Autism: An evolutionary perspective, Professor Simon Baron-Cohen, 1st Symposium of EPSIG, 2016

now our next speaker is Professor Simon Baron-Cohen, who was the first at Helios. You've probably heard this every time he's Sasha's cousin. I simply feel privileged. Hyphenated cousin. I get it, so yeah, congratulations on your cousin. Festa Baron Cohen is a

professor

of developmental psychopathology. at the University of Cambridge and director of the

autism

research center at the University of Cambridge that information is not out of date he has his dual education now I, when I was taking a look at his kind of background, what I could find on the Internet, I What I should know is that I believe you published over 300 articles and numerous books and that your extraordinarily prolific creative career over the last thirty years dates back more to the early work on the theory of mind and the treatment of dilemmas that patients with

autism

spectrum disorders and their families face, which I think is fair to say, have shaped all of our thinking over the years as clinicians interested in helping this particular group of patients.

Such a wonderful contribution to psychiatry. Professor Simon Burger, Professor Baron Cohen, has worked on issues of sexual dimorphism. in the human brain and the adaptive differences between men and women and a familiar work on systematizing and emphasizing brains that I suspect may be part of the presentation of it. I think he's probably the author of several books that I think are worth mentioning, not because of his name. and in great detail, but just to make it clear that I think he has written extraordinarily accessible books that are very important for their ability to share scientific knowledge not only within the medical community and work very well as medical textbooks but also within the medical community. a much broader community of interested people, the general public, which is of course what we want to influence and shape, so we are very grateful for joining us this afternoon, thank you very much, thank you very much and first of all, thank you . for inviting me to participate in this very interesting day.

I'm sorry I missed the morning. I was here to see most of your lecture, Andy, and that was a real privilege for me, so I've been teaching psychology and atypical psychology. medical students at Cambridge for about 20 years and to give them a lecture on

evolutionary

psychiatry describing their work, making it accessible to doctors who are really at the beginning of their career so that they are starting to think in this Darwinian way so that some of It is They may be former students of mine and hopefully these ideas are starting to permeate the field of psychiatry so that we start thinking about the function of behaviors and emotions, not just how to eliminate them, so I'm talking about a process of neurodevelopment. conditioning autism again from an

evolutionary

perspective

I thought I'd just start with a picture of a child with autism doing the classic thing that children with autism do: playing alone, so one of the characteristics of autism is not really interacting socially, but rather it does. something intelligent, it is lining things up to create very clear patterns that it is imposing on the world and, as many of you know, children with autism become very distressed if someone disturbs their perfect universe, their order of patterns, that they are creating another child before we.

Delve back into what we understand about autism: a child who plays alone, so it encompasses the word autism, which simply means that oneself does not interact with others, but again does something very intelligent, so they are playing with water and is fascinated by the patterns that can be created. As you block the flow of water with your hands, fascinated by the patterns but lonely, what you probably know is that the prevalence of autism has increased year after year, so this shows you data from the mid-90s to the early 2000s. , so autism has been Increasingly more common if we continue with that graph by simply looking at the US data from the Center for Disease Control you can see that the increase has continued and if we go to the most recent data , which are those of the US Center for Disease Control from 2014, the current estimate is that autism is diagnosed in one in 48 boys and one in 189 girls, these are childhood data and If you average the two genders, about one in 68 children ends up with an autism diagnosis, so this is much more common than when I started in this field in the mid. 80s, when Michael Rutter and others, whose names you will recognize, said that autism was four in 10,000, so it was very rare.

We now think that autism is very common and my talk is not about why the increase, but I think we can probably attribute most of that to greater recognition, better awareness, many more services on the ground looking for autism, more eyes looking for potential cases and, of course, we have expanded the definition of autism to include Asperger's syndrome, so we have moved from a categorical diagnosis. to a spectrum diagnosis and added a whole subgroup and the graph on the right really shows how to take a look at the full picture of autism because you can see that within both men and women there are some people who have below average IQ , so not only do they have autism but they also have learning difficulties and of course some have average or even above average IQ, what we would call Asperger's syndrome, so we tried to measure this idea of ​​a spectrum by creating something called autism spectrum quotient, it's a questionnaire that adults can complete on their own the Q so that self-reports or parents can complete it about their child and each item on the questionnaire is an autistic trait and the scale, as you can see, goes from zero to fifty, the dotted line on the left is the normal distribution that emerges when adults in the population are asked to complete this instrument.

What that tells us is that we all have some autistic traits. In reality, no one gets a score of zero. The solid line on the right is the scores of adults who already have. a diagnosis of autism or Asperger's syndrome and again we get this kind of bell curve, so there is a kind of range of scores, but what I wanted to highlight here is that there is a spectrum not only within those who come to the clinic , but also on a spectrum. that runs through the entire population and evolution, natural selection could well have been operating on those individual differences in autistic traits that we see in the population, so the first part of my talk is just to tell you what we know about autism and I'm going to have to go through this at a pretty rapid pace so that we can get to the kind of evolutionary relevance, but what we do know is that autism is partly genetic because if you have a child with autism in the family, the likelihood that There is another One in three children also has autism, so if we take the general population prevalence of about one percent, you can see that the presence of a family member with autism quickly increases the likelihood that someone more also have it, so it seems that it is partly genetic.

The reason I would say it's not just familial but genetic is that the search for autism genes is turning up hundreds of so-called risk genes. This comes from a website called Safari org where they report on every new genetic association found for autism, so here are the humans. The chromosomes and colored dots represent a published finding of an association of Ajan etic with autism or Asperger's syndrome, where you can see at a glance that almost all human chromosomes harbor some genes for autism, as far as we know that autism is not monogenic, it is enormously polygenic.

I don't know what these genes do, what their function is, what genes are necessary and sufficient to cause certain types of autism or certain symptoms of autism, but there is no doubt that autism is partly genetic, but we know that autism is not completely genetic. because of identical twins like these girls, where one has autism and the other doesn't, if the autism was one hundred percent genetic, if one has it, they should both have it, so discordant pairs like this suggest epigenetic factors, environmental factors that can act on the gene in Someone who is genetically predisposed to autism could also be part of the story and you can see that this study from the Robert Plomin group at King's College London shows differences in gene expression in pairs of discordant twins in terms of what happens in the brain in autism. differences, so just by zooming in on the different structures you can see a difference in the size of the amygdala in autism compared to controls, that the amygdala is larger in children with autism than in children with a typical development.

We also know that the brain in autism appears to be growing. faster than in typical development, so on the left is a graph showing growth trajectories; In blue, typically developing children have had to undergo MRIs so you can connect the dots to create growth curves and in red, children with autism again. who had a repeat MRI done so they can see how fast the brain is growing and they can see that the autism group at each time point shows a larger brain, suggesting that the brain is growing faster. The cartoon on the right comes from Eric.

The post-mortem study by Krauss Shen's group in San Diego where you have the opportunity to observe the brains of people with autism and dissect it, observe it in great detail and find 60% more neurons or nerve cells in the frontal cortex of people with autism that In comparison, folks, the larger brain seems to correspond to a heavier brain if you weigh it post mortem and also more nerve cells, more neurons in different parts of the brain. Here's another structure that differs between autism and controls the corpus callosum, the connective tissue between the two hemispheres which in autism are smaller at the back of the corpus callosum compared to typical individuals, so I'm just showing you a few. examples of differences in brain development, brain structure and we will move on to brain function to show that these children From the earliest point, the brain is developing differently.

This is a paper that was just published this year by Christina Kerr again at King's College London, but using data from a national dataset and showing that short connections and more can be identified in the spread of DTI and in images. long-range connections and then in autism you find more short-range connections and fewer long-range connections than in a typical sample, so again there are just differences in the wiring of the brain and we go back to the post-mortem evidence if we simply look at the individual neuron, the nerve cell, this is a very interesting study, so on the right we have a neuron from the brain of someone who had autism and on the left a typical individual and again with the naked eye you should be able to see more white dots along along the neuron and each point is the location of a dendritic spine or at the location of synapses where the neuron makes connections with its neighbor, suggesting greater connectivity between neurons in the autistic.

The brain not only has more neurons, but more connections between neurons in autism compared to a typical brain, which gives you an idea of ​​the differences between someone with autism and someone without autism, so that has to do a little bit. with genetics and a little with the brain and, of course, there are important differences. differences in behavior and cognition. This is again a UC San Diego study by Karen Pierce. What they did was observe two-year-old children who entered the clinic and presented them with a face to look at as a social stimulus or a geometric design and they filmed how long each child looked at the social or non-social stimulus, what they found was that the gaze different looked at the non-social stimulus more than 70% of the time, the probability that that child had autism was one hundred percent, so when I read this article I was impressed because maybe a behavioral test could be diagnostic and could save us hours of interview families and observe the child, etc.

Obviously, a caveat with a study like this was a clinical one. study, we don't know if the accuracy would be as good if implemented in the community and general population, but either way, the main message of the study is that a typical child tends to naturally look at faces that we are drawn to look at. people and presumably the emotional information in faces and the child with autism does not show that typical preference, but rather they are more interested in patterns, in this case geometric patterns, so what we are seeing is evidence of difference, not necessarily pathology only a brain that iswired differently and finds different aspects of the environment of interest, so other psychological differences between autism and a typical person are in terms of attention to detail, some of you recognize this task in what on the left are called figures embedded.

Test in which you have to find the shape hidden in the overall design as quickly as possible. People with autism are super fast and super accurate on tests like this, where the cube is hidden there. I'll let you see if you can find it and When we asked people to not only do this test at the behavioral level but also while lying in an MRI scanner, people with autism show less activity in the posterior parietal cortex while solving the problem. task. at a higher level, so the brain is in some sense more efficient, they end up performing better but show less brain activity to achieve that performance, so the differences in function between the autistic brain and the typical brain are another suggestion that people with autism focus on details.

While the rest of us focus on the big picture comes from the results of the block design test that many of you will have seen or used as part of IQ testing in children or adults, people with autism show their better performance in block design where you have to take it to select which little cubes you need that have different colored faces to create the design above and children with autism are very fast at this and it doesn't seem to improve their speed whether you segment to designers, it was made right to help a child find the solution or if you simply present them with the general design, as evidence of superiority.

By understanding the components that make up a larger design, there is more evidence that people with autism are detail-oriented in this test that simply asks the person what letter they see. People with autism are more likely to report seeing the lyrics. H, obviously both answers H or a are correct and the test is actually designed to see if you are more focused on local details or more global information that suggests that people with autism and more detail or local orientation and finally a study that emerged a couple of years ago again showed superior performance in children on the autism spectrum in detecting patterns in which they are given repeated information from where it is obtained if individuals have the opportunity to learn that certain shapes always They coexist and always occur together, so children with autism seem to be quicker to pick up on these regularities, so when we think about autism we imagine him as a child who is quite isolated, he has problems making friends, he has problems communicating, we tend to focus on social deficits, but we must keep in mind that autism is more complex than that.

This 10-year-old boy, Max Park, from California, loves the Rubik's cube, so he is fascinated with the patterns. He is ranked among the top 100 Rubik's Cube players in the world, so although he has trouble socializing, he also demonstrates not only intact skill but also superior skill that we need. Thinking about both sides of autism when we try to think about how a partially genetic condition may have been selected for in evolutionary terms and this is Derrick Parravicini, who lives in this country, so he has a mental age of a four-year-old. very limited language so he has learning difficulties, he has also been blind from birth so he has congenital blindness and autism, he is quite a package and every time he hears a jazz song he can play it immediately after listening to it once if you play a ten note chord.

On the keyboard he can instantly identify the ten notes of the chord, suggesting that in his case the talent is obviously auditory information. He is blind, but he can dissect information into its component parts very quickly, as we saw in the embedded figures test or Block Design tests this same ability seen in autism to take information and reduce it to its components very quickly and detect patterns, so the other side of autism that just came into the latest DSM dsm-5 is sensory issues. Parents and people with autism told us for about 40 years that they had sensory issues, but it wasn't part of DSM 3 or 4, now it's part of DSM-5.

God bless you and this really shows you that if you put someone with autism. In fMRI, you give them blindfolded headphones and simply look at what part of the brain responds when they hear a tone, an unexpected auditory stimulus. You see a greater response in the auditory cortex in people with autism compared to people with autism. A typical individual suggests hypersensitivity. Obviously, this is a study only in the auditory domain, but you could do the same thing in the tactile or visual domain, where they detect gustatory channels, and still find this hypersensitivity, so in terms of the social difficulties that we know they are present, the earliest demonstration. of these comes from these studies, they're called baby sibling doublet studies, where you know there's already a child with autism in the family, so you're looking at the new baby in the family who has a higher genetic risk for autism. and you find that, and for example.

If they are presented with an eye stimulus looking directly at the baby or away from the baby, the p400 electrophysiological wave that can be recorded simply using ERP or EEG type equipment is reduced in those children who develop autism, so the perception of faces and social information appear to be different, even in the first year of life, this work comes from a meek Linh who was at Yale University and has now moved to Emory, where he used gaze tracking to see where he looks someone while watching a movie. So, this clip is from Who's Afraid of Virginia Woolf? and in yellow the gaze tracker shows us that that is where the typical individual looks while watching the movie looking at Elizabeth Taylor's face, but particularly her eyes, and in red is where people with autism tend to look, so They look at the face, but focus more on the mouth than the eyes, so eye-tracking technology gives us a window into what is of interest and what the attention of people with autism and is directed to. , as you kindly.

As I mentioned in the introduction, there has been a lot of work since our group, but many other groups look at so-called theory of mind, the ability to put yourself in someone else's shoes and imagine other people's

perspective

s, which I find challenging for children. and people with autism. so that they don't tend to engage in games like hide-and-seek when they are very young or trick-or-treating that typical four-year-olds enjoy because they are aware of what other people know, what other people might want and intend, and in On the other hand, children with autism tend to avoid these types of interactions, finding them very confusing.

We developed this test called the vision test that some of you may know to measure social cognition in adults with Asperger's syndrome and in the general population, so it's shown to you. photographs of the eye region of the face when you have to choose which of the four words surrounding the photo best describes what the person in the photo is thinking or feeling. Very degraded black and white still photographs, but people are quite accurate in identifying that they are down or a little sad simply by minimal information about the emotions around the eyes, you can see that the data shown in the graph on the left come from thousands of people who have taken this test online, showing that both men and women with autism score lower on this test of reading emotions in the eye region of the face and when we ask them to take the same tested while lying in the scanner, we found that people with autism show less activity in the left inferior frontal. turns while trying to decode someone's facial expression from information around the eyes compared to a typical control group, so I hope I have presented evidence of both talent and disabilities in the same individuals, so some of you They knew it last year.

An important new book was published about autism called Neuro Triumph, written by a journalist named Steve Silverman, which very deservedly won the Samuel Johnson Prize for Nonfiction because it tells a whole new story about autism, but also, if you look at the subtitle of his book, he speaks. about the future of neurodiversity and his book in many ways is a kind of manifesto for this new concept of neurodiversity that psychiatrists and clinical psychologists should pay close attention to because it's really the idea that there are many ways for the brain to develop. There is no single way to be normal.

There are individual differences in the population that may be there for reasons of natural selection. Not everyone was made equal. We all have our strengths and weaknesses and autism may be just one example of the neurodiversity in the environment. environment Silverman chose as a cover design for his book an image of biodiversity and everyone was very familiar with that related concept of how important it is for us to preserve diversity in the Amazon rainforest or in other places and he really defends the same thing it should be true for neurodiversity: in any children's classroom you will find that some children are more verbal, some children are more spatial, some children are more sociable and some children are more musical and all these different types of brains, if you will.

They are part of the diversity found in any kindergarten, so in any elementary school two or three children with autism should be expected to be part of that diversity. On the right here we have our photo of Henry Cavendish Silverman, he dedicates an entire chapter to him. from his book to the biography of this physicist who was not famous for the discovery of hydrogen, but as Silverman makes a very strong case, he probably had autism, he did his best to avoid people, so he left messages for his servants and for other people. he had to interact with them instead of meeting them face to face and he was actually content with doing his physics to do his scientific experiments away from the social world, so here is the concept of neurodiversity attributed to a Judy singer who has autism but who appeared for the first time. printed in 1998, the reason for insisting on this is that I believe it is a revolutionary concept for our field and this poster is produced by the neurodiversity movement which comes from the autism community which calls for acceptance of the idea that they are not necessarily inferior or deteriorated. or I am pathological in some way, they are simply different, just as we might find, for example, among fruits, they are not all the same for genetic reasons, we might expect them to be of different flavors.

I think the notion of neurodiversity goes back quite some time. way beyond what I was suggesting, so here's Albert Einstein and there's a quote from him on the left. If you judge a fish by its ability to climb a tree, it will live believing it is stupid, so we think of animals in different ways and Einstein again. It has been argued that he could have had autism. Here is a quote from his biography. I don't socialize because he would distract me from my work, so he really just focused on the physics of it. He did quite well and cooked.

He also liked to sail. but he did it only when he was at Princeton and he used to enjoy playing the violin, but you know, people were not his main focus, the world of objects in the world of systems and understanding the laws behind the physical world that made it. they guided to his discovery of relativity, so his hands have Asperger's on the left, the pediatrician whose name is now given to one of those subgroups and said that a hint of autism is essential for success in science, so There is the idea that autism could come and go gradually.

It is possible that everyone has some of that and perhaps a certain minimum of autism could be good enough to focus your attention on just one of the so-called obsessive themes. Part of the autism diagnosis, as you know, is developing obsessive interests, but that's a pretty pejorative way of describing them as just having passions or interests and right here we have Newton again, it's been shown that he also had autism, so Not only did he discover gravity but he quarreled with almost all of his colleagues and had difficulties with communication, so we see This potential link between autism and scientific talent is at least speculated in biographies and anecdotes.

We have tried to measure this to see if this is really the case and so we developed a questionnaire called the systemizing quotient which asks how interested you are in different types of systems, whether they are mechanical systems like computers, mathematical systems like mathematics, natural systems likethe weather, and you can see that people with autism score higher in terms of their interest strengths in systems than people in the general population that we've also gone to. Test whether children with autism or Asperger's might be better at solving mechanical reasoning tasks like this one where you had to look at the wheel spinning counterclockwise and predict what will happen at that point P, the correct answer here is C, it will move . back and forth and 12-year-old children with Asperger syndrome outperform typical 12-year-olds in solving these types of mechanical reasoning problems, suggesting that despite their social difficulties in certain aspects of the environment, their understanding is actually precocious, which is why I am so opportunistically located in Cambridge.

We decided to look at the rate of autism among mathematics students at the University of Cambridge, so we simply asked them that very direct question: do they have autism? And you'll see that the results show a much higher rate of diagnosed autism in students than I would say. This is a very good university in the field of mathematics compared to the humanities, which again reinforces this idea that there could be a link between many autistic traits or even a clinical diagnosis of autism and the talent to understand systems that include the math and again just take advantage of it.

If you like the students at the door thing, we gave the aq to that measure of autistic traits to students working in the Sciences or Humanities and found that scientists didn't have a higher rate of autism, they just had more autistic traits in compared to those who worked. in the humanities, again, those individuals who are attracted to the most predictable world that can be systematized, which is what we do in science, where we try to understand the legal relationships between variables, may end up in science; They may have a greater number of autistic traits than those.

Who can deal with the less legal world of people? The unpredictability of people and the way we write about people, for example in literature, where this link between autism and scientific talent arises, is probably genetic because years ago we looked at parents' occupations. of children with autism simply ask them where they work and find that a disproportionate number of parents of children with autism work in the engineering field compared to parents of typically developing children, obviously engineering is a very good case of where you have to be good at understanding the systems, but to get the job you may not have been selected based on your social skills, but rather your understanding of how things work, so looking back, if there is a child with autism in the family, in genetics, if you like what has been positively selected, perhaps in evolutionary terms it is not autism itself but no aptitude for understanding systems, which would be an advantage in fields where a system is built like engineering or trying to understand the system, we found the same pattern among grandparents of children with autism on both sides of the family, so this led to the prediction that autism is more common in places like Silicon Valley, so What Silicon Valley has obviously been attracting people who have an aptitude for systems for quite a few years and they moved there and worked there and potentially raised a family there and had children, so if there is a genetic link between scientific aptitude or intelligence technique and the risk of autism in offspring.

We should see it in places like Silicon Valley, so Silicon Valley is quite far from London, so we went to a Silicon Valley a little bit closer to home in the Netherlands and focused especially on the city of Eindhoven Eindhoven has the Institute of Eindhoven Technology, a bit like MIT, has also had the Philips factory there for over a hundred years, attracting people to come and work there in the fields of electronics and, more recently, IT. so now a third of the jobs in Eindhoven are in the IT sector, we compared the autism rate in Eindhoven with other Dutch cities that Utrecht and Harlem selected because they have a similar size and similar demographics and we found that the autism rate in Eindhoven it was more than double that in those other two Dutch cities.

This was based on school records that contacted each school in each of these three cities to ask the number of children who already had an autism diagnosis. We don't know much about the parents, this was a school based study where the inference is that this may have something to do with the parents' occupations, so to try to make sense of all the data I have shown you this afternoon and try to make them more relevant to an evolutionary perspective, I just want to mention the model that was mentioned in the introduction, this model of systematization of empathy, the idea is that in the general population, these are two dimensions along the which we see individual differences, so along the y axis You have empathy and if you are at zero it means you are absolutely average for the population.

As you move up the y-axis, you are above average in empathy, or the ability to read other people's thoughts and feelings, but also respond with emotion. with an appropriate emotion, if you are below zero, it means that you have difficulties in that domain and on the x-axis we have the ability to systematize UM's ability to understand a system but also build a system by identifying the rules that govern the system and then you can predict how the system works again to the right so positive values ​​are above average in systematization and to the left you are below average.

The idea is that we all fall somewhere in this space. dimensions, what we found in our research is that in the dark blue quadrant at the top left, more women in the population fall in that area where they have above average empathy, but the systematization could be from average to below average , I'm sorry. that's in the light blue part of the graph, in the white part of the graph there are individuals who are equally good at systematization or empathy, so they may have the same talent or challenges, but they don't show much discrepancy in their aptitudes. or abilities in both areas, the pink area is where most men on average fall in the population where their systemizing is at a slightly higher level than their empathy and what we predicted is that people with autism would fall in the lower quadrant Right out of that dark red zone where your systematization may be between average and above average, but your empathy would be less than minus one, so in the below average range, which is often the trigger for needing a diagnosis. that they are struggling with relationships, so that was the model and what we did was we went out to the population, we gave people these two questionnaires the empathy quotient that measures your empathy the systematization quotient that measures your systematization and We simply help you read the data here in yellow there are women in the population and it is possible that you will be able to see them grouped in the upper left quadrant of the graph; in green, there are men in the population, where you may see them grouped more in the center; and in purple and red, there are men and women with autism who you might be able to see. we see clusters in the lower right quadrant, so each data point here is an individual, and of course all we can do is look at the groups of men, women, and people with autism on average because individuals can be typical or atypical for their group, so you know that We can see, we can see a little green dot up here of a man who is in the female range in his empathy and we can see that they know a woman down here who is in the so-called autistic range, so individuals may not fit.

Well, we can talk about the trends of your groups is statistical averages, but if we take into account these different brain types and this is my last slide so we can leave time for discussion, this is what we find, that if we look at individuals whose empathy is at a higher level than their systematization we find more women than men who have that profile if we look at the opposite profile individuals whose systematization is at a higher level than their empathy these are percentages we find that more men than women show that cognitive profile and if we look at one end of it, systematization is intact or above average, but empathy is below average, well, this is where we find the majority of people with autism or Asperger syndrome , so the data is in line with the directions predicted by the model, but actually the reason for leaving this as my final slide is to show that the diversity that exists in the population, we all fall into one or another of these five types of brain, if you prefer to define them in cognitive terms, although increasingly We are beginning to map their neuronal substrate and the environmental and biological determinants of these different types of brain, but we could well imagine that natural selection has favored one type of brain. brain over another for different types of evolutionary niches over thousands of hundreds of thousands of years or millions of years in the evolution of primates, some of which coincide with sex differences, but actually have nothing to do with their sex because it turns out that prenatal hormones and genes play a much bigger role than their actual sex and that people with autism may simply be showing one extreme of the variation that we see in the population potentially selected for their basic talents being very good at detecting patterns being very good at innovation to understand new machines or new tools that will help us even if they find the social world more challenging I'm going to stop there, thank our sponsors and in particular the autism research trust who support our work and we can open it for discussion.

Thank you. Thanks Simon. I'm sure there would be many questions, but could you just ask yourself a flea. I've had cause to work with a large number of transgender patients over the years and what I've observed is that there are certainly some trans women who will say, "You know, I've always socialized with women and the reason I liked doing it" . That was that not only were they hitting and kicking each other, but they were talking to each other at school, for example, and it was a better, safer place to be, which seems to be fine and arranged with the model, as if it were there, another A group of people. although those who seem to describe a kind of theme that changes when they start taking when they start estrogen hormone treatment and I have a very vivid memory of one patient in particular who talked about the kind of eye-opening experience of being among the girls and finally feeling like in home, which was very surprising at the time.

I'm not aware that it should be, but I'm not aware of the literature looking specifically at that group of people and particularly the hormonal exposure of transgender patients, so I'm wondering if I have any knowledge of that area to comment on or Just a brief comment and that is that the area of ​​autism and gender research is just beginning to open up and include transgender people, so we are now becoming a little more aware that Instead of asking people about their sex and give them a binary option, male or female, we need to be a little more fluid because many people with autism don't want to identify as male or female and prefer to check the box. another box and that more and more people with autism are identifying as transgender or discussing how their gender doesn't fit neatly into traditional categories, so whether there is a hormonal element to this or some other factor, but this is a new area of ​​research . certainly evident for the recruitment and the expected number of trans male patients with autistic traits and that would certainly be our clinical experience and okay, so you have the furry microphone somewhere, pause, can I ask a question?

Please, do engineers who get married have as many children as the other two engineers? get married and have that many children, yes, because evolutionary theory, yes, would focus on reproduction, Shawn, so presumably people with autistic traits have an evolutionary advantage, some would have as many children, not fewer, because it's hard to explain the autism in evolutionary terms, yes, if physical condition decreases. Sure, I don't know the data on fertility rates among engineers versus other groups and the population, maybe someone else does, but you know, if you think about fertility again in relation to resources, an engineer might be someone who You end up with considerable resources if you have the skills and tools that other people need in the community, so if engineering skills are related to resources, we know that there is a connection between the economic level of wealthand fertility rates that can explain the persistence of the range realistic engineering Jeanne yeah, I mean, the puzzle always was that in the old days the kind of autism that we saw in the clinic we couldn't really imagine this person growing up to have a relationship let alone an intimate relationship that could result in children, so why do autism genes persist in the gene pool?

Now that we've expanded autism to a spectrum and we can look at Asperger's syndrome and we see what's called the broader phenotype among parents of children with autism, which might include engineering skills or technical intelligence skills, we can see that actually There is a good chance that these individuals have not only married and had children, thereby passing on their genes, but even being positively selected by a mate for those positive traits. Well, Bill Gates is a really interesting example, so everyone speculates that he has autism, he resists the idea, so every time a journalist tries to shove a microphone in his face and say, "Meet Mr.

Gates , do you have autism? Sir, and it's a bit of a blunt way that journalists sometimes get a little irritated, but people who have worked with games report that you actually have a lot of those behaviors and you've done quite well, yes. What do you think about the claim that autism represents or is associated with a slow life history strategy and that its success or reproductive niche is due to a state of intense monogamy and relationships and investment? long term in a single relationship as opposed to psychosis which is claimed to be a quick life story strategy and I mean there has been this research and these claims I don't know what you think about that yeah no no.

I know. That research, but I mean it makes sense the way you describe it, slow living and fast living, there's certainly a lot of data accumulating that shows that parents of children with autism tend to marry late, so maybe that fits with the slow life. That's right and you know it's been open to interpretation as to why that's the case and some people suggest that it might just be because their social skills aren't as good, they have some of the autism genes because we see it coming. in the next generation, so maybe it took them longer to find a mate due to their reduced social skills, but I mean, I guess you're talking about slow living and fast life trajectories that may not be within the norm . consciousness of the individual, this is for sure, but it is very interesting from one Simon to another.

I'm Simon Forester of the red car, and yet I'm a child psychiatrist, so I'm fascinated by autism. I heard you speak 20 years ago and you. You're just as accessible and entertaining as you were then, so it's great to hear you again. What I'm wondering is whether the extent of genetics or the extent of the distribution of genes between chromosomes doesn't suggest that autism is very old. You've been with us for a long time, do you have any thoughts on that and could that be an implication? So, you know, the only view on the genetics of autism is that it is not diseases, two genes or mutations, rare mutations, although there are rare mutations that can lead to so-called syndromic autism, but autism can also be the result of common variants in the population and that these common variants can be distributed throughout the genome.

Each of these common variants may be contributing greatly. small effects, so they may be combinations of particular variants that are not disease genes, they just contribute in different ways to two skills, whether it's language or mechanical skills or whatever, now you're suggesting that because we see those points correctly. in the 23 pairs of chromosomes, that means it is very old. Another opinion might be that actually epigenetic factors are more important than perhaps Apple's genetics. The factors cannot influence gene expression much and that when we detect genetic findings we are not looking at the epigenome, so there are different ways of interpret it and I think the first person who detected a burning stick or a bit of half-burned meat from a thunder and lightning storm and I thought this is tasty maybe we could reproduce this effect ourselves if they systematized it, sure, well, I think You're asking the question about and when in evolution some of these very human attributes first emerged and I think if we look at the evidence of tools, for example, the fossil evidence of tools in evolution, we would probably go back to the least 70,000 years ago in terms of when the tools were made. has already taken off and where you can see the evidence of a very systematic mind in varying its tools, something that was not really seen much before, 70,000 years ago. spirituality.

I get tired. adult psychiatrist. I have been and have been seeing people on the autism spectrum. in clinics over the years and one of the things that impressed me was that he had in mind the difference between Asperger's and autism and that autistic people didn't want to be with people where Asperger's wanted to be. with people and it seems like that's not that important, but for me in clinical practice and especially in how you can deal with people that you meet there is a big difference, yeah, right, I mean, it's not a binary that OR you want to be with people or not, it's probably about the kind of dose of social interaction that each of us enjoys, so some of us enjoy seeing a friend once a week, other people need to see a friend once a day .

I know there are individual differences in social motivation and social behavior and you know if it's some kind of discrimination between autism and Asperger's syndrome. I'm not sure because even within the group called Asperger's you see a lot of variation that some people are very happy with. They are loners and actually sleep during the day, they are awake at night because then they don't have to have any social contact and others you know want social contact but don't have the social skills to know it. how to have those relationships and feel very alone and isolated, so I think there is a kind of individual difference, even within Asperger's syndrome, do you ever feel that the events will cause a predisposition to autism in a more florid form and, if so? so?

I see something like in a bed and then I think of the word bloom like the word that adult psychiatrists use in relation to psychosis, you know, that kind of university, suddenly you see all the symptoms that you know bloom, while in the autism no. I know we really think about the manifestation of symptoms in this kind of Florida way. I think it's very much like that and if you look back you can see a particular pattern of behavior that was there from the first moment, so in We work in an NHS clinic for adults with suspected Asperger's syndrome, but we ask the parents to come in with their 40-year-old so we can get a developmental history of what the behavior pattern was there, even in elementary school, and so it's not so To a large extent, this kind of explosion of symptoms in Florida where there is a trigger, it's more from the get-go, this was a child who didn't really socialize in the same way, they were more focused on objects than people, maybe they didn't need them. a diagnosis in elementary school or even high school because they somehow managed in elementary school, maybe they were focused on their academic work, they didn't really mix with the kids on the playground in high school, We often see a kind of more difficult picture where suddenly The teenage group is much more demanding of you, you know, and if you don't have social skills, it's much harder to get by, which is why a lot of kids get their diagnosis by first time in high school, but some of them have managed to obtain it. until they leave home and go to college and then need their diagnosis or when they don't function well at work, in middle age, so it's not about particular triggers, it's about knowing what niche they're in, who protects them, whether it is their family to some extent who is concerned about the child or the individual and at what point they...

Are symptoms their autistic traits begin to interfere with where they have been at one point I was told when I was a student that Several children became autistic when their parents returned from the war, and the mother-child partnership was disrupted, so I would say that theories about autism have probably changed a bit. I mean, we used to have all kinds of theories. about autism has to do with how the mothers were cold and unemotional or maybe too involved with the child and you know, I can imagine that this kind of event of the father returning from the war could have fit into certain types of theories about autism, but I think that today we understand autism as this neurodevelopmental biomechanical condition that I hoped to have shown is simply a different pattern of the relative type of focus that the individual has on the social world versus the non-social world and those types of events that could happen in the child's life whether the father is absent or present, as they are probably less important than genetic predisposition and there must be environmental factors, but we are not very good at identifying what they are yet.

I guess if dad comes home with PTSD and imitates whiskey drinking, a big wave starts hitting mom, that might have an impact on the social ladder, but for a fair kid, yeah, that's right, it can be a creation of spectacle phenotypes, since yes, yes, that's just a It's a good question, I think about the retired Oxford psychiatrist, David Guinea, could you ask him a little bit about the group at the other end of the spectrum, it's That is, individuals who have a lot of empathy, yes, and little systematization, yes, what are they? This group is like Oh clinically, so I see well, the word clinically is probably the most important word here because they may not come to clinics, so these people have very good empathy, so we could infer that they have a good social network and good relationships. friends and you know the community, so they may actually be protected from needing to go to a clinic;

It's probably the people who have below average empathy who struggle with relationships and who might then develop secondary depression because they're isolated who end up coming to clinical care, so people in the upper left quadrant with super empathy maybe they are doing well, we don't know much about them, we know they exist because you can see them there, we can see more yellow dots, so there are more women, but you can see the occasional green dot and we also know that they can have problems with the systems, so maybe at school they didn't like mathematics or natural sciences and opted for other types of subjects and that when the computer crashes they simply call the help desk so that you I know that I don't believe that these individuals necessarily have problems, they are simply part of the variety that we see in the population.

I guess I was wondering if they were the group you see from time to time, people who seemed deeply empathetic. but really very disorganized and that kind of term, I'm not sure about this at all PC, the term that comes to mind is confusing and it's just not a clinical diagnosis, which is fine, it's a non-clinical term, but it is a description of what how a person might be like that and I'm here, I'm thinking, wow, how does that fit into the evolutionary picture, if you think that might characterize what that kind of person might be like, so like I say, we don't. .

No, there hasn't been a lot of research done on people who are at the opposite end of the spectrum from autism, so we know a lot about people with autism because they come into clinical care and then they come into each other's group's research studies. At the end of that dimension, if we think about the diagonal, which we know less about, maybe they have executive type problems and being very systematic and organizing things, but I think that may be too simplistic because people with autism can also have those executive-type organizational difficulties and we just say no, but I think it would be good to do more research on that other group.

I'm just wondering if those of us who might ask that question tend to be men. I just had two daughters. of adolescence that I have seen surprisingly empathetic and sometimes I find it very difficult to understand women, we are a kind of coffee hour. I think I'm actually necessarily asking really pressing questions, so first of all, I think Thank you very much for a really insightful and beautifully fluid presentation, which I think has been great for us as clinicians and for thinking in terms of the evolutionary background. of these conditions, choosing my words carefully, so thank you very much.