Eshkol–Wachman movement notation in diagnosis:
The early detection of Asperger’s syndrome

Osnat Teitelbaum, Tom Benton, Prithvi K. Shah, Andrea Prince, Joseph L. Kelly, and Philip Teitelbaum

Department of Psychology, University of Florida, Gainesville, FL 32611;
Benton Pediatrics, 5612 NW 43rd Street, Gainesville, FL 32653; and Department of Physical Therapy, University of Florida, Gainesville, FL 32610

Abstract: PNAS 2004 101(32):11989

Findings

The diagnostic criteria of Asperger’s syndrome (AS), a disorder considered part of the autism spectrum disorder (ASD), are still unclear. Generally, a physician uses the acquisition of language as a diagnosis. Compared with autism, AS is usually diagnosed rather late in the child’s life, around 6-7 years of age. The early severe deficits in social behavior and language abnormalities found in children with autism do not occur in AS, thus leaving the AS child undiagnosed until much later than autistic children, which are diagnosed about age 3. The authors of this article suggest that movement patterns in infants can be thought of as their “first language” and may be a more accurate way of distinguishing autism from AS. The development of motor autonomy is the infant’s central task in the first year of life.
In this study, they suggest and test the theory that abnormal movement patterns similar to those seen in autistic children, also exist in infants who will later be diagnosed with AS. They used the “Eshkol-Wachman” movement notation (EWMN), a movement analysis developed for dance. It was designed to enable choreographers to write movement down on paper that dancers could later reconstruct in its entirety, in a manner analogous to a musical score, and thus, the EWMN is very detailed in analyzing a person’s movement.
Videotapes of 16 infants that had been diagnosed with AS, all provided by parents, were analyzed by this method. Simply, the detailed analysis looked at infants mouth movements, patterns of lying down, standing up, sitting or crawling, falling down, and movement while being tilted. Many deficits in movement were seen in the infants studied. For example the infants studied showed such defects as (1) “Moebius mouth”, an abnormally shaped or formed mouth during smiling, (2) abnormal or asymmetrical tonic neck reflexes when righting from supine to prone position, (3) failure to synchronize a normal shift of weight and frequent falling, (4) failure use protective reflexes when falling, and (5) failure to keep the head oriented properly when the infant was purposely tilted. Normal infants showed none of the deficits described in this study.

Conclusions

An infant’s reflexes are easy to spot and can be used as early detection signs. When these reflexes persist too long or do not appear when they should, the motor development of the infant and, subsequently, other aspects of his behavior will be affected. They can therefore serve as early detection markers for abnormal neurological development in AS and autism.