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Just after Christmas last year,

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132 kids in California got the measles

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by either visiting Disneyland

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or being exposed to someone
who'd been there.

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The virus then hopped the Canadian border,

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infecting more than
100 children in Quebec.

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One of the tragic things
about this outbreak

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is that measles, which can be fatal
to a child with a weakened immune system,

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is one of the most easily
preventable diseases in the world.

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An effective vaccine against it

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has been available for more
than half a century,

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but many of the kids involved
in the Disneyland outbreak

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had not been vaccinated

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because their parents were afraid

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of something allegedly even worse:

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autism.

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But wait -- wasn't the paper
that sparked the controversy

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about autism and vaccines

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debunked, retracted,

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and branded a deliberate fraud

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by the British Medical Journal?

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Don't most science-savvy people

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know that the theory
that vaccines cause autism is B.S.?

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I think most of you do,

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but millions of parents worldwide

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continue to fear that vaccines
put their kids at risk for autism.

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Why?

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Here's why.

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This is a graph of autism
prevalence estimates rising over time.

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For most of the 20th century,

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autism was considered
an incredibly rare condition.

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The few psychologists and pediatricians
who'd even heard of it

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figured they would get through
their entire careers

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without seeing a single case.

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For decades, the prevalence estimates
remained stable

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at just three or four children in 10,000.

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But then, in the 1990s,

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the numbers started to skyrocket.

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Fundraising organizations
like Autism Speaks

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routinely refer to autism as an epidemic,

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as if you could catch it
from another kid at Disneyland.

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So what's going on?

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If it isn't vaccines, what is it?

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If you ask the folks down at
the Centers for Disease Control in Atlanta

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what's going on,

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they tend to rely on phrases like
"broadened diagnostic criteria"

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and "better case finding"

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to explain these rising numbers.

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But that kind of language

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doesn't do much to allay
the fears of a young mother

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who is searching her
two-year-old's face for eye contact.

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If the diagnostic criteria
had to be broadened,

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why were they so narrow
in the first place?

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Why were cases of autism
so hard to find

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before the 1990s?

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Five years ago, I decided to try
to uncover the answers to these questions.

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I learned that what happened

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has less to do with the slow and cautious
progress of science

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than it does with the seductive
power of storytelling.

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For most of the 20th century,

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clinicians told one story

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about what autism is
and how it was discovered,

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but that story turned out to be wrong,

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and the consequences of it

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are having a devastating impact
on global public health.

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There was a second,
more accurate story of autism

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which had been lost and forgotten

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in obscure corners
of the clinical literature.

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This second story tells us everything
about how we got here

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and where we need to go next.

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The first story starts with a child
psychiatrist at Johns Hopkins Hospital

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named Leo Kanner.

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In 1943, Kanner published a paper

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describing 11 young patients
who seemed to inhabit private worlds,

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ignoring the people around them,

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even their own parents.

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They could amuse themselves for hours

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by flapping their hands
in front of their faces,

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but they were panicked by little things

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like their favorite toy
being moved from its usual place

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without their knowledge.

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Based on the patients
who were brought to his clinic,

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Kanner speculated
that autism is very rare.

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By the 1950s, as the world's
leading authority on the subject,

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he declared that he had seen
less than 150 true cases of his syndrome

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while fielding referrals from
as far away as South Africa.

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That's actually not surprising,

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because Kanner's criteria
for diagnosing autism

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were incredibly selective.

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For example, he discouraged giving
the diagnosis to children who had seizures

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but now we know that epilepsy
is very common in autism.

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He once bragged that he had turned
nine out of 10 kids

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referred to his office as autistic
by other clinicians

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without giving them an autism diagnosis.

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Kanner was a smart guy,

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but a number of his theories
didn't pan out.

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He classified autism as a form
of infantile psychosis

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caused by cold and unaffectionate parents.

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These children, he said,

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had been kept neatly
in a refrigerator that didn't defrost.

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At the same time, however,

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Kanner noticed that some
of his young patients

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had special abilities
that clustered in certain areas

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like music, math, and memory.

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One boy in his clinic

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could distinguish between 18 symphonies
before he turned two.

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When his mother put on
one of his favorite records,

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he would correctly declare,
"Beethoven!"

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But Kanner took a dim view
of these abilities,

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claiming that the kids
were just regurgitating things

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they'd heard their pompous parents say,

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desperate to earn their approval.

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As a result, autism became
a source of shame and stigma for families,

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and two generations of autistic children

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were shipped off to institutions
for their own good,

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becoming invisible to the world at large.

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Amazingly, it wasn't until the 1970s

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that researchers began to test
Kanner's theory that autism was rare.

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Lorna Wing was a cognitive
psychologist in London

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who thought that Kanner's theory
of refrigerator parenting

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were "bloody stupid," as she told me.

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She and her husband John were warm
and affectionate people,

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and they had a profoundly
autistic daughter named Susie.

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Lorna and John knew how hard it was
to raise a child like Susie

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without support services,

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special education,

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and the other resources that are
out of reach without a diagnosis.

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To make the case
to the National Health Service

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that more resources were needed
for autistic children and their families,

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Lorna and her colleague Judith Gould

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decided to do something that should
have been done 30 years earlier.

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They undertook a study of autism
prevalence in the general population.

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They pounded the pavement
in a London suburb called Camberwell

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to try to find autistic children
in the community.

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What they saw made clear
that Kanner's model was way too narrow,

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while the reality of autism
was much more colorful and diverse.

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Some kids couldn't talk at all,

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while others waxed on at length
about their fascination with astrophysics,

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dinosaurs, or the genealogy of royalty.

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In other words, these children
didn't fit into nice, neat boxes,

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as Judith put it,

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and they saw lots of them,

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way more than Kanner's monolithic model
would have predicted.

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At first, they were at loss
to make sense of their data.

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How had no one noticed
these children before?

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But then Lorna came upon a reference
to a paper that had been published

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in German in 1944,

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the year after Kanner's paper,

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and then forgotten,

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buried with the ashes of a terrible time

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that no one wanted to remember
or think about.

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Kanner knew about this competing paper,

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but scrupulously avoided
mentioning it in his own work.

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It had never even
been translated into English,

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but luckily, Lorna's husband spoke German,

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and he translated it for her.

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The paper offered
an alternate story of autism.

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Its author was a man named Hans Asperger,

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who ran a combination clinic
and residential school

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in Vienna in the 1930s.

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Asperger's ideas about teaching children
with learning differences

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were progressive even
by contemporary standards.

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Mornings at his clinic began
with exercise classes set to music,

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and the children put on plays
on Sunday afternoons.

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Instead of blaming parents
for causing autism,

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Asperger framed it as a lifelong,
polygenetic disability

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that requires compassionate forms
of support and accommodations

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over the course of one's whole life.

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Rather than treating the kids
in his clinic like patients,

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Asperger called him his little professors,

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and enlisted their help in developing
methods of education

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that were particularly suited to them.

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Crucially, Asperger viewed autism
as a diverse continuum

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that spans an astonishing range
of giftedness and disability.

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He believed that autism
and autistic traits are common

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and always have been,

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seeing aspects of this continuum
in familiar archetypes from pop culture

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like the socially awkward scientist

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and the absent-minded professor.

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He went so far as to say,

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it seems that for success
in science and art,

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a dash of autism is essential.

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Lorna and Judith realized that Kanner
had been as wrong about autism being rare

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as he had been about parents causing it.

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Over the next several years,

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they quietly worked with
the American Psychiatric Association

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to broaden the criteria for diagnosis

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to reflect the diversity of what
they called "the autism spectrum."

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In the late '80s and early 1990s,

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their changes went into effect,

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swapping out Kanner's narrow model

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for Asperger's broad and inclusive one.

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These changes weren't
happening in a vacuum.

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By coincidence, as Lorna and Judith
worked behind the scenes

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to reform the criteria,

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people all over the world were seeing
an autistic adult for the first time.

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Before "Rain Man" came out in 1988,

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only a tiny, ingrown circle of experts
knew what autism looked like,

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but after Dustin Hoffman's unforgettable
performance as Raymond Babbitt

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earned "Rain Man" four Academy Awards,

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pediatricians, psychologists,

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teachers, and parents all over the world
knew what autism looked like.

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Coincidentally, at the same time,

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the first easy-to-use clinical tests
for diagnosing autism were introduced.

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You no longer had to have a connection
to that tiny circle of experts

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to get your child evaluated.

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The combination of "Rain Man,"

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the changes to the criteria,
and the introduction of these tests

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created a network effect,

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a perfect storm of autism awareness.

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The number of diagnoses started to soar,

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just as Lorna and Judith predicted,
indeed hoped, that it would,

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enabling autistic people
and their families

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to finally get the support
and services they deserved.

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Then Andrew Wakefield came along

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to blame the spike
in diagnoses on vaccines,

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a simple, powerful,

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and seductively believable story

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that was as wrong as Kanner's theory

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that autism was rare.

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If the CDC's current estimate,

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that one in 68 kids in America
are on the spectrum, is correct,

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autistics are one of the largest
minority groups in the world.

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In recent years, autistic people
have come together on the Internet

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to reject the notion that they
are puzzles to be solved

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by the next medical breakthrough,

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coining the term "neurodiversity"

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to celebrate the varieties
of human cognition.

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One way to understand neurodiversity

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is to think in terms
of human operating systems.

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Just because a PC is not running Windows
doesn't mean that it's broken.

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By autistic standards,
the normal human brain

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is easily distractable,

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obsessively social,

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and suffers from a deficit
of attention to detail.

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To be sure, autistic people
have a hard time

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living in a world not built for them.

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Eighty years later, we're still
catching up to Asperger,

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who believed that the "cure"
for the most disabling aspects of autism

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is to be found in understanding teachers,

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accommodating employers,

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supportive communities,

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and parents who have faith
in their children's potential.

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An autistic woman
named Xoxia Zax once said,

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"We need all hands on deck
to right the ship of humanity."

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As we sail into an uncertain future,

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we need every form
of human intelligence on the planet

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working together to tackle
the challenges that we face as a society.

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We can't afford to waste a brain.

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Thank you.

251
00:13:30,136 --> 00:13:34,136
(Applause)