Ami Klin: A new way to diagnose autism
September 10, 2011
Early diagnosis of autism spectrum disorder can improve the lives of everyone affected, but the complex network of causes make it incredibly difficult to predict. At TEDxPeachtree, Ami Klin describes a new early detection method that uses eye-tracking technologies to gauge babies' social engagement skills and reliably measure their risk of developing autism.
(Filmed at TEDxPeachTree.)
- Autism researcher
Ami Klin is an award winning autism spectrum disorder researcher finding new avenues for early diagnosis. Full bio
Double-click the English subtitles below to play the video.
I always wanted to become
a walking laboratory of social engagement,
to resonate other people's feelings, thoughts,
intentions, motivations, in the act of being with them.
As a scientist, I always wanted to measure that resonance,
that sense of the other that happens so quickly,
in the blink of an eye.
We intuit other people's feelings.
We know the meaning of their actions
even before they happen.
We're always in this stance of being
the object of somebody else's subjectivity.
We do that all the time. We just can't shake it off.
It's so important that the very tools that we use
to understand ourselves, to understand
the world around them, is shaped by that stance.
We are social to the core.
So my journey in autism really started when I lived
in a residential unit for adults with autism.
Most of those individuals had spent most of their lives
in long-stay hospitals. This is a long time ago.
And for them, autism was devastating.
They had profound intellectual disabilities.
They didn't talk. But most of all,
they were extraordinarily isolated
from the world around them, from their environment
and from the people.
In fact, at the time, if you walked into a school
for individuals with autism, you'd hear a lot of noise,
plenty of commotion, actions, people doing things,
but they're always doing things by themselves.
So they may be looking at a light in the ceiling,
or they may be isolated in the corner,
or they might be engaged in these repetitive movements,
in self-stimulatory movements that led them nowhere.
Extremely, extremely isolated.
Well, now we know that autism
is this disruption, the disruption of this resonance
that I am telling you.
These are survival skills.
These are survival skills that we inherited
over many, many hundreds of thousands of years
You see, babies are born in a state of utter fragility.
Without the caregiver, they wouldn't survive, so it stands
to reason that nature would endow them with
these mechanisms of survival.
They orient to the caregiver.
From the first days and weeks of life,
babies prefer to hear human sounds rather than just
sounds in the environment.
They prefer to look at people rather than at things,
and even as they're looking at people,
they look at people's eyes, because
the eye is the window to the other person's experiences,
so much so that they even prefer to look at people who are
looking at them rather than people who are looking away.
Well, they orient to the caregiver.
The caregiver seeks the baby.
And it's out of this mutually reinforcing choreography
that a lot that is of importance to the emergence of mind,
the social mind, the social brain, depends on.
We always think about autism
as something that happens later on in life.
It doesn't. It begins with the beginning of life.
As babies engage with caregivers, they soon realize
that, well, there is something in between the ears
that is very important --
it's invisible, you can't see -- but is really critical,
and that thing is called attention.
And they learn soon enough, even before they can
utter one word that they can take that attention
and move somewhere in order to get things they want.
They also learn to follow other people's gaze,
because whatever people are looking at is
what they are thinking about.
And soon enough, they start to learn about the meaning
of things, because when somebody is looking at something
or somebody is pointing at something,
they're not just getting a directional cue,
they are getting the other person's meaning
of that thing, the attitude, and soon enough
they start building this body of meanings,
but meanings that were acquired within the realm
of social interaction.
Those are meanings that are acquired as part
of their shared experiences with others.
Well, this is a little 15-month-old little girl,
and she has autism.
And I am coming so close to her that I am maybe
two inches from her face, and she's quite oblivious to me.
Imagine if I did that to you,
and I came two inches from your face.
You'd do probably two things, wouldn't you?
You would recoil. You would call the police. (Laughter)
You would do something, because it's literally impossible
to penetrate somebody's physical space
and not get a reaction.
We do so, remember, intuitively, effortlessly.
This is our body wisdom. It's not something that is
mediated by our language. Our body just knows that,
and we've known that for a long time.
And this is not something that happens to humans only.
It happens to some of our phylatic cousins,
because if you're a monkey,
and you look at another monkey,
and that monkey has a higher hierarchy position than you,
and that is considered to be a signal or threat,
well, you are not going to be alive for long.
So something that in other species are survival mechanisms,
without them they wouldn't basically live,
we bring into the context of human beings,
and this is what we need to simply act, act socially.
Now, she is oblivious to me, and I am so close to her,
and you think, maybe she can see you,
maybe she can hear you.
Well, a few minutes later, she goes to the corner of
the room, and she finds a tiny little piece of candy, an M&M.
So I could not attract her attention,
but something, a thing, did.
Now, most of us make a big dichotomy
between the world of things and the world of people.
Now, for this girl, that division line is not so clear,
and the world of people is not attracting her
as much as we would like.
Now remember that we learn a great deal
by sharing experiences.
Now, what she is doing right now is that
her path of learning is diverging moment by moment
as she is isolating herself further and further.
So we feel sometimes that the brain is deterministic,
the brain determines who we are going to be.
But in fact the brain also becomes who we are,
and at the same time that her behaviors are taking away
from the realm of social interaction, this is what's happening
with her mind and this is what's happening with her brain.
Well, autism is the most strongly genetic condition
of all developmental disorders,
and it's a brain disorder.
It's a disorder that begins much prior to the time
that the child is born.
We now know that there is a very broad spectrum of autism.
There are those individuals who are profoundly
intellectually disabled, but there are those that are gifted.
There are those individuals who don't talk at all.
There are those individuals who talk too much.
There are those individuals that if you observe them
in their school, you see them running the periphery fence
of the school all day if you let them,
to those individuals who cannot stop coming to you
and trying to engage you repeatedly, relentlessly,
but often in an awkward fashion,
without that immediate resonance.
Well, this is much more prevalent than we thought at the time.
When I started in this field, we thought that there were
four individuals with autism per 10,000,
a very rare condition.
Well, now we know it's more like one in 100.
There are millions of individuals with autism all around us.
The societal cost of this condition is huge.
In the U.S. alone, maybe 35 to 80 billion dollars,
and you know what? Most of those funds are associated
with adolescents and particularly adults
who are severely disabled,
individuals who need wrap-around services, services
that are very, very intensive, and those services
can cost in excess of 60 to 80,000 dollars a year.
Those are individuals who did not benefit from early treatment,
because now we know that autism creates itself
as they diverge in that pathway of learning
that I mentioned to you.
Were we to be able to identify this condition
at an earlier point, and intervene and treat,
I can tell you, and this has been probably
something that has changed my life in the past 10 years,
this notion that we can absolutely attenuate
Also, we have a window of opportunity, because
the brain is malleable for just so long,
and that window of opportunity happens
in the first three years of life.
It's not that that window closes. It doesn't.
But it diminishes considerably.
And yet, the median age of diagnosis in this country
is still about five years,
and in disadvantaged populations,
the populations that don't have access to clinical services,
rural populations, minorities,
the age of diagnosis is later still,
which is almost as if I were to tell you that we are
condemning those communities to have individuals
with autism whose condition is going to be more severe.
So I feel that we have a bio-ethical imperative.
The science is there,
but no science is of relevance if it doesn't have an impact
on the community, and we just can't afford
that missed opportunity,
because children with autism become adults with autism,
and we feel that those things that we can do
for these children, for those families, early on,
will have lifetime consequences,
for the child, for the family, and for the community at large.
So this is our view of autism.
There are over a hundred genes that are associated
with autism. In fact, we believe that there are going to be
something between 300 and 600 genes associated with autism,
and genetic anomalies, much more than just genes.
And we actually have a bit of a question here,
because if there are so many different causes of autism,
how do you go from those liabilities
to the actual syndrome? Because people like myself,
when we walk into a playroom,
we recognize a child as having autism.
So how do you go from multiple causes
to a syndrome that has some homogeneity?
And the answer is, what lies in between,
which is development.
And in fact, we are very interested in those first
two years of life, because those liabilities
don't necessarily convert into autism.
Autism creates itself.
Were we to be able to intervene during those years of life,
we might attenuate for some, and God knows,
maybe even prevent for others.
So how do we do that?
How do we enter that feeling of resonance,
how do we enter another person's being?
I remember when I interacted with that 15-month-older,
that the thing that came to mind was,
"How do you come into her world?
Is she thinking about me? Is she thinking about others?"
Well, it's hard to do that, so we had to create
the technologies. We had to basically step inside a body.
We had to see the world through her eyes.
And so in the past many years we've been building
these new technologies that are based on eye tracking.
We can see moment by moment
what children are engaging with.
Well, this is my colleague Warren Jones, with whom
we've been building these methods, these studies,
for the past 12 years,
and you see there a happy five-month-older,
it's a five-month little boy who is going to watch things
that are brought from his world,
his mom, the caregiver, but also experiences
that he would have were he to be in his daycare.
What we want is to embrace that world
and bring it into our laboratory,
but in order for us to do that, we had to create
these very sophisticated measures,
measures of how people, how little babies,
how newborns, engage with the world,
moment by moment,
what is important, and what is not.
Well, we created those measures, and here,
what you see is what we call a funnel of attention.
You're watching a video.
Those frames are separated by about a second
through the eyes of 35 typically developing
and we freeze one frame,
and this is what the typical children are doing.
In this scan pass, in green here, are two-year-olds with autism.
So on that frame, the children who are typical
are watching this,
the emotion of expression of that little boy
as he's fighting a little bit with the little girl.
What are the children with autism doing?
They are focusing on the revolving door,
opening and shutting.
Well, I can tell you that this divergence
that you're seeing here
doesn't happen only in our five-minute experiment.
It happens moment by moment in their real lives,
and their minds are being formed,
and their brains are being specialized in something other
than what is happening with their typical peers.
Well, we took a construct from
our pediatrician friends,
the concept of growth charts.
You know, when you take a child to the pediatrician,
and so you have physical height, and weight.
Well we decided that we're going to create growth charts
of social engagement,
and we sought children from the time that they are born,
and what you see here on the x-axis is two, three, four,
five, six months and nine, until about the age of 24 months,
and this is the percent of their viewing time
that they are focusing on people's eyes,
and this is their growth chart.
They start over here, they love people's eyes,
and it remains quite stable.
It sort of goes up a little bit in those initial months.
Now, let's see what's happening with babies
who became autistic.
It's something very different.
It starts way up here, but then it's a free fall.
It's very much like they brought into this world the reflex
that orients them to people, but it has no traction.
It's almost as if that stimulus, you,
you're not exerting influence on what happens
as they navigate their daily lives.
Now, we thought that those data were so powerful
in a way, that we wanted to see what happened
in the first six months of life, because if you interact
with a two- and a three-month-older,
you'd be surprised by how social those babies are.
And what we see in the first six months of life
is that those two groups can be segregated very easily.
And using these kinds of measures, and many others,
what we found out is that our science could, in fact,
identify this condition early on.
We didn't have to wait for the behaviors of autism
to emerge in the second year of life.
If we measured things that are, evolutionarily,
highly conserved, and developmentally very early emerging,
things that are online from the first weeks of life,
we could push the detection of autism
all the way to those first months,
and that's what we are doing now.
Now, we can create the very best technologies
and the very best methods to identify the children,
but this would be for naught if we didn't have an impact
on what happens in their reality in the community.
Now we want those devices, of course,
to be deployed by those who are in the trenches,
our colleagues, the primary care physicians,
who see every child,
and we need to transform those technologies
into something that is going to add value to their practice,
because they have to see so many children.
And we want to do that universally
so that we don't miss any child,
but this would be immoral
if we also did not have an infrastructure for intervention,
We need to be able to work with the families,
to support the families, to manage those first years
with them. We need to be able to really go
from universal screening to universal access to treatment,
because those treatments are going to change
these children's and those families' lives.
Now, when we think about what we [can] do
in those first years,
I can tell you,
having been in this field for so long,
one feels really rejuvenated.
There is a sense that the science that one worked on
can actually have an impact on realities,
preventing, in fact, those experiences
that I really started in my journey in this field.
I thought at the time that this was an intractable condition.
No longer. We can do a great deal of things.
And the idea is not to cure autism.
That's not the idea.
What we want is to make sure
that those individuals with autism can be free from
the devastating consequences that come with it at times,
the profound intellectual disabilities, the lack of language,
the profound, profound isolation.
We feel that individuals with autism, in fact,
have a very special perspective on the world,
and we need diversity, and they can work extremely well
in some areas of strength:
predictable situations, situations that can be defined.
Because after all, they learn about the world almost like
about it, rather than learning how to function in it.
But this is a strength, if you're working, for example,
And there are those individuals who have incredible
We want them to be free of that.
We want that the next generations of individuals with autism
will be able not only to express their strengths
but to fulfill their promise.
Well thank you for listening to me. (Applause)
- Autism researcher
Ami Klin is an award winning autism spectrum disorder researcher finding new avenues for early diagnosis.Why you should listen
Born in Brazil to Holocaust survivors, Ami Klin is the Georgia Research Alliance Eminent Scholar Professor and Chief of the Division of Autism and Developmental Disabilities at Emory University School of Medicine, and Director of the Marcus Autism Center, a subsidiary of Children’s Healthcare of Atlanta. After studying psychology, political science and history at Hebrew University in Jerusalem, Klin received his PhD in Psychology at the University of London in 1988. He completed clinical and research post-doctoral fellowships at the Yale Child Study Center at the Yale University School of Medicine -- where he would direct the Autism Program as Harris Professor of Child Psychology & Psychiatry. He has written in over over 180 publications, including five books on the subject of Autism.
The original video is available on TED.com