The Autistic Brain: Thinking Across the Spectrum (13 page)

It doesn’t cost anything to try on sunglasses. You’ve got nothing to lose and everything to gain. I know a four-year-old girl who put on a pair of pink sunglasses that her parents had bought at Disneyland, and she went from being able to tolerate five minutes at Walmart to being able to handle an hour. It makes a big difference for parents if they can take a child shopping!

Auditory-Processing Problems

Over the years I’ve identified four auditory-processing problems as the most common.

• Language input. One type of language-input problem is not being able to hear hard-consonant sounds. When I was a child, I had difficulty differentiating hard-consonant sounds. To me,
  cat, hat,
  and
  pat
  sounded the same, because those consonants are quick. They’re spoken fast. I had to figure out which was which by thinking about what word made sense in a particular context. This description certainly fits the “World Changing Too Fast” article’s hypothesis that I discussed earlier. The other type of language-input problem is hearing the words but not being able to connect meaning to them, a syndrome that Donna Williams calls being “meaning blind.”
  
• Language output. I describe this problem as “a big stutter.” As a child, I could understand the words that people spoke slowly but I could not get my speech out. The solution my speech therapist proposed was the same one suggested in the “World Changing Too Fast” paper: Slow down.
  
• Attention-shifting slowness. Once a sound has my attention, I have trouble letting go and moving on to the next sound. If a mobile phone rings during one of my talks, it totally disrupts my train of thought; it grabs my attention, and my ability to shift back is slower than most people’s.
  
• Hypersensitivity to sound. The Internet is full of autistics’ testimonials to the problem of loud and sudden sounds of all sorts—balloons, sirens, fireworks. But some of the problematic sounds are the kind that you would think would be more mundane
  : “I can’t tolerate the sound of noodles being stirred (that horrid squishy sound).” Sometimes, though, hypersensitivity involves not a specific sound but a wealth of sounds
  : “You may have to ask the guy talking to you to repeat himself a few times because you were trying to get past the cars going by, the dog barking three blocks away, and the bug that buzzed past your ear.”
  

Although these are the most common auditory problems that I’ve encountered, there are plenty more problems of a more specialized nature. For instance, I’ve seen a number of kids who are echolalic. These are the kids who can yak out TV commercials word for word. Their speech is just fine. But they have no idea what the words actually mean. Lots of times, they don’t even understand that the meaning is in the words. They think it’s in the tone of voice. Contrast this syndrome with my childhood problem of understanding what words meant but having trouble getting them out. I’m actually working on a brain-scan proposal to study these two types of syndromes side by side.

Whatever form they take, auditory problems seem to be especially prevalent in persons with autism. A 2003 study
compared brain activation in response to speechlike sounds in five autistic and eight control subjects. The autistic subjects uniformly showed less activation in speech areas. Another study
from 2003 compared the responses of fourteen autistic and ten control subjects to subtle changes in a sequence of repetitive sounds—what’s called a mismatch field (MMF). Magnetoencephalographic (MEG) measurements of the controls uniformly indicated that their brains were detecting the changes, while MEG measurements of the autistic subjects’ responses uniformly indicated that their brains were not.

And just to complicate matters, autistic people seem to get visual cues mixed up with aural cues. Normally when a person is listening, the visual cortex gets turned down. But a 2012 fMRI study
found that when autistics were listening to sound cues, their visual cortices remained more active than neurotypicals’. If that’s the case, then even while they’re straining to process aural cues, they’re being distracted and confused by visual cues.

But there’s hope, and not just for autistics. Researchers have begun looking into the therapeutic effects of singing. Again and again I’ve heard from parents and teachers that they taught kids to talk through singing, and I wondered if there was a scientific basis for this relationship.

In healthy brains, the parts that appear to be related to language and music overlap to a high degree. Yet researchers have long noted
that even nonverbal autistic patients exhibit a strong response to music. In a 2012 study
conducted at the Columbia University Medical Center in New York under the supervision of Joy Hirsch (the same researcher we met in chapter 2), thirty-six nonverbal autistic subjects ranging in age from six to twenty-two were matched with twenty-one nonautistic controls ages four to eighteen. Through functional MRI, functional connectivity MRI, and DTI scans, the researchers found that during speech stimulation, activation in the left inferior frontal gyrus, which is closely associated with language, was reduced in the autistic sample relative to the controls. During song stimulation, however, the activation in the same area was greater in the autistic population than in the controls.

Until recently, though, very few studies on the use of music therapy in autistic subjects—never mind studies on the use of music therapy to help nonverbal autistics achieve speech—had been done. A 2005 study
analyzed the data from forty autistic subjects, ranging in age from two to forty-nine, who had undergone two years of music therapy. All forty exhibited improvements in language and communication, as well as in behavioral, psychosocial, cognitive, musical, and perceptual/motor skills. And the parents or caregivers of all forty reported that the improvements extended beyond music and into other areas of the subjects’ lives.

“Theoretically grounded music-based interventions have been underutilized, which is unfortunate because music perception and music making is known to be a relative strength of individuals with autism,” the authors of a 2010 paper
concluded. “In particular, no study has systematically investigated the efficacy of a music-based intervention in facilitating speech output, and whether an intensive program can induce plastic changes in the brains of these individuals. On the basis of previous and current research, we hope that such specialized treatments for autism will be developed in the near future.”

One of the authors of that study—Catherine Y. Wan, of the Music and Neuroimaging Laboratory in the Department of Neurology at Harvard Medical School—not only hoped for specialized treatments but went on to help create one. It’s called auditory-motor mapping training (AMMT), and it is designed to promote speech production directly by training subjects to experience the relationship between speaking at different pitches while tapping tuned electronic drum pads. “The therapist introduces the target words or phrases by simultaneously intoning the words and tapping the drums tuned to the same pitches,” Wan wrote in a proof-of-concept study
published in 2011. The paper reported that after having forty-five-minute individual sessions five times a week over an eight-week period, the six nonverbal children in the study, ages five to nine, showed “significant improvements in their ability to articulate words and phrases, with generalization to items that were not practiced during therapy sessions.”

The paper concluded, poignantly if predictably, that the number of interventions of this type currently in use are “extremely limited.” So do we have conclusive scientific proof that music therapy facilitates communication in nonverbal autistic children? No. But I’d bet that the anecdotal evidence I’ve heard over the years, from teachers and parents, is right.

Touch and Tactile Sensitivity

As the person who felt the need to invent the squeeze machine to counter her anxiety and panic attacks, I obviously have a strong case of touch sensitivity—and I’ve written extensively about it in my other books. But my tactile problems don’t stop there. Clothing drives me crazy if it’s not the right texture. I’ve gotten a lot of T-shirts as presents from members of the audience at my public talks. Sometimes the T-shirts are scratchy, and sometimes they aren’t, even if they’re all made of 100 percent cotton and I’ve washed them to soften the fabric. The difference, believe it or not, is something in the weave or in the type of cotton.

What other tactile experiences present problems? You’d be surprised. Here are some examples from the website Wrong Planet (wrongplanet.net) about autistic sensitivities involving the sense of touch.

• “I simply cannot stand wet sand. Enforced beach holidays were hell for me.”
  
• “I am utterly incapable of touching soft things . . . teddy bears, very soft blankets, etc., especially when my hands are dry. The thought of that disgusts me beyond words.” (This person’s solution would drive me absolutely crazy: “roughest, lowest thread count sheets I can find.”)
  
• “Wet sand, cream, and towels. These can be combined into my worst possible combination, which is sun-lotioned skin, covered in sand, wiped off with a wet towel.”
  
• “Wet sleeves.”
  
• “I can’t stand the feel of newsprint—it feels like teeny-tiny splinters all in my fingertips.”
  
• “Sponges are pretty nasty, although oddly enough I did used to quite enjoy eating sponge.”
  
• “Every time I wear something that is not loose fitting enough my skin feels like there are small insects crawling all over it.”
  
• “I HATE HATE HATE the feeling and texture of denim jeans. It’s so dry and scratchy.”
  
• “Petting a dry dog with wet hands.”
  
• “Glass that has come out of a dishwasher—it feels squeaky in an awful way.”
  

Olfactory Sensitivity and Abnormal Smell / Taste Sensitivity

Some people just cannot tolerate certain smells. They walk down the detergent aisle in the supermarket, and they’re overwhelmed. My collaborator Richard has a friend who gets headaches from the smell of newsprint. Growing up, she used to dread the fat Sunday edition. Today she reads newspapers only online.

Some people just cannot tolerate certain tastes. A lot of times, this aversion has to do with texture. I don’t like slimy things. Runny egg whites?
Yuck.
(Although what seems like a taste sensitivity might actually be an auditory problem. For some people, the crackle of a potato chip heard inside the cranium is unbearable.)

As with tactile sensitivity, the range of triggers is astonishing:

• “Any grain or carb that is soggy.”
  
• “Flat soda—once it is open more than a minute I won’t drink it.”
  
• “Taco seasoning makes me dizzy.”
  
• “I never ate at a fish restaurant in my life. Just driving by one makes me gag. I can’t stand the smell of it.”
  

Researchers might not trust self-reports, but to my mind these quotations are an invaluable resource, not just for the information they contain but for the larger lesson: If you want to know what the symptoms of autism mean, you have to go beyond the behavior of the autistic person and into his or her brain.

But wait. Isn’t the diagnosis of autism based on behaviors? Isn’t our whole approach to autism a result of what the experience looks like from the outside (the acting self) rather than what the experience feels like from the inside (the thinking self)?

Yes. Which is why I believe the time has come to rethink the autistic brain.