; Piaget, 1962). Games with 6-month-olds increasingly involve objects (Hubley & Tre-varthen, 1979; Pecheux et al., in press ; Trevarthen &Hubley, 1978), and infants take more opportunities forjoining their exploration of the private knowledge ofthings with the social experience of being an actor.

Imbalance in the complex of motives emerging at thistime in a disordered brain mechanism of intentions andintersubjectivity may be the principle factor precipitatingdiagnostic features of autistic behaviour, which wediscuss further below (Hobson, 1993a; S. J. Rogers,


Figure 2. Intrinsic motives coordinate three types of engagement of a human subject with the body and the outside world:A—Processes that regulate the physiological functions of the body maintain the subject’s organismic integrity and sustain vitalfunctions; B—Engagements with physical objects and situations assume anticipatory control over the effects of actions, aided byperception of the properties of the objects and surroundings and what they afford for different purposes ; C—Communication withother subjects, and any adjustment to their behaviour, must take account of their purposes and awareness. This communication andanticipation of other subjects’ behaviour is aided by perception of their motives and emotions, which are detected by perception ofmovements and autonomic adjustments that prepare for critical intentions to be carried out. Combinations of these three kinds ofmotive generate three domains of subjective and intersubjective life : I—Individual subjects can act on the physical world to benefittheir existence as organisms, evaluating objects and situations in terms of their usefulness for nutrition, self-protection, comfort, etc. ;II—Aid from other subjects may be enlisted to benefit individual’s state of wellbeing or comfort. The kind of relationship describedas ‘‘Attachment’’ between a child and caregiver is of this kind; III—When subjects act collaboratively with joint and mutually awareinterest in their common world of objects and places where they may act and plan actions together, they gain intersubjective

understanding of common meanings. This is the ‘‘companionship’’ that leads to cultural learning of all kinds.

1999; S. J. Rogers & Pennington, 1991; Trevarthen,Aitken, Papoudi, & Robarts, 1998). Autism usuallybecomes evident in, or before, the second year ; it cannottake on the appearance of a disorder in a verbalisabletheory of mind (Baron-Cohen, Leslie, & Frith, 1985) untilmany months later. Nor is the investigative 1-year-oldonly concerned with mastering object concepts. Throughsharing protoconversation and play with other persons’motives, understandings, and purposes, learning becomesa part of intentional self-regulation with relation to thingsand events, and self-other regulationwith persons (Aitken& Trevarthen, 1997; S. J. Rogers, 1999).

We distinguish three directions of a subject’s mo-

tivation, or anticipation of regulation and experience: inone’s own body, to objects, and to other persons, andthere are three corresponding functions of emotion(Trevarthen, 1993a, 1998a, in press ; Trevarthen &Hubley, 1978). These, we propose, by their regulated andresponsive interactions, give the fundamental organis-ation to the changing consciousness and learning ofinfants, as diagrammed in Fig. 2. At times the mind of theinfant and young child is more taken up with intrinsicproblems of self-regulation and self-organisation or‘‘autopoesis ’’. Other periods of experience are cognitivelydirected to investigate physical objects, to performoperations on them, and to learn their substantive


properties and processes. Then again, the infant may beseeking to share experiences, purposes, and the explo-ration of meaning in conscious companionship with otherpersons. There is evidence that motive transitions andPRCs that lead to advances in motives and behavioursmay be coupled to difficult or regressive periods atparticular ages when the infant becomes more demandingof the main caregiver’s attention and has difficulty withequilibrating emotional states, and with internal auto-nomic states and sleeping (Brazelton, 1993; Trevarthenet al., 2000; Van de Rijt-Plooij & Plooij, 1993) (seeFig. 1).

Socioemotional Learning, Shared NarrativeAwareness, and First Comprehension of Words

At the same time as it provides for joyful sharing offeelings and for teasing games, intuitive parenting (H.Papousek & Papousek, 1987) is clearly adapted to guidethe child towards customary ways of appraising theworld, proper use of objects, and communicating insocially approved ways. By 6 months infants are capableof reproducing routines learned in musical}rhythmic playor other structured games as gestures of communicationby deferred imitation (Nadel & Butterworth, 1999;Trevarthen, 1990a, 1998a, p. 40). These behaviours arenot simply imitations of the forms of procedures ormannerisms—they are significant, emotionally chargedinterpersonal messages or displays, as, indeed, all infants’imitations tend to be in some measure from the earliestdays (Kokkinaki, 1998; Trevarthen et al., 1999).

In the intimate relation with a parent or other familiarcompanion the infant can take the role of instructor orinformer to the adult’s communications. This is very clearin the developments of parental expressive behavioursand speech in musical and other games around the middleof the first year, and also in the further transformations ofthe adult’s speech acts when the infant becomes adept atfollowing and cooperatingwith pointing and instructions,led by the adult’s changing tone of interest and sat-isfaction. Before 40 weeks, when the critical developmentin infant cooperativeness normally occurs, mothers tendto ask many questions and to use many provocative orinviting forms of utterance to attract the child’s attentionand to give pleasure, such as rhetorical questions, playcomments, exclamations, and mock emotional outbursts.After the infant becomes attentive and compliant to themother’s utterances and gestures of purpose and interest,many more directives are used (Trevarthen & Marwick,1986) and the adult talks in a more matter-of-fact tone. Ina sense, the infant gives an external curriculum of motivechanges for the parents’ intuitions to follow, and thiscurriculum changes intrinsically as the infant develops. Itis not simply a reflection of what the infant has beentaught.

A toddler picks up language socially—by doing thingswith it and by noticing what other persons do with it,sharing interests, actions, fantasy, and mimesis (Bates,Camioni, & Volterra, 1975; Ninio & Snow, 1988, 1996).But it does not help, especially with the infants under 9months of age, to think only aboutwhat is called language‘‘pragmatics ’’—the factors that govern choice of lang-uage in social contexts. The origin of the word from Greekpragmatikos implies an expertise taking practical accountof real, factual situations, and accepted principles ofconduct. When children are negotiating ongoing activity,

participating in social routines and well-practised for-mats, or regulating mutual attention, they carry out theseintentions with intersubjectively regulated feeling—beingserious, acting silly, expressing enjoyment or exuberance,teasing. Acts by means of which toddlers negotiatemotives of social participation are found to come earlierin development than intention-directing ‘‘protoimper-atives ’’ (Ninio & Snow, 1996; Snow, Pan, Imbens-Bailey,& Herman, 1996), just as person-person games comebefore person-person-object games in the middle of thefirst year (Trevarthen & Hubley, 1978). Meltzoff (1985b,1995) has noted the importance of deferred imitation inthe developing understanding of others’ intentions in thesecond year of infancy. Reproduction of the act checksthe original purpose.

‘‘Languagepragmatics ’’carries implicationsofrationalobjectivity that are especially unfortunate in applicationto the early protolanguage communications of infants.In the social life of a 1-year-old, communication withother persons is primarily concerned with how the rela-tionship offers opportunities for taking part in intentionsand attentions with the emotions that accompany them(Papaeliou, 1998). What is important in a protolanguagesign or ‘‘act of meaning’’ is not the fact referred to, oreven just the social convention of its form, but thesympathy and aspects of intersubjectivity exhibited in thelooking, gesturing, and vocalising (Halliday, 1975). In-fants can use others as conditions or context for theimplementation of their will, but their behaviours haveintrinsic interpersonal value—as irony, humour, or teas-ing, for example. Infant semiosis is emotional, not justrepresentational or referential (Trevarthen, 1994). It isfundamentally ‘‘self-with-other-referred’’, and from thatas foundation it can become ‘‘self-object-referred’’ orgain a practical objective. It is metacommunicative, inGregory Bateson’s sense (1956), before it is meta-cognitive.

Even among adults, much of language is not so muchfor practical use, the applying of purposes to reality. Noris it just governed by rules. It is social in the sense that itis interpersonal, emotive, relational, intersubjective—concerned not with the truth of a context and itsconstraints or usable affordances, nor so much withmaxims of speaking, but with impulses and emotions inimmediate human contact while imaginations are activelyrunning ahead of purposes (Rommetveit, 1979, 1998).Much confusion has been generated by attempting toexplain the early stages of language learning as a matterof coordinating vocalisations just with referential in-tentions and attentions—requests, pointing, showing,giving—without concern for the human feelings andsensitivities which form the dynamic texture of all livecommunication and ‘‘experiencing together ’’. Joint at-tention, which is strongly associated with the picking upof words in the second and third years (Locke, 1993;Rollins & Snow, 1998; Tomasello, 1988; Tomasello &Farrar, 1986), is not just a convergence of lines of sightand directions of instrumental action. It depends on themotives for doing while child and partner are attentive toone another in communication.

Nadel (Nadel, Gue! rini, Peze! , & Rivet, 1999; Nadel &Peze! , 1993; Nadel & Tremblay-Leveau, 1999) has demon-strated the importance of immediate imitation amongtoddlers, including imitation of utterances, for the sharingof meaning, and she underlines the pleasure and humourof the sharing. Emotional narrative, the dramatics ofexpressive intentions, may even provide the underlying


energy of the relatively inanimate, decontextualised, ordisembedded (Donaldson, 1978), language of informativetext or prepositional logic. Human stories (includingscientific theories, which are just explanatory storieswherein emotive aspects have been disciplined!) seekjoint imaginative, and emotive, experiences that evolvetheir purposes far beyond the present context and exploreideas and feelings for both the past and the future,making fiction out of artificial recollections (Akhtar &Tomasello, 1998; Bruner, 1986; Donald, 1991; Ricouer,1981, 1984). Children and adults alike are easily caught inthe drama of make-believe (P. L. Harris, 1998), and eveninfants seem to be playing with narratives of emotionlong before they can talk (Malloch, 1999; Trevarthen,1987, 1998a, 1999a). Both the emotional process and theform of the action are certainly important in toddlers’sense of play, and both are shared.

Emotional intonation in speech to infants prepares apath to the meaning of words. Kitamura and Burnham(1998b) used the preferential looking paradigm to showthat 6-month-olds prefer ‘‘high affect ’’ speech of afemale actor with good voice control who had been ananny and was therefore practised in IDS. She recordedsimple utterances with high and low affect, and high andlow pitch. The infants oriented to the affective content,and in certain instances, low-pitched utterances werepreferred. The authors concluded that the affectionatetone is, ‘‘ the pivotal quality that attracts infant at-tention’’, and that, ‘‘ the exaggerated intonation of IDSmay normally be used as a vehicle to convey such affect toinfants ’’ (Kitamura & Burnham, 1998b, p. 234). Theycompared infants’ reactions to normal full-spectral IDSand filtered speech in which only the intonational featureswere preserved, and found that filtered speech is asinteresting to 6-month-olds as full spectrum speech. Theinfants were attending to speech, ‘‘as a communicativesignal rather than a linguistic signal. ’’ … ‘‘Thus, IDSpotentially accommodates early cognitive and linguisticlimitations, not only because this quality is more capableof gaining infant attention, but also because maternalaffective expression provides a primitive method ofconveying meaning to the pre-lingual infant, an essentialfirst step in developing a facility for processing language’’(p. 235).

Although it had been claimed that very young infantsmay be more responsive to the spectral complexity thanthe intonation contour of IDS (R. P. Cooper & Aslin,1994), and that exaggerated intonation accommodates tothe immaturity of the infant’s attention and perception(Fernald, 1984, 1992a), affect is demonstrated to be moreimportant than heightened frequency characteristics. Asthe developmental linguistic Locke has proposed, ‘‘Affectis logically necessary—it impels the child to exploit andtherefore to develop linguistic capacity’’ (1993, p. 330).Adults speaking affectively and with attention to theresponses they receive stimulate infants to enhance theircommunication skills, and language development isslowed if affect communication is reduced, as in the caseof post-natal depression, discussed below. IDS canregulate and modulate infant behaviour, comfort distress,gain attention, convey emotion, or direct behaviour(Kitamura & Burnham, 1996).

Mothers’ vocalisations to infants can be compared tothe graded system of vocal signalling in highly evolvedsocial animals. In humans, the brain mechanisms of thesesocial signals are presumed to be largely subcortical,because the cortex is very immature in young infants

(Lecours, 1975), and homologous structures are used byhigher primates in the production of the modulatedsignals used in social and territorial settings (Marler,Evans, & Hauser, 1992; Ploog, 1992). Species-specificvocalisations of higher primates convey nuances ofaffective and communicative intent similar in form tothose important in speech to infants (Fernald, 1989,1992b; Kitamura & Burnham, 1996; H. Papousek, 1996).The infants’ responses to this kind of speech are socio-emotional. They can be modified culturally, but they havean innate basis, which needs more study.

A Theory of Behaviour in Relationships

Motives in Animal Subjectivity and Intersubjectivity

Animals actively investigate environmental infor-mation, provoking experience. They search for particularbenefits that are defined as the goals of behaviour by thestructure and process of their motives. Motives initiatecoordinated whole-body movements of the kind thatengage with the environment, and muscular partialadjustments, such as looking with the eyes, turning thehead to listen, or reaching to touch with the fingers. Thelatter anticipate and ‘‘gate ’’ information from the sensesthat may be needed to guide the next body movements(Trevarthen, 1978). Motives define perceptual afford-ances prospectively (Lee, 1993). Coherent purposivenessin time and space and selective interest are necessarilyfounded on innate, adaptive psychoneural functions thatmap the body with its motor potentialities and receptorsand that form inherited behaviours and set up environ-mental readiness for learning, and this applies to com-munication movements as well as to behaviours for theindividual alone (Trevarthen, 2001).

The physics of an animal’s body determines how itmust function psychologically. First, everything that theanimal does is conditioned by the form, mass, and motorcapacities of its body. Second, effective regulation ofactions will depend upon a vital integration of internalphysiology and visceral or autonomic states with theenergy-expending forces of the body moving in itsperceived world. Subjects are coherently motivated toexploit the benefits that the environment affords, and todo this effectively they must anticipate the consequencesof their movements, both for their internal state ofwellbeing, and for their future situation in the world. Thisessential anticipatory function of intelligence means thatwhat a subject perceives is powerfully conditioned, fromthe outset, by how it chooses or plans to move. Intrinsicspatiotemporal, body-related determinants of movement,i.e. motives and motor images, will evoke and shape thesubject’s awareness. This aspect of perceptual and cog-nitive processes has been addressed by motor theories ofreafferent perception (Bernstein, 1967; Jeannerod, 1994,1999; Sperry, 1952; Von Holst & Mittelstaedt, 1950).

A consequence of the necessary prospective control ofmovement, geared to environmental affordances (Gib-son, 1979; Lee, 1993), is that the behaviour of the animal,the way its body acts, makes its consciousness evident.The causal processes in an individual’s vitalsubjectivity—intentional, goal-directed agency; activeand selective awareness ; motives of seeking and avoiding;emotional expressions that reflect internal state andautonomic regulations—have the potentiality to becomeinformation for another similarly endowed subject aboutwhat the acting subject is doing, or about to do. The fact


that a subject’s purposes, experiences, and emotions canbe ‘‘read’’ by other subjects through the visible, audible,mechanical, and chemical signals produced by an activebody means that reactions of these other subjects canbecome part of the process that directs and reinforceslearning in the reader or audience of the message. Twosubjects can potentiate one another’s action, conscious-ness, and memory.

Intersubjectivity in animals is a direct consequence ofthe regular polarity, symmetry, and special patterning oftheir inherent body form, and of the rhythmic dynamicsof their motivation in awareness, both of which areaccentuated in social signalling to conspecifics (Tre-varthen, 1998b). Subjective purpose is signalled by therhythms of movements, mirrored in the displacement ofbody parts that signify a directed awareness, and an-ticipated in selective orientations. The mind is extendedbeyond the body, interwoven in increasingly intricateways with the environment (G. Bateson, 1973). Itsmanifestations are picked up by other individuals whopossess contingent responsiveness and a capacity fortransferred initiatives, or cooperative intentionality.Autonomic (visceral) self-preserving and reproductiveregulations are elaborated into an emotional signallingmechanism (Panksepp, 1998a), which evolves in the morehighly cooperative species into a powerful control ofrelationships and attachments by negotiatory self-other(complex) emotions (Porges, 1997), and this produces asympathy of emotional states or a fundamental moralityin the life of the group. The evolution of social signalling,and of social cognition, generates increasingly subtle anddetailed evidence on motive dynamics that reveal sub-jects’ purposes and awareness. In humans intersubjectiveawareness motivates cultural learning—the intergener-ational transmission of knowledge and skills with all theconceptual and material consequences.

A human body has exceptionally elaborate motorpotentialities, and unique polyrhythmic coordination ofexpression (Trevarthen, 1999a). In the first, highlydependent, infant period it is clear that movements ofcommunication, of mental engagement with adult care-givers and siblings, by vocalisation, facial expressions,and gestures of the hands, develop before observationaland manipulative investigations of objects and events,and both these long precede the ability of the child tostand and walk. It is as if the evolutionary process hasbeen reversed in individual ontogeny, but the logic orstrategy of this development fits with the general principlethat intrinsic motives provoke and guide acquisition ofmore specialised cognitive and motor representations.This evolutionary advance in innate psychobiologicalprocesses, which may be observed to have its origins inthe evolution of social intelligence in many other species,and most notably in subhuman primates, especiallychimpanzees (Bard, 1998; Bard & Russell, 1999; Butter-worth, 1999), creates a new potentiality for imitation andlearned consciousness (Byrne, 1998; Go! mez, 1998;Whiten, 1991). In humans it motivates use of artificiallycreated meanings and technologies that have been accum-ulated over generations (Donald, 1991; Uzgiris, 1999).

Thus, human intersubjectivity is conceived as a processthat makes it possible for subjects to detect and changeeach other’s minds and behaviour, by purposeful, nar-rative expressions of emotion, intention, and interest. Itis also the avenue by which any theory of mind orintellectual and reflective description of consciousness,purposeful intelligence, and language may be acquired.

Since emotions are the essential regulatory factor inintersubjective contact, expressed emotions are fund-amentally dialogic or between persons, in same sense thatBakhtine (1981) treats all thought as dialogic—evenmonologue. Turner (1996) proposes that literary, meta-phorical powers are the basis of everyday thought in theordinary human mind. He concludes that cognitivepsychology and psycholinguistics has been looking in thewrong places for answers to the basic questions aboutmeaning, mind, and language.

The Problem of the Initial State of the HumanMind

In their abstract discussions of the nature and originsof subjectivity of self-consciousness, philosophers en-counter many disagreements, and in the social sciences(Social Psychology, Sociology, Anthropology) there isconfusion about the original nature or initial state of thehuman subject. Most academics in these disciplines,insofar as they consciously address the problem, areinclined to give full responsibility for all consciouscivilised and ethical attributes of persons to experiencegained after birth, and preferably to linguistically me-diated learning late in childhood—to the systematic orcasual picking-up of the verbal record of arbitraryconventions of the culture and beliefs of the society inwhich children are brought up. Inevitably, the place ofthe infant in both the natural philosophy and the scientifictheory of subjectivity is anomalous. Between the re-ductive certainties of medical science, which treats theinfant as a biological organism that may develop dis-orders requiring treatment, and the social sciences, whichcan only note the absence of all cultural knowledge andskills in the infant mind, the state of that mind is left in thedark. Piaget, early in his career, called it ‘‘une abı#me demyste' re’’.

As we have shown, accurate recordings of the initiatedactivities, oriented movements, preferential awareness,discriminating subtleties of emotional expressions, andcontingent responses to the behaviour of other personscan solve the riddle. There is actually abundant evidencein the spontaneous behaviours of a newborn infant for awell-integrated psychological state—for subjectivity, andfor intersubjectivity (Trevarthen, 1999b).

In the past century, more and more evidence of inbornbehavioural and perceptual abilities has had to be grantedto the infant. But there remains the one fundamentaldisbelief ; it is inconceivable for many specialists in thesciences of human mental development that an infantcould be conscious of another person’s subjectivity. Forthis we see a cultural-historical explanation. Post-en-lightenment psychology has been developed and em-ployed to provide ways of measuring the discriminations,interests, skills, and individual differences in intelligence,personality, and mental health, of the individual self—orof social collections of selves as subjects of conventionalunderstanding. Communication is understood as transferof information, and its processing is linguistic. Languageproductions are objects (texts) of special interest insociety, where they are constructed and learned, or theyare the outcome of a rational instinct for generation oflinguistic structures (Pinker, 1994) rather than the naturalbehaviour of persons who actively seek mutual awarenesswhile living and moving together. The same is true formusic, which is treated as a thing that has to be acquiredby training of perceptions and performance, not as a


universal human activity, something humans do (Black-ing, 1976; Small, 1998).

Psychological research, including neuropsychologicaland neurophysiological research linked to medicalscience, especially that in psychiatry, has built an im-pressive set of models for the working, and malfunc-tioning, of the individual mind. The subject’s or patient’sself, often an unhappy and subjectively challenged one,remains the privileged unit, and most of his or herattributes are accounted for in mechanistic terms relatedto the cognitive processing of stimuli, regulations ofcognitive effort and efficiency, or the neurochemistry ofself-regulating emotions. Both motor activity andemotions are viewed as products of cognition, learning,and memory that serve self-preserving physiologicalneeds and physiological regulations, using environmentalresources. Motives and emotions are not, in themselves,plausible, objectively acceptable, psychological causes.

Not surprisingly, evidence that an inexperienced infantcan both be conscious of the mental states of anotherperson, and react in communicative, emotive ways to linktheir subjectivities, has been rejected. Indeed, manyresearch projects have been motivated, overtly or un-wittingly, to disprove any such proposition, calling theevidence subjective, uncontrolled, or not empiricallyverified. It has not been difficult to outwit the infant withreduced (controlled) conditions that are unnatural withrelation to any subtle motives that might enable sym-pathetic encounters between the infant and a person. Themodel of the infant as organism or cognitive processorleads easily to tests that merely seek to stimulate andobserve orientations and responses of either a physio-logical or instrumental kind to some environmental event,the objective being defined a priori by the experimenter.

Comparative functional anatomy of the brain andbody in different animal species, and especially devel-opmental comparisons through the earliest embryo stagesof the human brain, when the most powerful geneticconstraints on cell activities in the organism are operatingand the cerebral cortex does not yet exist, invite a muchmore generous interpretation of innate functions thatanticipate experience of, and selective action on, theenvironment (Trevarthen, 2001). However, medicalscience of the human brain is channelled, in the main, toanalyse all conscious mental functions as attributes of thecerebral cortex, which is relatively unformed at birth, abias sustained by available technologies of electro-encephalography and functional brain imaging. Othermore comprehensive means of investigating cell processesand system functions in the deeper parts of the brain yieldtheir evidence slowly (Panksepp, 1998a). Moreover,neuropsychology has grown up as a discipline that applieslaboratory measures of performance indicative of per-ception, cognition, and memory, testing single subjectswho have suffered local brain dysfunction or trauma, todetermine the localisation of higher functions in thecerebral cortex. And scientific psychiatry is more focusedon neurochemical perturbations of neural functions thanon the intracerebral organisation of motives that seekhuman sympathy. In consequence both emotional andintentional processes are not well understood. Theseare likely to be the very same psychological activities thatan infant should possess in the form of impulses toinvestigate the world and regulate experiences, especiallyexperiences of the persons who are to be their familiarprotectors and teachers.

If infants have intersubjective capacities as part of their

natural intelligence, this talent has implications for thetheory of the origins of the human mind, for educationand for explanations of both socioemotional and cog-nitive pathology. It is incompatible with extreme re-ductive (nature limiting) environmentalist theories of theconstruction of human intelligence by either the self-generated experience of the child, or by parental shapingor instruction of rudimentary infantile intentions andconsciousness.

A recent summary of evidence concerning the de-velopment of social cognition by Rochat and Striano(1999) clearly presents the view that infants under 2months lack coherent conscious and self-awareness. Theresearch data in support of this ‘‘empirically basedaccount’’ is mainly concerned with changes in visuallydirected behaviour. Reactions to auditory stimulation,especially to human voices, are not covered. The descrip-tions given of neonatal behaviours and of selectivelooking and listening in the first 2 months are selective.There is said to be a dramatic 2-month (6-week) transitionto a contemplative stance as ‘‘reflex smiling’’ gives way toexternally elicited smiling, a positive emotional displayoriented outward. This is described as the psychologicalbirth of the infant, which is accompanied by a sudden shiftin state regulation, as the infant spends more time in anawake-alert state attending to and processing (visual)information form the outside world, scanning displaysfor detail more critically. Crying and fussing is ‘‘moreinstrumental, modulated by environmental and socialfactors ’’. In all, this change is taken as the ‘‘ true origin ofsocial cognition’’. The theory of Johnson and Morton(1991) that the infant has an instinctive, prewired sub-cortical mechanism for (visual) detection of and orien-tation to the human face, in some of its salient features,called CONSPEC, and that this is transformed byemergence of a neocortical learning mechanismCONLEARN, finds support from the mistaken con-tention that there is no detection of similarities anddifferences between faces before the 2-month transition.Neonatal imitation is explained as the consequence offacial displays triggering a preorganised fixed actionpattern, the infant being ‘‘not actively engaged’’, showingonly a form of response that ‘‘does not call for aware-ness ’’. Regarding the development of active probing forperceptual information, which is taken to require ‘‘higherperceptual and cognitive mechanisms’’, this is, Rochatand Striano say, ‘‘ to our knowledge not demonstrated fornew-borns’’. Data showing that after 2 months infantsare more deliberate in their exploration and instrumentaluse of perceptual experiences, or more controlled ex-ploration of self-agency, is taken to indicate that theylack this capacity in the neonate stage, even thoughnewborn infants have been demonstrated as capable ofoperant learning in, for example, speech-sound discrimi-nation (DeCasper & Carstens, 1981; Fifer & Moon,1995; Hepper, 1995).

Nonbasic Emotions Have Primary Functions

In a recent critical review of theories of emotion ininfancy, Draghi-Lorenz, Reddy, and Costall (2000) showhow the dominant individualist and cognitivist positionin academic psychology has accepted the Cartesiandistinction between emotions and thinking. Emotions, inthis view, are assumed to arise from primitive physio-logical regulations of the organism, inside the body, andthought or reason requires the acquisition of represen-


tations and logical operations concerning (describing andexplaining) the outside world. These representationsgenerally assume forms essentially identical with thesemantic representations and grammatical or syntacticrules of language or other symbol system. Their self-consciousness is verbal and reflective rather than intuitiveand enactive.

This dualistic theory of the thinking mind assumes thatan infant, initially, and for some ill-defined period(usually taken to be years rather than months becausechildren do not speak in the first 2 years), lacks allrepresentation of a thinking (reflective) self. The mind ofa young infant cannot separate its functions from theautomatic, reflex, biological reactions to stimuli ofenvironmental origin, and therefore cannot, of course,conceive (reason or theorise about) any condition ofrelationship to an other. The logic is somewhat circular—the infant is taken to be lacking in self-awareness becauseit cannot possibly have the necessary cognitive represen-tations, which are to be acquired, and it cannot acquirethought-representations because its self-image does notyet exist.

A different view is taken by ecological perceptiontheory, or the theory of environmental affordances (E. J.Gibson, 1993; J. J. Gibson, 1979; Neisser, 1993, 1994),which takes into consideration the specific invariantconfigurations of stimulation that arise when the activesubject is in receptive contact with the media and objectsof the outside world, subject and world being in resonantrelation with one another, their effects interpenetrating ascomponents of a dynamic system (Fogel & Thelen, 1987).The mind of the perceiving subject is taken by this theoryto have sufficient organisation to be receptive to, and ableto distinguish, different constellations of stimulation thatdefine the motion, position in body-related space, anddynamic features of activity invariably present in sit-uations and objects. The subject is thus able to im-mediately, without rational representations, enter intoadaptive behaviours that use the environment to thesubject’s advantage.

Apart from this important difference, both the abovetheories are primarily concerned with the consciousnessand actions of an individual perceiver}thinker, and bothappeal, though in different degrees, to a notion ofconstruction (or emergence), which takes it as evidentthat the psychological state of the infant at birth, and foran uncertain time afterwards, is one that lacks anyconception or representing configuration or schema ofself (body)-object, and consequently must lack both self-awareness and other-awareness.

We take a different position on the basis of observ-ations of the intricate coordinations of expression andawareness that infants do have from birth, especiallyfrom how an infant can behave in relation to theexpressions of feelings, purposes, and interests of anotherperson who is entering into engagement with the infant’sexpressions.

The evidence from early infancy suggests that therelational affects (Stern, 1993, p. 207) are specificallyadapted to real-time regulation of the balance of in-itiatives and reactions between the child and another.They contribute to the building of relationships ofaffectionate attachment, trust, and companionship, andto defence against abuse, mistrust, and disregard, andthey appear to be fundamental to human consciousness(Trevarthen, 1998d). It follows that emotions hithertodeemed complex, nonbasic, and acquired will have to be

reinterpreted as primary and necessary to the child’s entryinto the social}cultural world, with all the rational,linguistic, and pragmatic conventions and rituals thatworld offers. Furthermore, the theory that cognitionsconstruct even the simplest reactive emotions, such as theclassical seven—interest, joy, surprise, fear, anger, sad-ness, disgust—with perhaps two more, contempt andshame (Izard, 1977, 1978; Tomkins, 1962, 1963), will notdo the job.

The emotions between persons, including those thatpowerfully colour every moment of our relating as adultsto one another—pride, jealousy, shame, resentment, rage,and the lasting evaluations and empathy of admiration,love, hate, and contempt that we can develop in regard toparticular individuals—have their foundations in dy-namic reactions of even young infants to the feel of‘‘being present ’’ with another. And we can make anotherobservation from infancy research. The fascination thateven 2-month-olds show for the narrative of feelings inprotoconversations with a parent may hint at a further,much more important, function of innate humanemotions. The feelings they project into the engagementseem to take on a life of their own, as if both adult andinfant are each tracking the experiences of a imaginedprotagonists—an other or others, different from them-selves. Such a fictitious emotional experience appearseven more clearly in the poetry of baby songs and nurseryrhymes. Maybe the infant’s absorption in the drama ofthe mother’s talk or song is foreshadowing the wonderfulinventive imagination that motivates fantasy play intoddlers.

Psychobiology of Human Communication

From Maternal Regulation of Organismic Stateover the Birth Transition to AffectionateCommunication of Mental States

Research on rodents, cats, and primates shows that theimmediate postnatal period of mammalian life is one ofgreat changes in brain structure, neurochemistry, andfunction, changes that are critically dependent onparental support (Blass, 1996; Hofer, 1990; McKenna& Mosko, 1994; Panksepp et al., 1997; Rosenblatt, 1994;Schore, 1994; Zeifman et al., 1996). Newborn infantsintegrate their state regulation with maternal care, andform an attachment to an identified caregiver (Carter etal., 1997). Infants’ states of arousal and distress arepotently expressed, and they are immediately responsiveto stimulation from the mother’s breast-feeding, calmingbeing, in part, due to the sugar and fat content of breastmilk (Blass, 1996). Of great interest is the finding that thisphysiological response is facilitated, not only by rec-ognition of the mother’s voice, but also when the newbornhas sight of the mother’s eyes (Zeifman et al., 1996).Young infants also respond to the touch, movement,smell, temperature, etc. of a mother, and sleeping with themother may aid development of cardiac and respiratoryself-regulations (McKenna, 1986). This is considered tobe of special importance in the period before thedevelopment of cerebral mechanisms, including those forbreathing control, that are specialised for future com-munication by speaking, which involves integrationbetween forebrain and brainstem centres. Newborns, andpossibly foetuses, too, react to, and gain regulation from,the rhythms of maternal breathing and heartbeat


(McKenna & Mosko, 1990), and foetuses and infants arealso supremely sensitive to maternal vocal patterns(DeCasper & Fifer, 1980; Fifer & Moon, 1995; Hepper,1995; Lecanuet, 1996).

The emotional and communicative precocity of humannewborns indicates that emotional responses to care-givers must play a crucial role in the regulation of earlybrain development (Als, 1995). They are likely to guidedifferentiation of perceptual discrimination, cognitiveprocessing, memory, voluntary deployment of attentionto environmental objects, and executive functioning orproblem solving (Schore, 1994). Regulatory mechanismsof the infant brain are subject to changes by endocrinesteroids and other hormones (McEwen, 1989, 1997;Suomi, 1997), but they are ready at birth to formulate andexpress motivated behaviours, including coherentemotions. An intricate mutual psychobiological depen-dency is set up between a newborn infant and the care ofa mother or mother substitute. Modern perinatal medi-cine finds evidence that this biological relationshiprequires direct human mediation, and cannot be fullyreplaced by artificial clinical technology (Als, 1995).

Poly-vagal Theory and the Signalling System forMutual Embodiment of Motives and Emotions

Self-regulatory brain mechanisms of ancient phylo-genetic origin (MacLean, 1990; Panksepp, 1998a, b;Porges, 1997), which evolved to signal bodily needs andto attract appropriate parental ministrations for physio-logical states, have been augmented by, or transformedinto, mechanisms of sympathetic mind-engagement. Inhumans they become part of motivations specialised forcultural learning.

Whenprimitive vertebrates evolved as active predators,presegmental tissues at the anterior end of the bodybecame elaborate organs of an independently mobilehead: receptors for sensing the external world, jaws forcontrolling food intake, and gill arches for gas exchange.Simultaneously, a forebrain developed, capable of co-ordinating a more vigorous life with more foresightfulintelligence (Gans & Northcutt, 1983). In socially in-telligent higher vertebrates, the head additions, and theautonomic systems linked to them, have become elab-orated as the expressive}receptive systems of the face,throat, eyes, and ears, to which, in humans, the handshave been recruited. The communication of psychologicalevents between subjects by expressive movements con-stitutes a function that integrates internal organismic orvisceral regulations, mediated in the brainstem, withenvironment-directed or somatic ones which rely ondiencephalic and forebrain functions (Ploog, 1992;Porges, 1997; Schore, 1994; Trevarthen, 1985, 1989,2001; Tucker, 2000) (Fig. 3; Table 1).

Core systems of interneurons in the brainstem, whichin the adult regulate attentional orientations, coordinatepurposeful movements of the body and its parts, andmediate the equilibria between autonomic and explora-tory or executive states, first emerge in the embryo brainas regulators of morphogenesis in emerging cognitivesystems (Trevarthen, 2001; Trevarthen & Aitken, 1994).An important output from this intrinsic motive formation(IMF; Trevarthen & Aitken, 1994) controls the sensory-accessory motor systems of the special receptors of thehead and hands (Table 1). The eyes, the ears and cochlear,the lips and tongue, and the palms and fingers are allhighly receptive and discriminating in their sensory

functions, and separately aimable and tuneable by virtueof special muscle structures. Movements of these struc-tures dynamically and rhythmically direct and censor theuptake of perceptual information in modalities of ex-ceptionally high sensitivity and resolution, and thesemotor adjustments occur in the exploratory and focusingphases of attention to the outside world, before the finalcommitment of a ‘‘consummatory act ’’. They thereforedisplay predictive information that an observer can pickup about emerging motor impulses and prospective self-regulations of the subject, and, indeed, they have evolvedinto specialised expressive movements that signal thesubject’s consciousness and intentions (Panksepp, 1998b;Porges, 1997; Trevarthen, 1993b, 1997a, 2001; Tre-varthen et al., 1999). All the organs of human linguisticexpression are recruited from this sensory-accessorymotor set. Brainstem efferent nuclei concerned withselectively aiming and focusing the uptake of visual,auditory, and haptic (tactile) information, on the onehand, and those that became dedicated to the control ofvisceral functions of body temperature, pain control,heart rate, respiration, vocalisation, and biting in lowervertebrates, on the other, have been adapted in humansto serve social functions of dynamic emotional expressionand, eventually, language (Ju$ rgens, 1979; Ploog, 1992;Porges, 1997), as summarised in Figure 3.

We have already suggested that in infancy the brainfunctions in such a way as to regulate two complementarymotive states, or states of commitment to engagementwith environmental resources—one trophotropic, con-tributing to the maintenance of organic functions andbodily wellbeing, the other ergotropic, seeking experienceto build efficient anticipatory cognitive systems that willexploit situations and objects, make adaptive actions,and store memories of how behaviours are to be executedand what affordances of objects they should seek inperception. We suppose that communicative functions ofthe conversational and cooperative kind will serve tointegrate these two, and further, that especially in infancy,the signalling of interpersonal interests and responses toattentions of other persons will be elaborations ofautonomic or self-regulatory motor activities. The mam-malian self-regulation by emotions (Panksepp, 1998a, b)and the emotional motor system (Holstege, Bandler, &Saper, 1996) are evolutionary successors to the auto-nomic regulatory systems of lower vertebrates (Porges,1997).

In higher mammals, and most impressively in humans,these brain systems have evolved into a way of life inwhich emotional communication links the young into aprocess of cooperative sociocultural transmission ofknowledge and skills from generation to generation, andthis depends on affectively regulated relationships andself-confidence in relationships (Damasio, 1994; Schore,1994; Tucker, 2000; Tucker, Derryberry, & Luu, 2000).These same systems predispose to mental and emotionaldisorders of peculiarly human complexity (Schore, 1996,1997; Trevarthen et al., 1998; Tucker & Derryberry,1992). The cerebral organs that mediate cultural learninginclude new perception and memory systems in temporaland parietal neocortex, limbic structures (hippocampusand amygdala), and basal ganglia intimately linked tomotor time-generators and movement coordinations thatimplicate structures throughout the brainstem andcerebellum (Panksepp, 1998a; Schore, 1994; Tucker,2000) (Fig. 3). Elaborations of the prefrontal neocortexand frontal limbic cortex confer new capacities for

22

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Figure 3. The emotional mechanisms of the human brain occupy all levels and their fundamental coordinations in communication are rooted in brainstem systems of ancient origin.In more primitive forms, these were concerned mainly with the regulation of visceral functions of the individuals ; in higher social species they are elaborated for communication ofmotive states (see Table 1). In the human embryo brain at 7 weeks gestational age (right) the brainstem emotional motor system, and associated sensory structures, are well formed.It includes the special visceral efferents of the cranial nerves, and projection systems that innervate the diencephalon and forebrain, including the neocortical regions, which are ina very rudimentary condition at this time. The heavy circle marks the region recently identified as a site of atrophy in brains of children that develop autism, an abnormality that

apparently occurs in the first month of gestation (Rodier, 2000).


Table 1The Cranial Nerves; Visceral and Somatic Functions, and Adaptations for Intersubjective Communication

Communicationmovements

Visceral & somaticmovements

Cranialnerves

Visceral & somaticsenses

Communicationsenses

1Olfactory

Odour, taste. Smelling, kissing.

2Optic

Vision. Seeing other.

Looking at other.Direction of gaze.

Eye rotation, lens &pupil adjustments.

3Oculomotor

Eye-muscle sense.

Looking at other.Direction of gaze.

Eye rotation. 4Trochlear

Eye-muscle sense.

Face expressions.Vocalising.

Mastication. 5Trigeminal

Facial feelings. Feeling other’s touch.Feeling own face.

Looking at other.Eye expressions, crying.

Eye rotation,lifting eyelids, tears.

6Abducens

Eye-muscle sense.

Face expressions, speech.Listening to speech.

Eating.Middle ear muscles.

7Facial

Taste, tongue, mouth. Kissing.

8Auditory

Hearing, balance. Hearing other.Hearing self.

Vocalising.Expression in voice.

Coughing, biting.Salivating, swallowing.

9Glossopharyngeal

Taste. Kissing.

Vocal expression.Signs of emotion.

Heart & gut. 10Vagus

Taste, heart, lungs, gut. Feeling own emotion.

Head and shoulderexpression.

Vocalising.

Head and shouldermovements.

Swallowing.

11Accessory

Vocalising, speaking. Tongue. 12Hypoglossal

The frontal cortex has descending control of expressions and of attention to persons, which is blocked by fear, anxiety, and stress.

mirroring and interacting with gestural and linguisticexpressions of other individuals (Rizzolatti & Arbib,1998) and the capacity for strategies of executive func-tioning (Fuster, 1989; Goldman-Rakic, 1987; Schore,1994). The narrative awareness that is so central to thepassing on of human concepts, ideas, fantasies, andbeliefs, including its symbolic formulation in language,results from coordinated action of all these cerebralsystems, cognitive and emotional, neocortical, limbic,and subcortical (Trevarthen, 1998c).

Infant Intersubjectivity and Developing MotiveSystems of the Brain (Trevarthen, 2001)

The human embryo and foetal brain displays elaborateformation of intrinsic regulatory mechanisms that areconnected, on the one hand, with the most complex(facial, vocal, and gestural) expressive organs among theprimates, and, on the other hand, with the most elaboratereciprocal connections between motivating structures ofthe core and limbus of the brain and the expandingneocortical system in which post-natal experience will beelaborated (O’Rahilly & Mu$ ller, 1994; Trevarthen, 1985,1989; Trevarthen & Aitken, 1994) (Fig. 3). The neocortexis laid down in the late embryo, but its dendritic arboursand billions of synapses mature postnatally, and thisprocess is regulated, at every step, by the brain coreintrinsic motivating systems (Huttenlocher, 1994; Rakic,1991, 1995). Cortical differentiation continues for years

after birth, regulated by communication with the socialenvironment. It is particularly intense in infancy, res-ponding to intimate affective exchanges withmore maturepersons and their more experienced brains (Schore, 1994;Trevarthen, 1990b). The ‘‘sculpting’’ by environmentalstimuli of the finer wiring within the intrinsic patterns ofcortical connections, and the ‘‘plasticity ’’ of corticalcognitive functions, depend upon the generation of a vastexcess of nerve cell branches and synaptic connections,and selective elimination. This process for acquiringadaptive knowledge and skills is constrained by instinc-tive motivating inputs from subcortical emotion systemsthat were wired-up prenatally (Panksepp, 1998a; Tre-varthen & Aitken, 1994).

The metaphor of ‘‘neural Darwinism’’ (Edelman,1987) has encouraged recognition of the adaptability ofhuman cognitive growth. Exuberantly overabundantcomponents in the developing nervous system are subjectto selection, through synaptic pruning, apoptosis (selec-tive cell death; Golstein, 1997), and other mechanismsthought to permit an increase of functional specificitythrough selective reduction in numbers of redundantneurons and}or neural connections (Changeux, 1985).Plastic responses to environmental factors certainly occurthroughout development, and play an essential part in thecreation of more effective psychological functions. How-ever, a postnatal selection theory offers no satisfactoryexplanation for robust panspecific features of humanbrain organisation such as those that have an active partin the determination of social and cultural adaptation inall human groups, and which are displayed by infants


from the first weeks, when the cortical selection processhas scarcely begun. Nor does it offer an explanation foranatomical and behavioural features of the body and thebrain that are consistent throughout widely separatephylogenetic lines, and that emerge in prenatal stages ofbrain development when the extracorporal environmenthas minimal selective power.

Aspects of human biology and behaviour have featuresin common with organisms that have homologous sym-metry of body form. These are encoded at a very generallevel in the genetic code (Cziko, 1995; Kauffman, 1993,1995). A wide range of homologous genes is found amongmammalian species (Nadeau & Sankoff, 1997). Homeo-box genes, for example, have preserved their structureand function in most of the segmented, cephalocaudallypolarised, bilaterally symmetrical animal kingdom. Bodysymmetry, segmentation, and a coherent multimodalsensory capacity integrated with a unified spontaneousrhythmic motricity are consistent features of the animalkingdom. These features were selected for stability inevolution because they are adapted to solving persistentand varying problems in animal life and individualontogeny. They specify a potential behaviour field aroundthe body into which acts are projected and within whichlayouts and goals are defined prospectively by perceptualsystems, and retrospectively by memories.

The anatomy of the infant’s face and hands, andcertain cyclic patterns of expression bywhich these organsdisplay the field of contrasting emotions, the specificrhythmic hierarchy of motor impulses shown in infantilevocalisations and spontaneous body movements, cor-responding to syllables, utterances, and phrases in thepatterns of adult speech and music (Lynch, Oller,Steffens, & Buder, 1995; Po$ ppel, 1994; Ross, 1993;Trevarthen, 1999a; Trevarthen et al., 1999), are innatepsychological features that act as developmentalorganisers (or constraints) and that enable infant andadult to meet as corresponding partners who can interactefficiently by exchanging complementary, mutuallyimitative, time-regulated messages, in synchrony or inalternation.

The cerebral cortex is generally conceived of as thetissue of higher cognitive processes, consciousness, mem-ory, and skills. However, throughout its development theneocortex is intimately and reciprocally connected withthe nerve systems of the brainstem and cerebellum, whichgive coherence to actions of the body, provide an essentialspatial and temporal frame for consciousness, and gen-erate autonomic self-regulations and the emotions ofsocial signalling (Holstege et al., 1996; Panksepp, 1998b).Asymmetries of psychological function that emerge in thefoetus and through childhood (Cynader, Lepore, & Guil-lemot, 1981; Hepper, 1995; Trevarthen, 1990b, 1996),and that have importance in the genesis of psychologicalstates and psychopathology (Tucker, 2000), depend uponasymmetries in these self-regulatory mechanisms of thebrainstem, including sympathetic and parasympatheticregulators of the heart (Davidson & Hugdahl, 1995;Wittling, Block, Genzel, & Schwiger, 1998).

The cerebral cortex appears in the late embryo at aboutweek 6. Input from subcortical regions has a role inregulating the structure of the neocortex at every stageduring foetal development, including the asymmetries ofemotional and cognitive function that become elaboratedin postnatal stages (Huttenlocher, 1994). There is acritical period in infancy of competition in the genesis andsegregation of synaptic contacts in the cortex, with only

reinforced intercellular contacts surviving (Hebb, 1949;Cynader, Shaw, Prusky, & Van Huizen, 1990). Myelin-isation studies show that while some cortical and sub-cortical structures are relatively mature at birth, othersundergo extensive functional development through child-hood and adolescence. In the first 3 months the greatestchange in myelin density is observed in motor pathways,sensory roots of the spinal cord, and visual projectionsto the midbrain tectum, thalamus, and cortex (Gillies,Shankle, & Dooling, 1983; Yakovlev & Lecours, 1967).Brainstem auditory pathways are more mature thanvisual ones at birth, but auditory projections to theneocortex develop much slower than the visual, over thefirst few years, as speech matures.

It is likely that a subcortical ‘‘mirror system’’ sensitiveto human movement programs is responsible for imi-tation in the first year, at least for the many imitations ofdiscrete and arbitrary expressions that neonates mayperform (Heimann, 1991, 1998; Heimann & Ullstadius,1999; Vinter, 1986). Mirroring actions involves multi-modal, or transmodal sensory recognition (Meltzoff &Moore, 1997), and there are many multimodal neuralpopulations in the brainstem, for example in the superiorcolliculus (Heimann, 1998; Heimann & Ullstadius, 1999;Sparks & Groh, 1995; Stein & Meredith, 1993). These areintegrated with systems that formulate motor images foraction and expression (Panksepp, 1998a, b). Preverbalcommunication will involve both limbic and neocorticalmechanisms in temporal and prefrontal parts of thehemispheres, as well as many subcortical structures of theforebrain, diencephalon, midbrain, and hindbrain. Theorbitofrontal cortex, linked to the mediolateral temporalcortex, has a key role in regulation of the balance betweenpsychobiological state and transactions with the environ-ment, and it undergoes important elaboration in infancy(Schore, 1994, 1998).

PET scan evidence on regional glucose utilisation ininfants’ brains has been used to trace synaptogenesis andcerebral plasticity and to make correlations with behav-ioural maturation (Chugani, 1994, 1998). In the newborn,the highest rates of metabolism are found in the primarysensory and motor cortices, thalamus, brainstem, and thevermis of the cerebellum, but the basal ganglia, hip-pocampus, and cingulate gyrus are also active. Parietal,temporal, and primary visual cortices, basal ganglia, andthe cerebellar hemispheres are increasingly active duringthe first 3 months. Lateral and inferior frontal corticesshows increase of glucose consumption after 6 to 8months and the dorsal and medial frontal cortices showcomparable increase only between 8 and 12 months. At 1year the infant’s pattern of glucose utilisation resemblesthat of an adult.

In the last 3 months of the first year conspicuousdevelopments in the prefrontal cortex have attractedattention. In this period the ratio of EEG alpha activity tobeta activity increases, coincidental with the many dev-elopments in intelligence. Bell and Fox (1996), who usebaseline EEG as an indicator of brain development (Bell& Fox, 1992), find that infants who crawl early, and whoare proficient crawlers at 8 months, exhibit an earlierdecrease in intrahemispheric EEG coherence, interpretedas evidence of pruning of superabundant intercellularconnections, which lead to greater coherence. The sameauthors (Bell & Fox, 1997) present evidence that infantswho were successful in performing an object permanencetest exhibited greater frontal EEG power and greateroccipital EEG power than unsuccessful infants, and the


unsuccessful infants were likely to also be pre-locomotor.This supports the conclusion that brain mechanisms forcognitive and locomotor maturation share commonregulatory factors, presumably motivational.

Conclusions Regarding the Role of Intersubjectivityin Early Brain Development

Early in infancy, developmental changes in the brainbalance the intrinsic regulation of physiological processeswithin the body against the somatic systems that engagethe body with the environment. Both kinds of brainregulation depend upon anticipation (motor images,Jeannerod, 1994, 1999)—of the needs imposed on theendocrine and autonomic systems for adjustment of thesupplies of energy and nutrition to tissues, of bio-mechanical contingencies within the body as it moves,and of the cognitive processes that perceive, learn, andrecall the locations, motions, properties, and potentialvalues to the subject of objects and situations outside thebody. It is important to recognise that it is potential usesand dangers that are the objects of motives concernedwith maintaining predictions about the real situation inwhich the subject will be in the immediate future. Cog-nitive processes of consciousness and working memory,increasing throughout childhood, bring in the benefits ofexperience from the past and build concepts that modelextensive predictions of future events, outside the presentsituation in time and space. The representations thatstore experiences and keep record of their values for thesubject are both emotional and cognitive. They dependupon a dynamic balance between self-experience andobject-experience, between reality-oriented experience ofthe body in action and body-protecting emotions(Damasio, 1994, 1999; Panksepp, 1998a, b).

All these levels of psychological process in the mind ofa developing child depend on reciprocal transmissionof activity between neural systems that represent, ana-tomically and physiologically, the body and its be-haviours. That is, autonomic-limbic-emotional systemsof the inner aspect of the self, and diencephalic-neocortical-cognitive systems that engage with and re-cord environmental effects that action generates. In theevolution of such a social and intensely cooperativespecies as humans are, every level of the mind}brain isfurther modified to make it possible for individuals to acttogether in their internal self-regulations, actions on theenvironment, and cognitive experiences. Infants showsystematic, age-related changes in the motives theyexpress for direct involvement in parental support fortheir physiological self-regulations and those motivesthat enable sharing of purposes and interests. Differenttheories give weight to interactions of one or other ofthese intersubjective levels. We apparently lack an inte-grated theory that will allow a comprehensive view ofwhat infants’ motives are seeking in companionship fromthe intuitive parenting behaviours of their mothers,fathers, and other family members.

Emphasis on the autonomic-visceral regulations andthe influence of emotion on cognition leads to attachmenttheory and investigation of the ways in which com-munication of needs and supply of satisfactions mayaffect the child’s mental health. Focus on the cognitiveassimilation of information by perceiving and remember-ing leads to interest in how communication leads to theconstruction of representations of purposes, as in thetheory of language pragmatics. Lack of appreciation of

the infant’s natural mirroring of behaviours that signalthe changing interests and purposes of partners leads toindividual constructivist theories, such as those Piagetelaborated, and to social learning theory. The latter isfurther limited by the assumption that the motives of ayoung infant are solely concerned with physiologicalrisks and benefits ; that they have nomeans of anticipatingeven their own experiences.

Current exploration of the abstract principles ofdynamic systems theory (Butterworth, 1999; Fogel &Thelen, 1987; Hopkins & Butterworth, 1997), withthe aim of overcoming the limitations of linear causaltheories, attempt to explain the emergence of order incomplex changing arrays of components that are capableof transforming one another at constant rates. The theorydiminishes attention to the adaptive ‘‘environment-expectant ’’ powers of a brain that grows intricate andorderly structures in coherent arrays before it is in engage-mentwith the environment, and before the body moves itsparts. Minimalist assumptions about the initial state ofthe foetal brain and body invalidates much sophisticatedmodelling of how the body can become effective inintegrated movement, and how the socially responsiveindividual can become coconscious and capable ofcontingent and cooperative communication under theinfluence of a more mature communicator.

Additions at the end of the human brain and aroundthe parietotemporal junction comprise a mechanism forintersubjective communication that affords the oppor-tunity for coupling of motives for extending the impulsesof narrative awareness of the environment, for learning torecognise its benefits and risks, and for taking hold of it touse it. Cultural exploitation of the environment is entirelydependent on the innate mirroring mechanisms that linkhuman minds which have different age, experience, andskill. Educational practices depend on this intersubjectivesystem and the collaborative learning it makes possible.Failure of intersubjectivity compromises social and cul-tural learning and education of the child, and requirescompensatory parenting and teaching practices that willsupport, by-pass, or substitute the deficient interpersonalawareness and communicative expression of the affectedchild.

Pathologies of Intersubjectivity in Childhood, andTheir Treatment

Pre- and Perinatal Factors in ChildPsychopathology

The evidence we have reviewed suggests that humanintersubjective motives are mediated by core regulatorymechanisms of the emotional brain that emerge in theembryo period, and that, with the support of specificforms of adult care, the same systems serve as regulatorsof embodied awareness and experience of the world,motor coordination, cognitive development, socio-emotional skills, and cultural learning throughout child-hood. These facts mean that interpretation of the causesof neurodevelopmental disorders will not be simple, andclinical literature confirms this (Bauman & Kemper,1994; Bishop, 1993; Bolton & Hill, 1996; Cicchetti, 1989;Cohen & Volkmar, 1997; Damasio & Maurer, 1978;Dawson, 1991; Fergusson, Horwood, Gretten, &Shannon, 1985; Gillberg & Coleman, 1996; Hobson,1993a, b; Kerr & Witt-Engerstro$ m, 2000; Klin, Volk-mar, & Sparrow, 2000; Murray & Cooper, 1997; O’Brien


& Yule, 1995; Pennington & Ozonoff, 1996; Risch et al.,1999; S. A. Rogers, 1998; S. J. Rogers & Pennington,1991; Schore, 1996; Tager-Flusberg, 1999; Thatcher,1994; Volkmar, 1998; Volkmar, Klin, Marans, & Cohen,1997).

Genetic factors, plus intrinsic epigenetic factors, de-termine aspects of the formation of neuronal systems,and thus how children will coordinate their actions,attend to the environment, and respond to parental careand education. Inadequate parental support that fails torespond to the child’s motives and emotions for com-munication can have detrimental effects, not only on thechild’s emotional health, but also in their cognitivedevelopment and sociocultural learning. Trauma atdifferent ages and damaging different locations or systemsof the brain have different effects on communication andintelligence, and often these consequences are not signif-icant, or even reliably detectable, until some later periodof the elaboration of the brain and of the knowledge andskills it incorporates. Other pathologies are due to theeffects of noxious agents or infections, and these, again,will depend on the stage or period of developmentaffected. Early damage will be expected to have a widerange of complex effects on later developing systems, andcognitive systems that emerge after infancy, when thechild is drawing on a narrative memory of meaningfulevents and using language, will manifest a great variety ofdisorders caused by the deviantmotivations,many arisingfrom the distortions of earlier formed systems.

Clinical research in developmental traumatology hasconfirmed the role of early adverse social experiences inthe pathogenesis of affective disorders (De Bellis, Baum,et al., 1999; De Bellis, Matcheri, et al., 1999; Heim &Nemeroff, 1999). Child abuse increases the likelihood ofa child developing Post-Traumatic Stress Disorder(PTSD) and anxiety and depression later in life (Mullen,Martin,Anderson, Romans, &Herbison, 1996; Portegijs,Jeuken, Van der Horst, Kraan, & Knottnerus, 1996;Zaidi & Foy, 1993). The effects of physical abuse anddeprivation on the developing child are sometimes as-sessed entirely in terms of the physical damage inflictedon the body, but violence and cruelty is always ac-companied, or preceded, by disruption to the affectivepatterns of caregiver-child or caregiver-infant interaction,and these psychosocial or psychiatric aspects should betaken into account in planning intervention. It is alsoimportant to recognise that constitutional abnormalitiesin the behaviour of an infant or child can significantlyperturb the emotions of caregivers, increasing the risk ofmaltreatment.

The term ‘‘ecological experiments ’’ has been used todescribe situations where a genetic condition or effects ofan imposed insult that interferes with formation of thebrain, sense organs, or skeletomuscular anatomy (such asanencephaly, anopthalmia, or thalidomide embryopathy)presents effects that enable us to infer factors of thenormal developmental processes (Eibl-Eibesfeldt, 1970).Morphogenic processes of brain and body are closelyinterrelated, especially in the embryo period. Develop-mental psychopathologies that change the organisationof core body-action-mapping motive systems that arecrucial for psychosocial development provide evidenceon the genesis and regulatory principles of intersubjectivephenomena (O’Brien & Yule, 1995). The time-course ofdevelopment of structures in the central nervous systemof mammalian embryos in relation to formation of theskull and face is now well characterised, and we can

expect that genetic research on the regulation of thedevelopment of the head, face, and forebrain will haveincreasing importance in interpretations of neurodev-elopmental disorders and psychopathology. Abnormali-ties in the distal parts of the limbs (hands and feet) arealso associated with anomalies of brain formation.Differences in human craniofacial morphology have beenexamined in autism (Rodier, 2000) and in schizophrenia(Deutsch, Price, Wussler, & D’Agostino, 1997; Wad-dington, Lane, Larkin, & O’Callaghan, 1999). Dys-morphologies of the embryo head, while not providinganything like a full explanation for a subsequent behav-ioural phenotype, may point to ‘‘setting events ’’ ingene regulation on which environmental and develop-mental processes act to produce a disorder (Waddington,Lane, Scully, et al., 1999). All systems of the organismmay be affected by a defective developmental programthat is responsible for a diagnosis of neurodevelopmentaldisorder, ranging from changes in the immune system(Denney, Frei, & Gaffney, 1996; Warren, Yonk, Burger,& Warren, 1995) or gastrointestinal function (Horvath,Papadimitriou, Rabsztyn, Drachenberg, & Tildon, 1999)to differences in physical attractiveness that have effectson social interaction (Etcoff, 1999). Any of these couldprecipitate abnormal psychosocial motivations and be-haviours, with effects in development of communicationand intelligence in childhood.

An insult to the CNS in infancy that has little effect onbehaviour in early childhood may determine a pattern ofdifficulties that emerge subsequently. Thus, for example,a recentMRI study found significant psychological effectsin adults who had apparently recovered well from lesionsto prefrontal cortex sustained in infancy. The affectedindividuals had normal basic cognitive abilities, butwere severely impaired in social behaviour, and theywere insensitive to the future consequences of theirdecisions and defective in their autonomic responses topunishment contingencies. Moreover, they failed torespond to behavioural interventions (S. W. Anderson,Bechara, Damasio, Tranel, & Damasio, 1999). It wasconcluded from these findings that ‘‘early dysfunctionin certain sectors of prefrontal cortex seems to causeabnormal development of social and moral behaviour,independently of social and psychological factors ’’ andthat ‘‘antisocial behaviour may depend, at least in part,on the abnormal operation of a multi-component neuralsystem which includes, but is not limited to, sectors of theprefrontal cortex’’. Reference was made to delayed onsetof social abnormalities of monkeys that had sustainedablations to the amygdala and inferior temporal cortex asneonates (Newman & Bachevalier, 1997).

In monkeys, the same lesions sustained at differentstages of development of the cerebral cortex—soon afterbirth or in adulthood—have different consequences inbehaviour (A. Diamond, 1991). In both animals andhumans, the detrimental effects on the brain of mal-nutrition and the benefits of environmental enrichmentwill depend on the age at which environmental changeswere experienced (Van Gelder, Butterworth, & Drujan,1990; M. C. Diamond et al., 1966; Graham-McGregor,Schofield, & Harris, 1983). The consequences of extremeenvironmental privation in inhuman orphanages add toour appreciation of the fragility of the young child’semotional brain, and the serious consequences to mentaldevelopment when psychosocial needs are not met(Rutter et al., 1999). Conversely, remedial work thatbrings the recovery of children disadvantaged by war or


severe deprivation of human care encourages hope thatthe intrinsic core systems can resist insults in some degree,and remain responsive to an intervention that directlyaddresses the socioemotional and cultural needs(Hundeide, 1991).

The period around birth brings new risks for de-velopment of the brain and behaviour, as well as forperturbation of parental support. The concept of acontinuum of pathology was expounded by WilliamLittle over a century ago, in a paper where he discussedthe effects of prematurity, difficult birth, and perinatalasphyxia on infant morbidity (Little, 1862). Pasamanickand Knobloch (1966), who described the effects ofperinatal injury, re-introduced Little’s concept under thetitle of a continuum of reproductive casualty to accountfor variation in physical or physiological care in theperinatal period. Sameroff andChandler (1975) employedthe term continuum of caretaker casualty, a dimension ofquality of parenting, to take account of the social factorin perinatal difficulties of dyadic functioning. The firstlarge-scale study of minimal intervention to offset care-taking casualty reported improvement of outcome incases where there were concerns about caretaking abilities(Ounsted, Roberts, Gordon, & Milligan, 1982).

Systematic procedures have been developed to assessbehaviour in the newborn, and these greatly improve thedetection of problems in neonatal care. These include: theBrazelton Neonatal Behaviour Assessment Scale(BNBAS; Brazelton, 1984) ; the Assessment of PretermInfant Behaviour (APIB; Als, Lester, Tronick, & Brazel-ton, 1982) ; the Mothers’ Assessment of the Behaviour ofher Infant (MABI; Widmayer & Field, 1980) ; theEinstein Neonatal Neurobehavioural Assessment Scale(ENNAS; Majnemer, Brownstein, Kadanoff, & Shevell,1992), and the Network Neurobehavioural Scale (NNS;Boukydis & Lester, 1999). The APIB has been used todemonstrate associations between abnormalities of brainanatomy, detected by structural neuroimaging, andneurobehavioural capacities (Huppi et al., 1996). TheENNAS correlates well with detailed neurological exam-ination (Limperopoulos et al., 1997). Demonstration ofinfant capabilities to parents using such assessments canbenefit development of early patterns of interaction(Fowles, 1999), and in high-risk groups this can signif-icantly reduce morbidity (Hart, Field, & Nearing, 1998;Widmayer & Field, 1980, 1981).

Methods of functional neuroimaging for trackingfunctional pathways within the brain are increasinglyreliable (Conturo et al., 1999), and knowledge of regionaldifferences in neural activation associated with adultdepression, anxiety, and schizophrenia is advancing(Davidson, Abercrombie, Nitschke, & Putnam, 1999;Tucker, 2000). However, developmental neuroimagingresearch is, at present, confined to a few centres, andapplication to brain functions in infants is just beginning.

Clinical Implications of Intersubjective Dysfunctionin Early Life

The neurodevelopmental origins of the more complexcognitive and emotional functions of consciousness ofself and others have become the object of research aspsychologists and clinicians seek a more accurate andcomprehensive understanding of mental illness in chil-dren and adults (Bolton & Hill, 1996; Schore, 1994).Early intervention strategies to improve the prospects ofchildren at high risk for poor developmental outcome are

dependent on accurate knowledge of how the brain growsand how it both motivates and responds to experience,especially in relation to the experience of parental care(Meisels & Shonkoff, 1990). Each condition brings itsown problems, but all demonstrate the active mutualemotional dependence of the infant or young child andthe caregiving adult.

Postnatal depression. Maternal postnatal depressioncan compromise the early cognitive development in achild (Field, 1992; Murray & Cooper, 1997; Radke-Yarrow, 1998), and disturbed features are found im-mediately in the behaviour of infants while their mothersare depressed, but the direction of effects is still an openquestion. Two independent studies have found evidencethat infants of postnatally depressed women had receivedabnormal scores on the Brazelton Neonatal BehaviouralAssessment at birth, which shows the babies were alreadyhaving problems at birth. Murray and her colleagueshave shown these infants were particularly affected intheir responses to the motor items of the scale (Murray,Stanley, Hooper, King, & Fiori-Cowley, 1996). N. A.Jones, Field, and Davalos (1998) also found that infantsof depressive mothers were obtaining lower scores onvarious Brazelton items when compared to group-matched controls, particularly on state-regulation andorientation, as well as on the Lester and Tronick de-pression and excitability scales. It is certainly possiblethat unclear reactions of the infants, and weak responsesto maternal care could be a factor precipitating a de-pressed state in the mother. But it is also possible thatmaternal emotional state may affect development of thebrain of the foetus before birth.

There is clear evidence for distortions from the normalpatterns of early mother-infant interaction in postnataldepression, with higher levels of maternal failure torespond to infant cues, slower response to sounds of theinfant, and a reduction in the exaggerated, repetitivevocalisation patterns seen in typical motherese (Bettes,1988). In every case, these changes in shared emotionaland motivational effects are evidence of the delicacy ofthe coregulation inmother-infant communication in earlyinfancy.

A second line of evidence, which may point to an effectof the mother’s behaviour on the infant, comes fromstudies that show abnormalities in brain electrical activityas early as 3 to 4 months in infants of postnatallydepressed mothers (Dawson, Grofer-Klinger, Pana-giotides, Spieker, & Frey, 1992; Field, Fox, Pickens, &Nawrocki, 1995; N. A. Jones, Field, Fox, Lundy, &Davalos, 1997). Infants cared for by depressed womendemonstrated a larger than normal right frontal EEGasymmetry during interaction with their mothers, and,moreover, this was predictive of inhibited behaviour ofthe children at 3 years (Field, 1997). EEG coherence is,indeed, one of the strongest available predictors ofsubsequent development in children (Thatcher, 1994). Itappears likely that the interactional difficulties andnegative emotions that these infants experienced withtheir mothers were inducing atypical patterns of neuralactivity, which could be expected to result in poorerdevelopmental outcome. Presumably surface-recordedEEG abnormalities, in the cortex, reflect patterns ofactivity projected forward in the brain from subcorticalsites. The distortions observed in the interactions ofpostnatally depressed mothers with their young infantshave been interpreted as having a direct effect on thedevelopment of neurotransmitter systems with conse-


quent vulnerability of the child to later affective disorders(Konyecsni & Rogeness, 1998). This is in accord withresearch demonstrating large effects in neurochemicalsystems and emotional behaviours of monkeys deprivedof normal maternal care (Suomi, 1997).

Prematurity. Difficulties in mothering due to weak ordisorganised motivation and behaviour in a young infantare clear when the infant is born well before term. Thesurvival in significant numbers of extremely low birth-weight infants, some delivered as early as mid-term, is amodern phenomenon, consequent upon improvedmethods of intensive postnatal support (Aitken & Tre-varthen, 1997; Stahlman, 1984). Because these foetuseshave not survived in the past, there is no set of culturalexpectations amongst parents and extended families ofhow best to care for the infants, and the medicalprofession has limited knowledge of the psychologicalneeds of very immature newborns.

Premature birth compromises the development of earlyinteraction, partly as a direct result of early separation ofthe infant and caregiver for intensive care, and partly inconsequence of the physical and physiological vulner-ability of the premature infant, and damaging effects ofanoxia, intraventricular haemorrhage, etc. The caregiveris confused by the immature behavioural repertoire andpsychological coordination of the premature infant. Theperiod immediately around term is one of change in theinfant’s readiness to meet the environment outside themother’s body, including many new experiences ofhuman care and communication. Infants born near termnormally have well-developed awareness of the feelingsand motives expressed in maternal vocalisation andhandling. Even visual recognition of face and hands ispossible, as has been proved by the imitation studiesreviewed above. All of these delicate sensitivities andreactions may be weakened or absent in the veryprematurely born (Als, 1987, 1995).

Autistic spectrum disorders. Autism, Asperger syn-drome, Pervasive Disintegrative Disorder (PDD; Volk-mar et al., 1997) and Rett’s syndrome, all of whichmanifest intersubjective problems or empathy disorders(Gillberg, 1991), result from a wide variety of genetic andenvironmental causes (Aitken, 1998; Cohen & Volkmar,1997; Klin et al., 2000; Tager-Flusberg, 1999; Volkmar,1998). Regressive-onset forms of autism (Tuchman &Rapin, 1997), PDD (Heller’s syndrome) (Volkmar et al.,1997), and Asperger syndrome are all given increasedattention in both the DSM and ICD diagnostic systems(Howlin, 1998). New syndromes, such as DAMP (Dis-orders of Attention, Motor Control and Perception),are described to characterise specific populations(Kadejso & Gillberg, 1998). These changes in criteria fordiagnosis will bring new information on varieties of earlysocial development within the autistic spectrum as morecases are identified, and as systematic research of earlysymptoms is undertaken with the aid of analysis of videorecordings of development in the first years. Particularcognitive profiles can be identified with specific sub-groups (Tager-Flusberg, 1999). For example, one non-verbal learning disability profile has been found to becharacteristic of children developing Asperger syndrome(Klin, Sparrow, Volkmar, Cicchetti, & Rourke, 1995;Klin et al., 2000).

Classical Kanner’s autism is first manifest in earlychildhood as an impairment in social and languagedevelopment, plus an unusual insistence on sameness, ordifficulty in accepting change. Abnormalities of response

to other people’s expressions and communications, i.e.of socio-emotional development, appear to be primary(Fein, Pennington, Markowitz, Braverman, & Water-house, 1986; S. A. Rogers, 1998). At least in a largeproportion of cases, the cause can be traced to abnormalbrain morphogenesis beginning very early in develop-ment, probably in the embryo period. The low populationprevalence of autism, around 4±5 per 10,000 (Trevarthenet al., 1998), has hampered population-based studies and,indeed, there is considerable debate and confusion overcurrent prevalence rates (Accardo & Bostwick, 1999;Fombonne, 1999). A number of recent reports suggestthat the numbers of autistic children in the populationmay be increasing, and it appears that this is not simply aconsequence of improved case assessment or changesin diagnostic criteria (Department of DevelopmentalServices Report, 1999; Taylor et al., 1999).

Hopes for a genetic explanation of autism led to asearch for a small number of interacting gene loci thatcould be responsible for a large proportion of the autisticpopulation (Szatmari, Jones, Zwaigenbaum,&MacLean,1998; Tager-Flusberg, 1999). However, as data comes infrom large studies with multiplex family pedigrees, such asimple polygenic model appears less likely. A recentmulti-centre study (Risch et al., 1999) concludes thatupwards of 15 loci are likely to be involved for a polygenicmodel consistent with their results.

Reliable behavioural evidence on the development ofinfants who would go on to manifest autism was rareuntil recently. Now widespread use of home video-recording and earlier identification of high-risk childrenhas led to detection of early differences in children wholater became autistic. The earliest report of which we areaware (Kubicek, 1980) was of a chance finding in a largeprospective study of normal infant development. Com-parison was made between films of interactions of twofraternal male twins, one of whom was subsequentlydiagnosed as being autistic, in interaction with theirmother at 4 months, and clear reductions were reportedin turn-taking, eye contact, and quality of interactionwith the affected twin. A well-controlled questionnairestudy by Dahlgren and Gillberg (1989) found variousfeatures discriminated autistic children from controls inthe first 2 years, empty gaze, abnormal response to sound,and deficits in directing attention being the strongestcorrelates of a subsequent autistic diagnosis. However, asthis was a retrospective study carried out after diagnosis,the results may be affected by selective recall. Osterlingand Dawson (1994) analysed videotapes taken by parentsat the first birthday parties of children subsequently diag-nosed as autistic and of matched control children. Onvarious criteria—including showing of objects, orientingto name, looking at others’ faces, and pointing—theautistic children were less responsive. Again, the be-haviour of the video-maker might result in a biasedselection. If this person was the father, as is likely, hemight also have had neuropsychological propensitiestypical of autistic spectrum disorder (Baron-Cohen &Hammer, 1997) and thismay have affected the behaviourshe chose to record.

In a study using a screening questionnaire (the Check-list for Autism in Toddlers, or CHAT) to investigate‘‘high-risk’’ children, i.e. children with an older siblingdiagnosed as autistic, it was found that children who wenton to develop autism exhibited abnormalities of eyecontact, pretend play, protodeclarative pointing (point-ing to show), social play, and social interest at 18 months


(Baron-Cohen, Allen, & Gillberg, 1992). This was thefirst study to demonstrate, using a reliable methodology,that at least some autistic children could be distinguishedstatistically from controls in the second year of life. Alarge-scale replication of the above study, screening apopulation of 16,000 children (Baron-Cohen et al., 1996),detected 12 children who showed abnormalities of proto-declarative pointing, gaze-monitoring, and pretend play,and 10 of these were subsequently diagnosed as autistic.Substantial numbers of children who had passed theCHAT were later screened at 3±5 years on the researchgroup’s Checklist for Referral, and at 5±5 years on thePervasive Developmental Disorders Questionnaire.Cases were also identified through subsequent referraland consultation of various local medical, educational,and social services records. The CHAT had originallyidentified nine autistic cases and one case of PDD.Rescreening within the following couple of months ofcases who had failed some items on the CHAT identifiedone further autistic case and nine additional PDD cases.However, of those children screened as normal on theCHAT, a significant number of cases (almost twice asmany again) of autism and PDD were subsequentlyidentified (Baird et al., 2000). Analysis of videotapematerial taken of eight autistic and seven PDD-NOSchildren (i.e. with PDD and no other symptoms) in thefirst 8–10 months of life has demonstrated differencesfrom controls in social behaviour, but only after threechildren identified as having late-onset autism wereremoved from the analyses (Werner, Dawson, Osterling,& Dinno, 2000). Eleven of the children in this study hadbeen subjects in the study of first-birthday videotapesby Osterling and Dawson (1994).

Difficulties in early differentiation demonstrated in theBaird et al. (2000) and Werner et al. (2000) studies suggestthat either a significant improvement in the sensitivity ofscreening instruments is required, or that late-onsetautism (Heller’s syndrome), for which no early clinicalfeatures have been identified, may be a clinical group thatis being identified more frequently as a consequence ofbetter detection or increased population prevalence. Thelatter possibility casts doubt on the potential utility ofearly screening for this condition. This is worrying in thelight of increasing pressure for the use of such measuresfor population screening and early intervention (Filipeket al., 1999; Senior, 2000). False negatives may giveundue reassurance to parents and professionals. Moresophisticated methods of identifying early social-inter-actional and subtle motor-developmental difficulties willbe needed.

A study of videotapes of 25 children with PDD between12 and 30 months of age (Mars, Mauk, & Dowrick, 1998)showed that this data could differentiate the childrenin this group from footage showing 25 age-matchedchildren who had no developmental problems. Within thePDD group, social interactional and communicativeproblems were related to severity, those children with noother symptoms (PDD-NOS) having milder problemsthan those shown by children with other PDD diag-noses. Baranek (1999) reported on edited 10-minutevideo segments that were interval-rated on a variety ofbehaviours, including looking, affect, response to name,anticipatory postures, motor}object stereotypies, socialtouch, and sensory modulation. Three groups of 9–12-month-old infants—11 with autism, 10 with develop-mental disabilities, and 11 with normal development—could be reliable discriminated using this coding.

In perhaps the most interesting recent report from theperspective of this review, videotape material from 17children which was taken by parents during the first yearof life was subjected to analysis using the Eshkol-Wachman Movement Analysis System and still-framevideodisc analysis of muscle patterns (Teitelbaum, Teitel-baum, Nye, Fryman, & Maurer, 1998). The authors claimthat analyses of these motor signs can clearly discriminatesubsequently diagnosed autistic children as early as 4–6months. This study of abnormal movements and posturesis less likely to have been compromised by selectiveanalysis. On the evidence now available, children whobecome autistic can manifest a range of differences inmotivation for behaviour as infants, including abnormalmotor coordination and focusing of attention.

A recent MRI and neuropsychological study of a pairof 7±5-year-old identical twins discordant for autismprovides new evidence on possible neuroanatomicaldifferences in autism. The first twin met diagnostic criteriafor autism (DSM-IV) (fulfilling ADI-R and ABC criteria,though not those on the ADOS, due to limited stereo-typy). The second twin did not meet autistic criteria onany of the four scales used. The autistic co-twin obtaineda significantly poorer WISC-III Verbal IQ. Both showedevidence of significant impairment on executive functiontasks, such as the Wisconsin Card Sorting Test. Onneuroimaging, both twins could be differentiated fromcontrol subjects. Frontal lobes and superior temporalgyri were smaller on both sides of the brain, and thefrontal gyri were irregular. The differences between thetwins were principally in four areas, all of which weresmaller in the affected twin: viz. caudate, amygdaloid,and hippocampal structures and vermal lobules VI andVII of the cerebellum (Kates et al., 1998). The authorsconclude as follows:

The results suggest the dysfunction of two separatebut overlapping neuroanatomical pathways, i.e. onesubcortical network differentiating the twins fromeach other that may underlie the traditional neuro-behavioural phenotype for strictly defined autism,and a second cortical network differentiating thetwins from the comparison sample that may leadto the broader phenotype for autism (Kates et al.,1998, p. 782).

These findings indicate that the neurobehavioural pheno-type for autism is underpinned at the gross neurologicallevel by disorganisation in a subcortical network, and notprimarily by prefrontal cortical pathology. The prefrontalmodel implicated in mentalising is becoming less con-vincing as it becomes clear that a deficit in this part of thebrain is not necessary for autism (Bishop, 1993), notspecific to autism (Shields, Varley, Broks, & Simpson,1996; Zelazo, Burack, Benedett, & Frye, 1996), and notsufficient to explain the variations in presentation ofautism (Happe! , 1994). Autism may be due to deviation inprenatal development affecting the IMF of the brainstem,with significant functional effects at an early stage inpreverbal social development of the infant and toddler.This fault operates in a manner that is potentiallyindependent of the cortical network, which would beinvolved in the mentalising difficulties seen in manyautistic individuals at a later age.

Evidence that individuals with autism may have ana-tomical deficiencies in the hindbrain brings the inceptionof the disorder back to early embryo stages, when thebasic mechanisms of visceral regulation, socioemotional


expression, and orientational motor control are beingformed in complete absence of forebrain function(Rodier, 2000; Rodier, Ingram, Tisdale, Nelson, &Romano, 1996). Rodier’s findings identify loss of tissue inthe facial nucleus and absence of the superior olivenucleus, both attributable to a reduction in a segment ofthe embryo hindbrain at about 20 to 24 days afterconception. These same structures, concerned with bothfacial expression and auditory perception, will certainlybe involved in intersubjective communication with new-born infants, who lack a developed neocortex. Autisticchildren exhibit characteristics of facial anatomy andpoverty of facial expression that are also attributable todeviations in morphogenesis of a particular segment ofthe embryo at a particular time after gestation begins.

In the normal mother-infant dyad, the extent ofaffective synchrony in face-to-face play at 3 and 9 monthspredicts subsequent self-control at 2 years (Feldman,Greenbaum, & Yirmiya, 1999). Recent studies of bothnormal (Rollins & Snow, 1998) and autistic children’s(Mundy, Sigman, & Kasari, 1990; Rollins, 1999) lan-guage development have pointed to interpersonal vari-ables such as emotional engagement and joint attentionrather than instrumental use of language as predictors oflanguage outcome. Preliminary work suggests that thismay provide an effective framework for clinical inter-vention to enhance communication skills in autisticchildren (Rollins, Wambacq, Dowell, Mathews, & Reese,1998). A longitudinal study in 3-year-olds suggests thatlinguistic competence, not earlier theory of mind ability,is the best predictor of subsequent performance on theoryof mind tasks (Astington & Jenkins, 1999).

Taken together, the above studies of developments inbrain and behaviour point to a progressive decline infunctions that mediate intersubjectivity : deficits in earlypreverbal interaction predict language abnormalities,which in turn predict the later emergence of differences inthe reflective thinking (mentalising) of autistic indiv-iduals. This does not imply that the difficulties in infancyare manifestations of faults in the same neural systemsthat appear to mediate later mentalising problems. Theresults of the discordant twin study of Kates et al. citedabove suggest that a subcortical neural system precip-itates the emergence of autism, and that this is parallel to,or at a different hierarchical level from, the prefrontalneural systems that subsequently become involved inmentalising. The obvious next step will be to examineindividuals who fulfil criteria for autism but who do notmanifest difficulties with mentalising tasks, to see whetherthey have the subcortical abnormalities without pre-frontal involvement. If this proves to be the case, anargument can be made that the abnormalities of caudate,hippocampal, amygdaloid, and cerebellar structures thatdifferentiated the two cases of Kates et al. (1998) are bothnecessary and sufficient for the manifestation of thedisorder.

Schizophrenia. Unusual features in intersubjectivebehaviours have been observed in the early behaviour ofchildren who are subsequently diagnosed as schizo-phrenic (Pamas, 1999). For example, pre-schizophrenicgirls, compared to controls, show a significantly lowerproportion of positive facial expressions (Walker,Grimes, Davis, & Smith, 1993). Such differences inbehaviour may result from differences in the antenatalenvironment, or from complications at labour anddelivery (Waddington et al., 1998). Factors such asmaternal antepartum depression, low birthweight, and

short gestation have been shown to be significantly morecommonly associated with the birth of children who aresubsequently diagnosed as schizophrenic (P. B. Jones,Rantakallio, Hartikainen, Isohanni, & Sipila, 1998). Ithas been suggested that distortions to early parent-infantcommunication may also be a factor increasing vul-nerability to schizophrenia (Brody, 1981), but this has notyet been subjected to systematic test. In one recent study,it was found that poorer prognosis in schizophrenia wasassociated with childhood diagnosis of ADHD (Elman etal., 1998).

There is evidence attesting to the neurodevelopmentalorigins of schizophrenia (Akbarian, Bunney, et al., 1993;Akbarian, Vinuela, et al., 1993; Harrison, 1997;Keshavan & Murray, 1997). Abnormalities of earlyinteraction can be related to complex neuropathologyconsistent with antenatal disruption to the processes thatform cortical-subcortical pathways. Within the adultschizophrenic population, deviant brain morphology isassociated with evidence of early behavioural dysfunc-tion; e.g. dilated brain ventricles are associated with earlyneuromotor deficits and negative affect (Walker, Lewine,& Neumann, 1996).

Attention-Deficit Hyperactivity Disorder. Attention-Deficit Hyperactivity Disorder (ADHD) in DSM-IV,corresponding to Hyperkinetic Disorder in ICD-10,affects up to 3% of the child population (Aitken, 2000).Early identification is problematic and often differencesare only apparent in retrospect. A recent study could notfind any way of discriminating between a group of 27children subsequently diagnosed as having ADHD and amatched group of 27 children diagnosed as having PDD-NOS (autistic spectrum difficulties). A wide range ofpre-, peri- and postnatal difficulties and atypical ordelayed development within the first 4 years wereexamined (Roeyers, Keymeulen, & Buysse, 1998).

There is good evidence for a neurobiological basis toADHD, including a number of fairly consistent ab-normalities on neuroimaging, including decreased frontallobe volume (Hynd, Semrud-Clikeman, Lorys, Novey, &Eliopulos, 1990; Castellanos, Giedd, Hamburger, Marsh,& Rapoport, 1996) and abnormalities of the corpuscallosum (Giedd et al., 1994) and of the cerebellum(Berquin et al., 1998). Many children subsequentlydiagnosed with ADHD had sustained minor head injuriesin childhood. Whether their activity and impulsivity ledto their being involved in accidents, or their ADHD wasin some cases secondary to traumatic damage, is stillunresolved (Herskovits et al., 1999).

There is debate over the significance of certain genemarkers claimed for ADHD. If these are confirmed theywould appear to specify differences in dopamine trans-porter and receptor activity (Castellanos et al., 1998;Rowe et al., 1998; Smalley et al., 1998).

Central auditory processing problems. Adults withdevelopmental aphasia are impaired in the discriminationof fast phonemes (Tallal & Piercy, 1974) and abnor-malities of temporal discrimination have been shown inseveral clinical groups, including children with dyslexia(Tallal, Miller, & Fitch, 1993), Specific Language Im-pairment (SLI) (Merzenich et al., 1996), ADHD (Barkley,1997), and in autistic spectrum disorders (Tallal,Merzenich, Miller, & Jenkins, 1998). Difficulties withtemporal discrimination appear to predict subsequentproblems with communication by speech and reading,and to be associated with deficiencies in the function of awidespread magnocellular system in the visual and


auditory systems of the brain, which implicate thecerebellum (Stein, 2000). Again, a system important inintersubjective communication with neural foundationsin the brainstem is indicated.

Intersubjective Therapies in Infancy and EarlyChildhood

Given the retention of a degree of conscious awareness,every human being, even one handicapped by severeneuropsychological disorder, is sensitive at some level tothe communicative expressions of other persons, and tothe motives and emotions behind them. All humans arecapable of detecting rhythmic impulses and qualities ofother persons’ behaviours that are contingent upon andrelated emotionally to their own expressions. Theseprinciples of fundamental intersubjectivity, which under-lie but are not dependent on reason and language, areinvolved, though often not deliberately employed, in alltherapeutic and educational procedures, just as they arecontinually present in family life and the daily activity ofsocial groups. Changes in motivation and emotionmediated by communication and responding to theexpressions of caregivers and partners in action andawareness can evoke and sustain improvements in motorcoordination, cognitive alertness, and discrimination,learning, and thinking.

What we have learned about fundamental inter-subjective processes in infancy can be applied to benefitthe wellbeing and development of children with de-velopmental disorders. However, many regimes for pro-fessional intervention with psychoaffective problems ofchildren do not directly or overtly address interpersonaland expressive functions. They rely more on the tra-ditional medical or educational models and the giving ofmedication or instruction to the child as a patient orpupil. In statistical assessment required by clinical trials,data on many individuals is grouped to provide adescription of a population based on what are inevitablyrather limited measures of psychological status andperformance. At the same time, it is the experience ofpractitioners and families that benefits may be obtainedby directly addressing, for each child and for theirparticular condition, the quality and receptivity of com-munication in treatment or teaching, and its managementin the family or school.

Cognitive or behavioural therapies are aimed to controlbehaviour and establish acceptable routines to benefit thechild’s physical and emotional health and to facilitateeasier relations with family caregivers, teachers, andschool partners. It is recognised that learning in suchregimes depends on positive motivations, but the range ofpleasurable rewards is generally not explored. Qualitativeand emotive aspects of communication require spec-ialised methods of continuous observation and quali-tative assessment that are capable of identifying whatcharacterises most effective practice. The theory ofnonverbal communication with emotionally disturbed orcognitively disorganised children is not explicit. Webelieve that evidence from the study of how infants entercommunication and progress to language has givenvaluable pointers to the kind of models and techniquesrequired.

The physical}acoustic analysis of vocal communi-cation has brought to light the principles of timing,emotional expression, and narrative that universally

mediate in interpersonal contacts and relationships, andthe same principles can be extended to observe the qualityof communication by touch or gesture. Research on themethods and effects of music therapy and movementtherapy is becoming more disciplined and scientificallycontrolled (Aldridge, 1996; Bruscia, 1991; Pavlicevic,1997; Wigram, 1996; Wigram & De Backer, 1999), andthe benefits have been demonstrated for many conditions,including autism and other emotional disorders of child-hood (Robarts, 1998; Wigram, 1996) and distressedinfants born very prematurely (Schoemark, 1999). Als(1995) reports on the beneficial effects, with clearreduction in indices of infant dysregulation, of in-dividualised care for very low birthweight infantsthat involves skin contact with mother or father(kangarooing). The evidence of both immediateand lasting physiological benefits of sympatheticindividualised care for infants in intensive care is con-vincing. We have described a mutually regulatedvocal exchange with a 2-month premature infant inkangarooing, a situation which favours the infant’shearing of the adult’s voice and sensing the vibrationsthat it produces (Trevarthen et al., 1999).

The profound mental handicap of Rett syndrome doesnot prevent the affected girls from attending to andjoining with improvisation by a trained music therapist,and the method has been employed to demonstrate a levelof intentional expression of preferences by the children ata level not hitherto expected (Merker & Wallin, 2000).Children with profound mental handicap, including girlswith Rett syndrome, also respond to the expressiveregime of movement therapy (Burford, 1988, 1993;Trevarthen & Burford, 2000). With adults, music therapyhas proved effective with depression and in the treatmentof mild schizophrenia (Pavlicevic & Trevarthen, 1989),and a method has been developed to quantify the thera-peutic effects by assessing the level of musicalityachieved in improvised treatment sessions (Pavlicevic,Trevarthen, & Duncan, 1994). Computerised acousticanalysis of musicality of expression and of interaction,which brings objectivity and accuracy to observations ofbasic subjective and intersubjective events, has beenused to observe the effects of depression on a mother’scommunication with her infant and the infant’s re-sponses, and the changes that occurred as the mother’scondition improved (Robb, 2000).

Methods of special education, including Portage,ABCedarian and others, developed as part of the Am-erican Head-Start program (Tingey, 1989), are aimed toimprove development of cognitive, perceptual, motor,and language skills. Their procedures do not clearlyrecognise that early interpersonal functioning is thestarting point from which developments in skills arise asa consequence of intersubjectively mediated learning.Evidence from infancy research suggests that explicitfocus on aspects of primary socioemotional development,such as turn-taking, prosody, reciprocal imitation, andjoint attention might prove particularly effective, at leastin the early stages of intervention, and especially in workwith groups where there are grounds for believing thatdeficiencies in interpersonal functioning are at the root ofthe problem. Nonverbal expressions, such as eye-pointing, gesture, and hand signs, as well as expressiveuse of the voice, are effective in communication withchildren who have little language comprehension, and arelikely to be less impaired in children with less severeabnormalities of language comprehension and use


(Bishop, 1989; Donaldson, 1995; Jordan, 1993; VonTetzchner & Martinsen, 1981).

In a model intervention program combining differenttechniques of therapy applied to both infants and theirmothers, in which the infant came to be viewed as acotherapist, Fraiberg (1980) demonstrated that severelymentally ill mothers could benefit greatly from assistancein responding to their infants and developmental guid-ance that alerted them to the responses that could beexpected when communication and care were meeting theinfants’ needs. In treatment for postnatal depression,interventions to foster improved early interaction, in-cluding music mood induction, have been confirmed tohave significant benefits for both mothers and theirinfants (P. J. Cooper & Murray, 1997; Field, 1997). In astudy comparing outcomes of routine primary care,nondirective counselling, cognitive-behaviour therapy,and dynamic psychotherapy, there were no significantdifferences ; all methods produced improvements in themothers’ status, with benefits to the infants’ psychologicalstate and development (P. J. Cooper & Murray, 1997).Therapies aimed at improving maternal mood andreducing infant arousal, including presentation of relax-ing music and infant massage, can make the dyad moreaccessible to approaches focused on improving the formof interaction itself (Field, 1998), and Field (1977) hasshown that inviting the mother to imitate her infant andmonitor the effects can increase a depressed mother’ssensitivity to an infant’s cues. A recent intervention studyfound that infant massage could significantly normalisethe right frontal EEG asymmetry associated with ma-ternal depression (N. A. Jones et al., 1998). With toddlers,it has been shown that a depressed mother fails to supportjoint attention and common awareness and she is moredistracted by competing events (Goldsmith & Rogoff,1997). Such avoidant maternal behaviours are known toaffect the toddlers’ language learning, and they can bechanged by a well-targeted positive feedback of infor-mation about how communication is improved inmoments when joint attention is achieved, for exampleby video-feedback training (Hugh & Rosenthal, 1981;Hundeide, 1991).

Psychodynamic therapy can prove beneficial to de-pressed women by lifting depressive features and self-esteem while clarifying maternal conflicts (Cramer, 1997).Joint mother-infant psychotherapy may be effective inhelping a mother’s transition to more supportive child-care with depression, but not with more serious emotionalproblems and economic or marital stress. Didacticinterventions, which gave the mother information oninfant behaviour and communication, and on practicalaspects of family adaptation when a preterm infant andmother return home, improved early interactions, en-hanced maternal sensitivity to infant cues and led tohigher levels of maternal speech, smiling, and physicalcontactwith the infant (Meyer et al., 1994). These changeswere accompanied by significant reductions in themother’s depressive symptomatology on the Beck De-pression Inventory, compared to controls. In one large-scale and intensive early intervention programme for lowbirthweight prematures, positive outcomes were seen at30 months, including improvements in dyadic synchrony,quality of maternal assistance to the infant, and infantcompetence and involvement (Spiker, Ferguson, &Brooks-Gunn, 1993).

There is considerable disagreement concerning theefficacy of therapies for autism, and differences in the

estimation of the improvement that can be generated(Howlin, 1997; Trevarthen, et al., 1998). Nevertheless, itis accepted that earlier interventions are likely to producegreater improvement than the same approaches used at alater stage. The Lovaas method of behavioural traininghas been demonstrated to have beneficial effects in anumber of independent studies (Lovaas, 1987; S. R.Anderson, Avery, DiPietro, Edwards, & Christian, 1987;Birnbauer & Leach, 1993; Fenske, Zalenski, Krantz, &McClannahan, 1985; S. L. Harris, Handleman, Gordon,Kristoff, & Fuentes, 1991; S. L. Harris, Handleman,Kristoff, Bass, & Gordon, 1990; McEachin, Smith, &Lovaas, 1993; Rogers & DiLalla, 1991; Sheinkopf &Seigel, 1998), but there is uncertainty concerning in whatway it is effective, and how general and lasting thebenefits are. It is also not clear how far the expressivemanner of communicating reinforcements and negotiat-ing routine procedures is critical to success, though highaffect speech by therapists is encouraged. A wide range ofother approaches focus more specifically on early aspectsof interaction (Alvarez, 1996; Trevarthen et al., 1998;Waterhouse, 2000). Most of these have not receivedcontrolled assessment. Their operation is not captured bymeasurements of performance on predefined measures ofintelligence, rational beliefs, or cognitive flexibility.

In the study of special education for autism, instructionin speech and language is naturally given great im-portance. However, speech therapy is not, by itself,generally effective, except for high-functioning cases whoneed assistance with semantic and pragmatic difficulties(Jordan, 1993). For more children with greater problemsin communication, an approach that addresses theunderlying interpersonal problems is more effective.Emotional engagement and joint attention appear tohave a more fundamental role in furthering languagedevelopment in autism than instrumental use of language(Rollins, 1999), and this approach may be applied forclinical intervention to enhance communication skills inautistic children more effectively than any training inthinking or beliefs (Astington & Jenkins, 1999; Rollins etal., 1998). Improvisation music therapy is gaining ac-ceptance as a remarkably effective way of gaining andregulating communicationwith even themost recalcitrantautistic youngsters (Robarts, 1998). It employs tech-niques of mirroring and enhancement or modulation ofexpression with the benefit of a trained musician’ssensitivity for pulse and expression in gestures made bythe patient. Imitative responses are found to be attractiveto autistic children and can act as a bridge to collaborativeplay or communication, and improve the child’s access tolanguage (Dawson & Galpert, 1990; Nadel, 1992; Nadel& Peze! , 1993; Tiegerman & Primavera, 1981, 1984). Theintensive training of parents by the Option method inresponsive care and education of autistic children, whichhas proved of great benefit to many families, employssystematic imitation to achieve joint attention and mo-tivation to learn collaboratively (Kaufman, 1981, 1994).

The importance of auditory communication at anonverbal level is clear from research with young infants,sensitivity to the human voice being much better de-veloped than visual awareness of human expression atbirth and in early weeks. Temporal and prosodic aspectsof early vocal interaction are critical to socioemotionaldevelopment, aswell as tomature functioning of languagecommunication. In recent clinical trials, by a multicentrestudy across 35 clinics and educational sites in the U.S.A.and Canada (Tallal et al., 1998), training in auditory


discrimination has been shown to be more broadlyapplicable than was initially thought, benefiting thosewith autistic spectrum disorders and ADHD in additionto those with speech and language impairment. Thetreatment appears to be directly redressing a commonproblem in early childhood that can interfere with manyaspects of social interaction. ADHD perturbs the normalprocesses of shared experience and motivation for learn-ing by instruction. However, children who diagnosed ashaving significant levels of anxiety as well as ADHD havebeen found to show a different and significantly bettertreatment response to psychosocial interventions thandid those without anxiety (The MTA CollaborativeGroup, 1999).

Modern psychodynamic treatments acknowledge thatthe classical theory of Mahler or Klein underestimatesthe young infant’s self-organisation and capacity forinterpersonal awareness (Stern, 1985), and methods ofsupporting emotional functioning, communication, andlearning now address more directly the motives that thechild brings to relationships. Tustin (1991) and Alvarez(1996) describe methods of regulating the anxieties andconfusion of autistic children and facilitating their ac-ceptance of communication. Psychoanalytic therapists(e.g. Haag, 1984; Meltzer, Bremer, Hoxter, Weddell, &Wittenberg, 1975; Tustin, 1981) are sensitive to thefeelings of fragmented body- and self-awareness andweak perceptual grasp of objects and the behaviours ofother persons that some autistic adults describe vividly(Grandin, 1997; O’Neill, 1998; Williams, 1996). Clearlythe insights and clinical experience developed by psycho-dynamic practitioners can be brought into harmony withmore conservative or objective approaches if both acceptthat there are fundamental intersubjective needs inhuman persons of all ages.

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Infant Intersubjectivity: Research, Theory, and Clinical Applications

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