The following is an excellent, informative piece on Autism and Asperger's from All in the Mind, RN’s weekly exploration of all things mental. The second part is supposed to be in week.
The Social Brain
For most people the ability to interact and communicate with each other seems almost second nature—but for those with a condition on the autism spectrum social skills can be difficult to grasp and challenging. We hear from the pioneering autism researcher from the UK Uta Frith and neuroscientist Chris Frith about what autism and Asperger's Syndrome can teach us about our Social Brain.
Transcript
Thomas Kuzma: Hi, my name is Thomas Kuzma. I am 22 and I have Asperger’s Syndrome. I also like long walks on the beach.
Lynne Malcolm: And I’m Lynne Malcolm with All in the Mind. Today, the intricacies of the social brain and what autism can teach us about how we interact and communicate with each other.
Benison O’Reilly remembers only too well when her son was diagnosed with autism.
Benison O’Reilly: When he was about two I took him to swimming lessons and I think that’s when I realised that not only did he not speak very much, but he really didn’t understand what the instructor was saying. He’d started saying a few words but when I took him back at three, the paediatrician changed his diagnosis to autism. Still that day is sort of seared in my memory. I sort of walked out of that room, and it, it’s just like a car crash, the thing that’s hit you, and I was quite depressed there for a couple of months and cried a lot and didn’t do an awful lot, I have to say.
He always had some connection with you. He was not aloof, in the sense that he was quite a cuddly boy. And he did look you in the eye. It’s more about the appropriateness of the eye contact; it’s about sharing experiences with you rather than just looking at you. So a typical childhood, they’d show you a toy and make sure you were looking at them and things like that.
And he didn’t really play with other children. He’d play near them but not with them. And imaginative play obviously is a huge social thing when you’re flying planes, or when you’re imagining you’re a plane, or pushing a train around, you know, he would line the trains up rather than actually push them round a track.
So he still doesn’t have a friend in a typical sense; like, he has people he calls his friends and he hangs around with them at school a little bit, but they don’t come round to our place to play and all that sort of thing.
Lynne Malcolm: Benison O’Reilly is co-author with Kathryn Wicks of The Australian Autism Handbook. Autism is a condition which affects neural development and its symptoms and severity vary widely. It has a strong genetic basis, but more precise detail about its causes has remained a mystery since pioneering researcher Uta Frith became interested in it in the early 1960s.
Uta Frith: In those days, people knew that there were different types of mental disability, learning disability, but amongst those were also those autistic people. And people began to see them, when first they seemed to be quite invisible.
Lynne Malcolm: Uta Frith is Emeritus Professor of Cognitive Development at University College London and visiting professor at Aarhus University in Denmark.
Her groundbreaking contributions to our understanding of autism led her to be given the title of Dame in the British honours system last year. While working at the Institute of Psychiatry at Maudsley Hospital in London, she first recognised that autism is a condition of the brain rather than the result of so-called cold parenting.
Utah Frith: And that seemed to me such an interesting subject to go into and I was very fortunate that some really pioneering psychologists, Beate Hermelin and Neil O'Connor, were at the Institute of Psychiatry at that time and were the first people, I think, in the world to apply proper experimental psychology methods to say something about the nature of the difficulties that these children had.
Lynne Malcolm: Thomas Kuzma, now in his twenties, first became aware he had Asperger’s Syndrome when he was in Year 10 at high school.
Thomas Kuzma: I was in the middle of being heavily bullied in my dark years, you could say.
Lynne Malcolm: You call them your ‘dark years’, why do you call them your dark years?
Thomas Kuzma: Because those were the years where I felt most alone.
Lynne Malcolm: How were the kids teasing you, what were they saying to you?
Thomas Kuzma: I’ve always been the smiley happy guy, jolly and all, and the cool kids, they saw that and they realised that I was at the time gullible, because I always felt whenever someone was talking to me they were not, I could say, serious. They played on the fact that I thought whatever I thought they were saying was the, you know, the bees knees or whatever. Because I didn’t understand things like sarcasm, they managed to wield that in a way where they got me to do some somewhat humiliating things.
The problem was I didn’t even understand why they were making fun of me. You know, I just wanted friends, that’s all, and I was being turned into a scapegoat and into a plaything you could say.
Lynne Malcolm: Autism was first described more than 60 years ago by Dr Leo Kanner and at the same time Dr Hans Asperger described what was viewed as a milder form, known as Asperger's Syndrome.
In the new Diagnostic and Statistical Manual, DSM V, which is about to be published in May, Asperger’s Syndrome won’t have a separate category but will be considered as part of the Spectrum of Autism Disorders. This is a controversial change, which we’ll discuss further next week. But in the 1960s when Uta Frith first became interested in Asperger’s, the thinking was very different.
Uta Firth: What actually drove the interest in my case in Asperger’s Syndrome was the recognition that perhaps the very narrow clinical picture that was described by Kanner in the first place, the kind of children that we started out studying, yes, they were there, but there were other children too at the margins that seemed to be just not quite conforming to this initial very, very narrow kind of category. So we saw children who actually were socially very, very inept, in this way that they couldn’t understand mental states and so on, but their language was good, their intelligence was very high, and in many ways people thought there might not be so much wrong with them. And with other people of course that’s not the case; they also suffer and they also need to learn a lot about how to negotiate this complicated social life.
Now, it’s really pushing apart the boundaries that drove my interest in Asperger’s Syndrome. And it was really a time where people realised that we couldn’t just forget about all these other cases, these other children and particularly adults who hadn’t even been diagnosed when they were children but who had these real problems in social interaction, which you just have to say they are just very typically autistic.
And that was how I think the concept got much more popularised. Many people really loved the idea that they could have a diagnosis of Asperger’s Syndrome, because it seemed sort of more interesting, more hopeful, more respectful to use that label than to use the label ‘autism’. Autism had this kind of very bleak picture associated with it and Asperger’s Syndrome I think gave a somewhat different idea about what perhaps a grown-up person could be like who actually has very many skills even though they can’t function very well in a neurotypical society.
Lynne Malcolm: The condition of autism various enormously. Some people are very withdrawn; they don’t speak at all and have debilitating repetitive behaviour and hypersensitivity. Others can be highly articulate and gifted. So it’s very difficult to categorise, but Uta Frith and her husband Chris Frith, Emeritus Professor of Neuropsychology at University College London, are collaborating to try and capture the nature of the autistic mind, particularly the social aspects.
Uta Frith: What we have concentrated on is this core problem of social interaction, reciprocal communication; that seems to be at the heart of the nature of autism. Even in these very extreme cases, we can see there is something in common in the way that they don’t quite integrate into the social world as we all do. This reciprocal interaction, that seems to be missing. It’s not whether they are uninterested and withdrawn, or in some sense aloof —no, that’s not the problem, because we find many who are not aloof—the problem is not understanding about social behaviour.
Now, we understand there’s an incredibly intuitive way. For us it’s completely obvious that we explain how somebody behaves in terms of their motivations; you know, their psychological attitudes, their beliefs. Now, that’s completely different from how we interpret the non-social world; you know, we can understand cause and effect in physical terms and we can interpret it in a completely different way. You know, the rock falls down and if something is in the way it will hit it—that’s a kind of cause and effect explanation.
Now, the interesting thing is this: the case of autism has shown us that these two worlds are really different. So there is always this understanding, really right from the beginning, that actually autistic children and adults could understand physical cause and effect perfectly well, but they couldn’t really cope with this social cause and effect stuff, which is different. It’s an innate kind of ability that we have this propensity to think of the social world in different terms, process it in a way that makes sense to us. So we would say, well, somebody has just seen an event, so obviously he knows about that event. If he hasn’t seen the event, then we might actually give him some false information; we can do all these things, we can lie, because we are constantly thinking of what’s going on in their mind. We’re not just taking into account what is actually the physical state of affairs.
Lynne Malcolm: So, just to explain a little bit further about the nature of the social difficulties that children with autism have, I know you’ve done a number of experiments on this. For example, they may have difficulty with pretence, with lying; they don’t understand irony.
Uta Frith: Well, one of the first clues that really stuck out when autistic children were studied was that unlike other really quite learning disabled children and very young ordinary children, they didn’t seem to understand make-believe play, pretend play. And then later on many parents said they can’t lie, they are so very honest, which of course is one of their really endearing qualities. And they don’t understand why people should lie.
So one of the experiments that I think really shows how different may be the understanding in the autistic mind is of a social situation where deception plays a role is an experiment I did long ago where we contrasted a situation we called ‘sabotage’ and a situation we called ‘deception’.
Now, sabotage is where you prevent somebody else from, say, getting into a box physically, because you lock the box. Absolutely cause and effect—the autistic children were totally able to do this. The contrast condition in this experiment we called ‘deception’. So there was no key, there was no lock to do this. They said ‘Wow, this is very difficult.’ You still don’t want the thief to get at that box, you can lie to the thief; you can say the box is locked, because of the thief can’t actually see that.
Now, very young children and also learning disabled children who are not autistic seem to immediately latch on to this and say to the thief the box is locked when it isn’t. Now, we found that autistic children had real, real problems with this and they really didn’t do that, although they were perfectly able to prevent the thief when they had a lock and key. So the sabotage was fine but the deception was not.
Lynne Malcolm: And you use a theory to explain the way individuals with autism interact socially and that’s what’s known as ‘the theory of mind’. Can you explain the theory of mind?
Uta Frith: Well, the theory of mind is a nickname and it’s very misleading, actually, because you immediately think that must be sort of some highfaluting thing that you know is like a philosophy, like having a theory of mind. Actually what it means is that we have this ability to automatically and spontaneously attribute mental states to other people and predict what they will do as a result of that.
So we actually coined the word ‘mentalising’ for this. So we say we ‘mentalise’ when we automatically think that somebody is, for example, behaving according to their particular knowledge or their particular intentions. And that is the basis of the theory, that we think this kind of mechanism that is somehow an innate predisposition in the mind, in the brain, is not functioning well in autism.
Lynne Malcolm: But then how do you explain the other superior abilities that many people with autism have? They can have extreme focus, they can be very creative, and show characteristics of real genius.
Uta Frith: Absolutely. This is the real amazing thing about autism, that we do have these sharp contrasts and they really show us that yes, we can separate social processes in the mind and non-social processes in the mind. Otherwise we wouldn’t have got this idea. We would have thought there are sort of all-purpose general thinking processes and you apply them to the social world, you apply them to the physical world, but it doesn’t seem to be the case. Autism teaches us that you can be very good in one and not at all good in the other. Actually I think Chris just wanted to say something that would probably just modify what I said myself.
Chris Frith: No, I think one possible explanation for the striking abilities of some autistic people is precisely that they are not stuck like the rest of us so much in the social world, so they can break out of the sorts of conformities that we have. And they are not so much influenced by what everybody else is doing and they can really do something different. And this is one aspect of creativity, of course.
Lynne Malcolm: Chris and Uta Frith, both from University College London.
You’re with All in the Mind on RN, Radio Australia and online, I’m Lynne Malcolm.
Today we’re exploring autism and what it can tell us about our social brain. Chris Frith specialises in researching the biological basis of the brain using imaging technologies. So what actually happens in the brain of an autistic person?
Chris Frith: Oh, that’s a very difficult question. It was because of the demonstration by Uta and others that autistic people seemed to have this particular circumscribed problem in social understanding and not in other kinds of understanding that we were beginning to think that maybe social understanding depends on special networks in the brain. And indeed over the last 20 years or so this has been confirmed. There is a relatively small number of brain regions that seem to be particularly active whenever we’re engaged in mentalising or social interactions, and we are beginning to understand to some extent what some of these regions are more precisely doing.
When we look at the autistic brain, I think what we tend to see is that these same areas are simply less active. It’s as if they are not able to, or choose not to use these kinds of computations, as I would call them, for dealing with the social world. But we’re very much at the beginning, so it would be very difficult for me to say, ‘This is what the autistic brain looks like,’ and it certainly can’t be used, for example, for diagnosis.
Lynne Malcolm: So caution has to be taken in terms of interpreting what you can see in brain scans into the actual experience of somebody.
Chris Frith: Right, that is correct. I mean, another theory which again you can use brain imaging to look at to some extent is the idea that for most of us, social interactions are very rewarding, simply being with people is rewarding and looking at smiling faces is rewarding. I mean, that’s fairly well established now there are particular bits of the brain that are interested in reward, whatever form it takes—whether it’s money, or food, or people saying you’re a good chap. So you can then explore whether there’s something going wrong with this system in autistic people. Are they simply not interested in the social world and that’s why they don’t learn about it? And at the moment I would say the jury is out, but this is the sort of thing you can explore with these techniques.
Lynne Malcolm: With Uta Frith’s pioneering work in autism research and Chris Frith’s expertise in the neural basis of the brain, they’re trying to get a better understanding of how we communicate and share representations of the world.
Uta Frith: Yes, we are embedded in the social world; for example, most of our learning is through other people. It’s not that we just go along and try things out and make our own mistakes; we actually observe what other people do, we copy them all the time. So there might be very special circuits in the brain that can also be part of the social brain that, you know, are sort of particularly watchful about what other people are doing—where they are looking, for example—and makes us copy them.
So that’s a very, very interesting aspect of our social nature and it’s also an aspect that makes us on the whole pro-social. We like to be where other people are, we like to do what other people do, we have quite a lot of pressure to conform.
Lynne Malcolm: So what are some other examples of the way we use interaction to communicate and to learn?
Chris Frith: Well, for example, when children are growing up they have to learn all sorts of things very rapidly. And, for example, they have to learn the words of their native language; I mean, a huge amount is being learned. But what is interesting is that this depends very much on an interaction. So, for example, they don’t simply observe adults talking about things; it’s mostly done because the adult actually points to a thing and names it.
And the child knows perfectly well when it’s being told that this is the name of an object and when this is purely an accident. So, for example, if the mother drops the saucepan on the floor and says ‘bother’ the child doesn’t learn to call saucepans ‘bother’, because they are very well aware of the nature of this interaction because it’s not directed at them. And, interestingly, there are at least anecdotes about autistic children not showing this effect so that they might forever afterwards call saucepans ‘bother’.
So that would be an example of the kind of interaction which is critical for our learning about the world. There is also something called ‘social referencing’, where when where a child is confronted with a new object they will typically look round at their mother and if she smiles they will approach it, and if she frowns they will not approach it. So again this is an example of an interaction being intimately concerned with how we learn about the world.
Lynne Malcolm: And there are some interactions and mechanisms that come naturally and spontaneously but there are other intentional mechanisms, aren’t there, that we learn?
Uta Frith: Well, for example, you could say that we have this tendency to form in-groups and out-groups and if you become aware of this, you can actually counteract it. So these are things that we learn until we can really manage all these tendencies given to us by millions of years of evolution which have to do with, you know, just survival in possibly small tribal groups that had to really fight to have enough resources, that kind of thing. Of course, things have changed now and we can actually think much more about these things and therefore also change them.
I think one interesting example also in our social interaction is empathy. And people often think that, ‘Oh, this must surely be part of mentalising,’ but we actually think it can be quite a separate brain mechanism and cognitive mechanism. So to feel empathy is really something where you turn off your self and you are completely feeling what another person feels. It’s like having some contagion. So if somebody cries, you know, you feel like crying. You may not actually go and break out in tears—you might if you are a young child—but you know you can inhibit that, but you are so influenced by this. That’s sort of like a really basic form of empathy.
And we think, for example, that in most autistic people we know, this is perfectly there; there are many examples of this kind of empathy. But then there are other forms of empathy which really have to do with mentalising and they have to do with saying ‘Oh, I must show a cheerful face when I actually know my friend is desperately sad, but if I’m sad too it will be worse for him.’ So these are forms of social interaction also governed by our brain but sort of in some sense by modifying other things that are there. So a lot of what the brain does is actually stopping and starting and enhancing and suppressing, perhaps, other kinds of mechanisms that just go into action automatically whether we like it or not.
Chris Frith: One of the big impetuses for developing ideas about the social brain was the discovery of the so-called mirror neurons, which again were found about 20-odd years ago. And these are neurons originally shown in the monkey, where the same neuron is active when the monkey makes an action like picking up a peanut and also when the monkey sees the experimenter picking up a peanut. So in that sense they are mirroring what you do and what you see other people doing seems to activate the same region of the brain.
And this in a sense is interesting because it shows that the brain has solved the problem of how you make the connection between what you do and what you see other people doing, which is quite an interesting computational problem. And this seems to be the basis of the sort of empathy or contagion that Uta was talking about. So you see similar responses, at least in people, that when I am in pain the particular bit of my brain lights up and when I see my friend in pain the same bit of the brain lights up.
So you get all this mirroring. This is happening all the time when we interact with people, although we’re probably mostly unaware of it. So in that sense there we’re very embedded in the social world, we are constantly being influenced by the emotions and behaviour of the person we are interacting with. And this is probably extremely helpful for the interaction to take place and to understand each other, because we will understand each other better the more similar we become.
Lynne Malcolm: So to what extent does Uta Frith believe that people with autistic conditions can learn to change the way they interact socially?
Uta Frith: They can learn enormously well. They are absolutely wonderful in the way they can also learn about mental states and what they mean. They can use them, but I believe they use them in a different way. So they can overcome many of the basic problems that perhaps they had when they were children. But it is, I think, in the end an effortful process for them. It is something that you should, you know, always say if an autistic person surprises you by their amazing insight, also by their use of mental states, that this may have come at a great cost to them.
So compensation is not cheap. It can be done, but you really also need all the resources you can possibly get. And they are not just from inside the person—you know, like this amazing intelligence that many of them have—but also from the outside: lots of support, lots of teaching, all of these things are incredibly important, but they can make a big difference.
(Music)
Autism I think gives us a unique insight into the human condition, into the mind. It’s always, I think, through some kind of unexpected behaviour that we suddenly become aware of the things that we otherwise completely take for granted, that seem completely automatic to us, we think nothing of. So autism has really made us much more aware of the complicated processes and computations that are necessary to function as social beings.
Chris Frith: I think that’s a very interesting point, because indeed we never really thought about mentalising and social interactions. I mean, before people started talking about autism in the social brain, it was striking that studies of people with brain lesions looked at all sorts of abilities but virtually never looked at their ability to interact socially.
And it’s only, in a sense, since the discovery of autism that people have started to ask, well, in dementia are there particular problems in social interactions. On the other side of this, of course, as Uta was hinting at, is that we hadn’t really thought about how social interactions work. And people like me who are interested in computers and robots and so on are now wondering about can you actually write computer algorithms that would enable computers or robots to interact with people and to make inferences about their mental states. And people are beginning to try and do this, but this is very early days and of course slightly worrying.
Lynne Malcolm: Emeritus Professors Chris and Uta Frith from University College London.
For more details on what you’ve heard today go to the All in the Mind website, where you’ll also find transcripts and audio of all the programs. While you’re there, leave a comment on the site or visit us on Facebook.
And do join me next week when you can hear more about the experience and treatment of people with an autism spectrum condition.
Today’s sound engineer is Steven Tilley. I’m Lynne Malcolm.
No comments:
Post a Comment