Horizon (1964–…): Season 50, Episode 11 - Living with Autism - full transcript
There are over half a million people
in Britain who experience the world
very differently to the rest of us.
These are people with autism.
A puzzling condition which, 70 years
after it was first given a name,
we still know very little about.
My name is Uta Frith.
I'm a psychologist
and I've spent my career
trying to unravel
the mysteries of the autistic mind.
By spending time with many different
people on the autistic spectrum,
I want to show you
what a complex condition it is.
I want you to join me as I reveal
what I've discovered about
these amazing people.
23rd of May.
16th of August 2001.
It was a Thursday.
Kenny, how do you do it?
How is it possible to have
this extraordinary ability?
And how do people with autism
cope with relationships?
I don't know. Why are we together?
You tell me.
You're my...required amount
of social contact.
These fascinating people
that I've met over the years
have shown me that another
kind of reality exists,
that is full of
immense challenges, mysteries...
but also joy.
Mum always wears blue
because of the dolphin thing.
He thinks I'm a dolphin! Why?
You've got the dolphin smile.
It's the smile! And you love fish,
like dolphins. I do love fish.
You like us to throw you sea bass
when you're in bed.
I want to show you that
by understanding their world,
we can learn more about world.
In my quest to understand
the autistic mind,
I've spent a lifetime
conducting rigorous experiments.
OK, let's have a look.
By comparing people with autism
to the rest of us,
we can start to see
what autism really is.
My fascination with autism
began 50 years ago
when I met some autistic children,
while I was training to be
a clinical psychologist.
I was immediately fascinated of
the paradox of how these beautiful,
bright-eyed children could be
so detached from the world.
When I asked a question,
an autistic child would repeat it
and not answer it. And I couldn't
engage them in a conversation.
And I couldn't engage them
with toys, either.
An autistic child might
rapidly complete a jigsaw puzzle
but show absolutely no interest
in a game of teddy bears' picnic.
I passionately wanted to find out
what was going on here.
Back in the 1960s,
these children were being given
the new diagnosis of autism.
"Autos" in Greek means "self"
and refers to their apparent
self absorption.
Autism takes on many forms
and exists on a wide spectrum,
from mild to severe.
It was, and still is,
characterised by the difficulty
these children have
communicating and interacting
with others
and by their tendency
to have very narrow interests
and to repeat activities
over and over again.
What's this, Joe? What's...
One of these children
was Joe Allison.
'And this? Bowl.
'Bowl. And this?
'Box. Box. And this?'
Who is that? Yes.
It's... Joe Allison.
It's Joe Allison learning to talk.
Yes.
'What's this, Joe? Money. Money.
'What's this, Joe? Money.
Yes, money.'
Joe is now 57
and this is the first time I've
seen him since he was a young boy.
Do you remember her, Joe? Yes.
She was very kind.
What is this, Joe?
What is it?
Ba-ma. A barrow. A bu-bbow.
Back then, we thought that
if only we could teach
these children to speak,
then everything would be OK
and the autism would go away.
'Joe understood about
the Christmas story,
'about Father Christmas
and Christmas dinner.
'And it's the first time we've been
able to have a tree
'and none of the ornaments
have been broken.'
And who's this? Mum.
Is it Mum? Yes.
'So now you have some hope for Joe?
I certainly do.
'I don't know how far he will go
but one feels if he's gone this far,
'why shouldn't he go
a great deal further?'
That's nice, isn't it? Yes.
'But 50 years on,
'we now know that autism is
a lifelong brain abnormality.
'Half of those affected have
significant learning disabilities
'and well over 80%
are unable to live independently.'
When I tell people what I do,
the first thing they ask about
are the autistic individuals
known as savants,
who have remarkable gifts.
Many people with autism have talents
that appear to be at odds with
the rest of their abilities.
And occasionally, these skills
can be quite extraordinary.
Start with the easy one...
and work your way down through
these operations
to get your answer at the bottom.
This is 15-year-old Kenny Mpanga,
who was diagnosed with autism
when he was eight.
Unlike many other autistic children,
Kenny is able to attend
a mainstream secondary school,
with a specialist autism unit.
Would anybody else be able to have
a go using that method now,
Kenny's method, for doing this?
24 squared.
Watch what he did again.
Kenny has a gift
for mental arithmetic...
How many could multiply 9 by 36
in your head, though?
..and constantly
amazes his classmates.
Kenny, you're too smart!
You are actually too smart!
You got all of them correct.
Why are you in this set? Why?
He's so smart! Seriously, how, how?
What do you do? It's a secret?
It's an African thing!
And Kenny has one
very unusual talent.
22nd of February.
Oh, that was a Thursday.
23rd of May. It was a Wednesday.
16th of August 2001.
It was a Thursday.
He's a calendrical calculator...
That was a Saturday.
..which means you can give him
a date in the past or future
and he'll tell you
which day of the week it falls on.
Thursday.
..1936. Er, that was a Tuesday.
Kenny's of huge interest
to psychologists,
who want to know how he has acquired
this remarkable skill
despite his language difficulties.
He and his mum Harriet have come to
the Institute of Education in
London, so that he can be assessed.
Then in 1878...
Professor Richard Cowan studies
calendrical calculators, like Kenny.
1889, it was a Wednesday. Yeah.
March the 14th 1985.
I would say that was a Thursday.
Absolutely right.
And how about April the 22nd 1977?
That was a...Friday.
Absolutely right again.
And the 6th of July 1987?
That was a Monday.
Brilliant, yeah.
I mean, it's remarkable, isn't it?
So you're very... It's almost
like you're taking no time at all!
I mean,
do you see anything in your head?
I mean, do you have a mental image
of the calendar or...? No, I don't.
So it's just... You hear the date
and you know the answer? Yeah.
It does blow you away sometimes,
you know,
the way he just knocks those off.
But it can be quite an amusing
party trick when, er,
he tells people these things and
they all go, "What, what, what?!"
It is quite amusing but, er,
yes, it does keep him busy.
It's good to have a hobby.
How did you go about working out
the dates in the future?
It all started
when I was about seven or eight.
I didn't look in
any diaries or calendars. OK.
I just, er...
I think I just
remembered that, er...
Certain dates being a certain day
and remembering that and, er,
knowing that, er, every...
Every year a day goes forward,
apart from leap years.
OK, so that's
the "one year, one day" rule.
That's when I also found out
that, er,
in one century
every 28 years are the same.
OK, so within a century
every 28 years repeat.
What's remarkable is that Kenny
has identified complex patterns
in the calendar,
including the irregularities
caused by leap years.
And he works the answers out
in a second.
The 20th of December in 1994.
That was a Tuesday. Yep.
And the 3rd of August in 1980?
Er, that was a Sunday. Yes, again.
Kenny's excellent memory and his
desire to practise obsessively
are two features
of the autistic mind.
But his skill goes far beyond
just memory and practice.
He's able to spot patterns
and he's devised his own system
for coming up with the correct
answers to date problems.
This is very creative.
Only about 10% of people with autism
are as gifted as Kenny,
but as many as a third
have unexpected abilities -
like perfect musical pitch
and being able to recite
from memory.
Well done.
So what does Kenny
think about his autism?
I see things in a different way
than my other peers do and, er...
And sometimes they think I'm,
sort of, weird, the way I, er...
I express my thoughts
and opinions and, er,
I guess some of my peers
don't understand.
I just... I think
about things a different way.
Can we ever discover
what it is about the autistic mind
that enables such remarkable talents
to develop,
aside from memory and practice?
Hello, Peter.
'I've devised a task,
'using the popular children's game
Where's Wally?,
'to help explain the way
autistic minds work.
'The challenge is to find
a tiny picture of Wally
'in amongst this chaotic scene.
'Peter, who doesn't have autism,
struggles to find Wally.'
Yeah, where's Wally?
Come on, Wally, where are you?
OK, let's have a look.
'Paul, who is autistic,
finds him really rather quickly...'
That his archenemy. I obviously
know that. And his girlfriend there!
Oh, there he is. Wow! That was
amazingly fast! That's amazing.
'..whereas Peter's still
trying to find Wally.
'Next up is Chloe,
who is also autistic.'
Amazing! That was fabulously quick.
Well done! Well done!
'And then Laurie, who's also
on the autistic spectrum.'
That's it! That's amazing. Yeah!
Amazing!
'Peter needs some help.'
Do you want, er, a kind of vague
clue, or not really? Er, yes.
A vague clue. Sort of like...
Oh, he's up, is he?
The boats are a good clue.
Yes, right, OK.
That him? Yeah!
'The one thing we've noticed
time and time again
'is that autistic people see details
that escape the rest of us.
'This gives us clues to
understanding the condition,
'because it means that they often
miss the bigger picture -
'focusing instead on the details
that are the same
whatever context they're in.'
And it doesn't just apply
to Where's Wally? -
it shows us how differently autistic
people experience the world.
And it explains why they get upset
when an ornament in their house
has been moved a fraction,
and also why their interests
seem so narrow.
This intense focus on detail
and the abilities that sometimes
emerge from
it is a strange quirk of our mind -
and it's a quirk that's
very frequent in autism.
But it doesn't begin to tell us
what autism is really like.
Sidney, can you start it for us,
sending a clap in one direction?
Thank you.
The serious problems
people with autism face
are when they have to interact
and communicate with others.
I've come to meet acting student
Jules Robertson,
who has a form of autism
known as Asperger syndrome.
People with Asperger syndrome
do not have language problems
and are of average
or above-average intelligence.
Jules has recently enrolled
on a drama course
because he wants to be an actor.
So, Sidney,
can we have you sitting on the bus?
I join him and his mum,
the novelist Kathy Lette,
for what turns out to be
an interesting and unusual
conversation.
Jules has this idea that
everybody has an animal. Oh!
They have a totem animal. Mum always
wears blue because of the dolphin.
He thinks I'm a dolphin
cos of my big... What about me?
What do you think? What animal am I?
Like a flamingo. A flamingo head.
You've got a face like a flamingo.
Like a flamingo! Why am I a dolphin?
Why? You've got a dolphin smile.
Smile. It's the smile!
And you love fish. I do love fish!
You love sea bass.
You like us to throw you sea bass
when you're in bed.
And I jump up and catch it!
I just wanted to ask you, what is it
like for you to have this chat here?
Well, yeah. Having...
I can tell you what it's like having
Asperger's, as well. That's very...
Well, please. So hard. Er...
It's really hard. People don't
understand how hard it is.
They just... They just don't.
They just expect me to be able to...
get on with life really easily
and it's not easy for me to do that.
But is that also why
it's difficult just to chat and...
You know, just to chat
for no reason? Yeah, it's hard to...
to, er...make effort with people.
To be engaging with people. Yes.
It's really challenging.
Jules, do you want to go in
and make... OK. ..Becka disappear?
Do you like Steve Martin?
What's remarkable about Jules
is that he's able to
use his acting classes
to help him cope
with the social world.
Oh!
You can leave any time you want,
Jules. Well done!
What we're seeing, really, here
is a little universe of social
interactions -
little miniature scenes
are being enacted.
And we see how much reciprocity
there is between these young people.
Freeze!
This acting class gives Jules
an opportunity
to learn about social interactions
and the natural flow
of everyday conversation,
which is precisely
what autistic people struggle with.
I was one foot from the ball!
I think that Jules really has
taken advantage of this
and he's able to learn a lot
about what's going on
in a very relaxed and playful way,
that situations can be rehearsed.
You cannot be serious! Freeze!
Dad, you need to seriously stop
wearing my clothes!
Mom's going to freak out again!
You remember she drove herself
to drink last night!
Well, I am a transvestite! No, but
Mom doesn't need to know that.
Freeze!
Jules copes really well
in his acting class
and his lack of filter helps
the other students
to lose their inhibitions, too.
But it's real-life
social interactions
that are the challenge for him.
I observed you being with
the other drama students
and you seemed really
happy there. Was that true?
I was very happy there.
I'm not so happy now
but I was really happy then.
Jules will always tell the truth.
I used to try and explain
to Jules that you couldn't always
be truthful -
you know, that you had
to be more diplomatic...
That is a problem, isn't it?
Can you sometimes tell a lie?
Is it sometimes all right
to tell a lie?
He used to say to me,
"Are you teaching me to lie?"
And it's a hard concept, isn't it?
What do you think, Jules? Do you...
Er...
Er...
No, I think it's good
to tell the truth.
So I'm always in favour of that.
Where does it come from?
Why does it happen? Autism? Yes.
What do you think?
What's your explanation?
I just think...
I just think
people's brains are different.
Yes, I think you've hit
the nail on the head.
People's brains are different. Yeah.
And that's how the world is.
Jules is so likeable and charming,
and really good company.
But it is clear that often
he just does not get it.
He dances to a different tune.
What I've learned over
the last 50 years is that not having
a special kind
of social navigation system
is what sets autistic people apart
from the rest of us.
So why can't people with autism
fully share in our social world?
Is there an extra social sense
beyond sound, sight and touch
that they don't have?
Here is a deceptively simple task
that I helped devise in the 1980s.
It gives some insight into how
most of us who don't have autism
instinctively understand the complex
to and fro of social interactions.
So, I'm going to tell you a little
story about these two dolls.
This one is Sally...
..and this one is Ann.
Sally has a basket
and Ann has a box.
And Sally...
..has a marble and she's putting
that marble into her basket.
Keep it safe.
Now Sally wants to go out to play
and she's going right
out of the room.
Now, Ann...
..naughty Ann...
..takes that marble
out of the basket...
..and puts it into her box.
There it is.
Now it's time for
Sally to come back...
..and she wants to play
with her marble.
Where will Sally
look for her marble?
In her basket.
Of course!
Why does she look in her basket?
Cos she put it there.
She did, and...?
She didn't know that
the other girl took it.
Yes.
Why didn't she know?
Cos she was out. She was outside.
She didn't see it, did she? No.
Ha!
Well done.
We'd expect most normally
developing four-to-five-year-olds
to correctly identify where Sally
will look for her marble
when she returns.
They understand that Sally has no
knowledge of the marble being moved
and so she will look for it
where she put it,
rather than where it really is.
What this shows is that most of us
instinctively know that other people
have their separate beliefs, wishes
and intentions - minds of their own.
It turns out that this is the key
to understanding other people,
to explain why they're doing
what they're doing.
It's our extra social sense
that we haven't had a name for
but I called it "mentalising",
because beliefs, wishes and
intentions are mental states.
Could you please hide
that coin somewhere?
All right, I shall hide it
in the special pyramid box.
There it is. OK.
Back in the 1980s we discovered
that autistic children
had a very different response
to Sally/Ann-type tests.
This is ten-year-old Aurelius,
who is autistic.
I take the coin from here...
My then colleague, Dr Alan Leslie,
asks Aurelius where he thinks
I will look for my coin
after it's been moved.
And when Uta comes back in... Yes.
..where will Uta look for her coin?
In the triangle box.
'Aurelius says that I will look
for the coin where it really is,
'rather than where
I must believe it is.
'He doesn't understand that I can't
know the coin has been moved
'and that I now have a false belief,
'because he doesn't take into
account that I have a mind of my own
'with beliefs and thoughts
that are different to his.
'And this is the key to
understanding the social problems
of autism.'
Well, my coin is here, isn't it?
No!
I believe that mentalising
is that extra social sense
that most of us are born with
and that makes us
so curious to know what's
in each other's minds.
Also, it enables us to change other
people's minds through persuasion
and sometimes to manipulate other
people's minds through deception.
You won't find autistic people
doing that.
Autistic people don't have
that extra social sense
and that explains why
they're often so frustrated
when we don't know already
what's in their minds.
The challenges caused by the absence
of this extra social sense
never go away
for people with autism.
Hello, Cathy, I'm Francesca.
Hi, nice to meet you.
My collaborator of 20 years,
Professor Francesca Happe, and I
hit on the idea of
using animated cartoons
that give the compelling
impression of social scenarios.
Would autistic people
interpret the scenarios
in a different way
from the rest of us?
You'll see two triangles moving
around, interacting on the screen,
and I just want you to tell me
what you think is going on.
As it unfolds, let me know
what you think's going on
between the triangles.
The actors in these movies
are two little triangles
and the challenge is to
work out what the story is.
Try it for yourself.
Cathy is not autistic
and she has just watched this
story about persuasion unfold.
The big triangle is trying to
persuade the little triangle
to come somewhere with him and
he's trying to encourage him
and now he's pushing him along.
The little triangle is
quite reluctant, I think.
Oh, and he's just been barred
from re-entering, hasn't he?
These animations invite
the spontaneous use
of our extra social sense,
mentalising,
and most of us immediately get
the gist of what is going on.
It's almost like a parent
pushing their kid out
or persuading them
to leave the little pen.
Fantastic. That's lovely.
OK, we've got another one now.
The second movie was
about the little triangle
playing a game of knock and run.
The little blue one's coming...
He's knocking on the door.
The red one's going to open
the door and he's gone, hidden.
Oh, it's like a knock-knock
and then hide round the corner
like a kid knocking and running
on the front door of the house.
Gone back inside.
Sat down, relaxing, and
the kid's knocking again.
There we go - open the door
and he's gone, yep.
It's knock and run.
Oh, he's going inside now.
Yeah, like a child playing
a trick on their mum or dad
while they're relaxing,
watching telly or something,
they get a knock on the door
and then they're running
round the corner. Fantastic.
..and I'll move you in
on your chair
so that you're just in the shot.
Can you edge forward
a little bit more..?
When the same movie is
shown to autistic people,
they miss the point
of what is going on.
They tell a story,
but it doesn't fit the action.
Yeah, so the big, red triangle
looks like it's trapped
in the big, blue square.
Then the small, blue triangle comes.
It looks like he's trying
to look for a way...
He unlocked the door for
the red triangle and then...
We showed these animations
to people in a brain scanner
and found that autistic people had
less activity in those brain regions
that are now known to be
dedicated to mentalising.
I think it was a boxing ring and
one of the opponents was sizing up
the other one before
he'd let him in.
And then when they got in,
they decided they
didn't want to fight.
It's more like an opening
and closing of something
for that one.
I think that's it for that one.
Ah, that's interesting -
the red one's escaped.
Oh, what's he going to do now?
Ah, I thought that would happen.
The red one's slipped back in.
Maybe he's been taken prisoner
by the blue triangle.
"You will like your dungeon!"
Oh, now they're having a bit of a
barney and fighting with each other.
When it comes to interpreting
the triangles as agents,
they really can get hold of
the wrong end of the stick and then,
of course, that leads them into a
completely different kind of script.
But it's really a wonder, isn't it,
how we can actually
agree with each other
about our interpretations of things
that are just geometric shapes?
Yes, or particularly
to think that we made up
the scripts of those
animations on the train
and we thought,
"How should they move?"
We made them so they
looked that way to us
and when we first showed them
to ordinary people,
we had no idea whether they'd see
them in the way that we'd seen them.
It was amazing that even children
as young as four or five
could get the gist.
We were very surprised at that.
We seem to share a way of
interpreting each other's actions,
so imagine being autistic
and not having this nifty piece
of mental machinery that instantly
tracks social interactions.
Just watching a cartoon
or listening in to a chat
can be a baffling experience.
You don't know why people
say what they say
and you don't get the point
of jokes and banter.
Likewise, if you don't
know what's going on,
you tend to say things
that others can't comprehend.
All this can make you anxious,
frustrated and vulnerable.
Is anyone here anxious now?
Anybody feeling particularly
anxious or worried now?
Why not?
Why aren't you anxious?
You should be.
Anxiety, really,
is the feeling that you're probably
not going to be able to cope
with something that
is about to happen,
something in the future...
This is Sarah Hendrickx.
She's an accomplished public speaker
on the challenges of autism.
Anxiety is about,
"I can't handle it."
When I saw that,
I thought it was a penguin.
I didn't think it
looked like a penguin.
I thought it was a penguin.
I thought that a penguin
by the side of the road
was possible in Brighton.
Your world has got lampposts in it.
Mine's got penguins.
And she has been diagnosed
with autism spectrum disorder.
It's not all bad.
It's much more interesting.
Thank you very much for your time.
So how can someone with autism,
who finds social
situations challenging,
get up in front of hundreds
of people to give a speech?
This is a functional communication,
and I'm very good
at those situations.
I'm good at doing my talks,
I'm good at doing training
because it is prescribed. The topic
is prescribed, it's my topic,
it's my script.
It's not two-way -
you have to listen,
I've got the microphone,
I've got the stage.
It's a completely different dynamic.
Just like Jules,
Sarah has no problem
performing in front of others.
But off the stage, chance encounters
and interactions with other people
are unbearable for her.
What are people
to you in this sort of situation?
Frightening.
Most people are frightening.
Most people who...
..who don't have a
purpose are frightening.
If I know who they are -
so, the bar staff, or the people
who organise the conference -
I know who they are,
they're not frightening,
because the type of communication
that we're going to have
is pretty set, is pretty limited,
is pretty inflexible
and I can fairly well predict
what that will be.
But a completely unknown person
that I either don't know
or I fail to recognise,
I have absolutely no idea
what's coming next
or what they're going to want
or what they're going to say
or whether I can respond
appropriately quickly enough.
Sarah is highly intelligent
and is one of the rare people
who are able to describe exactly why
social situations are so baffling.
This gives us a real insight
into her condition.
Every day I try to wake up
about an hour before
I actually need to get up
and I spend that hour running
through what's likely to happen,
what types of people I might meet,
if I'm having a meeting
or something like that,
what kind of conversation.
I will run, re-enact a potential
conversation over and over again
before I get out of bed to try
and have a kind of sense
of what the whole day
is going to be like.
What's amazing about Sarah is
that she very consciously studies
and imitates the way people respond
to each other in social situations.
That enables her to effectively mask
her autism when she's in public.
What do I do? Do I sit here?
Sit there.
Sit there?
'I've had to watch people,
I've had to study people,'
because it's not there intuitively
and if I didn't do that,
I'd be completely lost.
But my failure rate is quite high
because my learning is rote
and therefore I'm prone
to not pick up the subtleties,
the nuances of situations,
so although I'm trying very hard
to apply all this stuff
that I've learned,
I do get it wrong
and I get it wrong with frequency.
And that's very, very stressful.
So it could be that imitation
is the key to Sarah's success.
Do you like my nose?
But there are different
kinds of imitation
and one kind might not be
so easy for people with autism,
but might be crucial to the way
most of us bond with each other
and fit into the social world.
It can be seen in an experiment by
my colleague Dr Antonia Hamilton.
Here, children are asked
to complete some simple tasks.
Hi, Joel. Hi.
Thank you for coming in today.
Here I've got a big box and hiding
inside this box I've got a boat.
First, I'll show you how I get the
boat out, then you'll get a turn.
There's my boat. It's a
nice red boat, isn't it?
I'll put that back in there.
Ordinary children mimic exactly
what their instructor has done,
even the pointless finger tapping.
Well done.
Now it's your turn.
Can you get the boat out? Yeah.
Well done.
There's my boat.
It's quite a little boat, isn't it?
Now, autistic kids have
a different approach,
cutting straight to the chase.
Can you get the boat out of the box?
Well done.
Now it's your turn.
Can you get the boat out of the box?
There, number three.
Well done.
So what does your experiment show?
Well, it shows us that typically
developing children will copy
even actions that are silly actions
that don't contribute
toward the goal.
We think the reason they're
copying that is that they want
to be like the adult or they want to
do everything that the adult does.
They're not just learning
about how this object behaves.
They're learning to be
adult-like and to be social,
but autistic children
are more selective.
They will do the thing
that gets the goal,
gets the boat out of the box
or gets the doll out,
but they don't bother to copy all
of these extra, unnecessary things.
Sarah is exceptional
and has made a point of
studying social scenarios
and has learned to copy
other people's behaviour.
This has help her greatly
to get on in life.
Back at home here in Worthing,
she's just moved in
with her partner Keith,
who is also on
the autistic spectrum.
It's the top of the tree
that comes from a well-known,
reputable shop where
everything costs... How much?
Just a pound!
Is it the top decoration
that goes on last?
They're about to spend their
first Christmas together
in their new home.
Or do you put that on first?
Oh, you might put lights on first.
I thought you put lights on first.
So how can these two people
forge a relationship
when social interactions
cause them crippling anxiety?
How did you find
each other, meet each other?
On the internet!
Where all socially awkward people
go to find each other.
Was there any rush of love
at any point in the early days?
I don't really know what that means.
Erm...
I never expected to fall for him
or be particularly attracted
to him or anything.
It was a really logical experiment,
to deliberately go out with someone
that I didn't fancy that much
in order to see what
it would be like
to have a nice friendship
with somebody,
cos that wasn't my kind of history.
What was your thinking?
You wanted someone to have sex with.
Yeah, yeah. And you were largely...
I think that was my initial
motivating force, yes.
..unconcerned about who that was.
There wasn't a huge amount
of selection process. No.
If someone was willing,
then so was I.
So why are we together, then?
I don't know. Why are we together?
You tell me.
You're my...
required amount of social contact.
I'm your 5ml teaspoon a day?
Yes, that's it.
Sarah and Keith constantly struggle
to make sense of social activities.
We don't do any socialising
whatsoever for Christmas.
I think you've got
a Christmas works lunch
that everybody goes to
in your office.
Doesn't even occur to me
to even think about anything.
It doesn't feel like...
It just doesn't occur to me
that we would go somewhere.
Where would we go? What would we do?
What would you do? I don't know.
What do you do? I don't know. No.
It wouldn't even occur to me
to want to do anything like that,
not at all. I don't miss people.
I don't have the emotion of missing
somebody when they're not there.
I might prefer them to be with me...
..but I don't think
it's quite the same emotion
that I understand that other people
have in terms of missing people.
And yet you two are
in a close relationship.
Yes. We are peas in a pod.
Do you miss me
when I'm not there?
I don't think you do. I think
we've talked about this before,
haven't we? When I have to
interact with others, then yes,
because the interaction
that I have with them
is never as satisfying as
the interaction I have with you.
Is that "missing"?
You've always said,
"I prefer it when you're there,"
which suggests to me
a sort of absence of a...
I think missing involves abstract
imagination. It involves...
..some kind of ability to picture
another reality other than
the one you're in at the moment
and I don't think either of us are
particularly capable at doing that.
Sarah and Keith get on really well
just the two of them
and are committed to total honesty
in their constant
reflection and analysis.
Although Sarah and Keith
have restricted
their contact to other people,
they do show us that autistic people
can have meaningful
social relationships.
It's often said that autistic
people don't have empathy,
but that is wrong.
Sarah and Keith really
care for each other.
What they find difficult
is this social navigation
that the rest of us
do automatically.
Since diagnosis has surged
in the last two decades,
it's tempting to think of
autism as a modern phenomenon.
But is there any
evidence in history
to show that autism has
been around for longer?
Today, people talk about
an autism epidemic.
When I saw the first cases
about 50 years ago,
the estimated number
was about five in 10,000.
Today it is 100 in 10,000.
This is a huge increase
and yet it does not
necessarily mean
that more children with
autism are born now.
It does mean that we are much
better at diagnosing autism.
So is autism a new condition,
or has it always been with us?
And how would we ever find out?
I've come to Dumfries & Galloway
in the Scottish borders,
where historian
Professor Rab Houston
has unearthed the story
of a family feud
caused by the very unusual behaviour
of an 18th century Scottish laird
called Hugh Blair.
This is the place where
Hugh Blair was born
and where he and his family lived
for the first half
of the 18th century.
Sometime during the 1740s, when Hugh
would have been in his mid-30s,
his brother John and his mother
had a tremendous falling out.
As a result of that,
his mother cooked up a marriage -
she arranged a marriage for Hugh
with the daughter of a local surgeon
who lived in Kirkcudbright, which
is the main town quite near to here.
John was furious,
absolutely furious,
so he took out a writ against Hugh
to have his marriage annulled
on the grounds that he didn't
understand what he was doing.
John, the younger son,
would lose his inheritance
if there were any children
from this marriage.
He needed to prove that Hugh
could not be legally married
since he was mentally incapacitated.
It's because of this court case that
we have an unprecedented insight
into Hugh Blair's odd behaviour
and how it relates to
the modern diagnosis of autism.
It was 5th July 1747
when the case was brought before
the Commissary Court of Edinburgh.
260 years on, Professor Houston
discovered the documents,
which had clearly been unread
since they were first written.
Transcripts of 27 witnesses
are very revealing
about Hugh's mental condition
and reminiscent of autism.
Here, one witness mentions
a strange special interest.
It says that Hugh...
"Went to all the burials about,
"whether rich or poor, and that
whether he was invited or not,
"and this he did both before
and after he was a man
"who arrived at
the age of majority."
Oh, that's just
a wonderful observation,
because that's an example of a
kind of special interest, you know?
A special interest in
something that other people
probably would not be interested in,
and for him to be able to find out
when all these burials were taking
place and then to just turn up
and go there,
regardless of who it was -
I think that's extraordinarily
reminiscent of autism.
Perhaps the most revealing document
is Hugh Blair's written testimony.
Here he was asked
questions in writing,
because the court wondered whether
perhaps he was deaf and dumb.
So, the clerk of the court
wrote out,
"Answer the following question -
what brought you to Edinburgh?"
Hugh Blair's answer reads,
"Answer the following question -
what brought you to Edinburgh?"
To me, it's really
as clear an indication
of what I call a mentalising failure
as you could wish for.
It's not understanding that
you need to tell another person
something that only you can tell,
that they want you to tell.
He just doesn't get that point.
The court was convinced that
Hugh was mentally incapacitated,
and his marriage was annulled.
The Blair estate was ruined
by the costs of the court case.
The case of Hugh Blair is by far the
earliest that I would be confident
in diagnosing as autism, and it's
astonishing that you can recognise
the condition across such vast
differences of time and of culture.
What's so important to me about
this is that it enables us to see
more clearly the common and
enduring features of autism.
It's often said that the
enduring features of autism
are present in many of us.
Today, we often say someone's
"on the spectrum"
as a catch-all phrase to describe
anyone who's a bit eccentric,
has unusual hobbies
or is socially awkward.
Here at Trinity College Cambridge
stands a statue to one of our
greatest scientists, Isaac Newton.
He certainly was eccentric,
and some people have suggested
that he may have been autistic.
I'm not convinced.
'I'm here to meet
Professor Simon Baron-Cohen,
'who long ago was my PhD student and
is now a fellow of Trinity himself.'
There are personal anecdotes
about his life.
There are. One of the stories
is that his lectures were
very difficult to follow.
And the students stopped coming
but he kept teaching,
even though there were no
students present. Oh, really?!
Because it was in his job
description. So he was very dutiful.
Simon is interested in autistic-like
traits in the general population,
so I've come to discuss with him
whether autism is in a category
by itself, or whether it's possible
to be a little bit autistic.
So can you sort of
make this a bit...
You can measure autistic traits,
just like any metric,
like a ruler, where if you
were down here at zero
or up here at 50, you'd be either
low or high or just average. Yeah.
So here you would have
no autistic traits at all,
here you would have everything.
Most people in the population
are scoring right in the middle.
That's the population average,
or the mean.
And people who have a diagnosis
on the autistic spectrum
tend to score right up here.
Above 30, or 32,
out of a scale of 50.
And actually when you look
at the whole population,
it turns out to be quite
a beautiful, normal distribution.
Very few people down at zero,
very few people at the maximum.
So you could almost say that there
might have been a natural selection
to have an average number.
At what point, then,
would the diagnosis of autism
become a sort of certainty?
Well, you get your diagnosis
when you go to a clinic.
It's not about these metrics.
It's about the clinician looking
at how much these traits
are interfering with
your everyday functioning.
So some people are
developing secondary depression,
because they've got a high number
of autistic traits.
Some children are being bullied,
because they've got a
high number of autistic traits.
But some people are doing
just fine...
If they're doing fine, irrespective
of their score, they don't need...
They're not autistic?
They don't need the diagnosis.
So you withhold the diagnosis,
unless there's a clear,
clinical need.
So now it's not about science,
it's about clinical judgment.
So there is something of a grey area
where some people might
get the diagnosis if they go to one
centre for the diagnostic assessment
and not get the diagnosis if they go
to another centre... Absolutely.
..because it is a judgment call.
The only thing that differentiates
people in the general population
from people who have
a diagnosis is simply
the number of
autistic traits that we have.
That we're all
on the same continuum.
And...part of what research needs
to do is to try and determine -
is there a qualitative break there?
Or is it the case that it's
simply a matter of degree?
I've often imagined myself
being a bit autistic.
I'm certainly obsessively focused
on my work.
And in my feelings I am often
very analytical and detached.
And I certainly have
said things that hurt people
without my realising this,
and I'm generally baffled
by the complexities of social
relationships. But here it stops.
It's easy to confuse autistic-like
traits with autism,
so if you think you might
be a little bit autistic,
you very probably are not.
But whether there is a precise
point at which autism begins
is an open question
and for now remains a mystery.
So in the right position
for her, basically.
Today, most children with autism
will be diagnosed
before they go to school,
but some
are diagnosed much later.
Like any condition, doctors
and parents want to identify it
as early as possible.
We know that the autistic brain
must be wired differently,
and that there is
a genetic reason for this,
but we don't really know
the details yet.
Here at Birkbeck College in London,
they're running a study to see
if they can detect very
early signs of autism.
They're studying babies who have
an increased genetic risk
of being autistic,
because they an autistic sibling.
And they're comparing them to
babies with no increased risk.
We are looking for early signs
of autism, early markers.
The reason being that, at the
moment, the earliest stage
that a child will possibly
get a diagnosis
is around two to three years of age.
So the main aim is to find
an early marker to enable us
to possibly diagnose
the disorder earlier.
They're looking to
see how the babies' brains
react to social and
non-social images.
They use equipment that gently
shines light onto the baby's head
to measure the oxygen level
in the blood and, therefore,
brain activity.
This is where we're having the
response, in this brain region.
And this one example is about
visual, social cues,
so this is when the babies
are watching the peek-a-boo
and the Incy Wincy Spider.
The graph here on the left is
what you would typically have
as a response in infants of this
age, so four to six-month-olds.
We've seen in many, many babies
that they would have an increase
in oxygen in their blood,
which is this red line here,
and this is the response
that we've had in the infants
that have a family risk of autism.
So they have the brother
or sister with autism.
And what you notice quite strikingly
is that the oxygen change
in this brain region is
almost absent in comparison to
the low-risk infants.
But the tantalising thing to have
emerged from this study so far
is that not all the babies
who have the autistic markers
go on to get a diagnosis of autism.
So, the babies we've seen who show
the possible
early markers of autism,
but who actually don't go on
to develop the disorder,
the ones that fall sort of
either side of the line, they...
It's an interesting thing.
That's one of the questions that
we hope to answer - why don't they?
Are there protective factors,
be that genetic or environmental,
that kick in,
or are these children programmed
in a slightly different way
that they're never going
to develop the full-blown disorder,
but they may carry these
subtle traits of autism
throughout their lives
without anyone noticing?
Ready, steady, go!
What's he doing?
The idea of a protective factor
might explain another mystery -
why many more boys than girls
are diagnosed with autism.
Could it be that girls have
some kind of protective factor,
perhaps for some genetic
or hormonal reason,
that reduces
the impact of autism?
We could even speculate that
these protective factors
are why many of us grow up to have
an autistic-like personality,
but not actually be autistic.
Sorry, you've got the wrong idea.
Despite the insights we've gained
over the last few decades
about how people with autism
perceive the world,
there are still so many questions
that remain unanswered.
How does the brain create
these different minds?
And why are some people
autistic in the first place?
And why does autism come in
so many forms?
Very good.
Joe needs constant care, and will
never be able to live by himself.
Good to do.
Are you happy here? Yes.
And sometimes you go out?
Yes.
And you can relax? Relax.
You also work? Yes.
'What's this, Joe? Money.
'Money. And what's this, Joe?
'Butter. Bread.
'And this?
'Milk. Milk. And this?'
Almost 50 years ago,
I met a bright-eyed young boy
who had terrible difficulties
interacting with the world.
'What is it? Ba-ma.
'A barrow. A barrow.
'What's this?'
Joe sees things very differently,
but he inspired me
to dedicate a lifetime
to studying minds like his.
And in its own way, I'm glad that
his life has been fulfilling too.
What flowers do you like?
Sunflowers.
Yes.
So you just put the seed in,
do you? Yes.
And...a plant comes out? Yes.
in Britain who experience the world
very differently to the rest of us.
These are people with autism.
A puzzling condition which, 70 years
after it was first given a name,
we still know very little about.
My name is Uta Frith.
I'm a psychologist
and I've spent my career
trying to unravel
the mysteries of the autistic mind.
By spending time with many different
people on the autistic spectrum,
I want to show you
what a complex condition it is.
I want you to join me as I reveal
what I've discovered about
these amazing people.
23rd of May.
16th of August 2001.
It was a Thursday.
Kenny, how do you do it?
How is it possible to have
this extraordinary ability?
And how do people with autism
cope with relationships?
I don't know. Why are we together?
You tell me.
You're my...required amount
of social contact.
These fascinating people
that I've met over the years
have shown me that another
kind of reality exists,
that is full of
immense challenges, mysteries...
but also joy.
Mum always wears blue
because of the dolphin thing.
He thinks I'm a dolphin! Why?
You've got the dolphin smile.
It's the smile! And you love fish,
like dolphins. I do love fish.
You like us to throw you sea bass
when you're in bed.
I want to show you that
by understanding their world,
we can learn more about world.
In my quest to understand
the autistic mind,
I've spent a lifetime
conducting rigorous experiments.
OK, let's have a look.
By comparing people with autism
to the rest of us,
we can start to see
what autism really is.
My fascination with autism
began 50 years ago
when I met some autistic children,
while I was training to be
a clinical psychologist.
I was immediately fascinated of
the paradox of how these beautiful,
bright-eyed children could be
so detached from the world.
When I asked a question,
an autistic child would repeat it
and not answer it. And I couldn't
engage them in a conversation.
And I couldn't engage them
with toys, either.
An autistic child might
rapidly complete a jigsaw puzzle
but show absolutely no interest
in a game of teddy bears' picnic.
I passionately wanted to find out
what was going on here.
Back in the 1960s,
these children were being given
the new diagnosis of autism.
"Autos" in Greek means "self"
and refers to their apparent
self absorption.
Autism takes on many forms
and exists on a wide spectrum,
from mild to severe.
It was, and still is,
characterised by the difficulty
these children have
communicating and interacting
with others
and by their tendency
to have very narrow interests
and to repeat activities
over and over again.
What's this, Joe? What's...
One of these children
was Joe Allison.
'And this? Bowl.
'Bowl. And this?
'Box. Box. And this?'
Who is that? Yes.
It's... Joe Allison.
It's Joe Allison learning to talk.
Yes.
'What's this, Joe? Money. Money.
'What's this, Joe? Money.
Yes, money.'
Joe is now 57
and this is the first time I've
seen him since he was a young boy.
Do you remember her, Joe? Yes.
She was very kind.
What is this, Joe?
What is it?
Ba-ma. A barrow. A bu-bbow.
Back then, we thought that
if only we could teach
these children to speak,
then everything would be OK
and the autism would go away.
'Joe understood about
the Christmas story,
'about Father Christmas
and Christmas dinner.
'And it's the first time we've been
able to have a tree
'and none of the ornaments
have been broken.'
And who's this? Mum.
Is it Mum? Yes.
'So now you have some hope for Joe?
I certainly do.
'I don't know how far he will go
but one feels if he's gone this far,
'why shouldn't he go
a great deal further?'
That's nice, isn't it? Yes.
'But 50 years on,
'we now know that autism is
a lifelong brain abnormality.
'Half of those affected have
significant learning disabilities
'and well over 80%
are unable to live independently.'
When I tell people what I do,
the first thing they ask about
are the autistic individuals
known as savants,
who have remarkable gifts.
Many people with autism have talents
that appear to be at odds with
the rest of their abilities.
And occasionally, these skills
can be quite extraordinary.
Start with the easy one...
and work your way down through
these operations
to get your answer at the bottom.
This is 15-year-old Kenny Mpanga,
who was diagnosed with autism
when he was eight.
Unlike many other autistic children,
Kenny is able to attend
a mainstream secondary school,
with a specialist autism unit.
Would anybody else be able to have
a go using that method now,
Kenny's method, for doing this?
24 squared.
Watch what he did again.
Kenny has a gift
for mental arithmetic...
How many could multiply 9 by 36
in your head, though?
..and constantly
amazes his classmates.
Kenny, you're too smart!
You are actually too smart!
You got all of them correct.
Why are you in this set? Why?
He's so smart! Seriously, how, how?
What do you do? It's a secret?
It's an African thing!
And Kenny has one
very unusual talent.
22nd of February.
Oh, that was a Thursday.
23rd of May. It was a Wednesday.
16th of August 2001.
It was a Thursday.
He's a calendrical calculator...
That was a Saturday.
..which means you can give him
a date in the past or future
and he'll tell you
which day of the week it falls on.
Thursday.
..1936. Er, that was a Tuesday.
Kenny's of huge interest
to psychologists,
who want to know how he has acquired
this remarkable skill
despite his language difficulties.
He and his mum Harriet have come to
the Institute of Education in
London, so that he can be assessed.
Then in 1878...
Professor Richard Cowan studies
calendrical calculators, like Kenny.
1889, it was a Wednesday. Yeah.
March the 14th 1985.
I would say that was a Thursday.
Absolutely right.
And how about April the 22nd 1977?
That was a...Friday.
Absolutely right again.
And the 6th of July 1987?
That was a Monday.
Brilliant, yeah.
I mean, it's remarkable, isn't it?
So you're very... It's almost
like you're taking no time at all!
I mean,
do you see anything in your head?
I mean, do you have a mental image
of the calendar or...? No, I don't.
So it's just... You hear the date
and you know the answer? Yeah.
It does blow you away sometimes,
you know,
the way he just knocks those off.
But it can be quite an amusing
party trick when, er,
he tells people these things and
they all go, "What, what, what?!"
It is quite amusing but, er,
yes, it does keep him busy.
It's good to have a hobby.
How did you go about working out
the dates in the future?
It all started
when I was about seven or eight.
I didn't look in
any diaries or calendars. OK.
I just, er...
I think I just
remembered that, er...
Certain dates being a certain day
and remembering that and, er,
knowing that, er, every...
Every year a day goes forward,
apart from leap years.
OK, so that's
the "one year, one day" rule.
That's when I also found out
that, er,
in one century
every 28 years are the same.
OK, so within a century
every 28 years repeat.
What's remarkable is that Kenny
has identified complex patterns
in the calendar,
including the irregularities
caused by leap years.
And he works the answers out
in a second.
The 20th of December in 1994.
That was a Tuesday. Yep.
And the 3rd of August in 1980?
Er, that was a Sunday. Yes, again.
Kenny's excellent memory and his
desire to practise obsessively
are two features
of the autistic mind.
But his skill goes far beyond
just memory and practice.
He's able to spot patterns
and he's devised his own system
for coming up with the correct
answers to date problems.
This is very creative.
Only about 10% of people with autism
are as gifted as Kenny,
but as many as a third
have unexpected abilities -
like perfect musical pitch
and being able to recite
from memory.
Well done.
So what does Kenny
think about his autism?
I see things in a different way
than my other peers do and, er...
And sometimes they think I'm,
sort of, weird, the way I, er...
I express my thoughts
and opinions and, er,
I guess some of my peers
don't understand.
I just... I think
about things a different way.
Can we ever discover
what it is about the autistic mind
that enables such remarkable talents
to develop,
aside from memory and practice?
Hello, Peter.
'I've devised a task,
'using the popular children's game
Where's Wally?,
'to help explain the way
autistic minds work.
'The challenge is to find
a tiny picture of Wally
'in amongst this chaotic scene.
'Peter, who doesn't have autism,
struggles to find Wally.'
Yeah, where's Wally?
Come on, Wally, where are you?
OK, let's have a look.
'Paul, who is autistic,
finds him really rather quickly...'
That his archenemy. I obviously
know that. And his girlfriend there!
Oh, there he is. Wow! That was
amazingly fast! That's amazing.
'..whereas Peter's still
trying to find Wally.
'Next up is Chloe,
who is also autistic.'
Amazing! That was fabulously quick.
Well done! Well done!
'And then Laurie, who's also
on the autistic spectrum.'
That's it! That's amazing. Yeah!
Amazing!
'Peter needs some help.'
Do you want, er, a kind of vague
clue, or not really? Er, yes.
A vague clue. Sort of like...
Oh, he's up, is he?
The boats are a good clue.
Yes, right, OK.
That him? Yeah!
'The one thing we've noticed
time and time again
'is that autistic people see details
that escape the rest of us.
'This gives us clues to
understanding the condition,
'because it means that they often
miss the bigger picture -
'focusing instead on the details
that are the same
whatever context they're in.'
And it doesn't just apply
to Where's Wally? -
it shows us how differently autistic
people experience the world.
And it explains why they get upset
when an ornament in their house
has been moved a fraction,
and also why their interests
seem so narrow.
This intense focus on detail
and the abilities that sometimes
emerge from
it is a strange quirk of our mind -
and it's a quirk that's
very frequent in autism.
But it doesn't begin to tell us
what autism is really like.
Sidney, can you start it for us,
sending a clap in one direction?
Thank you.
The serious problems
people with autism face
are when they have to interact
and communicate with others.
I've come to meet acting student
Jules Robertson,
who has a form of autism
known as Asperger syndrome.
People with Asperger syndrome
do not have language problems
and are of average
or above-average intelligence.
Jules has recently enrolled
on a drama course
because he wants to be an actor.
So, Sidney,
can we have you sitting on the bus?
I join him and his mum,
the novelist Kathy Lette,
for what turns out to be
an interesting and unusual
conversation.
Jules has this idea that
everybody has an animal. Oh!
They have a totem animal. Mum always
wears blue because of the dolphin.
He thinks I'm a dolphin
cos of my big... What about me?
What do you think? What animal am I?
Like a flamingo. A flamingo head.
You've got a face like a flamingo.
Like a flamingo! Why am I a dolphin?
Why? You've got a dolphin smile.
Smile. It's the smile!
And you love fish. I do love fish!
You love sea bass.
You like us to throw you sea bass
when you're in bed.
And I jump up and catch it!
I just wanted to ask you, what is it
like for you to have this chat here?
Well, yeah. Having...
I can tell you what it's like having
Asperger's, as well. That's very...
Well, please. So hard. Er...
It's really hard. People don't
understand how hard it is.
They just... They just don't.
They just expect me to be able to...
get on with life really easily
and it's not easy for me to do that.
But is that also why
it's difficult just to chat and...
You know, just to chat
for no reason? Yeah, it's hard to...
to, er...make effort with people.
To be engaging with people. Yes.
It's really challenging.
Jules, do you want to go in
and make... OK. ..Becka disappear?
Do you like Steve Martin?
What's remarkable about Jules
is that he's able to
use his acting classes
to help him cope
with the social world.
Oh!
You can leave any time you want,
Jules. Well done!
What we're seeing, really, here
is a little universe of social
interactions -
little miniature scenes
are being enacted.
And we see how much reciprocity
there is between these young people.
Freeze!
This acting class gives Jules
an opportunity
to learn about social interactions
and the natural flow
of everyday conversation,
which is precisely
what autistic people struggle with.
I was one foot from the ball!
I think that Jules really has
taken advantage of this
and he's able to learn a lot
about what's going on
in a very relaxed and playful way,
that situations can be rehearsed.
You cannot be serious! Freeze!
Dad, you need to seriously stop
wearing my clothes!
Mom's going to freak out again!
You remember she drove herself
to drink last night!
Well, I am a transvestite! No, but
Mom doesn't need to know that.
Freeze!
Jules copes really well
in his acting class
and his lack of filter helps
the other students
to lose their inhibitions, too.
But it's real-life
social interactions
that are the challenge for him.
I observed you being with
the other drama students
and you seemed really
happy there. Was that true?
I was very happy there.
I'm not so happy now
but I was really happy then.
Jules will always tell the truth.
I used to try and explain
to Jules that you couldn't always
be truthful -
you know, that you had
to be more diplomatic...
That is a problem, isn't it?
Can you sometimes tell a lie?
Is it sometimes all right
to tell a lie?
He used to say to me,
"Are you teaching me to lie?"
And it's a hard concept, isn't it?
What do you think, Jules? Do you...
Er...
Er...
No, I think it's good
to tell the truth.
So I'm always in favour of that.
Where does it come from?
Why does it happen? Autism? Yes.
What do you think?
What's your explanation?
I just think...
I just think
people's brains are different.
Yes, I think you've hit
the nail on the head.
People's brains are different. Yeah.
And that's how the world is.
Jules is so likeable and charming,
and really good company.
But it is clear that often
he just does not get it.
He dances to a different tune.
What I've learned over
the last 50 years is that not having
a special kind
of social navigation system
is what sets autistic people apart
from the rest of us.
So why can't people with autism
fully share in our social world?
Is there an extra social sense
beyond sound, sight and touch
that they don't have?
Here is a deceptively simple task
that I helped devise in the 1980s.
It gives some insight into how
most of us who don't have autism
instinctively understand the complex
to and fro of social interactions.
So, I'm going to tell you a little
story about these two dolls.
This one is Sally...
..and this one is Ann.
Sally has a basket
and Ann has a box.
And Sally...
..has a marble and she's putting
that marble into her basket.
Keep it safe.
Now Sally wants to go out to play
and she's going right
out of the room.
Now, Ann...
..naughty Ann...
..takes that marble
out of the basket...
..and puts it into her box.
There it is.
Now it's time for
Sally to come back...
..and she wants to play
with her marble.
Where will Sally
look for her marble?
In her basket.
Of course!
Why does she look in her basket?
Cos she put it there.
She did, and...?
She didn't know that
the other girl took it.
Yes.
Why didn't she know?
Cos she was out. She was outside.
She didn't see it, did she? No.
Ha!
Well done.
We'd expect most normally
developing four-to-five-year-olds
to correctly identify where Sally
will look for her marble
when she returns.
They understand that Sally has no
knowledge of the marble being moved
and so she will look for it
where she put it,
rather than where it really is.
What this shows is that most of us
instinctively know that other people
have their separate beliefs, wishes
and intentions - minds of their own.
It turns out that this is the key
to understanding other people,
to explain why they're doing
what they're doing.
It's our extra social sense
that we haven't had a name for
but I called it "mentalising",
because beliefs, wishes and
intentions are mental states.
Could you please hide
that coin somewhere?
All right, I shall hide it
in the special pyramid box.
There it is. OK.
Back in the 1980s we discovered
that autistic children
had a very different response
to Sally/Ann-type tests.
This is ten-year-old Aurelius,
who is autistic.
I take the coin from here...
My then colleague, Dr Alan Leslie,
asks Aurelius where he thinks
I will look for my coin
after it's been moved.
And when Uta comes back in... Yes.
..where will Uta look for her coin?
In the triangle box.
'Aurelius says that I will look
for the coin where it really is,
'rather than where
I must believe it is.
'He doesn't understand that I can't
know the coin has been moved
'and that I now have a false belief,
'because he doesn't take into
account that I have a mind of my own
'with beliefs and thoughts
that are different to his.
'And this is the key to
understanding the social problems
of autism.'
Well, my coin is here, isn't it?
No!
I believe that mentalising
is that extra social sense
that most of us are born with
and that makes us
so curious to know what's
in each other's minds.
Also, it enables us to change other
people's minds through persuasion
and sometimes to manipulate other
people's minds through deception.
You won't find autistic people
doing that.
Autistic people don't have
that extra social sense
and that explains why
they're often so frustrated
when we don't know already
what's in their minds.
The challenges caused by the absence
of this extra social sense
never go away
for people with autism.
Hello, Cathy, I'm Francesca.
Hi, nice to meet you.
My collaborator of 20 years,
Professor Francesca Happe, and I
hit on the idea of
using animated cartoons
that give the compelling
impression of social scenarios.
Would autistic people
interpret the scenarios
in a different way
from the rest of us?
You'll see two triangles moving
around, interacting on the screen,
and I just want you to tell me
what you think is going on.
As it unfolds, let me know
what you think's going on
between the triangles.
The actors in these movies
are two little triangles
and the challenge is to
work out what the story is.
Try it for yourself.
Cathy is not autistic
and she has just watched this
story about persuasion unfold.
The big triangle is trying to
persuade the little triangle
to come somewhere with him and
he's trying to encourage him
and now he's pushing him along.
The little triangle is
quite reluctant, I think.
Oh, and he's just been barred
from re-entering, hasn't he?
These animations invite
the spontaneous use
of our extra social sense,
mentalising,
and most of us immediately get
the gist of what is going on.
It's almost like a parent
pushing their kid out
or persuading them
to leave the little pen.
Fantastic. That's lovely.
OK, we've got another one now.
The second movie was
about the little triangle
playing a game of knock and run.
The little blue one's coming...
He's knocking on the door.
The red one's going to open
the door and he's gone, hidden.
Oh, it's like a knock-knock
and then hide round the corner
like a kid knocking and running
on the front door of the house.
Gone back inside.
Sat down, relaxing, and
the kid's knocking again.
There we go - open the door
and he's gone, yep.
It's knock and run.
Oh, he's going inside now.
Yeah, like a child playing
a trick on their mum or dad
while they're relaxing,
watching telly or something,
they get a knock on the door
and then they're running
round the corner. Fantastic.
..and I'll move you in
on your chair
so that you're just in the shot.
Can you edge forward
a little bit more..?
When the same movie is
shown to autistic people,
they miss the point
of what is going on.
They tell a story,
but it doesn't fit the action.
Yeah, so the big, red triangle
looks like it's trapped
in the big, blue square.
Then the small, blue triangle comes.
It looks like he's trying
to look for a way...
He unlocked the door for
the red triangle and then...
We showed these animations
to people in a brain scanner
and found that autistic people had
less activity in those brain regions
that are now known to be
dedicated to mentalising.
I think it was a boxing ring and
one of the opponents was sizing up
the other one before
he'd let him in.
And then when they got in,
they decided they
didn't want to fight.
It's more like an opening
and closing of something
for that one.
I think that's it for that one.
Ah, that's interesting -
the red one's escaped.
Oh, what's he going to do now?
Ah, I thought that would happen.
The red one's slipped back in.
Maybe he's been taken prisoner
by the blue triangle.
"You will like your dungeon!"
Oh, now they're having a bit of a
barney and fighting with each other.
When it comes to interpreting
the triangles as agents,
they really can get hold of
the wrong end of the stick and then,
of course, that leads them into a
completely different kind of script.
But it's really a wonder, isn't it,
how we can actually
agree with each other
about our interpretations of things
that are just geometric shapes?
Yes, or particularly
to think that we made up
the scripts of those
animations on the train
and we thought,
"How should they move?"
We made them so they
looked that way to us
and when we first showed them
to ordinary people,
we had no idea whether they'd see
them in the way that we'd seen them.
It was amazing that even children
as young as four or five
could get the gist.
We were very surprised at that.
We seem to share a way of
interpreting each other's actions,
so imagine being autistic
and not having this nifty piece
of mental machinery that instantly
tracks social interactions.
Just watching a cartoon
or listening in to a chat
can be a baffling experience.
You don't know why people
say what they say
and you don't get the point
of jokes and banter.
Likewise, if you don't
know what's going on,
you tend to say things
that others can't comprehend.
All this can make you anxious,
frustrated and vulnerable.
Is anyone here anxious now?
Anybody feeling particularly
anxious or worried now?
Why not?
Why aren't you anxious?
You should be.
Anxiety, really,
is the feeling that you're probably
not going to be able to cope
with something that
is about to happen,
something in the future...
This is Sarah Hendrickx.
She's an accomplished public speaker
on the challenges of autism.
Anxiety is about,
"I can't handle it."
When I saw that,
I thought it was a penguin.
I didn't think it
looked like a penguin.
I thought it was a penguin.
I thought that a penguin
by the side of the road
was possible in Brighton.
Your world has got lampposts in it.
Mine's got penguins.
And she has been diagnosed
with autism spectrum disorder.
It's not all bad.
It's much more interesting.
Thank you very much for your time.
So how can someone with autism,
who finds social
situations challenging,
get up in front of hundreds
of people to give a speech?
This is a functional communication,
and I'm very good
at those situations.
I'm good at doing my talks,
I'm good at doing training
because it is prescribed. The topic
is prescribed, it's my topic,
it's my script.
It's not two-way -
you have to listen,
I've got the microphone,
I've got the stage.
It's a completely different dynamic.
Just like Jules,
Sarah has no problem
performing in front of others.
But off the stage, chance encounters
and interactions with other people
are unbearable for her.
What are people
to you in this sort of situation?
Frightening.
Most people are frightening.
Most people who...
..who don't have a
purpose are frightening.
If I know who they are -
so, the bar staff, or the people
who organise the conference -
I know who they are,
they're not frightening,
because the type of communication
that we're going to have
is pretty set, is pretty limited,
is pretty inflexible
and I can fairly well predict
what that will be.
But a completely unknown person
that I either don't know
or I fail to recognise,
I have absolutely no idea
what's coming next
or what they're going to want
or what they're going to say
or whether I can respond
appropriately quickly enough.
Sarah is highly intelligent
and is one of the rare people
who are able to describe exactly why
social situations are so baffling.
This gives us a real insight
into her condition.
Every day I try to wake up
about an hour before
I actually need to get up
and I spend that hour running
through what's likely to happen,
what types of people I might meet,
if I'm having a meeting
or something like that,
what kind of conversation.
I will run, re-enact a potential
conversation over and over again
before I get out of bed to try
and have a kind of sense
of what the whole day
is going to be like.
What's amazing about Sarah is
that she very consciously studies
and imitates the way people respond
to each other in social situations.
That enables her to effectively mask
her autism when she's in public.
What do I do? Do I sit here?
Sit there.
Sit there?
'I've had to watch people,
I've had to study people,'
because it's not there intuitively
and if I didn't do that,
I'd be completely lost.
But my failure rate is quite high
because my learning is rote
and therefore I'm prone
to not pick up the subtleties,
the nuances of situations,
so although I'm trying very hard
to apply all this stuff
that I've learned,
I do get it wrong
and I get it wrong with frequency.
And that's very, very stressful.
So it could be that imitation
is the key to Sarah's success.
Do you like my nose?
But there are different
kinds of imitation
and one kind might not be
so easy for people with autism,
but might be crucial to the way
most of us bond with each other
and fit into the social world.
It can be seen in an experiment by
my colleague Dr Antonia Hamilton.
Here, children are asked
to complete some simple tasks.
Hi, Joel. Hi.
Thank you for coming in today.
Here I've got a big box and hiding
inside this box I've got a boat.
First, I'll show you how I get the
boat out, then you'll get a turn.
There's my boat. It's a
nice red boat, isn't it?
I'll put that back in there.
Ordinary children mimic exactly
what their instructor has done,
even the pointless finger tapping.
Well done.
Now it's your turn.
Can you get the boat out? Yeah.
Well done.
There's my boat.
It's quite a little boat, isn't it?
Now, autistic kids have
a different approach,
cutting straight to the chase.
Can you get the boat out of the box?
Well done.
Now it's your turn.
Can you get the boat out of the box?
There, number three.
Well done.
So what does your experiment show?
Well, it shows us that typically
developing children will copy
even actions that are silly actions
that don't contribute
toward the goal.
We think the reason they're
copying that is that they want
to be like the adult or they want to
do everything that the adult does.
They're not just learning
about how this object behaves.
They're learning to be
adult-like and to be social,
but autistic children
are more selective.
They will do the thing
that gets the goal,
gets the boat out of the box
or gets the doll out,
but they don't bother to copy all
of these extra, unnecessary things.
Sarah is exceptional
and has made a point of
studying social scenarios
and has learned to copy
other people's behaviour.
This has help her greatly
to get on in life.
Back at home here in Worthing,
she's just moved in
with her partner Keith,
who is also on
the autistic spectrum.
It's the top of the tree
that comes from a well-known,
reputable shop where
everything costs... How much?
Just a pound!
Is it the top decoration
that goes on last?
They're about to spend their
first Christmas together
in their new home.
Or do you put that on first?
Oh, you might put lights on first.
I thought you put lights on first.
So how can these two people
forge a relationship
when social interactions
cause them crippling anxiety?
How did you find
each other, meet each other?
On the internet!
Where all socially awkward people
go to find each other.
Was there any rush of love
at any point in the early days?
I don't really know what that means.
Erm...
I never expected to fall for him
or be particularly attracted
to him or anything.
It was a really logical experiment,
to deliberately go out with someone
that I didn't fancy that much
in order to see what
it would be like
to have a nice friendship
with somebody,
cos that wasn't my kind of history.
What was your thinking?
You wanted someone to have sex with.
Yeah, yeah. And you were largely...
I think that was my initial
motivating force, yes.
..unconcerned about who that was.
There wasn't a huge amount
of selection process. No.
If someone was willing,
then so was I.
So why are we together, then?
I don't know. Why are we together?
You tell me.
You're my...
required amount of social contact.
I'm your 5ml teaspoon a day?
Yes, that's it.
Sarah and Keith constantly struggle
to make sense of social activities.
We don't do any socialising
whatsoever for Christmas.
I think you've got
a Christmas works lunch
that everybody goes to
in your office.
Doesn't even occur to me
to even think about anything.
It doesn't feel like...
It just doesn't occur to me
that we would go somewhere.
Where would we go? What would we do?
What would you do? I don't know.
What do you do? I don't know. No.
It wouldn't even occur to me
to want to do anything like that,
not at all. I don't miss people.
I don't have the emotion of missing
somebody when they're not there.
I might prefer them to be with me...
..but I don't think
it's quite the same emotion
that I understand that other people
have in terms of missing people.
And yet you two are
in a close relationship.
Yes. We are peas in a pod.
Do you miss me
when I'm not there?
I don't think you do. I think
we've talked about this before,
haven't we? When I have to
interact with others, then yes,
because the interaction
that I have with them
is never as satisfying as
the interaction I have with you.
Is that "missing"?
You've always said,
"I prefer it when you're there,"
which suggests to me
a sort of absence of a...
I think missing involves abstract
imagination. It involves...
..some kind of ability to picture
another reality other than
the one you're in at the moment
and I don't think either of us are
particularly capable at doing that.
Sarah and Keith get on really well
just the two of them
and are committed to total honesty
in their constant
reflection and analysis.
Although Sarah and Keith
have restricted
their contact to other people,
they do show us that autistic people
can have meaningful
social relationships.
It's often said that autistic
people don't have empathy,
but that is wrong.
Sarah and Keith really
care for each other.
What they find difficult
is this social navigation
that the rest of us
do automatically.
Since diagnosis has surged
in the last two decades,
it's tempting to think of
autism as a modern phenomenon.
But is there any
evidence in history
to show that autism has
been around for longer?
Today, people talk about
an autism epidemic.
When I saw the first cases
about 50 years ago,
the estimated number
was about five in 10,000.
Today it is 100 in 10,000.
This is a huge increase
and yet it does not
necessarily mean
that more children with
autism are born now.
It does mean that we are much
better at diagnosing autism.
So is autism a new condition,
or has it always been with us?
And how would we ever find out?
I've come to Dumfries & Galloway
in the Scottish borders,
where historian
Professor Rab Houston
has unearthed the story
of a family feud
caused by the very unusual behaviour
of an 18th century Scottish laird
called Hugh Blair.
This is the place where
Hugh Blair was born
and where he and his family lived
for the first half
of the 18th century.
Sometime during the 1740s, when Hugh
would have been in his mid-30s,
his brother John and his mother
had a tremendous falling out.
As a result of that,
his mother cooked up a marriage -
she arranged a marriage for Hugh
with the daughter of a local surgeon
who lived in Kirkcudbright, which
is the main town quite near to here.
John was furious,
absolutely furious,
so he took out a writ against Hugh
to have his marriage annulled
on the grounds that he didn't
understand what he was doing.
John, the younger son,
would lose his inheritance
if there were any children
from this marriage.
He needed to prove that Hugh
could not be legally married
since he was mentally incapacitated.
It's because of this court case that
we have an unprecedented insight
into Hugh Blair's odd behaviour
and how it relates to
the modern diagnosis of autism.
It was 5th July 1747
when the case was brought before
the Commissary Court of Edinburgh.
260 years on, Professor Houston
discovered the documents,
which had clearly been unread
since they were first written.
Transcripts of 27 witnesses
are very revealing
about Hugh's mental condition
and reminiscent of autism.
Here, one witness mentions
a strange special interest.
It says that Hugh...
"Went to all the burials about,
"whether rich or poor, and that
whether he was invited or not,
"and this he did both before
and after he was a man
"who arrived at
the age of majority."
Oh, that's just
a wonderful observation,
because that's an example of a
kind of special interest, you know?
A special interest in
something that other people
probably would not be interested in,
and for him to be able to find out
when all these burials were taking
place and then to just turn up
and go there,
regardless of who it was -
I think that's extraordinarily
reminiscent of autism.
Perhaps the most revealing document
is Hugh Blair's written testimony.
Here he was asked
questions in writing,
because the court wondered whether
perhaps he was deaf and dumb.
So, the clerk of the court
wrote out,
"Answer the following question -
what brought you to Edinburgh?"
Hugh Blair's answer reads,
"Answer the following question -
what brought you to Edinburgh?"
To me, it's really
as clear an indication
of what I call a mentalising failure
as you could wish for.
It's not understanding that
you need to tell another person
something that only you can tell,
that they want you to tell.
He just doesn't get that point.
The court was convinced that
Hugh was mentally incapacitated,
and his marriage was annulled.
The Blair estate was ruined
by the costs of the court case.
The case of Hugh Blair is by far the
earliest that I would be confident
in diagnosing as autism, and it's
astonishing that you can recognise
the condition across such vast
differences of time and of culture.
What's so important to me about
this is that it enables us to see
more clearly the common and
enduring features of autism.
It's often said that the
enduring features of autism
are present in many of us.
Today, we often say someone's
"on the spectrum"
as a catch-all phrase to describe
anyone who's a bit eccentric,
has unusual hobbies
or is socially awkward.
Here at Trinity College Cambridge
stands a statue to one of our
greatest scientists, Isaac Newton.
He certainly was eccentric,
and some people have suggested
that he may have been autistic.
I'm not convinced.
'I'm here to meet
Professor Simon Baron-Cohen,
'who long ago was my PhD student and
is now a fellow of Trinity himself.'
There are personal anecdotes
about his life.
There are. One of the stories
is that his lectures were
very difficult to follow.
And the students stopped coming
but he kept teaching,
even though there were no
students present. Oh, really?!
Because it was in his job
description. So he was very dutiful.
Simon is interested in autistic-like
traits in the general population,
so I've come to discuss with him
whether autism is in a category
by itself, or whether it's possible
to be a little bit autistic.
So can you sort of
make this a bit...
You can measure autistic traits,
just like any metric,
like a ruler, where if you
were down here at zero
or up here at 50, you'd be either
low or high or just average. Yeah.
So here you would have
no autistic traits at all,
here you would have everything.
Most people in the population
are scoring right in the middle.
That's the population average,
or the mean.
And people who have a diagnosis
on the autistic spectrum
tend to score right up here.
Above 30, or 32,
out of a scale of 50.
And actually when you look
at the whole population,
it turns out to be quite
a beautiful, normal distribution.
Very few people down at zero,
very few people at the maximum.
So you could almost say that there
might have been a natural selection
to have an average number.
At what point, then,
would the diagnosis of autism
become a sort of certainty?
Well, you get your diagnosis
when you go to a clinic.
It's not about these metrics.
It's about the clinician looking
at how much these traits
are interfering with
your everyday functioning.
So some people are
developing secondary depression,
because they've got a high number
of autistic traits.
Some children are being bullied,
because they've got a
high number of autistic traits.
But some people are doing
just fine...
If they're doing fine, irrespective
of their score, they don't need...
They're not autistic?
They don't need the diagnosis.
So you withhold the diagnosis,
unless there's a clear,
clinical need.
So now it's not about science,
it's about clinical judgment.
So there is something of a grey area
where some people might
get the diagnosis if they go to one
centre for the diagnostic assessment
and not get the diagnosis if they go
to another centre... Absolutely.
..because it is a judgment call.
The only thing that differentiates
people in the general population
from people who have
a diagnosis is simply
the number of
autistic traits that we have.
That we're all
on the same continuum.
And...part of what research needs
to do is to try and determine -
is there a qualitative break there?
Or is it the case that it's
simply a matter of degree?
I've often imagined myself
being a bit autistic.
I'm certainly obsessively focused
on my work.
And in my feelings I am often
very analytical and detached.
And I certainly have
said things that hurt people
without my realising this,
and I'm generally baffled
by the complexities of social
relationships. But here it stops.
It's easy to confuse autistic-like
traits with autism,
so if you think you might
be a little bit autistic,
you very probably are not.
But whether there is a precise
point at which autism begins
is an open question
and for now remains a mystery.
So in the right position
for her, basically.
Today, most children with autism
will be diagnosed
before they go to school,
but some
are diagnosed much later.
Like any condition, doctors
and parents want to identify it
as early as possible.
We know that the autistic brain
must be wired differently,
and that there is
a genetic reason for this,
but we don't really know
the details yet.
Here at Birkbeck College in London,
they're running a study to see
if they can detect very
early signs of autism.
They're studying babies who have
an increased genetic risk
of being autistic,
because they an autistic sibling.
And they're comparing them to
babies with no increased risk.
We are looking for early signs
of autism, early markers.
The reason being that, at the
moment, the earliest stage
that a child will possibly
get a diagnosis
is around two to three years of age.
So the main aim is to find
an early marker to enable us
to possibly diagnose
the disorder earlier.
They're looking to
see how the babies' brains
react to social and
non-social images.
They use equipment that gently
shines light onto the baby's head
to measure the oxygen level
in the blood and, therefore,
brain activity.
This is where we're having the
response, in this brain region.
And this one example is about
visual, social cues,
so this is when the babies
are watching the peek-a-boo
and the Incy Wincy Spider.
The graph here on the left is
what you would typically have
as a response in infants of this
age, so four to six-month-olds.
We've seen in many, many babies
that they would have an increase
in oxygen in their blood,
which is this red line here,
and this is the response
that we've had in the infants
that have a family risk of autism.
So they have the brother
or sister with autism.
And what you notice quite strikingly
is that the oxygen change
in this brain region is
almost absent in comparison to
the low-risk infants.
But the tantalising thing to have
emerged from this study so far
is that not all the babies
who have the autistic markers
go on to get a diagnosis of autism.
So, the babies we've seen who show
the possible
early markers of autism,
but who actually don't go on
to develop the disorder,
the ones that fall sort of
either side of the line, they...
It's an interesting thing.
That's one of the questions that
we hope to answer - why don't they?
Are there protective factors,
be that genetic or environmental,
that kick in,
or are these children programmed
in a slightly different way
that they're never going
to develop the full-blown disorder,
but they may carry these
subtle traits of autism
throughout their lives
without anyone noticing?
Ready, steady, go!
What's he doing?
The idea of a protective factor
might explain another mystery -
why many more boys than girls
are diagnosed with autism.
Could it be that girls have
some kind of protective factor,
perhaps for some genetic
or hormonal reason,
that reduces
the impact of autism?
We could even speculate that
these protective factors
are why many of us grow up to have
an autistic-like personality,
but not actually be autistic.
Sorry, you've got the wrong idea.
Despite the insights we've gained
over the last few decades
about how people with autism
perceive the world,
there are still so many questions
that remain unanswered.
How does the brain create
these different minds?
And why are some people
autistic in the first place?
And why does autism come in
so many forms?
Very good.
Joe needs constant care, and will
never be able to live by himself.
Good to do.
Are you happy here? Yes.
And sometimes you go out?
Yes.
And you can relax? Relax.
You also work? Yes.
'What's this, Joe? Money.
'Money. And what's this, Joe?
'Butter. Bread.
'And this?
'Milk. Milk. And this?'
Almost 50 years ago,
I met a bright-eyed young boy
who had terrible difficulties
interacting with the world.
'What is it? Ba-ma.
'A barrow. A barrow.
'What's this?'
Joe sees things very differently,
but he inspired me
to dedicate a lifetime
to studying minds like his.
And in its own way, I'm glad that
his life has been fulfilling too.
What flowers do you like?
Sunflowers.
Yes.
So you just put the seed in,
do you? Yes.
And...a plant comes out? Yes.