{"version":"1.0.0","segments":[{"startTime":8.355,"endTime":12.798,"body":"It's a great pleasure and privilege to be here with you today and to share"},{"startTime":12.798,"endTime":17.241,"body":"some thoughts on the 30 years and more that I've been working in the area"},{"startTime":17.241,"endTime":21.685,"body":"of autism and reflect on how our understanding of autism has changed over that time."},{"startTime":21.985,"endTime":23.605,"body":"And I really look forward to your questions."},{"startTime":23.855,"endTime":25.405,"body":"Where I will get to learn from you."},{"startTime":26.775,"endTime":30.904,"body":"The Gresham College lecture that you're listening to right now is giving you knowledge and"},{"startTime":30.904,"endTime":35.034,"body":"insight from one of the world's leading academic experts, making it takes a lot of"},{"startTime":35.034,"endTime":39.164,"body":"time, but because we want to encourage a love of learning, we think it's well"},{"startTime":39.164,"endTime":39.715,"body":"worth it."},{"startTime":40.695,"endTime":43.835,"body":"We never make you pay for lectures, although donations are needed."},{"startTime":44.335,"endTime":45.675,"body":"All we ask in return is this."},{"startTime":46.225,"endTime":48.515,"body":"Send a link to this lecture to someone you think would benefit."},{"startTime":48.855,"endTime":52.538,"body":"And if you haven't already, click the follow or subscribe button from wherever you are"},{"startTime":52.538,"endTime":53.275,"body":"listening right now."},{"startTime":54.375,"endTime":56.435,"body":"Now, let's get back to the lecture you."},{"startTime":60.695,"endTime":65.635,"body":"So autism is perhaps more present in everyone's consciousness than ever before."},{"startTime":66.495,"endTime":71.282,"body":"And you can see autism being reflected in news articles like the one today about"},{"startTime":71.282,"endTime":74.155,"body":"employment and also in fiction in books and films."},{"startTime":74.945,"endTime":80.204,"body":"Some of the coverage is very misleading, of course, and some of it, uh, perpetuates"},{"startTime":80.204,"endTime":80.555,"body":"myths."},{"startTime":80.975,"endTime":85.337,"body":"But I think there's greater awareness of autism than any time during the, uh, 30"},{"startTime":85.337,"endTime":87.955,"body":"or decades that I've been working in the area."},{"startTime":88.255,"endTime":92.637,"body":"And most people when I tell them what I do, will say, oh, yes, I"},{"startTime":92.637,"endTime":96.435,"body":"have a friend whose, whose child is autistic, or some sort of connection."},{"startTime":98.655,"endTime":99.875,"body":"But what is autism?"},{"startTime":100.065,"endTime":102.115,"body":"Well, you can answer that question in lots of different ways."},{"startTime":102.695,"endTime":107.153,"body":"We know that autism has a strong genetic component in most cases, but we don't"},{"startTime":107.153,"endTime":111.611,"body":"have a genetic or a blood test for autism, and we're still defining and diagnosing"},{"startTime":111.611,"endTime":113.395,"body":"autism on the basis of behavior."},{"startTime":114.095,"endTime":120.957,"body":"So we're talking about a, a behavioral syndrome, a pattern of behavior, um, characterized by"},{"startTime":120.957,"endTime":127.82,"body":"social and communication differences, and sometimes difficulties by rigid and repetitive behavior, uh, which now"},{"startTime":127.82,"endTime":134.682,"body":"includes sensory sensitivities also, um, and something that, a characteristic that is present from early"},{"startTime":134.682,"endTime":139.715,"body":"in life, even though the diagnosis may come much, much later."},{"startTime":139.715,"endTime":143.14,"body":"And as I'll go on to talk about later, we have some people coming for"},{"startTime":143.14,"endTime":145.195,"body":"first diagnosis in their fifties or in their seventies."},{"startTime":146.015,"endTime":149.475,"body":"But the characteristics of autism were always present from very early on."},{"startTime":151.655,"endTime":157.094,"body":"So the first way that autism has changed, uh, is from being considered rather narrowly"},{"startTime":157.094,"endTime":159.995,"body":"defined rather narrowly, to a much broader definition."},{"startTime":160.655,"endTime":165.755,"body":"So in the 1980s, the diagnosis was called infantile autism."},{"startTime":166.215,"endTime":172.578,"body":"Uh, reflecting again, a very different history where initially autism was distinguished from and talked"},{"startTime":172.578,"endTime":174.275,"body":"about as childhood schizophrenia."},{"startTime":175.015,"endTime":180.805,"body":"Um, and some of the diagnostic criteria were pervasive lack of responsiveness to other people."},{"startTime":180.865,"endTime":186.425,"body":"So being oblivious of others, gross deficits in languish development, often an individual who didn't"},{"startTime":186.425,"endTime":191.245,"body":"speak or only spoke a few words and absence of delusions and hallucinations."},{"startTime":191.245,"endTime":197.045,"body":"And you can see that that is an attempt to distinguish autism from schizophrenia, from"},{"startTime":197.045,"endTime":198.205,"body":"psycho psychosis spectrum."},{"startTime":199.665,"endTime":205.215,"body":"Now, most of us, when we think about our autistic friends and relatives, they may"},{"startTime":205.215,"endTime":210.765,"body":"not fit those criteria at all, certainly not pervasively unresponsive to other people, for example."},{"startTime":210.765,"endTime":211.965,"body":"And they may have very good language."},{"startTime":212.745,"endTime":220.095,"body":"Our current diagnostic criteria for what we now call autism spectrum disorder, um, include things"},{"startTime":220.095,"endTime":221.565,"body":"like persistent deficits."},{"startTime":221.565,"endTime":227.355,"body":"Some people would rather say differences in social communication and social interaction restricted repetitive patterns"},{"startTime":227.355,"endTime":229.285,"body":"of behavior, interests or activities."},{"startTime":229.625,"endTime":232.725,"body":"And as I said, that now includes sensory sensitivities."},{"startTime":233.545,"endTime":239.482,"body":"Um, and importantly in our current conception, you can have an autism diagnosis and a"},{"startTime":239.482,"endTime":243.045,"body":"diagnosis of A DHD or of anxiety of depression."},{"startTime":243.425,"endTime":249.045,"body":"And surprisingly, that was only allowed from 2013, uh, in the current diagnostic criteria."},{"startTime":249.065,"endTime":253.399,"body":"Before that, if you were anxious and autistic, your anxiety was put down to your"},{"startTime":253.399,"endTime":257.445,"body":"autism, which obviously isn't helpful, and I'll talk more about mental health later on."},{"startTime":258.785,"endTime":263.765,"body":"So a great widening of those diagnostic criteria, incorporating many more people."},{"startTime":264.075,"endTime":268.725,"body":"When I started in the field, most autistic children were in special school."},{"startTime":269.185,"endTime":275.927,"body":"Uh, many or most had intellectual disability, um, language difficulties, and we were really fighting"},{"startTime":275.927,"endTime":277.725,"body":"a lot of underdiagnosis."},{"startTime":278.705,"endTime":281.325,"body":"Now, most autistic children are in mainstream school."},{"startTime":281.825,"endTime":286.533,"body":"Uh, that may not always be the best place for 'em if they're not well"},{"startTime":286.533,"endTime":291.241,"body":"supported, but most are in mainstream, most will have pretty good intellectual functioning and serviceable"},{"startTime":291.241,"endTime":293.125,"body":"or, or good or excellent language."},{"startTime":293.705,"endTime":296.965,"body":"So the picture, the autistic population has really changed."},{"startTime":298.945,"endTime":304.133,"body":"And as autism has changed from being narrowly defined to much more broadly defined, it's"},{"startTime":304.133,"endTime":308.285,"body":"also changed from being a rare condition to a, a common condition."},{"startTime":309.265,"endTime":315.25,"body":"So in the 1980s, we talked about between four and six in every 10,000 individuals"},{"startTime":315.25,"endTime":317.245,"body":"meeting diagnostic criteria for autism."},{"startTime":317.625,"endTime":324.079,"body":"But today we talk about 1% of people or maybe even 2% of people, and"},{"startTime":324.079,"endTime":330.534,"body":"sometimes studies in the states saying even higher, um, numbers, what happened between 1980s and"},{"startTime":330.534,"endTime":330.965,"body":"today?"},{"startTime":330.995,"endTime":336.883,"body":"Well, one thing that happened was that in the mid nineties, a new diagnostic label,"},{"startTime":336.883,"endTime":342.771,"body":"Asperger's syndrome was introduced and it was introduced to capture people who didn't have a"},{"startTime":342.771,"endTime":348.659,"body":"language delay or cognitive delay, but still had those social communication difficulties and the regional"},{"startTime":348.659,"endTime":349.445,"body":"repetitive traits."},{"startTime":350.025,"endTime":354.842,"body":"And I think for the first time then in the nineties, if a parent had"},{"startTime":354.842,"endTime":359.66,"body":"a child diagnosed with more classic or obvious autism, they might read around the topic"},{"startTime":359.66,"endTime":364.477,"body":"and they might find descriptions of Asperger's syndrome and think, ah, that might be me,"},{"startTime":364.477,"endTime":366.405,"body":"or that might be my father."},{"startTime":366.465,"endTime":369.485,"body":"The grandfather of of the child who's just had a diagnosis of autism."},{"startTime":369.985,"endTime":375.56,"body":"Before that, when the picture was very much about autism with language today with intellectual"},{"startTime":375.56,"endTime":380.765,"body":"disability, parents weren't likely to read about autism and think that's me as well."},{"startTime":381.625,"endTime":383.245,"body":"So we see a big expansion there."},{"startTime":383.945,"endTime":388.61,"body":"But I also want to point out that there probably hasn't been a real increase"},{"startTime":388.61,"endTime":390.165,"body":"in the rates of autism."},{"startTime":390.465,"endTime":395.546,"body":"We can't be sure because we can't go back retrospectively and apply our current diagnostic"},{"startTime":395.546,"endTime":395.885,"body":"criteria."},{"startTime":396.785,"endTime":401.622,"body":"But what I've shown you on the slide is the smooth, smooth blue curve that"},{"startTime":401.622,"endTime":406.46,"body":"is often used by, uh, autism charities and campaigners, particularly in the states, to say,"},{"startTime":406.46,"endTime":409.685,"body":"look at this huge rise in the rates of autism."},{"startTime":410.305,"endTime":415.085,"body":"Please give more resources, please give more, uh, um, intervention and support."},{"startTime":415.825,"endTime":422.262,"body":"But in set, I put the, the rates of autism in 2002 and in 2000"},{"startTime":422.262,"endTime":426.125,"body":"and, and um, six in different states in America."},{"startTime":426.745,"endTime":431.855,"body":"And remember that in America, the code, the diagnostic code you have on your health"},{"startTime":431.855,"endTime":436.965,"body":"insurance claim determines how much money you get and what resources and services you get."},{"startTime":437.585,"endTime":442.187,"body":"And it happens that you get more for autism thanks to the campaigning of, of,"},{"startTime":442.187,"endTime":446.79,"body":"you know, hardworking advocates and parents, you get more for autism than for a diagnosis,"},{"startTime":446.79,"endTime":448.325,"body":"for example, of intellectual disability."},{"startTime":449.105,"endTime":454.995,"body":"So the very different rates and the very different degrees of change in that inset"},{"startTime":454.995,"endTime":460.885,"body":"bar graph in different states is unlikely to to be telling us that actually, um,"},{"startTime":460.885,"endTime":466.776,"body":"in Arizona there has, in 2006 there was a change in what was in the"},{"startTime":466.776,"endTime":469.525,"body":"water so that more people were autistic."},{"startTime":469.795,"endTime":474.845,"body":"It's much more likely that services have changed, awareness has changed, provision has changed."},{"startTime":475.465,"endTime":481.661,"body":"And the other thing that helps us to understand the change in the rates of"},{"startTime":481.661,"endTime":487.858,"body":"autism, apart from the broadening of the diagnostic criteria and greater awareness and understanding is"},{"startTime":487.858,"endTime":488.685,"body":"diagnostic substitution."},{"startTime":489.145,"endTime":493.302,"body":"So as the rates of autism have gone up, the rates of intellectual disability as"},{"startTime":493.302,"endTime":494.965,"body":"a sole diagnosis have gone down."},{"startTime":495.865,"endTime":499.736,"body":"Um, so I don't think there's a change in the numbers of people who are"},{"startTime":499.736,"endTime":501.285,"body":"autistic, although I can't prove that."},{"startTime":501.505,"endTime":503.605,"body":"But there are lots of other possible explanations."},{"startTime":504.505,"endTime":511.685,"body":"So that's data from America and we have that proviso about, um, um, medical insurance"},{"startTime":511.685,"endTime":512.164,"body":"records."},{"startTime":513.544,"endTime":518.461,"body":"Here's some recent data from the uk and um, what I want to highlight are,"},{"startTime":518.461,"endTime":519.445,"body":"are two things."},{"startTime":519.895,"endTime":524.044,"body":"First, note that these graphs show the percentage increase."},{"startTime":524.635,"endTime":529.669,"body":"It's not the numbers of people with an autism diagnosis, it's the percentage increase over"},{"startTime":529.669,"endTime":530.005,"body":"time."},{"startTime":530.665,"endTime":535.838,"body":"So if you start off with very, very few diagnoses in a particular age group"},{"startTime":535.838,"endTime":541.011,"body":"or in say females versus males, you will get a big percentage increase, even if"},{"startTime":541.011,"endTime":544.805,"body":"there are still fewer females being diagnosed than males, for example."},{"startTime":545.425,"endTime":551.101,"body":"But it's still informative, I think, because it shows that the big increase has been"},{"startTime":551.101,"endTime":554.885,"body":"in first diagnosis in adulthood over the age of 19."},{"startTime":555.665,"endTime":561.494,"body":"And in women and girls rather than in men and boys and the authors of"},{"startTime":561.494,"endTime":567.324,"body":"that work, GI Ross and her collaborators at Exeter conclude from those two facts that"},{"startTime":567.324,"endTime":570.045,"body":"they don't think were over diagnosing autism."},{"startTime":570.475,"endTime":574.445,"body":"Instead, were catching up on people who have historically been missed."},{"startTime":575.425,"endTime":578.885,"body":"And we'll come back to the catching up in in older people a bit later."},{"startTime":582.405,"endTime":587.639,"body":"A third change in how we think about autism is from thinking about autism is"},{"startTime":587.639,"endTime":592.525,"body":"mainly affecting boys and men to recognizing that autism is relevant for all genders."},{"startTime":593.305,"endTime":600.662,"body":"So in the 1980s, we estimated that perhaps five or 10 times as many males"},{"startTime":600.662,"endTime":603.605,"body":"as females warranted an autism diagnosis."},{"startTime":604.385,"endTime":609.894,"body":"But most of that data was from clinical records or records of who was on"},{"startTime":609.894,"endTime":615.404,"body":"the special educational needs registers from those records, it looked as if fewer, many fewer"},{"startTime":615.404,"endTime":620.913,"body":"girls and women were autistic compared to males, but when they were autistic, they were"},{"startTime":620.913,"endTime":623.485,"body":"more likely to also have intellectual disability."},{"startTime":624.665,"endTime":631.599,"body":"Now, fast forward to the 2020s, and it seems from good meta analytic studies that"},{"startTime":631.599,"endTime":636.685,"body":"maybe the ratio is three times as many males to females."},{"startTime":637.225,"endTime":642.033,"body":"And that's taking data from really good epidemiological studies that have gone out into the"},{"startTime":642.033,"endTime":646.841,"body":"community and ascertained who would get an autism diagnosis rather than looking at the lists"},{"startTime":646.841,"endTime":649.085,"body":"of the people we already know about."},{"startTime":649.515,"endTime":653.793,"body":"Because if we're missing women or girls, then the lists of people we already know"},{"startTime":653.793,"endTime":656.645,"body":"about are not going to give us a fair estimate."},{"startTime":657.825,"endTime":660.725,"body":"So maybe three times, uh, more females than males."},{"startTime":660.865,"endTime":667.322,"body":"And in those population-based, uh, databases, it doesn't seem that women are necessarily more likely"},{"startTime":667.322,"endTime":669.045,"body":"to have intellectual disability."},{"startTime":669.625,"endTime":673.885,"body":"The ratio of three to one seems to be true across the ability spectrum."},{"startTime":674.745,"endTime":680.104,"body":"So that suggests to me that we have been missing or misdiagnosing women and girls"},{"startTime":680.104,"endTime":682.605,"body":"and particularly those who are intellectually able."},{"startTime":683.665,"endTime":688.226,"body":"And when you make that comparison of, of five to one or 10 to one,"},{"startTime":688.226,"endTime":692.787,"body":"when we used to talk about Asperger syndrome compared to three to one, I think"},{"startTime":692.787,"endTime":697.045,"body":"we're missing or have historically missed a really large number of women and girls."},{"startTime":697.705,"endTime":698.965,"body":"And I'm going to say a little bit about that."},{"startTime":701.305,"endTime":705.321,"body":"So is there evidence that we're missing or have historically missed women and girls on"},{"startTime":705.321,"endTime":706.125,"body":"the autism spectrum?"},{"startTime":706.475,"endTime":711.605,"body":"Well, we know that females are, are identified or diagnosed on average later than males."},{"startTime":712.145,"endTime":716.332,"body":"We know that a male and a female individual with the same level of autistic"},{"startTime":716.332,"endTime":718.845,"body":"traits, the female is less likely to get diagnosed."},{"startTime":719.345,"endTime":724.511,"body":"So those are, uh, some reasons why we can think that we probably have missed"},{"startTime":724.511,"endTime":728.645,"body":"them, and we then need to say why are we missing them?"},{"startTime":729.265,"endTime":733.904,"body":"And I think a large part of this is that we all carry an unconscious,"},{"startTime":733.904,"endTime":737.925,"body":"uh, bias and stereotype of autism as being male apart from anything else."},{"startTime":738.075,"endTime":742.796,"body":"Most people will have met more autistic males than females if only because of the"},{"startTime":742.796,"endTime":744.685,"body":"historical underdiagnosis of women and girls."},{"startTime":745.465,"endTime":749.405,"body":"But I think we also, uh, carry a lot of unconscious stereotypes."},{"startTime":749.985,"endTime":755.114,"body":"So the picture here of the lined up cars and then the lined up cuddly"},{"startTime":755.114,"endTime":760.243,"body":"toys, if you look at the lined up cars, you might well think, ah, yes,"},{"startTime":760.243,"endTime":764.005,"body":"that's quite autistic lining things up, enduring repetitively lining things up."},{"startTime":764.235,"endTime":769.785,"body":"That could be a sign that this child has high autistic traits or warrants an"},{"startTime":769.785,"endTime":770.525,"body":"autism diagnosis."},{"startTime":771.225,"endTime":774.941,"body":"But then you look at the cuddly toys lined up and your first response might"},{"startTime":774.941,"endTime":775.685,"body":"be quite different."},{"startTime":775.945,"endTime":780.376,"body":"It might be, ah, how sweet, maybe she making an assumption, maybe she's going to"},{"startTime":780.376,"endTime":782.445,"body":"play school and pretend to teach them."},{"startTime":782.785,"endTime":784.405,"body":"And then that doesn't look autistic at all."},{"startTime":784.985,"endTime":786.685,"body":"But in fact, they're the same behaviors."},{"startTime":786.815,"endTime":789.805,"body":"We're just bringing a a sort of gendered lens to them."},{"startTime":790.905,"endTime":796.069,"body":"And in the same way we know that, um, that the kinds of obvious signs"},{"startTime":796.069,"endTime":801.234,"body":"of autism that's say primary school teachers might on average look for, don't always work"},{"startTime":801.234,"endTime":803.645,"body":"to pick up girls on the spectrum."},{"startTime":804.305,"endTime":809.841,"body":"So you might see a little boy who's autistic who is quite obvious in the"},{"startTime":809.841,"endTime":815.377,"body":"playground because while the other boys are playing football, um, he's just walking the perimeter"},{"startTime":815.377,"endTime":816.485,"body":"pacing the perimeter."},{"startTime":816.865,"endTime":818.325,"body":"And a teacher will spot that."},{"startTime":818.745,"endTime":822.791,"body":"But a teacher might not spot a girl who is just on the edge of"},{"startTime":822.791,"endTime":826.837,"body":"the social group of girls who are all chatting, who's laughing just a little bit"},{"startTime":826.837,"endTime":829.805,"body":"after they're laughing or looking just a little bit outta place."},{"startTime":830.745,"endTime":835.276,"body":"So the manifestation of autism in girls may also sometimes look a bit different or"},{"startTime":835.276,"endTime":836.485,"body":"not fit our stereotypes."},{"startTime":836.785,"endTime":842.554,"body":"So for example, many people might think that the autistic, um, social style will be"},{"startTime":842.554,"endTime":848.324,"body":"to be socially aloof, but in fact, many autistic girls and many autistic boys as"},{"startTime":848.324,"endTime":853.325,"body":"well are very, very attached to one person, to one child at school."},{"startTime":853.625,"endTime":855.725,"body":"In fact, unusually clingy to them."},{"startTime":856.105,"endTime":858.405,"body":"But that doesn't always fit with our stereotype of autism."},{"startTime":860.755,"endTime":866.552,"body":"Another reason that we may be missing women and girls on the autism spectrum has"},{"startTime":866.552,"endTime":868.485,"body":"to do with diagnostic overshadowing."},{"startTime":868.485,"endTime":875.269,"body":"And of course this can happen also with boys and men, but particularly diagnostic overshadowing"},{"startTime":875.269,"endTime":880.245,"body":"from pertinent diagnoses that are more gender, uh, sort of stereotyped."},{"startTime":880.985,"endTime":887.59,"body":"So eating disorders is a very good example, and from my colleagues at the I-O-P-P-N,"},{"startTime":887.59,"endTime":894.196,"body":"we know that around 20 to 30% of women coming to services for anorexia will,"},{"startTime":894.196,"endTime":900.802,"body":"if they're tested for autism, will pass the diagnostic threshold for an autism diagnosis even"},{"startTime":900.802,"endTime":903.885,"body":"though they've never had that diagnosis before."},{"startTime":904.945,"endTime":910.61,"body":"You have to be careful about making conclusions because we know that when you are"},{"startTime":910.61,"endTime":914.765,"body":"at starvation weight that affects your cognition, particularly your social cognition."},{"startTime":915.705,"endTime":920.479,"body":"But I think the evidence is amassing that when these young women, uh, reach a"},{"startTime":920.479,"endTime":925.253,"body":"healthy weight, they still have the traits of autism, uh, that would probably be sufficient"},{"startTime":925.253,"endTime":926.845,"body":"to have an autism diagnosis."},{"startTime":927.625,"endTime":933.451,"body":"So what's happened is that perhaps a clinician sees the eating disorder but doesn't go"},{"startTime":933.451,"endTime":937.725,"body":"further to ask, is this anorexia in the context of autism?"},{"startTime":938.465,"endTime":939.445,"body":"And that really matters."},{"startTime":940.145,"endTime":945.415,"body":"Um, the, my colleagues on the eating disorder ward told me about, um, they now"},{"startTime":945.415,"endTime":950.685,"body":"have a wonderful pathway for autistic women and men if they have eating disorders too."},{"startTime":950.945,"endTime":956.431,"body":"But before that, when they were still learning, they, uh, told me about a woman"},{"startTime":956.431,"endTime":961.918,"body":"on the ward who, unlike all the other anorexia patients who were, um, very well"},{"startTime":961.918,"endTime":967.405,"body":"turned out, always clean hair, always washed, she was quite disheveled and a bit chaotic."},{"startTime":968.145,"endTime":973.359,"body":"Um, and nobody wanted to say anything because you don't make negative comments about how"},{"startTime":973.359,"endTime":975.445,"body":"someone looks on an anorexia ward."},{"startTime":975.945,"endTime":979.915,"body":"But somebody talking to her thought, well, maybe this is not just anorexia, maybe this"},{"startTime":979.915,"endTime":980.445,"body":"is autism."},{"startTime":980.905,"endTime":985.994,"body":"And they talked to her and in fact, she wanted to be given a regime"},{"startTime":985.994,"endTime":990.405,"body":"to have a shower every morning to wash her hair every three days."},{"startTime":990.425,"endTime":995.466,"body":"She wanted a routine that was written down and then she was very happy to"},{"startTime":995.466,"endTime":1000.507,"body":"stick to the routine, but without structure, she wasn't sure what to do to keep"},{"startTime":1000.507,"endTime":1005.548,"body":"herself, um, sort of clean and, and well, and similarly, it turned out that her"},{"startTime":1005.548,"endTime":1009.245,"body":"eating disorder wasn't at all to do with body image concerns."},{"startTime":1009.675,"endTime":1013.516,"body":"Instead, she wanted to keep her weight at a particular number, which happened to be"},{"startTime":1013.516,"endTime":1014.285,"body":"a prime number."},{"startTime":1014.985,"endTime":1019.152,"body":"And it was about, uh, interest in that number and a need for control, which"},{"startTime":1019.152,"endTime":1022.765,"body":"of course is often the case with, uh, many people with eating disorders."},{"startTime":1022.765,"endTime":1025.285,"body":"But she wanted to control this number."},{"startTime":1025.704,"endTime":1029.837,"body":"And when it was explained to her that she could aim for a different prime"},{"startTime":1029.837,"endTime":1033.971,"body":"number that was in a healthy range of weight, she was quite happy with that,"},{"startTime":1033.971,"endTime":1038.105,"body":"with some counseling around the fact that it's hard to guarantee that you will always"},{"startTime":1038.105,"endTime":1041.964,"body":"be absolutely on a particular number, but a very different driver for eating disorder."},{"startTime":1041.983,"endTime":1046.165,"body":"So very important to know that this was autism, um, as well as anorexia."},{"startTime":1049.025,"endTime":1053.19,"body":"And another reason why we might miss not only women and girls, but also some"},{"startTime":1053.19,"endTime":1056.245,"body":"men and boys, has to do with what's been called camouflaging."},{"startTime":1056.985,"endTime":1063.743,"body":"So many autistic adults and some young people tell us that they work incredibly hard"},{"startTime":1063.743,"endTime":1070.501,"body":"to fit into the neurotypical world to pass as neurotypical, usually because they've been bullied"},{"startTime":1070.501,"endTime":1073.205,"body":"or ostracized for their autistic behaviors."},{"startTime":1074.465,"endTime":1079.321,"body":"And, uh, they will say that for example, they selected a girl in their class"},{"startTime":1079.321,"endTime":1084.177,"body":"at school or a woman at work who seems to be socially successful and copy"},{"startTime":1084.177,"endTime":1089.033,"body":"everything about her copy, how she dresses, how she does her hair, maybe how she"},{"startTime":1089.033,"endTime":1093.889,"body":"does her makeup, how she talks, what she talks about, copy everything to put on"},{"startTime":1093.889,"endTime":1098.745,"body":"a sort of suit of armor to go, um, undiscovered and not bullied and maybe"},{"startTime":1098.745,"endTime":1103.601,"body":"even accepted and talk to until you can get to that point to develop a"},{"startTime":1103.601,"endTime":1103.925,"body":"friendship."},{"startTime":1105.705,"endTime":1111.792,"body":"So based on what autistic people have told us themselves, Laura Hall developed, um, a"},{"startTime":1111.792,"endTime":1115.445,"body":"short, uh, questionnaire to measure this sort of camouflaging."},{"startTime":1115.945,"endTime":1119.445,"body":"And it asks you things like how much do you agree with the following statements?"},{"startTime":1120.005,"endTime":1124.431,"body":"I learn how people use their bodies and faces to interact by watching TV or"},{"startTime":1124.431,"endTime":1128.857,"body":"films or when I'm interacting with somebody, I deliberately copy their body language or facial"},{"startTime":1128.857,"endTime":1133.284,"body":"expressions and you can answer that you disagree or you agree a little or you"},{"startTime":1133.284,"endTime":1135.645,"body":"agree fully and you get a camouflaging score."},{"startTime":1138.065,"endTime":1143.213,"body":"Now camouflaging is important because we know that although it has some advantages that autistic"},{"startTime":1143.213,"endTime":1148.362,"body":"people tell us about, like for example, being able to go to a job interview"},{"startTime":1148.362,"endTime":1153.511,"body":"or, um, striking up a conversation with somebody you'd like to be friends with, it"},{"startTime":1153.511,"endTime":1154.885,"body":"also has significant costs."},{"startTime":1156.025,"endTime":1161.328,"body":"So this graph just shows you some of our work where we've found that how"},{"startTime":1161.328,"endTime":1165.925,"body":"much people say they camouflage is negatively correlated with self-reported quality of life."},{"startTime":1166.585,"endTime":1169.045,"body":"That's true for both males and females in this sample."},{"startTime":1169.545,"endTime":1175.245,"body":"Um, and we also know that autistic people tell us that camouflaging is is exhausting."},{"startTime":1175.745,"endTime":1179.974,"body":"And if you imagine trying to keep up a mask 24 hours a day or"},{"startTime":1179.974,"endTime":1184.203,"body":"or all day at school, it's no surprise that you come home and have a"},{"startTime":1184.203,"endTime":1184.485,"body":"meltdown."},{"startTime":1185.265,"endTime":1187.365,"body":"And also that it erodes the sense of self."},{"startTime":1187.945,"endTime":1192.366,"body":"So an autistic 16-year-old that I was talking to was telling me about her mental"},{"startTime":1192.366,"endTime":1194.725,"body":"health crisis, which had landed her own hospital."},{"startTime":1195.185,"endTime":1198.801,"body":"And she talked to me about how when she came out, her friends had really"},{"startTime":1198.801,"endTime":1199.525,"body":"rallied around her."},{"startTime":1199.945,"endTime":1202.645,"body":"And as she was talking, I was thinking, that's lovely, that's so nice."},{"startTime":1203.225,"endTime":1206.605,"body":"And then she said, but of course it's not me they're friends with at all."},{"startTime":1207.115,"endTime":1208.205,"body":"It's the mask I wear."},{"startTime":1208.865,"endTime":1213.152,"body":"And so all of that love and affection wasn't reaching her because she didn't feel"},{"startTime":1213.152,"endTime":1215.725,"body":"that she was her authentic self with her friends."},{"startTime":1216.585,"endTime":1219.965,"body":"She felt that they were friends with the masks that she wore."},{"startTime":1222.025,"endTime":1227.579,"body":"And masking camouflaging has really made me think very differently about the traditional route of"},{"startTime":1227.579,"endTime":1233.133,"body":"social skills training That for so many years was absolutely what was assumed to be"},{"startTime":1233.133,"endTime":1235.725,"body":"a good idea for say, autistic teenagers."},{"startTime":1236.225,"endTime":1239.768,"body":"Do social skills groups tell them what they should be doing and what they're doing"},{"startTime":1239.768,"endTime":1240.005,"body":"wrong."},{"startTime":1240.305,"endTime":1242.934,"body":"And if anyone wants to ask about that in questions, I'm very happy to talk"},{"startTime":1242.934,"endTime":1243.285,"body":"about it."},{"startTime":1245.765,"endTime":1254.217,"body":"Autism's also changed from being a childhood condition and really the, the preserve of child"},{"startTime":1254.217,"endTime":1258.725,"body":"psychiatrists and pediatricians to being a lifespan condition."},{"startTime":1259.185,"endTime":1261.565,"body":"We know that people don't stop being autistic."},{"startTime":1261.795,"endTime":1263.525,"body":"They don't grow outta autism."},{"startTime":1263.525,"endTime":1267.085,"body":"Autism is inherent to how they see the world and how they process the world."},{"startTime":1267.545,"endTime":1272.249,"body":"And although as for everyone, we change as we get older, most autistic people will"},{"startTime":1272.249,"endTime":1274.445,"body":"live most of their lives as adults."},{"startTime":1275.705,"endTime":1281.417,"body":"And, uh, we know from a recent study of GP records that over the age"},{"startTime":1281.417,"endTime":1284.845,"body":"of 59 out of 10 autistic adults are undiagnosed."},{"startTime":1285.745,"endTime":1291.285,"body":"So we really are missing and know very little about older age with autistic people."},{"startTime":1293.425,"endTime":1297.353,"body":"Um, and it's important to know because we need to know whether the the health"},{"startTime":1297.353,"endTime":1298.925,"body":"needs, for example, will be different."},{"startTime":1299.625,"endTime":1305.709,"body":"The medical records, um, in the states suggests that all sorts of physical illnesses are"},{"startTime":1305.709,"endTime":1309.765,"body":"worse among those who are who have an autism diagnosis."},{"startTime":1310.625,"endTime":1316.165,"body":"Um, some of that may reflect, uh, lives that are hard, lives that are stressful."},{"startTime":1316.745,"endTime":1322.028,"body":"And we have one study where we looked in a, again, a population-based cohort at"},{"startTime":1322.028,"endTime":1323.085,"body":"pace of aging."},{"startTime":1323.705,"endTime":1327.941,"body":"And those individuals who had high autistic traits, we didn't require a diagnosis because we"},{"startTime":1327.941,"endTime":1330.765,"body":"know over the age of 50 most people aren't diagnosed."},{"startTime":1331.265,"endTime":1337.422,"body":"But, um, those with high autistic traits had a faster pace of biological aging as"},{"startTime":1337.422,"endTime":1339.885,"body":"well as worse reported physical health."},{"startTime":1340.665,"endTime":1346.677,"body":"But a mediation analysis suggested it wasn't the autism that was responsible for that worse"},{"startTime":1346.677,"endTime":1350.685,"body":"aging outcome, but instead it was the things in between."},{"startTime":1351.305,"endTime":1357.765,"body":"So social isolation, poor mental health and anxiety, um, poor sleep and poor health."},{"startTime":1358.545,"endTime":1360.645,"body":"So not being able to have a healthy lifestyle."},{"startTime":1360.975,"endTime":1364.965,"body":"Those were the things that led to that faster pace of aging."},{"startTime":1365.345,"endTime":1369.666,"body":"So there's nothing fatalistic about, as far as we know to tell us that autistic"},{"startTime":1369.666,"endTime":1373.988,"body":"people will have a less healthy old age, but we do know that autistic people"},{"startTime":1373.988,"endTime":1376.005,"body":"on average have a less happy life."},{"startTime":1376.225,"endTime":1379.445,"body":"That's something we can all change and a less happy life."},{"startTime":1379.465,"endTime":1384.035,"body":"And being bullied, for example, is for all of us related to poorer mental and"},{"startTime":1384.035,"endTime":1384.645,"body":"physical health."},{"startTime":1389.625,"endTime":1396.462,"body":"So autism has also changed from us thinking about it as, uh, categorically different from"},{"startTime":1396.462,"endTime":1402.845,"body":"any other diagnosis and from neurotypical development to having a much more dimensional approach."},{"startTime":1404.025,"endTime":1407.775,"body":"So in the old days, it would've been, yes, you get the autism diagnosis, or"},{"startTime":1407.775,"endTime":1409.525,"body":"no, you don't get the autism diagnosis."},{"startTime":1410.185,"endTime":1416.335,"body":"But people first became interested when it became clear from twin studies that autism was"},{"startTime":1416.335,"endTime":1417.565,"body":"quite strongly genetic."},{"startTime":1417.905,"endTime":1424.523,"body":"People became interested in measuring what they called the broader autism phenotype in the relatives"},{"startTime":1424.523,"endTime":1431.141,"body":"of diagnosed autistic children or adults, and looking for little signs, gray signs of autistic"},{"startTime":1431.141,"endTime":1437.76,"body":"traits in not diagnosed, not autistic relatives to try and understand the family treats, try"},{"startTime":1437.76,"endTime":1439.525,"body":"and understand the genetics."},{"startTime":1440.385,"endTime":1446.743,"body":"And once people started creating measures for autistic traits dimensionally, you could see that actually"},{"startTime":1446.743,"endTime":1453.101,"body":"in the general population, at least at the behavioral level, we're all somewhere on that"},{"startTime":1453.101,"endTime":1453.525,"body":"continuum."},{"startTime":1454.105,"endTime":1458.363,"body":"So this is the autism spectrum quotient is perhaps the the best known autism trait"},{"startTime":1458.363,"endTime":1462.622,"body":"measure, uh, which is also freely available and happens to be what nice recommend as"},{"startTime":1462.622,"endTime":1466.881,"body":"a sort of first screener to know whether it's worth going further on a diagnostic"},{"startTime":1466.881,"endTime":1467.165,"body":"journey."},{"startTime":1467.955,"endTime":1471.207,"body":"It's not without its critics, but the, these are some of the questions that you"},{"startTime":1471.207,"endTime":1472.725,"body":"would be asked if you used it."},{"startTime":1473.225,"endTime":1476.787,"body":"You have to say to what extent you, you agree that, um, I prefer to"},{"startTime":1476.787,"endTime":1478.925,"body":"do things the same way over and over again."},{"startTime":1479.645,"endTime":1483.49,"body":"I often notice small sounds when others do not, or you prefer to do things"},{"startTime":1483.49,"endTime":1485.285,"body":"with others rather than on your own."},{"startTime":1485.385,"endTime":1489.206,"body":"And that would be reverse scored, expecting that on average, more autistic people would say"},{"startTime":1489.206,"endTime":1491.245,"body":"they prefer to do things on their own."},{"startTime":1491.805,"endTime":1497.43,"body":"Although I would really emphasize that and counter the myth that autistic people are not"},{"startTime":1497.43,"endTime":1497.805,"body":"sociable."},{"startTime":1498.035,"endTime":1503.405,"body":"Many autistic people are highly sociable and, and many autistic people are, are absolute extroverts."},{"startTime":1503.825,"endTime":1509.342,"body":"Um, and also take the opportunity to counter the myth that autistic people lack emotional"},{"startTime":1509.342,"endTime":1512.285,"body":"empathy because there's absolutely no evidence for that."},{"startTime":1512.645,"endTime":1515.805,"body":"Autistic people are, um, empathic with others."},{"startTime":1516.315,"endTime":1521.479,"body":"They may find it difficult to read somebody else's mind in the sense of knowing"},{"startTime":1521.479,"endTime":1526.643,"body":"that somebody else might think something different, but they certainly care about other people's suffering"},{"startTime":1526.643,"endTime":1528.365,"body":"and emotions and so on."},{"startTime":1528.985,"endTime":1533.167,"body":"So you can see that if you answer these sorts of trait questions, you get"},{"startTime":1533.167,"endTime":1533.725,"body":"a distribution."},{"startTime":1533.985,"endTime":1539.253,"body":"And you can see here from collected studies, the distribution for males on average and"},{"startTime":1539.253,"endTime":1542.765,"body":"females with the males on average, scoring a bit higher."},{"startTime":1546.825,"endTime":1551.566,"body":"Now, when we think about a dimensional approach to autism, sometimes, uh, including some autistic"},{"startTime":1551.566,"endTime":1556.308,"body":"self-advocates, we'll say, oh, no, no, no, you can't be a bit autistic just like"},{"startTime":1556.308,"endTime":1558.205,"body":"you can't be a bit pregnant."},{"startTime":1559.385,"endTime":1561.605,"body":"So I think it depends on the level of analysis."},{"startTime":1561.745,"endTime":1566.1,"body":"So behaviorally we've just seen behaviorally you can be a bit autistic, you can have"},{"startTime":1566.1,"endTime":1570.165,"body":"a lot of autistic traits or very few autistic traits or anywhere in between."},{"startTime":1571.105,"endTime":1576.523,"body":"Um, of course, sometimes there's measures at the behavioral level are not getting at qualitative"},{"startTime":1576.523,"endTime":1576.885,"body":"differences."},{"startTime":1577.025,"endTime":1580.436,"body":"So if you were socially anxious, if you had social phobia, you might say you"},{"startTime":1580.436,"endTime":1583.165,"body":"prefer things to do on your, to do things on your own."},{"startTime":1583.905,"endTime":1586.989,"body":"If you have OCD, you might say you, you, you wouldn't say you prefer to"},{"startTime":1586.989,"endTime":1590.073,"body":"repeat things over and over, but you might say you tend to repeat things over"},{"startTime":1590.073,"endTime":1590.485,"body":"and over."},{"startTime":1591.065,"endTime":1593.845,"body":"So there are other ways you could score up on those behavioral items."},{"startTime":1595.465,"endTime":1599.885,"body":"Um, if we think about the genetic level, you can certainly be a bit autistic."},{"startTime":1600.545,"endTime":1608.081,"body":"So what we know about the genetics of autism, um, from twin studies, um, is"},{"startTime":1608.081,"endTime":1615.617,"body":"that the genetic influences on diagnosed autism are largely overlapping with the genetic influences on"},{"startTime":1615.617,"endTime":1617.125,"body":"subclinical autistic traits."},{"startTime":1618.305,"endTime":1624.533,"body":"Um, we also know that for most autistic people, um, the genetics of their autism"},{"startTime":1624.533,"endTime":1628.685,"body":"is just like the genetics of their and our height."},{"startTime":1629.555,"endTime":1634.187,"body":"It's a product of hundreds and hundreds of common alleles, common genetic variants, which we"},{"startTime":1634.187,"endTime":1634.805,"body":"all share."},{"startTime":1635.425,"endTime":1639.216,"body":"And some people have more of them and are taller or have more autistic traits,"},{"startTime":1639.216,"endTime":1643.008,"body":"and some people have fewer of them or a different combination of them and are"},{"startTime":1643.008,"endTime":1644.525,"body":"shorter or have fewer autistic traits."},{"startTime":1645.675,"endTime":1650.295,"body":"It's only in a very small minority of autistic people that a rare mutation that"},{"startTime":1650.295,"endTime":1654.916,"body":"is qualitatively different from what all the rest of us have seems to be playing"},{"startTime":1654.916,"endTime":1656.765,"body":"a large part in their autism."},{"startTime":1656.825,"endTime":1662.978,"body":"But for most people, genetics of autism, just like the genetics of height, and we"},{"startTime":1662.978,"endTime":1669.132,"body":"know that from twin studies, another way that autism has changed is from thinking of"},{"startTime":1669.132,"endTime":1673.645,"body":"autism as one thing to thinking of autism as many things."},{"startTime":1674.225,"endTime":1679.525,"body":"So this is pictures meant to show apples and oranges, and one speculation for why"},{"startTime":1679.525,"endTime":1683.765,"body":"we've actually made rather little progress in understanding the biology of autism."},{"startTime":1684.385,"endTime":1686.445,"body":"Um, and to some extent the genetics of autism."},{"startTime":1686.985,"endTime":1692.603,"body":"One hypothesis is that we're mixing apples and oranges in our studies that we've actually"},{"startTime":1692.603,"endTime":1698.222,"body":"got a lot of different individuals who all come under this behavioral umbrella of autism,"},{"startTime":1698.222,"endTime":1700.845,"body":"but have different etiological or biological underpinnings."},{"startTime":1703.195,"endTime":1708.049,"body":"So I told you about the, the genetics, which is again shown here, the very"},{"startTime":1708.049,"endTime":1712.903,"body":"small part of the pie that is to do with, with, um, mutations or de"},{"startTime":1712.903,"endTime":1717.757,"body":"novo new events that are different from the general population and the large part of"},{"startTime":1717.757,"endTime":1722.611,"body":"the pie where it's just a matter of how many common variants you happen to"},{"startTime":1722.611,"endTime":1722.935,"body":"have."},{"startTime":1723.955,"endTime":1729.693,"body":"People now talk sometimes not about autism, but the autisms to try to recognize that"},{"startTime":1729.693,"endTime":1735.432,"body":"there may be this enormous biological, at least heterogeneity within the category that we call"},{"startTime":1735.432,"endTime":1735.815,"body":"autism."},{"startTime":1737.575,"endTime":1743.3,"body":"Interestingly, despite the search for biomarkers and ways to stratify or cut up the big"},{"startTime":1743.3,"endTime":1746.735,"body":"autism spectrum, to date, there's been very little success."},{"startTime":1747.035,"endTime":1754.741,"body":"And the only real distinction that carries weight in terms of prognosis, for example, is"},{"startTime":1754.741,"endTime":1761.935,"body":"the difference between autism with intellectual disability, language difficulties, and autism without intellectual disability."},{"startTime":1761.945,"endTime":1767.298,"body":"Those two seem to take rather different roads and relate rather differently to the genetic"},{"startTime":1767.298,"endTime":1767.655,"body":"story."},{"startTime":1769.135,"endTime":1774.135,"body":"\u003caffirmative\u003e,"},{"startTime":1771.075,"endTime":1774.692,"body":"Autism, we can also think of as changing from one thing to many in a"},{"startTime":1774.692,"endTime":1775.175,"body":"different sense."},{"startTime":1775.635,"endTime":1780.633,"body":"So before I was talking about taking the whole autism spectrum and saying that when"},{"startTime":1780.633,"endTime":1785.632,"body":"you compare one autistic person to another, they may have very different biological underpinnings or"},{"startTime":1785.632,"endTime":1789.965,"body":"etiologies, but now I want you to think about just one autistic person."},{"startTime":1790.505,"endTime":1796.194,"body":"And I want to suggest that in, in even one autistic person, the origins of"},{"startTime":1796.194,"endTime":1801.125,"body":"different characteristics that make up what we call autism may be very distinct."},{"startTime":1801.985,"endTime":1808.127,"body":"So traditionally we used to talk about the triad in autism, social differences, communication differences,"},{"startTime":1808.127,"endTime":1809.765,"body":"rigid and repetitive behaviors."},{"startTime":1810.665,"endTime":1814.058,"body":"And we used to think of those as three sides of one thing that was"},{"startTime":1814.058,"endTime":1814.285,"body":"autism."},{"startTime":1815.385,"endTime":1820.001,"body":"But while it's true that if you go into an autism clinic and you look"},{"startTime":1820.001,"endTime":1824.617,"body":"at people who have the diagnosis, you will always find that they have all three"},{"startTime":1824.617,"endTime":1824.925,"body":"parts."},{"startTime":1825.745,"endTime":1830.445,"body":"If you look in the general population, you'll find that actually those three parts pull"},{"startTime":1830.445,"endTime":1832.325,"body":"apart in a lot of cases."},{"startTime":1833.025,"endTime":1838.717,"body":"And indeed in families too, in families where there's an autistic child, you'll quite often"},{"startTime":1838.717,"endTime":1844.41,"body":"find that Greatgrandfather was an engineer or a proofreader, had an amazing eye for detail,"},{"startTime":1844.41,"endTime":1848.965,"body":"liked to eat the same lunch every day was socially just fine."},{"startTime":1849.825,"endTime":1855.095,"body":"And then there's aunt, so-and-So who was a bit of a hermit who had one"},{"startTime":1855.095,"endTime":1860.365,"body":"or two close friends, but really found social very difficult, but wasn't particularly rigid otherwise."},{"startTime":1861.105,"endTime":1865.119,"body":"So you can see different parts of what's come together in the autistic child in"},{"startTime":1865.119,"endTime":1866.725,"body":"different parts of the family tree."},{"startTime":1867.385,"endTime":1871.901,"body":"And in the same way when we look at the general population and we were"},{"startTime":1871.901,"endTime":1876.418,"body":"able to do this in the twins early development study, we found that, uh, while"},{"startTime":1876.418,"endTime":1880.935,"body":"there were more than expected by chance, children who had all three difficulties or differences,"},{"startTime":1880.935,"endTime":1883.645,"body":"there were lots of children who had only one."},{"startTime":1884.345,"endTime":1890.115,"body":"So there were around 3% of children who just had social difficulties as rated by"},{"startTime":1890.115,"endTime":1895.885,"body":"their parents, uh, 3% who had only communication difficulties, 4% who were a bit rigid."},{"startTime":1896.585,"endTime":1900.445,"body":"And these all defined as being in the top 5% compared to your peers."},{"startTime":1901.425,"endTime":1906.569,"body":"So the largest group are those who have just one area of difference or difficulty,"},{"startTime":1906.569,"endTime":1910.685,"body":"even though when we look at autism, we see everything coming together."},{"startTime":1911.945,"endTime":1917.904,"body":"And so we've also found with twin work that these different parts of what we"},{"startTime":1917.904,"endTime":1920.685,"body":"call autism actually have distinct genetic influences."},{"startTime":1921.145,"endTime":1927.205,"body":"So most of the genetic influence on social skills and difficulties is not overlapping with"},{"startTime":1927.205,"endTime":1931.245,"body":"the genetic influences on how rigid or flexible you are."},{"startTime":1933.505,"endTime":1939.712,"body":"And one of the reasons that that's helpful to know or propose a hypothesis is"},{"startTime":1939.712,"endTime":1945.919,"body":"that historically we've tried to look for one explanation at the psychological level to understand"},{"startTime":1945.919,"endTime":1950.885,"body":"all the different facets of how an autistic person understands the world."},{"startTime":1951.545,"endTime":1956.503,"body":"But I don't think we need to, because if the different parts of autism have"},{"startTime":1956.503,"endTime":1961.461,"body":"different origins genetically, then why can't the different facets of autism also have different origins"},{"startTime":1961.461,"endTime":1963.445,"body":"in the processes of the mind?"},{"startTime":1964.265,"endTime":1969.77,"body":"So very briefly, these are three different explanations for different parts of what we call"},{"startTime":1969.77,"endTime":1971.605,"body":"autism, even in one person."},{"startTime":1972.385,"endTime":1975.245,"body":"Um, and I'll just tell you very briefly about them in cases of interest."},{"startTime":1976.105,"endTime":1981.145,"body":"So the social differences in autism, which include, uh, not a lack of sociability, but"},{"startTime":1981.145,"endTime":1986.186,"body":"a difficulty sometimes in knowing whether somebody, for example, is joking or lying or being"},{"startTime":1986.186,"endTime":1991.227,"body":"sarcastic in knowing how to strike up a friendship, how to say the right thing,"},{"startTime":1991.227,"endTime":1996.268,"body":"how to not say the wrong thing, even if it happens to be the true"},{"startTime":1996.268,"endTime":1996.605,"body":"thing."},{"startTime":1997.215,"endTime":2003.342,"body":"Those social difficulties are well explained by a difficulty putting yourself in somebody else's shoes"},{"startTime":2003.342,"endTime":2009.469,"body":"a difficulty automatically tracking what somebody else is thinking and knowing, because we've known for"},{"startTime":2009.469,"endTime":2015.596,"body":"a long time that many autistic children neither tell lies nor understand that others might"},{"startTime":2015.596,"endTime":2016.005,"body":"lie."},{"startTime":2016.705,"endTime":2021.58,"body":"But telling lies only makes sense if you know that something you know, I might"},{"startTime":2021.58,"endTime":2025.805,"body":"not know, or that you can make me think something that isn't true."},{"startTime":2026.665,"endTime":2030.589,"body":"But if you don't understand that minds have different thoughts, if you can't track what"},{"startTime":2030.589,"endTime":2033.205,"body":"others are thinking, then that's not going to make sense."},{"startTime":2033.505,"endTime":2038.344,"body":"And that leaves some autistic people very vulnerable, uh, and also very honest, which of"},{"startTime":2038.344,"endTime":2040.925,"body":"course can be a, a, a wonderful asset."},{"startTime":2042.225,"endTime":2047.702,"body":"Um, then we have on the, on the more non-social side, we know that autism"},{"startTime":2047.702,"endTime":2052.085,"body":"is characterized not only by some difficulties, but also by some assets."},{"startTime":2052.705,"endTime":2057.804,"body":"And one aspect of, of skill in autism is an amazing eye for detail."},{"startTime":2058.145,"endTime":2062.245,"body":"Not every autistic person, but on average, most autistic people have a better eye for"},{"startTime":2062.245,"endTime":2063.885,"body":"detail than the rest of us."},{"startTime":2064.475,"endTime":2069.757,"body":"Sometimes that eye for detail makes it hard to get the big picture, to understand"},{"startTime":2069.757,"endTime":2075.041,"body":"the gist, but still, for example, in this task, which is the embedded figures test,"},{"startTime":2075.041,"endTime":2080.324,"body":"where you have to find the simple shape hidden in the colored, more complex shape."},{"startTime":2081.505,"endTime":2085.747,"body":"For most non-autistic people, that's difficult because we see the colored shape as a gal,"},{"startTime":2085.747,"endTime":2087.445,"body":"we see it as a whole."},{"startTime":2088.065,"endTime":2093.717,"body":"But autistic people often describe seeing things as parts, and therefore they can easily zoom"},{"startTime":2093.717,"endTime":2097.485,"body":"in on and see where that simple shape will be."},{"startTime":2098.945,"endTime":2103.445,"body":"And then another aspect of autism seems to be around difficulty with planning and coping"},{"startTime":2103.445,"endTime":2104.045,"body":"with change."},{"startTime":2104.905,"endTime":2107.605,"body":"And some of that might be about being very detailed."},{"startTime":2107.745,"endTime":2111.822,"body":"So even a small, what is to us, a small detailed change really, really matters"},{"startTime":2111.822,"endTime":2113.725,"body":"if that's what you're zoomed in on."},{"startTime":2114.225,"endTime":2120.2,"body":"But some of it's also probably to do with what's called executive dysfunction or difficulty"},{"startTime":2120.2,"endTime":2126.175,"body":"in those frontal lobe functions of planning, monitoring, being flexible in the face of change,"},{"startTime":2126.175,"endTime":2128.565,"body":"dealing with novelty and so on."},{"startTime":2128.985,"endTime":2131.845,"body":"And that's often what holds some autistic people back."},{"startTime":2131.945,"endTime":2137.354,"body":"So working in a university environment, we have many, many students who are autistic and"},{"startTime":2137.354,"endTime":2142.764,"body":"very, very smart, but sometimes they struggle when they come to university in organizing their"},{"startTime":2142.764,"endTime":2143.125,"body":"lives."},{"startTime":2143.585,"endTime":2147.765,"body":"And it's the organization that really, um, begins to be a problem for them."},{"startTime":2147.785,"endTime":2151.713,"body":"And the coping with change, the coping with the fact that that lecture actually is"},{"startTime":2151.713,"endTime":2155.641,"body":"happening somewhere different now and you weren't given any notice, and that can just throw"},{"startTime":2155.641,"endTime":2156.165,"body":"you completely."},{"startTime":2159.145,"endTime":2164.29,"body":"So another way in which autism has changed is from thinking of autism and studying"},{"startTime":2164.29,"endTime":2166.005,"body":"autism in its pure form."},{"startTime":2166.305,"endTime":2171.589,"body":"So there was a, a fashion for saying, well, we must only study autistic people"},{"startTime":2171.589,"endTime":2176.873,"body":"who don't have language problems, don't have intellectual disability, don't have mental health problems, because"},{"startTime":2176.873,"endTime":2181.805,"body":"then we're studying pure autism and recognizing now that pure autism is vanishingly rare."},{"startTime":2182.345,"endTime":2187.561,"body":"And Christopher Gilberg tends to say that pure autism won't come to the clinic because"},{"startTime":2187.561,"endTime":2192.777,"body":"if autism is, is the only, um, issue or the only characteristic, it's not a"},{"startTime":2192.777,"endTime":2193.125,"body":"problem."},{"startTime":2193.905,"endTime":2197.445,"body":"And you can find your niche and you can live very well with just autism."},{"startTime":2197.705,"endTime":2202.362,"body":"But unfortunately, just autism is very rare and most autistic people are battling with a"},{"startTime":2202.362,"endTime":2203.605,"body":"lot of other things."},{"startTime":2204.625,"endTime":2207.885,"body":"And it's those other things that make life hard to live, not the autism."},{"startTime":2208.265,"endTime":2214.048,"body":"And those other things include epilepsy and intellectual disability, sleep problems, sleep problems can be"},{"startTime":2214.048,"endTime":2215.205,"body":"an absolute killer."},{"startTime":2215.225,"endTime":2221.641,"body":"And yet a relatively easily treated for many autistic people, sensory sensitivities can be, uh,"},{"startTime":2221.641,"endTime":2222.925,"body":"very, very difficult."},{"startTime":2223.105,"endTime":2228.622,"body":"And that's one of the things in the workplace, um, thinking about that report today,"},{"startTime":2228.622,"endTime":2233.405,"body":"that what, where reasonable accommodations are needed, but anxiety and depression, very common."},{"startTime":2233.645,"endTime":2240.023,"body":"A DHD, uh, OCD, developmental coordination disorder or dyspraxia, those all very common in autism"},{"startTime":2240.023,"endTime":2246.402,"body":"and can make life difficult and even more important for us to recognize because that"},{"startTime":2246.402,"endTime":2252.781,"body":"lies with society to address stigma and bullying, being ostracized, being discriminated against are all"},{"startTime":2252.781,"endTime":2257.885,"body":"the things that make life hard for autistic people, not the autism."},{"startTime":2260.385,"endTime":2265.238,"body":"So we know that around 70 or 80% of children and adults on the autism"},{"startTime":2265.238,"endTime":2270.092,"body":"spectrum will have a diagnosed, uh, mental health condition, and many will have more than"},{"startTime":2270.092,"endTime":2273.005,"body":"one with anxiety and depression being among the highest."},{"startTime":2273.345,"endTime":2279.015,"body":"And we've, uh, learned in recent years tragically that suicide is elevated among autistic people,"},{"startTime":2279.015,"endTime":2284.685,"body":"particularly among women on the autism spectrum and women who don't have an intellectual disability."},{"startTime":2286.635,"endTime":2293.153,"body":"This is from our longitudinal study in again the twins, uh, early development study where"},{"startTime":2293.153,"endTime":2299.672,"body":"we, uh, asked parents about different sorts of difficulties, emotionals that might be anxiety and"},{"startTime":2299.672,"endTime":2301.845,"body":"depression, conduct problems, uh, hyperactivity."},{"startTime":2302.625,"endTime":2305.925,"body":"And we asked them at age four, seven, and 13."},{"startTime":2306.585,"endTime":2311.811,"body":"And the, in these diagrams, each horizontal line is one child, and if they're in"},{"startTime":2311.811,"endTime":2313.205,"body":"the green, they're okay."},{"startTime":2313.205,"endTime":2314.925,"body":"They don't have problems in any of these areas."},{"startTime":2315.465,"endTime":2319.005,"body":"And if they're in the orange, they've got at least one clinical level difficulty."},{"startTime":2320.145,"endTime":2323.693,"body":"And we have a comparison group drawn from Ted's where they don't have autism, and"},{"startTime":2323.693,"endTime":2327.005,"body":"you can see that most of those children are in the green at four."},{"startTime":2327.685,"endTime":2330.965,"body":"A few pick up, there's some difficulties at seven, some drop difficulties."},{"startTime":2331.425,"endTime":2336.445,"body":"And again, by 13, most do not have any parent reported difficulties."},{"startTime":2336.825,"endTime":2342.184,"body":"And then you can look at the autism group and at four, about 50% already"},{"startTime":2342.184,"endTime":2344.685,"body":"have difficulties in one of these areas."},{"startTime":2345.145,"endTime":2348.359,"body":"And as you go to age seven more, pick them up, a few drop them,"},{"startTime":2348.359,"endTime":2349.645,"body":"but many more pick them up."},{"startTime":2349.905,"endTime":2353.845,"body":"And again at age 13, so you can see the persistence."},{"startTime":2354.465,"endTime":2356.325,"body":"And below we've got the cot, twins."},{"startTime":2356.625,"endTime":2358.085,"body":"Now autism is highly genetic."},{"startTime":2358.185,"endTime":2362.085,"body":"So many cot, twins of autistic children are autistic themselves, but some are not."},{"startTime":2362.625,"endTime":2366.634,"body":"And when you look at the cot, twins, you have a perfect control for the"},{"startTime":2366.634,"endTime":2370.643,"body":"family environment for SES and those other kinds of things that of course we know"},{"startTime":2370.643,"endTime":2371.445,"body":"affect children's wellbeing."},{"startTime":2372.185,"endTime":2377.076,"body":"But here you can see that the non-autistic twins in those families where there's an"},{"startTime":2377.076,"endTime":2379.685,"body":"autistic twin are in generally in the green."},{"startTime":2382.105,"endTime":2383.885,"body":"And this is some work by Dr."},{"startTime":2383.885,"endTime":2388.743,"body":"Gavin Stewart, who I have to also thank for, uh, co-authoring the, um, the text,"},{"startTime":2388.743,"endTime":2393.601,"body":"the piece of writing, which will be on the Gresham College website to accompany this"},{"startTime":2393.601,"endTime":2393.925,"body":"lecture."},{"startTime":2394.665,"endTime":2400.674,"body":"And Gavin's been working very hard on aging and autism, and he's worked with, um,"},{"startTime":2400.674,"endTime":2406.684,"body":"a long-term, uh, aging study, which isn't about autism, but he is just about healthy"},{"startTime":2406.684,"endTime":2407.085,"body":"aging."},{"startTime":2407.305,"endTime":2411.001,"body":"If you, you're over the age of 50, you can sign up for protect, and"},{"startTime":2411.001,"endTime":2414.205,"body":"every year you can do cognitive tasks and answer questions about your wellbeing."},{"startTime":2415.425,"endTime":2418.921,"body":"And because we know that most autistic people over the age of 50 are not"},{"startTime":2418.921,"endTime":2422.418,"body":"diagnosed, we've given an autism trait measure, and we look at those who have high"},{"startTime":2422.418,"endTime":2422.885,"body":"autistic traits."},{"startTime":2423.985,"endTime":2430.06,"body":"And in this Venn diagram, the size of the circles shows the relative percentage of"},{"startTime":2430.06,"endTime":2436.135,"body":"people being affected by sleep problems in yellow, by depression in blue, by anxiety in"},{"startTime":2436.135,"endTime":2438.565,"body":"orange, and the overlap between those."},{"startTime":2439.345,"endTime":2444.098,"body":"And you can see that sleep problems are much more of a problem for the"},{"startTime":2444.098,"endTime":2448.851,"body":"high autism trait group compared to well-matched peers, uh, who aren't autistic and have low"},{"startTime":2448.851,"endTime":2449.485,"body":"autistic traits."},{"startTime":2449.985,"endTime":2454.873,"body":"Um, and the overlap of those of those sleep problems with mental health problems is"},{"startTime":2454.873,"endTime":2455.525,"body":"very significant."},{"startTime":2457.665,"endTime":2462.055,"body":"And I want to tell you briefly about, uh, one particular area of mental health"},{"startTime":2462.055,"endTime":2466.446,"body":"that we think is rather neglected for the autism spectrum, and it's important to, to"},{"startTime":2466.446,"endTime":2467.325,"body":"be thinking about."},{"startTime":2468.465,"endTime":2473.975,"body":"So with Freya Rumble, who is a clinical psychologist, we've been speculating for some time"},{"startTime":2473.975,"endTime":2479.485,"body":"now that autistic people might, on average be more vulnerable to developing post-traumatic stress disorder."},{"startTime":2480.785,"endTime":2485.856,"body":"And this is because firstly, we know that autistic people experience more adverse life events"},{"startTime":2485.856,"endTime":2490.928,"body":"than non-autistic people, bullying I've already mentioned, but also assault and other kinds of negative"},{"startTime":2490.928,"endTime":2491.605,"body":"life events."},{"startTime":2492.625,"endTime":2498.405,"body":"Uh, we also know that autistic people process information differently with an eye for detail."},{"startTime":2498.945,"endTime":2504.491,"body":"And one of the, um, individual differences in the general population that tends to determine"},{"startTime":2504.491,"endTime":2510.037,"body":"whether two individuals who've experienced a trauma traumatic event, which one will go on to"},{"startTime":2510.037,"endTime":2513.365,"body":"develop long-term PTSD symptoms and which one will not."},{"startTime":2514.385,"endTime":2520.31,"body":"One individual difference of relevance is how well you can weave your experiences into a"},{"startTime":2520.31,"endTime":2522.285,"body":"coherent story, a coherent narrative."},{"startTime":2522.785,"endTime":2528.14,"body":"And if you stay rather fragmented and detail focused, you are more likely to continue"},{"startTime":2528.14,"endTime":2529.925,"body":"to have symptoms of PTSD."},{"startTime":2530.265,"endTime":2535.525,"body":"So that detailed focus in autism might make them more vulnerable to develop PTSD symptoms."},{"startTime":2536.455,"endTime":2541.217,"body":"There are also a aspects of sensory processing that are important in PTSD, and I've"},{"startTime":2541.217,"endTime":2542.805,"body":"mentioned sensory sensitivities in autism."},{"startTime":2543.545,"endTime":2549.437,"body":"And lastly, um, how you cope with the natural early stages of flashbacks and so"},{"startTime":2549.437,"endTime":2553.365,"body":"on that maybe everyone would have after a traumatic event."},{"startTime":2553.475,"endTime":2559.272,"body":"Whether you use an avoidant coping style or a more adaptive coping style also determines"},{"startTime":2559.272,"endTime":2561.205,"body":"your likelihood of developing PTSD."},{"startTime":2561.345,"endTime":2565.53,"body":"And again, we thought that autistic people who sometimes show an avoidant coping style might"},{"startTime":2565.53,"endTime":2567.205,"body":"be more vulnerable for that reason."},{"startTime":2568.745,"endTime":2573.669,"body":"So in one study, which, uh, we did with autistic adults, we asked autistic adults"},{"startTime":2573.669,"endTime":2578.593,"body":"to take part if they felt something had happened to them that was negative and"},{"startTime":2578.593,"endTime":2582.205,"body":"that still remained with them, that they felt was a trauma."},{"startTime":2583.625,"endTime":2589.937,"body":"And, um, in this particular study, we had 59 who, who took part and who"},{"startTime":2589.937,"endTime":2593.725,"body":"reported to us a trauma of a traditional sort."},{"startTime":2594.065,"endTime":2599.721,"body":"And by that I mean it would qualify for PTSD diagnosis in the American system,"},{"startTime":2599.721,"endTime":2605.377,"body":"the DSM five, where there's a very narrow definition of trauma and it has to"},{"startTime":2605.377,"endTime":2611.033,"body":"involve either witnessing or being subject to something that is either a serious assault or"},{"startTime":2611.033,"endTime":2612.165,"body":"threat to life."},{"startTime":2613.345,"endTime":2619.037,"body":"So you can see here that, um, a, a large proportion in of the blue"},{"startTime":2619.037,"endTime":2624.73,"body":"slice of the pie are people reporting a physical assault, the orange slice of the"},{"startTime":2624.73,"endTime":2629.285,"body":"pipe, um, people are reporting sexual assault, um, and other qualifying traumas."},{"startTime":2630.305,"endTime":2635.125,"body":"And we gave these individuals a trauma symptom checklist, A-P-T-S-D checklist."},{"startTime":2635.635,"endTime":2637.165,"body":"It's not the same as a diagnosis."},{"startTime":2637.165,"endTime":2641.938,"body":"This was done mainly during covid, so it's done remotely, but it's a, a, a"},{"startTime":2641.938,"endTime":2644.485,"body":"valid instrument to measure your symptoms of PTSD."},{"startTime":2645.025,"endTime":2650.83,"body":"And we found that 45% of those autistic adults reported symptoms that were in the"},{"startTime":2650.83,"endTime":2651.605,"body":"clinical range."},{"startTime":2652.865,"endTime":2659.043,"body":"Now, that's a really high percentage in general population samples where they report having experienced"},{"startTime":2659.043,"endTime":2665.221,"body":"a traumatic event like a physical assault around 10% will go on to have persistent"},{"startTime":2665.221,"endTime":2666.045,"body":"PTSD symptoms."},{"startTime":2666.785,"endTime":2669.725,"body":"So much, much higher percentage here for the autistic people."},{"startTime":2670.505,"endTime":2674.911,"body":"But the reason that I showed you a picture of a bus when I started"},{"startTime":2674.911,"endTime":2679.317,"body":"talking about PTSD and autism is that one of the reasons I got interested in"},{"startTime":2679.317,"endTime":2683.724,"body":"this area was, uh, an autistic man telling me about his experience of taking the"},{"startTime":2683.724,"endTime":2688.13,"body":"bus to work every day, and then one day the bus having to take a"},{"startTime":2688.13,"endTime":2692.537,"body":"detour because of roadworks and him having to get off the bus in the middle"},{"startTime":2692.537,"endTime":2693.125,"body":"of nowhere."},{"startTime":2693.785,"endTime":2696.045,"body":"He didn't know whether it was a safe area of London or not."},{"startTime":2696.225,"endTime":2701.675,"body":"He didn't know how he was gonna get to work, and he was absolutely frightened"},{"startTime":2701.675,"endTime":2702.765,"body":"and, uh, distraught."},{"startTime":2703.425,"endTime":2707.167,"body":"And after that, not only would he not take that bus to work, he wouldn't"},{"startTime":2707.167,"endTime":2708.165,"body":"take any bus anywhere."},{"startTime":2708.465,"endTime":2712.822,"body":"And when he walked past his usual bus stop, he would start re-experiencing that fear"},{"startTime":2712.822,"endTime":2714.565,"body":"and have flashbacks of that event."},{"startTime":2715.505,"endTime":2721.315,"body":"Now, a bus detour would not count in DSM five as a trauma, but I"},{"startTime":2721.315,"endTime":2727.125,"body":"think it was clear that this man was experiencing trauma related, uh, mental health problems."},{"startTime":2727.905,"endTime":2733.455,"body":"So we were particularly interested in looking at whether autistic people are not only more"},{"startTime":2733.455,"endTime":2739.005,"body":"vulnerable to PST PTSD, but also develop those symptoms following unusual events that most people"},{"startTime":2739.005,"endTime":2740.485,"body":"might not find traumatic."},{"startTime":2741.865,"endTime":2747.476,"body":"And so this graph, this, uh, pie chart now shows you for the 59 autistic"},{"startTime":2747.476,"endTime":2751.965,"body":"adults who told us about a trauma that wouldn't fit DSM five."},{"startTime":2752.705,"endTime":2758.965,"body":"So, um, the, uh, large blue segment is bereavement, the yellow segment is bullying."},{"startTime":2759.705,"endTime":2765.77,"body":"Um, and the, um, the, there's a gray segment, which is, um, uh, difficult social"},{"startTime":2765.77,"endTime":2769.005,"body":"situations, having very negative experiences in social situations."},{"startTime":2769.505,"endTime":2774.685,"body":"Um, and the orange segment after the blue is their own mental health crises."},{"startTime":2776.185,"endTime":2782.605,"body":"Um, and of these people, again, 43% had symptoms of PTSD past threshold."},{"startTime":2783.225,"endTime":2790.125,"body":"So it doesn't seem to matter whether what you've experienced is, um, objectively life threatening."},{"startTime":2790.785,"endTime":2796.05,"body":"Um, if for you it's traumatic, then for autistic people, the rate of PTSD symptoms"},{"startTime":2796.05,"endTime":2797.805,"body":"seems to be alarmingly high."},{"startTime":2800.065,"endTime":2804.251,"body":"And one more point on, uh, autism and mental health, before I go to the,"},{"startTime":2804.251,"endTime":2806.485,"body":"the final change in the concept of autism."},{"startTime":2807.265,"endTime":2814.715,"body":"So this is, um, data from, um, Miriam Martini, uh, working in, uh, in Stockholm"},{"startTime":2814.715,"endTime":2816.205,"body":"using population registers."},{"startTime":2816.385,"endTime":2823.316,"body":"And this is data from young people between the ages of 16 and 25, um,"},{"startTime":2823.316,"endTime":2825.165,"body":"information about psychiatric hospitalization."},{"startTime":2825.785,"endTime":2829.085,"body":"And the, the bars are, uh, closest to me."},{"startTime":2829.105,"endTime":2835.217,"body":"The dark bar is autistic, um, boys and young men, then autistic girls and young"},{"startTime":2835.217,"endTime":2838.885,"body":"women, and then they're neurotypical peers, male and female."},{"startTime":2840.185,"endTime":2844.405,"body":"And you can see the alarmingly high rates of psychiatric hospitalization."},{"startTime":2845.265,"endTime":2851.242,"body":"And, uh, Miriam writes in the paper by as young as age 25 years, 22%"},{"startTime":2851.242,"endTime":2857.22,"body":"of autistic, uh, females and almost 11% of autistic males compared to less than 4%"},{"startTime":2857.22,"endTime":2861.205,"body":"of their neurotypical peers had been hospitalized for psychiatric difficulties."},{"startTime":2861.865,"endTime":2864.445,"body":"So really serious level of mental health burden."},{"startTime":2866.105,"endTime":2871.65,"body":"So the final change from, um, our understanding of autism is from thinking of autism"},{"startTime":2871.65,"endTime":2877.196,"body":"as a disorder from very much a medical model where we would think about, well,"},{"startTime":2877.196,"endTime":2879.045,"body":"what's wrong with the child?"},{"startTime":2879.065,"endTime":2885.397,"body":"Why does the child not understand the social world to the neurodiversity lens, to a"},{"startTime":2885.397,"endTime":2891.73,"body":"more social model where we understand that the difficulties in autism come about from a"},{"startTime":2891.73,"endTime":2898.062,"body":"mismatch between the autistic way of understanding the world and the neurotypical designed environment and"},{"startTime":2898.062,"endTime":2898.485,"body":"expectations."},{"startTime":2899.505,"endTime":2904.205,"body":"And so, um, instead of the rhetoric of the past and still sometimes in the"},{"startTime":2904.205,"endTime":2907.965,"body":"states or other countries, how would you save your son from autism?"},{"startTime":2908.795,"endTime":2911.965,"body":"Instead, we would have a, a much more neurodiversity lens."},{"startTime":2912.705,"endTime":2918.454,"body":"And like these autism, um, self-advocates insist that to talk about curing autism would be"},{"startTime":2918.454,"endTime":2924.203,"body":"as inappropriate now as it was inappropriate when psychiatrists used to talk about curing homosexuality,"},{"startTime":2924.203,"endTime":2929.952,"body":"for example, that autism is a different way of being in the world, is a"},{"startTime":2929.952,"endTime":2935.702,"body":"neurodivergent condition in the sense that it, it diverges from the average, but is just"},{"startTime":2935.702,"endTime":2940.685,"body":"as valuable and just as valid a way of being and encouraging that."},{"startTime":2940.945,"endTime":2945.952,"body":"Um, some, some employers, as we were hearing about on the news today, are specifically"},{"startTime":2945.952,"endTime":2950.959,"body":"employing autistic people for the many strengths they have, including integrity and a sense of"},{"startTime":2950.959,"endTime":2954.965,"body":"justice and eye for detail, persistence in a task, and so on."},{"startTime":2956.545,"endTime":2961.957,"body":"Um, and this is just to highlight, uh, some work by a colleague, uh, Dr."},{"startTime":2961.957,"endTime":2965.565,"body":"Rebecca Wood, looking at what an inclusive school really means."},{"startTime":2966.105,"endTime":2971.021,"body":"And for her, that means that it accepts the neurodivergence of the teachers and the"},{"startTime":2971.021,"endTime":2972.005,"body":"other school staff."},{"startTime":2972.665,"endTime":2974.765,"body":"So most of us would think, is a school inclusive?"},{"startTime":2975.115,"endTime":2977.725,"body":"Does it have a good attitude towards children?"},{"startTime":2978.185,"endTime":2982.885,"body":"Pupils who are autistic, have a DHD have dyslexia, but what about the teachers?"},{"startTime":2983.305,"endTime":2987.786,"body":"If the teachers don't feel comfortable to disclose their diagnosis, then it's not an inclusive"},{"startTime":2987.786,"endTime":2988.085,"body":"school."},{"startTime":2988.785,"endTime":2994.368,"body":"And of course there are now similar projects for autistic police, uh, workforce, autistic doctors,"},{"startTime":2994.368,"endTime":2995.485,"body":"and so on."},{"startTime":2997.545,"endTime":3003.257,"body":"So to conclude, uh, autism has changed from narrow to wide with a rise in"},{"startTime":3003.257,"endTime":3008.97,"body":"the diagnoses from rare to common, uh, although still underdiagnosed in some groups from childhood"},{"startTime":3008.97,"endTime":3014.682,"body":"to lifespan with much more research needed on aging from discreet to dimensional, and from"},{"startTime":3014.682,"endTime":3020.395,"body":"one thing to many from pure to complex, with a real emphasis now on understanding"},{"startTime":3020.395,"endTime":3024.965,"body":"and improving mental health autistic people and from disorder to a difference."},{"startTime":3025.465,"endTime":3027.805,"body":"And the challenge now is to hear all voices."},{"startTime":3028.025,"endTime":3032.407,"body":"The autistic voice is coming into research, but how do we hear the autistic voice"},{"startTime":3032.407,"endTime":3036.205,"body":"from people who have intellectual disability as well as being autistic, for example?"},{"startTime":3036.745,"endTime":3041.232,"body":"And really fascinating to think, looking forward, what are the implications for the future of"},{"startTime":3041.232,"endTime":3043.925,"body":"autism research and improving the lives of autistic people."},{"startTime":3044.335,"endTime":3045.165,"body":"Thank you very much."},{"startTime":3056.815,"endTime":3058.045,"body":"Thank you very much, Francesca."},{"startTime":3058.045,"endTime":3059.045,"body":"That's just stunning."},{"startTime":3059.545,"endTime":3064.331,"body":"And the, um, unsurprisingly, we have an awful lot of questions, so I'm gonna try"},{"startTime":3064.331,"endTime":3066.885,"body":"and group one or two of them together."},{"startTime":3067.545,"endTime":3071.201,"body":"Um, there are so many questions in fact that we are definitely not going to"},{"startTime":3071.201,"endTime":3074.858,"body":"be able to cover them today, so I will probably approach you and see if"},{"startTime":3074.858,"endTime":3078.515,"body":"we can perhaps do what we do sometimes and have a follow up podcast where"},{"startTime":3078.515,"endTime":3081.685,"body":"we can discuss the questions which we've not been able to get through."},{"startTime":3082.825,"endTime":3088.439,"body":"Um, there seems to be a strong correlation between those who identify as trans or"},{"startTime":3088.439,"endTime":3090.685,"body":"non-binary and who are also autism."},{"startTime":3091.195,"endTime":3092.805,"body":"Have you any thoughts of why that might be?"},{"startTime":3092.805,"endTime":3093.005,"body":"So,"},{"startTime":3093.425,"endTime":3097.883,"body":"So it's certainly true that, that among autistic people, there are many more who either"},{"startTime":3097.883,"endTime":3102.045,"body":"I, I identify, uh, with some, uh, gender identity other than the traditional binary."},{"startTime":3102.625,"endTime":3106.207,"body":"Um, and, uh, there seem to be more people who are trans as well and"},{"startTime":3106.207,"endTime":3106.685,"body":"vice versa."},{"startTime":3107.505,"endTime":3110.365,"body":"We don't really know why there's research going on in that area."},{"startTime":3110.365,"endTime":3114.045,"body":"There are, you can just imagine lots of theories at different levels."},{"startTime":3114.145,"endTime":3118.984,"body":"So some would say it's a sort of sociological theory that autistic people, uh, are"},{"startTime":3118.984,"endTime":3121.565,"body":"less conformist and more able to be themselves."},{"startTime":3122.225,"endTime":3126.362,"body":"Um, and then there are people, um, like Simon Baron Cohen who are interested in,"},{"startTime":3126.362,"endTime":3128.845,"body":"in sex hormones and might have a biological explanation."},{"startTime":3129.065,"endTime":3131.915,"body":"And I think at the moment we don't know, but it's, it's, uh, now a"},{"startTime":3131.915,"endTime":3132.485,"body":"hot topic, yes."},{"startTime":3133.315,"endTime":3133.605,"body":"Okay."},{"startTime":3133.665,"endTime":3135.205,"body":"And, uh, two which slightly overlap."},{"startTime":3135.425,"endTime":3143.285,"body":"Um, one is about the way in which the media generate stereotypical perceptions of autism."},{"startTime":3143.785,"endTime":3148.801,"body":"One particular question about do you think shows like love on the Spectrum are indirectly"},{"startTime":3148.801,"endTime":3149.805,"body":"fueling that stereotype?"},{"startTime":3150.145,"endTime":3152.365,"body":"And how might we as society respond to that?"},{"startTime":3152.985,"endTime":3156.93,"body":"Um, so I haven't seen that particular show, but I know that obviously in autism"},{"startTime":3156.93,"endTime":3158.245,"body":"is all over the media."},{"startTime":3158.945,"endTime":3161.365,"body":"Um, it is very difficult."},{"startTime":3161.365,"endTime":3166.54,"body":"I mean, one of the things that that, that, that we need to be aware"},{"startTime":3166.54,"endTime":3171.715,"body":"of is that, um, research is neglecting that part of the autism spectrum that has"},{"startTime":3171.715,"endTime":3172.405,"body":"intellectual disability."},{"startTime":3172.905,"endTime":3178.048,"body":"And there's a danger that we also neglect them when we have shows, uh, or,"},{"startTime":3178.048,"endTime":3183.192,"body":"or, uh, documentaries about autism because it's easier to talk to an autistic person who"},{"startTime":3183.192,"endTime":3186.965,"body":"can talk back, but that doesn't capture the experiences of everybody."},{"startTime":3187.225,"endTime":3192.543,"body":"And I think that some parents of children who have very high support needs and"},{"startTime":3192.543,"endTime":3197.862,"body":"on the autism spectrum feel quite worried or upset when maybe a celebrity has their"},{"startTime":3197.862,"endTime":3203.181,"body":"adult diagnoses and they want to say, well, but, but my child's autism is not"},{"startTime":3203.181,"endTime":3204.245,"body":"like your autism."},{"startTime":3204.255,"endTime":3206.525,"body":"Their challenge is not like your challenges."},{"startTime":3206.905,"endTime":3209.845,"body":"So I think it's really about trying to get all voices heard."},{"startTime":3209.925,"endTime":3215.015,"body":"I mean, clearly there are some TV programs including about neurotypical people that exploitative, um,"},{"startTime":3215.015,"endTime":3220.105,"body":"and certainly any program I've been involved with, it's, it's very, very important that, um,"},{"startTime":3220.105,"endTime":3225.195,"body":"autistic or the National Autistic Society, people who have autistic people's welfare at heart are"},{"startTime":3225.195,"endTime":3230.285,"body":"involved in making sure that that participants really know what they're participating in, for example."},{"startTime":3230.905,"endTime":3236.29,"body":"So here's clearly somebody from an academic background is saying, okay, you've now got a"},{"startTime":3236.29,"endTime":3238.085,"body":"grant of several million pounds."},{"startTime":3238.415,"endTime":3239.525,"body":"Where are you gonna put your money?"},{"startTime":3239.635,"endTime":3245.363,"body":"What would be your next big area of this really large number of overlapping Venn"},{"startTime":3245.363,"endTime":3249.565,"body":"diagrams where you think the biggest return on investment might be?"},{"startTime":3249.745,"endTime":3253.071,"body":"Yes, it's a, it's a really hard question and sadly I haven't had that problem"},{"startTime":3253.071,"endTime":3254.845,"body":"of being given that large amount of money."},{"startTime":3255.625,"endTime":3260.409,"body":"But I mean, I think that one really interesting area that's been under recognized our"},{"startTime":3260.409,"endTime":3261.685,"body":"motor difficulties in autism."},{"startTime":3262.465,"endTime":3267.614,"body":"Um, and that's not just sort of clumsiness or development of coordination disorder, but somewhat"},{"startTime":3267.614,"endTime":3272.763,"body":"people will describe that when they have a sort of shutdown, which can be something"},{"startTime":3272.763,"endTime":3277.912,"body":"like autistic burnout from exhaustion of coping and neurotypical world, or can be a more"},{"startTime":3277.912,"endTime":3283.061,"body":"short lived sort of shutdown meltdown, that they lose volition, they can't act, they can't"},{"startTime":3283.061,"endTime":3283.405,"body":"speak."},{"startTime":3284.105,"endTime":3289.981,"body":"And there's also very interesting, but very little research on catatonia of freezing, uh, among"},{"startTime":3289.981,"endTime":3290.765,"body":"autistic people."},{"startTime":3290.785,"endTime":3293.645,"body":"And I think that's been really under researched."},{"startTime":3293.905,"endTime":3298.157,"body":"So we've, we've woken up to sensory a bit, although there's still lots more research"},{"startTime":3298.157,"endTime":3298.725,"body":"needed there."},{"startTime":3298.945,"endTime":3303.193,"body":"But I think the motor part of the puzzle and in relation to that kind"},{"startTime":3303.193,"endTime":3307.441,"body":"of freedom of will and volition, um, I think that be is a fascinating future"},{"startTime":3307.441,"endTime":3307.725,"body":"area."},{"startTime":3308.515,"endTime":3314.052,"body":"There's a, um, a growing number of people asking about, um, an American charity like"},{"startTime":3314.052,"endTime":3319.59,"body":"autism speaks Mm-hmm, \u003caffirmative\u003e who, who are pushing the concept of cure in autism still"},{"startTime":3319.59,"endTime":3321.805,"body":"even after all of this work."},{"startTime":3321.825,"endTime":3322.045,"body":"Yes."},{"startTime":3322.345,"endTime":3326.061,"body":"Uh, how is, how is, how do you feel about that and do you think"},{"startTime":3326.061,"endTime":3326.805,"body":"it requires challenge?"},{"startTime":3327.945,"endTime":3333.351,"body":"So, um, so many years ago, um, the founder, one of the founders of Autism"},{"startTime":3333.351,"endTime":3338.757,"body":"Speaks, who was a grandfather of a autistic young boy with high support needs, um,"},{"startTime":3338.757,"endTime":3344.163,"body":"came to London and gave a, a, a talk where he talked about defeating autism"},{"startTime":3344.163,"endTime":3345.965,"body":"like he had defeated cancer."},{"startTime":3346.785,"endTime":3352.37,"body":"And that's clearly not acceptable in our views of autism and in our genuine acceptance"},{"startTime":3352.37,"endTime":3357.955,"body":"of, of neurodivergence, autism is not a cancer and autism isn't something you have, autism"},{"startTime":3357.955,"endTime":3359.445,"body":"is how you are."},{"startTime":3360.065,"endTime":3363.165,"body":"Um, and that's just as valid a way to be as anything else."},{"startTime":3363.505,"endTime":3365.645,"body":"So we certainly don't talk about curing autism."},{"startTime":3365.945,"endTime":3372.325,"body":"We talk about curing anxiety, curing depression, curing epilepsy, curing gut problems, curing sleep problems."},{"startTime":3372.345,"endTime":3374.805,"body":"All of these things would transform the lives of autistic people."},{"startTime":3375.065,"endTime":3377.365,"body":"But there's, we have no desire to change the autism."},{"startTime":3377.905,"endTime":3384.195,"body":"Um, often for parents when they're, they are, are sympathetic to the idea of a"},{"startTime":3384.195,"endTime":3390.486,"body":"cure, it's because their child has intellectual disability, maybe self-injurious behavior, maybe a lot of"},{"startTime":3390.486,"endTime":3391.325,"body":"other things."},{"startTime":3391.715,"endTime":3393.965,"body":"It's not the autism that's making their life hard."},{"startTime":3394.125,"endTime":3396.588,"body":"I would say it's those other things and we should look for ways to help"},{"startTime":3396.588,"endTime":3397.245,"body":"with those other things."},{"startTime":3398.175,"endTime":3398.885,"body":"Thank you so much."},{"startTime":3398.945,"endTime":3401.325,"body":"It was fascinating in every respect."},{"startTime":3401.905,"endTime":3408.655,"body":"Um, but given you've described so many different behaviors and, and a spectrum and autistic"},{"startTime":3408.655,"endTime":3415.405,"body":"traits, you are talking about such diversity, I wonder how easy or difficult it is"},{"startTime":3415.405,"endTime":3420.805,"body":"to make a diagnosis and what the procedure would be to diagnose?"},{"startTime":3421.705,"endTime":3425.257,"body":"That's a really interesting question, and it goes in some sense to the heart of"},{"startTime":3425.257,"endTime":3426.205,"body":"the complexity of autism."},{"startTime":3426.705,"endTime":3431.842,"body":"So on the one hand, autism can be, uh, one of the diagnoses that where,"},{"startTime":3431.842,"endTime":3436.98,"body":"where clinicians have the greatest agreement, and people will talk slightly flippantly about the receptionist"},{"startTime":3436.98,"endTime":3442.117,"body":"who works in the diagnostic clinic, being able to diagnose somebody as they come through"},{"startTime":3442.117,"endTime":3445.885,"body":"the door by how they're walking and how they greet them."},{"startTime":3446.075,"endTime":3451.605,"body":"Because autism in, its, in its most push typical form, is very, very recognizable."},{"startTime":3452.305,"endTime":3457.245,"body":"What's difficult is that when you then have overlays of camouflaging and learnt behaviors or"},{"startTime":3457.245,"endTime":3462.185,"body":"when you have a lot of intellectual disabilities so that the range of behaviors you"},{"startTime":3462.185,"endTime":3467.125,"body":"can see is not very great, um, or when you have additional complexities, so you"},{"startTime":3467.125,"endTime":3472.066,"body":"have autism and a lot of mental health difficulties, then it can be more difficult"},{"startTime":3472.066,"endTime":3472.725,"body":"to distinguish."},{"startTime":3473.845,"endTime":3476.405,"body":"Absolutely, there's a lot of heterogeneity within the spectrum."},{"startTime":3476.425,"endTime":3477.405,"body":"That's definitely true."},{"startTime":3477.985,"endTime":3483.066,"body":"But also remember that it can be that you start, uh, with the same 4-year-old"},{"startTime":3483.066,"endTime":3488.148,"body":"who is, um, you know, doesn't have much language is a bit aloof, repetitively lining"},{"startTime":3488.148,"endTime":3493.229,"body":"up toys, grows up to be the math professor who has a lot of language,"},{"startTime":3493.229,"endTime":3498.311,"body":"who has a lot of friends, but he tends to monologue about his own special"},{"startTime":3498.311,"endTime":3500.005,"body":"interests as I'm doing now."},{"startTime":3500.425,"endTime":3504.568,"body":"Um, and you know, the, the same person can transition through different parts of the"},{"startTime":3504.568,"endTime":3504.845,"body":"spectrum."},{"startTime":3505.505,"endTime":3509.255,"body":"So, and in that sense, we can say yes, they're all, they're all parts of"},{"startTime":3509.255,"endTime":3511.005,"body":"the same thing, if that makes sense."},{"startTime":3512.305,"endTime":3515.685,"body":"Um, I, I have a grandson who is severely autistic."},{"startTime":3515.785,"endTime":3518.245,"body":"Uh, he's, he's 19 now and has no speech."},{"startTime":3518.905,"endTime":3523.693,"body":"He, he's in the states and one, one of the, um, procedures that he's been"},{"startTime":3523.693,"endTime":3526.885,"body":"through is something called, I think it's applied behavioral analysis."},{"startTime":3526.885,"endTime":3527.125,"body":"Mm-Hmm."},{"startTime":3527.165,"endTime":3527.525,"body":"\u003caffirmative\u003e, does that make sense?"},{"startTime":3527.745,"endTime":3527.965,"body":"Yes."},{"startTime":3528.265,"endTime":3535.645,"body":"Um, but it, um, is had I think relatively little effect on, on his behavior."},{"startTime":3536.385,"endTime":3541.632,"body":"Um, and the, the, the other thing that, um, is perhaps interesting is that recently"},{"startTime":3541.632,"endTime":3546.879,"body":"he had some wisdom teeth removed under anesthetic and, um, be because it's difficult to"},{"startTime":3546.879,"endTime":3552.126,"body":"communicate with him and had him not to do things, he severely bit his lip,"},{"startTime":3552.126,"endTime":3554.925,"body":"uh, because it was anesthetized of course, yes."},{"startTime":3554.945,"endTime":3558.525,"body":"And, um, nearly, uh, went into plastic surgery."},{"startTime":3558.945,"endTime":3560.765,"body":"Um, would you have any comments on, uh,"},{"startTime":3561.035,"endTime":3561.765,"body":"This sort of thing?"},{"startTime":3562.275,"endTime":3562.565,"body":"Yeah."},{"startTime":3562.565,"endTime":3563.965,"body":"So that's very difficult, isn't it?"},{"startTime":3563.965,"endTime":3568.525,"body":"And, and I mean, communication is, without communication, life is so very, very difficult."},{"startTime":3569.105,"endTime":3574.48,"body":"Um, so applied behavioral analysis, a, BA for those in the audience who might not"},{"startTime":3574.48,"endTime":3579.855,"body":"be familiar with it, um, grew outta the sort of behaviorist tradition of, of response"},{"startTime":3579.855,"endTime":3582.005,"body":"and punishment to train an animal."},{"startTime":3582.785,"endTime":3587.253,"body":"So it it, it was used with the best intentions to help a child who"},{"startTime":3587.253,"endTime":3591.721,"body":"maybe was just running around the room to settle at a table to begin to"},{"startTime":3591.721,"endTime":3596.19,"body":"be able to learn something so the sitting at the table would be rewarded maybe"},{"startTime":3596.19,"endTime":3599.765,"body":"with a suite, um, and then other behaviors would also be rewarded."},{"startTime":3599.865,"endTime":3602.485,"body":"And in the old days, negative behaviors would be punished."},{"startTime":3603.275,"endTime":3604.445,"body":"That doesn't happen anymore."},{"startTime":3604.945,"endTime":3609.997,"body":"But, um, but there is a large body of thought, particularly in this country, and"},{"startTime":3609.997,"endTime":3613.365,"body":"particularly among autistic self-advocates, that a BA is not respectful."},{"startTime":3613.595,"endTime":3617.885,"body":"That we, that we, that it looks too much like the trainee of an animal."},{"startTime":3618.145,"endTime":3622.292,"body":"And it doesn't give people on the autism spectrum a choice in a sense about"},{"startTime":3622.292,"endTime":3622.845,"body":"their behaviors."},{"startTime":3624.005,"endTime":3627.698,"body":"I I do know parents where their child was just so much all around the"},{"startTime":3627.698,"endTime":3631.392,"body":"room that they needed to find some way that they would sit long enough to"},{"startTime":3631.392,"endTime":3631.885,"body":"learn something."},{"startTime":3632.465,"endTime":3635.685,"body":"And to be fair, most parents bribe their children at some point."},{"startTime":3636.105,"endTime":3641.885,"body":"But I think the level of, of, of mechanical teaching makes people feel uncomfortable."},{"startTime":3641.885,"endTime":3646.245,"body":"And some autistic people have said that they felt they felt damaged by that process."},{"startTime":3646.865,"endTime":3650.138,"body":"Um, but it is very hard to know how best to try and reach a"},{"startTime":3650.138,"endTime":3651.885,"body":"child who has very, very high support needs."},{"startTime":3652.425,"endTime":3659.906,"body":"Um, I think that there are more available alternative communication devices now with iPads and"},{"startTime":3659.906,"endTime":3660.405,"body":"things."},{"startTime":3660.405,"endTime":3665.565,"body":"There are more ways that you can let a child unlock communication of some sort."},{"startTime":3666.065,"endTime":3669.33,"body":"Um, and that's so important for the reasons that you've highlighted that, that we need"},{"startTime":3669.33,"endTime":3672.596,"body":"to be able to tell people what's going to happen and them to tell us"},{"startTime":3672.596,"endTime":3673.685,"body":"what's going on with them."},{"startTime":3673.985,"endTime":3679.297,"body":"And I would just take the opportunity to say, I'm sure it's not, may not"},{"startTime":3679.297,"endTime":3684.61,"body":"be relevant to your grandson, but for anybody else who has a child of whatever"},{"startTime":3684.61,"endTime":3689.922,"body":"age, um, with very little language, um, if their behavior changes, suddenly, if they seem"},{"startTime":3689.922,"endTime":3695.235,"body":"very distressed or violent or self-injurious, please check that they're not in pain because we've"},{"startTime":3695.235,"endTime":3699.485,"body":"only recently begun to realize that often that's a symptom of pain."},{"startTime":3700.385,"endTime":3705.819,"body":"Um, and because the autistic person can't tell us that, for example, they have absolute"},{"startTime":3705.819,"endTime":3709.805,"body":"crippling constipation, um, they will express it in some other way."},{"startTime":3709.805,"endTime":3712.886,"body":"And that might be like by lashing out, or it might be by by crying,"},{"startTime":3712.886,"endTime":3714.325,"body":"or it might be by biting themselves."},{"startTime":3714.665,"endTime":3718.707,"body":"So don't forget about pain, um, if somebody's behavior changes when they haven't got any"},{"startTime":3718.707,"endTime":3720.325,"body":"other way of, of telling you."},{"startTime":3720.785,"endTime":3722.405,"body":"But thank you very much for the example."},{"startTime":3722.665,"endTime":3725.929,"body":"I'm, I'm going to take just two more questions so that we can be quite"},{"startTime":3725.929,"endTime":3726.365,"body":"your next,"},{"startTime":3727.145,"endTime":3729.245,"body":"Um, hello, firstly."},{"startTime":3729.245,"endTime":3730.885,"body":"Thank you so, so very much."},{"startTime":3730.885,"endTime":3732.205,"body":"This is a wonderful, wonderful talk."},{"startTime":3732.625,"endTime":3737.38,"body":"Um, I was wondering on one of the slides, you briefly talked about, uh, Asperger's"},{"startTime":3737.38,"endTime":3738.965,"body":"becoming something in the nineties."},{"startTime":3739.485,"endTime":3743.569,"body":"I was wondering if you could talk a little bit about how that's developed from,"},{"startTime":3743.569,"endTime":3746.565,"body":"perhaps where that came from, um, and how that's seen now."},{"startTime":3746.585,"endTime":3748.805,"body":"And, you know, you're speaking about this wide spectrum."},{"startTime":3749.345,"endTime":3752.365,"body":"How is Asperger's now viewed in the wider spectrum?"},{"startTime":3752.685,"endTime":3756.408,"body":"I, personally, that was the diagnosis that I had, and I know that I've had"},{"startTime":3756.408,"endTime":3760.132,"body":"trouble communicating that with other people, that that's not something that's necessarily an appropriate, um,"},{"startTime":3760.132,"endTime":3761.125,"body":"way to do it."},{"startTime":3761.125,"endTime":3765.977,"body":"So I'm wondering how maybe in studies and clinicians, uh, are able to communicate that"},{"startTime":3765.977,"endTime":3770.829,"body":"in different ways and maybe how that also specifically applies to women and girls and,"},{"startTime":3770.829,"endTime":3775.681,"body":"and different, um, you know, more female concepts of special interests and how that translates"},{"startTime":3775.681,"endTime":3776.005,"body":"together."},{"startTime":3776.165,"endTime":3776.365,"body":"Sorry."},{"startTime":3776.365,"endTime":3776.845,"body":"Does does"},{"startTime":3776.845,"endTime":3777.245,"body":"That make sense?"},{"startTime":3777.425,"endTime":3777.645,"body":"Yes."},{"startTime":3777.645,"endTime":3777.845,"body":"Yes."},{"startTime":3777.845,"endTime":3778.125,"body":"Okay."},{"startTime":3778.345,"endTime":3780.974,"body":"So I I I'll give, try and give a short answer to capture some of"},{"startTime":3780.974,"endTime":3781.325,"body":"those things."},{"startTime":3781.665,"endTime":3787.524,"body":"So, so Asperger's, um, was introduced as a sort of experimental diagnosis, um, because, uh,"},{"startTime":3787.524,"endTime":3793.383,"body":"historically autism was so much associated with language problems and language delay, or even lack"},{"startTime":3793.383,"endTime":3794.165,"body":"of language."},{"startTime":3794.825,"endTime":3798.379,"body":"So when there were some children who didn't seem to have any language delay and"},{"startTime":3798.379,"endTime":3801.934,"body":"yet had all the other characters who were autism people at the time felt, we've"},{"startTime":3801.934,"endTime":3802.645,"body":"gotta study this."},{"startTime":3803.095,"endTime":3804.285,"body":"Maybe it's a whole different group."},{"startTime":3804.985,"endTime":3809.405,"body":"Um, the research that happened after that suggested that it wasn't a whole different group."},{"startTime":3809.745,"endTime":3811.485,"body":"It was part of the autism spectrum."},{"startTime":3812.105,"endTime":3816.245,"body":"Um, and not different from autistic people who maybe had a bit of language delay"},{"startTime":3816.245,"endTime":3819.005,"body":"but had good verbal in intelligence, you know, later on."},{"startTime":3819.785,"endTime":3824.565,"body":"So, um, so in the latest diagnostic system, it's folded into this bigger category of"},{"startTime":3824.565,"endTime":3829.345,"body":"autism spectrum disorder with the expectation that anybody who had an Asperger diagnosis would simply"},{"startTime":3829.345,"endTime":3834.125,"body":"be included in autism spectrum disorder, not have to go and get a new diagnosis."},{"startTime":3834.665,"endTime":3840.02,"body":"Uh, the other piece of the puzzle is that Hans Asperger, who of course was"},{"startTime":3840.02,"endTime":3845.375,"body":"working in, uh, Nazi dominated Vienna, wasn't a member of the Nazi party, unlike all"},{"startTime":3845.375,"endTime":3850.731,"body":"the rest of his department, but has it, there has been a question over whether"},{"startTime":3850.731,"endTime":3856.086,"body":"he was saving children or whether he was colluding with a process of eugenics for,"},{"startTime":3856.086,"endTime":3861.085,"body":"um, uh, um, for a handicapped children perceived to be handicapped at the time."},{"startTime":3861.625,"endTime":3864.995,"body":"So that's another reason why people are not so keen on naming a syndrome after"},{"startTime":3864.995,"endTime":3865.445,"body":"him anymore."},{"startTime":3865.785,"endTime":3869.403,"body":"Um, although I think the full story of his involvement is yet to be un"},{"startTime":3869.403,"endTime":3869.645,"body":"uncovered."},{"startTime":3870.445,"endTime":3877.011,"body":"I just wanted to know, in your estimation, to what extent do modern lifestyles, for"},{"startTime":3877.011,"endTime":3883.578,"body":"example, our largely sugar based diets and our tend tendency to spend a lot more"},{"startTime":3883.578,"endTime":3886.205,"body":"time online impact on autistic people?"},{"startTime":3886.645,"endTime":3891.845,"body":"'cause I, I've definitely found that definitely the, the, um, the online aspect, a lot"},{"startTime":3891.845,"endTime":3897.045,"body":"of autistic people spend a lot of time online and this kind of exacerbates, uh,"},{"startTime":3897.045,"endTime":3900.165,"body":"our difficulties with, uh, your communication and, and socializing."},{"startTime":3900.465,"endTime":3904.29,"body":"So just how does that, how do, how do these things impact in your estimation"},{"startTime":3904.29,"endTime":3905.565,"body":"on lives of autistic people?"},{"startTime":3905.775,"endTime":3906.325,"body":"Thank you."},{"startTime":3906.325,"endTime":3907.125,"body":"It's an interesting question."},{"startTime":3907.385,"endTime":3911.688,"body":"So just, I know it's not your question, but just to clarify, I don't think"},{"startTime":3911.688,"endTime":3914.845,"body":"that screen time could ever make somebody autistic nor could diet."},{"startTime":3915.385,"endTime":3919.549,"body":"Um, but your question isn't that, I know your question is for autistic people, is"},{"startTime":3919.549,"endTime":3922.325,"body":"the increase in screen time and so on more problematic?"},{"startTime":3923.085,"endTime":3925.285,"body":"I think, I don't think we have the research to know."},{"startTime":3925.745,"endTime":3929.754,"body":"Um, the research that's been done suggests that autistic people use, um, the electronic media"},{"startTime":3929.754,"endTime":3933.763,"body":"and so on in the same way for the same purposes, enjoyment and so on,"},{"startTime":3933.763,"endTime":3934.565,"body":"as non-autistic people."},{"startTime":3935.465,"endTime":3941.593,"body":"Um, and it was interesting talking to my autistic students under lockdown, some of whom"},{"startTime":3941.593,"endTime":3944.045,"body":"said they much preferred meeting online."},{"startTime":3944.345,"endTime":3947.045,"body":"It was much less stressful and they could control their environment."},{"startTime":3947.705,"endTime":3952.19,"body":"Um, whether, as you say, when you then have to do more face-to-face time, it"},{"startTime":3952.19,"endTime":3953.685,"body":"has it become more difficult."},{"startTime":3953.685,"endTime":3955.765,"body":"That's something I think we still need to study."},{"startTime":3956.145,"endTime":3960.245,"body":"But there's certainly lots and lots of benefits to the digital world for autistic people."},{"startTime":3960.505,"endTime":3964.776,"body":"One of the things I often think about is autistic people often are very, really"},{"startTime":3964.776,"endTime":3966.485,"body":"good at understanding how systems work."},{"startTime":3967.185,"endTime":3972.069,"body":"In the old days, if you to be an engineer, you had to be physically"},{"startTime":3972.069,"endTime":3975.325,"body":"a, a droid, then that was outta out of reach."},{"startTime":3975.625,"endTime":3981.198,"body":"But now when you can understand a system and do it all on screen wonderfully,"},{"startTime":3981.198,"endTime":3985.285,"body":"you've unlocked a beautiful mind that was perhaps had clumsy hands."},{"startTime":3985.745,"endTime":3988.957,"body":"So I think there are lots and lots of advantages, but you're right, we should"},{"startTime":3988.957,"endTime":3990.885,"body":"be careful about the downsides for, for, for everyone."},{"startTime":3991.875,"endTime":3995.803,"body":"Well, it's, it's been a privilege being exposed to a beautiful mind, I think today,"},{"startTime":3995.803,"endTime":3998.685,"body":"\u003claugh\u003e, it was, um, a absolute delight to hear you talk."},{"startTime":3998.685,"endTime":3999.525,"body":"It was a wonderful lecture."},{"startTime":3999.535,"endTime":4000.325,"body":"Thank you very much."},{"startTime":4000.465,"endTime":4002.525,"body":"Please join me in thanking professor."}]}