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A new way to diagnose autism

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    I always wanted to become
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    a walking laboratory of social engagement,
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    to resonate other people's feelings, thoughts,
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    intentions, motivations, 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
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    even before they happen.
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    We're always in this stance of being
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    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 that we use
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    to understand ourselves, to understand
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    the world around them, is 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 when I lived
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    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. 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. But most of all,
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    they were extraordinarily isolated
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    from the world around them, 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, 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
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    is this disruption, the disruption of this resonance
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    that I am telling you.
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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
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    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, so it stands
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    to reason that nature would endow them with
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    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 rather than just
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    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,
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    they look at people's eyes, because
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    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 who are
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    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
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    that, well, there is something in between the ears
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    that is very important --
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    it's invisible, you can't see -- but is really critical,
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    and that thing is called attention.
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    And they learn soon enough, even before they can
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    utter one word that they can take that attention
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    and move somewhere in order to get things they want.
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    They also learn to follow other people's gaze,
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    because whatever people are looking at is
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    what they are thinking about.
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    And soon enough, they start to learn about the meaning
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    of things, 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
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    of that thing, the attitude, and soon enough
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    they start building this body of meanings,
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    but meanings that were acquired within the realm
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    of social interaction.
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    Those are meanings that are acquired as part
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    of their shared experiences with others.
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    Well, this is a little 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
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    two inches from her face, and she's quite oblivious to me.
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    Imagine if I did that to you,
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    and I 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. (Laughter)
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    You would do something, because it's literally impossible
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    to penetrate somebody's physical space
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    and not get a reaction.
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    We do so, remember, intuitively, effortlessly.
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    This is our body wisdom. It's not something that is
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    mediated by our language. 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 phylatic cousins,
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    because if you're a monkey,
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    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 them 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, act socially.
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    Now, she is oblivious to me, and I am 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, she goes to the corner of
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    the room, 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
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    by sharing experiences.
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    Now, what she is doing right now is that
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    her path of learning is diverging 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 are 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, this is what's happening
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    with her mind 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
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    intellectually disabled, 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
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    in their school, you see them running the periphery fence
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    of the school all 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, we thought that there were
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    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 U.S. alone, maybe 35 to 80 billion dollars,
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    and you know what? Most of those funds are associated
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    with adolescents and particularly adults
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    who are severely disabled,
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    individuals who need wrap-around services, services
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    that are very, very intensive, and those services
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    can cost in excess of 60 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 they diverge in that pathway of learning
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    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, and this has been probably
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    something that has changed my life in the past 10 years,
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    this notion that we can absolutely attenuate
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    this condition.
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    Also, we have a window of opportunity, because
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    the brain is malleable for just so long,
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    and that window of opportunity happens
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    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 that we are
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    condemning those communities to have individuals
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    with autism whose condition is going to be more severe.
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    So I feel that we have a bio-ethical imperative.
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    The science is there,
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    but no science is of relevance if it doesn't have an impact
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    on the community, and we just can't afford
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    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 that 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
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    with autism. In fact, we believe that 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
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    to the actual syndrome? 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
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    two years of life, because those liabilities
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    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,
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    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-older,
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    that the thing that came to 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, so we had to create
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    the technologies. 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 we've been building
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    these new technologies that are based on eye tracking.
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    We can see moment by moment
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    what children are engaging with.
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    Well, this is my colleague Warren Jones, with whom
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    we've been building these methods, these studies,
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    for the past 12 years,
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    and you see there a happy five-month-older,
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    it's a five-month little boy who is going to watch things
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    that are brought from his world,
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    his mom, the caregiver, but also experiences
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    that he would have were he to be in his daycare.
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    What we want is to embrace that world
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    and bring it into our laboratory,
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    but in order for us to do that, we had to create
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    these very sophisticated measures,
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    measures of how people, how little babies,
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    how newborns, engage with the world,
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    moment by moment,
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    what is important, and what is not.
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    Well, we created those measures, and here,
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    what you see is what we call a funnel of attention.
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    You're watching a video.
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    Those frames are separated by about a second
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    through the eyes of 35 typically developing
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    two-year-olds,
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    and we freeze one frame,
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    and this is what the typical children are doing.
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    In this scan pass, in green here, are two-year-olds with autism.
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    So on that frame, the children who are typical
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    are watching this,
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    the emotion of expression of that little boy
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    as he's fighting a little bit with the little girl.
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    What are the children with autism doing?
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    They are focusing on the revolving door,
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    opening and shutting.
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    Well, I can tell you that this divergence
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    that you're seeing here
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    doesn't happen only in our five-minute experiment.
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    It happens moment by moment in their real lives,
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    and their minds are being formed,
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    and their brains are being specialized in something other
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    than what is happening with their typical peers.
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    Well, we took a construct from
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    our pediatrician friends,
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    the concept of growth charts.
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    You know, when you take a child to the pediatrician,
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    and so you have physical height, and weight.
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    Well we decided that we're going to create growth charts
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    of social engagement,
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    and we sought children from the time that they are born,
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    and what you see here on the x-axis is two, three, four,
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    five, six months and nine, until about the age of 24 months,
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    and this is the percent of their viewing time
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    that they are focusing on people's eyes,
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    and this is their growth chart.
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    They start over here, they love people's eyes,
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    and it remains quite stable.
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    It sort of goes up a little bit in those initial months.
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    Now, let's see what's happening with babies
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    who became autistic.
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    It's something very different.
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    It starts way up here, but then it's a free fall.
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    It's very much like they brought into this world the reflex
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    that orients them to people, but it has no traction.
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    It's almost as if that stimulus, you,
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    you're not exerting influence on what happens
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    as they navigate their daily lives.
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    Now, we thought that those data were so powerful
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    in a way, that we wanted to see what happened
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    in the first six months of life, because if you interact
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    with a two- and a three-month-older,
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    you'd be surprised by how social those babies are.
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    And what we see in the first six months of life
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    is that those two groups can be segregated very easily.
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    And using these kinds of measures, and many others,
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    what we found out is that our science could, in fact,
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    identify this condition early on.
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    We didn't have to wait for the behaviors of autism
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    to emerge in the second year of life.
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    If we measured things that are, evolutionarily,
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    highly conserved, and developmentally very early emerging,
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    things that are online from the first weeks of life,
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    we could push the detection of autism
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    all the way to those first months,
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    and that's what we are doing now.
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    Now, we can create the very best technologies
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    and the very best methods to identify the children,
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    but this would be for naught if we didn't have an impact
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    on what happens in their reality in the community.
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    Now we want those devices, of course,
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    to be deployed by those who are in the trenches,
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    our colleagues, the primary care physicians,
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    who see every child,
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    and we need to transform those technologies
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    into something that is going to add value to their practice,
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    because they have to see so many children.
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    And we want to do that universally
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    so that we don't miss any child,
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    but this would be immoral
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    if we also did not have an infrastructure for intervention,
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    for treatment.
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    We need to be able to work with the families,
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    to support the families, to manage those first years
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    with them. We need to be able to really go
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    from universal screening to universal access to treatment,
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    because those treatments are going to change
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    these children's and those families' lives.
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    Now, when we think about what we [can] do
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    in those first years,
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    I can tell you,
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    having been in this field for so long,
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    one feels really rejuvenated.
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    There is a sense that the science that one worked on
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    can actually have an impact on realities,
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    preventing, in fact, those experiences
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    that I really started in my journey in this field.
  • 18:11 - 18:14
    I thought at the time that this was an intractable condition.
  • 18:14 - 18:18
    No longer. We can do a great deal of things.
  • 18:18 - 18:21
    And the idea is not to cure autism.
  • 18:21 - 18:24
    That's not the idea.
  • 18:24 - 18:26
    What we want is to make sure
  • 18:26 - 18:28
    that those individuals with autism can be free from
  • 18:28 - 18:33
    the devastating consequences that come with it at times,
  • 18:33 - 18:36
    the profound intellectual disabilities, the lack of language,
  • 18:36 - 18:39
    the profound, profound isolation.
  • 18:39 - 18:42
    We feel that individuals with autism, in fact,
  • 18:42 - 18:44
    have a very special perspective on the world,
  • 18:44 - 18:48
    and we need diversity, and they can work extremely well
  • 18:48 - 18:50
    in some areas of strength:
  • 18:50 - 18:53
    predictable situations, situations that can be defined.
  • 18:53 - 18:57
    Because after all, they learn about the world almost like
  • 18:57 - 19:01
    about it, rather than learning how to function in it.
  • 19:01 - 19:04
    But this is a strength, if you're working, for example,
  • 19:04 - 19:06
    in technology.
  • 19:06 - 19:08
    And there are those individuals who have incredible
  • 19:08 - 19:10
    artistic abilities.
  • 19:10 - 19:12
    We want them to be free of that.
  • 19:12 - 19:15
    We want that the next generations of individuals with autism
  • 19:15 - 19:18
    will be able not only to express their strengths
  • 19:18 - 19:20
    but to fulfill their promise.
  • 19:20 - 19:24
    Well thank you for listening to me. (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.)

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Video Language:
English
Team:
closed TED
Project:
TEDTalks
Duration:
19:44
  • 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."

English subtitles

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