1
99:59:59,999 --> 99:59:59,999
Just after Christmas last year,

2
99:59:59,999 --> 99:59:59,999
132 kids in California got the measles

3
99:59:59,999 --> 99:59:59,999
by either visiting Disneyland

4
99:59:59,999 --> 99:59:59,999
or being exposed to someone
who'd been there.

5
99:59:59,999 --> 99:59:59,999
The virus then hopped the Canadian border,

6
99:59:59,999 --> 99:59:59,999
infecting more than
a hundred children in Quebec.

7
99:59:59,999 --> 99:59:59,999
One of the tragic things
about this outbreak

8
99:59:59,999 --> 99:59:59,999
is that measles, which can be fatal
to a child with a weakened immune system,

9
99:59:59,999 --> 99:59:59,999
is one of the most easily
preventable diseases in the world.

10
99:59:59,999 --> 99:59:59,999
An effective vaccine against it

11
99:59:59,999 --> 99:59:59,999
has been available for more
than half a century,

12
99:59:59,999 --> 99:59:59,999
but many of the kids involved
in the Disneyland outbreak

13
99:59:59,999 --> 99:59:59,999
had not been vaccinated

14
99:59:59,999 --> 99:59:59,999
because their parents were afraid

15
99:59:59,999 --> 99:59:59,999
of something allegedly even worse:

16
99:59:59,999 --> 99:59:59,999
autism.

17
99:59:59,999 --> 99:59:59,999
But wait: wasn't the paper
that sparked the controversy

18
99:59:59,999 --> 99:59:59,999
about autism and vaccines

19
99:59:59,999 --> 99:59:59,999
debunked, retracted,

20
99:59:59,999 --> 99:59:59,999
and branded a deliberate fraud

21
99:59:59,999 --> 99:59:59,999
by the British Medical Journal?

22
99:59:59,999 --> 99:59:59,999
Don't most science-savvy people

23
99:59:59,999 --> 99:59:59,999
know that the theory
that vaccines cause autism is B.S.?

24
99:59:59,999 --> 99:59:59,999
I think most of you do,

25
99:59:59,999 --> 99:59:59,999
but millions of parents worldwide

26
99:59:59,999 --> 99:59:59,999
continue to fear that vaccines
put their kids at risk for autism.

27
99:59:59,999 --> 99:59:59,999
Why?

28
99:59:59,999 --> 99:59:59,999
Here's why.

29
99:59:59,999 --> 99:59:59,999
This is a graph of autism
prevalence estimates rising over time.

30
99:59:59,999 --> 99:59:59,999
For most of the 20th century,

31
99:59:59,999 --> 99:59:59,999
autism was considered
an incredibly rare condition.

32
99:59:59,999 --> 99:59:59,999
The few psychologists and pediatricians
who'd even heard of it

33
99:59:59,999 --> 99:59:59,999
figured they would get through
their entire careers

34
99:59:59,999 --> 99:59:59,999
without seeing a single case.

35
99:59:59,999 --> 99:59:59,999
For decades, the prevalence estimates
remained stable

36
99:59:59,999 --> 99:59:59,999
at just three or four children
in ten thousand.

37
99:59:59,999 --> 99:59:59,999
But then, in the 1990s,

38
99:59:59,999 --> 99:59:59,999
the numbers started to skyrocket.

39
99:59:59,999 --> 99:59:59,999
Fundraising organizations
like Autism Speaks

40
99:59:59,999 --> 99:59:59,999
routinely refer to autism as an epidemic,

41
99:59:59,999 --> 99:59:59,999
as if you could catch it
from another kid at Disneyland.

42
99:59:59,999 --> 99:59:59,999
So what's going on?

43
99:59:59,999 --> 99:59:59,999
If it isn't vaccines, what is it?

44
99:59:59,999 --> 99:59:59,999
If you ask the folks down at
the Centers for Disease Control in Atlanta

45
99:59:59,999 --> 99:59:59,999
what's going on,

46
99:59:59,999 --> 99:59:59,999
they tend to rely on phrases like
"broadened diagnostic criteria"

47
99:59:59,999 --> 99:59:59,999
and "better case finding"

48
99:59:59,999 --> 99:59:59,999
to explain these rising numbers.

49
99:59:59,999 --> 99:59:59,999
But that kind of language

50
99:59:59,999 --> 99:59:59,999
doesn't do much to allay
the fears of a young mother

51
99:59:59,999 --> 99:59:59,999
who is searching her
two-year old's face for eye contact.

52
99:59:59,999 --> 99:59:59,999
If the diagnostic criteria
had to be broadened,

53
99:59:59,999 --> 99:59:59,999
why were they so narrow
in the first place?

54
99:59:59,999 --> 99:59:59,999
Why were cases of autism
so hard to find

55
99:59:59,999 --> 99:59:59,999
befor the 1990s?

56
99:59:59,999 --> 99:59:59,999
Five years ago, I decided to try
to uncover the answers to these questions.

57
99:59:59,999 --> 99:59:59,999
I learned that what happened

58
99:59:59,999 --> 99:59:59,999
has less to do with the slow and cautious
progress of science

59
99:59:59,999 --> 99:59:59,999
than it does with the seductive
power of storytelling.

60
99:59:59,999 --> 99:59:59,999
For most of the 20th century,

61
99:59:59,999 --> 99:59:59,999
clinicians told one story

62
99:59:59,999 --> 99:59:59,999
about what autism is
and how it was discovered,

63
99:59:59,999 --> 99:59:59,999
but that story turned out to be wrong,

64
99:59:59,999 --> 99:59:59,999
and the consequences of it

65
99:59:59,999 --> 99:59:59,999
are having a devastating impact
on global public health.

66
99:59:59,999 --> 99:59:59,999
There was a second,
more accurate story of autism

67
99:59:59,999 --> 99:59:59,999
which had been lost and forgotten

68
99:59:59,999 --> 99:59:59,999
in obscure corners
of the clinical literature.

69
99:59:59,999 --> 99:59:59,999
This second story tells us everything
about how we got here

70
99:59:59,999 --> 99:59:59,999
and where we need to go next.

71
99:59:59,999 --> 99:59:59,999
The first story starts with a child
psychiatrist at Johns Hopkins Hospital

72
99:59:59,999 --> 99:59:59,999
named Leo Kanner.

73
99:59:59,999 --> 99:59:59,999
In 1943, Kanner published a paper

74
99:59:59,999 --> 99:59:59,999
describing 11 young patients
who seemed to inhabit private worlds,

75
99:59:59,999 --> 99:59:59,999
ignoring the people around them,

76
99:59:59,999 --> 99:59:59,999
even their own parents.

77
99:59:59,999 --> 99:59:59,999
They could amuse themselves for hours

78
99:59:59,999 --> 99:59:59,999
by flapping their hands
in front of their faces,

79
99:59:59,999 --> 99:59:59,999
but they were panicked by little things

80
99:59:59,999 --> 99:59:59,999
like their favorite toy
being moved from its usual place

81
99:59:59,999 --> 99:59:59,999
without their knowledge.

82
99:59:59,999 --> 99:59:59,999
Based on the patients
who were brought to his clinic,

83
99:59:59,999 --> 99:59:59,999
Kanner speculated
that autism is very rare.

84
99:59:59,999 --> 99:59:59,999
By the 1950s, as the world's
leading authority on the subject,

85
99:59:59,999 --> 99:59:59,999
he declared that he had seen
less than 150 true cases of his syndrome

86
99:59:59,999 --> 99:59:59,999
while fielding referrals from
as far away as South Africa.

87
99:59:59,999 --> 99:59:59,999
That's actually not surprising,

88
99:59:59,999 --> 99:59:59,999
because Kanner's criteria
for diagnosing autism

89
99:59:59,999 --> 99:59:59,999
were incredibly selective.

90
99:59:59,999 --> 99:59:59,999
For example, he discouraged giving
the diagnosis to children who had seizures

91
99:59:59,999 --> 99:59:59,999
but now we know that epilepsy
is very common in autism.

92
99:59:59,999 --> 99:59:59,999
He once bragged that he had turned
nine out of 10 kids

93
99:59:59,999 --> 99:59:59,999
referred to his office as autistic
by other clinicians

94
99:59:59,999 --> 99:59:59,999
without giving them an autism diagnosis.

95
99:59:59,999 --> 99:59:59,999
Kanner was a smart guy,

96
99:59:59,999 --> 99:59:59,999
but a number of his theories
didn't pan out.

97
99:59:59,999 --> 99:59:59,999
He classified autism as a form
of infantile psychosis

98
99:59:59,999 --> 99:59:59,999
caused by cold and unaffectionate parents.

99
99:59:59,999 --> 99:59:59,999
These children, he said,

100
99:59:59,999 --> 99:59:59,999
had been kept neatly
in a refrigerator that didn't defrost.

101
99:59:59,999 --> 99:59:59,999
At the same time, however,

102
99:59:59,999 --> 99:59:59,999
Kanner noticed that some
of his young patients

103
99:59:59,999 --> 99:59:59,999
had special abilities
that clustered in certain areas

104
99:59:59,999 --> 99:59:59,999
like music, math, and memory.

105
99:59:59,999 --> 99:59:59,999
One boy in his clinic

106
99:59:59,999 --> 99:59:59,999
could distinguish between 18 symphonies

107
99:59:59,999 --> 99:59:59,999
before he turned two.

108
99:59:59,999 --> 99:59:59,999
When his mother put on
one of his favorite records,

109
99:59:59,999 --> 99:59:59,999
he would correctly declare,
"Beethoven!"

110
99:59:59,999 --> 99:59:59,999
But Kanner took a dim view
of these abilities,

111
99:59:59,999 --> 99:59:59,999
claiming that the kids
were just regurgitating things

112
99:59:59,999 --> 99:59:59,999
they'd heard their pompous parents say,

113
99:59:59,999 --> 99:59:59,999
desperate to earn their approval.

114
99:59:59,999 --> 99:59:59,999
As a result, autism became
a source of shame and stigma for families,

115
99:59:59,999 --> 99:59:59,999
and two generations of autistic children

116
99:59:59,999 --> 99:59:59,999
were shipped off to institutions
for their own good,

117
99:59:59,999 --> 99:59:59,999
becoming invisible to the world at large.

118
99:59:59,999 --> 99:59:59,999
Amazingly, it wasn't until the 1970s

119
99:59:59,999 --> 99:59:59,999
that researchers began to test
Kanner's theory that autism was rare.

120
99:59:59,999 --> 99:59:59,999
Lorna Wing was a cognitive
psychologist in London

121
99:59:59,999 --> 99:59:59,999
who thought that Kanner's theory
of refrigerator parenting

122
99:59:59,999 --> 99:59:59,999
were "bloody stupid," as she told me.

123
99:59:59,999 --> 99:59:59,999
She and her husband John were warm
and affectionate people,

124
99:59:59,999 --> 99:59:59,999
and they had a profoundly
autistic daughter named Susie.

125
99:59:59,999 --> 99:59:59,999
Lorna and John knew how hard it was

126
99:59:59,999 --> 99:59:59,999
to raise a child like Susie

127
99:59:59,999 --> 99:59:59,999
without support services,

128
99:59:59,999 --> 99:59:59,999
special education,

129
99:59:59,999 --> 99:59:59,999
and the other resources that are
out of reach without a diagnosis.

130
99:59:59,999 --> 99:59:59,999
To make the case
to the National Health Service

131
99:59:59,999 --> 99:59:59,999
that more resources were needed

132
99:59:59,999 --> 99:59:59,999
for autistic children and their families,

133
99:59:59,999 --> 99:59:59,999
Lorna and her colleague Judith Gould

134
99:59:59,999 --> 99:59:59,999
decided to do something that should
have been done 30 years earlier.

135
99:59:59,999 --> 99:59:59,999
They undertook a study of autism
prevalence in the general population.

136
99:59:59,999 --> 99:59:59,999
They pounded the pavement
in a London suburb called Camberwell

137
99:59:59,999 --> 99:59:59,999
to try to find autistic children
in the community.

138
99:59:59,999 --> 99:59:59,999
What they saw made clear

139
99:59:59,999 --> 99:59:59,999
that Kanner's model was way too narrow,

140
99:59:59,999 --> 99:59:59,999
while the reality of autism

141
99:59:59,999 --> 99:59:59,999
was much more colorful and diverse.

142
99:59:59,999 --> 99:59:59,999
Some kids couldn't talk at all,

143
99:59:59,999 --> 99:59:59,999
while others waxed on at length

144
99:59:59,999 --> 99:59:59,999
about their fascination with astrophysics,

145
99:59:59,999 --> 99:59:59,999
dinosaurs, or the genealogy of royalty.

146
99:59:59,999 --> 99:59:59,999
In other words, these children
didn't fit into nice, neat boxes,

147
99:59:59,999 --> 99:59:59,999
as Judith put it,

148
99:59:59,999 --> 99:59:59,999
and they saw lots of them,

149
99:59:59,999 --> 99:59:59,999
way more than Kanner's monolithic model
would have predicted.

150
99:59:59,999 --> 99:59:59,999
At first, they were at loss
to make sense of their data.

151
99:59:59,999 --> 99:59:59,999
How had no one noticed
these children before?

152
99:59:59,999 --> 99:59:59,999
But then Lorna came upon a reference
to a paper that had been published

153
99:59:59,999 --> 99:59:59,999
in German in 1944,

154
99:59:59,999 --> 99:59:59,999
the year after Kanner's paper,

155
99:59:59,999 --> 99:59:59,999
and then forgotten,

156
99:59:59,999 --> 99:59:59,999
buried with the ashes of a terrible time

157
99:59:59,999 --> 99:59:59,999
that no one wanted to remember
or think about.

158
99:59:59,999 --> 99:59:59,999
Kanner knew about this competing paper,

159
99:59:59,999 --> 99:59:59,999
but scrupulously avoided
mentioning it in his own work.

160
99:59:59,999 --> 99:59:59,999
It had never even
been translated into English,

161
99:59:59,999 --> 99:59:59,999
but luckily, Lorna's husband spoke German,

162
99:59:59,999 --> 99:59:59,999
and he translated it for her.

163
99:59:59,999 --> 99:59:59,999
The paper offered
an alternate story of autism.

164
99:59:59,999 --> 99:59:59,999
Its author was a man named Hans Asperger,

165
99:59:59,999 --> 99:59:59,999
who ran a combination clinic
and residential school

166
99:59:59,999 --> 99:59:59,999
in Vienna in the 1930s.

167
99:59:59,999 --> 99:59:59,999
Asperger's ideas about teaching children
with learning differences

168
99:59:59,999 --> 99:59:59,999
were progressive even
by contemporary standards.

169
99:59:59,999 --> 99:59:59,999
Mornings at his clinic began
with exercise classes set to music,

170
99:59:59,999 --> 99:59:59,999
and the children put on plays
on Sunday afternoons.

171
99:59:59,999 --> 99:59:59,999
Instead of blaming parents
for causing autism,

172
99:59:59,999 --> 99:59:59,999
Asperger framed it as a lifelong,
polygenetic disability

173
99:59:59,999 --> 99:59:59,999
that requires compassionate forms
of support and accommodations

174
99:59:59,999 --> 99:59:59,999
over the course of one's whole life.

175
99:59:59,999 --> 99:59:59,999
Rather than treating the kids
in his clinic like patients,

176
99:59:59,999 --> 99:59:59,999
Asperger called him his little professors,

177
99:59:59,999 --> 99:59:59,999
and enlisted their help in developing
methods of education

178
99:59:59,999 --> 99:59:59,999
that were particularly suited to them.

179
99:59:59,999 --> 99:59:59,999
Crucially, Asperger viewed autism
as a diverse continuum

180
99:59:59,999 --> 99:59:59,999
that spans an astonishing range

181
99:59:59,999 --> 99:59:59,999
of giftedness and disability.

182
99:59:59,999 --> 99:59:59,999
He believed that autism
and autistic traits are common

183
99:59:59,999 --> 99:59:59,999
and always have been,

184
99:59:59,999 --> 99:59:59,999
seeing aspects of this continuum
in familiar archetypes from pop culture

185
99:59:59,999 --> 99:59:59,999
like the socially awkward scientist

186
99:59:59,999 --> 99:59:59,999
and the absent-minded professor.

187
99:59:59,999 --> 99:59:59,999
He went so far as to say,

188
99:59:59,999 --> 99:59:59,999
it seems that for success
in science and art,

189
99:59:59,999 --> 99:59:59,999
a dash of autism is essential.

190
99:59:59,999 --> 99:59:59,999
Lorna and Judith realized that Kanner
had been as wrong about autism being rare

191
99:59:59,999 --> 99:59:59,999
as he had been about parents causing it.

192
99:59:59,999 --> 99:59:59,999
Over the next several years,

193
99:59:59,999 --> 99:59:59,999
they quietly worked with
the American Psychiatric Association

194
99:59:59,999 --> 99:59:59,999
to broaden the criteria for diagnosis

195
99:59:59,999 --> 99:59:59,999
to reflect the diversity of what
they called "the autism spectrum."

196
99:59:59,999 --> 99:59:59,999
In the late '80s and early 1990s,

197
99:59:59,999 --> 99:59:59,999
their changes went into effect,

198
99:59:59,999 --> 99:59:59,999
swapping out Kanner's narrow model

199
99:59:59,999 --> 99:59:59,999
for Asperger's broad and inclusive one.

200
99:59:59,999 --> 99:59:59,999
These changes weren't
happening in a vacuum.

201
99:59:59,999 --> 99:59:59,999
By coincidence, as Lorna and Judith
worked behind the scenes

202
99:59:59,999 --> 99:59:59,999
to reform the criteria,

203
99:59:59,999 --> 99:59:59,999
people all over the world were seeing
an autistic adult for the first time.

204
99:59:59,999 --> 99:59:59,999
Before "Rain Man" came out in 1988,

205
99:59:59,999 --> 99:59:59,999
only a tiny, ingrown circle of experts
knew what autism looked like,

206
99:59:59,999 --> 99:59:59,999
but after Dustin Hoffman's unforgettable
performance as Raymond Babbitt

207
99:59:59,999 --> 99:59:59,999
earned "Rain Man" four Academy Awards,

208
99:59:59,999 --> 99:59:59,999
pediatricians, psychologists,

209
99:59:59,999 --> 99:59:59,999
teachers, and parents all over the world
knew what autism looked like.

210
99:59:59,999 --> 99:59:59,999
Coincidentally, at the same time,

211
99:59:59,999 --> 99:59:59,999
the first easy-to-use clinical tests

212
99:59:59,999 --> 99:59:59,999
for diagnosing autism were introduced.

213
99:59:59,999 --> 99:59:59,999
You no longer had to have a connection
to that tiny circle of experts

214
99:59:59,999 --> 99:59:59,999
to get your child evaluated.

215
99:59:59,999 --> 99:59:59,999
The combination of "Rain Man,"

216
99:59:59,999 --> 99:59:59,999
the changes to the criteria,
and the introduction of these tests

217
99:59:59,999 --> 99:59:59,999
created a network effect,

218
99:59:59,999 --> 99:59:59,999
a perfect storm of autism awareness.

219
99:59:59,999 --> 99:59:59,999
The number of diagnoses started to soar,

220
99:59:59,999 --> 99:59:59,999
just as Lorna and Judith predicted,

221
99:59:59,999 --> 99:59:59,999
indeed hoped, that it would,

222
99:59:59,999 --> 99:59:59,999
enabling autistic people
and their families

223
99:59:59,999 --> 99:59:59,999
to finally get the support
and services they deserved.

224
99:59:59,999 --> 99:59:59,999
Then Andrew Wakefield came along

225
99:59:59,999 --> 99:59:59,999
to blame the spike
in diagnoses on vaccines,

226
99:59:59,999 --> 99:59:59,999
a simple, powerful,

227
99:59:59,999 --> 99:59:59,999
and seductively believable story

228
99:59:59,999 --> 99:59:59,999
that was as wrong as Kanner's theory

229
99:59:59,999 --> 99:59:59,999
that autism was rare.

230
99:59:59,999 --> 99:59:59,999
If the CDC's current estimate,

231
99:59:59,999 --> 99:59:59,999
that one in 68 kids in America
are on the spectrum, is correct,

232
99:59:59,999 --> 99:59:59,999
autistics are one of the largest
minority groups in the world.

233
99:59:59,999 --> 99:59:59,999
In recent years, autistic people
have come together on the Internet

234
99:59:59,999 --> 99:59:59,999
to reject the notion that they
are puzzles to be solved

235
99:59:59,999 --> 99:59:59,999
by the next medical breakthrough,

236
99:59:59,999 --> 99:59:59,999
coining the term "neurodiversity"

237
99:59:59,999 --> 99:59:59,999
to celebrate the varieties
of human cognition.

238
99:59:59,999 --> 99:59:59,999
One way to understand neurodiversity

239
99:59:59,999 --> 99:59:59,999
is to think in terms
of human operating systems.

240
99:59:59,999 --> 99:59:59,999
Just because a PC is not running Windows

241
99:59:59,999 --> 99:59:59,999
doesn't mean that it's broken.

242
99:59:59,999 --> 99:59:59,999
By autistic standards,
the normal human brain

243
99:59:59,999 --> 99:59:59,999
is easily distractable,

244
99:59:59,999 --> 99:59:59,999
obsessively social,

245
99:59:59,999 --> 99:59:59,999
and suffers from a deficit
of attention to detail.

246
99:59:59,999 --> 99:59:59,999
To be sure, autistic people
have a hard time

247
99:59:59,999 --> 99:59:59,999
living in a world not built for them.

248
99:59:59,999 --> 99:59:59,999
Eighty years later, we're still
catching up to Asperger,

249
99:59:59,999 --> 99:59:59,999
who believed that the cure
for the most disabling aspects of autism

250
99:59:59,999 --> 99:59:59,999
is to be found in understanding teachers,

251
99:59:59,999 --> 99:59:59,999
accommodating employers,

252
99:59:59,999 --> 99:59:59,999
supportive communities,

253
99:59:59,999 --> 99:59:59,999
and parents who have faith
in their children's potential.

254
99:59:59,999 --> 99:59:59,999
An autistic woman
named Xoxia Zax once said,

255
99:59:59,999 --> 99:59:59,999
"We need all hands on deck

256
99:59:59,999 --> 99:59:59,999
to right the ship of humanity.

257
99:59:59,999 --> 99:59:59,999
As we sail into an uncertain future,

258
99:59:59,999 --> 99:59:59,999
we need every form
of human intelligence on the planet

259
99:59:59,999 --> 99:59:59,999
working together to tackle
the challenges that we face as a society.

260
99:59:59,999 --> 99:59:59,999
We can't afford to waste a brain."

261
99:59:59,999 --> 99:59:59,999
Thank you.

262
99:59:59,999 --> 99:59:59,999
(Applause)