Ami Klin: A new way to diagnose autism

(Script extract)

6:11 Now, she is oblivious to me and I'm so close to her, and you think, maybe she can see you, maybe she can
hear you. Well, a few minutes later, she goes to the corner of the room, and she finds a tiny little piece of candy, an
M&M. So I could not attract her attention, but something a thing did. Now, most of us make a big
dichotomy between the world of things and the world of people. Now, for this girl, that division line is not so clear, and
the world of people is not attracting her as much as we would like. Now, remember that we learn a great deal by
sharing experiences. What she is doing right now is that her path of learning is diverging, moment by moment, as
she is isolating herself further and further. So we feel sometimes that the brain is deterministic, the brain determines
who we're going to be. But, in fact, the brain also becomes who we are, and at the same time that her behaviors are
taking away from the realm of social interaction, this is what's happening with her mind, and this is what's happening
with her brain.

7:26 Well, autism is the most strongly genetic condition of all developmental disorders. And it's a brain disorder. It's
a disorder that begins much prior to the time that the child is born. We now know that there is a very broad spectrum
of autism. There are those individuals who are profoundly intellectually disabledbut there are those that are
gifted. There are those individuals who don't talk at all; there are those individuals who talk too much. There are
those individuals that if you observe them in their school, you see them running the periphery fence all the school
day if you let them, to those individuals who cannot stop coming to you and trying to engage you repeatedly,
relentlessly, but often in an awkward fashion,without that immediate resonance.

8:16 Well, this is much more prevalent than we thought at the time. When I started in this field, we thought there
were four individuals with autism per 10,000 a very rare condition. Well, now we know it's more like one in
100. There are millions of individuals with autism all around us.

8:36 The societal cost of this condition is huge, in the US alone, maybe 35 to 80 billion dollars. And you know
what? Most of those funds are associated with adolescents and particularly adults who are severely
disabled, individuals who need wraparound services services that are very, very intensive. And those services
can cost in excess of 60,000 to 80,000 dollars a year. Those are individuals who did not benefit from early
treatment, because now we know that autism creates itself as individuals diverge in that pathway of learning that I
mentioned to you. Were we to be able to identify this condition at an earlier point, and intervene and treat I can
tell you, this has been probably something that has changed my life in the past 10 years, this notion that we can
absolutely attenuate this condition. Also, we have a window of opportunity, because the brain is malleable for just
so long, and that window of opportunity happens in the first three years of life. It's not that that window closes; it
doesn't. But it diminishes considerably. And yet, the median age of diagnosis in this country is still about five
years, and in disadvantaged populations, the populations that don't have access to clinical services, rural
populations, minorities, the age of diagnosis is later still, which is almost as if I were to tell you that we are
condemning those communities to have individuals with autism whose condition is going to be more severe. So I
feel that we have a bioethical imperative. The science is there. But no science is of relevanceif it doesn't have an
impact on the community. And we just can't afford that missed opportunity, because children with autism become
adults with autism. And we feel that those things we can do for these children, for those families, early on, will have
lifetime consequences for the child, for the family, and for the community at large. So this is our view of autism.

10:45 There are over a hundred genes that are associated with autism. In fact, we believe there are going to
besomething between 300 and 600 genes associated with autism, and genetic anomalies, much more than just
genes. And we actually have a bit of a question here, because if there are so many different causes of autism, how
do you go from those liabilities to the actual syndrome? Because people like myself, when we walk into a
playroom, we recognize a child as having autism. So how do you go from multiple causesto a syndrome that has
some homogeneity? And the answer is what lies in between, which is development. And in fact, we are very
interested in those first two years of life, because those liabilities don't necessarily convert into autism. Autism
creates itself. Were we to be able to intervene during those years of life, we might attenuate for some, and God
knows, maybe even prevent for others.

11:50 So how do we do that? How do we enter that feeling of resonance, how do we enter another person's being? I
remember when I interacted with that 15-month-old, the thing that came to my mind was, "How do you come into
her world? Is she thinking about me? Is she thinking about others?" Well, it's hard to do that, so we had to create
the technologies. We had to basically step inside a body. We had to see the world through her eyes.