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Is There an Up Side to Autism?


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Is There an Up Side to Autism?

Society's Negative Bias Toward Autism Needs Rethinking, Expert Says

Yael Waknine

November 7, 2011 — Autism may be an advantage in some settings and should not be viewed as a defect that needs suppressing, according to a provocative article published online November 2 in Nature. Laurent_Mottron_120x156.png

Dr. Laurent Mottron

"Recent data and my own personal experience suggest it's time to start thinking of autism as an advantage in some spheres, not a cross to bear," author Laurent Mottron, MD, PhD, from the University of Montreal's Centre for Excellence in Pervasive Development Disorders, toldMedscape Medical News.

According to the article, the definition of autism itself is biased, being characterized by "a suite of negative characteristics," focusing on deficits that include problems with language and social interactions. However, in certain settings, such as scientific research, people with autism exhibit cognitive strength.

"We think that the kind of strengths and cognitive profile that we find in autistics are much more specific than scientists usually acknowledge," said Dr. Mottron.

"Unfortunately, there is no gold standard for the diagnosis of autism. Clinical diagnoses are reliable among scientists, but it is just a consensus...everybody may fail."

He noted that as a result of a diagnosis, many individuals with autism end up working at repetitive, menial jobs despite their potential to make more significant contributions to society.

"After 18 years of age they're not kids anymore, and they're forgotten," he said. "People have a cliché, that if he's autistic you can do nothing with him. That's not true. The fact that you have some terrible autistic life is not representative of autism in general."

Advantages

Autism should be described and investigated as an accepted variant within human species, not as a defect to be suppressed.

Dr. Mottron has 8 individuals with autism people in his research group including 4 assistants, 3 students, and 1 researcher, Michelle Dawson, whom he met almost 10 years ago during a television documentary about autism.

Following the show, Ms. Dawson experienced problems in her job as a postal worker and was asked by Dr. Mottron to edit some of his papers.

"She gave exceptional feedback, and it was clear that she had read the entire bibliography," Dr. Mottron noted. Her single-minded autistic abilities to discern patterns out of mountains of data and instant recall of correct information made her perfectly suited to a career in science, he said.

Though lacking a formal doctorate, Ms Dawson has since coauthored 13 papers and several book chapters.

Dr. Mottron said Ms. Dawson and other individuals with autism have convinced him that more than anything, people with autism "need opportunities, [and] frequently support, but rarely treatment."

As a result, he believes that "autism should be described and investigated as an accepted variant within human species, not as a defect to be suppressed."

Dr. Mottron noted that autistic brains do function differently, relying less on verbal centers and demonstrating stimulation in regions that process both visual information and language.

Advantages may include spotting a pattern in a distracting environment, auditory tasks such as discriminating sound pitches, detecting visual structures, and mentally manipulating complex 3-dimensional shapes.

Individuals with autism also perform Raven's Matrices at an average of 40% faster than nonautistics, using their analytical skills to complete an ongoing visual pattern.

Other benefits of autism include the ability to simultaneously process large amounts of perceptual information as data sets and the presence of instantaneous and correct recall.

Because data and facts are of paramount importance to people with autism, they also tend not to get bogged down in career politics or seek popularity via promotional publishing; online essays such as those posted by Ms. Dawson in her blog may instead receive unintentional acclaim.

Intellectual Disability Not Intrinsic

What we know is that if we reach these individuals at a young age, when their brains are malleable, we can cognitively redirect the transmission of information via the corpus callosum to the speech areas in the left hemisphere of the brain and oftentimes speech and language will kick in.

"I no longer believe intellectual disability is intrinsic to autism," Dr. Mottron said, noting that intelligence in people with autism should be measured with nonverbal tests.

In his article, Dr. Mottron cites recent data, including an epidemiological study that showed the disorder is 3.5 times more prevalent than common statistics suggest.

He noted that the study showed that many of those with autism have "no adaptive problems at all," and can function relatively normally.

However, he added, a focus on "normocentrism" prevails in some countries. France, for example, has proposed mandatory interventions aimed at forcing children with autism to adopt "typical" learning and social behaviors, rather than allowing them to make the most of their differently wired brains.

Dr. Mottron finds such a concept concerning.

"There is no current treatment for autism, just educational strategies that do not put the emphasis on learning abilities for nonsocial information.... [W]e need to take their learning style for what it is and feed it," he said. ht_111107_joanne_lara_120x156.png

Joanne Lara

Some of these therapies may include engaging children with autism in a music and movement program, said Joanne Lara, MA, founder of Autism Movement Therapy, Inc, in an interview with Medscape Medical News.

"What we know is that if we reach these individuals at a young age, when their brains are malleable, we can cognitively redirect the transmission of information via the corpus callosum to the speech areas in the left hemisphere of the brain, and oftentimes speech and language will kick in."

She continued: "The audio processing of music in the brain combined with the forward, backward, and side-to-side movements stimulate and activate the dormant areas of the brain that, in autism, do not generally receive transmission of neurons.

"Movement and music, when combined with gross motor and visual processing, oftentimes helps the areas of the brain of the individual with autism to work together to allow for a whole-brain processing approach," she added.

Counterpoint ht_111107_jonathan_tarbox_120x156.png

Dr. Jonathan Tarbox

"I think it's critically important to acknowledge the potential strengths associated with autism, but it's equally important, if not more important, to reiterate the notion of the right to effective treatment," Jonathan Tarbox, PhD, BCBA-D, director of research and development at the Center for Autism and Related Disorders, Tarzana, California, toldMedscape Medical News.

"If an individual with [autism] is having a difficult time in their life because they don't know how to do something that they want to do, and there is a proven effective method to teach that skill, then we as fellow humans have a moral and ethical responsibility to provide the treatment that addresses it," he said.

Behavioral intervention programs, he said, should be used in a supportive environment to treat skill deficits in individuals with autism wanting to learn, similar to those used for literacy and mathematics. He added that autism is no different: People who have skill deficits and want to learn have a right to effective treatment.

Dr. Tarbox took exception to Dr. Mottron's contention that individuals with autism need opportunity more than treatment.

Environmental support, he said, does create opportunity. In addition, he noted that research shows that early intensive behavioral intervention increases the ability to communicate and function independently.

"How can a newly found ability to communicate not be considered an opportunity?" he said.

One of Dr. Mottron's main points is that the performance of individuals with autism on visual intelligence tests is often overlooked, showing that the true intelligence of people with autism is higher overall than verbal intelligence tests would indicate.

"This is, of course, true, but true intelligence is of little relevance to a person's everyday quality of life. What really matters is one's ability to do what one wants to do in life independently; that is, without having to rely on support from others," said Dr. Tarbox.

There are many people, autistic and nonautistic, who have superior intelligence, but still have much difficulty in life and suffer for it.

"There are many people, autistic and nonautistic, who have superior intelligence but still have much difficulty in life and suffer for it. Unfortunately, vocal language is the medium with which most humans interact, so deficits in one's ability to vocally communicate are going to create barriers for people."

Dr. Mottron also states that no education programs are tailored to the unique ways that people with autism learn.

However, Dr. Tarbox noted that there are "many tens of thousands of special education teachers, speech and language pathologists, and applied behavior analysts working to change what they do to help individuals with autism learn."

The aim of behavioral interventions, he added, is not to try to teach individuals with autism to adopt typical learning and behavior but, rather, to teach skills that help increase independence.

Such programs, he said, "teach skills that open doors for individuals with autism, but they do not dictate which door to take."

First-Hand Experience

I think what Dr. Mottron was getting to is the idea that autism is a different way of being, not necessary a disordered way of being, and the difference can give us strengths and abilities that other people may not have.

"I think what Dr. Mottron was getting to is the idea that autism is a different way of being, not necessary a disordered way of being, and the difference can give us strengths and abilities that other people may not have," said Stephen M. Shore, EdD, assistant professor at Adelphi University in Long Island, New York, in an interview with Medscape Medical News, citing the well-known accomplishments of Temple Grandin, PhD.

"At the same time, there are many challenges that come with being on the autistic spectrum, such as sensory issues, communication, interacting with others. These things are challenges, and we do have to address them," Dr. Shore noted. ht_111107_steve_cover_120x156.png

Dr. Stephen M. Shore

Diagnosed himself with autism at age 2 and a half years, and nonverbal until age 4 years, Dr. Shore was originally recommended for institutionalization. With the help of family and others, he completed a doctoral dissertation at Boston University in Massachusetts that was focused on matching best practice to the needs of people on the autism spectrum. He now spends his time researching, teaching, writing books, and conducting autism workshops around the world.

According to Dr. Shore, the best way to address those issues is to find a way to use a person's strengths to overcome their challenges.

"There is a point in time when you have to get off the remediation and start moving on to finding a way the person can be successful in communication," he said. Methods may include use of a computer keyboard, rather than a pen, to write, or pointing at pictures to communicate, he said.

Adjusting the environment also plays a vital role and often benefits people without autism.

"Many autistics have sensory issues and perceive fluorescent lights as most people strobe lights, which will really affect productivity at work and school," Dr. Shore said. "Research shows that everybody's productivity is affected by fluorescent lamps, so everyone benefits by using alternate lighting."

With respect to the plethora of methodologies used to address autism in children, Dr. Shore notes that the wide variety of diversity within the autism spectrum disorders necessitates a tailored approach.

Parents and educators are encouraged to pick one or more approaches that best suits the child's needs and abilities. This may include use of Applied Behavioral Analysis, Treatment and Education of Autistic and Related Communication-Handicapped Children, Daily Life Therapy, the Miller Method, the Developmental/Individual Difference/Relationship-based method, relationship development intervention, and social communication/emotional regulation.

"You can have a right or wrong approach on an individual basis, but not on a generic basis," he said.

Nature. Published online November 2, 2011. Full text

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Changing perceptions: The power of autism

  • Laurent Mottron

    Nature 479, 33–35 (03 November 2011) doi:10.1038/479033a Published online 02 November 2011



    Recent data — and personal experience — suggest that autism can be an advantage in some spheres, including science, says Laurent Mottron.
    http://www.nature.co...ll/479033a.html

    Most grant proposals, research papers and reviews on autism open with, “Autism is a devastating disorder”. Mine do not.
    I am a researcher, clinician and lab director concentrating on the cognitive neuroscience of autism. Eight autistic people have been associated with my group: four research assistants, three students and one researcher.
    Their roles have not been limited to sharing their life experiences or performing mindless data entry. They are there because of their intellectual and personal qualities. I believe that they contribute to science because of their autism, not in spite of it.
    Everyone knows stories of autistics with extraordinary savant abilities, such as Stephen Wiltshire, who can draw exquisitely detailed urban landscapes from memory after a helicopter tour. None of my lab members is a savant. They are 'ordinary' autistics, who as a group, on average, often outperform non-autistics in a range of tasks, including measures of intelligence.

    As a clinician, I also know all too well that autism is a disability that can make daily activities difficult. One out of ten autistics cannot speak, nine out of ten have no regular job and four out of five autistic adults are still dependent on their parents. Most face the harsh consequences of living in a world that has not been constructed around their priorities and interests.
    But in my experience, autism can also be an advantage. In certain settings, autistic individuals can fare extremely well. One such setting is scientific research. For the past seven years, I have been a close collaborator of an autistic woman, Michelle Dawson. She has shown me that autism, when combined with extreme intelligence and an interest in science, can be an incredible boon to a research lab.

    “Too often, employers don't realize what autistics are capable of, and assign them repetitive, almost menial tasks.”


    I first met Dawson when we were interviewed together for a television documentary about autism. Some time later, after disclosing to her employers that she was autistic, she experienced problems in her job as a postal worker and so had learned everything about how the legal system deals with employees with disabilities. I recognized her skill for learning and asked her to become a research assistant in my lab. When she edited some of my papers, she gave exceptional feedback and it was clear that she had read the entire bibliography. The more she read, the more she learned about the field. Almost ten years ago, I offered her an affiliation to the lab. We've now co-authored 13 papers and several book chapters.
    Testing assumptions

    Since joining the lab, Dawson has helped the research team question many of our assumptions about and approaches to autism — including the perception that it is always a problem to be solved. Autism is defined by a suite of negative characteristics, such as language impairment, reduced interpersonal relationships, repetitive behaviours and restricted interests. Autism's many advantages are not part of the diagnostic criteria. Most educational programmes for autistic toddlers aim to suppress autistic behaviours, and to make children follow a typical developmental trajectory. None is grounded in the unique ways autistics learn.
    In cases where autistic manifestations are harmful — when children bang their heads on the walls for hours, for example — it is unquestionably appropriate to intervene. But often, autistic behaviours, although atypical, are still adaptive.
    For instance, one sign of autism is using another person's hand to ask for something, such as when a child places her mother's hand on the refrigerator to ask for food, or on the door knob to ask to go outside. This behaviour is unusual, but it lets children communicate without language.
    Even researchers who study autism can display a negative bias against people with the condition. For instance, researchers performing functional magnetic resonance imaging (fMRI) scans systematically report changes in the activation of some brain regions as deficits in the autistic group — rather than evidence simply of their alternative, yet sometimes successful, brain organization.


    479033a-i2.0.jpg

    SOURCE: REF. 4





    For certain tasks, autistics use their brains differently: these fMRI images depict the perceptual regions of the brain activated more among autistics than non-autistics during a non-verbal intelligence test.
    Similarly, variations in cortical volume have been ascribed to a deficit when they appear in autism, regardless of whether the cortex is thicker or thinner than expected1.
    When autistics outperform others in certain tasks, their strengths are frequently viewed as compensatory of other deficits, even when no such deficit has been demonstrated empirically.
    Without question, autistic brains operate differently. Most notably, they rely less on their verbal centres. When non-autistic people look at an image of a saw, for example, their brains are activated in regions that process both visual information and language.
    In autistics, there is comparatively more activity in the visual-processing network than in the speech-processing one2, and this seems to be a robust characteristic of autism, across a wide array of tasks3. This redistribution of brain function may nonetheless be associated with superior performance4 (see fMRI images below).
    These differences may also have downsides, such as difficulties with spoken language. But they can confer some advantages. A growing body of research is showing that autistics outperform neurologically typical children and adults in a wide range of perception tasks, such as spotting a pattern in a distracting environment5.
    Other studies have shown that most autistic people outperform other individuals in auditory tasks (such as discriminating sound pitches6), detecting visual structures7 and mentally manipulating complex three-dimensional shapes. They also do better in Raven's Matrices, a classic intelligence test in which subjects use analytical skills to complete an ongoing visual pattern. In one of my group's experiments, autistics completed this test an average of 40% faster than did non-autistics4.
    A changed mind

    A few years ago, my colleagues and I decided to compare how well autistic and non-autistic adults and children performed in two different types of intelligence test: non-verbal ones, such as Raven's Matrices, that need no verbal instructions to complete, and tests that rely on verbal instructions and answers. We found that non-autistics as a group performed consistently in both types of test — if they scored in the 50th percentile in one, they tended to score around the 50th percentile in the other. However, autistics tended to score much higher in the non-verbal test than in the verbal one (see 'Autistic intelligence') — in some cases, as many as 90 percentile points higher8.

    479033a-i3.0.jpg

    SOURCE: REF. 8



    Despite autistics' success in Raven's Matrices, I, too, used to believe that verbal tests were the best measures of intelligence. It was Dawson who opened my eyes to this 'normocentric' attitude. She asked me: if autistics excel in a task that is used to measure intelligence in non-autistics, why is this not considered a sign of intelligence in autistics?
    It is now amazing to me that scientists continue to use, as they have for decades, inappropriate tests to evaluate intellectual disability among autistics,which is routinely estimated to be about 75%. Only 10% of autistics have an accompanying neurological disease that affects intelligence, such as fragile-X syndrome, which renders them more likely to have an intellectual disability.
    I no longer believe that intellectual disability is intrinsic to autism. To estimate the true rate, scientists should use only those tests that require no verbal explanation. In measuring the intelligence of a person with a hearing impairment, we wouldn't hesitate to eliminate components of the test that can't be explained using sign language; why shouldn't we do the same for autistics?
    Of course, autism affects other functions, such as communication, social behaviour and motor abilities. These differences can render autistics more dependent on others, and make everyday life much more difficult. None of my arguments above is intended to minimize that.
    Too often, employers don't realize what autistics are capable of, and assign them repetitive, almost menial tasks. But I believe that most are willing and capable of making sophisticated contributions to society, if they have the right environment. Sometimes the hardest part is finding the right job — but organizations are now arising to address this problem. For example, Aspiritech, a non-profit organization based in Highland Park, Illinois, places people who have autism (mainly Asperger's syndrome) in jobs testing software (http://www.aspiritech.org). The Danish company Specialisterne has helped more than 170 autistics obtain jobs since 2004. Its parent company, the Specialist People Foundation, aims to connect one million autistic people with meaningful work (http://www.specialistpeople.com).
    Many autistics, I believe, are suited for academic science. From a young age, they may be interested in information and structures, such as numbers, letters, mechanisms and geometrical patterns — the basis of scientific thinking9. Their intense focus can lead them to become self-taught experts in scientific topics. Dawson, for example, does not have a scientific degree, but she has learned and produced enough in a few years of reading neuroscience papers to conduct certain types of research. At this point, she deserves a PhD.
    Instant recall

    Research has consistently shown that, on average, autistics present strengths that can be directly useful in research. They can simultaneously process large pieces of perceptual information, such as large data sets, better than non-autistics can10. They often have exceptional memories: most non-autistic people can't remember what they read ten days ago; for some autistics, that's an effortless task. Autistic people are also less likely to misremember data. This comes in handy in science: whereas the methodologies used in studies of face-perception in autism are for me terribly similar, Dawson can instantaneously recall them.
    Many autistics are good at spotting recurrent patterns in large amounts of data, and instances in which those patterns have been broken. In my lab, Dawson noticed a discrepancy in the standards applied to various types of treatments: to develop a drug, researchers must conduct elaborate studies including randomized controlled trials, but this is not a requirement for behavioural interventions for autistics, despite the huge costs of such interventions (up to US$60,000 a year for each individual) and their potential negative consequences.
    It is thus worrying that some countries, including France, have proposed mandatory interventions that aim to get autistics to adopt 'typical' learning and social behaviours, which have not been tested using the standards applied to other areas in science.
    Dawson's keen viewpoint also keeps the lab focused on the most important aspect of science: data. She has a bottom-up heuristic, in which ideas come from the available facts, and from them only. As a result, her models never over-reach, and are almost infallibly accurate, but she does need a very large amount of data to draw conclusions.By contrast, I have a top-down approach: I grasp and manipulate general ideas from fewer sources, and, after expressing them in a model, go back to facts supporting or falsifying this model. Combining the two types of brains in the same research group is amazingly productive.
    Because data and facts are paramount to autistic people, they tend not to get bogged down by the career politics that can sidetrack even the best scientists. They prefer not to seek popularity, promotions or vast numbers of papers; they may post their best ideas on the web rather than publish them.
    In 2004, Dawson gained recognition within the autistic community and among autism researchers and clinicians after posting online an essay detailing the ethical shortcomings of the intensive behavioural therapies used with autistic children.
    Of course, autistics will not thrive in all careers. Given their social differences, they will often struggle in people-oriented fields, such as retail or customer service. Ideally, autistic individuals would have mediators who could help settle situations that trigger anxiety in them — typically anything unscheduled or hostile, such as changes to an existing plan, computer problems or negative criticism.
    Despite these caveats, Dawson and other autistic individuals have convinced me that, in many instances, people with autism need opportunities and support more than they need treatment. As a result, my research group and others believe that autism should be described and investigated as a variant within the human species. These variations in gene sequence or expression may have adaptive or maladaptive consequences, but they cannot be reduced to an error of nature that should be corrected.
    The hallmark of an enlightened society is its inclusion of non-dominant behaviours and phenotypes, such as homosexuality, ethnic differences and disabilities. Governments have spent time and money to accommodate people with visual and hearing impairments, helping them to navigate public places and find employment, for instance — we should take the same steps for autistics.
    Scientists, too, should do more than simply study autistic deficits. By emphasizing the abilities and strengths of people with autism, deciphering how autistics learn and succeed in natural settings, and avoiding language that frames autism as a defect to be corrected, they can help shape the entire discussion.


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