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A new way to diagnose autism

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    I always wanted to become
    a walking laboratory of social engagement:
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    to resonate other people's feelings,
    thoughts, intentions, motivations,
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    in the act of being with them.
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    As a scientist, I always wanted
    to measure that resonance,
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    that sense of the other
    that happens so quickly,
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    in the blink of an eye.
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    We intuit other people's feelings;
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    we know the meaning of their actions
    even before they happen.
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    We're always in this stance
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    of being the object
    of somebody else's subjectivity.
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    We do that all the time.
    We just can't shake it off.
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    It's so important that the very tools
    we use to understand ourselves,
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    to understand the world around us,
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    are shaped by that stance.
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    We are social to the core.
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    So my journey in autism really started
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    when I lived in a residential unit
    for adults with autism.
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    Most of those individuals
    had spent most of their lives
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    in long-stay hospitals.
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    This is a long time ago.
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    And for them, autism was devastating.
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    They had profound
    intellectual disabilities.
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    They didn't talk.
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    But most of all,
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    they were extraordinarily isolated
    from the world around them,
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    from their environment
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    and from the people.
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    In fact, at the time,
    if you walked into a school
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    for individuals with autism,
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    you'd hear a lot of noise,
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    plenty of commotion, actions,
    people doing things.
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    But they're always doing
    things by themselves.
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    So they may be looking
    at a light in the ceiling,
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    or they may be isolated in the corner,
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    or they might be engaged
    in these repetitive movements,
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    in self-stimulatory movements
    that led them nowhere.
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    Extremely, extremely isolated.
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    Well, now we know that autism
    is this disruption,
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    the disruption of this resonance
    that I am telling you about.
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    These are survival skills.
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    These are survival skills
    that we inherited
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    over many, many hundreds
    of thousands of years of evolution.
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    You see, babies are born
    in a state of utter fragility.
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    Without the caregiver,
    they wouldn't survive,
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    so it stands to reason
    that nature would endow them
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    with these mechanisms of survival.
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    They orient to the caregiver.
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    From the first days and weeks of life,
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    babies prefer to hear human sounds,
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    rather than just sounds
    in the environment.
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    They prefer to look at people
    rather than at things,
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    and even as they're looking at people,
    they look at people's eyes,
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    because the eye is the window
    to the other person's experiences,
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    so much so that they even prefer
    to look at people
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    who are looking at them
    rather than people who are looking away.
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    Well, they orient to the caregiver.
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    The caregiver seeks the baby.
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    And it's out of this mutually
    reinforcing choreography
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    that a lot that is of importance
    to the emergence of mind --
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    the social mind, the social
    brain -- depends on.
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    We always think about autism
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    as something that happens
    later on in life.
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    It doesn't; it begins
    with the beginning of life.
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    As babies engage with caregivers,
    they soon realize that, well,
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    there is something between the ears
    that is very important --
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    it's invisible, you can't see it,
    but it's really critical.
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    And that thing is called attention.
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    And they learn soon enough,
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    even before they can utter one word,
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    that they can take that attention
    and move somewhere
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    in order to get things they want.
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    They also learn to follow
    other people's gazes,
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    because whatever people are looking at
    is what they are thinking about.
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    And soon enough, they start to learn
    about the meaning of things,
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    because when somebody
    is looking at something
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    or somebody is pointing at something,
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    they're not just getting
    a directional cue.
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    They are getting the other
    person's meaning of that thing,
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    the attitude.
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    And soon enough, they start
    building this body of meanings,
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    but meanings that were acquired
    within the realm of social interaction.
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    Those are meanings that are acquired
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    as part of their shared
    experiences with others.
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    Well, this is a 15-month-old little girl,
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    and she has autism.
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    And I am coming so close to her
    that I am maybe two inches from her face,
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    and she's quite oblivious to me.
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    Imagine if I did that to you,
    came two inches from your face.
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    You'd do probably
    two things, wouldn't you?
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    You would recoil.
    You would call the police.
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    (Laughter)
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    You would do something,
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    because it's literally impossible
    to penetrate somebody's physical space
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    and not get that reaction.
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    We do so, remember,
    intuitively, effortlessly.
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    This is our body wisdom;
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    it's not something mediated
    by our language.
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    Our body just knows that.
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    And we've known that for a long time.
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    And this is not something
    that happens to humans only.
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    It happens to some
    of our phyletic cousins,
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    because if you're a monkey,
    and you look at another monkey,
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    and that monkey has a higher
    hierarchy position than you,
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    and that is considered
    to be a signal or threat,
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    well, you are not going
    to be alive for long.
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    So something that in other species
    are survival mechanisms,
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    without which they
    wouldn't basically live,
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    we bring into the context of human beings,
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    and this is what we need
    to simply act, socially.
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    Now, she is oblivious to me
    and I'm so close to her,
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    and you think, maybe she can see you,
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    maybe she can hear you.
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    Well, a few minutes later,
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    she goes to the corner of the room,
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    and she finds a tiny little piece
    of candy, an M&M.
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    So I could not attract her attention,
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    but something -- a thing -- did.
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    Now, most of us make a big dichotomy
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    between the world of things
    and the world of people.
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    Now, for this girl,
    that division line is not so clear,
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    and the world of people
    is not attracting her
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    as much as we would like.
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    Now, remember that we learn a great deal
    by sharing experiences.
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    What she is doing right now
    is that her path of learning is diverging,
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    moment by moment,
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    as she is isolating herself
    further and further.
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    So we feel sometimes
    that the brain is deterministic,
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    the brain determines
    who we're going to be.
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    But, in fact, the brain
    also becomes who we are,
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    and at the same time
    that her behaviors are taking away
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    from the realm of social interaction,
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    this is what's happening with her mind,
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    and this is what's happening
    with her brain.
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    Well, autism is the most strongly
    genetic condition
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    of all developmental disorders.
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    And it's a brain disorder.
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    It's a disorder that begins
    much prior to the time
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    that the child is born.
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    We now know that there is a very
    broad spectrum of autism.
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    There are those individuals
    who are profoundly intellectually disabled
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    but there are those that are gifted.
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    There are those individuals
    who don't talk at all;
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    there are those individuals
    who talk too much.
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    There are those individuals
    that if you observe them in their school,
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    you see them running the periphery fence
    all the school day if you let them,
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    to those individuals
    who cannot stop coming to you
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    and trying to engage you
    repeatedly, relentlessly,
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    but often in an awkward fashion,
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    without that immediate resonance.
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    Well, this is much more prevalent
    than we thought at the time.
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    When I started in this field,
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    we thought there were four individuals
    with autism per 10,000 --
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    a very rare condition.
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    Well, now we know it's more
    like one in 100.
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    There are millions of individuals
    with autism all around us.
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    The societal cost
    of this condition is huge,
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    in the US alone,
    maybe 35 to 80 billion dollars.
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    And you know what?
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    Most of those funds are associated
    with adolescents and particularly adults
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    who are severely disabled,
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    individuals who need
    wraparound services --
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    services that are very, very intensive.
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    And those services can cost in excess
    of 60,000 to 80,000 dollars a year.
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    Those are individuals who did not
    benefit from early treatment,
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    because now we know
    that autism creates itself
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    as individuals diverge in that pathway
    of learning that I mentioned to you.
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    Were we to be able
    to identify this condition
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    at an earlier point,
    and intervene and treat --
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    I can tell you, this has been probably
    something that has changed my life
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    in the past 10 years,
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    this notion that we can absolutely
    attenuate this condition.
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    Also, we have a window of opportunity,
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    because the brain
    is malleable for just so long,
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    and that window of opportunity
    happens in the first three years of life.
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    It's not that that window
    closes; it doesn't.
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    But it diminishes considerably.
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    And yet, the median age
    of diagnosis in this country
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    is still about five years,
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    and in disadvantaged populations,
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    the populations that don't have
    access to clinical services,
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    rural populations, minorities,
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    the age of diagnosis is later still,
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    which is almost as if I were to tell you
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    that we are condemning those communities
    to have individuals with autism
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    whose condition is going
    to be more severe.
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    So I feel that we have
    a bioethical imperative.
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    The science is there.
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    But no science is of relevance
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    if it doesn't have an impact
    on the community.
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    And we just can't afford
    that missed opportunity,
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    because children with autism
    become adults with autism.
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    And we feel that those things we can do
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    for these children,
    for those families, early on,
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    will have lifetime consequences --
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    for the child, for the family,
    and for the community at large.
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    So this is our view of autism.
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    There are over a hundred genes
    that are associated with autism.
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    In fact, we believe there are going to be
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    something between 300 and 600
    genes associated with autism,
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    and genetic anomalies,
    much more than just genes.
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    And we actually have
    a bit of a question here,
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    because if there are so many
    different causes of autism,
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    how do you go from those liabilities
    to the actual syndrome?
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    Because people like myself,
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    when we walk into a playroom,
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    we recognize a child as having autism.
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    So how do you go from multiple causes
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    to a syndrome that has some homogeneity?
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    And the answer is what lies in between,
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    which is development.
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    And in fact, we are very interested
    in those first two years of life,
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    because those liabilities
    don't necessarily convert into autism.
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    Autism creates itself.
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    Were we to be able to intervene
    during those years of life,
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    we might attenuate for some, and God
    knows, maybe even prevent for others.
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    So how do we do that?
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    How do we enter that feeling of resonance,
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    how do we enter another person's being?
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    I remember when I interacted
    with that 15-month-old,
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    the thing that came to my mind was,
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    "How do you come into her world?
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    Is she thinking about me?
    Is she thinking about others?"
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    Well, it's hard to do that,
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    so we had to create the technologies.
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    We had to basically step inside a body.
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    We had to see the world through her eyes.
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    And so in the past many years,
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    we've been building these new technologies
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    that are based on eye tracking.
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    We can see, moment by moment,
    what children are engaging with.
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    This is my colleague, Warren Jones,
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    with whom we've been building
    these methods, these studies,
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    for the past 12 years.
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    And you see there a happy five-month-old,
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    a five-month little boy
    who is going to watch things
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    that are brought from his world:
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    his mom, the caregiver,
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    but also experiences that he would have
    were he to be in his daycare.
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    What we want is to embrace that world
    and bring it into our laboratory,
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    but in order for us to do that,
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    we had to create
    these very sophisticated measures,
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    measures of how people, how little babies,
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    how newborns, engage
    with the world, moment by moment.
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    What is important and what is not.
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    Well, we created those measures,
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    and here, what you see
    is what we call a funnel of attention.
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    You're watching a video --
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    those frames are separated
    by about a second --
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    through the eyes of 35 typically
    developing two-year-olds.
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    And we freeze one frame,
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    and this is what the typical
    children are doing.
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    In this scan pass, in green here,
    are two-year-olds with autism.
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    So on that frame, the children
    who are typical are watching this,
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    the emotion of expression
    of that little boy
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    as he's fighting a little bit
    with the little girl.
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    What are the children with autism doing?
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    They are focusing on the revolving door,
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    opening and shutting.
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    Well, I can tell you that this divergence
    that you're seeing here
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    doesn't happen only
    in our five-minute experiment.
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    It happens moment by moment
    in their real lives,
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    and their minds are being formed
    and their brains are being specialized
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    in something other than what is happening
    with their typical peers.
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    Well, we took a construct
    from our pediatrician friends,
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    the concept of growth charts --
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    you know, when you take
    a child to the pediatrician,
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    and you have physical height and weight.
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    Well, we decided we were going
    to create growth charts
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    of social engagement.
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    We sought children
    from the time they're born.
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    What you see here on the x-axis
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    is two, three, four, five,
    six months and nine,
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    until about the age of 24 months.
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    This is the percent of their viewing time
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    that they're focusing on people's eyes,
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    and this is their growth chart.
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    They start over here --
    they love people's eyes --
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    and it remains quite stable.
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    It sort of goes up a little bit
    in those initial months.
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    Now, let's see what's happening
    with babies who became autistic.
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    It's something very different.
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    It starts way up here,
    but then it's a free fall.
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    It's very much like they brought
    into this world the reflex
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    that orients them to people,
    but it has no traction.
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    It's almost as if that stimulus -- you --
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    you're not exerting
    influence on what happens
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    as they navigate their daily lives.
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    Now, we thought those data
    were so powerful, in a way,
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    that we wanted to see what happened
    in the first six months of life,
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    because if you interact
    with a two- and a three-month-old,
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    you'd be surprised
    by how social those babies are.
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    And what we see
    in the first six months of life
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    is that those two groups
    can be segregated very easily.
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    And using these kinds
    of measures and many others,
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    what we found out
    is that our science could, in fact,
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    identify this condition early on.
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    We didn't have to wait
    for the behaviors of autism
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    to emerge in the second year of life.
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    If we measured things that are,
    evolutionarily, highly conserved,
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    and developmentally very early-emerging --
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    things that are online
    from the first weeks of life --
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    we could push the detection of autism
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    all the way to those first months,
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    and that's what we are doing now.
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    Now, we can create
    the very best technologies
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    and the very best methods
    to identify the children,
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    but this would be for naught
    if we didn't have an impact
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    on what happens in their reality
    in the community.
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    Now we want those devices, of course,
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    to be deployed by those
    who are in the trenches --
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    our colleagues, the primary care
    physicians, who see every child --
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    and we need to transform
    those technologies
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    into something that is going
    to add value to their practice,
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    because they have to see so many children.
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    And we want to do that universally
    so that we don't miss any child.
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    But this would be immoral
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    if we also did not have an infrastructure
    for intervention, for treatment.
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    We need to be able to work
    with the families, support the families,
  • 17:24 - 17:27
    to manage those first years with them.
  • 17:28 - 17:31
    We need to be able to really go
  • 17:31 - 17:35
    from universal screening
    to universal access to treatment,
  • 17:35 - 17:38
    because those treatments
    are going to change
  • 17:38 - 17:41
    these children's
    and those families' lives.
  • 17:42 - 17:49
    Now, when we think about what we [can]
    do in those first years,
  • 17:49 - 17:53
    I can tell you, having been
    in this field for so long,
  • 17:54 - 17:56
    one feels really rejuvenated.
  • 17:57 - 18:02
    There is a sense that the science
    that one worked on
  • 18:02 - 18:04
    can actually have an impact on realities,
  • 18:04 - 18:07
    preventing, in fact, those experiences
  • 18:08 - 18:11
    that I really started
    in my journey in this field.
  • 18:11 - 18:15
    I thought at the time
    that this was an intractable condition.
  • 18:15 - 18:18
    No longer. We can do
    a great deal of things.
  • 18:19 - 18:21
    And the idea is not to cure autism.
  • 18:21 - 18:23
    That's not the idea.
  • 18:24 - 18:26
    What we want is to make sure
  • 18:26 - 18:28
    that those individuals
    with autism can be free
  • 18:28 - 18:32
    from the devastating consequences
    that come with it at times,
  • 18:33 - 18:36
    the profound intellectual disabilities,
    the lack of language,
  • 18:36 - 18:38
    the profound, profound isolation.
  • 18:40 - 18:42
    We feel that individuals
    with autism, in fact,
  • 18:42 - 18:44
    have a very special
    perspective on the world,
  • 18:44 - 18:46
    and we need diversity.
  • 18:46 - 18:50
    And they can work extremely well
    in some areas of strength:
  • 18:50 - 18:53
    predictable situations,
    situations that can be defined.
  • 18:53 - 18:56
    Because after all,
    they learn about the world
  • 18:56 - 18:58
    almost, like, about it,
  • 18:58 - 19:01
    rather than learning
    how to function in it.
  • 19:01 - 19:05
    But this is a strength if you're working,
    for example, in technology.
  • 19:06 - 19:10
    And there are those individuals
    who have incredible artistic abilities.
  • 19:10 - 19:12
    We want them to be free to do that.
  • 19:12 - 19:15
    We want that the next generations
    of individuals with autism
  • 19:15 - 19:19
    will be able not only
    to express their strengths,
  • 19:19 - 19:20
    but to fulfill their promise.
  • 19:21 - 19:23
    Well, thank you for listening to me.
  • 19:23 - 19:25
    (Applause)
Title:
A new way to diagnose autism
Speaker:
Ami Klin
Description:

Early diagnosis of autism spectrum disorder can improve the lives of everyone affected, but the complex network of causes make it incredibly difficult to predict. At TEDxPeachtree, Ami Klin describes a new early detection method that uses eye-tracking technologies to gauge babies' social engagement skills and reliably measure their risk of developing autism. (Filmed at TEDxPeachTree.)

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Video Language:
English
Team:
TED
Project:
TEDTalks
Duration:
19:44
  • The English transcript was updated on 11/21/2016. At 05:27, "phylatic" was changed to "phyletic." At 13:46, "emotion of expression" was changed to "emotional expression."

English subtitles

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