The Boy :
But we've got communications devices --
Tom :
But not A Police Box.
The Boy :
....a Police box?
Tom :
Yes. What the mathematical model
of the TARDIS exterior is based upon.
The Boy :
I'd like to see Earth, but why go all
that way just to look at something
that looks like The TARDIS?
Tom :
Because I want
to measure it.
The Boy :
Whatever for?
Tom :
Block transfer computation.
"....if you're below zero it means
you've got difficulties in that domain,
and on the x-axis we've got Systemising --
The Ability to understand A System
but also build A System by identifying
The Rules that govern The System and
so You can predict how The System works --"
Autism: An evolutionary perspective, Professor Simon Baron-Cohen, 1st Sy...
now our next speaker is Professor Simon baron-cohen who first Helios you've probably heard this every time Sasha's cousin I'm just I feel so privileged hyphenated cousin I understand so yeah congratulations on your cousin Festa Baron Cohen is a professor of developmental psychopathology at the University of Cambridge and director of the University of Cambridge autism research centre that information hasn't gone out of date has its dual education now I when I was just having a look at your kind of background what I could glean on the internet what I've got from that is I think you published over 300 papers on and numerous books and that you extraordinarily prolific creative career over the last thirty years dating back to more the early work about theory of mind and dealing with the dilemmas faced by patients with autistic spectrum disorders and their families which i think is fair to say have shaped all of our thinking over the years as clinicians interested in helping this particular group of patients so marvelous contribution to psychiatry professor Simon burger professor Baron Cohen has worked on issues of sexual dimorphism in the human brain and differences of adaptation between males and females and familiar work about systematizing and emphasizing brains which I suspect may be part of your presentation I think probably well author of a number of books which I think it's worth mentioning not it not by name and in great detail but just to make the point that I think you've written extraordinarily accessible books which are very important because of their ability to share scientific knowledge not only within the medical community and they work very well as medical textbooks but also within the much broader community of interested people out there the general public which is of course what we want to influence and shape so we're very grateful to you for joining us this afternoon thank you very much thank you very much and so first of all thank you for inviting me to take part in this very interesting day I'm sorry I missed the morning I was here to catch What is autism most of your lecture Andy and that was a real privilege for me and so I've been teaching and psychology atypical psychology to the medical students in Cambridge for about 20 years and being given giving them a lecture on evolutionary psychiatry describing your work making it accessible to doctors who are really at the beginning of their career so that they're starting to think in this Darwinian way so some of you may may be former students of mine and but hopefully these ideas are beginning to permeate into the field of Psychiatry so that we start thinking about the function of behaviors and emotions not just thinking about how to eliminate them so I'm talking about a neurodevelopmental condition autism again from an evolutionary perspective I thought I'd start just with a picture of a child with autism doing the classic thing that kids with autism do so he's playing alone so one of the features of autism is not really interacting socially but he's doing something intelligent he's lining things up to make very clear patterns that he is imposing on the world and as many of you know kids with autism get very distressed if anyone disturbs their perfect universe their order of patterns that they're creating one other child before we get into what we understand about autism again a child playing on his own so it's a encompassing the word autism which just means self not interacting with others but again doing something very intelligent so he's playing with water and he's fascinated by the patterns that can be created as you block the flow of water with your hands so fascination with patterns but solitary Autism prevalence what you probably know is that the prevalence of autism has been rising year by year so this shows you data from the mid 90s through to the early 2000s so autism has been getting more and more common if we continue that graph just looking at data from the u.s. from the Center for Disease Control you can see that the increase has continued and if we go right up to the latest data which is 2014 Center for Disease Control in the US the estimate now is autism is diagnosed in one in 48 boys and one in a hundred and eighty-nine girls this is child data and if you average across the two genders it's about one in 68 kids end up with a diagnosis of autism so this is way more common than when I first started out in this field back in the mid 80s when Michael Rutter and others whose names you'll recognize was saying that autism was four in 10,000 so very rare we now think of autism is very common and my talk isn't about why the increase but I think we can probably attribute most of that to greater recognition better awareness a lot more services on the ground looking for autism so more eyes looking for potential cases and of course we've broadened the definition of autism to include Asperger's syndrome so we've we've moved from a categorical diagnosis to a spectrum diagnosis and added a whole subgroup and the graph on the right there really shows you how to glance the whole picture of autism because you can see that within both males and females there are some people who have below average IQ so they not only have autism but they have learning difficulties as well and of course some who have average or even above-average IQ what we would call Asperger's syndrome Autism Spectrum Quotient so we tried to measure this idea of a spectrum by creating something called the autism spectrum quotient it's a questionnaire that adults can fill in for themselves the a Q so that self-report or parents can fill it in about their child and each item on the questionnaire is one autistic trait and the scale as you can see goes from zero to fifty the dotted line on the left is the normal distribution that emerges when you ask adults in the population to fill in this instrument so what that's telling us is that we all have some autistic traits nobody really scores zero the solid line on the right are the scores from adults who already have a diagnosis of autism or Asperger's syndrome and again we get this kind of bell curve so there's a kind of range of scores but the point I wanted to make here is that there's a spectrum not only within those who come to the clinic but it's a spectrum that runs right through the population and evolution natural selection could well have been operating on those individual differences in autistic traits that we see in the population Autism is genetic so the first part of my talk is just to tell you what we know about autism and I'm going to go through this at a quite a fast pace so we can get on to the kind of evolutionary relevance but what we do know is that autism is in part genetic because if you've got one child with autism in the family the likelihood of another child also having autism is one in three so if we take the general population prevalence of about one percent you can see that the presence of one family member with autism rapidly increases the likelihood of somebody else also having it so this looks like it's partly genetic the reason I would say that not just familial but genetic is that the hunt for autism genes is revealing hundreds of so-called risk genes this comes from a website called Safari org where they report every new genetic Association that's found for autism so here are the human chromosomes and the colored dots represent a published finding of an Ajan etic association with autism or Asperger's syndrome where you can see at a glance is that almost every human chromosome harbors some genes for autism so we know autism is not monogenic it's massively polygenic what we don't know is what what these genes are doing what their function is which genes are necessary and sufficient to cause certain types of autism or certain symptoms of autism but there's no doubt that autism is in part genetic but we know autism isn't completely genetic because of identical twins like these girls where one has autism and one doesn't if autism was a hundred percent genetic if one has it they should both have it so discordant pairs of this kind suggest epigenetic factors environmental factors that can act on the gene in someone who's genetically predisposed to autism might also be part of the story and you can see that this study from King's College London Robert Plomin group shows differences in gene expression in discordant twin pairs in terms of what's going on in the brain in autism we certainly see differences so just zooming in on different structures you can see a difference in the size of the amygdala in autism compared to controls that the amygdala is larger in children with autism than in typically developing children we also know that the brain in autism Brain growth seems to be growing faster than in typical development so on the left is a graph showing growth trajectories in blue are typically developing children who've at each had to MRI scans so that you can join the dots to to create growth curves and in red are kids with autism again who've had a repeat MRI so you can look at how quickly the brain is growing and you can see that the autism group at each time point is showing a larger brain suggesting that the brain is growing quicker the cartoon on the right comes from Eric Krauss Shen's group in San Diego post-mortem study where you get the opportunity to look at the brain from people with autism and dissect it observe it in in fine detail finding 60% more neurons or nerve cells in the frontal cortex in people with autism than in comparison friends so the larger brain seems to correspond with a heavier brain if you weigh it at post mortem and also more nerve cells more neurons in different parts of the brain Corpus callosum here's another structure which differs between autism and controls the corpus callosum the connective tissue between the two hemispheres which in autism is smaller in the posterior part of the corpus callosum compared to typical individuals so I'm just showing you some examples of differences in brain development brain structure and we'll come on to brain function to show that these kids right from the earliest point the brain is developing differently this is a paper that was just published this year Christina Kerr again at King's College London but using data from a national data set and showing that you can identify in DTI diffusion and imaging short connections and more long range connections and then in autism you find more of the short range connections and fewer of the long range connections than you do in a typical sample so again just differences in the wiring of the brain Postmortem evidence again back to the post-mortem evidence if you just look at the individual neuron the nerve cell this is a very I think a very interesting study so on the right we've got a neuron from a brain from someone who had autism and on the left a typical individual and again with the naked eye you should be able to see more of the white dots all along the neuron and each dot is a location of a dendritic spine or at the location of synapses where the neuron is making connections with its neighbor so this is suggesting more connectivity between neurons in the autistic brain not just more neurons but more connections between neurons in autism compared to a typical brain giving you a flavor of the differences between someone with autism and someone without autism so that's a bit about genetics and a bit about the brain and of course there are Behavior and cognition major differences in behavior and cognition this is again a study from UC San Diego by Karen Pierce what they did was they looked at two-year-old children coming into the clinic and they presented them either with a face to look at as a social stimulus or a geometric design and they filmed how long each child looked at either the social or the non social stimulus what they found was the different look looked for more than 70% of the time at the non social stimulus the probability that that child had autism was a hundred percent so when I read this paper I was sort of blown away that maybe a behavioral test could be diagnostic and it could save us hours of interviewing families and observing the child and so forth obviously a caveat with a study like this it was a clinic study we don't know whether the accuracy would be as good if you rolled it out into the community into the general population but either way just the take-home message from the study is that a typical child tends to naturally look at faces they're drawn to look at people and presumably the emotional information in faces and the child with autism doesn't show that that typical preference rather they're more interested in patterns in this case geometric patterns so what we're seeing is evidence of difference not necessarily pathology just a brain that's wired differently and finds different aspects of the environment of interest so other differences psychologically Attention to detail between autism and a typical person is in terms of attention to detail some of you recognize this task on that on the left it's called the embedded figures test where you have to find the shape hidden in the overall design as quickly as you can people with autism are super quick and super accurate on tests like this where the cube is hidden in there I'll let you see if you can find it and when we've asked people not just to do this test at the behavioral level but also to do it whilst they're lying in an MRI scanner functional imaging people with autism show less activity in the posterior parietal cortex whilst they're solving the task at a higher level so the brain is in some sense more efficient they are ending up with better performance but showing less brain activity to achieve that performance so differences in function between the autistic brain and the typical brain another suggestion that people with Block design test autism focus on detail whilst the rest of us focus on the big picture comes from the results of the block design test which many of you will have seen or used as part of the IQ test in children or adults people with autism show their best performance on block design where you have to take it to select which little cubes you need which have different colored faces to create the design up above and kids with autism are very quick at this and they don't seem to improve in their speed whether you segment the designers it's been done on the right to help a child to find the solution or whether you just present them with the overall design so evidence of superiority in understanding the components that make up a larger design more more evidence for people with autism being detail-oriented is in this test where you simply ask the person what letter do you see people with autism are more likely to report they've seen the letter H obviously both answers H or a are correct and the test is really just designed to see whether you're more focused on local detail or more global information suggesting that people with autism and more detail or local oriented and finally a study that came out a couple of years ago showing again superior performance in kids on the autism spectrum in spotting patterns where you give them repeat information where you get it whether the individuals getting a chance to learn that certain shapes always co-occur always occur together then kids with autism seem to be quicker at picking up these regularities Max Park so when we think of autism we think of it as a child who's quite isolated trouble making friends trouble communicating we tend to focus on the social deficits but we should keep in mind that autism is more complex than that this 10 year old child Max Park in California loves the rubic cube so he's fascinated by patterns he's ranked in the top 100 100 Rubik cube players in the world so whilst he has trouble socializing he's also showing of not just intact ability but superior ability we need to think of both sides of autism when we try to think about um how a partly genetic condition may have been selected for in evolutionary terms Derrick Parravicini and this is Derrick parravicini who lives in this country so he has a mental age of a four-year-old very limited language so learning difficulties he's also been blind from birth so congenital blindness and he has autism it's quite a package and whenever he hears any jazz song that's played he can immediately reproduce it after just hearing it once if you play a ten note chord on the keyboard he can instantly identify all of the ten notes in the chord suggesting that in his case the talent is obviously an auditory information he's blind but he can dissect the information into its component parts very fast just as we saw on the embedded figures test or the block design test this same ability that you see in autism of taking information and reducing it down to its component parts very rapidly and spotting patterns Sensory issues so the other side of autism which has only just made it into the latest DSM dsm-5 is sensory issues parents and people with autism were telling us for about 40 years that they had sensory issues but it wasn't part of DSM 3 or 4 it's now part of dsm-5 bless you and this is really showing you that if you put someone with autism into functional magnetic resonance imaging you give them headphones whilst they're blindfolded and you simply look at which part of the brain responds when they hear a tone an unexpected auditory stimulus you see a greater response in the auditory cortex in people with autism compared to the typical individual suggesting hypersensitivity this is obviously a study just in the auditory domain but you could do the same in the tactile or the visual where they taste channels and still find this hypersensitivity Social difficulties so in terms of the social difficulties which we know are present the earliest demonstration of these comes from these studies they're called baby siblings doublet studies where you know there's already one child with autism in the family so you're watching the new baby in the family who's at genetic increased risk of autism and finding that and for example if you present them with a stimulus of the eyes looking direct at the infant or away from the infant the p400 electrophysiological wave that can be recorded just using erp or EEG type equipment is reduced in those children who go on to develop autism so perception of faces and social information seems to be different this is even in the first year of life this work comes from a meek Linh who was Gaze tracking at Yale University is now moved to Emory where he used gaze tracking to see where somebody looks whilst they're watching a movie so this clip is from Who's Afraid of Virginia Woolf and in yellow the gaze tracker is showing us that that's where the typical individual is looking whilst they're watching the movie looking in Elizabeth Taylor's face but particularly her eyes and in red is where people with autism tend to look so they are looking at the face but focusing more on the mouth than the eyes so the gaze tracking technology is giving us a window into what is of interest and what is at the attentional focus of people with autism and as you kindly mentioned in the Theory of mind introduction there's been a lot of work starting from our group but many other groups looking at so-called theory of mind the ability to put yourself into someone else's shoes and to imagine other people's perspectives which children and add with autism I find challenging so that they don't tend to participate in games like hide-and-seek when they're very young or deception which typical four-year-olds enjoy because they're keeping track of what other people know what other people might want and intend and instead children with autism tend to avoid those kinds of interactions finding them very confusing The Eyes Test we developed this test called the eyes test which some of you may know to measure social cognition in adults with Asperger's syndrome and in the general population so you're shown photographs of the eye region of the face when you have to pick which of the four words that surround the photo best describes what the person in the photo is thinking or feeling so very degraded black-and-white still photographs but people are pretty accurate at picking out that she's dispirited or a bit sad just from minimal information of emotions around the eyes you can see that the data down on me in the graph on the left comes from thousands of individuals who've taken this test online showing that both males and females with autism score lower on this test of reading emotions from the eye region of the face and when we ask them to take that same test whilst they're lying in the scanner we find that people with autism shown less activity in the left inferior frontal gyrus whilst they're trying to decode someone's facial expression from information around the eyes compared to a typical control group so evidence I hope I've presented for both talent but also disabilities in the same individuals so some of you know that at just last Neurodiversity year an important new book was published about autism called neuro triumph which by a journalist called Steve Silverman it won the Samuel Johnson prize for nonfiction very deservedly because it tells a whole new history of autism but also if you look at the subtitle of his book he talks about the future of neurodiversity and his book in many ways is a sort of manifesto for this new concept of neurodiversity which has psychiatrists and clinical psychologists we should be paying a lot of attention to because it's really the idea that there are many ways for the brain to develop there isn't a single way to be normal there are individual differences in the population which may be there for reasons of natural selection were not all made the same that we all have our strengths and our weaknesses and autism may be just one example of neuro diversity in the environment Silverman chose as the front cover design for his book an image of biodiversity and were all very familiar with that related concept of how important it is for us to preserve diversity in the Amazon rainforest or elsewhere and he really argues the same should be true for neurodiversity that in any classroom of children you're going to find some some kids are more verbal some kids are more spatial some kids are more sociable and some kids are more musical and all of these different brain types if you like are part of the diversity that you find in any garden so that in any primary school you should expect two or three kids with autism to be part of that diversity on the right here we've got our picture of Henry Cavendish Silverman devotes a whole chapter of his book to the biography of this physicist who was not any famous for the discovery of hydrogen but as Silverman makes a very strong case probably had autism he did his absolute utmost to avoid people so he would leave messages for his servants and for other people he had to interact with rather than meeting them face to face and was really just content to do his physics to do his scientific experiments away from the social world so here's the concept of neurodiversity attributed to a Judy singer who has autism herself but which first appeared in print in 1998 the reason for dwelling on this is I think it's a revolutionary concept for our field and Neurodiversity movement this poster is produced by the neurodiversity movement which comes from the autism community asking for autism acceptance the idea that they're not necessarily inferior or impaired or am pathological in some way they're just different just like we might find amongst for example fruit they're not all the same for genetic reasons we might expect them to be of different flavors I Albert Einstein think the notion of neuro diversity goes back quite a lot further than I was suggesting so here's Albert Einstein and there's a quote from him on the left if you judge a fish by its ability to climb a tree it will live believing it is stupid so we just think about animals in different ways and Einstein again the case has been made that he might have had autism here's a quote from his his biography I do not socialize because it would distract me from my work so he was really just focused on his physics he did quite well and he cook he also enjoyed sailing but he did that alone when he was at Princeton and he used to enjoy playing the violin but um you know people weren't his main focus the the world of objects in the world of systems and understanding the laws behind the physical world which led him to his discovery of relativity Autism in science so his hands asperger on the left the pediatrician who's name is now given to one of those subgroups and he said for success in science a dash of autism is essential so there's that idea that autism might come and come by degrees we might all have some of it and maybe a certain modicum of autism might be quite good for focusing your attention just on one so called obsessional topic part of the autism diagnosis as you know is that develop obsessional interests but that's a rather kind of pejorative way of describing that they just have passions or interests and on the right here we have Newton again the case has been made the he too had autism so not only discovered gravity but famously fell out with almost all of his colleagues and had difficulties with communication so we see this potential link between autism and scientific talent at least speculated in biographies and anecdotes well we've tried to measure this to see if it's actually the case and so we developed a questionnaire called the systemising quotient which asks how interested you are in different kinds of systems whether they're mechanical systems like computers mathematical systems like mathematics natural systems like the weather and you can see that people with autism score higher in terms of their strengths of interest in systems than people in the general population Autism and mechanical reasoning we've also gone out to test whether kids with autism or Asperger's might be better at solving mechanical reasoning tasks like this one where you had to look at the wheel going anti-clockwise and predict what will happen to that point P the correct answer here is it is C it will move back and forth and kids with with Asperger's syndrome age 12 outperform typical 12 year olds in solving these kinds of mechanical reasoning problems suggesting that despite their social difficulties in certain aspects of the environment their understanding is actually precocious so I'm located at Cambridge so opportunistically we decided to look at the rate of autism amongst the math students at Cambridge University so we just asked them that very straight question do you have autism and you see you see the results show a much higher rate of diagnosed autism in students at I would say this a very good University in the field of mathematics compared to the humanities so again reinforcing this idea that there might be a link between a lot of autistic traits or even a clinical diagnosis of autism and talent at understanding systems including mathematics and again just taking advantage if you Autism and science like of students thing on the doorstep we gave the aq that measure of autistic traits to students working in Sciences or in the humanities finding that the scientists didn't have a higher rate of autism they just had more autistic traits compared to those working in the humanities so again those individuals who are attracted by the more predictable world that can be systemized which is what we do in science where we try to understand lawful relationships between variables might end up in science it may have higher number of autistic traits than those who can deal with the less lawful world of people the unpredictability of people and the way we write about people for example in literature where this link comes from between autism and scientific talent is likely to be genetic because years ago we looked at the occupations of fathers of children with autism just asking them about where they work and finding a disproportionate number of fathers of children with autism work in the field of engineering compared to fathers of typically developing children obviously engineering is a very good case of where you need to be good at understanding systems but to get the job you may not have been selected on the basis of your social skills more your understanding of how things work so looking back where there's a child with autism in the family at the genetics if you like what's been positively selected perhaps in evolutionary terms is not autism itself but absent aptitude for understanding systems which would be an advantage in fields where you're either building a system like engineering or trying to understand the system we found the same pattern amongst the grandfathers of children with autism on both sides of the family so this led to the prediction is autism Autism in Silicon Valley more common in places like Silicon Valley so Silicon Valley obviously obviously been attracting people who have an aptitude for systems for quite a few years and they moved there and they work there and they potentially start a family there and have children so if there's a genetic link between scientific aptitude or technical intelligence and risk of autism in the offspring we should see it in places like Silicon Valley so Silicon Valley is quite a long way away from London so we went to a Silicon Valley a bit closer to home in the Netherlands and looked particularly at the city of Eindhoven Eindhoven has got the Eindhoven Institute of Technology a bit like MIT it's also had the Philips Factory there for over a hundred years attracting people to go and work there in the fields of electronics and more recently IT so that now a third of jobs in Eindhoven are in the IT sector we compared the rate of autism in Eindhoven to to other Dutch cities Utrecht and Harlem selected because there are a similar size and similar demographic and found that the rate of autism in Eindhoven was more than twice as high as in those two other Dutch cities this was based on school records contacting every school in each of these three cities to ask them for the number of kids who already have a diagnosis of autism we don't know much about the parents this was a school-based study where the inference is that this may be something to do with the parents occupations
Empathy systemising model so and to try to make sense of all of the data that I've shown you this afternoon and to try and make it more relevant to an evolutionary perspective I just want to mention the model that was mentioned at the introduction this empathy systemising model the idea is that in the population in the general population these are two dimensions along which we see individual differences so along the y-axis we've got empathy and if you're at zero it means you're absolutely average for the population as you go up the y-axis you're above average at empathy or the ability to read other people's thoughts and feelings but also respond emotion with an appropriate emotion
if you're below zero it means you've got difficulties in that domain and on the x-axis we've got systemising the ability to UM like to understand a system but also build a system by identifying the rules that govern the system and so you can predict how the system works again towards the right so the positive values you're above average on systemizing and over to the left you're below average the idea is that we all fall somewhere in this space these two dimensions what we found in our research is that in the dark blue quadrant up at the top left more women in the population fall in that area where they've got above-average empathy but there systemising could be anywhere from average through to below average sorry that's in the light blue part of the graph in the white part of the graph are individuals who are equally good at systemising or empathy so they may be equally talented or equally challenged but they don't show much of just of a discrepancy in their aptitudes or abilities in both areas the pink area is where most men on average fall in the population where their systemising is at a slightly higher level than their empathy and what we were predicting is that people with autism would fall in the bottom right hand quadrant that dark red zone where their systemising may be anywhere from average to above average but their empathy would be less than minus one so in the below average range which is often the trigger for needing a diagnosis that they're struggling with relationships so that was the model and what we did was we went out into the population we gave people these two questionnaires the empathy quotient which measures your empathy the systemising quotient which measures your systemizing and just sort of helping you read the data here in yellow are females in the population and you might be able to see them clustering in the top left-hand quadrant of the graph in green are males in the population where you might see them clustering more in the center and in purple and red are males and females with autism who you might be able to see clustering in the lower right-hand quadrant so each data point here is an individual and and of course all we can do is look at groups males females people with autism on average because individuals may be typical or atypical for their group so you know we can see we can see a little green dot up here of a man who's well up in the female range on his empathy and we can see you know a woman all the way down here who's in the so-called autistic range so individuals may not fit the trends for their groups well we can talk about is statistical averages but if we do account for these Discussion different brain types and this is my last slide so we can leave time for discussion this is what we find that if we look at individuals whose empathy is at a higher level than their systemising we find more women than men in that have that profile if we look at the opposite profile individuals whose systemising is at a higher level than their empathy this is percentages we find more men than women show that cognitive profile and if we look at it at it at an extreme of this one so systemizing is either intact or above-average but empathy is below average well this is where we find the majority of people with autism or Asperger's syndrome so the data and are in line with the directions predicted by the model but really the reason for leaving this up as my final slide is to show that diversity that exists in the population we all fall in one or other of these five brain types if you like defined in cognitive terms although increasingly we're starting to map their neural substrate and the both environmental and biological determinants of these different brain types but we might well imagine that natural selection has favored one type of brain over another for different kinds of evolutionary niches over thousands hundreds of thousands of years or millions of years in primate evolution some of which fall out along and sex differences but actually are nothing to do with your sex because it turns out that prenatal hormones and genes play a much bigger role than your actual sex and that people with autism may just be showing an extreme of the variation that we see in the population selected potentially for their bare talents being very good at spotting patterns being very good at innovation at understanding new machines or new tools that will help us even if they find the social world more challenging so I'm going to stop there thank our funders and particularly the autism research trust that supports our work and we can open it up for discussion thank you [Applause] Thank You Simon I'm sure there'd be quite a number of questions but could I just ask you a flea I've had reason to work with large numbers of transgender patients over the years and what the observations I have is that there are certainly some trans women who will say you know I always socialized with women and the reason I liked doing that was that they didn't just kind of thump and kick each other they talk to each other at school for example and it was a safer and better place to be which seems fine and fixed with the model as it were there another group of people though who appear to describe a kind of subject to change when they start to take when they begin estrogen hormone treatment and I got a very vivid recollection of one patient in particular who talked about you know the sort of revelatory experience of being amongst the girls and finally feeling at home as it were which was very striking at the time I'm not aware of that should be but not aware of literature looking specifically at that group of people and particularly at hormone exposure for transgender patients so I just wonder if you've got any knowledge of that area to comment on or just a brief comment and which is that the and the the area of research of autism and gender is just beginning to open up and including transgender so we're now becoming a bit more aware that instead of asking people for their sex and giving them a binary choice male or female we need to be a bit more sort of fluid because a lot of people with autism don't want to identify as either male or female and they prefer to tick the other box and that increasingly a lot of people with autism are identifying as either transgender or discussing how their gender doesn't fit neatly into traditional categories so whether there's a hormonal element to this or some other factor but there's this is a new area of research certainly evident for hire and expected number of trans male patients with autistic traits and that would certainly be our clinical experience and okay so you have the furry microphone somewhere pause can I ask a question please do engineers that marry have as many children as others two engineers marry and have as many children yes because the evolutionary theory yeah would be about reproduction Shawn so presumably people with autistic traits it does an evolutionary advantage some would have as many children not less because it's difficult to explain autism in evolutionary terms yeah if it decreases Fitness sure and so I don't know the data on fertility fertility rates amongst engineers versus other groups and the population maybe other someone else does and but you know if you think again about um for the fertility in relation to resources an engineer could be someone who ends up with considerable resources if they have the skills and the tools that other people need in the community so if engineering skill is related to resources we know that you know there is a connection between wealth economic status and fertility rates that may explain the persistence of the range realistic engineering Jeanne's yeah I mean the puzzle always was that you know back in the old days the kind of autism we saw in the clinic we couldn't really imagine this person ever growing up to have a relationship let alone an intimate relationship that might result in children so why were the genes for autism persisting in the gene pool now we've broadened autism into a spectrum and we can look at Asperger syndrome and we see what's called the broader phenotype amongst the parents of children with autism which might include skills in engineering or in technical intelligence we can see that actually there's plenty of scope for these individuals not only having married and had children so passing on their genes but maybe even being selected positively selected by a mate for those positive traits well Bill Gates is a really interesting example so everyone speculates that he's got autism he resists the idea so anytime a journalist a journalist tries to sort of thrust a microphone into his into his face and say you know mr. gates do you have autism Lord and it kind of they're sort of a blunt way that journalists sometimes do he gets sort of irritated but those people who've worked with games a sort of report that actually he's got a lot of those behaviors and he's done quite well yeah what are you thoughts about the contention that autism represents a slow life history strategy or is associated with a slow life history strategy and that their reproductive success or niche is with a state of intense monogamy and long term relationships and investment in a single relationship as opposed to psychosis which is claimed to be a fast life history strategy and that I mean there has been this research and these claims I don't know what your thoughts are about that yeah I don't I don't know that research but I mean it makes sense the way you're describing it slow life and fast life certainly there's quite a lot of data that's accumulating showing that fathers of children with autism tend to marry late so maybe that fits in with the slow life is that right and you know it's been kind of open to interpretation as to why that's the case and some people suggest well that could just be because their social skills are not as great they've got some of the genes for autism because we see it coming out in the next generation so maybe they've just taken longer to find a partner because of reduced social skills but I mean you know I guess you're talking about slow life and fast life trajectories which may not be sort of under the within the awareness of the individual these are just sure but it's very interesting from one Simon to another I'm Simon Simon Forester Forester from red car and yet I'm a child psychiatrist so I'm fascinated by autism I heard you talk 20 years ago and you're just as accessible and entertaining as you were then so it's great to hear you again what I'm wondering is did the extent of genetic or the the extent that the genes are distributed amongst the chromosomes doesn't that suggest that autism is very old it's been with us for a long time have you got any thoughts on that and that might be one implication and so you know the one one view about the genetics of autism is that it's not about disease two genes or you know mutations rare mutations although there are rare mutations that can give rise to so-called syndromic autism but autism may also be the result of common variants in the population and that these common variants may be distributed in you know right across the genome each of these common variants may be contributing very small effects so it may be combinations of particular variants that are not disease genes they just contribute in different ways to two skills whether its language or whether its mechanical skills or or any other now you're sort of suggesting that because we see those dots right across all 23 pairs of chromosomes that that means it's very old another view might be that actually the epigenetic factors are more important that actually maybe the Apple genetic factors cannot can influence a lot of gene expression and that when we pick up genetic findings we're kind of we're not looking at the epigenome so there's different ways of interpreting it and I just think that the first person that picked up a burning stick or a bit of half half burnt flesh from a thunder and lightning storm and thought this is tasty maybe we can reproduce this effect ourselves were they systematizes sure well I mean I think I think you're sort of raising the question about and about when an evolution did some of some of these very human attributes first emerge and I think if you look at the evidence from tools for example the fossil evidence from tools in evolution you'd probably go back at least 70,000 years in terms of when tool-making already took off and where you can see the evidence of a very systematic mind at varying their tools which you didn't really see much before 70,000 years ago spiritualness I make cansado adult psychiatrist I've been and I have been seeing people with autistic spectrum in the clinics over the years and one of the things that they impressed me it was in the what I had in my mind the difference between Asperger's and autism and that the autistic people they did not want to be with people where the Asperger's wanted to be with people and it seems that that that has it's as if it's not so much important but it for me in the clinical practice and especially how you can deal with the people you know a huge amount of difference yeah sure I mean it's not an binary that you either want to be with people or don't want to it's probably about the kind of dose of social interaction that each of us enjoys so some of us enjoy seeing a friend once a week other people need to see a friend once a day you know so there's an individual differences in social motivation and social behavior and and you know whether it's a kind of discriminated between autism and Asperger's I'm not sure because even within the group called Asperger's you see quite a variation that some people are very content just being solitary and they actually sleep during the day they're awake at night because then they're not they're not having to have any social contact and others you know do want the social contact but don't have the social skills to know how to have those relationships and so feel very lonely and isolated so I think there's kind of this individual difference is even within Asperger's syndrome do you ever feel that events will a pre-submission a predisposition to autism to a more florid form and if so what sort of in a bed I see and so I think of the word florid as the word that sort of adult psychiatrists use in relation to psychosis you know that kind of uni you suddenly see all the symptoms you know blossoming whereas in autism I don't know that we kind of really think about the manifestation of symptoms in this kind of Florida way I think it's much more sort of and that if you look back you can see a particular pattern of behavior that was there right from the earliest point so in I work in a clinic NHS clinic for adults with suspected Asperger's syndrome but we ask the parents to come along with their 40 year old son so that we can get a developmental history of was the pattern of behavior there even at primary school and so it's not so much this kind of Florida explosion of symptoms where there's a trigger it's more that actually right from the earliest point this was a child who didn't really socialize in the same way they were more focused on objects than on people maybe they didn't need a diagnosis in primary school or even secondary school because they somehow sort of managed in primary school maybe they were focused on their academic work didn't really mix with kids in the playground in secondary school we often see a kind of more difficult picture where suddenly the adolescent teenage group is much more demanding of you know and if you don't have social skills it's much harder to navigate that so a lot of the kids get their diagnosis for the first time in secondary school but some of them have managed to get through till they leave home and they go to college and then they need their diagnosis or when they are not functioning well at work so in midlife so it's not about particular triggers it's about what you know what niche they're in who's protecting them whether it's their family up until a certain point who's concerned about the child or the individual and at what point do they - they're symptoms they're autistic traits start to interfere with their where they've been
One point — I was told as A Theory of Autism student that a number of children became autistic when their fathers came back from The War —
—right and you
—the association between mother and child was interrupted right
So I would say that probably theories of autism have changed a little bit —
I mean we used to have all sorts of theories about autism
to do with how the mothers were cold and unemotional or maybe over involved with the child and you know —
so I can imagine this kind of event of the father coming back from war might have fitted in to certain kinds of theories of autism but I think nowadays we kind of understand autism as this biomechanical neurodevelopmental condition which I've hoped I've shown is is just a different pattern of the relative sort of focus that the the individual has on the social world versus the non social world and that sort of events that might happen in the child's life about whether the father is absent or present as they're probably less important than the genetic predisposition and there are there must be environmental factors but we're not very good at identifying what those are yet —
I guess if dad comes home with PTSD imitates takes to whisky in a big way,
Autism as a biomechanical neurodevelopmental condition,
starts knocking mum around that might have an impact on the social scale —
well but for a fairly child yeah that's right it may be a creation of show phenotypes as yeah yeah that's just a it's a good question I think on the David guinea retired psychiatrist from Oxford could I ask you a little bit about the group at the other end of the spectrum that is individuals who are very high empathize yes and low in system systematizing yeah what are they what is this group like Oh clinically so I see well the word clinically is probably the most important word here because they may not come to clinics so these people have got very good empathy so we might infer that they've got good social network and good relationships friends and you know community so actually there may be protected from needing to go to a clinic it's probably the people who have below average empathy who struggle with relationships who might then develop secondary depression because they're isolated who end up coming to clinical attention so the people up at the top left-hand quadrant with super empathy maybe doing just fine we don't know too much about them we know that they exist because you can see them there we can see more yellow dots so there's more females but you can see the odd green dot and we know also that they may struggle with systems so maybe at school they didn't enjoy mathematics or the Natural Sciences and went for other kinds of subjects and that when the computer goes wrong they just phone the helpdesk so you know I don't think that these individuals would necessarily have problems they just are part of the variety we see in the population I suppose I was wondering whether they were the group that one does see from time to time people who are do seemed deeply empathic but really very disorganized and that the sort of term I'm not sure this at all PC the term that springs to mind is scatty and just not a clinical diagnosis which is them okay it's a it's a non clinical term but its description of what of how a person may be like that and I'm here I'm thinking wow how that fits into the evolutionary picture right if you think that is that could characterize what that sort of person might be like right so as I say we don't we don't there hasn't been much research into the people who are at the opposite end of autism so we know a lot about people with autism because they come to clinical attention and then they make it into research studies the group at the other end of that dimension if we think of the diagonal we know less about maybe they've got sort of executive type problems and in being very systematic and organizing things but I think that may be a bit too simplistic because people with autism can also have those executive type organizing difficulties and we just say no but I think it'd be good to have more research into that other group I just wonder whether those of us who might ask you that question have tend to be male I just got to two daughters both of gone through adolescence that I've seen both shockingly empathic and I found it very difficult to comprehend at times women we're sort of a coffee time I think really I'm necessarily really pressing questions so so I think first of all just to thank you very much for a really enlightening and beautifully flowing presentation which i think is just you know been excellent for us as clinicians and and to think about in terms of the evolutionary background to these conditions choosing my words carefully there so thank you very much [Applause]
