TEDxPeachtree
Ami Klin: A new way to diagnose autism
阿米克林：診斷自閉症的新方法
Filmed:
Readability: 3.9
674,356 views
如果能夠早早診斷出泛自閉症，就能提升相關人等的生活品質。但由於成因複雜，泛自閉症的預測也就難上加難。阿米克林在 TEDxPeachtree 的演說中，描述了一種早期偵測的新方法：利用眼球追蹤技術來評估嬰兒是否具備社交技巧。這種技術能夠可靠地評估嬰兒是否有罹患自閉症的風險。
Ami Klin - Autism researcher
Ami Klin is an award winning autism spectrum disorder researcher finding new avenues for early diagnosis. Full bio
Ami Klin is an award winning autism spectrum disorder researcher finding new avenues for early diagnosis. Full bio
Double-click the English transcript below to play the video.
00:17
I always wanted to become
0
1119
1908
我總是想成為
00:18
a walking laboratory of social engagement,
1
3027
2840
人際交流的行動實驗室
00:21
to resonate other people's feelings, thoughts,
2
5867
4076
藉由和別人在一起
00:25
intentions, motivations, in the act of being with them.
3
9943
5056
來體會他們的感受、想法、意圖與動機
00:30
As a scientist, I always wanted to measure that resonance,
4
14999
5879
身為科學家，我總希望能度量這種人與人之間
00:36
that sense of the other that happens so quickly,
5
20879
2498
身為科學家，我總希望能度量這種人與人之間
00:39
in the blink of an eye.
6
23377
2305
瞬間即生的共鳴感
00:41
We intuit other people's feelings.
7
25682
2350
我們能自然領會別人的感受
00:43
We know the meaning of their actions
8
28032
987
甚至在他們行動以前
00:44
even before they happen.
9
29019
2940
就知道行動所代表的意義
00:47
We're always in this stance of being
10
31959
1898
無論何時
00:49
the object of somebody else's subjectivity.
11
33857
2971
我們總是某人主觀意識中的客體
00:52
We do that all the time. We just can't shake it off.
12
36828
3197
這是我們無法擺脫的一點
00:55
It's so important that the very tools that we use
13
40025
1651
這很重要
00:57
to understand ourselves, to understand
14
41676
2403
我們正是仰賴這一點
00:59
the world around them, is shaped by that stance.
15
44079
4147
來學會了解我們自己及周遭的世界
01:04
We are social to the core.
16
48226
3234
我們完完全全是社會動物
01:07
So my journey in autism really started when I lived
17
51460
2774
我對自閉症的了解是從我住進一個
01:10
in a residential unit for adults with autism.
18
54234
3577
為自閉症患者而設的成人之家中開始的
01:13
Most of those individuals had spent most of their lives
19
57811
3318
他們多數都在醫院裡度過大部分的人生
01:17
in long-stay hospitals. This is a long time ago.
20
61129
3892
這是很久以前的事了
01:20
And for them, autism was devastating.
21
65021
4282
對他們來說，自閉症是場災難
01:25
They had profound intellectual disabilities.
22
69303
3255
他們有嚴重的智力障礙、不說話
01:28
They didn't talk. But most of all,
23
72558
3302
更糟的是
01:31
they were extraordinarily isolated
24
75860
3830
他們極度封閉在自己的世界裡
01:35
from the world around them, from their environment
25
79690
3241
與周遭的環境隔絕
01:38
and from the people.
26
82931
2461
與他人隔絕
01:41
In fact, at the time, if you walked into a school
27
85392
2852
如果你走進一所當時的自閉症特教學校
01:44
for individuals with autism, you'd hear a lot of noise,
28
88244
4023
事實上你會聽到很多聲音
01:48
plenty of commotion, actions, people doing things,
29
92267
5463
喧鬧聲、人們做各種事情的聲音
01:53
but they're always doing things by themselves.
30
97730
3725
但他們總是各自做自己的事
01:57
So they may be looking at a light in the ceiling,
31
101455
4072
可能在看天花板上的燈
02:01
or they may be isolated in the corner,
32
105527
3409
可能獨自待在角落
02:04
or they might be engaged in these repetitive movements,
33
108936
3559
或反覆做一些無意義的動作
02:08
in self-stimulatory movements that led them nowhere.
34
112495
4201
來達到自我刺激的目的
02:12
Extremely, extremely isolated.
35
116696
3399
極度地封閉在自己的世界裡
02:15
Well, now we know that autism
36
120095
3593
如今我們知道
02:19
is this disruption, the disruption of this resonance
37
123688
3738
是自閉症使他們無法
02:23
that I am telling you.
38
127426
2344
與他人產生共鳴感
02:25
These are survival skills.
39
129770
1958
但這是生存本能
02:27
These are survival skills that we inherited
40
131728
2151
是經由數十萬年的演化
02:29
over many, many hundreds of thousands of years
41
133879
2554
所傳承下來的生存本能
02:32
of evolution.
42
136433
2286
所傳承下來的生存本能
02:34
You see, babies are born in a state of utter fragility.
43
138719
5314
你們都知道，新生兒是全然無助的
02:39
Without the caregiver, they wouldn't survive, so it stands
44
144033
2031
沒有人照顧便不能生存
02:41
to reason that nature would endow them with
45
146064
2383
所以大自然賦予他們
02:44
these mechanisms of survival.
46
148447
3233
這些生存的機制
02:47
They orient to the caregiver.
47
151680
2575
他們會追尋照顧他們的人
02:50
From the first days and weeks of life,
48
154255
3442
從出生後的幾天到幾周內
02:53
babies prefer to hear human sounds rather than just
49
157697
3486
嬰兒就偏好人聲
02:57
sounds in the environment.
50
161183
1945
而不是周遭的其他聲音
02:59
They prefer to look at people rather than at things,
51
163128
2010
他們偏好看著人而不是其他東西
03:01
and even as they're looking at people,
52
165138
2045
當他們對著人看時
03:03
they look at people's eyes, because
53
167183
2564
他們甚至會盯著人的眼睛看
03:05
the eye is the window to the other person's experiences,
54
169747
4349
因為眼睛是通往他人經驗的途徑
03:09
so much so that they even prefer to look at people who are
55
174096
2118
所以他們甚至會偏好盯著正在看他們的人
03:12
looking at them rather than people who are looking away.
56
176214
4311
而不是看著旁邊的人
03:16
Well, they orient to the caregiver.
57
180525
2606
他們追尋照顧他們的人
03:19
The caregiver seeks the baby.
58
183131
2327
照顧者則追尋著嬰兒
03:21
And it's out of this mutually reinforcing choreography
59
185458
3627
人的心智，尤其是社會性的心智
03:24
that a lot that is of importance to the emergence of mind,
60
189085
3819
就是在這如舞步般的過程中
03:28
the social mind, the social brain, depends on.
61
192904
4683
一來一往、逐漸成形
03:33
We always think about autism
62
197587
2681
我們總以為自閉症
03:36
as something that happens later on in life.
63
200268
5079
是出生成長後逐漸形成的
03:41
It doesn't. It begins with the beginning of life.
64
205347
5398
不是這樣的。它在出生時就發生了
03:46
As babies engage with caregivers, they soon realize
65
210745
4304
當嬰兒接觸到照顧他們的人
03:50
that, well, there is something in between the ears
66
215049
4207
他們很快就理解到，在兩耳間
03:55
that is very important --
67
219256
1410
有些非常重要的東西
03:56
it's invisible, you can't see -- but is really critical,
68
220666
4183
那是看不到、但非常重要的東西─
04:00
and that thing is called attention.
69
224849
1459
就是別人對他們的關注
04:02
And they learn soon enough, even before they can
70
226308
2830
在能夠開口說話前
04:05
utter one word that they can take that attention
71
229138
2680
他們就先學會藉由吸引別人的注意
04:07
and move somewhere in order to get things they want.
72
231818
5737
來得到自己想要的
04:13
They also learn to follow other people's gaze,
73
237555
3124
他們也學會跟隨別人的目光
04:16
because whatever people are looking at is
74
240679
2270
因為別人目光所及
04:18
what they are thinking about.
75
242949
3755
就是他們心中所想
04:22
And soon enough, they start to learn about the meaning
76
246704
2642
很快地，他們就開始學習事物的意義
04:25
of things, because when somebody is looking at something
77
249346
3425
因為當某人看著一樣東西
04:28
or somebody is pointing at something,
78
252771
2052
或是指著一樣東西
04:30
they're not just getting a directional cue,
79
254823
2929
那並不只代表了一個方向
04:33
they are getting the other person's meaning
80
257752
2558
也代表了這樣東西對這個人的意義
04:36
of that thing, the attitude, and soon enough
81
260310
3079
這個人對這樣東西的看法
04:39
they start building this body of meanings,
82
263389
4099
他們開始架構事物的意義
04:43
but meanings that were acquired within the realm
83
267488
2313
那些他們在跟別人互動的過程中
04:45
of social interaction.
84
269801
2401
所學習到的意義
04:48
Those are meanings that are acquired as part
85
272202
1841
這些都是從與他人共享的經驗中
04:49
of their shared experiences with others.
86
274043
3987
所學習到的
04:53
Well, this is a little 15-month-old little girl,
87
278030
6832
這是一個十五個月大
05:00
and she has autism.
88
284862
3732
患有自閉症的小女孩
05:04
And I am coming so close to her that I am maybe
89
288594
3422
我已經靠近到離她的臉只有五公分
05:07
two inches from her face, and she's quite oblivious to me.
90
292016
4249
她卻完全無視於我
05:12
Imagine if I did that to you,
91
296265
1358
想像一下我對你做同樣的事
05:13
and I came two inches from your face.
92
297623
1926
我向你靠近到離你的臉只有五公分
05:15
You'd do probably two things, wouldn't you?
93
299549
2106
你可能會有兩個反應
05:17
You would recoil. You would call the police. (Laughter)
94
301655
4112
你會向後退、或是叫警察（笑聲）
05:21
You would do something, because it's literally impossible
95
305767
2549
你一定會做點什麼
05:24
to penetrate somebody's physical space
96
308316
2576
因為侵犯到某人的空間而不引起任何反應
05:26
and not get a reaction.
97
310892
1355
實在是不太可能的事
05:28
We do so, remember, intuitively, effortlessly.
98
312247
3684
記住，這是我們不加思索的直覺反應
05:31
This is our body wisdom. It's not something that is
99
315931
1417
是我們身體自然的判斷
05:33
mediated by our language. Our body just knows that,
100
317348
4550
不需要言語作為媒介
05:37
and we've known that for a long time.
101
321898
2763
我們的身體本來就知道該這樣做
05:40
And this is not something that happens to humans only.
102
324661
2939
而這並不是人類獨有的
05:43
It happens to some of our phylatic cousins,
103
327600
3224
我們在演化上的遠親也是如此
05:46
because if you're a monkey,
104
330824
1994
因為如果你是隻猴子
05:48
and you look at another monkey,
105
332818
2096
你這樣看著另一隻地位比你高的猴子
05:50
and that monkey has a higher hierarchy position than you,
106
334914
4018
你這樣看著另一隻地位比你高的猴子
05:54
and that is considered to be a signal or threat,
107
338932
3553
而你的舉動被認為是一種暗示或威脅
05:58
well, you are not going to be alive for long.
108
342485
2880
你就活不久了
06:01
So something that in other species are survival mechanisms,
109
345365
4421
這對其他物種來說
06:05
without them they wouldn't basically live,
110
349786
3421
是不可或缺的生存本能
06:09
we bring into the context of human beings,
111
353207
2700
對人類而言
06:11
and this is what we need to simply act, act socially.
112
355907
4163
則是產生人際互動的基本條件
06:15
Now, she is oblivious to me, and I am so close to her,
113
360070
2903
好，我離她這麼近她還是無視於我
06:18
and you think, maybe she can see you,
114
362973
1998
你們可能會想
06:20
maybe she can hear you.
115
364971
1620
她也許看得見或聽得見我
06:22
Well, a few minutes later, she goes to the corner of
116
366591
2340
幾分鐘後她到房間的角落去了
06:24
the room, and she finds a tiny little piece of candy, an M&M.
117
368931
5599
找到一小顆M&M's巧克力
06:30
So I could not attract her attention,
118
374530
4870
所以我不能吸引她的注意
06:35
but something, a thing, did.
119
379400
2429
但是某樣東西卻可以
06:37
Now, most of us make a big dichotomy
120
381829
2642
好，我們多數人會用二分法來看這世界─
06:40
between the world of things and the world of people.
121
384471
4335
物品的世界、人的世界
06:44
Now, for this girl, that division line is not so clear,
122
388806
4591
但對這女孩來說，人與物的分別
06:49
and the world of people is not attracting her
123
393397
3130
不是那麼清楚，而人的世界
06:52
as much as we would like.
124
396527
1483
並不像我們所想的那樣吸引她
06:53
Now remember that we learn a great deal
125
398010
2034
要記住
06:55
by sharing experiences.
126
400044
2401
我們很多的學習都是從經驗分享而來
06:58
Now, what she is doing right now is that
127
402445
3171
現在在她身上發生的事是
07:01
her path of learning is diverging moment by moment
128
405616
4479
她的學習隨著她越來越封閉自己
07:05
as she is isolating herself further and further.
129
410095
3818
而逐漸走上不同的道路
07:09
So we feel sometimes that the brain is deterministic,
130
413913
2966
所以有時候我們會覺得
07:12
the brain determines who we are going to be.
131
416879
2522
大腦決定了我們會成為怎樣的人
07:15
But in fact the brain also becomes who we are,
132
419401
2840
但事實上我們也會影響大腦的發展
07:18
and at the same time that her behaviors are taking away
133
422241
4013
所以當她跟別人的互動越來越少
07:22
from the realm of social interaction, this is what's happening
134
426254
2883
在此同時
07:25
with her mind and this is what's happening with her brain.
135
429137
5392
這對她的心智及大腦都造成影響
07:30
Well, autism is the most strongly genetic condition
136
434529
5838
自閉症是所有發展障礙中
07:36
of all developmental disorders,
137
440367
3453
與基因關聯最強的一種
07:39
and it's a brain disorder.
138
443820
2875
它是一種腦部疾病
07:42
It's a disorder that begins much prior to the time
139
446695
2609
是一種早在出生前就發生的疾病
07:45
that the child is born.
140
449304
2866
是一種早在出生前就發生的疾病
07:48
We now know that there is a very broad spectrum of autism.
141
452170
3714
我們現在知道了
07:51
There are those individuals who are profoundly
142
455884
2512
自閉症會以很多不同樣貌顯現
07:54
intellectually disabled, but there are those that are gifted.
143
458396
2998
有些人有嚴重的智力障礙
07:57
There are those individuals who don't talk at all.
144
461394
2128
有些人則是有特殊的天份
07:59
There are those individuals who talk too much.
145
463522
2272
有些人完全不說話，有些人卻說個不停
08:01
There are those individuals that if you observe them
146
465794
2501
如果你到他們的學校去
08:04
in their school, you see them running the periphery fence
147
468295
3009
你可能會看到有些人若未經制止
08:07
of the school all day if you let them,
148
471304
2299
會繞著學校的圍籬跑個不停
08:09
to those individuals who cannot stop coming to you
149
473603
2358
有些人則會不斷試圖引起你的注意
08:11
and trying to engage you repeatedly, relentlessly,
150
475961
2005
有些人則會不斷試圖引起你的注意
08:13
but often in an awkward fashion,
151
477966
3931
但他們使用的方式通常讓人感到不舒服
08:17
without that immediate resonance.
152
481897
3775
也無法引起別人共鳴
08:21
Well, this is much more prevalent than we thought at the time.
153
485672
3932
這種狀況遠比我們當初想的要普遍
08:25
When I started in this field, we thought that there were
154
489604
1484
當我剛踏入這個領域時
08:26
four individuals with autism per 10,000,
155
491088
2853
我們認為每一萬人中約有四人患有自閉症
08:29
a very rare condition.
156
493941
2031
算是一種很罕見的疾病
08:31
Well, now we know it's more like one in 100.
157
495972
4033
現在我們知道大約每百人中就有一個
08:35
There are millions of individuals with autism all around us.
158
500005
5023
我們周遭有幾百萬的人患有自閉症
08:40
The societal cost of this condition is huge.
159
505028
3366
這種疾病的社會成本很大
08:44
In the U.S. alone, maybe 35 to 80 billion dollars,
160
508394
3163
只在美國，也許就要花上350億到800億美金
08:47
and you know what? Most of those funds are associated
161
511557
3307
而你們知道嗎？
08:50
with adolescents and particularly adults
162
514864
2180
絕大多數的經費都被用在
08:52
who are severely disabled,
163
517044
2161
青少年及有嚴重障礙的成人身上
08:55
individuals who need wrap-around services, services
164
519205
2139
他們需要非常密集的全方位服務
08:57
that are very, very intensive, and those services
165
521344
2726
他們需要非常密集的全方位服務
08:59
can cost in excess of 60 to 80,000 dollars a year.
166
524070
4269
每年就需要六到八萬美金以上的費用
09:04
Those are individuals who did not benefit from early treatment,
167
528339
3562
這些都是未從早期療育獲益的人
09:07
because now we know that autism creates itself
168
531901
4459
因為我們現在知道，當他們的學習
09:12
as they diverge in that pathway of learning
169
536360
2704
像我之前說的那樣走上另一條路時
09:14
that I mentioned to you.
170
539064
2136
自閉症的狀況就會越加惡化
09:17
Were we to be able to identify this condition
171
541200
2413
如果我們能做到早期發現
09:19
at an earlier point, and intervene and treat,
172
543613
4067
並且在早期就介入治療
09:23
I can tell you, and this has been probably
173
547680
1974
我告訴你們
09:25
something that has changed my life in the past 10 years,
174
549654
3380
我們絕對可以減輕自閉症的症狀
09:28
this notion that we can absolutely attenuate
175
553034
3731
這個想法在過去十年裡
09:32
this condition.
176
556765
2157
改變了我的人生
09:34
Also, we have a window of opportunity, because
177
558922
2379
但我們只有一小段時間可以採取行動
09:37
the brain is malleable for just so long,
178
561301
3136
因為大腦只在那一段時間裡有可塑性
09:40
and that window of opportunity happens
179
564437
1352
這段寶貴的時間是在三歲以前
09:41
in the first three years of life.
180
565789
1703
這段寶貴的時間是在三歲以前
09:43
It's not that that window closes. It doesn't.
181
567492
3398
並不是說在那之後就完全沒有機會了
09:46
But it diminishes considerably.
182
570890
3569
但是機會確實大大降低
09:50
And yet, the median age of diagnosis in this country
183
574459
3104
目前在美國自閉症得到確診的平均年齡
09:53
is still about five years,
184
577563
2151
一般還是在五歲
09:55
and in disadvantaged populations,
185
579714
2266
對於那些得不到臨床服務
09:57
the populations that don't have access to clinical services,
186
581980
3249
住在偏遠地區或
10:01
rural populations, minorities,
187
585229
3109
身為少數族裔的弱勢族群來說
10:04
the age of diagnosis is later still,
188
588338
2619
確診的年齡還要更晚
10:06
which is almost as if I were to tell you that we are
189
590957
2345
這幾乎像是我們對這些族群宣告
10:09
condemning those communities to have individuals
190
593302
2417
他們的自閉症患者
10:11
with autism whose condition is going to be more severe.
191
595719
4476
注定要陷入越來越嚴重的狀況
10:16
So I feel that we have a bio-ethical imperative.
192
600195
2973
就醫學倫理而言，我們有不可推卸的責任
10:19
The science is there,
193
603168
2857
我們已經有這些科學知識
10:21
but no science is of relevance if it doesn't have an impact
194
606025
3058
但如果它們不能為社會所用
10:24
on the community, and we just can't afford
195
609083
3658
它們就沒有多大用處
10:28
that missed opportunity,
196
612741
1964
而我們不能失去這樣的機會
10:30
because children with autism become adults with autism,
197
614705
3156
因為患有自閉症的兒童會長大成人
10:33
and we feel that those things that we can do
198
617861
4278
我們如果能夠及早盡我們所能
10:38
for these children, for those families, early on,
199
622139
2323
為他們及他們的家庭做點事
10:40
will have lifetime consequences,
200
624462
2394
對這些家庭或整個社會來說
10:42
for the child, for the family, and for the community at large.
201
626856
4096
都會有長遠的影響
10:46
So this is our view of autism.
202
630952
2720
這就是我們對自閉症的看法
10:49
There are over a hundred genes that are associated
203
633672
2866
跟自閉症有關的基因有上百個
10:52
with autism. In fact, we believe that there are going to be
204
636538
2126
事實上我們相信
10:54
something between 300 and 600 genes associated with autism,
205
638664
4504
可能有300到600個基因或基因異常
10:59
and genetic anomalies, much more than just genes.
206
643168
3671
與自閉症有關
11:02
And we actually have a bit of a question here,
207
646839
4591
問題來了
11:07
because if there are so many different causes of autism,
208
651430
3485
這麼多不同的不利因素
11:10
how do you go from those liabilities
209
654915
3015
到底是怎樣發展成自閉症的呢？
11:13
to the actual syndrome? Because people like myself,
210
657930
3000
因為當人們─ 好比我自己
11:16
when we walk into a playroom,
211
660930
2685
走入一間遊戲室時
11:19
we recognize a child as having autism.
212
663615
3220
我們可以分辨出一個孩子是不是有自閉症
11:22
So how do you go from multiple causes
213
666835
2143
到底為什麼這麼多不同成因
11:24
to a syndrome that has some homogeneity?
214
668978
3450
最後會導致這麼相似的症狀呢？
11:28
And the answer is, what lies in between,
215
672428
2577
原來答案在成因與呈現的症狀之間:
11:30
which is development.
216
675005
2655
也就是孩子的發育
11:33
And in fact, we are very interested in those first
217
677660
3116
事實上，我們對兩歲之前這段時間非常有興趣
11:36
two years of life, because those liabilities
218
680776
2739
因為這些不利因素並不必然發展成自閉症
11:39
don't necessarily convert into autism.
219
683515
2754
因為這些不利因素並不必然發展成自閉症
11:42
Autism creates itself.
220
686269
2496
自閉症是自行形成
11:44
Were we to be able to intervene during those years of life,
221
688765
4849
如果我們能在兩歲之前就介入
11:49
we might attenuate for some, and God knows,
222
693614
2503
我們也許可以減輕一些孩子的症狀
11:52
maybe even prevent for others.
223
696117
3636
誰知道，我們說不定甚至可以預防它的發生
11:55
So how do we do that?
224
699753
2084
但我們要怎麼做呢？
11:57
How do we enter that feeling of resonance,
225
701837
2916
我們要怎麼創造共鳴感？
12:00
how do we enter another person's being?
226
704753
4025
又要怎麼進入另一個人的世界呢？
12:04
I remember when I interacted with that 15-month-older,
227
708778
3498
我記得在我跟那十五個月大的女孩互動時
12:08
that the thing that came to mind was,
228
712276
2162
我心裡在想
12:10
"How do you come into her world?
229
714438
2515
「要怎麼進入她的世界呢？」
12:12
Is she thinking about me? Is she thinking about others?"
230
716953
4280
「她在想著我嗎？還是想著別人？」
12:17
Well, it's hard to do that, so we had to create
231
721233
4344
嗯，這有點難做到
12:21
the technologies. We had to basically step inside a body.
232
725577
3479
所以我們必須創造這樣的技術
12:24
We had to see the world through her eyes.
233
729056
3929
好透過她的眼睛來看這個世界
12:28
And so in the past many years we've been building
234
732985
3039
所以過去幾年中我們都在發展
12:31
these new technologies that are based on eye tracking.
235
736024
3633
這種以眼球追蹤為基礎的新技術
12:35
We can see moment by moment
236
739657
2518
我們可以每時每刻地看到
12:38
what children are engaging with.
237
742175
3281
什麼吸引了孩子的注意
12:41
Well, this is my colleague Warren Jones, with whom
238
745456
2719
這是我同事瓦倫 ‧ 瓊斯
12:44
we've been building these methods, these studies,
239
748175
2977
在過去十二年中
12:47
for the past 12 years,
240
751152
1991
我們一起做研究、發展這些方法
12:49
and you see there a happy five-month-older,
241
753143
2720
這是一個快樂的男孩
12:51
it's a five-month little boy who is going to watch things
242
755863
5823
五個月大
12:57
that are brought from his world,
243
761686
2823
正要用眼睛去探索這個世界
13:00
his mom, the caregiver, but also experiences
244
764509
2579
看看他媽媽、照顧他的人
13:02
that he would have were he to be in his daycare.
245
767088
4432
還有其他在托兒所裡可能看見的事物
13:07
What we want is to embrace that world
246
771520
2632
我們想要做的是把他所經驗到的世界
13:10
and bring it into our laboratory,
247
774152
1329
帶進我們的實驗室
13:11
but in order for us to do that, we had to create
248
775481
3122
但要做到這點
13:14
these very sophisticated measures,
249
778603
3250
我們必須要能夠精密地測量
13:17
measures of how people, how little babies,
250
781853
3427
人們以及嬰幼兒
13:21
how newborns, engage with the world,
251
785280
2983
在每時每刻中是怎樣與這個世界互動
13:24
moment by moment,
252
788263
1627
什麼對他們來說是重要的
13:25
what is important, and what is not.
253
789890
3273
什麼又是不重要的
13:29
Well, we created those measures, and here,
254
793163
2941
我們發展出了一些評量方法
13:32
what you see is what we call a funnel of attention.
255
796104
3399
這裡看到的是注意力的漏斗模型
13:35
You're watching a video.
256
799503
2333
你們看到的是一段影片的紀錄
13:37
Those frames are separated by about a second
257
801836
2658
每個影像的間距大概是一秒鐘
13:40
through the eyes of 35 typically developing
258
804494
2768
這是35個正常發展的兩歲幼兒
13:43
two-year-olds,
259
807262
1282
眼中所看到的世界
13:44
and we freeze one frame,
260
808544
2975
我們現在停在其中一刻
13:47
and this is what the typical children are doing.
261
811519
3501
這是正常發展的兩歲幼兒在做的事
13:50
In this scan pass, in green here, are two-year-olds with autism.
262
815020
4441
綠色的這些則是有自閉症的孩子做的事
13:55
So on that frame, the children who are typical
263
819461
3623
所以在那一刻
13:58
are watching this,
264
823084
2955
正常的孩子在看這個
14:01
the emotion of expression of that little boy
265
826039
2549
一個小男孩在跟一個小女孩吵架
14:04
as he's fighting a little bit with the little girl.
266
828588
2910
所表現出的情緒反應
14:07
What are the children with autism doing?
267
831498
2060
有自閉症的孩子又在做些什麼呢？
14:09
They are focusing on the revolving door,
268
833558
3445
他們專心地看著旋轉門開開關關
14:12
opening and shutting.
269
837003
2091
他們專心地看著旋轉門開開關關
14:14
Well, I can tell you that this divergence
270
839094
2452
我可以告訴你們
14:17
that you're seeing here
271
841546
869
你們所看到的這些差異
14:18
doesn't happen only in our five-minute experiment.
272
842415
3190
並不只發生在我們進行實驗的五分鐘裡
14:21
It happens moment by moment in their real lives,
273
845605
3401
他們真實生活裡的每時每刻都是這樣的
14:24
and their minds are being formed,
274
849006
2720
而他們的心智隨之成形
14:27
and their brains are being specialized in something other
275
851726
3080
他們的大腦也以
14:30
than what is happening with their typical peers.
276
854806
3779
與其他孩子不同的方式成長
14:34
Well, we took a construct from
277
858585
3187
我們從當小兒科醫生的朋友處
14:37
our pediatrician friends,
278
861772
3194
我們從當小兒科醫生的朋友處
14:40
the concept of growth charts.
279
864966
1927
借用了生長曲線圖的概念
14:42
You know, when you take a child to the pediatrician,
280
866893
1969
當你帶小孩去看小兒科醫生時
14:44
and so you have physical height, and weight.
281
868862
4204
你可以由此得知他的身高體重
14:48
Well we decided that we're going to create growth charts
282
873066
2829
所以我們決定要做出
14:51
of social engagement,
283
875895
2459
社交發展的曲線圖來
14:54
and we sought children from the time that they are born,
284
878354
2801
我們徵求新生兒來參與研究
14:57
and what you see here on the x-axis is two, three, four,
285
881155
5829
在這X軸上是以月來看
15:02
five, six months and nine, until about the age of 24 months,
286
886984
3840
從兩個月到24個月
15:06
and this is the percent of their viewing time
287
890824
2731
這是他們盯著人眼看的時間百分比
15:09
that they are focusing on people's eyes,
288
893555
1696
這是他們盯著人眼看的時間百分比
15:11
and this is their growth chart.
289
895251
2360
這就是他們的發展曲線圖
15:13
They start over here, they love people's eyes,
290
897611
3030
他們一開始就喜歡看著別人的眼睛
15:16
and it remains quite stable.
291
900641
2454
這點一直沒有改變
15:18
It sort of goes up a little bit in those initial months.
292
903095
3926
在最初的幾個月中它還上升了一點
15:22
Now, let's see what's happening with babies
293
907021
2294
現在讓我們看看
15:25
who became autistic.
294
909315
2508
後來被診斷出自閉症的孩子的發展曲線
15:27
It's something very different.
295
911823
2205
它看起來就很不一樣了
15:29
It starts way up here, but then it's a free fall.
296
914028
3790
它一開始在上面這邊，再來就一直下降
15:33
It's very much like they brought into this world the reflex
297
917818
3419
就像他們生來具有追尋他人的本能
15:37
that orients them to people, but it has no traction.
298
921237
3931
但這本能無法持續下去
15:41
It's almost as if that stimulus, you,
299
925168
3070
這幾乎像是「你」作為一個外界刺激
15:44
you're not exerting influence on what happens
300
928238
2901
在他們探索日常生活的過程中
15:47
as they navigate their daily lives.
301
931139
3891
無足輕重
15:50
Now, we thought that those data were so powerful
302
935030
6022
這些資料讓我們很想看看
15:56
in a way, that we wanted to see what happened
303
941052
3008
出生後六個月的期間發生了什麼事
15:59
in the first six months of life, because if you interact
304
944060
3393
因為如果你試著跟兩、三個月大的嬰兒互動
16:03
with a two- and a three-month-older,
305
947453
1337
因為如果你試著跟兩、三個月大的嬰兒互動
16:04
you'd be surprised by how social those babies are.
306
948790
4552
你會訝異他們是多麼善於與人接觸
16:09
And what we see in the first six months of life
307
953342
2607
我們在這頭六個月中所看到的是
16:11
is that those two groups can be segregated very easily.
308
955949
6138
這兩組嬰兒有非常明顯的分別
16:17
And using these kinds of measures, and many others,
309
962087
2874
運用這些或者其他各類的測量方法
16:20
what we found out is that our science could, in fact,
310
964961
4016
我們發現現代科學事實上可以做到
16:24
identify this condition early on.
311
968977
2641
早期發現這些狀況
16:27
We didn't have to wait for the behaviors of autism
312
971618
2904
我們不用等到兩歲來看
16:30
to emerge in the second year of life.
313
974522
3148
自閉症的行為是否出現
16:33
If we measured things that are, evolutionarily,
314
977670
3262
如果我們測量那些演化上保存下來的
16:36
highly conserved, and developmentally very early emerging,
315
980932
4122
在早期發展就會出現的東西
16:40
things that are online from the first weeks of life,
316
985054
2701
那些在出生後頭幾周就應該發生的事
16:43
we could push the detection of autism
317
987755
1862
我們就能把診斷自閉症的時間
16:45
all the way to those first months,
318
989617
2464
提早到出生後頭幾個月
16:47
and that's what we are doing now.
319
992081
4141
這就是我們現在在做的
16:52
Now, we can create the very best technologies
320
996222
3068
是的，我們可以發展出最好的科技
16:55
and the very best methods to identify the children,
321
999290
3605
最好的方法來找出這些孩子
16:58
but this would be for naught if we didn't have an impact
322
1002895
3143
但如果我們不能改變他們所處的現實環境
17:01
on what happens in their reality in the community.
323
1006038
3642
這些都是徒勞無功
17:05
Now we want those devices, of course,
324
1009680
2306
當然我們會希望這些工具
17:07
to be deployed by those who are in the trenches,
325
1011986
2853
能被送到那些第一線工作人員的手中
17:10
our colleagues, the primary care physicians,
326
1014839
2523
我們的同業
17:13
who see every child,
327
1017362
2705
還有那些負責替孩子們看診的醫生
17:15
and we need to transform those technologies
328
1020067
2143
我們必須要把這些科技轉變成
17:18
into something that is going to add value to their practice,
329
1022210
3105
能在實務上發揮價值的東西
17:21
because they have to see so many children.
330
1025315
2205
因為他們必須面對很多的孩子
17:23
And we want to do that universally
331
1027520
2074
我們希望把它變成一個普遍性的措施
17:25
so that we don't miss any child,
332
1029594
2133
不要漏失任何一個孩子
17:27
but this would be immoral
333
1031727
2453
但如果我們沒有介入及治療的配套措施
17:30
if we also did not have an infrastructure for intervention,
334
1034180
4901
但如果我們沒有介入及治療的配套措施
17:34
for treatment.
335
1039081
1247
這就會是不道德的
17:36
We need to be able to work with the families,
336
1040328
2536
我們必須要和這些家庭一起合作
17:38
to support the families, to manage those first years
337
1042864
3415
去支持他們度過頭幾年的時間
17:42
with them. We need to be able to really go
338
1046279
3912
我們必須從普遍性的篩選
17:46
from universal screening to universal access to treatment,
339
1050191
4157
做到普遍性的治療
17:50
because those treatments are going to change
340
1054348
3103
因為這些治療將會改變這些孩子
17:53
these children's and those families' lives.
341
1057451
3579
以及他們家人的人生
17:56
Now, when we think about what we [can] do
342
1061030
4257
一想到在這生命的頭幾年中
18:01
in those first years,
343
1065287
3223
我們能夠做些什麼
18:04
I can tell you,
344
1068510
2400
我告訴你
18:06
having been in this field for so long,
345
1070910
2827
即使在這領域工作了這麼久
18:09
one feels really rejuvenated.
346
1073737
3095
我還是感到充滿了幹勁
18:12
There is a sense that the science that one worked on
347
1076832
3832
覺得我所鑽研的科學
18:16
can actually have an impact on realities,
348
1080664
3707
能夠真正有所貢獻
18:20
preventing, in fact, those experiences
349
1084371
2895
讓其他人不會再有
18:23
that I really started in my journey in this field.
350
1087266
4002
我初踏入這領域時的那種經驗
18:27
I thought at the time that this was an intractable condition.
351
1091268
3192
那時我以為這是沒法治療的症狀
18:30
No longer. We can do a great deal of things.
352
1094460
3886
不再是這樣了，我們有很多事可以做
18:34
And the idea is not to cure autism.
353
1098346
2737
但重點並不在治癒自閉症
18:36
That's not the idea.
354
1101083
2600
不是的
18:39
What we want is to make sure
355
1103683
2206
我們是想讓那些患有自閉症的人
18:41
that those individuals with autism can be free from
356
1105889
2576
可以不必承受它的嚴重後果─
18:44
the devastating consequences that come with it at times,
357
1108465
4230
可以不必承受它的嚴重後果─
18:48
the profound intellectual disabilities, the lack of language,
358
1112695
2874
嚴重的智力障礙、語言發展的缺乏
18:51
the profound, profound isolation.
359
1115569
3669
以及全然地封閉
18:55
We feel that individuals with autism, in fact,
360
1119238
2267
我們認為自閉症患者
18:57
have a very special perspective on the world,
361
1121505
2795
事實上擁有很特別的世界觀
19:00
and we need diversity, and they can work extremely well
362
1124300
3423
我們的社會需要多元性
19:03
in some areas of strength:
363
1127723
2367
而他們可以在穩定、明確的狀況下
19:05
predictable situations, situations that can be defined.
364
1130090
3403
發揮他們的長處
19:09
Because after all, they learn about the world almost like
365
1133493
3009
畢竟他們專注於了解世界本來的面貌
19:12
about it, rather than learning how to function in it.
366
1136502
4701
而不是學習如何生活其中
19:17
But this is a strength, if you're working, for example,
367
1141203
2798
如果你在科技業工作
19:19
in technology.
368
1144001
2080
這就是項長處
19:21
And there are those individuals who have incredible
369
1146081
2273
另外還有一些人
19:24
artistic abilities.
370
1148354
1425
他們擁有非凡的藝術才能
19:25
We want them to be free of that.
371
1149779
1920
我們希望他們可以不受自閉症所限
19:27
We want that the next generations of individuals with autism
372
1151699
3385
我們想讓未來的自閉症患者
19:30
will be able not only to express their strengths
373
1155084
3155
不但可以發揮他們的長處
19:34
but to fulfill their promise.
374
1158239
2222
也可以達成他們的夢想
19:36
Well thank you for listening to me. (Applause)
375
1160461
3569
謝謝你們來聽我的演講（掌聲）
ABOUT THE SPEAKER
Ami Klin - Autism researcherAmi 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.
Ami Klin | Speaker | TED.com