J. Child Psychol. Psychiat. Vol. 42, No. 1, pp.

348, 2001
Cambridge University Press
' 2001 Association for Child Psychology and Psychiatry
Printed in Great Britain. All rights reserved
00219630\01 $15n00j0n00

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 mental
health practice with children. This relates to how communication begins and develops in
infancy, how it influences the individual subjects movement, perception, and learning, and
how the infants biologically grounded self-regulation of internal state and self-conscious
purposefulness is sustained through active engagement with sympathetic others. Mutual selfother-consciousness is found to play the lead role in developing a childs cooperative
intelligence for cultural learning and language. A variety of preconceptions have animated
rival research traditions investigating infant communication and cognition. We distinguish
the concept of intersubjectivity , and outline the history of its use in developmental
research.
The transforming body and brain of a human individual grows in active engagement with an
environment of human factorsorganic at first, then psychological or inter-mental.
Adaptive, human-responsive processes are generated first by interneuronal activity within
the developing brain as formation of the human embryo is regulated in a support-system of
maternal tissues. Neural structures are further elaborated with the benefit of intra-uterine
stimuli in the foetus, then supported in the rapidly growing forebrain and cerebellum of the
young 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 brain
maturation that anticipate psychosocial support in infancy. The operation of an intrinsic
motive formation (IMF) that developed in the core of the brain before birth is evident in the
tightly integrated intermodal sensory-motor coordination of a newborn infants orienting to
stimuli and preferential learning of human signals, by the temporal coherence and intrinsic
rhythms of infant behaviour, especially in communication, and neonates extraordinary
capacities for reactive and evocative imitation. The correct functioning of this integrated
neural motivating system is found to be essential to the development of both the infants
purposeful consciousness and his or her ability to cooperate with other persons actions and
interests, and to learn from them.
The relevance of infants inherent intersubjectivity to major child mental health issues is
highlighted by examining selected areas of clinical concern. We review recent findings on
postnatal depression, prematurity, autism, ADHD, specific language impairments, and
central auditory processing deficits, and comment on the efficacy of interventions that aim
to support intrinsic motives for intersubjective communication when these are not developing
normally.
Keywords : Infant intersubjectivity, parent-infant communication, developmental disorders,
pathologies of empathy, therapies.
Abbreviations : ADS : adult-directed speech ; DTV : double video link ; F0 : fundamental
frequency ; IDS : infant-directed speech ; IMF : intrinsic motive formation ; IMP : intrinsic
motive pulse ; PDD : Pervasive Disintegrative Disorder ; PRC : period of rapid change.

nitive theory in empirical psychology, this is hardly

surprising. The central problem in early development of
the mind has been taken to be object awareness, not
person awareness. Nevertheless, there is evidence that
even newborn infants, with their very immature though
elaborate brains, limited cognitions, and weak bodies, are
specifically motivated, beyond instinctive behaviours that
attract parental care for immediate biological needs, to
communicate intricately with the expressive forms and
rhythms of interest and feeling displayed by other
humans. This evidence of purposeful intersubjectivity, or
an initial psychosocial state, must be fundamental for our
understanding of human mental development. It will also
be crucial for accurate interpretations of the influences
of nature and nurture in the baffling spectrum of psychosocial pathologies in children, as for the development of

Introduction
This is the first Annual Research Review on infancy
research for the JCPP. The time is ripe for an examination
of changing conceptions of first steps in human psychosocial growth.
The idea that normal human sensitivity for psychological impulses in other persons may have a basis in
inherent cognitive and emotional systems of the brain
specialised for this function has received attention in
psychology recently, much of it sceptical. Given the
predominance of individualist, constructivist, and cogRequests for reprints to : Professor Colwyn Trevarthen, Department of Psychology, University of Edinburgh, 7 George
Square, Edinburgh EH8 9JZ, U.K.
3

C. TREVARTHEN and K. J. AITKEN

effective treatment strategies, be they therapeutic or

educational.
Observation and experimentation in the motor, sensory, and cognitive developments in early childhood has
grown spectacularly since the 1960s, stimulating models
of developmental change in perceptual discrimination
and representation, operational thinking, skills and memory, and attempts to relate these achievements to brain
development, as well as to the design of artificial neural
nets that simulate cognition and learning. With the
success of precise experimental methods developed to
measure infant object-perception and cognition in controlled conditions, the everyday social-interpersonal factors of development and the intrinsic motives that
normally regulate them, for which new evidence was
obtained in the 1970s by micro-descriptive studies, have
been less regarded. Or they have been explained in
reduced physicalistic terms as secondary effects of social
contingencies, or as the outcome of some kind of acquired
intellectual process that can read others minds. Now
research on infants special awareness of persons, and
their active influence over caregivers behaviour, is having
a comeback, along with a renewed interest in the motives
and emotions that animate consciousness and selfawareness in humans and animals.
We believe that the existence of specialised innate
human-environment-expectant social regulatory and
intersubjective functions in the infant mind has been
firmly established, and argue that the corresponding
anticipatory motives constitute an essential framework
for the regulation of all human cognitive development ;
guiding, limiting, extending, and evaluating what the
individual can discover inside and outside his or her
body. Related, though psychologically simpler, processes
of intersubjective regulation appear in all animal species
that are both highly social and at first dependent on
intelligent parental care. The human case is unique in its
adaptations, which guide children through dialogic exchange of emotive and referential narratives in bodymimesis to language and learning of a cultural accumulation of well-reasoned knowledge and strategic technical
skills. The emotional investment of the child in this
learning how to mean is of primary importance in
clinical work with children, as well as in their education.
A cognitive description of psychological development
in the individual human baby, focusing on the processes
that take in perceptual information about objects and the
physical situation, is certainly possible. However, it would
appear to be a logical category error to infer that
interaction between subjects can be explained by decomposing their behaviours and perceptual discriminations
into cognitive components that are adapted to guide one
agent in engagement with things that have no psychological anticipation and no adaptive behaviour.
The social intelligence of the infant is evidently a
specific human talentan inherent, intrinsic, psychobiological capacity that integrates perceptual information
from many modalities to serve motive states. Moreover,
this capacity is a necessary prerequisite, although not in
itself a sufficient cause, for a child to go through
psychological development of the kind that leads to and
depends on cultural learning. Such a premise leads to a
different research agenda in clinical psychology from one
that views the cerebral mechanisms of social behaviour,
and the emotions that regulate it, as a product of
emerging, or constructed, modular components of
general representation, or of processing in cognition

(Karmiloff-Smith, 1992 ; Piaget, 1954 ; Rutkowska, 1993,

1997 ; Spelke, 1991), or uni-modal perceptual patternrecognising mechanisms (Bremner, Slater, & Butterworth, 1997 ; Johnson & Morton, 1991). We believe that
the prevailing logic needs to be reversed ; that object
cognition and rational intelligence in infants, and
their perceptual preferences, should be viewed as the
outcomes of a process that seeks guidance by personperception and through communication with equivalent
processes, of cognition-with-intention-and-emotion, in
other persons.
Evidence will be given from a number of clinical areas
for the effects of early difficulties in interpersonal functions that degrade subsequent developments, including
those rational, experience-dependent skilful, and more
utilitarian aspects of conscious life subsumed under the
titles of social cognition , theory of mind , and
pragmatics of speech and language.

Normal Intersubjectivity in Early Infancy

The Discovery of Innate Intersubjectivity in Protoconversations and Games with Young Infants
The theory of innate intersubjectivitythat the infant
is born with awareness specifically receptive to subjective
states in other personswas put forward 25 years ago to
account for observations made descriptively or ethologically from films of the behaviours of infants in natural
interaction with their mothers, who were attempting to
engage the infants in face-to-face chat, or playing games
with them (Trevarthen, 1974, 1979, 1998 a). In the 1970s,
researchers in different fields reported the findings of film
studies of live interactions between adults and infants a
few months old (Bateson, 1971, 1979 ; Brazelton, Koslowski, & Main, 1974 ; Stern, 1971, 1974, 1977 ; Tronick,
Als, & Adamson, 1979). They were impressed with the
similarities of timing and expression between these
simplest, intuitive human encounters and informal conversations between adults. The techniques of conversational analysis, with accurate measurement of the
timing of the contributions by adult and infant, brought
statistical confirmation of this similarity (Beebe, 1982 ;
Beebe, Jaffe, Feldstein, Mays, & Alson, 1985 ; Beebe,
Stern, & Jaffe, 1979 ; Feldstein et al., 1993 ; Fogel, 1977,
1985 a ; Stern, 1971). It was M. C. Bateson (1971, 1975,
1979) who termed the mother-infant interactions protoconversations.
Further study revealed that this natural sociability of
infants, engaging the interest, purposes, and feelings of
willing and affectionate parents, serves to intrinsically
motivate companionship, or cooperative awareness, leading the infant towards development of confidence,
confiding and acts of meaning , and, eventually, to
language (Trevarthen, 1980, 1982, 1987, 1988, 1990 a ;
Trevarthen & Hubley, 1978 ; Trevarthen, Murray, &
Hubley, 1981). The infants communicative motivation,
and the intuitive parenting that fosters it, have been
identified with the special human aptitude for cultural
learning, including language learning (Adamson & Bakeman, 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 infants

INFANT INTERSUBJECTIVITY

need for communication animates the initial self-other

awareness and reception of motives and emotions in the
intersubjective messages that underlie all languagea
human sense , as Donaldson (1978) called it, that
emerges in progressively more powerful forms through
the course of infancy (Bra/ ten, 1998 ; Reddy, Hay, Murray,
& Trevarthen, 1997 ; Rommetveit, 1998 ; Ryan, 1974).
The earliest meanings are conveyed to the infant or
toddler nonverbally or paralinguistically by vocal and
gestural expression in natural social situations, at the
same time as language is being used by older interactants
to convey referential information and to specify purposes,
experiences, thoughts, and recollections. Regulation of
this primary human communication depends on an innate
virtual other process in the infants mind (Bra/ ten,
1988 a, b, 1998).
Researchers found that as early as 2 months, infants
and mothers, while they were looking at and listening to
each other, were mutually regulating one anothers
interests 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, 1985 a, b,
1993 a, 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). Mothers
and fathers were behaving in an intensely sympathetic
and highly expressive way that absorbed the attention of
the infants and led to intricate, mutually regulated
interchanges with turns of displaying and attending. The
infant was thus proved to possess an active and immediately responsive conscious appreciation of the
adults communicative intentions. This is what was called
primary intersubjectivity (Trevarthen, 1979). The distinction between subjectivity and intersubjectivity in early
infancy was defined as follows :
Subjectivity and intersubjectivity : a definition of terms

Human beings understand one another intimately

and at many levels. To analyse this ability of persons
to act together and to share experience in harmony,
we have first to view communication in relation to
the private activities of conscious, purposeful action.
All voluntary actions are performed in such a way
that their effects can be anticipated by the actor and
then adjusted within the perceived situation to meet
criteria set in advance. Interpersonal communication
is controlled by feedback of information, as in all
voluntary behaviour. But there is an essential difference between a person doing things in relation to
the physical world and the control of communication
between persons. Two persons can share control,
each can predict what the other will know and do.
Physical objects cannot predict intentions and they
have no social relationships.
For infants to share mental control with other
persons they must have two skills. First, they must
be able to exhibit to others at least the rudiments of
individual consciousness and intentionality. This
attribute of acting agents I call subjectivity. In order
to communicate, infants must also be able to adapt
or fit this subjective control to the subjectivity of
others : they must also demonstrate intersubjectivity.
By subjectivity I mean the ability to show by
coordinated acts that purposes are being consciously

regulated. Subjectivity implies that infants master

the difficulties of relating objects and situations to
themselves and predict consequences, not merely in
hidden cognitive processes but in manifest, intelligible actions (Trevarthen, 1979, pp. 321322).
Perturbation tests, by the still or blank face or double
television replay procedures, discussed below, further
demonstrated that a 2- to 3-month-old infant was emotionally aware of a mothers contingent and emotionally appropriate behaviour, and actively engaging with it
(Murray & Trevarthen, 1985, 1986 ; Trevarthen,
1993 a, b ; Trevarthen et al., 1981 ; Tronick, 1989 ;
Tronick, Als, Adamson, Wise, & Brazelton, 1978), and
these findings are confirmed by more recent investigations
(Nadel, Carchon, Kervella, Marcelli, & Re! serbat-Plantey,
1999).
Longitudinal film study of behaviours recorded in
semicontrolled lab\studio conditions that favoured close
observation revealed an orderly age-related transformation of the infants motives through the middle of the
first year, toward increasingly intricate, precise, and
selective coordination with the mothers richly inflected,
rhythmically patterned, and repetitive expressions of
communication and dramatised actions of play (Beebe et
al., 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 babys increasing interest in
objects was observed to grow in some competition with
the earlier developed motives for protoconversational
play, and led, around the middle of the first year, to the
elaboration of more lively games with objects. Just before
the end of the first year, there was a rather sudden
development of joint interest of mother and infant in their
surroundings, triggered by the infants emerging curiosity
about the timing and direction and focus of attentions
and intentions of the mother (Hubley & Trevarthen,
1979 ; Pecheux, Ruel, & Findji, in press). This change in
infants experience, and acceptance of joint attention to
the world, clearly has momentous consequences in
subsequent learning, and profound effects on the ways
mothers act with and speak to their infants.
Parallel study of the development of younger infants
orientationsactivities aimed to engage objects and
physical events (tracking and reaching, grasping, and
manipulating)clarified the differences between subjective motives that led them to experience, for themselves,
the sensations and affordances of their own bodies and of
things, and the intersubjective motives that were drawing
them into games and self-other regulations of a strictly
interpersonal kind, in which the babies had to react
alertly to the expressions of purpose and emotion in their
partners (Trevarthen et al., 1981). It was confirmed that
the differing motives for these two kinds of objectivefor
object awareness or doing with things, and for personawareness and communicating with persons (see
Trevarthen, 1998 a)were, indeed, undergoing divergent
and periodically competing development during the first
year, leading, at around 9 months after the infants birth,
to integration in the new form of cooperative intersubjectivity (person-person-object awareness), which was
named secondary intersubjectivity (Trevarthen & Hubley,
1978).
It is significant that the evidence for person awareness and a capacity for intersubjectivity came from
description in detail, from frame-by-frame analysis with

C. TREVARTHEN and K. J. AITKEN

accurate measurement of the timing, of how infants

moved their bodies, especially their expressive organs, in
responses, both contingent and provocative, to the
expressions of another person. Importantly, the behaviours selected to define the infants intersubjectivitythe ways the infants look, express their feelings in
face and voice, how they gesture and move in rhythmic
cycles to accept or reject contactwere homologous with
behaviours that are essential to the elaborate intersubjectivity of all collaborative intentional activity in
adult society, including live conversational language.
They are regulated and negotiated purposefully and
emotionally, by expressive and receptive processes engaging 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, 1984 a, 1993 a, b ;
Trevarthen, Kokkinaki, & Fiamenghi, 1999 ; Weinberg &
Tronick, 1994).
By 1 year a baby can not only communicate directly
with human expression without language, but can also
energetically share complex arbitrary experiences, boldly
displaying to familiar persons an individual, socially
adapted personality. The baby attends to and imitates
conventional vocalisations and gestures, as well as making orientations to and handling objects that other
persons use, imitating their actions (Adamson & Bakeman, 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, 1990 a, 1992 ; Trevarthen & Hubley, 1978 ;
Trevarthen & Logotheti, 1987 ; Trevarthen et al., 1981 ;
Uzgiris, 1981, 1999). Motivation to regulate fluent
person-person-object awareness, joint attention, and
mutually adjusted intentionality, all at once, is coming
to the fore at this age (Trevarthen & Hubley, 1978).
Details of the expression of the developing motives that
drive the earliest communications of humans are summarised as follows. In the gentle, intimate, affectionate,
and rhythmically regulated playful exchanges of protoconversation, 2-month-old infants look at the eyes and
mouth of the person addressing them while listening to
the voice. In measured and predictable cycles of response
to regular time patterns in the adults behaviour, the
infant moves its face, which it cannot see or hear, and
reacts with movements of face, hands, or vocal system to
modified patterns of adult vocal expression that it is
incapable of mimicking, and that have not been available
in that form in utero. The communicatively active hands
of young infants may make expressive movements in
rhythmic coordination with a persons speech (as was first
noted by Condon & Sander in 1974), and this can occur
when the baby has been blind from birth, and thus never
seen its hands, or anyone elses hands (Tnsberg &
Hauge, 1996 ; Trevarthen, 1999 a). Thus we may conclude
that the infant has a coherent psychoneural organisation
that specifies the timing and form of body movements.
This organisation can react with appropriate dynamic
changes to another persons dynamic expressions, matching their rhythms and accents. Evidently the responses of
the infant are made expressive by internally generated
motives and emotions that resemble those carried in the
adult expressions. Infant and adult can, for a time,

sympathise closely and apparently equally with one

anothers motive states, using similar melodic or prosodic
forms of utterance and similar rhythms of gesture. This
entails an absorption of the adults motivations into an
affectionate intuitive parenting mode that tends to mimic
the infant and that releases in the adult a specialised,
emotionally coordinated musicality of voicing, with
animated but sympathetic and joyful facial expressions
and dance like postural, gestural movements that match
vocal expressions, and affectionate and playful touching
and moving of the infants 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 psychology
that a human newborn, lacking coherence of psychological representation even of itself as a subject, cannot
distance itself perceptually or conceptually from the
adult who cares for it. That, consequently, the relationship with the mother is one of symbiotic fusion , to use
the term employed by Mahler, Pine, and Bergman (1975).
In the same way, the British Object Relations School of
psychoanalysis, while developing a framework for appreciating the emotional needs of infants, took it as
evident that newborn is confluent emotionally with the
mother, and emerging to self-awareness within her
rational consciousness in a growing attachment to her
person (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, no
separate ego, no representation of self distinct from the
other. These ideas recall ancient philosophical inferences
about the primacy of reason, the role of learning by
imitation, and the opposition of reason and emotion
(Kugiumutzakis, 1998, p. 88).
In fact, while neonates are undoubtedly endowed with
reflex panic responses that serve physiological maintenance and survival (Panksepp, 1998 a), if a newborn is
alert, rested, free of stress, and responded to sympathetically, voluntary behaviours appear that are wellcoordinated, perceptive, and specifically adapted to excite
and regulate an engagement with the autonomous expressions of interest and emotion of another person, all of
which makes the behaviours intensely rewarding for a
new mother or father, who feel they are interacting with
a human person (Murray & Andrews, 2000 ; Van Rees,
Limburg, Smulders, & Kloosterman, 1992). The expressive behaviours in affectionate chat and play have no
immediate role in the regulation of the neonates physiological state, comfort, or survival. They are distinct from
maternal breast-feeding, stroking, holding, rocking, vocal
comforting, and the like. The caregiver responds to
neonatal signals that are very different from appetitive
movements, distress cries, or gestural signs of fear, anger,
or fatigue. The interactions are calm, enjoyable, and
dependent upon sustained mutual attention and rhythmic
synchrony of short utterances which include, beside
vocalisations, touching and showing the face and hands,
all these expressions being performed with regulated
reciprocity and turn-taking. Newborn and adult spontaneously display a mutually satisfying intersubjectivity
(Kugiumutzakis, 1998 ; Trevarthen et al., 1999).
A comparable intimacy with mutual imitation can be

INFANT INTERSUBJECTIVITY

seen in interspecies communication between a human

adult and a newborn chimpanzee (Bard, 1998 ; Bard &
Russell, 1999), which proves that face-to-face transmission of the basic intersubjective motives is not
restricted to humans. The state-regulating communicative behaviours and reactions of infants resemble the
needs for parental attention shown by the helpless young
of many other mammals (Blass, 1994, 1996 ; Carter,
Lederhendler, & Kirkpatrick, 1997 ; Hofer, 1990 ; McKenna & Mosko, 1994 ; Panksepp, 1998 a ; Panksepp,
Nelson, & Bekkedal, 1997 ; Panksepp, Nelson, & Siviy,
1994 ; Rosenblatt, 1994 ; Schore, 1994 ; Suomi, 1997).
By recording changes in their heartbeat with attention
to novel events, where they chose to look, or by causing
their head rotations, leg movements, or sucking to trigger
stimuli, it has been possible to show in experimental
situations that newborns are sensitive to expressions of
emotion in body movements and touching, voice, or
facial movements (Bower, 1982 ; DeCasper & Carstens,
1981 ; Eisenberg, 1976 ; Jusczyk, 1985 ; Lipsett, 1967 ; H.
Papousek, 1967). However, the most striking evidence for
an innate protoconversational readiness comes from
intended imitations and provocations of newborns in
close reciprocal interaction with adults who are seeking
to make their behaviours interesting for, and contingent
with, the infants signs of attending. Infants only a few
hours old are capable of expressing communicative
capacities 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, 1985 a ;
Meltzoff & Moore, 1977, 1994, 1997, 1998 ; Nagy &
Molna! r, 1994 ; Reissland, 1988 ; Trevarthen, 1979, 1997 a ;
Trevarthen et al., 1999 ; Zeifman, Delaney, & Blass,
1996). The infants act assertively or apprehensively in
appropriate coordination with the assertive phases or
watchful apprehensive states of a sympathetic partner
(Trevarthen et al., 1999). This active involvement in
communication of rudimentary intentions and feelings
confirms that the human mind is, from the start,
motivated not only to elicit, guide, and learn from
maternal physical care to benefit regulation of the infants
internal biological states, but also for cooperative psychological learningthe mastery of socially or interpersonally contrived meaning specified in intelligent
reciprocal 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 on
communication with a caregiver to service the babys
needs for an emotional attachment, but also to maintain
and develop an intimate emotionally expressed companionship in changing purposes and conscious experiences (Trevarthen, 1998 d, in press). The infants
mind and body has special functions adapted to anticipate
this development of the imagination of meaning (see
Fig. 2).
Even an infant born more than 2 months before term
can begin to share dynamic protoconversational motives
in precisely regulated rhythms of purposeful movement
and investigative awareness by exchanging facial expressions, vocalisations, and gestures of the hands with a

sympathetic partner (Trevarthen et al., 1999 ; Van Rees &

De Leeuw, 1993). Learning tests that examine preferential
orienting or autonomic regulations of newborns prove
that perceiving the mothers rhythmic vocal expressions
of motive state from her speech can begin in utero, many
weeks before birth (DeCasper & Spence, 1986 ; Fifer &
Moon, 1995 ; Hepper, 1995 ; Lecanuet, 1996). Her characteristic patterns of speech can be identified by her
newborn immediately. Recognition of the visible appearance of the mothers face is acquired within hours of
full-term birth, aided by the newborns coherent or
integrated capacity for interest in interaction with the
feelings behind the other persons facial expressions and
vocalisations (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, 1985 a ; Meltzoff & Moore, 1977, 1994 ; Nagy &
Molna! r, 1994 ; Reissland, 1988 ; Zeifman et al., 1996).
The complex adaptive structure of the foetal human
brain, and notably the peripheral organs and neural
systems of social or interpersonal perception and expression, determine directions and limits to future acquisition of skills or knowledge by a child (Als, 1995).
Although it has been shown that prematurely born infants
can imitate facial expressions (Field et al., 1983 ; Kugiumutzakis, 1985, 1998), it appears likely that the auditory
learning of foetuses and the vocal imitations of premature
newborns may be related to the precocity of the auditory
sense and its special reception of other persons expressions (Mehler et al., 1988). Development of audition
may be inhibited after birth by the sudden acceleration of
development of the visual system that occurs in early
months (Lecours, 1982). Longitudinal data (Kugiumutzakis, 1999, pp. 42, 44, 48) indicate that vocal
imitations may be declining immediately after birth, as
imitations of seen mouth movements increase, and then
vocal imitations pick up after 2 months.
Imitation by infants is not mere reproduction or
repetition of movements made by another individual, and
it serves interpersonal functions, not just acquisition of
motor skills and expression (Kugiumutzakis, 1993, 1998,
1999 ; Uzgiris, 1981, 1984). It is, even for newborns, an
emotionally charged mutual influence of motive states in
which certain salient expressive actions of the other are
identified and repeated to further an ongoing communication (Nagy & Molna! r, 1994, 1997). Imitative responses
occur at a moment in the stream of interaction where they
can act as affirmations, acceptances, or commentaries
with respect to accentuated displays of the other person
(Trevarthen et al., 1999). Older infants and toddlers
imitate to display and reinforce friendship or affiliation,
showing great sensitivity to pleasure and praise shown by
familiar companions. But even in young infants, imitations serve to qualify an attachment relationship
(Meltzoff & Moore, 1994), possibly to identify an
individual person as an object of heightened affecti.e.
of love or admiration.
The manner of imitating proves the natural complexity
and specificity of the infants motives for human contact
and communication. The imitative reactions recognise
communication, as a hand-shake or a head-nod does
between adults in conversation, and they have a further
peculiar feature. An inventory of the actions that neonates can imitate reveals a rather bizarre set : e.g. large

C. TREVARTHEN and K. J. AITKEN

tongue protrusions, exaggerated opening of the mouth or

eyes, 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 to
be forced or emphatically marked innovations, not
normal spontaneous currency in mutual affective regulation, such as ordinary smiles, staring, crying, or
frowning. The imitations are emitted after prolonged
attention and with effort, and they show improvement in
accuracy over a series of repeated attempts. Where it has
been found that neonates imitate expressions of emotion
(Field et al., 1982), these have been responses to the
exaggerated performances of an actress, not normal
contingent responses in reciprocal communication. This
appears to indicate that, even at this age, imitation is part
of a motivation specialised for purposeful negotiation
and learning of new or arbitrary social habits or conventions, in the form of behaviours that have been
isolated and given emphasis in the stream of engagement.
Further research on the timing of neonatal imitations is
needed to establish this curious point.

Intuitive Parenting and Maternal Speech :

Sympathetic Emotions Evoked by the Infants
Expressions of Feeling, Initiative, and Curiosity
The very distinctive manner of an affectionate adults
vocalisations to a young baby has now been analysed in
detail. Motherese or infant directed speech (IDS) has
defined rhythmic and melodic features as well as voicing
qualities. It is organised in repeated phrases, and tends to
create slowly changing, cyclic narratives of emotion. The
similarity of this speech and vocal play to music and to
the rhythmic and rhyming forms, phrases, and verses of
poetry has drawn researchers attention, and led to a
concept of preverbal or subverbal musicality as a
fundamental basis for communication of motives and
feelings (Malloch, 1999 ; H. Papousek, 1996). Infants
have been found to have astonishing powers of discrimination for subtle features of musical sounds and melodic
forms, especially as these are represented in the inflections
of a mothers voice (see below). These features are evidently manifestations of a fundamentally innate process of emotional physiology, by expression of which a
primary level of intermental communication is established between human subjects.
The dynamic narrative envelopes of a mothers utterances, their pitch contours, and other dynamic qualities,
have been identified as necessary alimentation for the
infants developing self-awareness and consciousness of
agency (Beebe & Lachmann, 1988 ; H. Papousek &
Papousek, 1977, 1987, 1989 ; Stern, 1974, 1985, 1993). On
the other hand, the extraordinary precision of the infants
mirroring, even with a restricted vocal repertoire, has
been taken as further evidence for an innate capacity
for such on-line communication (Beebe et al., 1985 ;
Stern & Gibbon, 1980 ; Stern et al., 1975, 1977, 1985 ;
Trevarthen et al., 1999). Infants, even newborns, can
exactly synchronise with certain salient moments in the
adults message by gesture or utterance, and the vocal
emissions can be matched in pitch and quality (timbre)
(Malloch, 1999). There clearly is a sensitive two-way
mirroring of the emotional values of expression in spite of
the 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 think
slowly and are hard of hearing, has exaggerated, but
modulated, expressivity. It clarifies the feelings, interests,
and intentions of the speaker, and it minimises the
remembering of meanings of words. This talk is understandable as effective communication only if it is accepted
that even young infants are as sensitive to the feelings
behind consciously regulated well-motivated utterances
as an old person or a cat. As Bateson, an anthropologist
and linguist, pointed out, it is a form of human communication that is related not only to education in
the forms and meanings of language, but also to the
rhythms and melodies of religious ritual and communion,
and traditional healing practices (M. C. Bateson, 1979,
pp. 7476).
Comparison of parents speech to young infants in
different languages confirms that there are universal
rhythmic and prosodic features in the expression of
human feelings and sympathetic interest (Fernald, 1992 a ;
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), compared to adult-directed speech (ADS) in either language,
has higher pitch (fundamental frequency, F0), larger F0
range, shorter utterances and longer pauses, fewer syllables per phrase, and less phrase time\sample time
(Grieser & Kuhl, 1988 ; M. Papousek et al., 1991).
Thanavisnuth and Luksaneeyanawin (1998) report similar features in Thai mothers speech to their infants.
Rising contours, used by parents to elicit infant attention
(Stern, Spieker, Barnett, & MacKain, 1983), are similar
in English and Mandarin (M. Papousek et al., 1991), and
this form of utterance is more effective in eliciting and
maintaining infant attention than falling pitch (Sullivan
& Horowitz, 1983). Infants prefer approving rather than
disapproving intonation (M. Papousek, Bornstein,
Nuzzo, Papousek, & Symmes, 1990) ; they show more
positive affect to this way of speaking (Fernald, 1993) and
are more interactive, interested, and emotionally positive
to IDS (Werker & McLeod, 1989). Adults, too, judge
role-play better from speech in the IDS register.
Maternal speech has often been studied as if it were just
an instructive register of language, an aid for the infant to
pick up words and sentence grammar. But cats presumably do not understand words, and nor do 2-montholds. With toddlers or the aged, linguistic communication
may also be part of the effective function of this way of
uttering, but its obvious attractiveness and regulatory
effects with the youngest infants can have little to do with
the grammatical or semantic purposes of language. Vocal
communication addressed to infants is, for the infant and
largely for the adult too, nonreferential, in the sense that
it does not matter that it may specify any reality or object
outside the human contact itself. It is intersubjective at a
fundamental level. It serves to respond to or affirm the
infants eagerness to become involved in protoconversation, which is a nonverbal discourse regulated by
dynamic relational affects, and a narrative sense of
transforming feelings.
Research on IDS, at first reacting to the theory of an
innate language acquisition device, which argued that
language input to infants is so linguistically impoverished
that it couldnt possibly teach grammar (Chomsky, 1965),
sought to demonstrate that mothers do provide a graded

INFANT INTERSUBJECTIVITY

instruction in features of language (Snow & Ferguson,

1977). Then acoustic speech analysis led to the demonstration that speech to infants has higher pitch, wider
pitch excursions, slower tempo, shorter utterances, and
longer pauses (Cruttenden, 1994 ; Fernald & Simon, 1984 ;
Stern et al., 1982), and it was claimed that the training
was perceptual rather than linguistic. But infants
clearly already have perceptual biases and attentional
preferences 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 three
different functions have been attributed to the way
adults talk to infants : this speech engages attention
(M. Papousek et al., 1991 ; Stern et al., 1982 ; Sullivan
& Horowitz, 1983), communicates affect, facilitating
social interaction (Fernald, 1989, 1992 a ; Kitamura &
Burnham, 1996, 1998 a ; M. Papousek et al., 1990 ;
Werker & McLeod, 1989), and facilitates language acquisition (Fernald & Mazzie, 1991 ; Hirsh-Pasek et al.,
1987).

Experimental Tests of Infants Emotions in

Protoconversation
The motives and emotions of protoconversation with
infants under 3 months of age have been tested by
perturbation experiments, situations that have been contrived to obstruct or distort the rhythmic traffic of
expressive signals and contingent and sympathetic
responses between infant and adult. Two procedures have
given valuable evidence on what infants expect from the
behaviour of a conversational partner, and how they act
when the adult fails to meet these requirements. They
confirm that the interaction is generated by coregulation,
coconsciousness, and contingent and reafferent mutual
regulation in a complex dynamic system wherein the
exact course of events is emergent or not defined in
advance (Fogel, 1993 a, b ; Fogel & Thelen, 1987 ; Tronick
& Weinberg, 1997). They also show that the young infant
has expectations of the emotional quality of the engagement and the normal contingencies of a sympathetic adult response, and that these emotions change
in ways that affect the adult, regulating positively
towards a happy encounter, and defending against failure of contact, by appealing with negative emotional
expressions for appropriate remedial action to repair
communication.
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 protoconversational interaction with her infant to arrest her
movements on a signal from the experimenter, and simply
look at the infant without any reaction to what the infant
does. This commonly results in the infant showing a
succession of appeals for communication by smiling,
vocalising, and gesturing, punctuated by increasingly
sober staring at the mother, then emission of signs of
avoidance of eye-contact and distress. The behaviour has
been charted by micro-description and proved by statistical analysis and to be a coherent emotional reaction
that shows the infant is disturbed or made unhappy by
the mothers unresponsiveness. Indeed, the infants behaviour assumes the configuration and interpersonal
timing of an expression of sad avoidance, an expression
which, in an older person, we would not hesitate to call

distressed embarrassment or shame (see below for a

discussion of the nonbasic emotions of infants).
A second experiment was designed to deal with the
objection that the infant was simply affected by the
mothers sober face and inactivity (Murray, 1980 ;
Murray & Trevarthen, 1985 ; Trevarthen et al., 1981). A
double video (DTV) link was set up so that infant subjects
a few weeks old (less than 3 months) and their mothers
could see each other and communicate by seeing one
anothers face expressions and hearing vocalisations live.
Once good, happy communication was obtained, a
portion of the recording of the mother approximately 1
minute in length from an animated and playful period of
the encounter was rewound and replayed to the infant.
The projection of the mothers behaviour to the infant
was exactly as before, but the physical recording was not,
in any reliable way, reacting contingently to what the
baby was expressing at any moment. Here infants showed
occasional accidental interaction with the taped behaviour of the mother, confusion when she failed to respond
in time and appropriately, then prolonged distress and
avoidance as in the still face experiment. It takes time for
the infant to recover from this perturbation when the
mother resumes normal sympathetic communication, or
is on-line again, as was the case in the still face experiment
(Weinberg & Tronick, 1996). Replay of the infants
behaviour to the mother in the DTV apparatus causes her
to feel something is wrong, and different mothers experience different emotions and make different verbal
evaluations, all uncomfortable, when the infant appears
not to connect.
Replication of this DTV replay experiment confirms
that 2-month-olds are highly sensitive to the timing and
emotion of a mothers expressions in communication
(Nadel, Carchon, et al., 1999). Evidently the infant, at 6
to 12 weeks of age, is able to anticipate and join a
sympathetic conversation , and is distressed by mistimed maternal expressions, no matter how joyful and
playful they may be. As we shall explain, this finding is
resolutely contested by proponents of the view that
infants 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 of
another persons communicative responses (Rochat,
Neisser, & Marian, 1998). According to this theory, the
self-awareness required for awareness of the other as an
agent is a product of acquired social cognition (Lewis,
1999)
Research on the effects of maternal postnatal depression, which causes the mother to express herself
without pleasure, with flat affect, and with erratic timing
of behaviours that do not engage with the infants
behaviours, leads to the same conclusion as the perturbation experiments, as is discussed further below.
Young infants seeking communication from a depressed
mother are affected by unsympathetic and inappropriately timed maternal behaviour (Breznitz & Sherman,
1987 ; Field, 1992 ; Lundy et al., 1996 ; H. Papousek &
Papousek, 1997 ; Tronick & Weinberg, 1997), the
mothers self-referred, unresponsive state (Murray,
Kempton, Woolgar, & Hooper, 1993) and the quality of
speaking that lacks musicality (Robb, 1999). They
become distressed and avoidant and may develop a
lasting depressed state that affects communication with
persons other than the mother (Field, 1992 ; Lundy et al.,
1996).

10

C. TREVARTHEN and K. J. AITKEN

Changes in older infants reactions to the two perturbation tests show that a capacity to withstand disengagement of a conversational game without distress
increases with the infants increasing alertness and curiosity for the environment at large. Infants over 4 months
easily engage in agile visual investigation of surroundings,
and they can use this new interest to escape an unresponsive mothers gaze. Whereas the 2-month-olds appear
to be trapped in the stressful encounter and usually
become seriously disturbed, the older infants are much
less concerned by brief unresponsiveness of the mother
(Biglow, MacLean, & MacDonald, 1996 ; Hains & Muir,
1996) ; they simply avoid looking at her (Muir & Hains,
1999 ; Trevarthen, 1984 a, 1990 a). Further age-related
changes in infants resistance to distress and separation
will affect how they behave in any situation where the
mothers responses are unusual, and when they are older
than 6 months infants often regard the still face test as an
entertaining game (Trevarthen, 1998 a, p. 40). The tests
with 2-month-olds engage the protoconversational
motives that are active in primary intersubjectivity ,
before motives for investigative looking and manipulating have become strong, and before the infant has
developed a robust self-confidence in game playing,
teasing, and showing off.

Developments of Intersubjectivity in the First

Year : Age-related Events and Changing Parental
Responses
Perceptuomotor Maturation in Infancy : Increasing
Body Awareness and Transitions in Motive and
Emotion
Infants consistently show conspicuous age-related
changes, not only in their physical size, acuity of
perception, and motor strength, but in the coordination
of their movements for different purposes, their perceptual discrimination and attentional preferences, and
their affectionate and cooperative engagements with
caregivers. These changes are reflections of transformations in brain function that have intrinsic causes.
They are clearly also consequences of experience and
learning, about the body and of the world and objects,
and therefore dependent on the kind and quantity of
experiential input. Infants learn recognition of human
signals from before birth, and at all ages they react
strongly to the emotional support they receive from other
persons, and the attentions given to their interests and
actions. But they also have their own powerful internal
impulses and motivations, and these are always important
factors in development of the infants awareness and
motor coordination, and in their responses to selfgenerated experience, as well as to care or teaching.
Figure 1 summarises the evidence we have concerning
age-related changes in infants behaviour. These appear
to express periods of rapid change (PRCs) in infants
psychological motives and capacities for action, cognition, and communication (Trevarthen, Aitken, &
Plooij, 2000). Four main epochs can be defined, and these
appear to reflect changing balance in three principle kinds
of intrinsic motive : (a) ergotropic, for attending to the
external world with the aid of motor adjustments of the
body and selective use of the senses ; (b) trophotropic, for
regulation of the internal autonomic or visceral state ; and
(c) communicative, this last being effective in regulating

both attachment, serving the developing infants trophotropic needs, and companionship, by which experiences
and skilful actions directed to the environment are shared
and learned socially (Trevarthen, 2000 ; and see Fig. 2).
The ergotropic\trophotropic distinction in animal motivations was first made by Hess (1954) on the basis of
physiological effects of brain stimulation. For modern
evidence on motive systems of the mammalian brain see
Panksepp (1998 a).
Experimental cognitive psychology has focused principally on the ergotropic, environment-assimilating functions of the infant as an individual perceiver and actor,
exploring and using objects, observing events, and acquiring skills of perceiving and acting. Consequently
primary importance has been given, first, to the very
conspicuous changes in visual focus at 4 to 6 weeks, then
in attention and manipulation with advances of postural
control, visual orienting, and discrimination, and reaching and grasping around 3 and 4 months (e.g. Rochat &
Striano, 1999). A second major change in cognition
comes toward the end of the first year as the infant, on the
threshold of independent locomotion, shows more deliberate interest in pursuing the kind of purposes which
adults see as intentional and becomes more capable of
solving problems of the ways objects interact and can be
used together.
These changes, at these three ages, have been taken by
developmental authorities as the beginnings of various
functions of consciousness, object concepts, volition, and
self-awareness. The program of developments in object
cognition has been assumed to set the pace and strategy
for social cognition , a product that must incorporate
the capacity for relational emotions, empathy, and
intersubjectivity (e.g. Bahrick & Watson, 1985 ; BaronCohen, 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 ; Tomasello, 1993 ; Yarrow et al., 1984 ; Zahn-Waxler, RadkeYarrow, Wagner, & Chapman, 1992). An alternative
view holds that self-awareness and emotional maturity
comes principally with language and social training, after
infancy (Dunn, 1994 ; Lewis, 1987, 1992, 1993). Such
conclusions can only be supported if the ways in which
younger infants, including newborns, react purposefully
and emotionally to the environment are disregarded, and
their reactions to the communicative signals from other
persons are explained as reflexive or mindless . We
believe that the changes through the first and second year
or childhood are more accurately seen as developmental
transformations in prenatally drafted motives that are
adapted for intelligent life in the company of other
subjects, not the first appearance of the adaptive behaviours.
Research on the social development of infants focused
on the supposed dependence of communication on
cognitive development, or on the dependence of the child
for emotional development on parental regulation, and,
on imitation, takes the childs self-awareness to be a
construct built of experiences acquired concerning how
other persons react to what the child does, inferring
purposes where they did not exist (Kaye, 1982). The
increasing self-consciousness of the infant in the second 6
months of life has been taken as evidence for the
beginning of a representation of other individuals intentions, or intersubjectivity. Advances in the dynamics of
interaction and in social signalling are supposed to reflect

INFANT INTERSUBJECTIVITY

Regulation of sleep, feeding and breathing. Innate pre-reaching.

Imitation of expressions. Smiles to voice.

Fixates eyes with smiling. Protoconversations. Mouth and tongue imitations

give 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.

11

Figure 1. Top : In protoconversation, a two-month-old infant and a mother communicate by many modalities of perception and
expression, transmitting information about intrinsic motive rhythms and emotions, principally by eye-to-eye contact, voice, facial
expression and gesture. Middle : In the first 18 months of life there are marked changes in the infants consciousness of other persons
and in their motives for communication, without language. Several major transitions can be observed in self-and-other awareness at
particular ages. These lead the child toward cooperative interest in actions and objects, and cultural learning. Below : Research studies
that have made detailed longitudinal observations at sufficiently frequent intervals have found evidence for major periods of rapid
change (PRCs) in motor coordination, perceptual abilities, and communication. All may be described as elaborations of the means
by 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).

12

C. TREVARTHEN and K. J. AITKEN

change to the social scaffolding offered to the infant as

parents are more playful, presenting game routines, with
the infants initiative in these changes of communication
being regarded as consequences of perceptual and motoric developments. The infants realisation that other
persons are like me (Mead, 1934) is taken to come as
a consequence of acquired contemplative or metacognitive functions (Leslie, 1987), developing expectations
regarding the dynamic vitality features of other persons,
and, especially, an emerging sense of variable contingency
in their responses (Bahrick & Watson, 1985 ; Gergeley &
Watson, 1999 ; Watson, 1984).
While not denying the importance of learned regulations in the management and recollection of experiences, and the influence parents may play through their
interpretation of infants expressions of emotion and
behavioural responses , we see the conspicuous developments in infants self-consciousness and sociability
in this period of games as continuous with, and developing from, the rhythmically patterned intersubjective
motives that were present and active in the newborn. We
believe that development is fostered best when parents
respond with perceptive sympathy to the motives and
feelings infants express to them.
As the infant gains in alertness, discriminative awareness, and power of movement in the early weeks, turning
more to explore the environment and manipulate objects,
exchanges with parents become more lively (Trevarthen,
1990 a, 1998 a ; Trevarthen & Hubley, 1978). After 3
months protoconversations give way to body games,
nonsense rhymes, nursery chants, and songs and to ritual
play routines involving body bouncing, hand-clapping,
tickling, peek-a-boo , and the like (Bruner & Sherwood, 1975). These are always strongly rhythmic, with
regular phrasing and highly predictable repetitions and
resolutions of emotional energy or excitement (Trevarthen, 1999 a). They involve the easy substitution and
matching of forms of expression in different modalities
(hand gestures, voice sounds, face expressions, looks, and
head orientations), which Daniel Stern called intermodal fluency , in the emotional complementation that
he describes as affect attunement (Stern et al., 1985).
By 4 months or so, infants are clearly interested in and
responsive to the adults changing mood and expressions
of excitement, surprise, pleasure, or displeasure, and,
with familiar persons, they can appreciate complex
teasing games (Nakano & Kanaya, 1993). Imitation
games between infants and their mothers and fathers, or
between infants, are emotional, and usually very pleasurable (Fiamenghi, 1997 ; Reddy et al., 1997 ; Trevarthen et
al., 1999). Older infants, when they are caught in
unfamiliar circumstances, orient purposefully to check
their mothers emotions (Klinnert, Campos, Sorce, Emde,
& Svejda, 1983). It follows that any implication that the
parent is giving organisation to the infant by scaffolding an erection of immature moves should be
qualified by the observation that the adult is often
assiduously tracking the infants varying mood with
imitations, and that the infant can take the role of
provocateur or teaser (Reddy, 1991). The infant can be
the one who attunes to and accompanies the parent with
nicely synchronous gestures or vocalisation, even showing anticipation of salient events, such as the prolonged
vowel at the end of a phrase or stanza (Malloch, 1999 ;
Trevarthen et al., 1999). As in protoconversation, there
are frequent occasions in games or songs when the infant
takes the role of leader, while the mother responds.

Communicative Musicality in The First Year

The subtleties of early preverbal interaction are being
studied in detail by methods for objectively assessing the
prosody and melody of infant-directed vocalisations and
musical sounds, and recording infants orientations and
preferences to such sounds. The evidence is that infants
are selectively attracted to the emotional narratives
carried in the human voice, and that they are excited to
participate in a shared performance that respects a
common pulse, phrasing, and expressive development.
Infants respond with synchronous rhythmic patterns of
vocalisations, body movements, and gestures to match or
complement the musical\poetic feelings expressed by the
mother. As infants become more energetic and alert,
mothers songs and games become more lively. They
develop ritual forms which are often repeated, to the
great satisfaction of infant and parent. The mood of the
mothers performance changes with the state of alertness
and humour of the baby, and reacts with a soothing,
calming mode when the infant is tired or distressed. The
songs can modulate the emotional state of the infant and
the 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. Play
songs are associated with increased alertness to the
external world and joint attention, whereas lullabies
result in more self-focused infant behaviours (Rock,
Trainor, & Addison, 1999). These developments parallel,
or accompany, changes in the ways parents talk to older
infants, conspicuous changes occurring in both musical
forms of play and in the affective and directive forms of
speech in different languages, first towards 3 months, and
then between 9 and 12 months (Kitamura & Burnham,
2000 ; Thanavisnuth & Luksaneeyanawin, 1998 ; Trevarthen & Marwick, 1986). There are interesting sex
differences in these developments, indicating not only
that females may be developing slightly ahead of boys in
communication, but that they are more responsive of and
stimulating to both affective and directive functions of
mothers speech after 9 months (Kitamura & Burnham,
2000 ; Masur, 1987 ; Papaeliou, 1998 ; Thanavisnuth &
Luksaneeyanawin, 1998).
Just as infant-directed speech and singing tends to be
higher-pitched, slower in tempo, and more repetitious in
content than talk addressed to older children or adults
(Trainor, 1996 ; Trehub et al., 1997), infants responses to
female singers confirm that parents propensity to interact
with infants using a higher vocal range is paralleled by the
infants preference for higher-pitched singing (Trainor &
Zacharias, 1998). However, further investigation has
shown that infants are not interested so much in the pitch
of singing per se. They are perceiving and mirroring the
narratives of emotion in the voice, as we explain below.
The intuitive time-patterns and motive contours of
protoconversation and mother-infant games can be carried by any means of sensory-motor contact. A recent
study focused on the importance of variations in maternal
touch and hand gestures during interaction with infants
(Stack & Arnold, 1998). Sixty mothers were videotaped
with their 5"-month-old infants during four phases of
#
interaction. At certain times they were instructed to use
only touch and gesture, at others to attend to the infants
face, and at others to engage in normal interaction with
their infants using vocalisation as well. Mothers were able
to engage successfully with their infants using touch and

INFANT INTERSUBJECTIVITY

gesture alone. This is in accord with studies of the

rhythmic tactile forms of communication that familiar
and experienced partners use to make contact with
profoundly mentally handicapped children or young
adults (Burford, 1988, 1993 ; Burford & Trevarthen, 1997 ;
Trevarthen & Burford, in press), as well as the findings of
research into the most effective ways of supporting selfregulation, communication, and cognitive development
in infants and children with sensory loss, including those
both deaf and blind (Tnsberg & Hauge, 1996).
Research on infants attentions and preferences brings
evidence that the essential features of what we may call
the intrinsic motive pulse (IMP) of musicality (Trevarthen, 1999 a) are possessed by infantsthey are shown in
play with adults, or when infants are responding to
artificial fragments of musical sound in laboratory tests.
Infants listen with perceptive preferences to the melodies
of speech, singing, and music, and songs and music make
them 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,
1986 a, 1987 ; Trevarthen et al., 1999 ; Zentner & Kagan,
1996).
Twenty-five years ago, Condon and Sander (1974)
reported entrainment of newborn arm movements to
the syllabic rhythms of adult speech in any language.
Since the infant can generate the same arm rhythms
without any external guide (Trevarthen, 1974, 1984 b, c ;
Von Hofsten, 1983), this coordination is evidently not a
passive locking-on of the infant to the adult pacemaker , but a sympathetic and flexible cross-modal, or
amodal (aud6itory to proprioceptive, and possibly to
visual) monitoring of actively generated impulses in
infant and adult (Trevarthen, 1986 a ; Trevarthen et al.,
1999). In early protoconversations, when the infant is 6
weeks old, alternation or turn taking on a slow adagio
(1 beat in 900 milliseconds or 70\minute) is set up. Within
a month or two, in animated games, the beat of shared
vocal play with an infant accelerates to andante
(1\700 milliseconds ; 90\minute) or moderato (1\500
milliseconds ; 120\minute). Different qualities of engagement are determined by shared emotions organised
mutually in the communications. Homologous feelings
and changes in affect of infant and caretaker generate
harmony, sympathy, support, comfort, restraint, or
antagonism.
In the first 6 months, the emotions become strung
together in increasingly impassioned plots , in which
protagonists play expressive parts to each other. Stern
describes feeling qualities transmitted with distinctive
activation contours, which are captured by such kinetic
terms as crescendo, decrescendo, fading, exploding, bursting, elongated, fleeting, pulsing,
wavering, effortful, easy, and so on (Stern, 1993,
p. 206). In Sterns terms, these give vitality forms to
the emotions (vitality affects), which would seem to be
homologous with the sentic forms described in musical
expression of feelings by Manfred Clynes (Clynes, 1980,
1983 ; Clynes & Nettheim, 1982). The intuitive parenting
behaviour of a father or mother at play with an infant
shows that the adult is sensitive to the infants emotion
and unconsciously skilled in giving the right level of
emotionally coloured contingent responses (H. Papousek

13

& Bornstein, 1992 ; H. Papousek & Papousek, 1987 ; M.

Papousek, 1996 ; Stern, 1971, 1974, 1992, 1999).
Laboratory tests have proved that, by the middle of the
first year, infants hear musical parameters amazingly well
(Demany, 1982 ; Trehub, 1987 ; Trehub et al., 1993, 1997 ;
Zentner & Kagan, 1996), and they show preferences for
these same parameters in the vocal productions of
mothers (DeCasper & Fifer, 1980 ; Trehub, 1990 ; Fassbender, 1996 ; M. Papousek, 1994, 1996). It seems that the
infants acute ability to hear musical elements in a
mothers voice is important for state regulation by the
mothers sympathetic response to the infants expressions
of arousal, fretfulness, tiredness, playfulness, joy, etc. (M.
Papousek & Papousek, 1981). But the infant is not just
responding to the mothers signals with a reflex state
change, and the adult is responding to the rhythms and
emotional quality of the infants expressions in a joint,
two-way performance . They are musicking performance and listening together (Small, 1998). The
mother is attuning to musicality in the infants expressions and communicating with the infant (M. Papousek, 1994, 1996 ; H. Papousek & Papousek, 1987 ; M.
Papousek & Papousek, 1981, 1989 ; Stern, 1993, 1999 ;
Stern et al., 1985).
Sustained orienting of the babys head towards a
loudspeaker that is presenting preferred sounds has been
used to show that infants 4 to 8 months old can
discriminate melodic patterns independent of pitch, and
melodic contours with variation of intervals (Chang &
Trehub, 1977 a ; Trehub, Bull, & Thorpe, 1984 ; Trehub,
Thorpe, & Morrongiello, 1985, 1987 ; for a synthesis, see
Trehub et al., 1995). Trehub (1990) concludes that
infants representation of melodies is abstract and adultlike (p. 437). It has been shown that infants can
distinguish pairs of notes separated by one semi-tone, and
they can recall a melody based on the tones of the major
triad better than one that is atonal. Other tests demonstrate that infants are sensitive to tempo and to
rhythmic sequences independent of tempo (Trehub &
Thorpe, 1989), and that they experience Gestalt grouping effects like adults (Chang & Trehub, 1977 b ;
Demany, 1982 ; Demany, McKenzie, & Vurpillot, 1977 ;
Fassbender, 1993 ; Me! len, 1999 a, b ; Thorpe & Trehub,
1989 ; Thorpe, Trehub, Morrongiello, & Bull, 1988).
They respond to fundamental pitch independent of tonal
composition (Clarkson & Clifton, 1985), perceiving and
categorising differences in timbre of nonspeech tones
(Clarkson & Clifton, 1985 ; Clarkson, Clifton, & Perris,
1988 ; Trehub, Endman, & Thorpe, 1990). They are
sensitive 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 on
human voices that the design features of infant music
should embody pitch levels in the vicinity of the octave
beginning with middle C (262 Hz), simple contours that
are unidirectional or that have few changes in pitch
direction (e.g., rise-fall), slow tempos (approximately 2n5
notes\sec), and simple rhythms (Trehub, 1990, p. 443).
These predictions match well the vocal patterns infants
produce in song-like play, the prosodic patterns parents
use to excite or calm their infants, and the songs that
adults sing to infants (Fernald, 1992 a ; 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).

14

C. TREVARTHEN and K. J. AITKEN

Self-awareness and Self-other Awareness : Showing

off, Stranger Fear, and Privileged Relationships for
Emotional Attachment, and for Companionship in
Experience
Two-month-old infants may show coyness when encountering their own reflection in a mirror (Reddy, 2000).
Older infants play with the fun and deceit of interactions
in teasing games (Nakano, 1994 ; Nakano & Kanaya,
1993 ; Reddy, 1991 ; Reddy et al., 1997). When they play
with reactive mobiles, this seems not simply a response to
contingency of physical motion, as Watson (1972, 1984 ;
Bahrick & Watson, 1985 ; Gergeley & Watson, 1999) has
proposed, nor just another kind of exploration of the
embodied, proprioceptive self (Rochat, 1998). Rather it is
an imaginative variant of the capacity for intersubjective
negotiation, as H. Papousek (1967) demonstrated when
he showed that 4-month-olds made communicatively
appropriate emotional reactions to success or failure in
predicting the behaviour of a reactive physical system,
showing their motivation in a human way. Play is more
lively and more satisfying for the infant with a partner
who is not merely moving with mechanical contingency,
but also varying the contingency and qualifying the
moves of self and other with mock expressions of surprise,
anxiety, joy, etc. The emotions communicated are essential to thefull game between two humans. An infant
playing with a reactive mobile is as if with another
personhe or she being other-aware, as much as a kitten
batting after a paper ball is chasing prey (Hall, 1998).
Sterns dynamic affects describe transforming states
that continuously and rhythmically synchronise and
regulate the flow of play (Stern, 1993). They give
communicative meaning to the discrete action patterns
shown in photographs of the climax facial expressions
(Ekman, 1993) representing the categorical affects of
anger, joy, sadness, disgust, fear, and surprise. Such
visible and static forms of emotion punctuate a dynamic
music-like expression of interpersonal feelings in the
voice, and the dance in body movement and hand
gestures. Even in newborns, expressions of emotion in
communication are blends, and the succession of changing expressions is a central component of the message
(Oster, 1978 ; Oster & Ekman, 1978). Analysis of DTV
recordings, and the effects of replay, clarify this point
(Murray & Trevarthen, 1985 ; Trevarthen, 1993 a, b ;
Nadel, Carchon, et al., 1999).
Alternations of address and reply, of asserting and
apprehending or attending (Trevarthen et al., 1999),
between the infant and an adult in a conversation game,
are animated by continuously changing and contingently
exchanged expressions of mixed relational emotions
smiles and laughter signalling joy in sharing, bold and
mock-angry threats as self-assertion, looks away and
frowns of impatience reacting to intrusions, fear to signal
the impact of strange and startling events, pouts and cries
of 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 easily
described by combining the classical discrete categories of
emotion. They are coherent, so-called non-basic emotions
with immediate interpersonal value, as discussed below.
Mutual attunement of dynamic feelings and imitation
of actions and expressions regulates sharing, or rejection,
of purposes. The infant can imitate, reply to, or ignore a
partner, or show decisive avoidance. The adults play
often seems designed to challenge the assertive inde-

pendence of an infant. Parental teasing games, characteristic of good relationships, demonstrate this negotiation. Infants, also, tease their companions, especially
after 3 months, and this behaviour, with early demonstrations of coyness (Reddy, 2000), proves that infants
already have an expectation of and interest in what the
other may perceive and do, an other-awareness (DraghiLorenz, Reddy, & Morris, 2000 ; Reddy, 1991, 2000 ;
Reddy et al., 1997).
Infants may react to others attention with self-testing
gestures and display, creating socially conscious mannerisms or bearing, which Wallon (1928) called, in French,
prestance : i.e., offering the self to others by assuming a
ceremonial posture or manner, acknowledging a public
and their formal or intuitive appreciation. Six-montholds often show off, making exaggerated postures or
grimaces, displaying imitated trick behaviours, such
as head shaking, bouncing, hand-clapping, silly faces,
shouting, theatrically coughing or squealing, and they
repeat appreciated behaviours to amuse themselves or
familiar companions (Reddy, 1991 ; Trevarthen, 1990 a,
1998 a). Infants also turn these display behaviours to face
a mirror, examining themselves with amusement and
displaying lively postures and hand gestures, which
indicates that this kind of self-consciousness is part of the
awareness of others (Fiamenghi, 1997 ; Reddy, 2000 ;
Reddy et al., 1997 ; Trevarthen, 1986 b, 1990 a ; Trevarthen et al., 1999). Siblings, and adults, take up the
developing sense of fun to make the infant laugh with
mock attacks and exaggerated comments, and this
evidently can assist development of the infants social
understanding and social expression (Dunn, 1994 ; Nadel
& Tremblay-Leveau, 1999). Expressions of these subtle
kinds gain value in the more intricate negotiations of
triads, such as mother-father-infant interactions (FivazDepeursinge & Corboz-Warnery, 1999) or those between
an adult and two infants (Nadel & Tremblay-Leveau,
1999).
Infants also develop, at about 7 or 8 months, both
stronger attachment to the mother and increased
stranger fear (Ainsworth & Bell, 1970 ; Sroufe, 1977,
1996). These developments, viewed in the whole context
of infants social behaviours at this age, appear to be
elaborations of motives that prepare for cooperative
learning in specific relationships, i.e. of conventional
behaviours and symbols that are meaningful with known
companions (Trevarthen & Logotheti, 1987). First meanings make sense only in the restricted culture of the
family, and an infants learned tricks and mannerisms are
likely to be misunderstood by unfamiliar persons, who
may, quite sensibly, be regarded with suspicion. In the
last months of the first year imitated behaviours are
readily incorporated in delayed reproductions (Meltzoff,
1995 ; Meltzoff & Moore, 1999 ; Trevarthen, 1990 a),
which proves their role in the development of arbitrary
symbolic representations (Akhtar & Tomasello, 1996 ;
Nadel & Butterworth, 1999 ; Piaget, 1962). Games with 6month-olds increasingly involve objects (Hubley & Trevarthen, 1979 ; Pecheux et al., in press ; Trevarthen &
Hubley, 1978), and infants take more opportunities for
joining their exploration of the private knowledge of
things with the social experience of being an actor.
Imbalance in the complex of motives emerging at this
time in a disordered brain mechanism of intentions and
intersubjectivity may be the principle factor precipitating
diagnostic features of autistic behaviour, which we
discuss further below (Hobson, 1993 a ; S. J. Rogers,

INFANT INTERSUBJECTIVITY

15

Figure 2. Intrinsic motives coordinate three types of engagement of a human subject with the body and the outside world :
AProcesses that regulate the physiological functions of the body maintain the subjects organismic integrity and sustain vital
functions ; BEngagements with physical objects and situations assume anticipatory control over the effects of actions, aided by
perception of the properties of the objects and surroundings and what they afford for different purposes ; CCommunication with
other subjects, and any adjustment to their behaviour, must take account of their purposes and awareness. This communication and
anticipation of other subjects behaviour is aided by perception of their motives and emotions, which are detected by perception of
movements and autonomic adjustments that prepare for critical intentions to be carried out. Combinations of these three kinds of
motive generate three domains of subjective and intersubjective life : IIndividual subjects can act on the physical world to benefit
their existence as organisms, evaluating objects and situations in terms of their usefulness for nutrition, self-protection, comfort, etc. ;
IIAid from other subjects may be enlisted to benefit individuals state of wellbeing or comfort. The kind of relationship described
as Attachment between a child and caregiver is of this kind ; IIIWhen subjects act collaboratively with joint and mutually aware
interest 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 usually
becomes evident in, or before, the second year ; it cannot
take on the appearance of a disorder in a verbalisable
theory of mind (Baron-Cohen, Leslie, & Frith, 1985) until
many months later. Nor is the investigative 1-year-old
only concerned with mastering object concepts. Through
sharing protoconversation and play with other persons
motives, understandings, and purposes, learning becomes
a part of intentional self-regulation with relation to things
and events, and self-other regulation with persons (Aitken
& Trevarthen, 1997 ; S. J. Rogers, 1999).
We distinguish three directions of a subjects mo-

tivation, or anticipation of regulation and experience : in

ones own body, to objects, and to other persons, and
there are three corresponding functions of emotion
(Trevarthen, 1993 a, 1998 a, in press ; Trevarthen &
Hubley, 1978). These, we propose, by their regulated and
responsive interactions, give the fundamental organisation to the changing consciousness and learning of
infants, as diagrammed in Fig. 2. At times the mind of the
infant and young child is more taken up with intrinsic
problems of self-regulation and self-organisation or
autopoesis . Other periods of experience are cognitively
directed to investigate physical objects, to perform
operations on them, and to learn their substantive

16

C. TREVARTHEN and K. J. AITKEN

properties and processes. Then again, the infant may be

seeking to share experiences, purposes, and the exploration of meaning in conscious companionship with other
persons. There is evidence that motive transitions and
PRCs that lead to advances in motives and behaviours
may be coupled to difficult or regressive periods at
particular ages when the infant becomes more demanding
of the main caregivers attention and has difficulty with
equilibrating emotional states, and with internal autonomic states and sleeping (Brazelton, 1993 ; Trevarthen
et al., 2000 ; Van de Rijt-Plooij & Plooij, 1993) (see
Fig. 1).

Socioemotional Learning, Shared Narrative

Awareness, and First Comprehension of Words
At the same time as it provides for joyful sharing of
feelings and for teasing games, intuitive parenting (H.
Papousek & Papousek, 1987) is clearly adapted to guide
the child towards customary ways of appraising the
world, proper use of objects, and communicating in
socially approved ways. By 6 months infants are capable
of reproducing routines learned in musical\rhythmic play
or other structured games as gestures of communication
by deferred imitation (Nadel & Butterworth, 1999 ;
Trevarthen, 1990 a, 1998 a, p. 40). These behaviours are
not simply imitations of the forms of procedures or
mannerismsthey are significant, emotionally charged
interpersonal messages or displays, as, indeed, all infants
imitations tend to be in some measure from the earliest
days (Kokkinaki, 1998 ; Trevarthen et al., 1999).
In the intimate relation with a parent or other familiar
companion the infant can take the role of instructor or
informer to the adults communications. This is very clear
in the developments of parental expressive behaviours
and speech in musical and other games around the middle
of the first year, and also in the further transformations of
the adults speech acts when the infant becomes adept at
following and cooperating with pointing and instructions,
led by the adults changing tone of interest and satisfaction. Before 40 weeks, when the critical development
in infant cooperativeness normally occurs, mothers tend
to ask many questions and to use many provocative or
inviting forms of utterance to attract the childs attention
and to give pleasure, such as rhetorical questions, play
comments, exclamations, and mock emotional outbursts.
After the infant becomes attentive and compliant to the
mothers 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. In
a sense, the infant gives an external curriculum of motive
changes for the parents intuitions to follow, and this
curriculum changes intrinsically as the infant develops. It
is not simply a reflection of what the infant has been
taught.
A toddler picks up language sociallyby doing things
with 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 9
months of age, to think only about what is called language
pragmatics the factors that govern choice of language in social contexts. The origin of the word from Greek
pragmatikos implies an expertise taking practical account
of real, factual situations, and accepted principles of
conduct. When children are negotiating ongoing activity,

participating in social routines and well-practised formats, or regulating mutual attention, they carry out these
intentions with intersubjectively regulated feelingbeing
serious, acting silly, expressing enjoyment or exuberance,
teasing. Acts by means of which toddlers negotiate
motives of social participation are found to come earlier
in development than intention-directing protoimperatives (Ninio & Snow, 1996 ; Snow, Pan, Imbens-Bailey,
& Herman, 1996), just as person-person games come
before person-person-object games in the middle of the
first year (Trevarthen & Hubley, 1978). Meltzoff (1985 b,
1995) has noted the importance of deferred imitation in
the developing understanding of others intentions in the
second year of infancy. Reproduction of the act checks
the original purpose.
Language pragmatics carries implications of rational
objectivity that are especially unfortunate in application
to the early protolanguage communications of infants.
In the social life of a 1-year-old, communication with
other persons is primarily concerned with how the relationship offers opportunities for taking part in intentions
and attentions with the emotions that accompany them
(Papaeliou, 1998). What is important in a protolanguage
sign or act of meaning is not the fact referred to, or
even just the social convention of its form, but the
sympathy and aspects of intersubjectivity exhibited in the
looking, gesturing, and vocalising (Halliday, 1975). Infants can use others as conditions or context for the
implementation of their will, but their behaviours have
intrinsic interpersonal valueas irony, humour, or teasing, for example. Infant semiosis is emotional, not just
representational or referential (Trevarthen, 1994). It is
fundamentally self-with-other-referred , and from that
as foundation it can become self-object-referred or
gain a practical objective. It is metacommunicative, in
Gregory Batesons sense (1956), before it is metacognitive.
Even among adults, much of language is not so much
for practical use, the applying of purposes to reality. Nor
is it just governed by rules. It is social in the sense that it
is interpersonal, emotive, relational, intersubjective
concerned not with the truth of a context and its
constraints or usable affordances, nor so much with
maxims of speaking, but with impulses and emotions in
immediate human contact while imaginations are actively
running ahead of purposes (Rommetveit, 1979, 1998).
Much confusion has been generated by attempting to
explain the early stages of language learning as a matter
of coordinating vocalisations just with referential intentions and attentionsrequests, pointing, showing,
givingwithout concern for the human feelings and
sensitivities which form the dynamic texture of all live
communication and experiencing together . Joint attention, which is strongly associated with the picking up
of 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 sight
and directions of instrumental action. It depends on the
motives for doing while child and partner are attentive to
one another in communication.
Nadel (Nadel, Gue! rini, Peze! , & Rivet, 1999 ; Nadel &
Peze! , 1993 ; Nadel & Tremblay-Leveau, 1999) has demonstrated the importance of immediate imitation among
toddlers, including imitation of utterances, for the sharing
of meaning, and she underlines the pleasure and humour
of the sharing. Emotional narrative, the dramatics of
expressive intentions, may even provide the underlying

INFANT INTERSUBJECTIVITY

energy of the relatively inanimate, decontextualised, or

disembedded (Donaldson, 1978), language of informative
text or prepositional logic. Human stories (including
scientific theories, which are just explanatory stories
wherein emotive aspects have been disciplined !) seek
joint imaginative, and emotive, experiences that evolve
their purposes far beyond the present context and explore
ideas 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 in
the drama of make-believe (P. L. Harris, 1998), and even
infants seem to be playing with narratives of emotion
long before they can talk (Malloch, 1999 ; Trevarthen,
1987, 1998 a, 1999 a). Both the emotional process and the
form of the action are certainly important in toddlers
sense of play, and both are shared.
Emotional intonation in speech to infants prepares a
path to the meaning of words. Kitamura and Burnham
(1998 b) used the preferential looking paradigm to show
that 6-month-olds prefer high affect speech of a
female actor with good voice control who had been a
nanny and was therefore practised in IDS. She recorded
simple utterances with high and low affect, and high and
low pitch. The infants oriented to the affective content,
and in certain instances, low-pitched utterances were
preferred. The authors concluded that the affectionate
tone is, the pivotal quality that attracts infant attention , and that, the exaggerated intonation of IDS
may normally be used as a vehicle to convey such affect to
infants (Kitamura & Burnham, 1998 b, p. 234). They
compared infants reactions to normal full-spectral IDS
and filtered speech in which only the intonational features
were preserved, and found that filtered speech is as
interesting to 6-month-olds as full spectrum speech. The
infants were attending to speech, as a communicative
signal rather than a linguistic signal. Thus, IDS
potentially accommodates early cognitive and linguistic
limitations, not only because this quality is more capable
of gaining infant attention, but also because maternal
affective expression provides a primitive method of
conveying meaning to the pre-lingual infant, an essential
first step in developing a facility for processing language
(p. 235).
Although it had been claimed that very young infants
may be more responsive to the spectral complexity than
the intonation contour of IDS (R. P. Cooper & Aslin,
1994), and that exaggerated intonation accommodates to
the immaturity of the infants attention and perception
(Fernald, 1984, 1992 a), affect is demonstrated to be more
important than heightened frequency characteristics. As
the developmental linguistic Locke has proposed, Affect
is logically necessaryit impels the child to exploit and
therefore to develop linguistic capacity (1993, p. 330).
Adults speaking affectively and with attention to the
responses they receive stimulate infants to enhance their
communication skills, and language development is
slowed if affect communication is reduced, as in the case
of post-natal depression, discussed below. IDS can
regulate and modulate infant behaviour, comfort distress,
gain attention, convey emotion, or direct behaviour
(Kitamura & Burnham, 1996).
Mothers vocalisations to infants can be compared to
the graded system of vocal signalling in highly evolved
social animals. In humans, the brain mechanisms of these
social signals are presumed to be largely subcortical,
because the cortex is very immature in young infants

17

(Lecours, 1975), and homologous structures are used by

higher primates in the production of the modulated
signals used in social and territorial settings (Marler,
Evans, & Hauser, 1992 ; Ploog, 1992). Species-specific
vocalisations of higher primates convey nuances of
affective and communicative intent similar in form to
those important in speech to infants (Fernald, 1989,
1992 b ; Kitamura & Burnham, 1996 ; H. Papousek, 1996).
The infants responses to this kind of speech are socioemotional. They can be modified culturally, but they have
an innate basis, which needs more study.

A Theory of Behaviour in Relationships

Motives in Animal Subjectivity and Intersubjectivity
Animals actively investigate environmental information, provoking experience. They search for particular
benefits that are defined as the goals of behaviour by the
structure and process of their motives. Motives initiate
coordinated whole-body movements of the kind that
engage with the environment, and muscular partial
adjustments, such as looking with the eyes, turning the
head to listen, or reaching to touch with the fingers. The
latter anticipate and gate information from the senses
that may be needed to guide the next body movements
(Trevarthen, 1978). Motives define perceptual affordances prospectively (Lee, 1993). Coherent purposiveness
in time and space and selective interest are necessarily
founded on innate, adaptive psychoneural functions that
map the body with its motor potentialities and receptors
and that form inherited behaviours and set up environmental readiness for learning, and this applies to communication movements as well as to behaviours for the
individual alone (Trevarthen, 2001).
The physics of an animals body determines how it
must function psychologically. First, everything that the
animal does is conditioned by the form, mass, and motor
capacities of its body. Second, effective regulation of
actions will depend upon a vital integration of internal
physiology and visceral or autonomic states with the
energy-expending forces of the body moving in its
perceived world. Subjects are coherently motivated to
exploit the benefits that the environment affords, and to
do this effectively they must anticipate the consequences
of their movements, both for their internal state of
wellbeing, and for their future situation in the world. This
essential anticipatory function of intelligence means that
what a subject perceives is powerfully conditioned, from
the outset, by how it chooses or plans to move. Intrinsic
spatiotemporal, body-related determinants of movement,
i.e. motives and motor images, will evoke and shape the
subjects awareness. This aspect of perceptual and cognitive processes has been addressed by motor theories of
reafferent perception (Bernstein, 1967 ; Jeannerod, 1994,
1999 ; Sperry, 1952 ; Von Holst & Mittelstaedt, 1950).
A consequence of the necessary prospective control of
movement, geared to environmental affordances (Gibson, 1979 ; Lee, 1993), is that the behaviour of the animal,
the way its body acts, makes its consciousness evident.
The causal processes in an individuals vital
subjectivityintentional, goal-directed agency ; active
and selective awareness ; motives of seeking and avoiding ;
emotional expressions that reflect internal state and
autonomic regulationshave the potentiality to become
information for another similarly endowed subject about
what the acting subject is doing, or about to do. The fact

18

C. TREVARTHEN and K. J. AITKEN

that a subjects purposes, experiences, and emotions can

be read by other subjects through the visible, audible,
mechanical, and chemical signals produced by an active
body means that reactions of these other subjects can
become part of the process that directs and reinforces
learning in the reader or audience of the message. Two
subjects can potentiate one anothers action, consciousness, and memory.
Intersubjectivity in animals is a direct consequence of
the regular polarity, symmetry, and special patterning of
their inherent body form, and of the rhythmic dynamics
of their motivation in awareness, both of which are
accentuated in social signalling to conspecifics (Trevarthen, 1998 b). Subjective purpose is signalled by the
rhythms of movements, mirrored in the displacement of
body parts that signify a directed awareness, and anticipated in selective orientations. The mind is extended
beyond the body, interwoven in increasingly intricate
ways with the environment (G. Bateson, 1973). Its
manifestations are picked up by other individuals who
possess contingent responsiveness and a capacity for
transferred initiatives, or cooperative intentionality.
Autonomic (visceral) self-preserving and reproductive
regulations are elaborated into an emotional signalling
mechanism (Panksepp, 1998 a), which evolves in the more
highly cooperative species into a powerful control of
relationships and attachments by negotiatory self-other
(complex) emotions (Porges, 1997), and this produces a
sympathy of emotional states or a fundamental morality
in the life of the group. The evolution of social signalling,
and of social cognition, generates increasingly subtle and
detailed evidence on motive dynamics that reveal subjects purposes and awareness. In humans intersubjective
awareness motivates cultural learningthe intergenerational transmission of knowledge and skills with all the
conceptual and material consequences.
A human body has exceptionally elaborate motor
potentialities, and unique polyrhythmic coordination of
expression (Trevarthen, 1999 a). In the first, highly
dependent, infant period it is clear that movements of
communication, of mental engagement with adult caregivers and siblings, by vocalisation, facial expressions,
and gestures of the hands, develop before observational
and manipulative investigations of objects and events,
and both these long precede the ability of the child to
stand and walk. It is as if the evolutionary process has
been reversed in individual ontogeny, but the logic or
strategy of this development fits with the general principle
that intrinsic motives provoke and guide acquisition of
more specialised cognitive and motor representations.
This evolutionary advance in innate psychobiological
processes, which may be observed to have its origins in
the evolution of social intelligence in many other species,
and most notably in subhuman primates, especially
chimpanzees (Bard, 1998 ; Bard & Russell, 1999 ; Butterworth, 1999), creates a new potentiality for imitation and
learned consciousness (Byrne, 1998 ; Go! mez, 1998 ;
Whiten, 1991). In humans it motivates use of artificially
created meanings and technologies that have been accumulated over generations (Donald, 1991 ; Uzgiris, 1999).
Thus, human intersubjectivity is conceived as a process
that makes it possible for subjects to detect and change
each others minds and behaviour, by purposeful, narrative expressions of emotion, intention, and interest. It
is also the avenue by which any theory of mind or
intellectual and reflective description of consciousness,
purposeful intelligence, and language may be acquired.

Since emotions are the essential regulatory factor in

intersubjective contact, expressed emotions are fundamentally dialogic or between persons, in same sense that
Bakhtine (1981) treats all thought as dialogiceven
monologue. Turner (1996) proposes that literary, metaphorical powers are the basis of everyday thought in the
ordinary human mind. He concludes that cognitive
psychology and psycholinguistics has been looking in the
wrong places for answers to the basic questions about
meaning, mind, and language.

The Problem of the Initial State of the Human

Mind
In their abstract discussions of the nature and origins
of subjectivity of self-consciousness, philosophers encounter many disagreements, and in the social sciences
(Social Psychology, Sociology, Anthropology) there is
confusion about the original nature or initial state of the
human subject. Most academics in these disciplines,
insofar as they consciously address the problem, are
inclined to give full responsibility for all conscious
civilised and ethical attributes of persons to experience
gained after birth, and preferably to linguistically mediated learning late in childhoodto the systematic or
casual picking-up of the verbal record of arbitrary
conventions of the culture and beliefs of the society in
which children are brought up. Inevitably, the place of
the infant in both the natural philosophy and the scientific
theory of subjectivity is anomalous. Between the reductive certainties of medical science, which treats the
infant as a biological organism that may develop disorders requiring treatment, and the social sciences, which
can only note the absence of all cultural knowledge and
skills in the infant mind, the state of that mind is left in the
dark. Piaget, early in his career, called it une ab# me de
myste' re .
As we have shown, accurate recordings of the initiated
activities, oriented movements, preferential awareness,
discriminating subtleties of emotional expressions, and
contingent responses to the behaviour of other persons
can solve the riddle. There is actually abundant evidence
in the spontaneous behaviours of a newborn infant for a
well-integrated psychological statefor subjectivity, and
for intersubjectivity (Trevarthen, 1999 b).
In the past century, more and more evidence of inborn
behavioural and perceptual abilities has had to be granted
to the infant. But there remains the one fundamental
disbelief ; it is inconceivable for many specialists in the
sciences of human mental development that an infant
could be conscious of another persons subjectivity. For
this we see a cultural-historical explanation. Post-enlightenment psychology has been developed and employed to provide ways of measuring the discriminations,
interests, skills, and individual differences in intelligence,
personality, and mental health, of the individual selfor
of social collections of selves as subjects of conventional
understanding. Communication is understood as transfer
of information, and its processing is linguistic. Language
productions are objects (texts) of special interest in
society, where they are constructed and learned, or they
are the outcome of a rational instinct for generation of
linguistic structures (Pinker, 1994) rather than the natural
behaviour of persons who actively seek mutual awareness
while living and moving together. The same is true for
music, which is treated as a thing that has to be acquired
by training of perceptions and performance, not as a

INFANT INTERSUBJECTIVITY

universal human activity, something humans do (Blacking, 1976 ; Small, 1998).

Psychological research, including neuropsychological
and neurophysiological research linked to medical
science, especially that in psychiatry, has built an impressive set of models for the working, and malfunctioning, of the individual mind. The subjects or patients
self, often an unhappy and subjectively challenged one,
remains the privileged unit, and most of his or her
attributes are accounted for in mechanistic terms related
to the cognitive processing of stimuli, regulations of
cognitive effort and efficiency, or the neurochemistry of
self-regulating emotions. Both motor activity and
emotions are viewed as products of cognition, learning,
and memory that serve self-preserving physiological
needs and physiological regulations, using environmental
resources. Motives and emotions are not, in themselves,
plausible, objectively acceptable, psychological causes.
Not surprisingly, evidence that an inexperienced infant
can both be conscious of the mental states of another
person, and react in communicative, emotive ways to link
their subjectivities, has been rejected. Indeed, many
research projects have been motivated, overtly or unwittingly, to disprove any such proposition, calling the
evidence subjective, uncontrolled, or not empirically
verified. It has not been difficult to outwit the infant with
reduced (controlled) conditions that are unnatural with
relation to any subtle motives that might enable sympathetic encounters between the infant and a person. The
model of the infant as organism or cognitive processor
leads easily to tests that merely seek to stimulate and
observe orientations and responses of either a physiological or instrumental kind to some environmental event,
the objective being defined a priori by the experimenter.
Comparative functional anatomy of the brain and
body in different animal species, and especially developmental comparisons through the earliest embryo stages
of the human brain, when the most powerful genetic
constraints on cell activities in the organism are operating
and the cerebral cortex does not yet exist, invite a much
more generous interpretation of innate functions that
anticipate experience of, and selective action on, the
environment (Trevarthen, 2001). However, medical
science of the human brain is channelled, in the main, to
analyse all conscious mental functions as attributes of the
cerebral cortex, which is relatively unformed at birth, a
bias sustained by available technologies of electroencephalography and functional brain imaging. Other
more comprehensive means of investigating cell processes
and system functions in the deeper parts of the brain yield
their evidence slowly (Panksepp, 1998 a). Moreover,
neuropsychology has grown up as a discipline that applies
laboratory measures of performance indicative of perception, cognition, and memory, testing single subjects
who have suffered local brain dysfunction or trauma, to
determine the localisation of higher functions in the
cerebral cortex. And scientific psychiatry is more focused
on neurochemical perturbations of neural functions than
on the intracerebral organisation of motives that seek
human sympathy. In consequence both emotional and
intentional processes are not well understood. These
are likely to be the very same psychological activities that
an infant should possess in the form of impulses to
investigate the world and regulate experiences, especially
experiences of the persons who are to be their familiar
protectors and teachers.
If infants have intersubjective capacities as part of their

19

natural intelligence, this talent has implications for the

theory of the origins of the human mind, for education
and for explanations of both socioemotional and cognitive pathology. It is incompatible with extreme reductive (nature limiting) environmentalist theories of the
construction of human intelligence by either the selfgenerated experience of the child, or by parental shaping
or instruction of rudimentary infantile intentions and
consciousness.
A recent summary of evidence concerning the development of social cognition by Rochat and Striano
(1999) clearly presents the view that infants under 2
months lack coherent conscious and self-awareness. The
research data in support of this empirically based
account is mainly concerned with changes in visually
directed behaviour. Reactions to auditory stimulation,
especially to human voices, are not covered. The descriptions given of neonatal behaviours and of selective
looking and listening in the first 2 months are selective.
There is said to be a dramatic 2-month (6-week) transition
to a contemplative stance as reflex smiling gives way to
externally elicited smiling, a positive emotional display
oriented outward. This is described as the psychological
birth of the infant, which is accompanied by a sudden shift
in state regulation, as the infant spends more time in an
awake-alert state attending to and processing (visual)
information form the outside world, scanning displays
for detail more critically. Crying and fussing is more
instrumental, modulated by environmental and social
factors . In all, this change is taken as the true origin of
social cognition . The theory of Johnson and Morton
(1991) that the infant has an instinctive, prewired subcortical mechanism for (visual) detection of and orientation to the human face, in some of its salient features,
called CONSPEC, and that this is transformed by
emergence of a neocortical learning mechanism
CONLEARN, finds support from the mistaken contention that there is no detection of similarities and
differences between faces before the 2-month transition.
Neonatal imitation is explained as the consequence of
facial displays triggering a preorganised fixed action
pattern, the infant being not actively engaged , showing
only a form of response that does not call for awareness . Regarding the development of active probing for
perceptual information, which is taken to require higher
perceptual and cognitive mechanisms , this is, Rochat
and Striano say, to our knowledge not demonstrated for
new-borns . Data showing that after 2 months infants
are more deliberate in their exploration and instrumental
use of perceptual experiences, or more controlled exploration of self-agency, is taken to indicate that they
lack this capacity in the neonate stage, even though
newborn infants have been demonstrated as capable of
operant learning in, for example, speech-sound discrimination (DeCasper & Carstens, 1981 ; Fifer & Moon,
1995 ; Hepper, 1995).

Nonbasic Emotions Have Primary Functions

In a recent critical review of theories of emotion in
infancy, Draghi-Lorenz, Reddy, and Costall (2000) show
how the dominant individualist and cognitivist position
in academic psychology has accepted the Cartesian
distinction between emotions and thinking. Emotions, in
this view, are assumed to arise from primitive physiological regulations of the organism, inside the body, and
thought or reason requires the acquisition of represen-

20

C. TREVARTHEN and K. J. AITKEN

tations and logical operations concerning (describing and

explaining) the outside world. These representations
generally assume forms essentially identical with the
semantic representations and grammatical or syntactic
rules of language or other symbol system. Their selfconsciousness is verbal and reflective rather than intuitive
and enactive.
This dualistic theory of the thinking mind assumes that
an infant, initially, and for some ill-defined period
(usually taken to be years rather than months because
children do not speak in the first 2 years), lacks all
representation of a thinking (reflective) self. The mind of
a young infant cannot separate its functions from the
automatic, reflex, biological reactions to stimuli of
environmental origin, and therefore cannot, of course,
conceive (reason or theorise about) any condition of
relationship to an other. The logic is somewhat circular
the infant is taken to be lacking in self-awareness because
it cannot possibly have the necessary cognitive representations, which are to be acquired, and it cannot acquire
thought-representations because its self-image does not
yet exist.
A different view is taken by ecological perception
theory, or the theory of environmental affordances (E. J.
Gibson, 1993 ; J. J. Gibson, 1979 ; Neisser, 1993, 1994),
which takes into consideration the specific invariant
configurations of stimulation that arise when the active
subject is in receptive contact with the media and objects
of the outside world, subject and world being in resonant
relation with one another, their effects interpenetrating as
components of a dynamic system (Fogel & Thelen, 1987).
The mind of the perceiving subject is taken by this theory
to have sufficient organisation to be receptive to, and able
to distinguish, different constellations of stimulation that
define the motion, position in body-related space, and
dynamic features of activity invariably present in situations and objects. The subject is thus able to immediately, without rational representations, enter into
adaptive behaviours that use the environment to the
subjects advantage.
Apart from this important difference, both the above
theories are primarily concerned with the consciousness
and actions of an individual perceiver\thinker, and both
appeal, though in different degrees, to a notion of
construction (or emergence), which takes it as evident
that the psychological state of the infant at birth, and for
an uncertain time afterwards, is one that lacks any
conception or representing configuration or schema of
self (body)-object, and consequently must lack both selfawareness and other-awareness.
We take a different position on the basis of observations of the intricate coordinations of expression and
awareness that infants do have from birth, especially
from how an infant can behave in relation to the
expressions of feelings, purposes, and interests of another
person who is entering into engagement with the infants
expressions.
The evidence from early infancy suggests that the
relational affects (Stern, 1993, p. 207) are specifically
adapted to real-time regulation of the balance of initiatives and reactions between the child and another.
They contribute to the building of relationships of
affectionate attachment, trust, and companionship, and
to defence against abuse, mistrust, and disregard, and
they appear to be fundamental to human consciousness
(Trevarthen, 1998 d). It follows that emotions hitherto
deemed complex, nonbasic, and acquired will have to be

reinterpreted as primary and necessary to the childs entry

into the social\cultural world, with all the rational,
linguistic, and pragmatic conventions and rituals that
world offers. Furthermore, the theory that cognitions
construct even the simplest reactive emotions, such as the
classical seveninterest, joy, surprise, fear, anger, sadness, disgustwith perhaps two more, contempt and
shame (Izard, 1977, 1978 ; Tomkins, 1962, 1963), will not
do the job.
The emotions between persons, including those that
powerfully colour every moment of our relating as adults
to one anotherpride, jealousy, shame, resentment, rage,
and the lasting evaluations and empathy of admiration,
love, hate, and contempt that we can develop in regard to
particular individualshave their foundations in dynamic reactions of even young infants to the feel of
being present with another. And we can make another
observation from infancy research. The fascination that
even 2-month-olds show for the narrative of feelings in
protoconversations with a parent may hint at a further,
much more important, function of innate human
emotions. The feelings they project into the engagement
seem to take on a life of their own, as if both adult and
infant are each tracking the experiences of a imagined
protagonistsan other or others, different from themselves. Such a fictitious emotional experience appears
even more clearly in the poetry of baby songs and nursery
rhymes. Maybe the infants absorption in the drama of
the mothers talk or song is foreshadowing the wonderful
inventive imagination that motivates fantasy play in
toddlers.

Psychobiology of Human Communication

From Maternal Regulation of Organismic State
over the Birth Transition to Affectionate
Communication of Mental States
Research on rodents, cats, and primates shows that the
immediate postnatal period of mammalian life is one of
great changes in brain structure, neurochemistry, and
function, changes that are critically dependent on
parental support (Blass, 1996 ; Hofer, 1990 ; McKenna
& Mosko, 1994 ; Panksepp et al., 1997 ; Rosenblatt, 1994 ;
Schore, 1994 ; Zeifman et al., 1996). Newborn infants
integrate their state regulation with maternal care, and
form an attachment to an identified caregiver (Carter et
al., 1997). Infants states of arousal and distress are
potently expressed, and they are immediately responsive
to stimulation from the mothers breast-feeding, calming
being, in part, due to the sugar and fat content of breast
milk (Blass, 1996). Of great interest is the finding that this
physiological response is facilitated, not only by recognition of the mothers voice, but also when the newborn
has sight of the mothers eyes (Zeifman et al., 1996).
Young infants also respond to the touch, movement,
smell, temperature, etc. of a mother, and sleeping with the
mother may aid development of cardiac and respiratory
self-regulations (McKenna, 1986). This is considered to
be of special importance in the period before the
development of cerebral mechanisms, including those for
breathing control, that are specialised for future communication by speaking, which involves integration
between forebrain and brainstem centres. Newborns, and
possibly foetuses, too, react to, and gain regulation from,
the rhythms of maternal breathing and heartbeat

INFANT INTERSUBJECTIVITY

(McKenna & Mosko, 1990), and foetuses and infants are

also supremely sensitive to maternal vocal patterns
(DeCasper & Fifer, 1980 ; Fifer & Moon, 1995 ; Hepper,
1995 ; Lecanuet, 1996).
The emotional and communicative precocity of human
newborns indicates that emotional responses to caregivers must play a crucial role in the regulation of early
brain development (Als, 1995). They are likely to guide
differentiation of perceptual discrimination, cognitive
processing, memory, voluntary deployment of attention
to environmental objects, and executive functioning or
problem solving (Schore, 1994). Regulatory mechanisms
of the infant brain are subject to changes by endocrine
steroids and other hormones (McEwen, 1989, 1997 ;
Suomi, 1997), but they are ready at birth to formulate and
express motivated behaviours, including coherent
emotions. An intricate mutual psychobiological dependency is set up between a newborn infant and the care of
a mother or mother substitute. Modern perinatal medicine finds evidence that this biological relationship
requires direct human mediation, and cannot be fully
replaced by artificial clinical technology (Als, 1995).

Poly-vagal Theory and the Signalling System for

Mutual Embodiment of Motives and Emotions
Self-regulatory brain mechanisms of ancient phylogenetic origin (MacLean, 1990 ; Panksepp, 1998 a, b ;
Porges, 1997), which evolved to signal bodily needs and
to attract appropriate parental ministrations for physiological states, have been augmented by, or transformed
into, mechanisms of sympathetic mind-engagement. In
humans they become part of motivations specialised for
cultural learning.
When primitive vertebrates evolved as active predators,
presegmental tissues at the anterior end of the body
became elaborate organs of an independently mobile
head : receptors for sensing the external world, jaws for
controlling food intake, and gill arches for gas exchange.
Simultaneously, a forebrain developed, capable of coordinating a more vigorous life with more foresightful
intelligence (Gans & Northcutt, 1983). In socially intelligent higher vertebrates, the head additions, and the
autonomic systems linked to them, have become elaborated as the expressive\receptive systems of the face,
throat, eyes, and ears, to which, in humans, the hands
have been recruited. The communication of psychological
events between subjects by expressive movements constitutes a function that integrates internal organismic or
visceral regulations, mediated in the brainstem, with
environment-directed or somatic ones which rely on
diencephalic 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, which
in the adult regulate attentional orientations, coordinate
purposeful movements of the body and its parts, and
mediate the equilibria between autonomic and exploratory or executive states, first emerge in the embryo brain
as regulators of morphogenesis in emerging cognitive
systems (Trevarthen, 2001 ; Trevarthen & Aitken, 1994).
An important output from this intrinsic motive formation
(IMF ; Trevarthen & Aitken, 1994) controls the sensoryaccessory motor systems of the special receptors of the
head and hands (Table 1). The eyes, the ears and cochlear,
the lips and tongue, and the palms and fingers are all
highly receptive and discriminating in their sensory

21

functions, and separately aimable and tuneable by virtue

of special muscle structures. Movements of these structures dynamically and rhythmically direct and censor the
uptake of perceptual information in modalities of exceptionally high sensitivity and resolution, and these
motor adjustments occur in the exploratory and focusing
phases of attention to the outside world, before the final
commitment of a consummatory act . They therefore
display predictive information that an observer can pick
up about emerging motor impulses and prospective selfregulations of the subject, and, indeed, they have evolved
into specialised expressive movements that signal the
subjects consciousness and intentions (Panksepp, 1998 b ;
Porges, 1997 ; Trevarthen, 1993 b, 1997 a, 2001 ; Trevarthen et al., 1999). All the organs of human linguistic
expression are recruited from this sensory-accessory
motor set. Brainstem efferent nuclei concerned with
selectively aiming and focusing the uptake of visual,
auditory, and haptic (tactile) information, on the one
hand, and those that became dedicated to the control of
visceral functions of body temperature, pain control,
heart rate, respiration, vocalisation, and biting in lower
vertebrates, on the other, have been adapted in humans
to serve social functions of dynamic emotional expression
and, eventually, language (Ju$ rgens, 1979 ; Ploog, 1992 ;
Porges, 1997), as summarised in Figure 3.
We have already suggested that in infancy the brain
functions in such a way as to regulate two complementary
motive states, or states of commitment to engagement
with environmental resourcesone trophotropic, contributing to the maintenance of organic functions and
bodily wellbeing, the other ergotropic, seeking experience
to build efficient anticipatory cognitive systems that will
exploit situations and objects, make adaptive actions,
and store memories of how behaviours are to be executed
and what affordances of objects they should seek in
perception. We suppose that communicative functions of
the conversational and cooperative kind will serve to
integrate these two, and further, that especially in infancy,
the signalling of interpersonal interests and responses to
attentions of other persons will be elaborations of
autonomic or self-regulatory motor activities. The mammalian self-regulation by emotions (Panksepp, 1998 a, b)
and the emotional motor system (Holstege, Bandler, &
Saper, 1996) are evolutionary successors to the autonomic 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 in
which emotional communication links the young into a
process of cooperative sociocultural transmission of
knowledge and skills from generation to generation, and
this depends on affectively regulated relationships and
self-confidence in relationships (Damasio, 1994 ; Schore,
1994 ; Tucker, 2000 ; Tucker, Derryberry, & Luu, 2000).
These same systems predispose to mental and emotional
disorders of peculiarly human complexity (Schore, 1996,
1997 ; Trevarthen et al., 1998 ; Tucker & Derryberry,
1992). The cerebral organs that mediate cultural learning
include new perception and memory systems in temporal
and parietal neocortex, limbic structures (hippocampus
and amygdala), and basal ganglia intimately linked to
motor time-generators and movement coordinations that
implicate structures throughout the brainstem and
cerebellum (Panksepp, 1998 a ; Schore, 1994 ; Tucker,
2000) (Fig. 3). Elaborations of the prefrontal neocortex
and frontal limbic cortex confer new capacities for

22
C. TREVARTHEN and K. J. AITKEN

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 of
motive 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 in
a 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).

INFANT INTERSUBJECTIVITY

23

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

Visceral & somatic

movements

Cranial
nerves
1
Olfactory
2
Optic

Looking at other.
Direction of gaze.

Eye rotation, lens &

pupil adjustments.

Looking at other.
Direction of gaze.

Visceral & somatic

senses
Odour, taste.

Smelling, kissing.

Vision.

Seeing other.

3
Oculomotor

Eye-muscle sense.

Eye rotation.

4
Trochlear

Eye-muscle sense.

Face expressions.
Vocalising.

Mastication.

5
Trigeminal

Facial feelings.

Looking at other.
Eye expressions, crying.

Eye rotation,
lifting eyelids, tears.

6
Abducens

Eye-muscle sense.

Face expressions, speech.

Listening to speech.

Eating.
Middle ear muscles.

7
Facial
8
Auditory

Vocalising.
Expression in voice.

Coughing, biting.
Salivating, swallowing.

Vocal expression.
Signs of emotion.

Heart & gut.

Head and shoulder

expression.
Vocalising.

Head and shoulder

movements.
Swallowing.

Vocalising, speaking.

Tongue.

9
Glossopharyngeal
10
Vagus

Communication
senses

Feeling others touch.

Feeling own face.

Taste, tongue, mouth.

Kissing.

Hearing, balance.

Hearing other.
Hearing self.

Taste.

Kissing.

Taste, heart, lungs, gut.

Feeling own emotion.

11
Accessory
12
Hypoglossal

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 linguistic

expressions of other individuals (Rizzolatti & Arbib,
1998) and the capacity for strategies of executive functioning (Fuster, 1989 ; Goldman-Rakic, 1987 ; Schore,
1994). The narrative awareness that is so central to the
passing on of human concepts, ideas, fantasies, and
beliefs, including its symbolic formulation in language,
results from coordinated action of all these cerebral
systems, cognitive and emotional, neocortical, limbic,
and subcortical (Trevarthen, 1998 c).

Infant Intersubjectivity and Developing Motive

Systems of the Brain (Trevarthen, 2001)
The human embryo and foetal brain displays elaborate
formation of intrinsic regulatory mechanisms that are
connected, on the one hand, with the most complex
(facial, vocal, and gestural) expressive organs among the
primates, and, on the other hand, with the most elaborate
reciprocal connections between motivating structures of
the core and limbus of the brain and the expanding
neocortical system in which post-natal experience will be
elaborated (ORahilly & Mu$ ller, 1994 ; Trevarthen, 1985,
1989 ; Trevarthen & Aitken, 1994) (Fig. 3). The neocortex
is laid down in the late embryo, but its dendritic arbours
and billions of synapses mature postnatally, and this
process is regulated, at every step, by the brain core
intrinsic motivating systems (Huttenlocher, 1994 ; Rakic,
1991, 1995). Cortical differentiation continues for years

after birth, regulated by communication with the social

environment. It is particularly intense in infancy, responding to intimate affective exchanges with more mature
persons and their more experienced brains (Schore, 1994 ;
Trevarthen, 1990 b). The sculpting by environmental
stimuli of the finer wiring within the intrinsic patterns of
cortical connections, and the plasticity of cortical
cognitive functions, depend upon the generation of a vast
excess of nerve cell branches and synaptic connections,
and selective elimination. This process for acquiring
adaptive knowledge and skills is constrained by instinctive motivating inputs from subcortical emotion systems
that were wired-up prenatally (Panksepp, 1998 a ; Trevarthen & Aitken, 1994).
The metaphor of neural Darwinism (Edelman,
1987) has encouraged recognition of the adaptability of
human cognitive growth. Exuberantly overabundant
components in the developing nervous system are subject
to selection, through synaptic pruning, apoptosis (selective cell death ; Golstein, 1997), and other mechanisms
thought to permit an increase of functional specificity
through selective reduction in numbers of redundant
neurons and\or neural connections (Changeux, 1985).
Plastic responses to environmental factors certainly occur
throughout development, and play an essential part in the
creation of more effective psychological functions. However, a postnatal selection theory offers no satisfactory
explanation for robust panspecific features of human
brain organisation such as those that have an active part
in the determination of social and cultural adaptation in
all human groups, and which are displayed by infants

24

C. TREVARTHEN and K. J. AITKEN

from the first weeks, when the cortical selection process

has scarcely begun. Nor does it offer an explanation for
anatomical and behavioural features of the body and the
brain that are consistent throughout widely separate
phylogenetic lines, and that emerge in prenatal stages of
brain development when the extracorporal environment
has minimal selective power.
Aspects of human biology and behaviour have features
in common with organisms that have homologous symmetry of body form. These are encoded at a very general
level in the genetic code (Cziko, 1995 ; Kauffman, 1993,
1995). A wide range of homologous genes is found among
mammalian species (Nadeau & Sankoff, 1997). Homeobox genes, for example, have preserved their structure
and function in most of the segmented, cephalocaudally
polarised, bilaterally symmetrical animal kingdom. Body
symmetry, segmentation, and a coherent multimodal
sensory capacity integrated with a unified spontaneous
rhythmic motricity are consistent features of the animal
kingdom. These features were selected for stability in
evolution because they are adapted to solving persistent
and varying problems in animal life and individual
ontogeny. They specify a potential behaviour field around
the body into which acts are projected and within which
layouts and goals are defined prospectively by perceptual
systems, and retrospectively by memories.
The anatomy of the infants face and hands, and
certain cyclic patterns of expression by which these organs
display the field of contrasting emotions, the specific
rhythmic hierarchy of motor impulses shown in infantile
vocalisations and spontaneous body movements, corresponding to syllables, utterances, and phrases in the
patterns of adult speech and music (Lynch, Oller,
Steffens, & Buder, 1995 ; Po$ ppel, 1994 ; Ross, 1993 ;
Trevarthen, 1999 a ; Trevarthen et al., 1999), are innate
psychological features that act as developmental
organisers (or constraints) and that enable infant and
adult to meet as corresponding partners who can interact
efficiently by exchanging complementary, mutually
imitative, time-regulated messages, in synchrony or in
alternation.
The cerebral cortex is generally conceived of as the
tissue of higher cognitive processes, consciousness, memory, and skills. However, throughout its development the
neocortex is intimately and reciprocally connected with
the nerve systems of the brainstem and cerebellum, which
give coherence to actions of the body, provide an essential
spatial and temporal frame for consciousness, and generate autonomic self-regulations and the emotions of
social signalling (Holstege et al., 1996 ; Panksepp, 1998 b).
Asymmetries of psychological function that emerge in the
foetus and through childhood (Cynader, Lepore, & Guillemot, 1981 ; Hepper, 1995 ; Trevarthen, 1990 b, 1996),
and that have importance in the genesis of psychological
states and psychopathology (Tucker, 2000), depend upon
asymmetries in these self-regulatory mechanisms of the
brainstem, including sympathetic and parasympathetic
regulators of the heart (Davidson & Hugdahl, 1995 ;
Wittling, Block, Genzel, & Schwiger, 1998).
The cerebral cortex appears in the late embryo at about
week 6. Input from subcortical regions has a role in
regulating the structure of the neocortex at every stage
during foetal development, including the asymmetries of
emotional and cognitive function that become elaborated
in postnatal stages (Huttenlocher, 1994). There is a
critical period in infancy of competition in the genesis and
segregation of synaptic contacts in the cortex, with only

reinforced intercellular contacts surviving (Hebb, 1949 ;

Cynader, Shaw, Prusky, & Van Huizen, 1990). Myelinisation studies show that while some cortical and subcortical structures are relatively mature at birth, others
undergo extensive functional development through childhood and adolescence. In the first 3 months the greatest
change in myelin density is observed in motor pathways,
sensory roots of the spinal cord, and visual projections
to the midbrain tectum, thalamus, and cortex (Gillies,
Shankle, & Dooling, 1983 ; Yakovlev & Lecours, 1967).
Brainstem auditory pathways are more mature than
visual ones at birth, but auditory projections to the
neocortex develop much slower than the visual, over the
first few years, as speech matures.
It is likely that a subcortical mirror system sensitive
to human movement programs is responsible for imitation in the first year, at least for the many imitations of
discrete and arbitrary expressions that neonates may
perform (Heimann, 1991, 1998 ; Heimann & Ullstadius,
1999 ; Vinter, 1986). Mirroring actions involves multimodal, or transmodal sensory recognition (Meltzoff &
Moore, 1997), and there are many multimodal neural
populations in the brainstem, for example in the superior
colliculus (Heimann, 1998 ; Heimann & Ullstadius, 1999 ;
Sparks & Groh, 1995 ; Stein & Meredith, 1993). These are
integrated with systems that formulate motor images for
action and expression (Panksepp, 1998 a, b). Preverbal
communication will involve both limbic and neocortical
mechanisms in temporal and prefrontal parts of the
hemispheres, as well as many subcortical structures of the
forebrain, diencephalon, midbrain, and hindbrain. The
orbitofrontal cortex, linked to the mediolateral temporal
cortex, has a key role in regulation of the balance between
psychobiological state and transactions with the environment, and it undergoes important elaboration in infancy
(Schore, 1994, 1998).
PET scan evidence on regional glucose utilisation in
infants brains has been used to trace synaptogenesis and
cerebral plasticity and to make correlations with behavioural maturation (Chugani, 1994, 1998). In the newborn,
the highest rates of metabolism are found in the primary
sensory and motor cortices, thalamus, brainstem, and the
vermis of the cerebellum, but the basal ganglia, hippocampus, and cingulate gyrus are also active. Parietal,
temporal, and primary visual cortices, basal ganglia, and
the cerebellar hemispheres are increasingly active during
the first 3 months. Lateral and inferior frontal cortices
shows increase of glucose consumption after 6 to 8
months and the dorsal and medial frontal cortices show
comparable increase only between 8 and 12 months. At 1
year the infants pattern of glucose utilisation resembles
that of an adult.
In the last 3 months of the first year conspicuous
developments in the prefrontal cortex have attracted
attention. In this period the ratio of EEG alpha activity to
beta activity increases, coincidental with the many developments in intelligence. Bell and Fox (1996), who use
baseline EEG as an indicator of brain development (Bell
& Fox, 1992), find that infants who crawl early, and who
are proficient crawlers at 8 months, exhibit an earlier
decrease in intrahemispheric EEG coherence, interpreted
as evidence of pruning of superabundant intercellular
connections, which lead to greater coherence. The same
authors (Bell & Fox, 1997) present evidence that infants
who were successful in performing an object permanence
test exhibited greater frontal EEG power and greater
occipital EEG power than unsuccessful infants, and the

INFANT INTERSUBJECTIVITY

unsuccessful infants were likely to also be pre-locomotor.

This supports the conclusion that brain mechanisms for
cognitive and locomotor maturation share common
regulatory factors, presumably motivational.

Conclusions Regarding the Role of Intersubjectivity

in Early Brain Development
Early in infancy, developmental changes in the brain
balance the intrinsic regulation of physiological processes
within the body against the somatic systems that engage
the body with the environment. Both kinds of brain
regulation depend upon anticipation (motor images,
Jeannerod, 1994, 1999)of the needs imposed on the
endocrine and autonomic systems for adjustment of the
supplies of energy and nutrition to tissues, of biomechanical contingencies within the body as it moves,
and of the cognitive processes that perceive, learn, and
recall the locations, motions, properties, and potential
values to the subject of objects and situations outside the
body. It is important to recognise that it is potential uses
and dangers that are the objects of motives concerned
with maintaining predictions about the real situation in
which the subject will be in the immediate future. Cognitive processes of consciousness and working memory,
increasing throughout childhood, bring in the benefits of
experience from the past and build concepts that model
extensive predictions of future events, outside the present
situation in time and space. The representations that
store experiences and keep record of their values for the
subject are both emotional and cognitive. They depend
upon a dynamic balance between self-experience and
object-experience, between reality-oriented experience of
the body in action and body-protecting emotions
(Damasio, 1994, 1999 ; Panksepp, 1998 a, b).
All these levels of psychological process in the mind of
a developing child depend on reciprocal transmission
of activity between neural systems that represent, anatomically and physiologically, the body and its behaviours. That is, autonomic-limbic-emotional systems
of the inner aspect of the self, and diencephalicneocortical-cognitive systems that engage with and record environmental effects that action generates. In the
evolution of such a social and intensely cooperative
species as humans are, every level of the mind\brain is
further modified to make it possible for individuals to act
together in their internal self-regulations, actions on the
environment, and cognitive experiences. Infants show
systematic, age-related changes in the motives they
express for direct involvement in parental support for
their physiological self-regulations and those motives
that enable sharing of purposes and interests. Different
theories give weight to interactions of one or other of
these intersubjective levels. We apparently lack an integrated theory that will allow a comprehensive view of
what infants motives are seeking in companionship from
the intuitive parenting behaviours of their mothers,
fathers, and other family members.
Emphasis on the autonomic-visceral regulations and
the influence of emotion on cognition leads to attachment
theory and investigation of the ways in which communication of needs and supply of satisfactions may
affect the childs mental health. Focus on the cognitive
assimilation of information by perceiving and remembering leads to interest in how communication leads to the
construction of representations of purposes, as in the
theory of language pragmatics. Lack of appreciation of

25

the infants natural mirroring of behaviours that signal

the changing interests and purposes of partners leads to
individual constructivist theories, such as those Piaget
elaborated, and to social learning theory. The latter is
further limited by the assumption that the motives of a
young infant are solely concerned with physiological
risks and benefits ; that they have no means of anticipating
even their own experiences.
Current exploration of the abstract principles of
dynamic systems theory (Butterworth, 1999 ; Fogel &
Thelen, 1987 ; Hopkins & Butterworth, 1997), with
the aim of overcoming the limitations of linear causal
theories, attempt to explain the emergence of order in
complex changing arrays of components that are capable
of transforming one another at constant rates. The theory
diminishes attention to the adaptive environmentexpectant powers of a brain that grows intricate and
orderly structures in coherent arrays before it is in engagement with the environment, and before the body moves its
parts. Minimalist assumptions about the initial state of
the foetal brain and body invalidates much sophisticated
modelling of how the body can become effective in
integrated movement, and how the socially responsive
individual can become coconscious and capable of
contingent and cooperative communication under the
influence of a more mature communicator.
Additions at the end of the human brain and around
the parietotemporal junction comprise a mechanism for
intersubjective communication that affords the opportunity for coupling of motives for extending the impulses
of narrative awareness of the environment, for learning to
recognise its benefits and risks, and for taking hold of it to
use it. Cultural exploitation of the environment is entirely
dependent on the innate mirroring mechanisms that link
human minds which have different age, experience, and
skill. Educational practices depend on this intersubjective
system and the collaborative learning it makes possible.
Failure of intersubjectivity compromises social and cultural learning and education of the child, and requires
compensatory parenting and teaching practices that will
support, by-pass, or substitute the deficient interpersonal
awareness and communicative expression of the affected
child.

Pathologies of Intersubjectivity in Childhood, and

Their Treatment
Pre- and Perinatal Factors in Child
Psychopathology
The evidence we have reviewed suggests that human
intersubjective motives are mediated by core regulatory
mechanisms of the emotional brain that emerge in the
embryo period, and that, with the support of specific
forms of adult care, the same systems serve as regulators
of embodied awareness and experience of the world,
motor coordination, cognitive development, socioemotional skills, and cultural learning throughout childhood. These facts mean that interpretation of the causes
of neurodevelopmental disorders will not be simple, and
clinical 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,
1993 a, b ; Kerr & Witt-Engerstro$ m, 2000 ; Klin, Volkmar, & Sparrow, 2000 ; Murray & Cooper, 1997 ; OBrien

26

C. TREVARTHEN and K. J. AITKEN

& 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, determine aspects of the formation of neuronal systems,
and thus how children will coordinate their actions,
attend to the environment, and respond to parental care
and education. Inadequate parental support that fails to
respond to the childs motives and emotions for communication can have detrimental effects, not only on the
childs emotional health, but also in their cognitive
development and sociocultural learning. Trauma at
different ages and damaging different locations or systems
of the brain have different effects on communication and
intelligence, and often these consequences are not significant, or even reliably detectable, until some later period
of the elaboration of the brain and of the knowledge and
skills it incorporates. Other pathologies are due to the
effects of noxious agents or infections, and these, again,
will depend on the stage or period of development
affected. Early damage will be expected to have a wide
range of complex effects on later developing systems, and
cognitive systems that emerge after infancy, when the
child is drawing on a narrative memory of meaningful
events and using language, will manifest a great variety of
disorders caused by the deviant motivations, many arising
from the distortions of earlier formed systems.
Clinical research in developmental traumatology has
confirmed the role of early adverse social experiences in
the pathogenesis of affective disorders (De Bellis, Baum,
et al., 1999 ; De Bellis, Matcheri, et al., 1999 ; Heim &
Nemeroff, 1999). Child abuse increases the likelihood of
a 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 and
deprivation on the developing child are sometimes assessed entirely in terms of the physical damage inflicted
on the body, but violence and cruelty is always accompanied, or preceded, by disruption to the affective
patterns of caregiver-child or caregiver-infant interaction,
and these psychosocial or psychiatric aspects should be
taken into account in planning intervention. It is also
important to recognise that constitutional abnormalities
in the behaviour of an infant or child can significantly
perturb the emotions of caregivers, increasing the risk of
maltreatment.
The term ecological experiments has been used to
describe situations where a genetic condition or effects of
an imposed insult that interferes with formation of the
brain, sense organs, or skeletomuscular anatomy (such as
anencephaly, anopthalmia, or thalidomide embryopathy)
presents effects that enable us to infer factors of the
normal developmental processes (Eibl-Eibesfeldt, 1970).
Morphogenic processes of brain and body are closely
interrelated, especially in the embryo period. Developmental psychopathologies that change the organisation
of core body-action-mapping motive systems that are
crucial for psychosocial development provide evidence
on the genesis and regulatory principles of intersubjective
phenomena (OBrien & Yule, 1995). The time-course of
development of structures in the central nervous system
of mammalian embryos in relation to formation of the
skull and face is now well characterised, and we can

expect that genetic research on the regulation of the

development of the head, face, and forebrain will have
increasing importance in interpretations of neurodevelopmental disorders and psychopathology. Abnormalities in the distal parts of the limbs (hands and feet) are
also associated with anomalies of brain formation.
Differences in human craniofacial morphology have been
examined in autism (Rodier, 2000) and in schizophrenia
(Deutsch, Price, Wussler, & DAgostino, 1997 ; Waddington, Lane, Larkin, & OCallaghan, 1999). Dysmorphologies of the embryo head, while not providing
anything like a full explanation for a subsequent behavioural phenotype, may point to setting events in
gene regulation on which environmental and developmental processes act to produce a disorder (Waddington,
Lane, Scully, et al., 1999). All systems of the organism
may be affected by a defective developmental program
that is responsible for a diagnosis of neurodevelopmental
disorder, 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 effects
on social interaction (Etcoff, 1999). Any of these could
precipitate abnormal psychosocial motivations and behaviours, with effects in development of communication
and intelligence in childhood.
An insult to the CNS in infancy that has little effect on
behaviour in early childhood may determine a pattern of
difficulties that emerge subsequently. Thus, for example,
a recent MRI study found significant psychological effects
in adults who had apparently recovered well from lesions
to prefrontal cortex sustained in infancy. The affected
individuals had normal basic cognitive abilities, but
were severely impaired in social behaviour, and they
were insensitive to the future consequences of their
decisions and defective in their autonomic responses to
punishment contingencies. Moreover, they failed to
respond to behavioural interventions (S. W. Anderson,
Bechara, Damasio, Tranel, & Damasio, 1999). It was
concluded from these findings that early dysfunction
in certain sectors of prefrontal cortex seems to cause
abnormal development of social and moral behaviour,
independently of social and psychological factors and
that antisocial behaviour may depend, at least in part,
on the abnormal operation of a multi-component neural
system which includes, but is not limited to, sectors of the
prefrontal cortex . Reference was made to delayed onset
of social abnormalities of monkeys that had sustained
ablations to the amygdala and inferior temporal cortex as
neonates (Newman & Bachevalier, 1997).
In monkeys, the same lesions sustained at different
stages of development of the cerebral cortexsoon after
birth or in adulthoodhave different consequences in
behaviour (A. Diamond, 1991). In both animals and
humans, the detrimental effects on the brain of malnutrition and the benefits of environmental enrichment
will depend on the age at which environmental changes
were experienced (Van Gelder, Butterworth, & Drujan,
1990 ; M. C. Diamond et al., 1966 ; Graham-McGregor,
Schofield, & Harris, 1983). The consequences of extreme
environmental privation in inhuman orphanages add to
our appreciation of the fragility of the young childs
emotional brain, and the serious consequences to mental
development when psychosocial needs are not met
(Rutter et al., 1999). Conversely, remedial work that
brings the recovery of children disadvantaged by war or

INFANT INTERSUBJECTIVITY

severe deprivation of human care encourages hope that

the intrinsic core systems can resist insults in some degree,
and remain responsive to an intervention that directly
addresses the socioemotional and cultural needs
(Hundeide, 1991).
The period around birth brings new risks for development of the brain and behaviour, as well as for
perturbation of parental support. The concept of a
continuum of pathology was expounded by William
Little over a century ago, in a paper where he discussed
the effects of prematurity, difficult birth, and perinatal
asphyxia on infant morbidity (Little, 1862). Pasamanick
and Knobloch (1966), who described the effects of
perinatal injury, re-introduced Littles concept under the
title of a continuum of reproductive casualty to account
for variation in physical or physiological care in the
perinatal period. Sameroff and Chandler (1975) employed
the term continuum of caretaker casualty, a dimension of
quality of parenting, to take account of the social factor
in perinatal difficulties of dyadic functioning. The first
large-scale study of minimal intervention to offset caretaking casualty reported improvement of outcome in
cases where there were concerns about caretaking abilities
(Ounsted, Roberts, Gordon, & Milligan, 1982).
Systematic procedures have been developed to assess
behaviour in the newborn, and these greatly improve the
detection of problems in neonatal care. These include : the
Brazelton Neonatal Behaviour Assessment Scale
(BNBAS ; Brazelton, 1984) ; the Assessment of Preterm
Infant Behaviour (APIB ; Als, Lester, Tronick, & Brazelton, 1982) ; the Mothers Assessment of the Behaviour of
her Infant (MABI ; Widmayer & Field, 1980) ; the
Einstein Neonatal Neurobehavioural Assessment Scale
(ENNAS ; Majnemer, Brownstein, Kadanoff, & Shevell,
1992), and the Network Neurobehavioural Scale (NNS ;
Boukydis & Lester, 1999). The APIB has been used to
demonstrate associations between abnormalities of brain
anatomy, detected by structural neuroimaging, and
neurobehavioural capacities (Huppi et al., 1996). The
ENNAS correlates well with detailed neurological examination (Limperopoulos et al., 1997). Demonstration of
infant capabilities to parents using such assessments can
benefit development of early patterns of interaction
(Fowles, 1999), and in high-risk groups this can significantly reduce morbidity (Hart, Field, & Nearing, 1998 ;
Widmayer & Field, 1980, 1981).
Methods of functional neuroimaging for tracking
functional pathways within the brain are increasingly
reliable (Conturo et al., 1999), and knowledge of regional
differences in neural activation associated with adult
depression, anxiety, and schizophrenia is advancing
(Davidson, Abercrombie, Nitschke, & Putnam, 1999 ;
Tucker, 2000). However, developmental neuroimaging
research is, at present, confined to a few centres, and
application to brain functions in infants is just beginning.

Clinical Implications of Intersubjective Dysfunction

in Early Life
The neurodevelopmental origins of the more complex
cognitive and emotional functions of consciousness of
self and others have become the object of research as
psychologists and clinicians seek a more accurate and
comprehensive understanding of mental illness in children and adults (Bolton & Hill, 1996 ; Schore, 1994).
Early intervention strategies to improve the prospects of
children at high risk for poor developmental outcome are

27

dependent on accurate knowledge of how the brain grows

and how it both motivates and responds to experience,
especially in relation to the experience of parental care
(Meisels & Shonkoff, 1990). Each condition brings its
own problems, but all demonstrate the active mutual
emotional dependence of the infant or young child and
the caregiving adult.
Postnatal depression. Maternal postnatal depression
can compromise the early cognitive development in a
child (Field, 1992 ; Murray & Cooper, 1997 ; RadkeYarrow, 1998), and disturbed features are found immediately in the behaviour of infants while their mothers
are depressed, but the direction of effects is still an open
question. Two independent studies have found evidence
that infants of postnatally depressed women had received
abnormal scores on the Brazelton Neonatal Behavioural
Assessment at birth, which shows the babies were already
having problems at birth. Murray and her colleagues
have shown these infants were particularly affected in
their 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 infants
of depressive mothers were obtaining lower scores on
various Brazelton items when compared to groupmatched controls, particularly on state-regulation and
orientation, as well as on the Lester and Tronick depression and excitability scales. It is certainly possible
that unclear reactions of the infants, and weak responses
to maternal care could be a factor precipitating a depressed state in the mother. But it is also possible that
maternal emotional state may affect development of the
brain of the foetus before birth.
There is clear evidence for distortions from the normal
patterns of early mother-infant interaction in postnatal
depression, with higher levels of maternal failure to
respond to infant cues, slower response to sounds of the
infant, and a reduction in the exaggerated, repetitive
vocalisation patterns seen in typical motherese (Bettes,
1988). In every case, these changes in shared emotional
and motivational effects are evidence of the delicacy of
the coregulation in mother-infant communication in early
infancy.
A second line of evidence, which may point to an effect
of the mothers behaviour on the infant, comes from
studies that show abnormalities in brain electrical activity
as early as 3 to 4 months in infants of postnatally
depressed mothers (Dawson, Grofer-Klinger, Panagiotides, Spieker, & Frey, 1992 ; Field, Fox, Pickens, &
Nawrocki, 1995 ; N. A. Jones, Field, Fox, Lundy, &
Davalos, 1997). Infants cared for by depressed women
demonstrated a larger than normal right frontal EEG
asymmetry during interaction with their mothers, and,
moreover, this was predictive of inhibited behaviour of
the children at 3 years (Field, 1997). EEG coherence is,
indeed, one of the strongest available predictors of
subsequent development in children (Thatcher, 1994). It
appears likely that the interactional difficulties and
negative emotions that these infants experienced with
their mothers were inducing atypical patterns of neural
activity, which could be expected to result in poorer
developmental outcome. Presumably surface-recorded
EEG abnormalities, in the cortex, reflect patterns of
activity projected forward in the brain from subcortical
sites. The distortions observed in the interactions of
postnatally depressed mothers with their young infants
have been interpreted as having a direct effect on the
development of neurotransmitter systems with conse-

28

C. TREVARTHEN and K. J. AITKEN

quent vulnerability of the child to later affective disorders

(Konyecsni & Rogeness, 1998). This is in accord with
research demonstrating large effects in neurochemical
systems and emotional behaviours of monkeys deprived
of normal maternal care (Suomi, 1997).
Prematurity. Difficulties in mothering due to weak or
disorganised motivation and behaviour in a young infant
are clear when the infant is born well before term. The
survival in significant numbers of extremely low birthweight infants, some delivered as early as mid-term, is a
modern phenomenon, consequent upon improved
methods of intensive postnatal support (Aitken & Trevarthen, 1997 ; Stahlman, 1984). Because these foetuses
have not survived in the past, there is no set of cultural
expectations amongst parents and extended families of
how best to care for the infants, and the medical
profession has limited knowledge of the psychological
needs of very immature newborns.
Premature birth compromises the development of early
interaction, partly as a direct result of early separation of
the infant and caregiver for intensive care, and partly in
consequence of the physical and physiological vulnerability of the premature infant, and damaging effects of
anoxia, intraventricular haemorrhage, etc. The caregiver
is confused by the immature behavioural repertoire and
psychological coordination of the premature infant. The
period immediately around term is one of change in the
infants readiness to meet the environment outside the
mothers body, including many new experiences of
human care and communication. Infants born near term
normally have well-developed awareness of the feelings
and motives expressed in maternal vocalisation and
handling. Even visual recognition of face and hands is
possible, as has been proved by the imitation studies
reviewed above. All of these delicate sensitivities and
reactions may be weakened or absent in the very
prematurely born (Als, 1987, 1995).
Autistic spectrum disorders. Autism, Asperger syndrome, Pervasive Disintegrative Disorder (PDD ; Volkmar et al., 1997) and Retts syndrome, all of which
manifest intersubjective problems or empathy disorders
(Gillberg, 1991), result from a wide variety of genetic and
environmental causes (Aitken, 1998 ; Cohen & Volkmar,
1997 ; Klin et al., 2000 ; Tager-Flusberg, 1999 ; Volkmar,
1998). Regressive-onset forms of autism (Tuchman &
Rapin, 1997), PDD (Hellers syndrome) (Volkmar et al.,
1997), and Asperger syndrome are all given increased
attention in both the DSM and ICD diagnostic systems
(Howlin, 1998). New syndromes, such as DAMP (Disorders of Attention, Motor Control and Perception),
are described to characterise specific populations
(Kadejso & Gillberg, 1998). These changes in criteria for
diagnosis will bring new information on varieties of early
social development within the autistic spectrum as more
cases are identified, and as systematic research of early
symptoms is undertaken with the aid of analysis of video
recordings of development in the first years. Particular
cognitive profiles can be identified with specific subgroups (Tager-Flusberg, 1999). For example, one nonverbal learning disability profile has been found to be
characteristic of children developing Asperger syndrome
(Klin, Sparrow, Volkmar, Cicchetti, & Rourke, 1995 ;
Klin et al., 2000).
Classical Kanners autism is first manifest in early
childhood as an impairment in social and language
development, plus an unusual insistence on sameness, or
difficulty in accepting change. Abnormalities of response

to other peoples expressions and communications, i.e.

of socio-emotional development, appear to be primary
(Fein, Pennington, Markowitz, Braverman, & Waterhouse, 1986 ; S. A. Rogers, 1998). At least in a large
proportion of cases, the cause can be traced to abnormal
brain morphogenesis beginning very early in development, probably in the embryo period. The low population
prevalence of autism, around 4n5 per 10,000 (Trevarthen
et al., 1998), has hampered population-based studies and,
indeed, there is considerable debate and confusion over
current prevalence rates (Accardo & Bostwick, 1999 ;
Fombonne, 1999). A number of recent reports suggest
that the numbers of autistic children in the population
may be increasing, and it appears that this is not simply a
consequence of improved case assessment or changes
in diagnostic criteria (Department of Developmental
Services Report, 1999 ; Taylor et al., 1999).
Hopes for a genetic explanation of autism led to a
search for a small number of interacting gene loci that
could be responsible for a large proportion of the autistic
population (Szatmari, Jones, Zwaigenbaum, & MacLean,
1998 ; Tager-Flusberg, 1999). However, as data comes in
from large studies with multiplex family pedigrees, such a
simple polygenic model appears less likely. A recent
multi-centre study (Risch et al., 1999) concludes that
upwards of 15 loci are likely to be involved for a polygenic
model consistent with their results.
Reliable behavioural evidence on the development of
infants who would go on to manifest autism was rare
until recently. Now widespread use of home videorecording and earlier identification of high-risk children
has led to detection of early differences in children who
later became autistic. The earliest report of which we are
aware (Kubicek, 1980) was of a chance finding in a large
prospective study of normal infant development. Comparison was made between films of interactions of two
fraternal male twins, one of whom was subsequently
diagnosed as being autistic, in interaction with their
mother at 4 months, and clear reductions were reported
in turn-taking, eye contact, and quality of interaction
with the affected twin. A well-controlled questionnaire
study by Dahlgren and Gillberg (1989) found various
features discriminated autistic children from controls in
the first 2 years, empty gaze, abnormal response to sound,
and deficits in directing attention being the strongest
correlates of a subsequent autistic diagnosis. However, as
this was a retrospective study carried out after diagnosis,
the results may be affected by selective recall. Osterling
and Dawson (1994) analysed videotapes taken by parents
at the first birthday parties of children subsequently diagnosed as autistic and of matched control children. On
various criteriaincluding showing of objects, orienting
to name, looking at others faces, and pointingthe
autistic children were less responsive. Again, the behaviour of the video-maker might result in a biased
selection. If this person was the father, as is likely, he
might also have had neuropsychological propensities
typical of autistic spectrum disorder (Baron-Cohen &
Hammer, 1997) and this may have affected the behaviours
he chose to record.
In a study using a screening questionnaire (the Checklist for Autism in Toddlers, or CHAT) to investigate
high-risk children, i.e. children with an older sibling
diagnosed as autistic, it was found that children who went
on to develop autism exhibited abnormalities of eye
contact, pretend play, protodeclarative pointing ( pointing to show), social play, and social interest at 18 months

INFANT INTERSUBJECTIVITY

(Baron-Cohen, Allen, & Gillberg, 1992). This was the

first study to demonstrate, using a reliable methodology,
that at least some autistic children could be distinguished
statistically from controls in the second year of life. A
large-scale replication of the above study, screening a
population of 16,000 children (Baron-Cohen et al., 1996),
detected 12 children who showed abnormalities of protodeclarative pointing, gaze-monitoring, and pretend play,
and 10 of these were subsequently diagnosed as autistic.
Substantial numbers of children who had passed the
CHAT were later screened at 3n5 years on the research
groups Checklist for Referral, and at 5n5 years on the
Pervasive Developmental Disorders Questionnaire.
Cases were also identified through subsequent referral
and consultation of various local medical, educational,
and social services records. The CHAT had originally
identified nine autistic cases and one case of PDD.
Rescreening within the following couple of months of
cases who had failed some items on the CHAT identified
one further autistic case and nine additional PDD cases.
However, of those children screened as normal on the
CHAT, a significant number of cases (almost twice as
many again) of autism and PDD were subsequently
identified (Baird et al., 2000). Analysis of videotape
material taken of eight autistic and seven PDD-NOS
children (i.e. with PDD and no other symptoms) in the
first 810 months of life has demonstrated differences
from controls in social behaviour, but only after three
children identified as having late-onset autism were
removed from the analyses (Werner, Dawson, Osterling,
& Dinno, 2000). Eleven of the children in this study had
been subjects in the study of first-birthday videotapes
by Osterling and Dawson (1994).
Difficulties in early differentiation demonstrated in the
Baird et al. (2000) and Werner et al. (2000) studies suggest
that either a significant improvement in the sensitivity of
screening instruments is required, or that late-onset
autism (Hellers syndrome), for which no early clinical
features have been identified, may be a clinical group that
is being identified more frequently as a consequence of
better detection or increased population prevalence. The
latter possibility casts doubt on the potential utility of
early screening for this condition. This is worrying in the
light of increasing pressure for the use of such measures
for population screening and early intervention (Filipek
et al., 1999 ; Senior, 2000). False negatives may give
undue reassurance to parents and professionals. More
sophisticated methods of identifying early social-interactional and subtle motor-developmental difficulties will
be needed.
A study of videotapes of 25 children with PDD between
12 and 30 months of age (Mars, Mauk, & Dowrick, 1998)
showed that this data could differentiate the children
in this group from footage showing 25 age-matched
children who had no developmental problems. Within the
PDD group, social interactional and communicative
problems were related to severity, those children with no
other symptoms (PDD-NOS) having milder problems
than those shown by children with other PDD diagnoses. Baranek (1999) reported on edited 10-minute
video segments that were interval-rated on a variety of
behaviours, including looking, affect, response to name,
anticipatory postures, motor\object stereotypies, social
touch, and sensory modulation. Three groups of 912month-old infants11 with autism, 10 with developmental disabilities, and 11 with normal development
could be reliable discriminated using this coding.

29

In perhaps the most interesting recent report from the

perspective of this review, videotape material from 17
children which was taken by parents during the first year
of life was subjected to analysis using the EshkolWachman Movement Analysis System and still-frame
videodisc analysis of muscle patterns (Teitelbaum, Teitelbaum, Nye, Fryman, & Maurer, 1998). The authors claim
that analyses of these motor signs can clearly discriminate
subsequently diagnosed autistic children as early as 46
months. This study of abnormal movements and postures
is less likely to have been compromised by selective
analysis. On the evidence now available, children who
become autistic can manifest a range of differences in
motivation for behaviour as infants, including abnormal
motor coordination and focusing of attention.
A recent MRI and neuropsychological study of a pair
of 7n5-year-old identical twins discordant for autism
provides new evidence on possible neuroanatomical
differences in autism. The first twin met diagnostic criteria
for autism (DSM-IV) (fulfilling ADI-R and ABC criteria,
though not those on the ADOS, due to limited stereotypy). The second twin did not meet autistic criteria on
any of the four scales used. The autistic co-twin obtained
a significantly poorer WISC-III Verbal IQ. Both showed
evidence of significant impairment on executive function
tasks, such as the Wisconsin Card Sorting Test. On
neuroimaging, both twins could be differentiated from
control subjects. Frontal lobes and superior temporal
gyri were smaller on both sides of the brain, and the
frontal gyri were irregular. The differences between the
twins were principally in four areas, all of which were
smaller in the affected twin : viz. caudate, amygdaloid,
and hippocampal structures and vermal lobules VI and
VII of the cerebellum (Kates et al., 1998). The authors
conclude as follows :
The results suggest the dysfunction of two separate
but overlapping neuroanatomical pathways, i.e. one
subcortical network differentiating the twins from
each other that may underlie the traditional neurobehavioural phenotype for strictly defined autism,
and a second cortical network differentiating the
twins from the comparison sample that may lead
to the broader phenotype for autism (Kates et al.,
1998, p. 782).
These findings indicate that the neurobehavioural phenotype for autism is underpinned at the gross neurological
level by disorganisation in a subcortical network, and not
primarily by prefrontal cortical pathology. The prefrontal
model implicated in mentalising is becoming less convincing as it becomes clear that a deficit in this part of the
brain is not necessary for autism (Bishop, 1993), not
specific to autism (Shields, Varley, Broks, & Simpson,
1996 ; Zelazo, Burack, Benedett, & Frye, 1996), and not
sufficient to explain the variations in presentation of
autism (Happe! , 1994). Autism may be due to deviation in
prenatal development affecting the IMF of the brainstem,
with significant functional effects at an early stage in
preverbal social development of the infant and toddler.
This fault operates in a manner that is potentially
independent of the cortical network, which would be
involved in the mentalising difficulties seen in many
autistic individuals at a later age.
Evidence that individuals with autism may have anatomical deficiencies in the hindbrain brings the inception
of the disorder back to early embryo stages, when the
basic mechanisms of visceral regulation, socioemotional

30

C. TREVARTHEN and K. J. AITKEN

expression, and orientational motor control are being

formed in complete absence of forebrain function
(Rodier, 2000 ; Rodier, Ingram, Tisdale, Nelson, &
Romano, 1996). Rodiers findings identify loss of tissue in
the facial nucleus and absence of the superior olive
nucleus, both attributable to a reduction in a segment of
the embryo hindbrain at about 20 to 24 days after
conception. These same structures, concerned with both
facial expression and auditory perception, will certainly
be involved in intersubjective communication with newborn infants, who lack a developed neocortex. Autistic
children exhibit characteristics of facial anatomy and
poverty of facial expression that are also attributable to
deviations in morphogenesis of a particular segment of
the embryo at a particular time after gestation begins.
In the normal mother-infant dyad, the extent of
affective synchrony in face-to-face play at 3 and 9 months
predicts subsequent self-control at 2 years (Feldman,
Greenbaum, & Yirmiya, 1999). Recent studies of both
normal (Rollins & Snow, 1998) and autistic childrens
(Mundy, Sigman, & Kasari, 1990 ; Rollins, 1999) language development have pointed to interpersonal variables such as emotional engagement and joint attention
rather than instrumental use of language as predictors of
language outcome. Preliminary work suggests that this
may provide an effective framework for clinical intervention to enhance communication skills in autistic
children (Rollins, Wambacq, Dowell, Mathews, & Reese,
1998). A longitudinal study in 3-year-olds suggests that
linguistic competence, not earlier theory of mind ability,
is the best predictor of subsequent performance on theory
of mind tasks (Astington & Jenkins, 1999).
Taken together, the above studies of developments in
brain and behaviour point to a progressive decline in
functions that mediate intersubjectivity : deficits in early
preverbal interaction predict language abnormalities,
which in turn predict the later emergence of differences in
the reflective thinking (mentalising) of autistic individuals. This does not imply that the difficulties in infancy
are manifestations of faults in the same neural systems
that appear to mediate later mentalising problems. The
results of the discordant twin study of Kates et al. cited
above suggest that a subcortical neural system precipitates the emergence of autism, and that this is parallel to,
or at a different hierarchical level from, the prefrontal
neural systems that subsequently become involved in
mentalising. The obvious next step will be to examine
individuals who fulfil criteria for autism but who do not
manifest difficulties with mentalising tasks, to see whether
they have the subcortical abnormalities without prefrontal involvement. If this proves to be the case, an
argument can be made that the abnormalities of caudate,
hippocampal, amygdaloid, and cerebellar structures that
differentiated the two cases of Kates et al. (1998) are both
necessary and sufficient for the manifestation of the
disorder.
Schizophrenia. Unusual features in intersubjective
behaviours have been observed in the early behaviour of
children who are subsequently diagnosed as schizophrenic (Pamas, 1999). For example, pre-schizophrenic
girls, compared to controls, show a significantly lower
proportion of positive facial expressions (Walker,
Grimes, Davis, & Smith, 1993). Such differences in
behaviour may result from differences in the antenatal
environment, or from complications at labour and
delivery (Waddington et al., 1998). Factors such as
maternal antepartum depression, low birthweight, and

short gestation have been shown to be significantly more

commonly associated with the birth of children who are
subsequently diagnosed as schizophrenic (P. B. Jones,
Rantakallio, Hartikainen, Isohanni, & Sipila, 1998). It
has been suggested that distortions to early parent-infant
communication may also be a factor increasing vulnerability to schizophrenia (Brody, 1981), but this has not
yet been subjected to systematic test. In one recent study,
it was found that poorer prognosis in schizophrenia was
associated with childhood diagnosis of ADHD (Elman et
al., 1998).
There is evidence attesting to the neurodevelopmental
origins of schizophrenia (Akbarian, Bunney, et al., 1993 ;
Akbarian, Vinuela, et al., 1993 ; Harrison, 1997 ;
Keshavan & Murray, 1997). Abnormalities of early
interaction can be related to complex neuropathology
consistent with antenatal disruption to the processes that
form cortical-subcortical pathways. Within the adult
schizophrenic population, deviant brain morphology is
associated with evidence of early behavioural dysfunction ; e.g. dilated brain ventricles are associated with early
neuromotor deficits and negative affect (Walker, Lewine,
& Neumann, 1996).
Attention-Deficit Hyperactivity Disorder. AttentionDeficit 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 differences
are only apparent in retrospect. A recent study could not
find any way of discriminating between a group of 27
children subsequently diagnosed as having ADHD and a
matched group of 27 children diagnosed as having PDDNOS (autistic spectrum difficulties). A wide range of
pre-, peri- and postnatal difficulties and atypical or
delayed development within the first 4 years were
examined (Roeyers, Keymeulen, & Buysse, 1998).
There is good evidence for a neurobiological basis to
ADHD, including a number of fairly consistent abnormalities on neuroimaging, including decreased frontal
lobe volume (Hynd, Semrud-Clikeman, Lorys, Novey, &
Eliopulos, 1990 ; Castellanos, Giedd, Hamburger, Marsh,
& Rapoport, 1996) and abnormalities of the corpus
callosum (Giedd et al., 1994) and of the cerebellum
(Berquin et al., 1998). Many children subsequently
diagnosed with ADHD had sustained minor head injuries
in childhood. Whether their activity and impulsivity led
to their being involved in accidents, or their ADHD was
in some cases secondary to traumatic damage, is still
unresolved (Herskovits et al., 1999).
There is debate over the significance of certain gene
markers claimed for ADHD. If these are confirmed they
would appear to specify differences in dopamine transporter and receptor activity (Castellanos et al., 1998 ;
Rowe et al., 1998 ; Smalley et al., 1998).
Central auditory processing problems. Adults with
developmental aphasia are impaired in the discrimination
of fast phonemes (Tallal & Piercy, 1974) and abnormalities of temporal discrimination have been shown in
several clinical groups, including children with dyslexia
(Tallal, Miller, & Fitch, 1993), Specific Language Impairment (SLI) (Merzenich et al., 1996), ADHD (Barkley,
1997), and in autistic spectrum disorders (Tallal,
Merzenich, Miller, & Jenkins, 1998). Difficulties with
temporal discrimination appear to predict subsequent
problems with communication by speech and reading,
and to be associated with deficiencies in the function of a
widespread magnocellular system in the visual and

INFANT INTERSUBJECTIVITY

auditory systems of the brain, which implicate the

cerebellum (Stein, 2000). Again, a system important in
intersubjective communication with neural foundations
in the brainstem is indicated.

Intersubjective Therapies in Infancy and Early

Childhood
Given the retention of a degree of conscious awareness,
every human being, even one handicapped by severe
neuropsychological disorder, is sensitive at some level to
the communicative expressions of other persons, and to
the motives and emotions behind them. All humans are
capable of detecting rhythmic impulses and qualities of
other persons behaviours that are contingent upon and
related emotionally to their own expressions. These
principles of fundamental intersubjectivity, which underlie but are not dependent on reason and language, are
involved, though often not deliberately employed, in all
therapeutic and educational procedures, just as they are
continually present in family life and the daily activity of
social groups. Changes in motivation and emotion
mediated by communication and responding to the
expressions of caregivers and partners in action and
awareness can evoke and sustain improvements in motor
coordination, cognitive alertness, and discrimination,
learning, and thinking.
What we have learned about fundamental intersubjective processes in infancy can be applied to benefit
the wellbeing and development of children with developmental disorders. However, many regimes for professional intervention with psychoaffective problems of
children do not directly or overtly address interpersonal
and expressive functions. They rely more on the traditional medical or educational models and the giving of
medication or instruction to the child as a patient or
pupil. In statistical assessment required by clinical trials,
data on many individuals is grouped to provide a
description of a population based on what are inevitably
rather limited measures of psychological status and
performance. At the same time, it is the experience of
practitioners and families that benefits may be obtained
by directly addressing, for each child and for their
particular condition, the quality and receptivity of communication in treatment or teaching, and its management
in the family or school.
Cognitive or behavioural therapies are aimed to control
behaviour and establish acceptable routines to benefit the
childs physical and emotional health and to facilitate
easier relations with family caregivers, teachers, and
school partners. It is recognised that learning in such
regimes depends on positive motivations, but the range of
pleasurable rewards is generally not explored. Qualitative
and emotive aspects of communication require specialised methods of continuous observation and qualitative assessment that are capable of identifying what
characterises most effective practice. The theory of
nonverbal communication with emotionally disturbed or
cognitively disorganised children is not explicit. We
believe that evidence from the study of how infants enter
communication and progress to language has given
valuable pointers to the kind of models and techniques
required.
The physical\acoustic analysis of vocal communication has brought to light the principles of timing,
emotional expression, and narrative that universally

31

mediate in interpersonal contacts and relationships, and

the same principles can be extended to observe the quality
of communication by touch or gesture. Research on the
methods and effects of music therapy and movement
therapy is becoming more disciplined and scientifically
controlled (Aldridge, 1996 ; Bruscia, 1991 ; Pavlicevic,
1997 ; Wigram, 1996 ; Wigram & De Backer, 1999), and
the benefits have been demonstrated for many conditions,
including autism and other emotional disorders of childhood (Robarts, 1998 ; Wigram, 1996) and distressed
infants born very prematurely (Schoemark, 1999). Als
(1995) reports on the beneficial effects, with clear
reduction in indices of infant dysregulation, of individualised care for very low birthweight infants
that involves skin contact with mother or father
(kangarooing). The evidence of both immediate
and lasting physiological benefits of sympathetic
individualised care for infants in intensive care is convincing. We have described a mutually regulated
vocal exchange with a 2-month premature infant in
kangarooing, a situation which favours the infants
hearing of the adults voice and sensing the vibrations
that it produces (Trevarthen et al., 1999).
The profound mental handicap of Rett syndrome does
not prevent the affected girls from attending to and
joining with improvisation by a trained music therapist,
and the method has been employed to demonstrate a level
of intentional expression of preferences by the children at
a level not hitherto expected (Merker & Wallin, 2000).
Children with profound mental handicap, including girls
with Rett syndrome, also respond to the expressive
regime of movement therapy (Burford, 1988, 1993 ;
Trevarthen & Burford, 2000). With adults, music therapy
has proved effective with depression and in the treatment
of mild schizophrenia (Pavlicevic & Trevarthen, 1989),
and a method has been developed to quantify the therapeutic effects by assessing the level of musicality
achieved in improvised treatment sessions (Pavlicevic,
Trevarthen, & Duncan, 1994). Computerised acoustic
analysis of musicality of expression and of interaction,
which brings objectivity and accuracy to observations of
basic subjective and intersubjective events, has been
used to observe the effects of depression on a mothers
communication with her infant and the infants responses, and the changes that occurred as the mothers
condition improved (Robb, 2000).
Methods of special education, including Portage,
ABCedarian and others, developed as part of the American Head-Start program (Tingey, 1989), are aimed to
improve development of cognitive, perceptual, motor,
and language skills. Their procedures do not clearly
recognise that early interpersonal functioning is the
starting point from which developments in skills arise as
a consequence of intersubjectively mediated learning.
Evidence from infancy research suggests that explicit
focus on aspects of primary socioemotional development,
such as turn-taking, prosody, reciprocal imitation, and
joint attention might prove particularly effective, at least
in the early stages of intervention, and especially in work
with groups where there are grounds for believing that
deficiencies in interpersonal functioning are at the root of
the problem. Nonverbal expressions, such as eyepointing, gesture, and hand signs, as well as expressive
use of the voice, are effective in communication with
children who have little language comprehension, and are
likely to be less impaired in children with less severe
abnormalities of language comprehension and use

32

C. TREVARTHEN and K. J. AITKEN

(Bishop, 1989 ; Donaldson, 1995 ; Jordan, 1993 ; Von

Tetzchner & Martinsen, 1981).
In a model intervention program combining different
techniques of therapy applied to both infants and their
mothers, in which the infant came to be viewed as a
cotherapist, Fraiberg (1980) demonstrated that severely
mentally ill mothers could benefit greatly from assistance
in responding to their infants and developmental guidance that alerted them to the responses that could be
expected when communication and care were meeting the
infants needs. In treatment for postnatal depression,
interventions to foster improved early interaction, including music mood induction, have been confirmed to
have significant benefits for both mothers and their
infants (P. J. Cooper & Murray, 1997 ; Field, 1997). In a
study comparing outcomes of routine primary care,
nondirective counselling, cognitive-behaviour therapy,
and dynamic psychotherapy, there were no significant
differences ; all methods produced improvements in the
mothers status, with benefits to the infants psychological
state and development (P. J. Cooper & Murray, 1997).
Therapies aimed at improving maternal mood and
reducing infant arousal, including presentation of relaxing music and infant massage, can make the dyad more
accessible to approaches focused on improving the form
of interaction itself (Field, 1998), and Field (1977) has
shown that inviting the mother to imitate her infant and
monitor the effects can increase a depressed mothers
sensitivity to an infants cues. A recent intervention study
found that infant massage could significantly normalise
the right frontal EEG asymmetry associated with maternal depression (N. A. Jones et al., 1998). With toddlers,
it has been shown that a depressed mother fails to support
joint attention and common awareness and she is more
distracted by competing events (Goldsmith & Rogoff,
1997). Such avoidant maternal behaviours are known to
affect the toddlers language learning, and they can be
changed by a well-targeted positive feedback of information about how communication is improved in
moments when joint attention is achieved, for example
by video-feedback training (Hugh & Rosenthal, 1981 ;
Hundeide, 1991).
Psychodynamic therapy can prove beneficial to depressed women by lifting depressive features and selfesteem while clarifying maternal conflicts (Cramer, 1997).
Joint mother-infant psychotherapy may be effective in
helping a mothers transition to more supportive childcare with depression, but not with more serious emotional
problems and economic or marital stress. Didactic
interventions, which gave the mother information on
infant behaviour and communication, and on practical
aspects of family adaptation when a preterm infant and
mother return home, improved early interactions, enhanced maternal sensitivity to infant cues and led to
higher levels of maternal speech, smiling, and physical
contact with the infant (Meyer et al., 1994). These changes
were accompanied by significant reductions in the
mothers depressive symptomatology on the Beck Depression Inventory, compared to controls. In one largescale and intensive early intervention programme for low
birthweight prematures, positive outcomes were seen at
30 months, including improvements in dyadic synchrony,
quality of maternal assistance to the infant, and infant
competence and involvement (Spiker, Ferguson, &
Brooks-Gunn, 1993).
There is considerable disagreement concerning the
efficacy of therapies for autism, and differences in the

estimation of the improvement that can be generated

(Howlin, 1997 ; Trevarthen, et al., 1998). Nevertheless, it
is accepted that earlier interventions are likely to produce
greater improvement than the same approaches used at a
later stage. The Lovaas method of behavioural training
has been demonstrated to have beneficial effects in a
number 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 what
way it is effective, and how general and lasting the
benefits are. It is also not clear how far the expressive
manner of communicating reinforcements and negotiating routine procedures is critical to success, though high
affect speech by therapists is encouraged. A wide range of
other approaches focus more specifically on early aspects
of interaction (Alvarez, 1996 ; Trevarthen et al., 1998 ;
Waterhouse, 2000). Most of these have not received
controlled assessment. Their operation is not captured by
measurements of performance on predefined measures of
intelligence, rational beliefs, or cognitive flexibility.
In the study of special education for autism, instruction
in speech and language is naturally given great importance. However, speech therapy is not, by itself,
generally effective, except for high-functioning cases who
need assistance with semantic and pragmatic difficulties
(Jordan, 1993). For more children with greater problems
in communication, an approach that addresses the
underlying interpersonal problems is more effective.
Emotional engagement and joint attention appear to
have a more fundamental role in furthering language
development in autism than instrumental use of language
(Rollins, 1999), and this approach may be applied for
clinical intervention to enhance communication skills in
autistic children more effectively than any training in
thinking or beliefs (Astington & Jenkins, 1999 ; Rollins et
al., 1998). Improvisation music therapy is gaining acceptance as a remarkably effective way of gaining and
regulating communication with even the most recalcitrant
autistic youngsters (Robarts, 1998). It employs techniques of mirroring and enhancement or modulation of
expression with the benefit of a trained musicians
sensitivity for pulse and expression in gestures made by
the patient. Imitative responses are found to be attractive
to autistic children and can act as a bridge to collaborative
play or communication, and improve the childs access to
language (Dawson & Galpert, 1990 ; Nadel, 1992 ; Nadel
& Peze! , 1993 ; Tiegerman & Primavera, 1981, 1984). The
intensive training of parents by the Option method in
responsive care and education of autistic children, which
has proved of great benefit to many families, employs
systematic imitation to achieve joint attention and motivation to learn collaboratively (Kaufman, 1981, 1994).
The importance of auditory communication at a
nonverbal level is clear from research with young infants,
sensitivity to the human voice being much better developed than visual awareness of human expression at
birth and in early weeks. Temporal and prosodic aspects
of early vocal interaction are critical to socioemotional
development, as well as to mature functioning of language
communication. In recent clinical trials, by a multicentre
study across 35 clinics and educational sites in the U.S.A.
and Canada (Tallal et al., 1998), training in auditory

INFANT INTERSUBJECTIVITY

discrimination has been shown to be more broadly

applicable than was initially thought, benefiting those
with autistic spectrum disorders and ADHD in addition
to those with speech and language impairment. The
treatment appears to be directly redressing a common
problem in early childhood that can interfere with many
aspects of social interaction. ADHD perturbs the normal
processes of shared experience and motivation for learning by instruction. However, children who diagnosed as
having significant levels of anxiety as well as ADHD have
been found to show a different and significantly better
treatment response to psychosocial interventions than
did those without anxiety (The MTA Collaborative
Group, 1999).
Modern psychodynamic treatments acknowledge that
the classical theory of Mahler or Klein underestimates
the young infants self-organisation and capacity for
interpersonal awareness (Stern, 1985), and methods of
supporting emotional functioning, communication, and
learning now address more directly the motives that the
child brings to relationships. Tustin (1991) and Alvarez
(1996) describe methods of regulating the anxieties and
confusion of autistic children and facilitating their acceptance of communication. Psychoanalytic therapists
(e.g. Haag, 1984 ; Meltzer, Bremer, Hoxter, Weddell, &
Wittenberg, 1975 ; Tustin, 1981) are sensitive to the
feelings of fragmented body- and self-awareness and
weak perceptual grasp of objects and the behaviours of
other persons that some autistic adults describe vividly
(Grandin, 1997 ; ONeill, 1998 ; Williams, 1996). Clearly
the insights and clinical experience developed by psychodynamic practitioners can be brought into harmony with
more conservative or objective approaches if both accept
that there are fundamental intersubjective needs in
human persons of all ages.
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