Autism: An evolutionary perspective, Professor Simon Baron-Cohen, 1st Symposium of EPSIG, 2016 - By Lumos Learning
Transcript
00:01 | uh , our next speaker is Professor Simon Baron Cohen | |
00:03 | , who you bust here . Also , you've probably | |
00:06 | heard this every time . Sasha , his cousin . | |
00:09 | I'm just I feel so privileged . Hyphenated cousin . | |
00:14 | I understood . So , yeah . Congratulations on your | |
00:17 | cousin's Professor Baron Cohen is a professor of developmental psychopathology | |
00:23 | at the University of Cambridge and director of the University | |
00:28 | of Cambridge Autism Research Center . And that information hasn't | |
00:31 | gone out of date as it is . Still the | |
00:32 | case . Um , now , when I was just | |
00:36 | having a look at your kind of background from what | |
00:39 | I could lean on the Internet , what I've got | |
00:41 | from that is I think you've published over 300 papers | |
00:43 | are and numerous books and extraordinarily prolific creative career over | |
00:49 | the last 30 years , dating back to a lot | |
00:51 | of only work about theory of mind and dealing with | |
00:54 | the dilemmas faced by patients with autistic spectrum disorders and | |
00:58 | their families . Which , I think it's fair to | |
01:01 | say , have shaped all of our thinking over the | |
01:04 | years as clinicians interested in helping this particular group of | |
01:10 | patients . Um , so marvelous contribution to psychiatry . | |
01:16 | Um , Professor Simon , Professor Baron Cohen has worked | |
01:22 | on issues of sexual dime or fees and in the | |
01:24 | human brain . And , ah , differences of adaptation | |
01:30 | between males and females and familiar work about systematize ng | |
01:37 | and empathizing brains , which I suspect may be part | |
01:39 | of your presentation . Um , uh , I think | |
01:45 | probably . Well , author of a number of books | |
01:48 | which I think it's worth mentioning . Not not by | |
01:52 | name and in great detail , But just to make | |
01:55 | the point that I think you've written extraordinarily accessible books | |
01:59 | which are very important because of their ability to share | |
02:03 | scientific knowledge , not only within the medical community and | |
02:07 | they work very well as medical textbooks , but also | |
02:09 | within the much broader community of interested people out there | |
02:13 | . The general public , which is , of course | |
02:15 | , what we want to influence and shape . So | |
02:17 | I'm very grateful to you for joining us this afternoon | |
02:20 | . Thank you very much . Thank you very much | |
02:23 | . So , first of all , thank you for | |
02:25 | inviting me to take part in this , uh , | |
02:27 | very interesting day . I'm sorry I missed the morning | |
02:31 | . I was here to catch most of your lecture | |
02:34 | , Randy , and that was a real privilege for | |
02:35 | me . So I've been teaching psychology , atypical psychology | |
02:41 | to the medical students in Cambridge for about 20 years | |
02:45 | and giving them a lecture on evolutionary psychiatry , describing | |
02:50 | your work , making it accessible to doctors who are | |
02:54 | really at the beginning of their career . So they're | |
02:56 | starting to think in this Darwinian way , so some | |
02:59 | of you may maybe former students of mine . But | |
03:03 | hopefully these ideas are beginning to permeate into the field | |
03:06 | of psychiatry so that we start thinking about the function | |
03:11 | of behaviors and emotions , not just thinking about how | |
03:14 | to eliminate them . So I'm talking about a neurodevelopmental | |
03:19 | condition , autism again from an evolutionary perspective . And | |
03:26 | I thought I'd start just with a picture of a | |
03:27 | child with autism doing the classic thing that kids with | |
03:32 | autism do . So he's playing alone . It's one | |
03:36 | of the features of autism is not really interacting socially | |
03:40 | , but he's doing something intelligent . He's lining things | |
03:43 | up to make very clear patterns that he is imposing | |
03:49 | on the world . And as many of you know | |
03:51 | , kids with autism get very distressed . If anyone | |
03:55 | disturbs their perfect universe , their order of patterns that | |
03:59 | they're creating one other child before we get into what | |
04:05 | we understand about autism again , a child playing on | |
04:09 | his own , so it's encompassing the word autism , | |
04:13 | which just means self not interacting with others but again | |
04:18 | doing something very intelligent . So he's playing with water | |
04:23 | , and he's fascinated by the patterns that can be | |
04:26 | created as you block the flow of water with your | |
04:29 | hands . So fascination with patterns but solitary . What | |
04:37 | you probably know is that the prevalence of autism has | |
04:40 | been rising year by year . So this shows you | |
04:43 | data from the mid nineties through to the early two | |
04:46 | thousands . So autism has been getting more and more | |
04:49 | common . If we continue that graph just looking at | |
04:54 | data from the U . S . From the Center | |
04:56 | for Disease Control , you can see that the increase | |
05:00 | has continued . And if we go right up to | |
05:04 | the latest data , which is 2014 , Center for | |
05:08 | Disease Control in the US uh , the estimate now | |
05:11 | is autism is diagnosed in one in 48 boys and | |
05:17 | one in 100 and 89 girls . This is child | |
05:21 | data , and if you average across the two gender | |
05:25 | is it's about one . In 68 kids end up | |
05:27 | with a diagnosis of autism . So this is way | |
05:30 | more common than when I first started out in this | |
05:33 | field back in the mid eighties , when Michael Rutter | |
05:37 | and others whose names you'll recognize was saying that autism | |
05:40 | was four in 10,000 . So very rare . We | |
05:44 | now think of autism is very common . Um , | |
05:48 | and my talk isn't about why the increase . But | |
05:51 | I think we can probably attribute most of that to | |
05:55 | greater recognition . Better awareness , a lot more services | |
05:59 | on the ground looking for autism . So more eyes | |
06:01 | looking for potential cases . And , of course , | |
06:04 | we've broadened the definition of autism to include Asperger's syndrome | |
06:09 | . So we've moved from a categorical diagnosis to a | |
06:12 | spectrum diagnosis and added a whole subgroup and the graph | |
06:16 | on the right there really shows you at a glance | |
06:19 | the whole picture of autism , because you can see | |
06:22 | that within both males and females , there are some | |
06:25 | people who have below average i Q . So they | |
06:28 | not only have autism , but they have learning difficulties | |
06:31 | as well . And , of course , some who | |
06:33 | have average or even above average IQ what we would | |
06:37 | call Asperger's syndrome . So we tried to measure this | |
06:43 | idea of a spectrum by creating something called the autism | |
06:47 | spectrum , questioned to questionnaire that adults can fill in | |
06:51 | for themselves the queue . So that's self report , | |
06:55 | or parents can fill it in about their child , | |
06:57 | and each item on the questionnaire is one autistic trait | |
07:02 | , and the scale , As you can see it | |
07:03 | , goes from 0 to 50 . The dotted line | |
07:06 | on the left is the normal distribution that emerges when | |
07:10 | you ask adults in the population to fill in this | |
07:13 | instrument . So what that's telling us is that we | |
07:16 | all have some autistic traits . Nobody really score zero | |
07:21 | . The solid line on the right are the scores | |
07:24 | from adults who already have a diagnosis of autism or | |
07:28 | Asperger's syndrome . And again we get this kind of | |
07:31 | bell curve , so there's a kind of range of | |
07:34 | scores . But the point I wanted to make here | |
07:38 | is that there's a spectrum not only within those who | |
07:42 | come to the clinic , but it's a spectrum that | |
07:45 | runs right through the population and evolution . Natural selection | |
07:50 | could well have been operating on those individual differences in | |
07:53 | autistic traits that we see in the population . So | |
08:00 | the first part of my talk is just to tell | |
08:02 | you what we know about autism , and I'm going | |
08:04 | to go through this quite a fast pace so we | |
08:07 | can get onto the kind of evolutionary relevance . But | |
08:10 | what we do know is that autism is in part | |
08:13 | genetic , because if you've got one child with autism | |
08:17 | in the family , the likelihood of another child also | |
08:20 | having autism is one in three . So if we | |
08:23 | take the general population prevalence of about 1% you can | |
08:27 | see that the presence of uh , one family member | |
08:31 | with autism rapidly increases the likelihood of somebody else also | |
08:34 | having it . So this looks like it's partly genetic | |
08:39 | . The reason I would say that not just familial | |
08:42 | but genetic is that the hunt for autism genes is | |
08:46 | revealing hundreds of so called risk genes . This comes | |
08:50 | from a website called safari dot org , where they | |
08:55 | report every new genetic association that's found for autism . | |
09:00 | So here are the human chromosomes , and the colored | |
09:03 | dots represent a published finding of a genetic association with | |
09:09 | autism or Asperger's syndrome . Where you can see at | |
09:12 | a glance is that almost every human chromosome harbors some | |
09:16 | genes for autism , so we know autism is not | |
09:20 | mono genic . It's massively palla genic . What we | |
09:24 | don't know is what these genes are doing , what | |
09:26 | their function is which genes are necessary and sufficient to | |
09:30 | cause certain types of autism or certain symptoms of autism | |
09:36 | . But there's no doubt that autism is in part | |
09:38 | genetic . But we know autism isn't completely genetic because | |
09:44 | of identical twins like these girls , where one has | |
09:47 | autism and one doesn't . If autism was 100% genetic | |
09:51 | , if one has it , they should both have | |
09:53 | it , um , so discordant pairs of this kind | |
09:57 | suggest epigenetic factors . Environmental factors that can act on | |
10:03 | the gene in someone who is genetically predisposed to autism | |
10:08 | might also be part of the story , and you | |
10:10 | can see that this study from King's College , London | |
10:13 | , um , Robert Clemens Group shows differences in gene | |
10:18 | expression in discordant twin pairs in terms of what's going | |
10:25 | on in the brain . In autism , we certainly | |
10:28 | see differences . So just zooming in on different structures | |
10:33 | , you can see a difference in the size of | |
10:35 | the amygdala in autism . Compared to controls that the | |
10:40 | amygdala is larger in Children with autism than in typically | |
10:43 | developing Children , we also know that the brain in | |
10:49 | autism seems to be growing faster than in typical development | |
10:54 | . So on the left is a graph showing growth | |
10:59 | trajectories um in blue are typically developing Children who each | |
11:04 | had to m r I scans so that you can | |
11:07 | join the dots to create growth curves . And in | |
11:11 | red are kids with autism again who had a repeat | |
11:15 | MRI so you can look at how quickly the brain | |
11:18 | is growing . And you can see that the autism | |
11:20 | group at each time point is showing a larger brain | |
11:24 | , suggesting that the brain is growing quicker . The | |
11:28 | cartoon on the right comes from Eric Cautions Group in | |
11:32 | San Diego postmortem study where you get the opportunity to | |
11:36 | look at the brain from people with autism and dissect | |
11:39 | it . Observe it , uh , in , uh | |
11:43 | , in fine detail , finding 60% more neurons or | |
11:48 | nerve cells in the frontal cortex in people with autism | |
11:52 | than in comparison , uh , brains . So the | |
11:55 | larger brain seems to correspond with heavier brain if you | |
12:01 | wear it at postmortem and also more nerve cells , | |
12:03 | more neurons in different parts of the brain . Here's | |
12:09 | another structure , which differs between autism and controls . | |
12:12 | The corpus callosum , the connective tissue between the two | |
12:15 | hemispheres , which in autism is smaller in the posterior | |
12:19 | part of the corpus callosum . Compared to typical individuals | |
12:23 | So I'm just showing you some examples of differences in | |
12:27 | brain development brain structure , and we'll come onto brain | |
12:31 | function to show that these kids right from the earliest | |
12:35 | point , the brain is developing differently . This is | |
12:40 | a paper that was just published this year . Uh | |
12:43 | , Christine occur again at King's College London . But | |
12:46 | using data from a national , uh , dataset um | |
12:51 | , showing that you can identify in DT diffusion imaging | |
13:00 | , short connections and more long range connections . And | |
13:05 | then in autism , you find more of the short | |
13:07 | range connections and fewer of the long range connections than | |
13:11 | you do in a typical sample . So again , | |
13:14 | just differences in the wiring of the brain again , | |
13:19 | back to the postmortem evidence . If you just look | |
13:23 | at the individual neuron , the nerve cell , this | |
13:28 | is a very , I think , a very interesting | |
13:30 | study . So on the right , we've got a | |
13:32 | neuron from a brain from someone who had autism and | |
13:37 | on the left of typical individual and again with the | |
13:40 | naked eye , you should be able to see more | |
13:42 | of the white dots all along the neuron . And | |
13:46 | each dot is a location of a dendritic spine or | |
13:50 | the location of synapses where the neuron is making connections | |
13:53 | with its neighbor . So this is suggesting more connectivity | |
13:58 | between neurons in the autistic brain . Not just more | |
14:02 | neurons , but more connections between neurons , uh , | |
14:05 | in autism compared to a typical brain giving you flavor | |
14:08 | of the differences between someone with autism and someone without | |
14:12 | autism . So that's a bit about genetics and a | |
14:15 | bit about the brain . And , of course , | |
14:17 | there are major differences in behavior and cognition . This | |
14:21 | is again a study from UC San Diego By Karen | |
14:26 | PIERCE . What they did was they looked at two | |
14:29 | year old Children coming into the clinic , and they | |
14:33 | presented them either with a face to look at a | |
14:36 | social stimulus or a geometric design . And they filmed | |
14:41 | how long each child looked at either the social or | |
14:44 | the non social stimulus . What they found was that | |
14:47 | if a child looked for more than 70% of the | |
14:50 | time at the non social stimulus , the probability that | |
14:54 | that child had autism was 100% . So when I | |
14:57 | read this paper , I was sort of blown away | |
15:00 | . That may be a behavioral test , could be | |
15:03 | diagnostic , and it could save us hours of interviewing | |
15:06 | families and observing the child and so forth . Obviously | |
15:10 | a caveat . With a study like this , it | |
15:12 | was a clinic study . We don't know whether the | |
15:14 | accuracy would be as good if you rolled it out | |
15:17 | into the community into the general population . But either | |
15:21 | way , just the take home message from the study | |
15:23 | is that a typical child tends to naturally look at | |
15:27 | faces . They're drawn to look at people , and | |
15:30 | presumably the emotional information in faces and a child with | |
15:35 | autism doesn't show that that typical preference . Rather , | |
15:39 | they're more interested in patterns in this case , geometric | |
15:42 | patterns . So what we're seeing is evidence of difference | |
15:46 | , not necessarily pathology , just a brain that's wired | |
15:49 | differently and finds different aspects of the environment of interest | |
15:56 | . So other differences psychologically between autism and a typical | |
16:00 | person is in terms of attention to detail . Some | |
16:04 | of you recognize this task on on the left . | |
16:08 | It's called the Embedded Figures test , where you have | |
16:10 | to find the shape hidden in the overall design as | |
16:13 | quickly as you can . People with autism are super | |
16:17 | quick and super accurate . On tests like this , | |
16:21 | where the cube is hidden in there , I'll let | |
16:23 | you see if you can find it and when we've | |
16:26 | asked people not just to do this test at the | |
16:29 | behavioral level , but also to do it whilst they're | |
16:31 | lying in an MRI scanner . Functional imaging People with | |
16:35 | autism show less activity in the posterior parietal cortex whilst | |
16:41 | they're solving the task at a higher level , so | |
16:44 | the brain is in some sense , more efficient . | |
16:47 | They're ending up with better performance but showing less brain | |
16:51 | activity to achieve that performance . So these differences in | |
16:55 | function between the autistic brain and the typical brain another | |
17:02 | suggestion that people with autism focus on detail whilst the | |
17:07 | rest of us focus on the big picture comes from | |
17:10 | the results of the block design test , which many | |
17:14 | of you will have seen or used as part of | |
17:17 | the test in Children or adults . People with autism | |
17:21 | show their best performance on block design . Where you | |
17:25 | have to take , you have to select which little | |
17:27 | cubes you need , which have different colored faces to | |
17:31 | create the design up above . And kids with autism | |
17:35 | are very quick at this , and they don't seem | |
17:37 | to improve in their speed . Whether you segment the | |
17:42 | designers , it's been done on the right to help | |
17:44 | a child to find the solution or whether you just | |
17:47 | present them with the overall design . So evidence of | |
17:51 | superiority in understanding the components that make up a larger | |
17:57 | design more more evidence for people with autism . Being | |
18:04 | detail oriented is in this test where you simply ask | |
18:08 | the person , What letter do you see ? People | |
18:12 | with autism are more likely to report they've seen the | |
18:14 | letter H . Um , obviously , both answers H | |
18:20 | or A are correct , and the test is really | |
18:23 | just designed to see whether you're more focused on local | |
18:26 | detail or more global information suggesting that people with autism | |
18:30 | are more detail or local oriented . And finally , | |
18:35 | a study that came out a couple of years ago | |
18:37 | showing again superior performance in kids on the autism spectrum | |
18:42 | in spotting patterns where you give them repeat information where | |
18:47 | you get it . Whether the individual is getting a | |
18:48 | chance to learn that certain shapes always co occur , | |
18:53 | always occur together , and kids with autism seem to | |
18:55 | be quicker picking up these regularities . So when we | |
19:01 | think of autism , we think of it as a | |
19:03 | child is quite isolated , trouble making friends trouble communicating | |
19:08 | . We tend to focus on the social deficits . | |
19:11 | But we should keep in mind that autism is more | |
19:14 | complex than that . This 10 year old child , | |
19:17 | Max Park in California , loves the Rubik's Cube , | |
19:21 | so he's fascinated by patterns . He's ranked in the | |
19:25 | top 101 100 Rubik Cube players in the world . | |
19:29 | So whilst he has trouble socializing , he's also showing | |
19:33 | areas of not just intact ability but superior ability . | |
19:38 | So we need to think of both sides of autism | |
19:41 | when we try to think about and how a partly | |
19:45 | genetic condition may have been selected for in evolutionary terms | |
19:52 | . And this is Derek Parra Vicini , who lives | |
19:55 | in this country . So he has a mental age | |
19:58 | of a four year old , very limited language , | |
20:01 | so learning difficulties . He's also been blind from birth | |
20:04 | . So congenital blindness . And he has autism . | |
20:09 | Quite a package . Um , whenever he hears any | |
20:13 | jazz song that's played , he can immediately reproduce it | |
20:17 | after just hearing it once . If you play a | |
20:21 | 10 note chord on the keyboard , he can instantly | |
20:25 | identify all of the 10 notes in the chord , | |
20:28 | suggesting that in his case , the talent is obviously | |
20:33 | an auditory information . He's blind , but he can | |
20:36 | dissect the information into its component parts very fast , | |
20:39 | just as we saw on the embedded figures test or | |
20:42 | the block design test . The same ability that you | |
20:45 | see in autism of taking information and reducing it down | |
20:49 | to its component parts very rapidly and spotting patterns . | |
20:55 | So the other side of autism , which has only | |
20:57 | just made it into the latest DSM DSM five , | |
21:01 | is sensory issues . Parents and people with autism were | |
21:06 | telling us for about 40 years that they had sensory | |
21:09 | issues , but it wasn't part of DSM three or | |
21:12 | four . It's now part of DSM five . Bless | |
21:15 | You , and this is really showing you that if | |
21:19 | you put someone with autism into functional magnetic resonance imaging | |
21:24 | , you give them headphones whilst they're blindfolded , and | |
21:27 | you simply look at which part of the brain responds | |
21:30 | when they hear a tone and unexpected auditory stimulus . | |
21:35 | You see a greater response in the auditory cortex in | |
21:38 | people with autism , compared to the typical individual suggesting | |
21:42 | hypersensitivity . This is obviously a study just in the | |
21:45 | auditory domain , but you could do the same in | |
21:48 | the tactile or the visual or the taste , uh | |
21:53 | , channels and still find this hypersensitivity so in terms | |
22:00 | of the social difficulties which we know are present . | |
22:04 | Uh , the earliest demonstration of these comes from these | |
22:09 | studies . They're called baby Siblings studies where , you | |
22:13 | know there's already one child with autism in the family | |
22:16 | . So you're watching the new baby in the family | |
22:18 | . Who is that genetic increased risk of autism and | |
22:22 | finding that , for example , if you present them | |
22:26 | with a stimulus of the eyes looking direct at the | |
22:29 | infant or away from the infant . The P 400 | |
22:34 | electro physiological wave that can be recorded just using e | |
22:37 | R P or E G type equipment is reduced in | |
22:41 | those Children who go on to develop autism . So | |
22:45 | perception of faces and social information seems to be different | |
22:50 | . This is even in the first year of life | |
22:55 | . This work comes from Ami Klin , who was | |
22:57 | at Yale University , has now moved to Emory , | |
23:00 | where he used gaze tracking to see where somebody looks | |
23:05 | whilst they're watching a movie . So this clip , | |
23:08 | um , is from Who's Afraid of Virginia Woolf ? | |
23:12 | And in Yellow , The Gaze Tracker is showing us | |
23:17 | that that's where the typical individual is looking whilst they're | |
23:19 | watching the movie . Looking at Elizabeth Taylor's face , | |
23:22 | but particularly her eyes and in red is where people | |
23:26 | with autism tend to look , so they are looking | |
23:28 | at the face but focusing more on the mouth than | |
23:30 | the eyes . So the gaze tracking technology is giving | |
23:33 | us a window into what is of interest and what | |
23:37 | is , uh , the attentional focus of people with | |
23:40 | autism . And as you kindly mentioned in the introduction | |
23:46 | , there's been a lot of work , uh , | |
23:48 | starting from our group . But many other groups looking | |
23:52 | at so called theory of mind , the ability to | |
23:54 | put yourself into someone else's shoes and to imagine other | |
23:57 | people's perspectives , which Children and adults with autism and | |
24:01 | find challenging so that they don't tend to participate in | |
24:05 | games like hide and seek when they're very young . | |
24:07 | Or deception , which typical four year olds enjoy , | |
24:11 | because they're keeping track of what other people know what | |
24:14 | other people might want and intend . And instead , | |
24:16 | Children with autism tend to avoid those kinds of interactions | |
24:20 | , finding them very confusing . We developed this test | |
24:26 | called the Eyes Test , which some of you may | |
24:28 | know to measure social cognition in adults with Asperger's syndrome | |
24:34 | and in the general population . Uh , so you're | |
24:37 | showing photographs of the eye region of the face , | |
24:40 | and you have to pick which of the four words | |
24:42 | that surrounds the photo . Best describes what the person | |
24:45 | in the photo is thinking or feeling so very degraded | |
24:50 | , black and white still photographs , Uh , but | |
24:53 | people are pretty accurate at picking out that she's dispirited | |
24:57 | or a bit sad , just from minimal information of | |
25:00 | emotions around the eyes . You can see that the | |
25:03 | data down on the in the graph on the left | |
25:06 | comes from thousands of individuals who have taken this test | |
25:09 | online , showing that both males and females with autism | |
25:12 | score lower on this test of reading emotions from the | |
25:16 | eye region of the face . And when we asked | |
25:19 | them to take that same test whilst they're lying in | |
25:21 | the scanner , we find that people with autism show | |
25:24 | less activity in the left inferior frontal gyrus whilst they're | |
25:29 | trying to decode someone's facial expression from information around the | |
25:34 | eyes compared to a typical control group . So evidence | |
25:38 | , I hope I've presented for both talents but also | |
25:42 | disabilities in the same individuals . So some of you | |
25:47 | know that just last year , an important new book | |
25:51 | was published about autism called neuro Triumphs . It's by | |
25:55 | a journalist called Steve Silberman . Um , it won | |
25:59 | the Samuel Johnson Prize for nonfiction , very deservedly , | |
26:03 | because it tells a whole new history of autism . | |
26:07 | But also , if you look at the subtitle of | |
26:10 | his book , he talks about the future of neuro | |
26:12 | diversity , and his book , in many ways is | |
26:15 | a sort of manifesto for this new concept of neuro | |
26:19 | diversity , which has psychiatrists and clinical psychologists We should | |
26:24 | be paying a lot of attention to because it's really | |
26:27 | the idea that there are many ways for the brain | |
26:29 | to develop . There isn't a single way to be | |
26:32 | normal . There are individual differences in the population which | |
26:36 | may be there for reasons of natural selection . We're | |
26:39 | not all made the same that we all have our | |
26:41 | strengths and our weaknesses and autism . Maybe just one | |
26:46 | example of neuro diversity in the environment . Silverman chose | |
26:52 | as the front cover design for his book An Image | |
26:55 | of Biodiversity and we're all very familiar with that related | |
26:59 | concept of how important it is for us to preserve | |
27:02 | diversity in the Amazon rainforest or elsewhere . And he | |
27:07 | really argues the same should be true for neuro diversity | |
27:12 | that in any classroom of Children , you're going to | |
27:15 | find some . Some kids are more verbal , some | |
27:18 | kids are more spatial , some kids are more sociable | |
27:21 | and some kids are more musical . And all of | |
27:23 | these different brain types , if you like , are | |
27:25 | part of the diversity that you find in any garden | |
27:29 | , so that in any primary school you should expect | |
27:33 | two or three kids with autism to be part of | |
27:35 | that diversity on the right here , we've got a | |
27:40 | picture of Henry Cavendish . Silberman devotes a whole chapter | |
27:43 | of his book to the biography of this physicist who | |
27:47 | was not only famous for the discovery of hydrogen but | |
27:52 | , as Silberman makes a very strong case , probably | |
27:55 | had autism . He did his absolute utmost to avoid | |
27:58 | people , um , so he would leave messages for | |
28:01 | his servants and for other people he had to interact | |
28:04 | with rather than meeting them face to face . And | |
28:07 | it was really just content to do his physics to | |
28:10 | do his scientific experiments away from the social world . | |
28:17 | So here's the concept of neuro diversity attributed to Judy | |
28:22 | Singer , who has autism herself but which first appeared | |
28:26 | in print in 1998 . The reason for dwelling on | |
28:30 | this is I think it's a revolutionary concept for our | |
28:33 | field . Um , and this poster is produced by | |
28:39 | the neurodivergent the movement , which comes from the autism | |
28:43 | community asking for autism acceptance , the idea that they're | |
28:48 | not necessarily inferior or impaired or , um , pathological | |
28:54 | . In some way they're just different , just like | |
28:56 | we might find amongst , for example , fruit . | |
29:00 | They're not all the same for genetic reasons . We | |
29:03 | might expect them to be of different flavors . I | |
29:08 | think the notion of neuro diversity goes back quite a | |
29:10 | lot further than I was suggesting . So here's Albert | |
29:14 | Einstein , and there's a quote from him on the | |
29:16 | left . If you judge a fish by its ability | |
29:19 | to climb a tree , it will live believing it | |
29:22 | is stupid . So we just think about animals in | |
29:26 | different ways . And Einstein again , The case has | |
29:30 | been made that he might have had autism . Here's | |
29:34 | a quote from his biography . I do not socialize | |
29:38 | because it would distract me from my work . So | |
29:40 | he was really just focused on his physics . He | |
29:44 | did quite well . He he also enjoyed sailing , | |
29:48 | but he did that alone when he was at Princeton | |
29:51 | , and he used to enjoy playing the violin . | |
29:54 | But , um , you know , people weren't his | |
29:57 | main focus the world of objects in the world of | |
30:00 | systems and understanding the laws behind , uh , the | |
30:05 | physical world , which led him to his discovery of | |
30:08 | relativity . So here's Hans Asperger on the left , | |
30:13 | the pediatrician whose name is now given to one of | |
30:15 | those subgroups and he said , for success in science | |
30:20 | , a dash of autism is essential . So there's | |
30:23 | that idea that autism might come and come by degrees | |
30:26 | . We might all have some of it . And | |
30:28 | maybe a certain modicum of autism might be quite good | |
30:32 | for focusing your attention just on one so called obsessional | |
30:36 | topic . Part of the autism diagnosis , as you | |
30:39 | know , is that they develop obsessional interests . But | |
30:42 | that's a rather kind of pejorative way of describing that | |
30:45 | they just have passions or interests . Um , and | |
30:49 | on the right , here we have Newton again . | |
30:51 | The case has been made that he , too had | |
30:54 | autism , so not only discovered gravity , but famously | |
30:58 | fell out with almost all of his colleagues and had | |
31:01 | difficulties with communication . So we see this potential link | |
31:07 | between autism and scientific talent , at least speculated in | |
31:12 | biographies and anecdotes . Well , we've tried to measure | |
31:16 | this to see if it's actually the case . Um | |
31:20 | , so we developed a questionnaire called the System Izing | |
31:22 | Questions , which asks how interested you are in different | |
31:26 | kinds of systems , whether they're mechanical systems like computers | |
31:31 | , mathematical systems like mathematics , natural systems like the | |
31:35 | weather . And you can see that people with autism | |
31:37 | score higher in terms of their strength of interest in | |
31:41 | systems than people in the general population . We've also | |
31:46 | gone out to test whether kids with autism or Asperger's | |
31:50 | might be better at solving mechanical reasoning tasks like this | |
31:55 | one , where you have to look at the wheel | |
31:57 | going anti clockwise and predict what will happen to that | |
32:00 | point . P . The correct answer here is See | |
32:04 | , it will move back and forth , and kids | |
32:06 | with Asperger's syndrome age 12 , outperform typical 12 year | |
32:12 | olds in solving these kinds of mechanical reasoning problems , | |
32:16 | suggesting that despite their social difficulties in certain aspects of | |
32:20 | the environment , their understanding is actually precocious . So | |
32:28 | I'm located at Cambridge , so opportunistically we decided to | |
32:33 | look at the rate of autism amongst the math students | |
32:36 | at Cambridge University . So we just asked them that | |
32:39 | very straight question do you have autism ? And you | |
32:42 | see , You see , the results show a much | |
32:46 | higher rate of diagnosed autism in students at I would | |
32:51 | say , this is a very good university in the | |
32:54 | field of mathematics compared to the humanities . So again | |
32:58 | reinforcing this idea that there might be a link between | |
33:02 | a lot of autistic traits or even a clinical diagnosis | |
33:05 | of autism and talent at understanding systems , including mathematics | |
33:13 | , and , again just taking advantage if you like | |
33:16 | , of students being on the doorstep . We gave | |
33:19 | the AQ that measure of autistic traits to students working | |
33:23 | in sciences or in the humanities , finding that the | |
33:27 | scientists didn't have a higher rate of autism . They | |
33:30 | just had more autistic traits compared to those working in | |
33:33 | the humanities . So again , those individuals who were | |
33:37 | attracted by the more predictable world that can be systemized | |
33:43 | , which is what we do in science , where | |
33:44 | we try to understand lawful relationships between variables might end | |
33:48 | up in science , Uh , may have higher number | |
33:51 | of autistic traits than those who can deal with the | |
33:54 | less lawful world of people , the unpredictability of people | |
33:59 | and the way we write about people . For example | |
34:01 | , in literature where this link comes from between autism | |
34:07 | and scientific talent is likely to be genetic , because | |
34:11 | years ago we looked at the occupations of fathers of | |
34:15 | Children with autism , just asking them about where they | |
34:19 | work and finding a disproportionate number of fathers of Children | |
34:23 | with autism work in the field of engineering compared to | |
34:27 | fathers of typically developing Children , obviously , engineering is | |
34:31 | a very good case of where you need to be | |
34:34 | good at understanding systems . But to get the job | |
34:37 | , you may not have been selected on the basis | |
34:40 | of your social skills , more your understanding of how | |
34:43 | things work . So looking back where there's a child | |
34:47 | with autism in the family , at the genetics , | |
34:49 | if you like . What's been positively selected , perhaps | |
34:53 | in evolutionary terms is not autism itself , but perhaps | |
34:57 | an aptitude for understanding systems , which would be an | |
35:00 | advantage in fields where you're either building a system like | |
35:04 | engineering or trying to understand the system . We found | |
35:07 | the same pattern amongst the grandfathers of Children with autism | |
35:10 | on both sides of the family , so this led | |
35:15 | to the prediction . Is autism more common in places | |
35:18 | like Silicon Valley ? So Silicon Valley has obviously been | |
35:22 | attracting people who have an aptitude for systems for quite | |
35:27 | a few years , and they moved there and they | |
35:29 | work there and they potentially start a family there and | |
35:32 | have Children . So if there's a genetic link between | |
35:35 | scientific attitude or technical intelligence and risk of autism in | |
35:40 | the offspring , we should see it in places like | |
35:43 | Silicon Valley . So Silicon Valley is quite a long | |
35:47 | way away from London . So we went to a | |
35:50 | Silicon Valley a bit closer to home in the Netherlands | |
35:54 | and looked particularly the city of Eindhoven Eindhoven has got | |
35:58 | the Eindhoven Institute of Technology a bit like mitt . | |
36:02 | It also had the Philips factory there for over 100 | |
36:05 | years , attracting people to go and work there in | |
36:08 | the fields of electronics and more recently , it so | |
36:12 | that now a third of jobs in Eindhoven are in | |
36:15 | the IT sector . We compared the rate of autism | |
36:18 | in Eindhoven to two other Dutch cities , Utrecht and | |
36:23 | Harlem , selected because there are similar size and similar | |
36:26 | demographic and found that the rate of autism in Eindhoven | |
36:30 | was more than twice as high as in those two | |
36:33 | other Dutch cities . So this was based on school | |
36:36 | records contacting every school in each of these three cities | |
36:40 | to ask them for the number of kids who already | |
36:43 | have a diagnosis of autism , we don't know much | |
36:46 | about the parents . This was a school based study | |
36:49 | , but the inferences that this may be something to | |
36:52 | do with the parents' occupations . So to try to | |
36:59 | make sense of all of the data that I've shown | |
37:02 | you this afternoon and to try and make it more | |
37:06 | relevant to an evolutionary perspective , I just want to | |
37:09 | mention the model that was mentioned in the introduction this | |
37:14 | empathy system izing model . The idea is that in | |
37:18 | the population in the general population , these are two | |
37:22 | dimensions along which we see individual differences . So along | |
37:28 | the y axis , we've got empathy . And if | |
37:30 | you're at zero , it means you're absolutely average for | |
37:34 | the population as you go up the Y axis , | |
37:38 | your above average and empathy or the ability to read | |
37:41 | other people's thoughts and feelings , but also responded with | |
37:45 | an appropriate emotion . If you're below zero , it | |
37:48 | means you've got difficulties in that domain . And on | |
37:51 | the X axis , we've got system izing the ability | |
37:55 | to , um to understand the system , but also | |
38:00 | build a system by identifying the rules that govern the | |
38:03 | system So you can predict how the system works again | |
38:07 | towards the right . So the positive values your above | |
38:11 | average on system izing and over to the left your | |
38:15 | below average . And the idea is that we all | |
38:17 | fall somewhere in this space , these two dimensions . | |
38:22 | What we found in our research is that in the | |
38:24 | dark blue quadrant , up at the top left more | |
38:27 | women in the population fall in that area where they've | |
38:30 | got above average empathy . But their system izing could | |
38:35 | be anywhere from average through to below average . Uh | |
38:39 | huh . Sorry . That's in the light blue part | |
38:43 | of the graph . Um in the white part of | |
38:46 | the graph are individuals who are equally good at system | |
38:49 | izing or empathy . So they may be equally talented | |
38:55 | or equally challenged . But they don't show much of | |
38:58 | a discrepancy in their aptitudes or abilities In both areas | |
39:03 | . The pink area is where most men on average | |
39:06 | , fall in the population where their system izing is | |
39:10 | at a slightly higher level than their empathy . And | |
39:13 | what we were predicting is that people with autism would | |
39:16 | fall in the bottom right hand quadrant that dark red | |
39:19 | zone where their system izing maybe anywhere from average to | |
39:24 | above average . But their empathy would be less than | |
39:27 | minus one . So in the below average range , | |
39:30 | which is often the trigger for needing a diagnosis , | |
39:33 | that they're struggling with relationships . So that was the | |
39:36 | model , and what we did was we went out | |
39:39 | into the population . We gave people these two questionnaires | |
39:44 | the empathy question which measures your empathy , the system | |
39:47 | izing question which measures your system izing and just sort | |
39:55 | of helping you read the data . Here in yellow | |
39:59 | are females in the population , and you might be | |
40:02 | able to see them clustering in the top left hand | |
40:05 | quadrant of the graph in green are males in the | |
40:09 | population where you might see them clustering more in the | |
40:13 | center and in purple and red are males and females | |
40:19 | with autism who you might be able to see clustering | |
40:22 | in the lower right hand quadrant . So each data | |
40:27 | point here is an individual . Um , and of | |
40:30 | course , all we can do is look at groups | |
40:33 | , males , females , people with autism , on | |
40:35 | average , because individuals may be typical or atypical for | |
40:39 | their group . So , you know , we can | |
40:44 | see . We can see a little green dot up | |
40:46 | here of a man whose well up in the female | |
40:49 | range on his empathy . Um , and we can | |
40:52 | see you know , a woman all the way down | |
40:55 | here who's in the so called autistic range . So | |
40:58 | individuals may not fit the trends for their groups or | |
41:03 | we can talk about is statistical averages . But if | |
41:06 | we do account for these different brain types , and | |
41:10 | this is my last slide so we can leave time | |
41:12 | for discussion , this is what we find that if | |
41:16 | we look at individuals whose empathy is at a higher | |
41:20 | level than their system izing , we find more women | |
41:24 | than men in that have that profile . If we | |
41:29 | look at the opposite profile individuals whose system izing is | |
41:33 | at a higher level than their empathy , this is | |
41:36 | percentages . We find more men than women , show | |
41:39 | that cognitive profile and if we look at it as | |
41:43 | an extreme of this one , so system izing is | |
41:47 | either intact or above average . But empathy is below | |
41:51 | average . Well , this is where we find the | |
41:53 | majority of people with autism or Asperger's syndrome , so | |
41:58 | the data and are in line with the directions predicted | |
42:03 | by the model . But really , the reason for | |
42:05 | leaving this up is my final slide is to show | |
42:08 | that diversity that exists in the population we all fall | |
42:12 | in one or other of these five brain types , | |
42:15 | if you like to find in cognitive terms , although | |
42:18 | increasingly we're starting to map their neural substrate and the | |
42:23 | both environmental and biological determinants of these different brain types | |
42:30 | . But we might well imagine that natural selection has | |
42:35 | favored one type of brain over another for different kinds | |
42:39 | of evolutionary niches over thousands hundreds of thousands of years | |
42:44 | or millions of years in primate evolution , some of | |
42:48 | which fallout along , um , sex differences . But | |
42:53 | actually nothing to do with your sex because it turns | |
42:56 | out that prenatal hormones and genes play a much bigger | |
43:00 | role than your actual sex , and that people with | |
43:03 | autism may just be showing an extreme of the variation | |
43:07 | that we see in the population selected potentially for their | |
43:12 | their talents , being very good at spotting patterns , | |
43:15 | being very good at innovation and understanding new machines or | |
43:20 | new tools that will help us even if they find | |
43:24 | the social world more challenging . So I'm going to | |
43:27 | stop there . Thank our funders . And particularly the | |
43:31 | autism research Trust that supports our work . And we | |
43:34 | can open it up for discussion . Thank you . | |
43:44 | Thank you , Simon . I'm sure there'll be quite | |
43:46 | a number of questions , but could I just ask | |
43:47 | you briefly ? I had reason to work with large | |
43:52 | numbers of transgender patients over the years . Um , | |
43:55 | one of the observations I have is that there are | |
43:58 | certainly some trans women who will say , you know | |
44:01 | , I always socialized with women , and the reason | |
44:03 | I like doing that was that they didn't just kind | |
44:04 | of thump and kick each other . They talk to | |
44:07 | each other at school , for example . And it | |
44:09 | was a safer and better place to be , which | |
44:11 | seems fine and fixed with the model , as it | |
44:14 | were there . Another group of people , though , | |
44:15 | who appear to describe a kind of subjective change when | |
44:19 | they start to take when they begin estrogen hormone treatment | |
44:22 | . Uh , and I've just got a very vivid | |
44:26 | recollection of one patient in particular who talked about the | |
44:29 | sort of revelatory experience of being amongst the girls and | |
44:32 | finally feeling at home as it were , which was | |
44:34 | very striking at the time . I'm not aware of | |
44:38 | that should be but not aware of literature looking specifically | |
44:42 | at that group of people and particularly at hormone exposure | |
44:46 | for transgender patients . But I just wonder if you've | |
44:48 | got any knowledge of that area to comment on , | |
44:51 | Uh , just a brief comment , which is that | |
44:55 | the the area of research of autism and gender is | |
45:00 | just beginning to open up and including transgender . So | |
45:04 | we're now becoming a bit more aware that instead of | |
45:07 | asking people for their sex and giving them a binary | |
45:10 | choice , male or female , we need to be | |
45:13 | a bit more sort of fluid because a lot of | |
45:18 | people with autism don't want to identify as either male | |
45:21 | or female . And they prefer to tick the other | |
45:24 | box , and that increasingly , a lot of people | |
45:27 | with autism are identifying as either transgender or discussing how | |
45:33 | their gender doesn't fit neatly into traditional categories . So | |
45:37 | whether there's a hormonal element to this or some other | |
45:40 | factor , But this is a new area of research | |
45:44 | , certainly evidence for higher than expected number of trans | |
45:48 | male patients with autistic traits , and that would certainly | |
45:52 | be our clinical experience . Okay , so you have | |
45:56 | the furry microphone somewhere . Can I ask a question | |
46:01 | , please do . Engineers that marry have as many | |
46:06 | Children as others . Two engineers marry and have as | |
46:09 | many Children . Yes , because the evolutionary theory would | |
46:13 | be about reproduction . Sure , so , presumably people | |
46:17 | with autistic traits . If there's an evolutionary advantage , | |
46:21 | some would have as many Children , not less , | |
46:24 | because it's difficult to explain autism in evolutionary terms if | |
46:28 | it decreases fitness . Sure . Um , so I | |
46:34 | don't know the data on fertility fertility rates amongst engineers | |
46:39 | versus other groups in the population . Maybe someone else | |
46:42 | does . Um , But if you think again , | |
46:46 | about for the fertility in relation to resources , an | |
46:52 | engineer could be someone who ends up with considerable resources | |
46:56 | if they have the skills and the tools that other | |
47:00 | people need in the community . So if engineering skill | |
47:05 | is related to resources , we know that there is | |
47:09 | a connection between wealth , economic status and fertility rates | |
47:13 | that may explain the persistence of the range of autistic | |
47:18 | or engineering type autistic jeans . Yeah , I mean | |
47:21 | , the puzzle always was that , You know , | |
47:24 | back in the old days , the kind of autism | |
47:26 | we saw in the clinic , we couldn't really imagine | |
47:28 | this person ever growing up to have a relationship , | |
47:31 | let alone an intimate relationship that might result in Children | |
47:35 | . So why were the genes for autism persisting in | |
47:38 | the gene pool ? Now we've broadened autism into a | |
47:41 | spectrum , and we can look at Asperger's syndrome and | |
47:44 | we see what's called the broader for genotype amongst the | |
47:49 | parents of Children with autism , which might include skills | |
47:53 | in engineering or in technical intelligence . We can see | |
47:57 | that actually , there's plenty of scope for these individuals | |
47:59 | not only having married and had Children so passing on | |
48:02 | their genes , but maybe even being selected positively selected | |
48:06 | by a mate for those positive trades . Well , | |
48:12 | Bill Gates is a really interesting examples . Everyone speculates | |
48:16 | that he's got autism . He resists the idea . | |
48:19 | So any time a journalist's journalist tries to sort of | |
48:22 | thrust a microphone into his into his face and say | |
48:25 | , You know , Mr Gates , do you have | |
48:27 | autism or kind of the sort of blunt way that | |
48:30 | journalists sometimes do ? He gets sort of irritated , | |
48:33 | But those people who worked with Gates , uh , | |
48:37 | sort of report that actually , he's got a lot | |
48:40 | of those behaviors , and he's done quite well . | |
48:42 | Yeah , mhm . What are your thoughts about the | |
48:47 | contention , uh , that autism represents a slow life | |
48:53 | history strategy or is associated with a slow life history | |
48:57 | strategy and that , um , their reproductive success or | |
49:01 | niche is with a state of intense monogamy and long | |
49:07 | term relationships and investment in a single relationship , as | |
49:11 | opposed to , uh , psychosis , which is claimed | |
49:16 | to be a fast life history strategy . And that | |
49:19 | , I mean , there has been this research and | |
49:21 | these claims . I don't know what your thoughts are | |
49:23 | about that I don't know that research , but I | |
49:26 | mean , it makes sense the way you're describing it | |
49:28 | . Slow life and fast life . Certainly there's quite | |
49:32 | a lot of data that's accumulating , showing that fathers | |
49:36 | of Children with autism tend to marry late . So | |
49:40 | maybe that fits in with the slow life . Is | |
49:43 | that right ? And you know , it's been kind | |
49:45 | of open to interpretation as to why that's the case | |
49:49 | . And some people suggest , well , that could | |
49:51 | just be because their social skills are not as great | |
49:55 | . They've got some of the genes for autism because | |
49:57 | we see it coming out in the next generation . | |
49:59 | So maybe they've just taken longer to find a partner | |
50:03 | because of reduced social skills . But I mean , | |
50:07 | you know , I guess you're talking about slow life | |
50:10 | and fast life trajectories which may not be sort of | |
50:13 | under the within the awareness of the individual . These | |
50:17 | are just sure , but it's very interesting from one | |
50:21 | Simon to another . Simon Foster from Red Car . | |
50:25 | And I'm a child psychiatrist . So I'm fascinated by | |
50:28 | autism . And I heard you talk 20 years ago | |
50:30 | , and you're just as accessible and entertaining as you | |
50:33 | were then . So it's great to hear again . | |
50:36 | Um , what I'm wondering is the extent of genetic | |
50:43 | , um , or the extent that the genes are | |
50:47 | distributed amongst the chromosomes . Doesn't that suggest that autism | |
50:52 | is very old ? It's been with us for a | |
50:54 | long time . Have you got any thoughts on that | |
50:58 | ? Um , that might be one implication . Um | |
51:04 | , so you know , one view about the genetics | |
51:07 | of autism is that it's not about diseased jeans or | |
51:11 | mutations . Rare mutations , although there are rare mutations | |
51:15 | that can give rise to so called syndrome IQ autism | |
51:19 | . But autism may also be the result of common | |
51:22 | variants in the population , and that these common variants | |
51:26 | may be distributed right across the genome . Each of | |
51:30 | these common variants may be contributing very smaller facts , | |
51:34 | so it may be combinations of particular variants that are | |
51:39 | not disease genes . They just contribute in different ways | |
51:44 | to , um to skills , whether it's language or | |
51:48 | whether it's mechanical skills or or any other . Now | |
51:51 | , you also suggesting that because we see those dots | |
51:54 | right across all 23 pairs of chromosomes , that means | |
51:58 | it's very old . Another view might be that actually | |
52:03 | , the epigenetic factors are more important that actually , | |
52:07 | maybe the epigenetic factors can can influence a lot of | |
52:11 | gene expression . And then when we pick up genetic | |
52:15 | findings were kind of we're not looking at the effigy | |
52:18 | name , so there's different ways of interpreting it . | |
52:22 | Um , I just think that the first person that | |
52:25 | picked up a burning stick or a bit of half | |
52:30 | half burnt flesh from a thunder and lightning storm and | |
52:33 | thought This is tasty . Maybe we can reproduce this | |
52:37 | effect ourselves . Were they systematize is sure . Well | |
52:43 | , I mean , I think I think you're sort | |
52:45 | of raising the question about , um , about when | |
52:48 | an evolution did some of some of these very human | |
52:53 | attributes first emerge , and I think if you look | |
52:56 | at the evidence from tools , for example , the | |
53:00 | fossil evidence from tools in evolution . You'd probably go | |
53:04 | back at least 70,000 years in terms of when toolmaking | |
53:09 | really took off and where you can see the evidence | |
53:12 | of a very systematic mind varying their tools , which | |
53:17 | you didn't really see much before 70,000 years ago . | |
53:22 | Spirits . California , uh , adult psychiatrist , I've | |
53:25 | been . I have been seeing people with autistic spectrum | |
53:30 | in the clinics over the years , and one of | |
53:33 | the things that impressed me it was in the what | |
53:37 | I had in my mind , the difference between Asperger's | |
53:40 | and autism , and that the autistic people they did | |
53:45 | not want to be with people where there's Vegas wanted | |
53:49 | to be with people , and it seems that that | |
53:53 | has just if it's not so much important . But | |
53:57 | for me , in the clinical practice and especially how | |
54:00 | you can deal with people , it's a huge amount | |
54:03 | of difference . Sure , I mean , it's not | |
54:07 | a binary that you either want to be with people | |
54:09 | or don't want to . It's probably about the kind | |
54:12 | of dose of social interaction that each of us enjoys | |
54:17 | , so some of us enjoy seeing a friend once | |
54:19 | a week . Other people need to see a friend | |
54:22 | once a day . So there are individual differences in | |
54:26 | social motivation and social behavior . Uh , and , | |
54:31 | uh , you know , whether it's a kind of | |
54:33 | discriminated between autism and Asperger's . I'm not sure , | |
54:36 | because even within the group called Asperger's , you see | |
54:40 | quite a variation that some people are very content just | |
54:45 | being solitary and they actually sleep during the day . | |
54:49 | They're awake at night because then they're not . They're | |
54:52 | not having to have any social contact . Um , | |
54:56 | and others , you know , do want the social | |
54:58 | contact but don't have the social skills to know how | |
55:01 | to have those relationships and so feel very lonely and | |
55:04 | isolated . So I think there's kind of this individual | |
55:07 | differences , even within Asperger's syndrome . Do you ever | |
55:11 | feel that events move a predisposition predisposition to autism ? | |
55:17 | Two more florid form , and if so , what | |
55:20 | sort of innovation ? Let's see , um , so | |
55:25 | I think of the word florid as the word that | |
55:28 | sort of adult psychiatrists use in relation to psychosis . | |
55:33 | You know , that kind of you suddenly see all | |
55:35 | the symptoms blossoming . Um , whereas in autism , | |
55:39 | I don't know that we kind of really think about | |
55:41 | the manifestation of symptoms in this kind of florid way | |
55:45 | . I think it's much more sort of , um | |
55:48 | , that if you look back , you can see | |
55:49 | a particular pattern of behavior that was there right from | |
55:53 | the earliest point . So I work in a clinic | |
55:57 | NHS clinic for adults with suspected Asperger's syndrome . But | |
56:01 | we ask the parents to come along with their 40 | |
56:04 | year old son so that we can get a developmental | |
56:08 | history of was the pattern of behavior there , even | |
56:11 | at primary school . And so it's not so much | |
56:14 | this kind of florid explosion of symptoms where there's a | |
56:17 | trigger , it's more that , actually right from the | |
56:21 | earliest point . This was a child who didn't really | |
56:24 | socialize in the same way they were more focused on | |
56:28 | objects than on people . Maybe they didn't need a | |
56:32 | diagnosis in primary school or even secondary school because they | |
56:35 | somehow sort of managed in primary school . Maybe they | |
56:40 | were focused on their academic work didn't really mix with | |
56:43 | kids in the playground . In secondary school , we | |
56:46 | often see a kind of more difficult picture where suddenly | |
56:52 | the adolescent teen age group is much more demanding of | |
56:57 | , you know , if you don't have social skills | |
56:59 | it's much harder to navigate that . So a lot | |
57:01 | of the kids get their diagnosis for the first time | |
57:04 | in secondary school . But some of them have managed | |
57:06 | to get through until they leave home and they go | |
57:08 | to college and then they need their diagnosis or when | |
57:12 | they are not functioning well at work . So in | |
57:15 | midlife , so it's not about particular triggers . It's | |
57:18 | about what nice there in who is protecting them , | |
57:24 | whether it's the family up until a certain point , | |
57:27 | who is concerned about the child or the individual . | |
57:29 | And at what point do they do their symptoms their | |
57:32 | autistic traits start to interfere with . At one point | |
57:37 | , I was told as a student that a number | |
57:40 | of Children became autistic when their fathers came back from | |
57:44 | the war right , and the association between mother and | |
57:49 | child was interrupted . Right ? So I would say | |
57:53 | that probably theories of autism have changed a little bit | |
57:59 | . I mean , we used to have all sorts | |
58:01 | of theories about autism to do with how the mothers | |
58:04 | were cold and unemotional , or maybe over involved with | |
58:07 | the child , and , you know , so I | |
58:08 | can imagine this kind of event of the father coming | |
58:11 | back from war might have fitted into certain kinds of | |
58:14 | theories of autism . But I think nowadays we kind | |
58:17 | of understand autism is this biomedical neurodevelopmental condition , which | |
58:23 | I've hoped I've shown is just a different pattern of | |
58:27 | , you know , the relative sort of focus that | |
58:31 | the individual has on the social world versus the non | |
58:33 | social world and that sort of events that might happen | |
58:38 | in the child's life , about whether the father is | |
58:40 | absent or present , their probably less important than the | |
58:44 | genetic predisposition . Uh , and there are there must | |
58:48 | be environmental factors . But we're not very good at | |
58:50 | identifying what those are yet . I guess if Dad | |
58:53 | comes home with PTSD and takes takes to whiskey in | |
58:56 | a big way and starts knocking them around , that | |
58:58 | might have an impact on the social scale . Well | |
59:00 | , but for any child Yeah , that's right . | |
59:03 | Maybe a confusion of sure Vina Titus Yeah , that's | |
59:07 | just it . A question , I think , on | |
59:09 | the David Guinea , retired psychiatrist from Oxford . Could | |
59:14 | I ask you a little bit about the group ? | |
59:17 | The other end of the spectrum that is the individuals | |
59:20 | who are very high empathizes and low , insistent , | |
59:25 | systematize ng What are they ? What is this group | |
59:30 | like ? Clinically . So I think . Well , | |
59:34 | the word clinically is probably the most important word here | |
59:37 | because they may not come to clinics . So these | |
59:39 | people have got very good empathy . So we might | |
59:42 | infer that they they've got good social network and good | |
59:45 | relationships . Friends community . So actually , they may | |
59:50 | be protected from needing to go to a clinic . | |
59:54 | It's probably the people who have below average empathy who | |
59:57 | struggle with with relationships , who might then develop secondary | |
60:01 | depression because they're isolated , who end up coming to | |
60:05 | clinical attention . So the people up at the top | |
60:08 | left hand quadrant with super empathy may be doing just | |
60:12 | fine . We don't know too much about them . | |
60:14 | We know that they exist because you can see them | |
60:16 | there . We can see more yellow dots , so | |
60:18 | there's more females . But you can see the odd | |
60:21 | green dot um , and we know also that they | |
60:26 | may struggle with systems . So maybe at school they | |
60:31 | didn't enjoy mathematics or the natural sciences and went for | |
60:35 | other kinds of subjects , and that when the computer | |
60:39 | goes wrong and they just phoned the help desk , | |
60:41 | so I don't think that these individuals would necessarily , | |
60:46 | um , have problems . They just are part of | |
60:50 | the variety we see in the population . I suppose | |
60:53 | . I was wondering whether they were the group that | |
60:56 | one does see from time to time people who do | |
61:00 | seem deeply empathic but really very disorganized and the sort | |
61:04 | of term I'm not sure if it's at all PC | |
61:07 | . The term that springs to mind is Scat e | |
61:10 | uh , she's not a clinical diagnosis , which is | |
61:12 | it's a non clinical term , but it's a description | |
61:17 | of what ? Of how a person may be like | |
61:20 | that . And I'm thinking how that fits into the | |
61:24 | evolutionary picture . If you think that is , that | |
61:29 | could characterize what that sort of person might be like | |
61:32 | , Right ? Uh , so , as I say | |
61:34 | , we don't we don't There hasn't been much research | |
61:37 | into the people who are at the opposite end of | |
61:40 | autism , so we know a lot about people with | |
61:42 | autism because they come to clinical attention , and then | |
61:45 | they make it into research studies . The group at | |
61:48 | the other end of that dimension . If we think | |
61:50 | of the diagonal , uh , we know less about | |
61:53 | maybe they've got sort of executive type problems in being | |
61:58 | very systematic in organizing things , but I think that | |
62:01 | maybe a bit too simplistic because people with autism can | |
62:04 | also have those executive types organizing difficulties . Um , | |
62:09 | but we just don't know . But I think it'll | |
62:11 | be good to have more research into that other group | |
62:14 | . I just wonder whether those of us who might | |
62:16 | ask you that question I tend to be mailed . | |
62:19 | I've got 22 daughters . Both have gone through adolescence | |
62:25 | . I have to say we're both shockingly empathic , | |
62:27 | and I found it very difficult to comprehend it . | |
62:31 | And we're sort of a coffee time , I think | |
62:34 | , really , Unless they're really , really pressing questions | |
62:36 | . So , um so I think , first of | |
62:38 | all , just to thank you very much for a | |
62:40 | really enlightening and beautifully flowing presentation , which I think | |
62:45 | is just , you know , uh , been excellent | |
62:47 | , uh , for us as clinicians . And to | |
62:50 | think about in terms of the evolutionary background to these | |
62:53 | conditions , choosing my words carefully there , Um So | |
62:58 | thank you very much . |
Summarizer
DESCRIPTION:
First Symposium of the Evolutionary Psychiatry Special Interest Group of the Royal College of Psychiatrists, Oct 4th 2016 in London. Lecture by Professor Simon Baron-Cohen from Cambridge University Autism Research Centre.
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