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Host: We're going to move along
with our content,

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providing it for you as we go on,

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our next presenter today
is doctor Ami Klin.

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He refers to himself as a walking
laboratory of social engagement.

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And I'll tell you, the man just
minding his own business at Yale,

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and Home Depot co-founder,
Bernie Marcus,

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went up there and persuaded him
to come down south,

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where he is now the new director
of the Marcus Autism Center.

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He is here today to share with us
some viewpoints

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on how early targeted
social engagement with autistic children

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can be an investment
in their future productivity.

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I'd like you to join me in welcoming him,

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to share an idea worth sharing -

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autism, disruptions is early human
social adaptation mechanisms.

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Welcoming doctor Ami Klin.

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(Applause)

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Ami Klin: For me,
autism has been a personal journey.

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As I was introduced,

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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.

248
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We can see, moment by moment,
what children are engaging with.

249
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This is my colleague, Warren Jones,

250
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with whom we've been building
these methods, these studies,

251
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for the past 12 years.

252
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And you see there a happy five-month-old,

253
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a five-month little boy
who is going to watch things

254
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that are brought from his world:

255
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his mom, the caregiver,

256
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but also experiences that he would have
were he to be in his daycare.

257
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What we want is to embrace that world
and bring it into our laboratory,

258
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but in order for us to do that,

259
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we had to create
these very sophisticated measures,

260
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measures of how people, how little babies,

261
00:14:12,090 --> 00:14:16,604
how newborns, engage
with the world, moment by moment.

262
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What is important and what is not.

263
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Well, we created those measures,

264
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and here, what you see
is what we call a funnel of attention.

265
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You're watching a video --

266
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those frames are separated
by about a second --

267
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through the eyes of 35 typically
developing two-year-olds.

268
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And we freeze one frame,

269
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and this is what the typical
children are doing.

270
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In this scan pass, in green here,
are two-year-olds with autism.

271
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So on that frame, the children
who are typical are watching this,

272
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the emotion of expression
of that little boy

273
00:14:55,088 --> 00:14:57,814
as he's fighting a little bit
with the little girl.

274
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What are the children with autism doing?

275
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They are focusing on the revolving door,

276
00:15:03,804 --> 00:15:05,225
opening and shutting.

277
00:15:06,042 --> 00:15:09,391
Well, I can tell you that this divergence
that you're seeing here

278
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doesn't happen only
in our five-minute experiment.

279
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It happens moment by moment
in their real lives,

280
00:15:16,320 --> 00:15:20,553
and their minds are being formed
and their brains are being specialized

281
00:15:20,577 --> 00:15:24,600
in something other than what is happening
with their typical peers.

282
00:15:25,307 --> 00:15:31,826
Well, we took a construct
from our pediatrician friends,

283
00:15:31,850 --> 00:15:33,369
the concept of growth charts --

284
00:15:33,393 --> 00:15:35,870
you know, when you take
a child to the pediatrician,

285
00:15:35,894 --> 00:15:38,976
and you have physical height and weight.

286
00:15:39,566 --> 00:15:42,500
Well, we decided we were going
to create growth charts

287
00:15:42,524 --> 00:15:43,825
of social engagement.

288
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We sought children
from the time they're born.

289
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What you see here on the x-axis

290
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is two, three, four, five,
six months and nine,

291
00:15:55,682 --> 00:15:57,445
until about the age of 24 months.

292
00:15:57,469 --> 00:16:00,240
This is the percent of their viewing time

293
00:16:00,264 --> 00:16:02,175
that they're focusing on people's eyes,

294
00:16:02,199 --> 00:16:04,128
and this is their growth chart.

295
00:16:04,644 --> 00:16:07,117
They start over here --
they love people's eyes --

296
00:16:07,141 --> 00:16:09,184
and it remains quite stable.

297
00:16:09,850 --> 00:16:13,113
It sort of goes up a little bit
in those initial months.

298
00:16:13,819 --> 00:16:17,556
Now, let's see what's happening
with babies who became autistic.

299
00:16:18,271 --> 00:16:19,763
It's something very different.

300
00:16:20,504 --> 00:16:23,434
It starts way up here,
but then it's a free fall.

301
00:16:24,299 --> 00:16:28,170
It's very much like they brought
into this world the reflex

302
00:16:28,194 --> 00:16:31,387
that orients them to people,
but it has no traction.

303
00:16:32,011 --> 00:16:34,445
It's almost as if that stimulus -- you --

304
00:16:35,040 --> 00:16:38,030
you're not exerting
influence on what happens

305
00:16:38,054 --> 00:16:40,408
as they navigate their daily lives.

306
00:16:41,736 --> 00:16:48,496
Now, we thought those data
were so powerful, in a way,

307
00:16:49,186 --> 00:16:52,436
that we wanted to see what happened
in the first six months of life,

308
00:16:52,460 --> 00:16:55,668
because if you interact
with a two- and a three-month-old,

309
00:16:55,692 --> 00:16:58,942
you'd be surprised
by how social those babies are.

310
00:17:00,013 --> 00:17:02,870
And what we see
in the first six months of life

311
00:17:02,894 --> 00:17:07,771
is that those two groups
can be segregated very easily.

312
00:17:08,659 --> 00:17:11,776
And using these kinds
of measures and many others,

313
00:17:11,800 --> 00:17:15,453
what we found out
is that our science could, in fact,

314
00:17:15,477 --> 00:17:17,701
identify this condition early on.

315
00:17:18,249 --> 00:17:21,410
We didn't have to wait
for the behaviors of autism

316
00:17:21,434 --> 00:17:23,512
to emerge in the second year of life.

317
00:17:24,656 --> 00:17:29,183
If we measured things that are,
evolutionarily, highly conserved,

318
00:17:29,207 --> 00:17:31,530
and developmentally very early-emerging --

319
00:17:31,554 --> 00:17:34,231
things that are online
from the first weeks of life --

320
00:17:34,255 --> 00:17:36,217
we could push the detection of autism

321
00:17:36,241 --> 00:17:38,769
all the way to those first months,

322
00:17:38,793 --> 00:17:40,777
and that's what we are doing now.

323
00:17:43,118 --> 00:17:46,275
Now, we can create
the very best technologies

324
00:17:46,299 --> 00:17:49,305
and the very best methods
to identify the children,

325
00:17:50,091 --> 00:17:53,005
but this would be for naught
if we didn't have an impact

326
00:17:53,029 --> 00:17:55,709
on what happens in their reality
in the community.

327
00:17:56,180 --> 00:17:58,462
Now we want those devices, of course,

328
00:17:58,486 --> 00:18:01,315
to be deployed by those
who are in the trenches --

329
00:18:01,339 --> 00:18:05,877
our colleagues, the primary care
physicians, who see every child --

330
00:18:06,567 --> 00:18:08,930
and we need to transform
those technologies

331
00:18:08,954 --> 00:18:11,956
into something that is going
to add value to their practice,

332
00:18:11,980 --> 00:18:14,166
because they have to see so many children.

333
00:18:14,190 --> 00:18:18,267
And we want to do that universally
so that we don't miss any child.

334
00:18:18,291 --> 00:18:19,902
But this would be immoral

335
00:18:21,029 --> 00:18:26,392
if we also did not have an infrastructure
for intervention, for treatment.

336
00:18:26,987 --> 00:18:30,879
We need to be able to work
with the families, support the families,

337
00:18:30,903 --> 00:18:33,916
to manage those first years with them.

338
00:18:34,884 --> 00:18:37,282
We need to be able to really go

339
00:18:37,306 --> 00:18:41,228
from universal screening
to universal access to treatment,

340
00:18:41,252 --> 00:18:44,241
because those treatments
are going to change

341
00:18:44,265 --> 00:18:47,130
these children's
and those families' lives.

342
00:18:48,950 --> 00:18:55,388
Now, when we think about what we [can]
do in those first years,

343
00:18:55,412 --> 00:18:59,982
I can tell you, having been
in this field for so long,

344
00:19:00,577 --> 00:19:02,953
one feels really rejuvenated.

345
00:19:03,332 --> 00:19:08,054
There is a sense that the science
that one worked on

346
00:19:08,078 --> 00:19:10,847
can actually have an impact on realities,

347
00:19:10,871 --> 00:19:13,851
preventing, in fact, those experiences

348
00:19:14,472 --> 00:19:17,216
that I really started
in my journey in this field.

349
00:19:17,843 --> 00:19:21,253
I thought at the time
that this was an intractable condition.

350
00:19:21,277 --> 00:19:24,556
No longer. We can do
a great deal of things.

351
00:19:25,207 --> 00:19:27,616
And the idea is not to cure autism.

352
00:19:27,640 --> 00:19:29,140
That's not the idea.

353
00:19:30,291 --> 00:19:32,365
What we want is to make sure

354
00:19:32,389 --> 00:19:34,941
that those individuals
with autism can be free

355
00:19:34,965 --> 00:19:38,580
from the devastating consequences
that come with it at times,

356
00:19:39,376 --> 00:19:42,437
the profound intellectual disabilities,
the lack of language,

357
00:19:42,461 --> 00:19:44,948
the profound, profound isolation.

358
00:19:46,063 --> 00:19:48,309
We feel that individuals
with autism, in fact,

359
00:19:48,333 --> 00:19:50,799
have a very special
perspective on the world,

360
00:19:50,823 --> 00:19:52,169
and we need diversity.

361
00:19:52,940 --> 00:19:56,566
And they can work extremely well
in some areas of strength:

362
00:19:56,590 --> 00:19:59,969
predictable situations,
situations that can be defined.

363
00:19:59,993 --> 00:20:02,951
Because after all,
they learn about the world

364
00:20:02,975 --> 00:20:04,857
almost, like, about it,

365
00:20:04,881 --> 00:20:07,678
rather than learning
how to function in it.

366
00:20:07,702 --> 00:20:11,701
But this is a strength if you're working,
for example, in technology.

367
00:20:12,581 --> 00:20:16,412
And there are those individuals
who have incredible artistic abilities.

368
00:20:16,436 --> 00:20:18,769
We want them to be free to do that.

369
00:20:18,793 --> 00:20:21,912
We want that the next generations
of individuals with autism

370
00:20:21,936 --> 00:20:25,014
will be able not only
to express their strengths,

371
00:20:25,038 --> 00:20:26,937
but to fulfill their promise.

372
00:20:27,452 --> 00:20:29,199
Well, thank you for listening to me.

373
00:20:29,223 --> 00:20:32,703
(Applause)

374
00:20:35,125 --> 00:20:36,792
Host: Dr Klin, thank you.

375
00:20:37,427 --> 00:20:41,077
You know, this talk is generating
quite a lot of talk

376
00:20:41,133 --> 00:20:42,934
all over the web right now,

377
00:20:42,974 --> 00:20:44,561
a lot of tweeting going on,

378
00:20:44,588 --> 00:20:47,721
and obviously a lot of interest
around the issue of autism.

379
00:20:47,990 --> 00:20:52,069
I'm curious to know whether
there are some new caregiving norms

380
00:20:52,094 --> 00:20:55,275
that you see - you mentioned
that early intervention is the key,

381
00:20:55,315 --> 00:20:57,212
but if there isn't early diagnoses,

382
00:20:57,220 --> 00:21:00,402
is there a look that caregivers
should perhaps be -

383
00:21:00,490 --> 00:21:03,942
evolving into new ways of caring
for children that might be helpful ?

384
00:21:04,140 --> 00:21:08,116
Ami Klin: Well, there are ways
of identifying children early.

385
00:21:08,148 --> 00:21:10,600
The fact that there is a slow
uptake of that

386
00:21:10,625 --> 00:21:13,799
has something to do with the fact
that people need to know how bad.

387
00:21:14,109 --> 00:21:17,242
That we can do a great deal
for these children and families.

388
00:21:17,331 --> 00:21:18,982
But the interesting thing,

389
00:21:19,014 --> 00:21:21,704
is that the forms of treatment
that are available now

390
00:21:21,752 --> 00:21:25,791
are not forms of treatment
that would be taking place in a center.

391
00:21:25,838 --> 00:21:27,771
They take place in the homes.

392
00:21:27,815 --> 00:21:30,748
Basically, what those treatments
are doing,

393
00:21:30,911 --> 00:21:33,711
is potentiating what every caregiver does.

394
00:21:33,919 --> 00:21:35,474
We need to make sure

395
00:21:35,490 --> 00:21:37,974
that those signals,
the communication signals,

396
00:21:37,998 --> 00:21:39,465
the social engagement,

397
00:21:39,490 --> 00:21:42,116
that that happens not
in a treatment session

398
00:21:42,188 --> 00:21:45,228
that would take place
for like 30 minutes a day,

399
00:21:45,799 --> 00:21:48,799
we basically need every moment
in these childrens' lives,

400
00:21:48,823 --> 00:21:50,490
to be a treatment moment.

401
00:21:50,601 --> 00:21:53,664
And for that, we need to both
support and train parents.

402
00:21:53,704 --> 00:21:57,140
And that's the way
those early forms of treatment take place.

403
00:21:57,196 --> 00:21:58,873
So there is plenty to do out there.

404
00:21:58,898 --> 00:22:01,573
Host: Well, it looks
like people are interested in that.

405
00:22:01,598 --> 00:22:04,111
Thank you very much, Dr Klin.
Pleasure to have you.

406
00:22:04,136 --> 00:22:05,136
(Applause)