A new way to diagnose autism
-
0:01 - 0:05I always wanted to become
a walking laboratory of social engagement: -
0:06 - 0:12to resonate other people's feelings,
thoughts, intentions, motivations, -
0:12 - 0:13in the act of being with them.
-
0:15 - 0:20As a scientist, I always wanted
to measure that resonance, -
0:21 - 0:23that sense of the other
that happens so quickly, -
0:23 - 0:25in the blink of an eye.
-
0:26 - 0:28We intuit other people's feelings;
-
0:28 - 0:31we know the meaning of their actions
even before they happen. -
0:32 - 0:34We're always in this stance
-
0:34 - 0:37of being the object
of somebody else's subjectivity. -
0:37 - 0:40We do that all the time.
We just can't shake it off. -
0:40 - 0:44It's so important that the very tools
we use to understand ourselves, -
0:44 - 0:46to understand the world around us,
-
0:46 - 0:47are shaped by that stance.
-
0:48 - 0:50We are social to the core.
-
0:52 - 0:54So my journey in autism really started
-
0:54 - 0:58when I lived in a residential unit
for adults with autism. -
0:58 - 1:01Most of those individuals
had spent most of their lives -
1:01 - 1:03in long-stay hospitals.
-
1:03 - 1:04This is a long time ago.
-
1:05 - 1:09And for them, autism was devastating.
-
1:09 - 1:12They had profound
intellectual disabilities. -
1:13 - 1:14They didn't talk.
-
1:14 - 1:16But most of all,
-
1:16 - 1:21they were extraordinarily isolated
from the world around them, -
1:21 - 1:23from their environment
-
1:23 - 1:25and from the people.
-
1:25 - 1:28In fact, at the time,
if you walked into a school -
1:28 - 1:30for individuals with autism,
-
1:30 - 1:32you'd hear a lot of noise,
-
1:32 - 1:36plenty of commotion, actions,
people doing things. -
1:38 - 1:40But they're always doing
things by themselves. -
1:41 - 1:45So they may be looking
at a light in the ceiling, -
1:46 - 1:48or they may be isolated in the corner,
-
1:49 - 1:52or they might be engaged
in these repetitive movements, -
1:52 - 1:56in self-stimulatory movements
that led them nowhere. -
1:57 - 1:59Extremely, extremely isolated.
-
2:01 - 2:06Well, now we know that autism
is this disruption, -
2:06 - 2:10the disruption of this resonance
that I am telling you about. -
2:10 - 2:12These are survival skills.
-
2:12 - 2:14These are survival skills
that we inherited -
2:15 - 2:18over many, many hundreds
of thousands of years of evolution. -
2:19 - 2:24You see, babies are born
in a state of utter fragility. -
2:24 - 2:26Without the caregiver,
they wouldn't survive, -
2:26 - 2:29so it stands to reason
that nature would endow them -
2:29 - 2:30with these mechanisms of survival.
-
2:32 - 2:34They orient to the caregiver.
-
2:35 - 2:37From the first days and weeks of life,
-
2:38 - 2:41babies prefer to hear human sounds,
-
2:41 - 2:43rather than just sounds
in the environment. -
2:43 - 2:45They prefer to look at people
rather than at things, -
2:45 - 2:49and even as they're looking at people,
they look at people's eyes, -
2:50 - 2:54because the eye is the window
to the other person's experiences, -
2:54 - 2:56so much so that they even prefer
to look at people -
2:56 - 3:00who are looking at them
rather than people who are looking away. -
3:01 - 3:03Well, they orient to the caregiver.
-
3:03 - 3:05The caregiver seeks the baby.
-
3:05 - 3:09And it's out of this mutually
reinforcing choreography -
3:09 - 3:13that a lot that is of importance
to the emergence of mind -- -
3:13 - 3:16the social mind, the social
brain -- depends on. -
3:18 - 3:21We always think about autism
-
3:21 - 3:25as something that happens
later on in life. -
3:25 - 3:29It doesn't; it begins
with the beginning of life. -
3:31 - 3:36As babies engage with caregivers,
they soon realize that, well, -
3:37 - 3:41there is something between the ears
that is very important -- -
3:41 - 3:44it's invisible, you can't see it,
but it's really critical. -
3:45 - 3:47And that thing is called attention.
-
3:47 - 3:48And they learn soon enough,
-
3:48 - 3:51even before they can utter one word,
-
3:51 - 3:54that they can take that attention
and move somewhere -
3:54 - 3:56in order to get things they want.
-
3:58 - 4:01They also learn to follow
other people's gazes, -
4:01 - 4:05because whatever people are looking at
is what they are thinking about. -
4:07 - 4:10And soon enough, they start to learn
about the meaning of things, -
4:10 - 4:13because when somebody
is looking at something -
4:13 - 4:15or somebody is pointing at something,
-
4:15 - 4:17they're not just getting
a directional cue. -
4:18 - 4:21They are getting the other
person's meaning of that thing, -
4:21 - 4:23the attitude.
-
4:23 - 4:27And soon enough, they start
building this body of meanings, -
4:27 - 4:31but meanings that were acquired
within the realm of social interaction. -
4:32 - 4:34Those are meanings that are acquired
-
4:34 - 4:37as part of their shared
experiences with others. -
4:38 - 4:44Well, this is a 15-month-old little girl,
-
4:46 - 4:47and she has autism.
-
4:49 - 4:54And I am coming so close to her
that I am maybe two inches from her face, -
4:54 - 4:56and she's quite oblivious to me.
-
4:56 - 5:00Imagine if I did that to you,
came two inches from your face. -
5:00 - 5:02You'd do probably
two things, wouldn't you? -
5:02 - 5:05You would recoil.
You would call the police. -
5:05 - 5:06(Laughter)
-
5:06 - 5:07You would do something,
-
5:07 - 5:11because it's literally impossible
to penetrate somebody's physical space -
5:11 - 5:12and not get that reaction.
-
5:12 - 5:16We do so, remember,
intuitively, effortlessly. -
5:16 - 5:17This is our body wisdom;
-
5:17 - 5:19it's not something mediated
by our language. -
5:19 - 5:22Our body just knows that.
-
5:22 - 5:25And we've known that for a long time.
-
5:25 - 5:28And this is not something
that happens to humans only. -
5:28 - 5:31It happens to some
of our phyletic cousins, -
5:31 - 5:35because if you're a monkey,
and you look at another monkey, -
5:35 - 5:39and that monkey has a higher
hierarchy position than you, -
5:39 - 5:42and that is considered
to be a signal or threat, -
5:42 - 5:45well, you are not going
to be alive for long. -
5:45 - 5:50So something that in other species
are survival mechanisms, -
5:50 - 5:53without which they
wouldn't basically live, -
5:53 - 5:56we bring into the context of human beings,
-
5:56 - 6:00and this is what we need
to simply act, socially. -
6:00 - 6:03Now, she is oblivious to me
and I'm so close to her, -
6:03 - 6:05and you think, maybe she can see you,
-
6:05 - 6:06maybe she can hear you.
-
6:07 - 6:08Well, a few minutes later,
-
6:08 - 6:10she goes to the corner of the room,
-
6:10 - 6:14and she finds a tiny little piece
of candy, an M&M. -
6:15 - 6:19So I could not attract her attention,
-
6:19 - 6:21but something -- a thing -- did.
-
6:22 - 6:24Now, most of us make a big dichotomy
-
6:24 - 6:27between the world of things
and the world of people. -
6:29 - 6:33Now, for this girl,
that division line is not so clear, -
6:33 - 6:37and the world of people
is not attracting her -
6:37 - 6:38as much as we would like.
-
6:38 - 6:42Now, remember that we learn a great deal
by sharing experiences. -
6:42 - 6:48What she is doing right now
is that her path of learning is diverging, -
6:48 - 6:50moment by moment,
-
6:50 - 6:53as she is isolating herself
further and further. -
6:54 - 6:57So we feel sometimes
that the brain is deterministic, -
6:57 - 6:59the brain determines
who we're going to be. -
6:59 - 7:02But, in fact, the brain
also becomes who we are, -
7:02 - 7:06and at the same time
that her behaviors are taking away -
7:06 - 7:08from the realm of social interaction,
-
7:08 - 7:10this is what's happening with her mind,
-
7:10 - 7:13and this is what's happening
with her brain. -
7:15 - 7:20Well, autism is the most strongly
genetic condition -
7:20 - 7:22of all developmental disorders.
-
7:24 - 7:26And it's a brain disorder.
-
7:27 - 7:30It's a disorder that begins
much prior to the time -
7:30 - 7:31that the child is born.
-
7:32 - 7:36We now know that there is a very
broad spectrum of autism. -
7:36 - 7:40There are those individuals
who are profoundly intellectually disabled -
7:40 - 7:42but there are those that are gifted.
-
7:42 - 7:44There are those individuals
who don't talk at all; -
7:44 - 7:47there are those individuals
who talk too much. -
7:47 - 7:50There are those individuals
that if you observe them in their school, -
7:50 - 7:54you see them running the periphery fence
all the school day if you let them, -
7:54 - 7:56to those individuals
who cannot stop coming to you -
7:56 - 7:59and trying to engage you
repeatedly, relentlessly, -
7:59 - 8:01but often in an awkward fashion,
-
8:02 - 8:05without that immediate resonance.
-
8:06 - 8:10Well, this is much more prevalent
than we thought at the time. -
8:10 - 8:11When I started in this field,
-
8:11 - 8:14we thought there were four individuals
with autism per 10,000 -- -
8:14 - 8:15a very rare condition.
-
8:16 - 8:20Well, now we know it's more
like one in 100. -
8:20 - 8:23There are millions of individuals
with autism all around us. -
8:25 - 8:28The societal cost
of this condition is huge, -
8:29 - 8:32in the US alone,
maybe 35 to 80 billion dollars. -
8:32 - 8:33And you know what?
-
8:33 - 8:37Most of those funds are associated
with adolescents and particularly adults -
8:37 - 8:39who are severely disabled,
-
8:39 - 8:41individuals who need
wraparound services -- -
8:41 - 8:44services that are very, very intensive.
-
8:44 - 8:48And those services can cost in excess
of 60,000 to 80,000 dollars a year. -
8:49 - 8:52Those are individuals who did not
benefit from early treatment, -
8:52 - 8:57because now we know
that autism creates itself -
8:57 - 9:01as individuals diverge in that pathway
of learning that I mentioned to you. -
9:01 - 9:04Were we to be able
to identify this condition -
9:04 - 9:07at an earlier point,
and intervene and treat -- -
9:08 - 9:12I can tell you, this has been probably
something that has changed my life -
9:12 - 9:13in the past 10 years,
-
9:13 - 9:17this notion that we can absolutely
attenuate this condition. -
9:19 - 9:21Also, we have a window of opportunity,
-
9:21 - 9:24because the brain
is malleable for just so long, -
9:24 - 9:28and that window of opportunity
happens in the first three years of life. -
9:28 - 9:31It's not that that window
closes; it doesn't. -
9:32 - 9:34But it diminishes considerably.
-
9:35 - 9:38And yet, the median age
of diagnosis in this country -
9:38 - 9:40is still about five years,
-
9:40 - 9:42and in disadvantaged populations,
-
9:42 - 9:45the populations that don't have
access to clinical services, -
9:45 - 9:48rural populations, minorities,
-
9:48 - 9:51the age of diagnosis is later still,
-
9:51 - 9:53which is almost as if I were to tell you
-
9:53 - 9:57that we are condemning those communities
to have individuals with autism -
9:57 - 9:59whose condition is going
to be more severe. -
10:00 - 10:03So I feel that we have
a bioethical imperative. -
10:03 - 10:05The science is there.
-
10:06 - 10:08But no science is of relevance
-
10:08 - 10:11if it doesn't have an impact
on the community. -
10:12 - 10:15And we just can't afford
that missed opportunity, -
10:15 - 10:18because children with autism
become adults with autism. -
10:18 - 10:22And we feel that those things we can do
-
10:22 - 10:25for these children,
for those families, early on, -
10:25 - 10:27will have lifetime consequences --
-
10:27 - 10:31for the child, for the family,
and for the community at large. -
10:31 - 10:34So this is our view of autism.
-
10:34 - 10:37There are over a hundred genes
that are associated with autism. -
10:37 - 10:39In fact, we believe there are going to be
-
10:39 - 10:43something between 300 and 600
genes associated with autism, -
10:43 - 10:47and genetic anomalies,
much more than just genes. -
10:47 - 10:51And we actually have
a bit of a question here, -
10:52 - 10:55because if there are so many
different causes of autism, -
10:55 - 10:59how do you go from those liabilities
to the actual syndrome? -
10:59 - 11:01Because people like myself,
-
11:02 - 11:04when we walk into a playroom,
-
11:04 - 11:06we recognize a child as having autism.
-
11:07 - 11:09So how do you go from multiple causes
-
11:09 - 11:11to a syndrome that has some homogeneity?
-
11:12 - 11:15And the answer is what lies in between,
-
11:16 - 11:17which is development.
-
11:18 - 11:22And in fact, we are very interested
in those first two years of life, -
11:22 - 11:26because those liabilities
don't necessarily convert into autism. -
11:26 - 11:28Autism creates itself.
-
11:29 - 11:33Were we to be able to intervene
during those years of life, -
11:34 - 11:39we might attenuate for some, and God
knows, maybe even prevent for others. -
11:40 - 11:41So how do we do that?
-
11:42 - 11:45How do we enter that feeling of resonance,
-
11:45 - 11:48how do we enter another person's being?
-
11:49 - 11:52I remember when I interacted
with that 15-month-old, -
11:52 - 11:54the thing that came to my mind was,
-
11:54 - 11:57"How do you come into her world?
-
11:57 - 12:01Is she thinking about me?
Is she thinking about others?" -
12:02 - 12:05Well, it's hard to do that,
-
12:05 - 12:07so we had to create the technologies.
-
12:07 - 12:09We had to basically step inside a body.
-
12:09 - 12:12We had to see the world through her eyes.
-
12:13 - 12:16And so in the past many years,
-
12:16 - 12:18we've been building these new technologies
-
12:18 - 12:20that are based on eye tracking.
-
12:20 - 12:24We can see, moment by moment,
what children are engaging with. -
12:26 - 12:28This is my colleague, Warren Jones,
-
12:28 - 12:31with whom we've been building
these methods, these studies, -
12:31 - 12:32for the past 12 years.
-
12:33 - 12:36And you see there a happy five-month-old,
-
12:37 - 12:42a five-month little boy
who is going to watch things -
12:42 - 12:44that are brought from his world:
-
12:45 - 12:47his mom, the caregiver,
-
12:47 - 12:51but also experiences that he would have
were he to be in his daycare. -
12:52 - 12:56What we want is to embrace that world
and bring it into our laboratory, -
12:56 - 12:58but in order for us to do that,
-
12:58 - 13:02we had to create
these very sophisticated measures, -
13:02 - 13:06measures of how people, how little babies,
-
13:06 - 13:10how newborns, engage
with the world, moment by moment. -
13:10 - 13:12What is important and what is not.
-
13:13 - 13:16Well, we created those measures,
-
13:16 - 13:19and here, what you see
is what we call a funnel of attention. -
13:20 - 13:21You're watching a video --
-
13:22 - 13:24those frames are separated
by about a second -- -
13:24 - 13:28through the eyes of 35 typically
developing two-year-olds. -
13:29 - 13:31And we freeze one frame,
-
13:32 - 13:35and this is what the typical
children are doing. -
13:35 - 13:39In this scan pass, in green here,
are two-year-olds with autism. -
13:39 - 13:45So on that frame, the children
who are typical are watching this, -
13:46 - 13:49the emotion of expression
of that little boy -
13:49 - 13:51as he's fighting a little bit
with the little girl. -
13:51 - 13:53What are the children with autism doing?
-
13:53 - 13:56They are focusing on the revolving door,
-
13:57 - 13:59opening and shutting.
-
14:00 - 14:03Well, I can tell you that this divergence
that you're seeing here -
14:03 - 14:06doesn't happen only
in our five-minute experiment. -
14:06 - 14:09It happens moment by moment
in their real lives, -
14:10 - 14:14and their minds are being formed
and their brains are being specialized -
14:14 - 14:18in something other than what is happening
with their typical peers. -
14:19 - 14:25Well, we took a construct
from our pediatrician friends, -
14:25 - 14:27the concept of growth charts --
-
14:27 - 14:29you know, when you take
a child to the pediatrician, -
14:29 - 14:32and you have physical height and weight.
-
14:33 - 14:36Well, we decided we were going
to create growth charts -
14:36 - 14:37of social engagement.
-
14:38 - 14:41We sought children
from the time they're born. -
14:42 - 14:45What you see here on the x-axis
-
14:45 - 14:49is two, three, four, five,
six months and nine, -
14:49 - 14:51until about the age of 24 months.
-
14:51 - 14:54This is the percent of their viewing time
-
14:54 - 14:56that they're focusing on people's eyes,
-
14:56 - 14:58and this is their growth chart.
-
14:58 - 15:01They start over here --
they love people's eyes -- -
15:01 - 15:03and it remains quite stable.
-
15:03 - 15:07It sort of goes up a little bit
in those initial months. -
15:07 - 15:11Now, let's see what's happening
with babies who became autistic. -
15:12 - 15:13It's something very different.
-
15:14 - 15:17It starts way up here,
but then it's a free fall. -
15:18 - 15:22It's very much like they brought
into this world the reflex -
15:22 - 15:25that orients them to people,
but it has no traction. -
15:26 - 15:28It's almost as if that stimulus -- you --
-
15:29 - 15:32you're not exerting
influence on what happens -
15:32 - 15:34as they navigate their daily lives.
-
15:35 - 15:42Now, we thought those data
were so powerful, in a way, -
15:43 - 15:46that we wanted to see what happened
in the first six months of life, -
15:46 - 15:49because if you interact
with a two- and a three-month-old, -
15:49 - 15:52you'd be surprised
by how social those babies are. -
15:54 - 15:56And what we see
in the first six months of life -
15:56 - 16:01is that those two groups
can be segregated very easily. -
16:02 - 16:05And using these kinds
of measures and many others, -
16:05 - 16:09what we found out
is that our science could, in fact, -
16:09 - 16:11identify this condition early on.
-
16:12 - 16:15We didn't have to wait
for the behaviors of autism -
16:15 - 16:17to emerge in the second year of life.
-
16:18 - 16:23If we measured things that are,
evolutionarily, highly conserved, -
16:23 - 16:25and developmentally very early-emerging --
-
16:25 - 16:28things that are online
from the first weeks of life -- -
16:28 - 16:30we could push the detection of autism
-
16:30 - 16:32all the way to those first months,
-
16:32 - 16:34and that's what we are doing now.
-
16:37 - 16:40Now, we can create
the very best technologies -
16:40 - 16:43and the very best methods
to identify the children, -
16:44 - 16:47but this would be for naught
if we didn't have an impact -
16:47 - 16:49on what happens in their reality
in the community. -
16:50 - 16:52Now we want those devices, of course,
-
16:52 - 16:55to be deployed by those
who are in the trenches -- -
16:55 - 16:59our colleagues, the primary care
physicians, who see every child -- -
17:00 - 17:02and we need to transform
those technologies -
17:02 - 17:05into something that is going
to add value to their practice, -
17:05 - 17:08because they have to see so many children.
-
17:08 - 17:12And we want to do that universally
so that we don't miss any child. -
17:12 - 17:13But this would be immoral
-
17:15 - 17:20if we also did not have an infrastructure
for intervention, for treatment. -
17:20 - 17:24We need to be able to work
with the families, support the families, -
17:24 - 17:27to manage those first years with them.
-
17:28 - 17:31We need to be able to really go
-
17:31 - 17:35from universal screening
to universal access to treatment, -
17:35 - 17:38because those treatments
are going to change -
17:38 - 17:41these children's
and those families' lives. -
17:42 - 17:49Now, when we think about what we [can]
do in those first years, -
17:49 - 17:53I can tell you, having been
in this field for so long, -
17:54 - 17:56one feels really rejuvenated.
-
17:57 - 18:02There is a sense that the science
that one worked on -
18:02 - 18:04can actually have an impact on realities,
-
18:04 - 18:07preventing, in fact, those experiences
-
18:08 - 18:11that I really started
in my journey in this field. -
18:11 - 18:15I thought at the time
that this was an intractable condition. -
18:15 - 18:18No longer. We can do
a great deal of things. -
18:19 - 18:21And the idea is not to cure autism.
-
18:21 - 18:23That's not the idea.
-
18:24 - 18:26What we want is to make sure
-
18:26 - 18:28that those individuals
with autism can be free -
18:28 - 18:32from the devastating consequences
that come with it at times, -
18:33 - 18:36the profound intellectual disabilities,
the lack of language, -
18:36 - 18:38the profound, profound isolation.
-
18:40 - 18:42We feel that individuals
with autism, in fact, -
18:42 - 18:44have a very special
perspective on the world, -
18:44 - 18:46and we need diversity.
-
18:46 - 18:50And they can work extremely well
in some areas of strength: -
18:50 - 18:53predictable situations,
situations that can be defined. -
18:53 - 18:56Because after all,
they learn about the world -
18:56 - 18:58almost, like, about it,
-
18:58 - 19:01rather than learning
how to function in it. -
19:01 - 19:05But this is a strength if you're working,
for example, in technology. -
19:06 - 19:10And there are those individuals
who have incredible artistic abilities. -
19:10 - 19:12We want them to be free to do that.
-
19:12 - 19:15We want that the next generations
of individuals with autism -
19:15 - 19:19will be able not only
to express their strengths, -
19:19 - 19:20but to fulfill their promise.
-
19:21 - 19:23Well, thank you for listening to me.
-
19:23 - 19:25(Applause)
- Title:
- A new way to diagnose autism
- Speaker:
- Ami Klin
- Description:
-
Early diagnosis of autism spectrum disorder can improve the lives of everyone affected, but the complex network of causes make it incredibly difficult to predict. At TEDxPeachtree, Ami Klin describes a new early detection method that uses eye-tracking technologies to gauge babies' social engagement skills and reliably measure their risk of developing autism. (Filmed at TEDxPeachTree.)
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDTalks
- Duration:
- 19:44
Krystian Aparta commented on English subtitles for A new way to diagnose autism | ||
Krystian Aparta edited English subtitles for A new way to diagnose autism | ||
Krystian Aparta edited English subtitles for A new way to diagnose autism | ||
Morton Bast edited English subtitles for A new way to diagnose autism | ||
Morton Bast edited English subtitles for A new way to diagnose autism | ||
Thu-Huong Ha approved English subtitles for A new way to diagnose autism | ||
Thu-Huong Ha edited English subtitles for A new way to diagnose autism | ||
Thu-Huong Ha edited English subtitles for A new way to diagnose autism |
Krystian Aparta
The English transcript was updated on 11/21/2016. At 05:27, "phylatic" was changed to "phyletic." At 13:46, "emotion of expression" was changed to "emotional expression."