WEBVTT 00:00:01.571 --> 00:00:03.880 Host: We're going to move along with our content, 00:00:03.913 --> 00:00:05.547 providing it for you as we go on, 00:00:05.595 --> 00:00:08.095 our next presenter today is doctor Ami Klin. 00:00:08.125 --> 00:00:12.537 He refers to himself as a walking laboratory of social engagement. 00:00:12.546 --> 00:00:16.251 And I'll tell you, the man just minding his own business at Yale, 00:00:17.363 --> 00:00:19.974 and Home Depot co-founder, Bernie Marcus, 00:00:19.999 --> 00:00:23.061 went up there and persuaded him to come down south, 00:00:23.109 --> 00:00:26.894 where he is now the new director of the Marcus Autism Center. 00:00:26.919 --> 00:00:29.267 He is here today to share with us some viewpoints 00:00:29.292 --> 00:00:32.609 on how early targeted social engagement with autistic children 00:00:32.665 --> 00:00:35.394 can be an investment in their future productivity. 00:00:35.807 --> 00:00:37.855 I'd like you to join me in welcoming him, 00:00:37.910 --> 00:00:39.505 to share an idea worth sharing - 00:00:39.553 --> 00:00:43.878 autism, disruptions is early human social adaptation mechanisms. 00:00:44.276 --> 00:00:45.577 Welcoming doctor Ami Klin. 00:00:45.633 --> 00:00:51.386 (Applause) 00:01:00.244 --> 00:01:03.844 Ami Klin: For me, autism has been a personal journey. 00:01:06.149 --> 00:01:07.482 As I was introduced, 00:01:07.600 --> 00:01:12.232 I always wanted to become a walking laboratory of social engagement: 00:01:13.513 --> 00:01:17.922 to resonate other people's feelings, thoughts, intentions, motivations, 00:01:18.107 --> 00:01:19.768 in the act of being with them. 00:01:21.399 --> 00:01:25.928 As a scientist, I always wanted to measure that resonance, 00:01:27.176 --> 00:01:29.794 that sense of the other that happens so quickly, 00:01:29.818 --> 00:01:31.125 in the blink of an eye. 00:01:32.082 --> 00:01:34.408 We intuit other people's feelings; 00:01:34.432 --> 00:01:37.575 we know the meaning of their actions even before they happen. 00:01:38.359 --> 00:01:40.105 We're always in this stance 00:01:40.129 --> 00:01:43.211 of being the object of somebody else's subjectivity. 00:01:43.235 --> 00:01:45.975 We do that all the time. We just can't shake it off. 00:01:46.425 --> 00:01:50.124 It's so important that the very tools we use to understand ourselves, 00:01:50.148 --> 00:01:51.975 to understand the world around us, 00:01:51.999 --> 00:01:53.605 are shaped by that stance. 00:01:54.626 --> 00:01:56.677 We are social to the core. 00:01:57.972 --> 00:02:00.423 So my journey in autism really started 00:02:00.447 --> 00:02:04.053 when I lived in a residential unit for adults with autism. 00:02:04.468 --> 00:02:07.559 Most of those individuals had spent most of their lives 00:02:07.583 --> 00:02:09.068 in long-stay hospitals. 00:02:09.092 --> 00:02:10.556 This is a long time ago. 00:02:11.421 --> 00:02:14.948 And for them, autism was devastating. 00:02:15.795 --> 00:02:18.438 They had profound intellectual disabilities. 00:02:18.958 --> 00:02:20.192 They didn't talk. 00:02:20.710 --> 00:02:22.029 But most of all, 00:02:22.617 --> 00:02:27.546 they were extraordinarily isolated from the world around them, 00:02:27.570 --> 00:02:29.407 from their environment 00:02:29.431 --> 00:02:31.304 and from the people. 00:02:31.792 --> 00:02:34.619 In fact, at the time, if you walked into a school 00:02:34.643 --> 00:02:36.431 for individuals with autism, 00:02:36.455 --> 00:02:38.768 you'd hear a lot of noise, 00:02:38.792 --> 00:02:42.865 plenty of commotion, actions, people doing things. 00:02:44.130 --> 00:02:46.615 But they're always doing things by themselves. 00:02:47.805 --> 00:02:51.286 So they may be looking at a light in the ceiling, 00:02:51.927 --> 00:02:54.709 or they may be isolated in the corner, 00:02:55.336 --> 00:02:58.871 or they might be engaged in these repetitive movements, 00:02:58.895 --> 00:03:02.314 in self-stimulatory movements that led them nowhere. 00:03:02.958 --> 00:03:05.557 Extremely, extremely isolated. 00:03:07.025 --> 00:03:12.605 Well, now we know that autism is this disruption, 00:03:12.629 --> 00:03:16.146 the disruption of this resonance that I am telling you about. 00:03:16.170 --> 00:03:18.104 These are survival skills. 00:03:18.128 --> 00:03:20.255 These are survival skills that we inherited 00:03:21.038 --> 00:03:24.419 over many, many hundreds of thousands of years of evolution. 00:03:25.245 --> 00:03:29.913 You see, babies are born in a state of utter fragility. 00:03:30.432 --> 00:03:32.561 Without the caregiver, they wouldn't survive, 00:03:32.585 --> 00:03:35.091 so it stands to reason that nature would endow them 00:03:35.115 --> 00:03:36.892 with these mechanisms of survival. 00:03:38.569 --> 00:03:40.512 They orient to the caregiver. 00:03:40.925 --> 00:03:43.777 From the first days and weeks of life, 00:03:44.340 --> 00:03:47.074 babies prefer to hear human sounds, 00:03:47.098 --> 00:03:49.222 rather than just sounds in the environment. 00:03:49.246 --> 00:03:51.723 They prefer to look at people rather than at things, 00:03:51.747 --> 00:03:55.088 and even as they're looking at people, they look at people's eyes, 00:03:56.147 --> 00:04:00.355 because the eye is the window to the other person's experiences, 00:04:00.379 --> 00:04:02.837 so much so that they even prefer to look at people 00:04:02.861 --> 00:04:06.100 who are looking at them rather than people who are looking away. 00:04:06.925 --> 00:04:09.507 Well, they orient to the caregiver. 00:04:09.531 --> 00:04:11.164 The caregiver seeks the baby. 00:04:11.672 --> 00:04:14.920 And it's out of this mutually reinforcing choreography 00:04:15.485 --> 00:04:19.279 that a lot that is of importance to the emergence of mind -- 00:04:19.303 --> 00:04:22.828 the social mind, the social brain -- depends on. 00:04:23.987 --> 00:04:27.059 We always think about autism 00:04:27.083 --> 00:04:31.723 as something that happens later on in life. 00:04:31.747 --> 00:04:35.152 It doesn't; it begins with the beginning of life. 00:04:37.301 --> 00:04:42.896 As babies engage with caregivers, they soon realize that, well, 00:04:42.920 --> 00:04:47.042 there is something between the ears that is very important -- 00:04:47.066 --> 00:04:50.481 it's invisible, you can't see it, but it's really critical. 00:04:51.249 --> 00:04:53.176 And that thing is called attention. 00:04:53.200 --> 00:04:54.533 And they learn soon enough, 00:04:54.557 --> 00:04:57.145 even before they can utter one word, 00:04:57.169 --> 00:05:00.052 that they can take that attention and move somewhere 00:05:00.673 --> 00:05:02.471 in order to get things they want. 00:05:03.955 --> 00:05:07.055 They also learn to follow other people's gazes, 00:05:07.079 --> 00:05:11.064 because whatever people are looking at is what they are thinking about. 00:05:13.104 --> 00:05:16.750 And soon enough, they start to learn about the meaning of things, 00:05:16.774 --> 00:05:19.147 because when somebody is looking at something 00:05:19.171 --> 00:05:21.389 or somebody is pointing at something, 00:05:21.413 --> 00:05:23.586 they're not just getting a directional cue. 00:05:24.152 --> 00:05:27.835 They are getting the other person's meaning of that thing, 00:05:27.859 --> 00:05:29.069 the attitude. 00:05:29.093 --> 00:05:33.864 And soon enough, they start building this body of meanings, 00:05:33.888 --> 00:05:37.740 but meanings that were acquired within the realm of social interaction. 00:05:38.510 --> 00:05:40.425 Those are meanings that are acquired 00:05:40.449 --> 00:05:43.081 as part of their shared experiences with others. 00:05:44.486 --> 00:05:50.302 Well, this is a 15-month-old little girl, 00:05:51.912 --> 00:05:53.559 and she has autism. 00:05:55.094 --> 00:06:00.882 And I am coming so close to her that I am maybe two inches from her face, 00:06:00.906 --> 00:06:02.741 and she's quite oblivious to me. 00:06:02.765 --> 00:06:06.193 Imagine if I did that to you, came two inches from your face. 00:06:06.217 --> 00:06:08.422 You'd do probably two things, wouldn't you? 00:06:08.446 --> 00:06:11.044 You would recoil. You would call the police. 00:06:11.068 --> 00:06:12.242 (Laughter) 00:06:12.266 --> 00:06:13.419 You would do something, 00:06:13.443 --> 00:06:17.501 because it's literally impossible to penetrate somebody's physical space 00:06:17.525 --> 00:06:18.928 and not get that reaction. 00:06:18.952 --> 00:06:22.407 We do so, remember, intuitively, effortlessly. 00:06:22.431 --> 00:06:23.596 This is our body wisdom; 00:06:23.620 --> 00:06:25.818 it's not something mediated by our language. 00:06:25.842 --> 00:06:28.273 Our body just knows that. 00:06:28.769 --> 00:06:31.137 And we've known that for a long time. 00:06:31.161 --> 00:06:34.076 And this is not something that happens to humans only. 00:06:34.100 --> 00:06:37.300 It happens to some of our phyletic cousins, 00:06:37.324 --> 00:06:41.390 because if you're a monkey, and you look at another monkey, 00:06:41.413 --> 00:06:45.407 and that monkey has a higher hierarchy position than you, 00:06:45.432 --> 00:06:48.961 and that is considered to be a signal or threat, 00:06:48.985 --> 00:06:51.379 well, you are not going to be alive for long. 00:06:51.865 --> 00:06:56.697 So something that in other species are survival mechanisms, 00:06:56.721 --> 00:06:59.828 without which they wouldn't basically live, 00:06:59.852 --> 00:07:02.383 we bring into the context of human beings, 00:07:02.407 --> 00:07:06.124 and this is what we need to simply act, socially. 00:07:06.680 --> 00:07:09.449 Now, she is oblivious to me and I'm so close to her, 00:07:09.473 --> 00:07:11.447 and you think, maybe she can see you, 00:07:11.471 --> 00:07:12.982 maybe she can hear you. 00:07:13.006 --> 00:07:14.628 Well, a few minutes later, 00:07:14.652 --> 00:07:16.593 she goes to the corner of the room, 00:07:16.617 --> 00:07:20.367 and she finds a tiny little piece of candy, an M&M. 00:07:21.359 --> 00:07:25.876 So I could not attract her attention, 00:07:25.900 --> 00:07:27.771 but something -- a thing -- did. 00:07:28.430 --> 00:07:30.947 Now, most of us make a big dichotomy 00:07:30.971 --> 00:07:33.851 between the world of things and the world of people. 00:07:35.382 --> 00:07:39.873 Now, for this girl, that division line is not so clear, 00:07:39.897 --> 00:07:43.003 and the world of people is not attracting her 00:07:43.027 --> 00:07:44.486 as much as we would like. 00:07:44.510 --> 00:07:48.197 Now, remember that we learn a great deal by sharing experiences. 00:07:48.945 --> 00:07:54.806 What she is doing right now is that her path of learning is diverging, 00:07:54.830 --> 00:07:56.571 moment by moment, 00:07:56.595 --> 00:07:59.815 as she is isolating herself further and further. 00:08:00.413 --> 00:08:03.355 So we feel sometimes that the brain is deterministic, 00:08:03.379 --> 00:08:05.556 the brain determines who we're going to be. 00:08:05.929 --> 00:08:08.717 But, in fact, the brain also becomes who we are, 00:08:08.741 --> 00:08:12.730 and at the same time that her behaviors are taking away 00:08:12.754 --> 00:08:14.916 from the realm of social interaction, 00:08:14.940 --> 00:08:16.965 this is what's happening with her mind, 00:08:16.989 --> 00:08:19.405 and this is what's happening with her brain. 00:08:21.643 --> 00:08:26.843 Well, autism is the most strongly genetic condition 00:08:26.867 --> 00:08:28.739 of all developmental disorders. 00:08:30.961 --> 00:08:32.619 And it's a brain disorder. 00:08:33.195 --> 00:08:36.424 It's a disorder that begins much prior to the time 00:08:36.448 --> 00:08:37.763 that the child is born. 00:08:38.717 --> 00:08:42.698 We now know that there is a very broad spectrum of autism. 00:08:42.722 --> 00:08:46.191 There are those individuals who are profoundly intellectually disabled 00:08:46.215 --> 00:08:48.172 but there are those that are gifted. 00:08:48.196 --> 00:08:50.590 There are those individuals who don't talk at all; 00:08:50.614 --> 00:08:53.002 there are those individuals who talk too much. 00:08:53.026 --> 00:08:56.523 There are those individuals that if you observe them in their school, 00:08:56.547 --> 00:09:00.217 you see them running the periphery fence all the school day if you let them, 00:09:00.241 --> 00:09:02.602 to those individuals who cannot stop coming to you 00:09:02.626 --> 00:09:05.479 and trying to engage you repeatedly, relentlessly, 00:09:05.591 --> 00:09:07.860 but often in an awkward fashion, 00:09:08.732 --> 00:09:11.389 without that immediate resonance. 00:09:12.312 --> 00:09:16.058 Well, this is much more prevalent than we thought at the time. 00:09:16.082 --> 00:09:17.493 When I started in this field, 00:09:17.517 --> 00:09:20.605 we thought there were four individuals with autism per 10,000 -- 00:09:20.629 --> 00:09:21.900 a very rare condition. 00:09:22.361 --> 00:09:26.015 Well, now we know it's more like one in 100. 00:09:26.457 --> 00:09:29.745 There are millions of individuals with autism all around us. 00:09:31.716 --> 00:09:34.969 The societal cost of this condition is huge, 00:09:35.085 --> 00:09:38.033 in the US alone, maybe 35 to 80 billion dollars. 00:09:38.057 --> 00:09:39.245 And you know what? 00:09:39.269 --> 00:09:43.906 Most of those funds are associated with adolescents and particularly adults 00:09:43.930 --> 00:09:45.681 who are severely disabled, 00:09:45.705 --> 00:09:47.866 individuals who need wraparound services -- 00:09:47.890 --> 00:09:50.146 services that are very, very intensive. 00:09:50.170 --> 00:09:54.256 And those services can cost in excess of 60,000 to 80,000 dollars a year. 00:09:55.036 --> 00:09:58.260 Those are individuals who did not benefit from early treatment, 00:09:58.974 --> 00:10:03.112 because now we know that autism creates itself 00:10:03.136 --> 00:10:07.288 as individuals diverge in that pathway of learning that I mentioned to you. 00:10:07.700 --> 00:10:10.273 Were we to be able to identify this condition 00:10:10.297 --> 00:10:13.047 at an earlier point, and intervene and treat -- 00:10:14.312 --> 00:10:18.366 I can tell you, this has been probably something that has changed my life 00:10:18.390 --> 00:10:19.686 in the past 10 years, 00:10:19.710 --> 00:10:23.964 this notion that we can absolutely attenuate this condition. 00:10:25.422 --> 00:10:27.777 Also, we have a window of opportunity, 00:10:27.801 --> 00:10:30.421 because the brain is malleable for just so long, 00:10:30.937 --> 00:10:34.450 and that window of opportunity happens in the first three years of life. 00:10:34.474 --> 00:10:37.185 It's not that that window closes; it doesn't. 00:10:38.121 --> 00:10:40.634 But it diminishes considerably. 00:10:41.399 --> 00:10:44.497 And yet, the median age of diagnosis in this country 00:10:44.521 --> 00:10:46.433 is still about five years, 00:10:46.457 --> 00:10:48.552 and in disadvantaged populations, 00:10:48.576 --> 00:10:51.705 the populations that don't have access to clinical services, 00:10:51.729 --> 00:10:54.142 rural populations, minorities, 00:10:54.838 --> 00:10:57.547 the age of diagnosis is later still, 00:10:57.571 --> 00:10:59.596 which is almost as if I were to tell you 00:10:59.620 --> 00:11:03.387 that we are condemning those communities to have individuals with autism 00:11:03.411 --> 00:11:05.734 whose condition is going to be more severe. 00:11:06.662 --> 00:11:09.206 So I feel that we have a bioethical imperative. 00:11:09.668 --> 00:11:11.397 The science is there. 00:11:12.525 --> 00:11:14.645 But no science is of relevance 00:11:14.669 --> 00:11:17.598 if it doesn't have an impact on the community. 00:11:18.227 --> 00:11:21.181 And we just can't afford that missed opportunity, 00:11:21.205 --> 00:11:24.150 because children with autism become adults with autism. 00:11:24.912 --> 00:11:28.916 And we feel that those things we can do 00:11:28.940 --> 00:11:31.318 for these children, for those families, early on, 00:11:31.342 --> 00:11:33.519 will have lifetime consequences -- 00:11:33.543 --> 00:11:37.551 for the child, for the family, and for the community at large. 00:11:37.575 --> 00:11:40.148 So this is our view of autism. 00:11:40.645 --> 00:11:43.967 There are over a hundred genes that are associated with autism. 00:11:43.991 --> 00:11:45.950 In fact, we believe there are going to be 00:11:45.974 --> 00:11:49.779 something between 300 and 600 genes associated with autism, 00:11:49.803 --> 00:11:53.106 and genetic anomalies, much more than just genes. 00:11:53.960 --> 00:11:57.279 And we actually have a bit of a question here, 00:11:58.144 --> 00:12:01.429 because if there are so many different causes of autism, 00:12:01.453 --> 00:12:05.721 how do you go from those liabilities to the actual syndrome? 00:12:05.745 --> 00:12:07.296 Because people like myself, 00:12:08.030 --> 00:12:10.267 when we walk into a playroom, 00:12:10.291 --> 00:12:12.649 we recognize a child as having autism. 00:12:13.335 --> 00:12:15.563 So how do you go from multiple causes 00:12:15.587 --> 00:12:17.915 to a syndrome that has some homogeneity? 00:12:18.991 --> 00:12:21.682 And the answer is what lies in between, 00:12:22.253 --> 00:12:23.685 which is development. 00:12:24.160 --> 00:12:28.933 And in fact, we are very interested in those first two years of life, 00:12:28.957 --> 00:12:32.745 because those liabilities don't necessarily convert into autism. 00:12:32.769 --> 00:12:34.527 Autism creates itself. 00:12:35.312 --> 00:12:39.157 Were we to be able to intervene during those years of life, 00:12:40.069 --> 00:12:45.485 we might attenuate for some, and God knows, maybe even prevent for others. 00:12:46.475 --> 00:12:47.713 So how do we do that? 00:12:48.337 --> 00:12:51.229 How do we enter that feeling of resonance, 00:12:51.253 --> 00:12:54.047 how do we enter another person's being? 00:12:55.637 --> 00:12:58.752 I remember when I interacted with that 15-month-old, 00:12:58.776 --> 00:13:00.914 the thing that came to my mind was, 00:13:00.938 --> 00:13:03.251 "How do you come into her world? 00:13:03.910 --> 00:13:07.307 Is she thinking about me? Is she thinking about others?" 00:13:08.410 --> 00:13:11.260 Well, it's hard to do that, 00:13:11.284 --> 00:13:13.462 so we had to create the technologies. 00:13:13.486 --> 00:13:15.955 We had to basically step inside a body. 00:13:15.979 --> 00:13:18.573 We had to see the world through her eyes. 00:13:19.692 --> 00:13:22.004 And so in the past many years, 00:13:22.028 --> 00:13:24.424 we've been building these new technologies 00:13:24.448 --> 00:13:26.029 that are based on eye tracking. 00:13:26.053 --> 00:13:30.969 We can see, moment by moment, what children are engaging with. 00:13:32.546 --> 00:13:34.310 This is my colleague, Warren Jones, 00:13:34.334 --> 00:13:37.628 with whom we've been building these methods, these studies, 00:13:37.652 --> 00:13:38.981 for the past 12 years. 00:13:39.379 --> 00:13:42.535 And you see there a happy five-month-old, 00:13:43.289 --> 00:13:48.356 a five-month little boy who is going to watch things 00:13:48.380 --> 00:13:50.292 that are brought from his world: 00:13:51.096 --> 00:13:53.329 his mom, the caregiver, 00:13:53.353 --> 00:13:57.583 but also experiences that he would have were he to be in his daycare. 00:13:58.384 --> 00:14:02.224 What we want is to embrace that world and bring it into our laboratory, 00:14:02.248 --> 00:14:04.282 but in order for us to do that, 00:14:04.306 --> 00:14:08.561 we had to create these very sophisticated measures, 00:14:08.585 --> 00:14:12.066 measures of how people, how little babies, 00:14:12.090 --> 00:14:16.604 how newborns, engage with the world, moment by moment. 00:14:16.628 --> 00:14:18.913 What is important and what is not. 00:14:19.663 --> 00:14:22.274 Well, we created those measures, 00:14:22.298 --> 00:14:25.659 and here, what you see is what we call a funnel of attention. 00:14:26.326 --> 00:14:27.691 You're watching a video -- 00:14:28.239 --> 00:14:30.970 those frames are separated by about a second -- 00:14:30.994 --> 00:14:34.866 through the eyes of 35 typically developing two-year-olds. 00:14:35.337 --> 00:14:37.634 And we freeze one frame, 00:14:38.408 --> 00:14:41.496 and this is what the typical children are doing. 00:14:41.520 --> 00:14:45.937 In this scan pass, in green here, are two-year-olds with autism. 00:14:45.961 --> 00:14:51.324 So on that frame, the children who are typical are watching this, 00:14:52.539 --> 00:14:55.064 the emotion of expression of that little boy 00:14:55.088 --> 00:14:57.814 as he's fighting a little bit with the little girl. 00:14:57.838 --> 00:14:59.875 What are the children with autism doing? 00:14:59.899 --> 00:15:02.994 They are focusing on the revolving door, 00:15:03.804 --> 00:15:05.225 opening and shutting. 00:15:06.042 --> 00:15:09.391 Well, I can tell you that this divergence that you're seeing here 00:15:09.415 --> 00:15:12.227 doesn't happen only in our five-minute experiment. 00:15:12.251 --> 00:15:15.185 It happens moment by moment in their real lives, 00:15:16.320 --> 00:15:20.553 and their minds are being formed and their brains are being specialized 00:15:20.577 --> 00:15:24.600 in something other than what is happening with their typical peers. 00:15:25.307 --> 00:15:31.826 Well, we took a construct from our pediatrician friends, 00:15:31.850 --> 00:15:33.369 the concept of growth charts -- 00:15:33.393 --> 00:15:35.870 you know, when you take a child to the pediatrician, 00:15:35.894 --> 00:15:38.976 and you have physical height and weight. 00:15:39.566 --> 00:15:42.500 Well, we decided we were going to create growth charts 00:15:42.524 --> 00:15:43.825 of social engagement. 00:15:44.854 --> 00:15:47.622 We sought children from the time they're born. 00:15:48.074 --> 00:15:51.449 What you see here on the x-axis 00:15:51.473 --> 00:15:55.658 is two, three, four, five, six months and nine, 00:15:55.682 --> 00:15:57.445 until about the age of 24 months. 00:15:57.469 --> 00:16:00.240 This is the percent of their viewing time 00:16:00.264 --> 00:16:02.175 that they're focusing on people's eyes, 00:16:02.199 --> 00:16:04.128 and this is their growth chart. 00:16:04.644 --> 00:16:07.117 They start over here -- they love people's eyes -- 00:16:07.141 --> 00:16:09.184 and it remains quite stable. 00:16:09.850 --> 00:16:13.113 It sort of goes up a little bit in those initial months. 00:16:13.819 --> 00:16:17.556 Now, let's see what's happening with babies who became autistic. 00:16:18.271 --> 00:16:19.763 It's something very different. 00:16:20.504 --> 00:16:23.434 It starts way up here, but then it's a free fall. 00:16:24.299 --> 00:16:28.170 It's very much like they brought into this world the reflex 00:16:28.194 --> 00:16:31.387 that orients them to people, but it has no traction. 00:16:32.011 --> 00:16:34.445 It's almost as if that stimulus -- you -- 00:16:35.040 --> 00:16:38.030 you're not exerting influence on what happens 00:16:38.054 --> 00:16:40.408 as they navigate their daily lives. 00:16:41.736 --> 00:16:48.496 Now, we thought those data were so powerful, in a way, 00:16:49.186 --> 00:16:52.436 that we wanted to see what happened in the first six months of life, 00:16:52.460 --> 00:16:55.668 because if you interact with a two- and a three-month-old, 00:16:55.692 --> 00:16:58.942 you'd be surprised by how social those babies are. 00:17:00.013 --> 00:17:02.870 And what we see in the first six months of life 00:17:02.894 --> 00:17:07.771 is that those two groups can be segregated very easily. 00:17:08.659 --> 00:17:11.776 And using these kinds of measures and many others, 00:17:11.800 --> 00:17:15.453 what we found out is that our science could, in fact, 00:17:15.477 --> 00:17:17.701 identify this condition early on. 00:17:18.249 --> 00:17:21.410 We didn't have to wait for the behaviors of autism 00:17:21.434 --> 00:17:23.512 to emerge in the second year of life. 00:17:24.656 --> 00:17:29.183 If we measured things that are, evolutionarily, highly conserved, 00:17:29.207 --> 00:17:31.530 and developmentally very early-emerging -- 00:17:31.554 --> 00:17:34.231 things that are online from the first weeks of life -- 00:17:34.255 --> 00:17:36.217 we could push the detection of autism 00:17:36.241 --> 00:17:38.769 all the way to those first months, 00:17:38.793 --> 00:17:40.777 and that's what we are doing now. 00:17:43.118 --> 00:17:46.275 Now, we can create the very best technologies 00:17:46.299 --> 00:17:49.305 and the very best methods to identify the children, 00:17:50.091 --> 00:17:53.005 but this would be for naught if we didn't have an impact 00:17:53.029 --> 00:17:55.709 on what happens in their reality in the community. 00:17:56.180 --> 00:17:58.462 Now we want those devices, of course, 00:17:58.486 --> 00:18:01.315 to be deployed by those who are in the trenches -- 00:18:01.339 --> 00:18:05.877 our colleagues, the primary care physicians, who see every child -- 00:18:06.567 --> 00:18:08.930 and we need to transform those technologies 00:18:08.954 --> 00:18:11.956 into something that is going to add value to their practice, 00:18:11.980 --> 00:18:14.166 because they have to see so many children. 00:18:14.190 --> 00:18:18.267 And we want to do that universally so that we don't miss any child. 00:18:18.291 --> 00:18:19.902 But this would be immoral 00:18:21.029 --> 00:18:26.392 if we also did not have an infrastructure for intervention, for treatment. 00:18:26.987 --> 00:18:30.879 We need to be able to work with the families, support the families, 00:18:30.903 --> 00:18:33.916 to manage those first years with them. 00:18:34.884 --> 00:18:37.282 We need to be able to really go 00:18:37.306 --> 00:18:41.228 from universal screening to universal access to treatment, 00:18:41.252 --> 00:18:44.241 because those treatments are going to change 00:18:44.265 --> 00:18:47.130 these children's and those families' lives. 00:18:48.950 --> 00:18:55.388 Now, when we think about what we [can] do in those first years, 00:18:55.412 --> 00:18:59.982 I can tell you, having been in this field for so long, 00:19:00.577 --> 00:19:02.953 one feels really rejuvenated. 00:19:03.332 --> 00:19:08.054 There is a sense that the science that one worked on 00:19:08.078 --> 00:19:10.847 can actually have an impact on realities, 00:19:10.871 --> 00:19:13.851 preventing, in fact, those experiences 00:19:14.472 --> 00:19:17.216 that I really started in my journey in this field. 00:19:17.843 --> 00:19:21.253 I thought at the time that this was an intractable condition. 00:19:21.277 --> 00:19:24.556 No longer. We can do a great deal of things. 00:19:25.207 --> 00:19:27.616 And the idea is not to cure autism. 00:19:27.640 --> 00:19:29.140 That's not the idea. 00:19:30.291 --> 00:19:32.365 What we want is to make sure 00:19:32.389 --> 00:19:34.941 that those individuals with autism can be free 00:19:34.965 --> 00:19:38.580 from the devastating consequences that come with it at times, 00:19:39.376 --> 00:19:42.437 the profound intellectual disabilities, the lack of language, 00:19:42.461 --> 00:19:44.948 the profound, profound isolation. 00:19:46.063 --> 00:19:48.309 We feel that individuals with autism, in fact, 00:19:48.333 --> 00:19:50.799 have a very special perspective on the world, 00:19:50.823 --> 00:19:52.169 and we need diversity. 00:19:52.940 --> 00:19:56.566 And they can work extremely well in some areas of strength: 00:19:56.590 --> 00:19:59.969 predictable situations, situations that can be defined. 00:19:59.993 --> 00:20:02.951 Because after all, they learn about the world 00:20:02.975 --> 00:20:04.857 almost, like, about it, 00:20:04.881 --> 00:20:07.678 rather than learning how to function in it. 00:20:07.702 --> 00:20:11.701 But this is a strength if you're working, for example, in technology. 00:20:12.581 --> 00:20:16.412 And there are those individuals who have incredible artistic abilities. 00:20:16.436 --> 00:20:18.769 We want them to be free to do that. 00:20:18.793 --> 00:20:21.912 We want that the next generations of individuals with autism 00:20:21.936 --> 00:20:25.014 will be able not only to express their strengths, 00:20:25.038 --> 00:20:26.937 but to fulfill their promise. 00:20:27.452 --> 00:20:29.199 Well, thank you for listening to me. 00:20:29.223 --> 00:20:32.703 (Applause) 00:20:35.125 --> 00:20:36.792 Host: Dr Klin, thank you. 00:20:37.427 --> 00:20:41.077 You know, this talk is generating quite a lot of talk 00:20:41.133 --> 00:20:42.934 all over the web right now, 00:20:42.974 --> 00:20:44.561 a lot of tweeting going on, 00:20:44.588 --> 00:20:47.721 and obviously a lot of interest around the issue of autism. 00:20:47.990 --> 00:20:52.069 I'm curious to know whether there are some new caregiving norms 00:20:52.094 --> 00:20:55.275 that you see - you mentioned that early intervention is the key, 00:20:55.315 --> 00:20:57.212 but if there isn't early diagnoses, 00:20:57.220 --> 00:21:00.402 is there a look that caregivers should perhaps be - 00:21:00.490 --> 00:21:03.942 evolving into new ways of caring for children that might be helpful ? 00:21:04.140 --> 00:21:08.116 Ami Klin: Well, there are ways of identifying children early. 00:21:08.148 --> 00:21:10.600 The fact that there is a slow uptake of that 00:21:10.625 --> 00:21:13.799 has something to do with the fact that people need to know how bad. 00:21:14.109 --> 00:21:17.242 That we can do a great deal for these children and families. 00:21:17.331 --> 00:21:18.982 But the interesting thing, 00:21:19.014 --> 00:21:21.704 is that the forms of treatment that are available now 00:21:21.752 --> 00:21:25.791 are not forms of treatment that would be taking place in a center. 00:21:25.838 --> 00:21:27.771 They take place in the homes. 00:21:27.815 --> 00:21:30.748 Basically, what those treatments are doing, 00:21:30.911 --> 00:21:33.711 is potentiating what every caregiver does. 00:21:33.919 --> 00:21:35.474 We need to make sure 00:21:35.490 --> 00:21:37.974 that those signals, the communication signals, 00:21:37.998 --> 00:21:39.465 the social engagement, 00:21:39.490 --> 00:21:42.116 that that happens not in a treatment session 00:21:42.188 --> 00:21:45.228 that would take place for like 30 minutes a day, 00:21:45.799 --> 00:21:48.799 we basically need every moment in these childrens' lives, 00:21:48.823 --> 00:21:50.490 to be a treatment moment. 00:21:50.601 --> 00:21:53.664 And for that, we need to both support and train parents. 00:21:53.704 --> 00:21:57.140 And that's the way those early forms of treatment take place. 00:21:57.196 --> 00:21:58.873 So there is plenty to do out there. 00:21:58.898 --> 00:22:01.573 Host: Well, it looks like people are interested in that. 00:22:01.598 --> 00:22:04.111 Thank you very much, Dr Klin. Pleasure to have you. 00:22:04.136 --> 00:22:05.136 (Applause)