Next up is a 2009 article by Esposito et al titled ” An exploration of symmetry in early autism spectrum disorders: Analysis of lying”. Again, the emphasis is on the movement analysis with young children looking at the symmetry of movement in the first 5 months of life in supine in autistic children, those with developmental delay and typically developing children. Video of the children from birth to 1 year of age was solicited from family for analysis.

The study built on Teitelbaum’s earlier work, looking at the positional pattern for symmetry in lying (PPSL) in 80 different positions based on the Eshkol-Wachman Movement Notation utilized in earlier studies. The authors examined both static symmetry and dynamic symmetry. When the position of the body fit in one of the position of the PPSL, the frame was coded as symmetric. When the position of the body differed from all the positions of the PPSL, it was coded as non-symmetric (see picture example below). 

From Esposito et al. 2009

There was a significant decrease in the symmetry of both static and dynamic postures in children with ASD when compared to typically developing children but also when compared to children with developmental delay.

This study was meant to support diagnosis but many therapists assess children in their first months of life for a variety of reasons. I know I could be more careful with the assessment of symmetry in supine during my sessions. Perhaps live observation could be combined with video clips of the child for a more in-depth assessment of symmetry which could assist in the development of intervention strategies. The authors note that analysis between the 3rd and 5th month of life would be most useful. However care must be taken as the 0-3 month period of development is characterized by asymmetry in typical development. Early asymmetry in some infants may also be an indication of hemiplegia. So this observation of symmetry is not a “one and done” assessment but rather an option which could contribute more information for a better overall understanding of the child. This understanding can then improve our support of the child with the development of both a motor and a perceptual sense of symmetry and therefore midline.