Transcript of Scientific American show on Autism

[Guest guest]

Circa Feb 24, 2004

BREAKING THE SHELL

ALAN ALDA (NARRATION) Tariq is two and a half years old. He was

diagnosed with autism 6 months ago. His parents and I are sitting

with him in a therapy room at the University of Washington in

Seattle. Since Tariq was diagnosed he's been receiving regular

therapy aimed at helping him break out of the mysterious and often

impenetrable shell that seems to surround people with autism,

cutting them off from the social world. DAD Two or three months ago

you couldn't redirect him. You couldn't say, " Throw the ball to your

sister. Now kick the ball to, you know, whatever. Now stop biting

the dog or something like that. "

ALAN ALDA How long every day do you work with him? DAD We're

planning up to forty hours a week of home-based therapy.

MOM Right now we do about fifteen hours of one-on-one with a tutor,

three hours here, and on top of that we do the occupational therapy

and the physical therapy once a week for an hour. We do speech

therapy for two hours. DAD And then he gets tired and he sort of

withdraws from us a little bit and he does his own thing and he did

his homework and he's darn well gonna be in his own world right now

and that's it. Right? Sort of what he's doing right now. I think

he's ticked off, he's tired.

ALAN ALDA (NARRATION) Autism is frighteningly common, affecting as

many as one in every seven or eight hundred children born. Many but

by no means all of these children are mentally retarded. Some

develop language, others never do.

ALAN ALDA There seems to be such a wide range of symptoms. Are they

all along this autism spectrum because they have a common cause?

Because they're related to the same part of the brain? Or what? What

links them together?

GERALDINE DAWSON Well, the key feature that links them together is

the difficulties in social relationships. So even the highest

functional person may have an I.Q. above average and really good

language may be out in the work world with a regular job. They would

still have that very fundamental problem in relating to other

people.

ALAN ALDA (NARRATION) Geraldine Dawson's own research is focused on

just why autistic children find it hard to relate to other people.

Six-year old has autism -- and to win his cooperation the

researchers have to employ patience, guile and fun rewards.

ASSISTANT You got it! LESLIE Ready to put on this silly hat with all

this hair on it, ?

ALAN ALDA (NARRATION) The hat is similar to the one we saw used in

the Syndrome research -- and like that study the plan here

is to monitor the electrical activity of 's brain as he looks at

faces.

ALAN ALDA Is each one of these EEG signals associated with a part of

's brain?

GERALDINE DAWSON Well, each one of these signals is one of those

electrodes that you saw being put on his scalp.

ALAN ALDA (NARRATION) The signals from 's brain are recorded and

processed as he looks at pictures of his mother's face or that of a

stranger. In a normal child, the brain's response to the two would

be very different. But 's brain responds to both his mother's

face and that of the stranger as if they are the same. When it comes

to faces, his brain is literally indifferent.

GERALDINE DAWSON In normal development, the brain is naturally wired

to draw our attention to faces. And you think about a young baby,

even a newborn will prefer to look at a face as compared to another

complex object. So there's something wired into our brain that

naturally draws our attention to the social world. So we think that

tells us that that mechanism which naturally draws our attention is

not working properly. If you're not paying attention to social

information, how are you ever going to learn to develop socially?

BONNIE Whoa. Oh, nice looking at me now. And you're smiling….

ALAN ALDA (NARRATION) In Tariq's therapy sessions, Bonnie spends a

lot of time trying to get him to look at her and respond, hoping to

instill in Tariq through endless repetition a facility most children

are born with.

GERALDINE DAWSON One of the things that we're understanding is that

the parts of the brain that are probably involved in autism are ones

that come online really early in life in the first and second year.

So what we want to do is to pick up kids, really hopefully by birth,

but right now we're at about 12 to 18 months. And we try to

stimulate those brain systems while they're still developing and

plastic, in hopes that the children will then kind of grow out of

their autism or at least be less affected.

BONNIE Oh, you picked dot art. Good choice.

ALAN ALDA (NARRATION) So the earlier autism can be spotted the

better. One early warning sign, which goes along with an

indifference to faces, is the lack of a special form of eye contact.

GERALDINE DAWSON We tend to look at people at very specific moments.

So, for example, when I want to communicate with you, I'll check in

visually, and then I'll point to something, then check back. This is

called joint attention. And it actually turns out to be the most

significant diagnostic sign of autism. So it's not just the sheer

amount of eye contact, but it's really how he combines eye contact

with communication.

ALAN ALDA (NARRATION) Two year old Kendall has great eye contact.

ALAN ALDA Right in the cup. You want to do it?

ALAN ALDA (NARRATION) She's a healthy, normal little girl who's here

to help psychologist Andy Meltzoff give me a lesson in the

importance of imitation.

ALAN ALDA Ah, good.

ANDREW MELTZOFF Kendall, watch this. I bet Alan doesn't even know

what we can do with this. Watch this. Isn't that funny? Kendall want

a turn?

ALAN ALDA Whoa. Very good.

ANDREW MELTZOFF Typically developing children are like sponges.

Adult in front of them just behave and the baby watches wide-eyed

and does what they do. They become little adults in the culture from

watching the adult.

ALAN ALDA Good pop.

ANDREW MELTZOFF You want Uncle Alan to try that?

ALAN ALDA (NARRATION) Four-year old Mia is another great imitator.

ALAN ALDA You want to try it?

ANDREW MELTZOFF Now that's imitation.

ALAN ALDA Yeah.

ANDREW MELTZOFF That's imitation.

ALAN ALDA (NARRATION) Andy Meltzoff has done the same experiment

with autistic children.

ANDREW MELTZOFF Now you remember this toy?

ALAN ALDA (NARRATION) This child seems social enough and intrigued

by the cup -- but he isn't collapsing it as Kendall did.

ALAN ALDA If you just walked in on the room and you were looking for

eye contact you'd think, oh, he's relating normally. But if you're

looking for imitation, you won't get it.

ANDREW MELTZOFF Exactly. I think imitation is a higher art of

activity than simply eye contact. So some children with autism can

make eye contact. But what they seem to have a profound deficit in,

is doing these simple imitation games which seems to be relating to

another person from the inside at a deeper level. It's this drive to

want to relate to you as a person. To be like you. They don't seem

to have that impulse.

ALAN ALDA (NARRATION) Andy Meltzoff thinks this failure to imitate

other people is yet another useful early warning sign of autism. But

he also believes it may be at the root of many of the later problems

people with autism struggle with -- a failure to see other people as

beings like them.

GERALDINE DAWSON So one of the first things you do in any kind of

early intervention program is teach a child how to imitate. And

there's lots of different ways to do that. What you may have seen

with Tariq is, she was imitating some of his behavior, just so he

starts to look at the correspondence between what he's doing and

what she's doing. So in this case the child doesn't have to

think, " I have to imitate you. " But they start seeing the

correspondence between their action and your action as you imitate

them.

ALAN ALDA Now, here, who initiated this?

GERALDINE DAWSON It appears that what she's done here is she's

brought out a toy that he's highly interested in and she's doing

something that is very appealing to him.

ALAN ALDA She's blowing on it and he's trying to get it to turn by…

now she's imitating him.

GERALDINE DAWSON That's right. Now she's imitated what he's doing.

ALAN ALDA So building up these interactions can develop the ability

to interact in other ways, in other areas, at other times.

GERALDINE DAWSON That's true, although we do target what are

sometimes called pivotal skills. These are fundamental skills, that

if you learn them, they open up the door to all kinds of learning.

ALAN ALDA (NARRATION) Among the most important such skills is

communication.

BONNIE Oh, you said cookie and you're looking at me?

ALAN ALDA (NARRATION) Tariq, like many other autistic children, is

being taught to use a communication system in which pictures replace

the spoken word.

BONNIE You told me juice? Yes, you want some juice?

ALAN ALDA (NARRATION) But while Tariq is benefiting from what's

already known about autism, the University of Washington program is

also investigating autism's many unknowns -- including what, if

anything, is different about the autistic brain. One of the

volunteers in this research effort is seven-year old .

She's being prepared for a scan of her brain in an MRI machine.

ALAN ALDA I did this once and you're taking it so much better than I

did.

STEVEN DAGER When you're in the magnet, when we talk to you, try not

to move your head like this because then we'll lose kind of where

your head is in the magnet.

ALAN ALDA (NARRATION) is the daughter of one of the

scientists here.

RESEARCHER So we're slicing from back to front, here's the

cerebellum…

ALAN ALDA (NARRATION) Her brain is one of the normal brains the

researchers are comparing to the brains of autistic children.

ALAN ALDA Have you found anything so far that seems typical of the

difference of the two?

STEVEN DAGER What we seem to be finding is that the kids with autism

have bigger brains.

ALAN ALDA Bigger brains?

STEVEN DAGER They have bigger cerebrums than both normally

developing children and kids with developmental delays.

ALAN ALDA So, that seems…

STEVEN DAGER Peculiar.

ALAN ALDA Odd, yeah.

STEVEN DAGER Bigger's not necessarily better.

ALAN ALDA Right.

STEVEN DAGER Clearly they have bigger brains but their brains aren't

working as well.

ALAN ALDA (NARRATION) To find out why autistic brains don't work as

well, Steve Dager and his colleagues are also peering deep inside

them, looking for differences in important brain structures. And

they've discovered another puzzle -- a region called the amygdala is

bigger than you'd expect, even given a bigger brain.

ALAN ALDA What is the amygdala normally associated with?

STEVEN DAGER Emotionality or emotional response. So the question

obviously is, if these kids have a paucity of emotional response, or

have a problem with emotional reciprocity, why would their amygdalas

be bigger?

ALAN ALDA Yeah.

STEVEN DAGER And I don't know. That's what we're trying to better

understand. We're trying to better understand as we study them over

time. So these kids are coming back now when their ages six to seven

and we're looking at the change over time as a dynamic way of

understanding brain development.

ALAN ALDA (NARRATION) Brain imaging is clearly one of the new

frontiers in autism research.

ALAN ALDA , you did great. That was great.

ALAN ALDA (NARRATION) But while 's contribution to autism

research will no doubt pay off one day, for now the main hope for

children like Tariq lies in the dedication of therapists like Bonnie

-- and hours of patient chipping away at the walls his autism

has erected. Tragically, for many children growing up with autism,

not even this is enough.

ALAN ALDA What do you think of the prospects for this little boy?

GERALDINE DAWSON Oh, I'm very hopeful that this boy will go on to

develop language and to do quite well. As I said, at this age it's

extremely hard to tell. That's another focus of our research is to

try to look at -are there early indicators that tell us which

child's going to go on and do extremely well and other children

could have exactly the same intervention and make very slow

progress. There must be something biologically different about those

two kids. But no, I'm very hopeful that he'll go on to develop

language and friendships. I have very positive prospects for him.