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I always wanted to become

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a walking laboratory of social engagement,

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to resonate other people's feelings, thoughts,

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intentions, motivations, 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

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even before they happen.

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We're always in this stance of being

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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 that we use

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to understand ourselves, to understand

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the world around them, is 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 when I lived

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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. 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. But most of all,

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they were extraordinarily isolated

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from the world around them, 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, 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

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is this disruption, the disruption of this resonance

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that I am telling you.

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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

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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, so it stands

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to reason that nature would endow them with

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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 rather than just

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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,

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they look at people's eyes, because

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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 who are

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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

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that, well, there is something in between the ears

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that is very important --

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it's invisible, you can't see -- but is really critical,

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and that thing is called attention.

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And they learn soon enough, even before they can

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utter one word that they can take that attention

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and move somewhere in order to get things they want.

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They also learn to follow other people's gaze,

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because whatever people are looking at is

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what they are thinking about.

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And soon enough, they start to learn about the meaning

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of things, 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

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of that thing, the attitude, and soon enough

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they start building this body of meanings,

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but meanings that were acquired within the realm

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of social interaction.

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Those are meanings that are acquired as part

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of their shared experiences with others.

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Well, this is a little 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

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two inches from her face, and she's quite oblivious to me.

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Imagine if I did that to you,

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and I 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. (Laughter)

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You would do something, because it's literally impossible

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to penetrate somebody's physical space

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and not get a reaction.

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We do so, remember, intuitively, effortlessly.

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This is our body wisdom. It's not something that is

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mediated by our language. 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 phylatic cousins,

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because if you're a monkey,

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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 them 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, act socially.

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Now, she is oblivious to me, and I am 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, she goes to the corner of

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the room, 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

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by sharing experiences.

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Now, what she is doing right now is that

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her path of learning is diverging 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 are 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, this is what's happening

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with her mind 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

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intellectually disabled, 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

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in their school, you see them running the periphery fence

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of the school all 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, we thought that there were

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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 U.S. alone, maybe 35 to 80 billion dollars,

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and you know what? Most of those funds are associated

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with adolescents and particularly adults

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who are severely disabled,

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individuals who need wrap-around services, services

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that are very, very intensive, and those services

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can cost in excess of 60 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 they diverge in that pathway of learning

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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, and this has been probably

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something that has changed my life in the past 10 years,

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this notion that we can absolutely attenuate

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this condition.

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Also, we have a window of opportunity, because

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the brain is malleable for just so long,

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and that window of opportunity happens

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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 that we are

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condemning those communities to have individuals

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with autism whose condition is going to be more severe.

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So I feel that we have a bio-ethical imperative.

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The science is there,

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but no science is of relevance if it doesn't have an impact

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on the community, and we just can't afford

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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 that 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

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with autism. In fact, we believe that 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

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to the actual syndrome? 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

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two years of life, because those liabilities

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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,

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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-older,

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that the thing that came to 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, so we had to create

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the technologies. 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 we've been building

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these new technologies that are based on eye tracking.

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We can see moment by moment

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what children are engaging with.

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Well, this is my colleague Warren Jones, with whom

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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-older,

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it's 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, but also experiences

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that he would have were he to be in his daycare.

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What we want is to embrace that world

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and bring it into our laboratory,

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but in order for us to do that, we had to create

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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,

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moment by moment,

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what is important, and what is not.

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Well, we created those measures, and here,

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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

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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

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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

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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,

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and their brains are being specialized in something other

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than what is happening with their typical peers.

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Well, we took a construct from

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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 so you have physical height, and weight.

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Well we decided that we're going to create growth charts

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of social engagement,

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and we sought children from the time that they are born,

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and what you see here on the x-axis is two, three, four,

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five, six months and nine, until about the age of 24 months,

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and this is the percent of their viewing time

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that they are 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

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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 that those data were so powerful

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in a way, that we wanted to see what happened

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in the first six months of life, because if you interact

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with a two- and a three-month-older,

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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,

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highly conserved, 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,

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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

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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,

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for treatment.

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We need to be able to work with the families,

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to support the families, to manage those first years

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with them. We need to be able to really go

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from universal screening to universal access to treatment,

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because those treatments are going to change

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these children's and those families' lives.

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Now, when we think about what we [can] do

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in those first years,

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I can tell you,

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having been in this field for so long,

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one feels really rejuvenated.

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There is a sense that the science that one worked on

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can actually have an impact on realities,

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preventing, in fact, those experiences

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that I really started in my journey in this field.

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I thought at the time that this was an intractable condition.

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No longer. We can do a great deal of things.

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And the idea is not to cure autism.

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That's not the idea.

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What we want is to make sure

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that those individuals with autism can be free from

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the devastating consequences that come with it at times,

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the profound intellectual disabilities, the lack of language,

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the profound, profound isolation.

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We feel that individuals with autism, in fact,

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have a very special perspective on the world,

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and we need diversity, and they can work extremely well

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in some areas of strength:

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predictable situations, situations that can be defined.

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Because after all, they learn about the world almost like

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about it, rather than learning how to function in it.

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But this is a strength, if you're working, for example,

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in technology.

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And there are those individuals who have incredible

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artistic abilities.

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We want them to be free of that.

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We want that the next generations of individuals with autism

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will be able not only to express their strengths

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but to fulfill their promise.

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Well thank you for listening to me. (Applause)