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2006 LECTURE SERIESAutism: Cognitive style not deficit?Dr. Francesca Happé Autism is diagnosed by social-communicative impairments, but is characterized by striking skills that pose a puzzle to deficit theories. Why do people with autism so often have perfect pitch, remember exact information, and spot tiny details others miss? Dr. Happé's studies suggest that autism comprises a different, not deficient, cognitive style; a tendency to see parts, rather than wholes. Thank you very much Mick. It is a great, great pleasure to be here in California. It is a particular honor to be here to talk in this lecture series where there have been so many distinguished speakers and also to talk to an audience such as yourself that have come along out of interest for the topic. I am aware that in the audience there will be a mixture of people. Many of you will be experts in autism, either from your own personal experience or from your work, and others may have never come across autism. I hope you will forgive me if I try and cover the topic at a level that everyone will understand. I really look forward to your questions because questions from interested people such as yourselves really help to push the field forward and to open new ideas that some of us who have been working in the field for a long time may have ignored. So please do ask all you questions at the end,I look forward to that. In the next 45 minutes I want to cover a number of ideas from our research. I want to begin with The question “Do we need to look for a single explanation for autism?”. Then I want to go on to what I think the current deficit accounts of autism, which focus on what people with autism can’t do. What those deficit accounts can’t explain. Instead, I want to focus on what many people with autism are extremely good at and how that might give us a different insight into understanding this condition. I want to stress that autism can be understood, in part, as a different cognitive style, a different way of looking at the world and understanding the world, not a deficit. I will go on to say a little bit about our exploration of what might be the causes for those differences in terms of genes for cognitive style and perhaps genes for talent. I will say a little bit about the brain and what might be the reasons at the neurological level for seeing the world in terms of details. And finish with some suggestions and ideas. As many of you all know, autism is a developmental disorder. It affects approximately 1 in 1,000 children and adults, and seems to have a strong genetic basis among possible environmental causes that we don’t yet know. Autism is diagnosed and defined on the basis of behavior. We don’t have a blood test or chromosome test as yet. The specific behaviors are social impairments, communication impairments, rigid and restricted behavior and interests. Those three simple areas of difficulty, in fact, cover an incredibly wide range of manifestations so one of the great challenges to autism research and to understanding autism is the heterogeneity within autism. One individual on the autism spectrum may be very different from another individual, and yet they share these three key characteristics. A very young child with severe autism may show social impairment by being entirely aloof; a child who does not go to his or her parents even when distressed or hurt, who seems to be happiest left alone. This child may have a severe communication impairment, no language, but unlike a deaf child who compensates in terms of gestures, this child does not even turn if their name is called, although they are not deaf. (They can hear when a sweet is unwrapped behind them.) The same child may be locked into simple motor repetitive actions or stereotypes, hand flapping or waving, rocking, may line up toys obsessively again and again in rows but never playing imaginatively with those toys. That might be part of the spectrum. But that child might grow up to be an adult who, while still showing the triad, the three difficulties, shows a very different manifestation. An adult with Asperger syndrome, a different form of the autism spectrum, who has a social impairment of being very actively social but odd in their social approach. A young man, for example, who thinks that the girl at the checkout at the supermarket is his girlfriend because she smiled at him, who might run down the street to talk to somebody and put them off in their odd and inappropriate social approach. Their communication impairment might be very different. Now if you have somebody who’s language is very good, who might be very verbose, very exact and meticulous in their use of language, but tends to, as I’m doing now, deliver a monolog about their own special interests and does not understand when somebody is joking or being sarcastic. Their restrictive and repetitive interests may be a very well and highly developed interest in astronomy or in electricity pylons or collecting the Latin names of every type of carrot – something very highly developed but still lucky in imagination. This will be an individual who really can’t understand why the rest of us so called neuro-typicals waste our time with gossip and storytelling and watching soap operas and all these other kinds of activities that engage the imagination to consider how one person thinks and feels about another person. There are a wide range of manifestations, and a key question is whether we need to come up with one explanation for these three different facets of autism and the autism spectrum. I want to suggest that maybe the search for a single explanation can be abandoned, that we have to understand the triad as three parts perhaps with three different causes. All people in the autism spectrum share these three characteristics. By studying autism itself we will never find out whether these three characteristics necessarily go together or whether they have different causes and can be split apart. At the Institute of Psychiatry we’ve been studying all ordinary, typically developing twins born in England and Wales in 1994, ‘95, and ‘96. Here you see just one twin pair that has been kind enough to participate. You can see them through the ages from one month to eight years, these children are still being followed up and will be seen again at ten years and at twelve years. By studying variation in the ordinary population, we can answer the question “do problems in communication, problems in social interaction, and problems in rigid and restrictive behavior go together, and do they have the same cause.” Because we are studying twins we can compare identical twins who share all their genes and fraternal twins who typically share half their genes to see what role genes and environment play in underlying these different difficulties. To give you a short answer from a long study, this twin study has suggested that each part of the triad has strong genetic influences. Individual differences in social functioning, whether you are able to interact well with your peers socially or whether you find social interaction a struggle, communication impairments and rigid and repetitive behavior – each of those has a strong genetic component. Different genes act on each of those parts of the triad. There are very, very few genetic influences that are causing an overlap. We also found that there were a lot of signs from twins who had autism spectrum disorders, there were many individuals in the study who had just one difficulty, who maybe had social impairments or had communication impairments, or were rigid and somewhat repetitive in their behavior. These different parts of the triad can split apart. I think the time has come now to search for the genes not for autism, but the genes that predispose to social difficulties, or predispose specifically to communication impairments. I think at the psychological level the same is true. In my view there has not been much success in finding a single explanation in terms of what is different in the minds of individuals with autism that can explain all three of the areas that mark out autism. Some of you may know that in recent years one of the very influential deficit theories has been that individuals with autism find it difficult to know what others are thinking and feeling. This has been termed theory of mind or a difficulty in mind reading. This provides quite a good description and explanation for social impairments and communication impairments. If you don’t understand that others have thoughts and feelings, then you are not going to communicate with them appropriately, you are not going to interact with them appropriately. But this can’t explain the rigid and repetitive behavior. Another theory, a non-social theory, has come in to try and describe and explain the rigid and repetitive behavior of autism. This theory suggests that some of the functions that are served by the frontal lobes (the most recently evolved and most sophisticated parts of our brains) functions like generating new behaviors, planning and monitoring our actions in novel situations. Those kinds of abilities are very difficult for people with autism and they get stuck into routines and repetitive behaviors. A single explanation does not seem to work. I want to suggest that these deficit explanations do not really take us all the way to explaining and understanding autism. That is because they can’t begin to explain the many things that people on the autism spectrum are surprisingly good at. Here you see some really beautiful drawings by an individual called Nadia, who at the time that she did these drawings, was three-years-old. She had severe autism and at the time of drawing these horses was non-verbal, she was unable to feed herself or do up her own buttons. But if you gave her a Barrow [phonetic], she would not draw with anything else, but if you gave her the right type of pen she would produce, spontaneously, these wonderful kinds of pictures. From somebody at a different place in the spectrum is a wonderful drawing by Gilles Trehin. And you can see his website here. He has drawn many, many pictures of this imaginary city. This is a young man who is really fascinating. He had a classically autistic childhood, he was the silent and aloof type of child. Apart from his artistic ability he also had perfect pitch. He could not only name a note he heard played on an instrument or sung, he also could name the pitch of a cork coming out of a bottle, or of the doors on the Paris Metro Underground. He also named the pitch of his parents speaking and when he was old enough to start speaking at five or six-year-old, he asked his parents, “why do you, mommy, say this word in a C flat and daddy says it in a D?” This is a young man with multiple talents. He also did calendar calculating. He could tell you the day of the week that any date would fall on. He used to do that when he was younger but he has lost interest in it now. He has many, many talents and he is now a young man who fits the Asperger kind of picture of highly verbal, highly intelligent, and very socially interested. But what I want you to notice, particularly in his beautiful drawing, is the level of detail because that is going to be important in what I want to talk to you about today. Here is another artist with autism, Steven Wiltshire, who is a British artist that some of you may have heard of. In particular I want to mention his prodigious memory, which is an ability that many individuals with autism have. Not only is he an artist but he has a fantastic visual memory. Here you can see him drawing from memory the full 360? skyline of Tokyo having viewed it for only 30 minutes from the top of a very high building. Over seven days he drew that panorama from memory. Again, an enormous detail and fantastic memory that I think none of us could match. Apart from savant skills, many individuals with autism have other kinds of abilities that may not be so well developed as those skills in music, or math, or memory, or calculation that we are familiar with from the famous cases of savant ability. An extraordinary eye for detail is very common in autism. I don’t know how many of you can spot the differences here. To put you out of your misery, I spotted one but that probably does not add up to much. If there is anybody with autism in the audience they can probably help us out. My feeling is that while savant skills occur in around 1 in 100 individuals, 1 in 10 individuals with autism, and many fewer – less than 1 in 100 individuals with other kinds of learning difficulties, they are very common in autism. There are many individuals with autism who don’t have savant skills. But I think that pretty much everybody on the autism spectrum is surprisingly good at something. There is something that is out of line with other abilities that their teachers, their parents will be surprised by and struck by. Sometimes it does not come across as a talent and it seems like a problem. If you have a young child with autism who, when they come into their sitting room or into their home, can immediately spot that an ornament has been moved a fraction of inch on the mantelpiece and is extremely distressed by that change and has a tantrum, you are not necessarily going to think that this is a wonderful talent. But it is a wonderful talent. They are doing something that the rest of us really can’t do. Just like Steven Wiltshire memorizing that skyline and that Tokyo panorama, the individual with autism has remembered that important place in a level of detail that the rest of us could not achieve. People with autism show superior performance in a number of areas, besides savant skills, many individuals with autism have excellent memory for facts. It may be in their own special area of interest. But they have wonderful memory for what they are really interested in. Many are good at spatial tasks. They may be good at jigsaw puzzles. Some children I know can do jigsaw puzzles even with the pieces turned face-down and many notice tiny changes and they may be sensitive to differences in pitch and so on. Now none of these assets can be explained in terms of our current deficit theories. Difficulties in reading minds, difficulties in planning and monitoring won’t explain these assets. I think they are as integral a part of autism as all the very real difficulties that I’m not wanting to wish away or ignore. But I think they also cry out for explanation. I want to tell you about our attempts to try and understand these areas of skill in terms of an idea of a cognitive or psychological style, a different way but not a deficient way of understanding and processing the world. What you can see here is a poster from The National Autistic Society in Great Britain who have, in this particular poster, taken up this idea. I don’t think you can read the text but it says, “when a person with autism walks into a room the first thing they see is” and then it lists off a load of things I can read the first few: a pillow with a coffee stain shaped like Africa, a train ticket sticking out of a magazine, 25 floorboards, a remote control, a paper clip on the mantelpiece, a marble under the chair, a crack in the ceiling, and so on, and so on. It says at the end, “so it is not surprising that they ignore you completely.” This captures a very strong sense that individuals with autism see the world in an entirely different way from the rest of us. They see the world in terms of details. So the idea of central coherence, this term central coherence was introduced by Uta Frith to refer to the general tendency that most of us neuro-typicals have to see the world in terms of the big picture. To integrate information and to lose the details so that when you leave this lecture, hopefully, you carry away some idea of the gist of what I was trying to convey. But it would be very surprising if any of you could repeat back verbatim the actual words I used. Now some individuals with autism can do exactly the opposite. They come away without the gist but they might be able to repeat back the exact words. While ordinary people we see a tendency to process the whole and lose the parts, individuals with autism appear to see the world in terms of the parts. They concentrate on the features. They often don’t seem to get the bigger picture or to put the information together for meaning or for global form. I can give you some examples of the kinds of tasks that we have used in our research to test and to illustrate this. This is a very simple task called the Embedded Figures Test and the job of the child or adult who is being assessed is simply to find this smaller part within the larger complex figure. I have had the experience of giving this task to some children and I remember in particular one young man who was entirely nonverbal. He was about eight-years-old when I tested him, and he was one of those children that was really happiest running around the room. You despair of testing them on anything that isn’t how well to work the video or how to rewind their favorite video again and again. But once I brought these little tasks out, these stimuli out he flicked through them, pointing to where the figure was, and in this case it is up here. He pointed out the figure to me as fast as I could turn them over. And he was genuinely a lot better at this than I was. That is not unusual. There are a lot of children and adults on the autism spectrum who are extremely good at this particular task. I will show you another example. This is a slightly harder one. And one of the reasons that this is difficult for most of us is that we see the complex shape on your left as a whole design. We don’t see it as made up of parallelograms in different parts. We see it as a whole and we can’t help it. That is how we are designed. We see it in terms of wholes. And to do the task we have to pull that apart and overcome our natural tendency to see the whole. It seems individuals with autism are not distracted by the whole form, they can see it in terms of its parts. I can give you another illustration of that. This is another task called the Block Design Task. Those of you who are familiar with intelligence assessments will be familiar with this one from the Wexler scales. The task of the participant here is to copy the whole design, the large design you can see at the bottom on your left, to copy that using the cubes that have different patterned faces that you can see at the top. Again one of the reasons that this is more or less difficult for us is that we see the whole design as a whole, as a black shape on a yellow ground. We don’t see it in terms of triangles and rectangles and so on. Now because of that, if you want to make it easy for an ordinary person like us, you can pull the design apart into its constituent pieces and then it becomes a very easy task. Individuals on the autism spectrum find copying these whole designs extremely easy, typically. They don’t find segmenting the design makes it that much easier. It is as if they already see the whole in terms of its parts. They are seeing the parts for free. I want to illustrate this again with some examples from a little study we did of how children on the autism spectrum draw. We compared individuals with autism, individuals with general learning difficulties and matched for ability level but without autism, typically developing children and also children with ADHD. On this simple drawing task we showed them a picture of a house, said here is a picture of the house that I drew, I’d like you to draw one like it and we just observed how they drew. And this will just show you the progression in this particular case. This child began his drawing with their window. Almost everybody would begin with the outline of the house, but this child began with a detail, with the window. Then he is going to the next parts, and then, finally, the outline of the house. Now this is a different child, another boy on the autism spectrum. He began this time with the outline but look at what he does when he gets to the window panes. He draws each square of the windowpane separately. He does not draw the cross in. He is drawing each of the four panes and he does it again over there. This is a boy asked to draw a house with four windows. You can see all the different parts. You can see at the bottom the house, and then you can see one, two, three, four windows, you can see the roof, and you can see the chimney. This drawing is perfect. It is all there. Everything is there. It is just all the parts are there and they are not put together in the way that you and I would think mattered. We have explored this idea of detail focus at a number of levels and one question is whether this might explain even some sensory or perceptual difficulties in autism. One intriguing finding is that being able to see the parts and ignore the whole might make you particularly good and accurate in certain kinds of tasks. Some visual illusions are due to our inability to ignore context. If I asked you to judge whether those two circles are the same size or different, that is pretty easy. But once I add a context it should, hopefully, make it harder. If an individual with autism is able to ignore the context and go straight to the part that matters, they may be unusually good at this task. And that is what we find in some of our studies. We have also explored part and whole processing in verbal tasks. Simple tasks like asking a verbal child with autism, say something to finish this off – “you can go hunting with a knife and. .” and the children with autism say fork. You can go hunting with a knife and fork. That is an example of weak coherence where you are going for the parts and not the whole. Then they will give you an answer that is perfectly sensible for the last part but does not take into account the whole. Now that is not what young typically developing children do or children who have general learning difficulties, intellectual impairment, they will say something like, “you can go hunting with a knife and catch a bear.” They don’t even seem to notice this apparent trap that is there. We have also done reading tasks where you have to use context. Most of us don’t even notice that in English there are a number of homographs – words that are written the same way but sound different and have different meanings. So tear (tîr) and tear (târ) is an example. We probably would not even notice that when asked to read aloud a sentence like ‘in her eye there was a big. . . tear.’ We use the context without thinking to disambiguate that single word. But an individual with autism will quite happily read aloud “in her eye there was a big tear (târ)”, “in her dress there was a big tear (tîr).” It does not seem to matter. It is as if they are reading each word on a list rather than putting them together in a sentence. This tendency to see the world in terms of details is, I think, a style or a bias rather than a deficit. And I want to say why. But first I want to just give an example, an anecdote that was, for me, very formative in thinking that this theory really had something important in it. This is from a clinician in England, Lorna Wing, who those of you in the autism world will know. She told me about an occasion when she tested a young man with autism and she got out various little toys objects and she asked him first of all to name what was there. He named the bed, the little toy quilt, the doll, and the doll’s chair. And then she, Lorna pointed to the little toy pillow that was on the bed and she said, “and what is this?” And he said, “it is piece of ravioli.” Now the important thing in this anecdote was that Lorna said when she looked at the pillow again, yes it did look exactly like a piece of ravioli. But she would never have seen it that way. She could have looked all day and never seen it for what it really looked like because her perception was entirely blinkered by the context. By what it was meant to be in the context. The important thing is the perception is accurate, but it is so different from ours because it is context free. It is seeing the part without the whole. This detail focus is often adaptive. If you think what it takes to be a good proofreader, to spot errors in text, you have to forget about guessing the next word from its meaning and see what is really there on the page. That is one reason why we can call this a cognitive style rather than a deficit. And we know that sometimes this can result in talents and I’ll say a little bit more about that in a moment. We also have reason to think that this style or bias can be overcome by deliberate effort. I mentioned the example of reading out “in her dress there was a big tear” as if it was a list of individual words. People with autism who might fail in that task or make those sorts of context-free errors are perfectly capable of reading text for meaning when they are asked to do so. But when is an open task to just read aloud this set of words on a card reading for meaning does not come naturally. One of the things that this research has taught me is never again to give somebody with autism something to read that I want them to take the gist from without telling them please to read it for meaning or please I’m going to ask you questions about it at the end. Because if I’m simply asking them to read it, that just means decode the words, it does not mean get the meaning. The way that I see this bias is that for most of us the whole and the meaning and the gestalt comes first. But we can process details if we need to. You think about the effort that you make to remember abstract information. Information that may not make any sense to you maybe when you were learning up for exams at school in something that you didn’t really understand but you could remember the facts by shear effort of will. Or if you have to remember a PIN number or bank number, it does not have any meaning but it is important to you so you make yourself learn it. What we do effortlessly is take the gist and remember meanings. Now the person with autism, I think, is just the other way around. They can by an effort of will by deliberate effort work out what a meaning is, put together information in context but that does not come naturally. The natural style or bias is to go for the details and notice the details and process in a piecemeal way that can be very adaptive. I also believe that this cognitive style or bias is independent of difficulties in social processing. We have some evidence that whether or not you have difficulties reading other minds you probably are going to be a detail focused processor if you are somebody on the autism spectrum. The two difficulties may interact, but I think that they are really somewhat separate. These are the reasons why I say this aspect of autism can be understood as a style and not a deficit. Now can it help us to understand better these savant skills that are so striking in autism? Well I think it can give us a start. I have shown you how some children on the autism spectrum who are not talented particularly, artistically, draw piece-to-piece, draw starting with a detail or break the picture up into details. Studies of artists who have autism also show that they tend to draw detail to detail even though the final production is wonderfully coherent. But the way that it is built up is from part to part to part. Studies have also shown that artistically talented people among the general population as well as individuals with autism are very good at that Block Design Task that I showed you. It seems to be a common component of artistic talent that you are able to see the parts within the whole. Turning to musical skills, we know that the musical savants, those wonderful individuals who maybe one day sit down at the piano and, to everyone’s surprise, can play a piece of Mozart that they have overheard. Or can play back some music that they have heard only once, just from memory and by ear. Individuals who may be nonverbal who may be severely impaired in other respects. We know that all of these known cases of savants have perfect pitch. That is they can label a note that they hear, they can identify the pitch of that note. But we also know from studies that many individuals on the autism spectrum who don’t have developed musical talents have the potential for perfect pitch. If you teach them that this is a note that the cat likes. This is the note that the dog likes. This is the note that the cow likes. You come back two weeks later and play a note and say which animal likes that? They will remember. That is not something that typically developing children can do. It is not something that I can do nor most of the audience can probably do. They have the potential to hang on to that exact, precise feature information. That seems to be a very good start for developing musical skill. Now it is interesting that studies suggest that in typical development up about until the age of four there is the potential to develop perfect pitch or absolute pitch. But that around the age of four in typical development there is a shift from paying attention to specific notes or pitches from exact notes to melody. So before that age a child who sings back a song that they know well from a tape will sing it back on the exact notes. But after that age they are paying attention to the melody and they can transpose it and they can sing it in different places. It is interesting many musicians think that having perfect pitch can be actually a little awkward and difficult because it makes it hard to transpose. Maybe the start for musical savant skills is that exact attention to the parts of music rather than the melody. Our working model for this idea of cognitive style or psychological style is that all of us can be placed on a continuum somewhere from weak coherence or detail focus to people who are very strongly global processors, and that all of us would be somewhere along that continuum. Some of us are very good proofreaders, others are very good at capturing the gist of what they have heard. They might leave the cinema knowing exactly what happened in the movie but forgetting the exact names or the details. All of us would be somewhere along that continuum. But the people with autism are at the extreme weak or detail-focused end of that continuum and there is an area of autism risk. What I’m suggesting is that that alone is not enough to make you what we call autistic. You need also to have the social difficulties and maybe the executive function difficulties but that is a part, an important part, but this is a variation where we can find perfectly ordinary people who would be very detail focused and people who would be the opposite. Maybe, when you think about the male to female ratio in autism, the fact that there are so many more boys and men with autism than girls and women, maybe there is a general shift, just a slight shift for males in the general population to be a little more detail focused. We have been exploring this in a study with about 200 typically developing volunteers. I will show you just data from one of our tasks. That sentence completion task where you ask them things like ‘you can go hunting with a knife and. . .’ fork, or ‘little boys grow up to be men and. . .’ women is what a child with autism might say. So here you can see the error score, the mistakes where it is very local, of completed but don’t make sense in the whole context. You can see how the errors are changing across the age span in typically developing samples of men and women. You can see, particularly in the younger ages, the much lower rate of these local responses among girls and among boys. We have been tracking some of these individual differences. And you can find real individual differences in the detail-focused quite apart from general intelligence, quite apart from age and sex. You can see these real individual differences. We have also tried to begin exploring this question of a relationship between autistic traits and giftedness. If this cognitive style of focusing on details actually tends to predispose you towards savant skills or toward special skills, then maybe we can see that in the general population too. Among our 12,000 twins, and this is data from when they are eight years old, we asked parents to tell us if their twins had any special gifts. If they were unusually good at something, either compared to their other skills or compared to their peers, or maybe even compared to children much older. We also asked parents to tell us about autistic-like traits. And we found that there is a real relationship between these two. The children who were said by their parents to be gifted were also said by their parents to be somewhat more autistic-like in a mild form, in a very mild form of normal types of individual differences but some autistic traits. When we looked at what aspect of that triad, it was not the social difficulties and it was not the communication problems, it was those rigid and repetitive behaviors that parents were saying their gifted children had. Now I would like to interpret that as a sign of this detail-focused processing. And of course, an alternative explanation is that kids who are very repetitive or obsessive may practice a lot and develop one skill that is out of line with others and we are exploring it to know which of those accounts will really explain it. But what I can tell you is that, again, comparing the identical and non-identical twins – there is evidence that the link between these autistic-like traits and the gifts is again mediated, in part, by genetic effects. So maybe the genes for some aspects of autism are the genes for talent. This gives us a different way to explore some of the genetic predisposition for autism. The traditional approach to looking for the genes for autism has been to, among other things, look at family members. Look at the first degree relatives of individuals with autism and spot that Uncle Arthur was a little bit socially odd and a bit autistic-like, and to spot that somebody else may have been a bit impaired in the communication and so on. Call these people mildly autistic or somewhere on the autistic spectrum. Then trying to work out where the genes are shared. Our approach suggests that one of the ways that we might need to look for individuals who are carrying some of the genes predisposing for aspects of autism would be to look for individuals who are talented, to look for individuals who have detail focus. They are not going to look autistic, they can be perfectly well-adapted, very, very, good perhaps at their particular jobs that may use this skill. We may need to look for that detail focus. That might help us to identify the members who are carrying some of the predisposing genes. We have done this with the help of some very kind volunteering families who had children with autism or had children with dyslexia, or had children with typical development. Just to show you a little bit of what we found, this is data from that visual illusion task. It just shows you the percentage of participants who were fooled by the visual illusions, who were making the usual kind of mistakes. On the left you can see data from clinical groups. Comparing children with autism, children with general learning difficulties or low IQ, and children who had typical development, you can see there the yellow bar, the children with autism were much less often fooled by these illusions than were the controls who were matched for ability and age and so on. This is the finding I mentioned before. But on the right hand side, you can see the data from our family study. Now we are not dealing with individuals who had any kind of disorder, we are dealing with the parents of children with autism, parents of children with dyslexia, and parents of typically developing children. And you can see the same kind of finding. The fathers of boys with autism were less fooled by visual illusions. The fathers of boys with autism were also very good at block design and they were not very much helped by pre-segmentation. They didn’t need us to pull the design into its parts, they could already see the parts, just like their sons with autism. The fathers of the boys with autism occasionally, just occasionally said, “the sea tastes of salt and. . .” pepper. Well these are smart people, they don’t so often say it. Sometimes they just hesitate. They really hesitate. They really struggle to come up with a global completion. But again, you are seeing the same local focus. And what we found was that around 50% of the fathers, and around 30%, a third of the mothers of the children with autism showed this pervasive tendency to process details first, to attend to details. It made them extremely good at many tasks. These were very well-adapted people, people who often had jobs in IT or in proofreading, in areas where detail focus was really an asset. Again, the social difficulties that some of the parents reported, some of the parents said well I never really found it easy to get on with other people – those seemed to be quite separate, with different parents who reported to us that they had some social difficulties quite different from the parents who said, “yes, you know I do spot details and I can see things that other people miss.” It is sort of interesting to ask whether there might be differences in the right hemisphere that might account for some of these detail-focused processing. We know, for example, that if you have a stroke or an accident and you damage your right hemisphere, you may start to draw things in a piecemeal way like the boy with the house, the four windows, the roof and the chimney. You may also start to process verbal information in a piecemeal way. When asked to tell back a story you may give back just fragments and details. That is a possibility, but other possibilities that have been suggested, a particular pathway in the brain, the magnicellular pathway is thought to be specialized for low-spacial frequency information that would give you more the global picture and less the details. There has been the suggestion that maybe there are problems in processing motion of certain sorts that are a clue to a problem in the magnicellular pathway. That is being very actively explored in autism. My best guess is that autism is not going to turn out to be due to a hole in the head. There have been enough imaging studies now and all sorts of studies, including a few autopsy studies that have shown us that there is not one area of the brain in autism that is knocked out or abnormal. It is not as simple as that. There is increasing interest instead in how the whole brain is wired up in autism spectrum disorders. I want to mention some of the research that is going on, in fact, in the States on this sort of topic. One of the more robust and exciting findings in recent years has been that the size of the brain may be different in autism. In particular, that although individuals with autism may be born with head size and brain size that is normal or even slightly small, in the first year or two there is rapid growth of the brain so that they then become unusually large. The brain is unusually large and heavy and the head size is unusually large. So what is happening during those early years? Well in typical development the brain is establishing a huge number of connections, which are then cut back so that only the connections that are useful, only the parts of the brain that we want to have talking to different parts are really remaining. Maybe that pruning back of connections is not happening in autism, leaving these much larger and rapidly developing and growing brains. That is one idea. Maybe the connectivity, maybe the way that the brain is wired up is very different. So Belmonte and others have suggested that if you have a lot of connections locally between neurons that are close together, you may get a noisy system without long-range connections and without organizing the connections in ways that are affected by meaning and by top-down modulation. Other ideas include the idea that there isn’t temporal integration, synchronization of firing of different parts of the brain. But again, would organize how the units fire together. What is exciting, I think, is that some of these new ideas about the wiring in the brain fit together with computational models that suggest that if you have too many units then what you end up with is not a super-brain, but a brain that can’t generalize. Imagine if you had the ability to remember each example, each event that you have experienced but you never put it together to take a prototype, you never generalized or extracted the gist, if you just hung on to each of those examples, that in the end gives you a head full of stuff that you can’t work with. It means that each instance is kept separate and unique. And Temple Grandin, who many of you will know is an incredibly able and intelligent woman with a PhD in animal science and her own business and so on, who has autism, says of herself that if you mention a cat she can’t think of a cat, she has to think of every cat she has ever seen, one by one. You think about a brain that can hold all those examples in mind, but that is also a brain that is going to be noticing the details in each of those examples and not extracting what is common or the gist. To conclude, autism is a devastating disorder. There is no doubt about that. There is no doubt about the difficulty that people on the autism spectrum have in living in our world. There is a real problem of translation in both directions. We don’t understand individuals with autism and they don’t understand us, and it is a real communication problem in both directions. I don’t want for a moment to wish away the difficulties that individuals with autism and their families have. But autism is also notable for strengths as well as weaknesses. And they need to be explained just as much. I think part of autism, the autism spectrum, might be a cognitive style and not a deficit. Maybe we want to work with that style rather than trying to change that aspect of autism. There may be a distinct genetic contribution to that part of autism versus, for example, the social impairment. If you want to find the genes or find the environmental effect we may have to consider that even separate from autism, wherever it occurs in whatever group. Understanding that genetic basis is going to be the key for identifying possible environmental factors. Our ultimate aim, of course, is to trace a causal chain all the way from genes to neural and cognitive or psychological models to behavior. All of that is only interesting if we can inform intervention, and if we can allow people with autism to reach their full potential and to recognize their very real strengths. Now a colleague of mine was giving a talk about autism and used the very outdated term now of autists. He was talking about a lot of deficits in autism. At the end there was a young man with autism in the audience. He stood up at the end and said, “well if I am an autist, then I have a word for you and for people like you, you are herterotists [phonetic] and a heterotist, the definition, a heterotist is somebody who can’t spot a piece of thread on a patterned carpet.” I want to thank and it is nice to have the opportunity in this kind of setting to thank first of all the children and adults with autism who have taught me so much. This is a picture of a little boy, well he is not a little boy any more. He was a little boy when I knew him and he was in the class, the special school for autism and in the class that I helped him when I was first finding out about autism and learning about autism, and children like Gabriel taught me more, of course, than anybody else possibly could. But also to thank parents and teachers who help us with our research. First Uta Frith, who has been my wonderful mentor and colleague, and all the individuals and research team that I work with at the Institute of Psychiatry. And thank you very much for your attention. |
Irvine Health Foundation |