Why 4 of 5 autistic children are male. What new science tells us about how our brain works. Is this mysterious and sometimes devastating condition just an extreme version of normal male intelligence? That’s one provocative new theory. Behind autism’s gender gap.
September 8, 2003
BY GEOFFREY COWLEY
Hannah Nurse, 4 and her autistic twin brother, Daniel
Andrew Bacalao has a good, sharp mind. At 13, he's a decent pianist, a devotee of Frank Lloyd Wright, a master at videogames and jigsaw puzzles. He remembers phone numbers like a Pocket PC, and he can dismantle a radio or a flashlight in the time it takes some people to find the power switch. But drop in on Andrew at home in Oak Park, Ill., and you quickly sense that something is amiss. "Can you look at her?" his mom, Dr. Cindy Mears, prompts, as a NEWSWEEK correspondent greets him in the living room. He stays on the couch, feet up, mesmerized by a handheld game called Bop It Extreme. Soon he's making soap bubbles and running outside to bang on the windows. Andrew does eventually talk, but conversation doesn't come easily. When his mom asks him not to burp, he tells the guest, "I'm going to unbutton your outfit." He's merely offering to take her jacket -and he seems to think his choice of words is just fine.
What do you make of such a kid? A generation ago, he might have been written off as a discipline problem or a psychopath -someone who insists on misbehaving even though he's smart enough to know better. But we now know there are different kinds of intelligence, which can crop up in unusual combinations. The world, as it turns out, is full of people who find fractal geometry easier than small talk, people who can spot a tiny lesion on a chest X-ray but can't tell a smile from a smirk. Most of these folks qualify as "autistic," but not in the traditional sense. Classic autism is a devastating neurological disorder. Though its causes are unclear, it has a strong genetic component and is marked by rapid brain growth during early childhood. Many sufferers are mentally retarded and require lifelong institutional care. But autism has many other faces. The condition, as experts now conceive it, is like high blood pressure-a "spectrum disorder" in which affected people differ from the rest of us only by degrees. The question is, degrees of what? Can autistic tendencies be measured on some scale? If so, is there a clear boundary between normal and abnormal? And is abnormality always a bad thing? What promise does life hold for people like Andrew?
Cambridge University psychologist Simon Baron-Cohen has a thesis that bears on all these questions. In a bold new book called "The Essential Difference," he defines autism as an imbalance between two kinds of intelligence: the kind used to understand people (he calls it "empathizing") and the kind used to understand things ("systemizing"). Though most of us have both abilities, studies suggest that females are better than males at empathizing, while males have a stronger knack for systemizing. By Baron-Cohen's account, autism is just an exaggerated version of the male profile-an extreme fondness for rule-based systems, coupled with an inability to intuit people's feelings and intentions. The truth may not be quite that simple, but the concepts of "E" and "S" offer a powerful new framework for thinking about boys, girls and autism. If Baron-Cohen is right, autism is not just a disease in need of a cure. It's a mental style that people can learn to accommodate. Sometimes it's even a gift.
It's no secret that autism affects boys more than girls. Males account for more than 80 percent of the million-plus Americans with autistic disorders. Are these conditions partly an expression of male thought patterns? Do boys live closer to the autistic spectrum than girls? Not in every case. But when researchers study groups of people -infants, toddlers, teens or adults- an interesting pattern emerges. Newborn girls gaze longer at faces than at mechanical mobiles, while boys show the opposite preference. By the age of 3, girls are more adept than boys at imagining fictional characters' feelings, and by 7 they're better at identifying a faux pas in a story. The disparity is just as striking when adults are asked to interpret facial expressions and tones of voice. Women rule.
Males aren't hopeless, though. They show a lifelong advantage on tests of spatial and mechanical reasoning. In fact they're nearly twice as likely as women to score more than 700 on the SAT math test, and four times as likely to become engineers. Social conditioning may account for some of that gap. It may also help explain the thrill that 2-year-old boys get from trucks, blocks and other mechanical toys. But there has to be more to the story. Consider what happened when psychologists Gerianne Alexander and Melissa Hines tried out six toys on vervet monkeys at UCLA's Non-Human Primate Laboratory. Male monkeys favored the boy toys (a ball and a car). Females spent more time with a doll and a pot. And the gender-neutral toys (a picture book and a stuffed dog) got equal attention from both groups. The findings suggest that sex hormones may sculpt our brains as well as our bodies, priming males and females for different styles of thought-what Baron-Cohen calls a "Type E" style and a "Type S" style.
It's not hard to see how autism fits into this scheme. In its classic form, the condition leaves people virtually devoid of social impulses. Autistic kids have trouble communicating, and games like peekaboo leave them cold. They seem to perceive people as unpredictable objects. Yet they often excel at systemizing. "Even young autistic children love to classify and order things' says Dr. Bryna Siegel of the University of California, San Francisco. "They're interested in categorical nformation.” Siegel recalls a mother's story about taking her autistic son and nonautistic daughters to see "Finding Nemo," a movie about a clown fish who loses his mom and gets separated from his dad. "The little girls wanted to know if Nemo was scared," she says. "The autistic boy wanted to know exactly what clown fish eat."
Autistic people are famous for collecting such facts, and many can recall them with breathtaking precision. Patricia Juhrs, director of a Rockville, Md., group called Community Services for Autistic Adults and Children, has an adult client who has memorized every top-10 song list Billboard magazine has published since 1947. Tell him which day you were born, and he'll tell you what was playing on the radio. Even when they lack such savant skills, autistic people often excel at mundane, detail-oriented tasks. "I maintain that we should have autistic people running the scanners at airports," says Catherine Johnson, an author and activist whose two autistic sons amuse themselves by putting together jigsaw puzzles with the picture-side down. "No normal human being can process that much detail.”
She's half joking, but studies support her contention. As you'd expect, autistic people score even lower than typical males on tests that involve predicting people's feelings and interpreting their facial expressions. But when challenged to find the triangle embedded in a complex design, or predict the behavior of a rod attached to a lever, they fare as well as normal males, if not better. The same pattern holds when autistic people are polled directly about empathizing ("I can pick up quickly if someone says one thing and means another") and systemizing ("I am fascinated by how machines work"). In a recently published study, Baron-Cohen's team found that mildly autistic adults trailed normal women and men on a 40-item empathy test, but trumped both groups on a systemizing survey. In short, they were more male than the men.
The findings square nicely with Baron-Cohen's model, but the model takes us only so far. As it turns out, autistic people are not just extreme systemizers. They systemize in a distinct and unusual way. When normally developing kids draw a picture of a train, they start with a gestalt, or general idea: a series of long, flat rectangles with wheels underneath. Autistic kids often start with peripheral details and expand them into
dazzling 3-D renderings. "They don't do it in a logical order,” says Siegel of UCSF. "They do it as you would if you were tracing.” Stephen Wiltshire, 29, had never spoken when he started sketching at the age of 5. He still lives with his mother in West London, but he has since achieved world renown for his visionary portraits of buildings and vehicles. "Cadillac, Chevy, Lincoln,” he says when asked about his passions. "Sears Tower, the Frick, the Chrysler building.” His speech, like his work, is virtually free of generalizations. As a friend once observed, he is "rooted in the literal, the concrete.”
Wiltshire may have Type S tastes, but his avoidance of abstractions can't be passed off as a typical Type S tendency, It gets at something more specific, says neuroscientist Laurent Mottron of Montreal's Hôpital Rivière-des-Prairies. It reveals a preference for parts over wholes, a tendency to process information one piece at a time instead of filtering it through general categories. Most of us simplify the world to make it more manageable. Whether we're taking in sights, sounds or sentences, our brains ignore countless details to create useful gestalts. Autistic people make generalizations, too ("it's a train,” "it's a blender"), but studies suggest they work from the bottom up, attending doggedly to everything their senses take in. That has nothing to do with maleness, but it helps explain various aspects of autism-the encyclopedic memory, the lightning-fast calculation and the extreme sensitivity to sounds, lights and textures. It also ties in neatly with recent studies linking autism to super-fast brain growth during the first years of life. Researchers believe that process may generate more sensory neurons than the brain can integrate into coherent networks.
Baron-Cohen doesn't dispute any of this. The E-S model may not capture all the nuances of autism, he says, but it sheds new light on the narrow interests and repetitive behaviors that people across the autistic spectrum display. "Consider the child who can spend hours watching how a glass bottle rotates in the sunlight but who cannot talk or make eye contact," he says. "The old theories said that this was purposeless repetitive behavior. The new theory says that the child, given his or her IQ, may be doing something intelligent: looking for predictable rules or patterns in the data.” In other words, the E-S model may be incomplete but it's still valuable-for it reveals the sanity and dignity of autistic behavior. "People with Asperger's syndrome [a mild form of autism] are like saltwater fish forced to live in fresh water," a patient once explained to Baron-Cohen. "We're fine if you put us into the right environment. But when the person and the environment don't match, we seem disabled.”
Some advocates insist that conditions like Asperger's syndrome are not disorders at all, just personality variants that have been misconstrued as defects. They believe that people at the high-functioning end of the autistic spectrum should be spared psychiatric labels. But when the labels are applied without stigma, they can be liberating.
Dave Spicer had never thought of himself as autistic until 1994, when his 8-year-old son, Andrew, got a formal diagnosis and he was diagnosed too. Spicer, then 46, was a computer programmer and system designer, but his social ineptitude had cost him two marriages and blighted his career. He recalls leaving business meetings thinking all had gone well, only to discover that he had annoyed or offended people. "A social situation is like a square dance where the caller is speaking Swahili," he says. "There will be a cue and I won't get it, and I'll stumble into people.” Spicer's son is now thriving in a mainstream high school after several years of special education, and Spicer himself has learned to play to his strengths. He has gone back to college. He socializes on his own terms, and doesn't berate himself for being different. "My favorite story about autism is 'The Emperor's New Clothes'," he says. "The boy didn't understand social norms, but he spoke the truth. I think society needs us.”
Gifted geeks aren't the only ones saying that. Juhrs, the social-service organizer, has found that even profoundly autistic adults are often highly employable. "If they're matched properly with work they enjoy," she says, "they can do as well or better than people who aren't disabled."
In seeking out jobs for her clients, Juhrs never appeals to employers for charity. She asks if there are jobs they've had trouble filling. As it turns out, the Type S tasks that her people thrive on-inspecting garments, coding inventory, assembling components for the fuses on nuclear submarines-are often the same ones that ordinary people can't stand. "Once our folks get into going to work, they don't want to miss a day," she says. "We have to talk them into holidays.”
Tapping these strengths makes obvious sense, but the deficits associated with autism are just as real. Are people like Spicer destined to fail in love and the workplace, or can their social handicaps be conquered? Unlike systemizing, empathy involves snap, intuitive judgments that you can't always make by following a recipe. "Most people learn to interact socially just by observation," says Stephen Shore, a mildly autistic Boston University doctoral student who heads the Asperger's Association of New England. "People on the autistic spectrum regard things as a set of rules. We have to figure them out or be taught.” Like Tom Hanks in "Big," Shore thought sleepover the first time a woman invited him to spend the night. But through painstaking study and practice, he has developed a good enough social repertoire to sustain a career and a 13-year marriage.
Was Shore just lucky, or is there a lesson to be drawn from his experience? Can people on the autistic spectrum learn to compensate for their lack of natural empathizing ability? The answer depends on the person and the condition. Siegel estimates that 25 percent of classically autistic children respond to intensive interventions and that 7 percent do well enough to attend mainstream schools and lead normal lives. The response rates are much higher among mildly affected kids, and experts agree that early intervention is the key to success. "The earlier you can get into a treatment program," says Andy Shih of the National Alliance for Autism Research, "the better the prognosis.”
The programs go by different names -applied behavioral analysis, discreet trial training, pivotal response treatment- but most of them use simple conditioning exercises to open lines of communication. "With an average child, you can point to something red and ask what color it is," says psychologist Robert Koegel of the University of California, Santa Barbara. "Autistic kids are screaming, trying to get out of it. But what if they love M&Ms? When we ask which one is red, they take a red one. They're highly motivated." Naming colors is simpler than decoding social signals, but they, too, can be mastered by unconventional means. Baron-Cohen's team has developed an interactive computer program that pairs 418 emotions with distinct facial expressions. Preliminary studies suggest that anyone, autistic or not, can develop a better eye for flattery, boredom or scorn simply by practicing for 10 weeks with these electronic flashcards.
As fate would have it, some of the best natural readers of feelings and faces are themselves profoundly disabled. People with a rare genetic disorder called Williams syndrome are often severely retarded. Yet they're hypersocial, highly verbal and often deeply empathetic. "In some ways' says research psychologist Teresa Doyle of the Salk Institute, "Williams syndrome is almost an opposite of autism.” Ten-year-old A. J. Arciniega will never play Bop It Extreme the way Andrew Bacalao does, let alone dismantle a radio. But he shakes hands eagerly when greeted by a NEWSWEEK correspondent, and gladly engages in conversation, asking about the visitor's children and their interests. Settling in with a wordless picture book, he pages through the story of a boy and a dog who lose their frog and set out to find him. There is no plot in A.J.'s telling, but his feeling for the characters is irrepressible. "Ron! Ron! Where are you?" he exclaims when the boy is shown calling for his frog. "'Woof! Woof!' the dog moans." Neither Andrew nor A.J. is in for an easy life -as Baron-Cohen might say, things are simpler in the middle of the E-S spectrum. But the world will be richer for both of them.
With ANNE UNDERWOOD, ANDREW MURR, KAREN SPRINGEN and SARAH SENNOTT