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 subject's movement, perception, and learning, and how the infant's biologically grounded self-regulation of internal state and self-conscious purposefulness is sustained through active engagement with sympathetic others. Mutual self-other-consciousness is found to play the lead role in developing a child's 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 factors--organic 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 infant's 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 infant's 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.

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 subject's movement, perception, and learning, and how the infant's biologically grounded self-regulation of internal state and self-conscious purposefulness is sustained through active engagement with sympathetic others. Mutual self-other-consciousness is found to play the lead role in developing a child's 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 factors--organic 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 infant's 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 infant's 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.

Evidence from the evolution of human cultural behavior and learning, embryology and genetics of the brain, and the behavior of human infants indicates that the critical and uniquely human motives for cooperative imagination and joint interest in objects and tasks are determined by expression of genes and epigenetic neural systems elaboration long before birth, along with essential peripheral organs of perception and motor expression that will serve in communication by rhythmic facial, vocal, gestural, and body movement signals. These cerebral motives continue to exercise their influence on neural development and behavior throughout life, transforming the behaviors of the developing individual through a succession of phases to which other individuals and cultural institutions are constrained to adapt. We discuss the theory of innate intersubjectivity and relate it to the hypothesis of an Innate Motive Formation that emerges in brain development as regulator of morphogenesis in neural systems, and that continues to function, postnatally, as generator of motives and emotions by which human contacts and relationships are regulated. We suggest that differentiates of the primary motive formation in the embryo brain later serve to generate intelligent exploration of the objective environment, and the emergence of an additional dialogic mechanism that represents the self-subject as a partner for an other-subject, intersubjectively. Intersubjective communication in infancy leads, through systematic age-related transformations of the brain and behavior, to preverbal mimetic negotiation of cooperative awareness and joint task performance. Finally we discuss, in relation to this theory, interpretations of faulty communication and development at different stages of the life cycle that result from maternal postnatal depression, autism, premature birth, and schizophrenia.

Disorders of emotion, communication, and learning in early childhood are considered in light of evidence on human brain growth from embryo stages. We cite microbehavioral evidence indicating that infants are born able to express the internal activity of their brains, including dynamic "motive states" that drive learning. Infant expressions stimulate the development of imitative and reciprocal relations with corresponding dynamic brain states of caregivers. The infant's mind must have an "innate self-with-other representation" of the inter-mind correspondence and reciprocity of feelings that can be generated with an adult.Primordial motive systems appear in subcortical and limbic systems of the embryo before the cerebral cortex. These are presumed to continue to guide the growth of a child's brain after birth. We propose that an "intrinsic motive formation" is assembled prenatally and is ready at birth to share emotion with caregivers for regulation of the child's cortical development, on which cultural cognition and learning depend.The intrinsic potentiality for "intersubjectivity" can be disorganized if the epigenetic program for the infant's brain fails. Indeed, many psychological disorders of childhood can be traced to faults in early stages of brain development when core motive systems form. Motives for Cultural Learning, Their Genesis and DisordersPsychological activities come about through growth of a brain that creates many orgaWe are grateful for helpful comments by Dr. Dante Cicchetti, Ellen Dissanayake, and Dr. John Locke. Our review of the relationship between brain development and emotional regulation of the infant's emerging personality has been greatly helped by a gift from Dr. Allan Schore of his book Affect Regulation and the Origin of the Self, which is a masterly review of the very large relevant literature. Much remains to be understood in this field linking psychology of affect and personality with the elaboration of neural systems in the brain. His is a courageous and generous attempt to bring us up to date.

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Intersubjectivity is an approach to the study of social interaction viewed from a perspective which rejects the view that reducing any such analysis to study at the level of the individual is adequate to address the issues of social functioning. It also stresses the view that social processes cannot be reduced to cognitive ones - most of the important questions in the study of developmental psychopathology deal with issues which have commonality with many other species and are patent well before the ontological emergence of 'cognitive' abilities. In this paper we review the evidence in this area, and discuss a range of issues relevant to autistic spectrum disorders. We focus in particular on social interaction; the role of the Intrinsic Motive Formation and recent work on mirror neurons in autism; genetic and teratogenic factors in the genesis of autism; and the role of a number of biological factors in pathogenesis - tryptophan; vitamin B12; sterol metabolism; glutamate and GABA; and the Fragile-X expansion.

A retrospective analysis of the epidemiological characteristics of non-accidental head injury (NAHI) in children in Scotland over the last fifteen years from 1981 until March 1996 was performed. The information was provided by the Information and Statistics Division of the Scottish Health Service. The average incidence of NAHI calculated over this period was 0.04 cases per year per 1000 children under 5 years. Fifty-five per cent of all cases occurred in those children who were less than a year old. 41% of cases were inflicted by a parent but in 47% the perpetrator could not be identified. The mortality rate was found to be 2%. Non-accidental head injury cases identified using the ICD-9 coding classification system gives a surprisingly low incidence. This number is probably an underestimate and the reasons for this are discussed. A prospective epidemiological analysis of NAHI in children in Scotland is being undertaken to determine the true incidence.