The Autistic Brain: Thinking Across the Spectrum (24 page)

Neuroanatomy isn’t destiny. Neither is genetics. They don’t define who you will be. But they do define who you might be. They define who you can be. So what I want to do here is focus on how the autistic brain can build up areas of real strength—how we can actually change the brain to help it do whatever it does best.

The idea of plasticity in the brain—that your brain can create new connections throughout your whole life, not just in childhood—is still quite new, and like so many new ideas about the brain, we owe our awareness of it to neuroimaging. Until the late 1990s, scientists tended to think that the brain remained essentially the same, or even deteriorated, over time. One particularly compelling finding that helped overturn this view was a 2000 study of London taxi drivers. In order to qualify for a license, a London taxi driver has to learn what’s known as the Knowledge—the location of every nook in the city, and the quickest way to get there. Specifically, he needs to memorize the names and locations of the twenty-five thousand streets that radiate from central London, a task that takes the average person two to four years. And the prospective cabdriver needs to demonstrate this knowledge in a series of tests taken over the course of several months. These tests consist of one-on-one interviews with inspectors who name a point of departure and a point of arrival; the applicant’s job is to describe how to make that trip, turn by turn.

A study led by Eleanor Maguire, a British neuroscientist, looked at MRIs of the hippocampi of sixteen licensed London cabbies. The hippocampus is believed to house three types of cells that help us navigate: place cells, which recognize landmarks; head-direction cells, which tell you which way you’re facing; and grid cells, which tell you where you are in relation to where you’ve been. What Maguire found was that the hippocampi of drivers who had mastered the Knowledge were larger than those of control subjects. What’s more, the longer a driver had been on the job, the larger the hippocampus.

And what happens when a driver leaves the job? In a follow-up study, Maguire found that the hippocampus returns to normal size.

“The brain behaves like a muscle,” Maguire said. “Use brain regions and they grow.”

But if you don’t use a brain region, it won’t necessarily wither. Neuroscientists have been intrigued by a case in India: A man who had been nearly blind since birth had his vision restored. SK (as he was known) had congenital aphakia, a condition in which the eyeball develops without a lens. He had 20/900 vision—that is, he could make out at twenty feet what people with regular vision could make out at nine hundred feet. For SK, the world was a shadowy landscape. When he was twenty-nine years old, some visiting doctors gave him a pair of glasses. His visual acuity improved to 20/120, but his doctors didn’t know if he would ever be able to make sense of what he saw. For example, he could see patches of black and white, but until those patches moved, he had no idea they were parts of a cow. Initially, his visual skills were rudimentary. He could recognize some basic two-dimensional objects, but nothing beyond that.

And for some time, that’s where the quality of his vision remained. His lack of progress was not surprising, at least according to the neurological theory that the brain has a window of opportunity in which to develop vision. Miss that window—which comes very early in life—and it shuts forever.

Yet about eighteen months after receiving his glasses, SK could recognize some complex objects. He could distinguish colors and levels of brightness that had previously eluded him. He didn’t need the cow to move to know it was a cow.

He could see.

What had changed wasn’t his vision. It was the way his brain proc- essed the images. His eyesight was still 20/120, but now he could interpret images in a new way. His brain had needed time to adapt.

Because of SK, researchers have had to jettison a lot of their ideas about how vision develops in the brain. Now they’ll have to see if they can help blind children who are older than eight—the previous standard cutoff point. They’ll have to see what neuroimaging reveals. As one neuroscientist marveled, “People can learn to use the vision they have.”

Not only can dormant areas of the brain “come to life” and do what they were always supposed to do, but those areas can get repurposed and do what they
aren’t
supposed to do.

Researchers at the Massachusetts Eye and Ear Infirmary have developed a method to research the brain activity of people who have been blind since birth.
It works like a video game. Players have to navigate through a building in a search for diamonds. But the game doesn’t use images. It uses sounds.

Players figure out where they are and where danger lurks by
listening
to their environment in 3-D sound instead of looking at it. Footsteps echo. The sound of a knock indicates the location of a door. A ping means the player has bumped a piece of furniture. The diamonds make a twinkling noise that grows louder as the player approaches.

The layout of the labyrinth actually corresponds to an administrative building next to the research lab—a place the players wouldn’t have visited. But when they finish the game and go into the building, they know their way around immediately. When a similar experiment was tried on both blind and sighted children in Santiago, Chile (where the research originated), the sighted subjects playing the game didn’t even realize that what they were supposed to be “inside” were corridors in a building.

Over the years, scientists have used PET scans and fMRI scanners and MRI machines to study the visual cortex (which covers 30 to 40 percent of the brain’s cortical surface) of subjects who have been blind since birth. They have found that even though the blind person’s visual cortex had never received any visual stimulation, it was nonetheless being used. In effect, it had been repurposed to perform the blind equivalent of visual tasks such as reading (Braille), localizing sounds, interpreting body language, and so on.

These results were consistent with what the Massachusetts researchers found when they looked at the brain activity of blind-since-birth players of the “video” game. They also found that when a sighted subject needed to make strategic decisions, he used the hippocampus, the brain’s memory center. But the blind subject used his
visual
cortex.

I witnessed some similarly remarkable abilities in the behavior of my blind roommate in high school. I called her a “cane master.” She didn’t want a guide dog leading her. She wanted to learn how to guide herself. And boy, did she ever. She needed to be walked through a new environment only once, and then she knew her way. Outside our dorm was a busy intersection; she navigated it as well as any sighted person. Now I can look back at what she was doing and have at least a little insight into how she was doing it. In a way, she really
was
seeing her environment. Maybe she wasn’t using actual images, but her
visual
cortex was allowing her to build a vivid, knowable, and navigable world.

A change in one part of the brain can also apparently lead to changes in other parts of the brain. I helped a dyslexic graduate student of mine overcome some of her visual problems through the use of tinted eyeglasses. They did the job—her eyesight got better, and she graduated to lighter and lighter tints until finally she didn’t need the glasses at all. But the correction to her vision helped correct other problems that you might think were unrelated. The organization of her writing improved. Suddenly she was expressing herself on paper with greater ease and clarity.

I don’t know how my own brain might have changed over the years, but I do know that as my career has shifted, so have my abilities. I haven’t been doing drawings for more than ten years now, partly because of changes in the industry. The fax machine was the ruination of good architectural drawings. Clients would say to me, “Oh, just shove it in the fax,” and then they’d use the fax as their blueprint. I lost the motivation to make a really nice drawing. But at the same time, my professional priorities were changing. I was becoming a lot busier giving lectures, and many people have told me that my speaking style became more and more natural. That was hard work. I knew I had to train myself to be someone I wasn’t naturally, and what is training yourself at a new skill but “rewiring” your brain?

This generation is fortunate in an important way. They’re the tablet generation—the touchscreen, create-anything generation. I’ve already talked about how these devices are an improvement over previous computers because the keyboard is right on the screen; autistic viewers don’t have to move their eyes to see the result of their typing. But tablets also have other advantages for the autistic population.

First, they’re cool. A tablet is not something that labels you as handicapped to the rest of the world. Tablets are things that normal people carry around.

Second, they’re relatively inexpensive. They’re even less expensive than high-end personal communication devices traditionally used in autism classrooms.

And the number of apps seems limitless. Instead of a device that performs a few functions, a tablet taps into a world of educational opportunities. You have to be careful, of course. I saw an educational app that visually was quite cute—it featured Dr. Seuss characters—but its approach was inconsistent. If you touched the image of a ball, the tablet said, “Ball.” But if you touched the bicycle, it said, “Play,” and if you touched the wall, it said, “House.” Those words are too abstract. It needs to say, “Bicycle,” and it needs to say, “Wall.” But the better programs and apps say what they mean, and they can be invaluable in helping nonverbals communicate.

These days you can get a whole education online. Numerous websites and high-tech tools that offer amazing opportunities have cropped up. The names and aims of these sites will undoubtedly change over the years, but at the moment here are some of my favorite educational accessories that are perfect for some autistic brains.

• Free videos. Khan Academy offers hundreds if not thousands of educational videos and interactive graphics in dozens of categories. You’re a pattern thinker who wants to know more about computer programming? Try the code-writing-for-animation category. You’re a picture thinker? Browse the hundreds of art history videos that cover historical movements, geographical specialties, and individual artists and artworks.
  
• Semester-long courses. Coursera offers free courses from more than thirty universities. And the courses are changing all the time. Your kid is a science geek who’s interested in the universe? You’re in luck. A professor from Duke University is teaching a nine-week Introduction to Astronomy course, three hours of video instruction per week. You’re a word-fact thinker who wants to write poetry? Learn from the masters with Modern and Contemporary American Poetry, a ten-week course taught by a University of Pennsylvania instructor. Udacity is another gateway to free courses, though ones with a more mathematical emphasis.
  
• Check out the universities themselves.
  I just typed
  Stanford
  and
  free courses
  into my browser, and up came a list of sixteen courses for the fall semester, including Cryptography and A Crash Course on Creativity. In 2012, Harvard, MIT, and the University of California at Berkeley created a nonprofit partnership in free courses called edX.
  
• 3-D drawing tools. They’re free, they’re downloadable, and they range in complexity. My personal favorite is probably SketchUp.
  
• Desktop 3-D printers. The programs—like SketchUp—are free, and the printers are dropping in price. Yes, they’re expensive at the very moment I’m writing this sentence—about $2,500 for a low-end but perfectly serviceable model. But at the rate technology changes, that price has probably dropped to $2,400 in the time it took me to write
  this
  sentence.
  

I’m certainly not saying we should lose sight of the need to work on deficits. But as we’ve seen, the focus on deficits is so intense and so automatic that people lose sight of the strengths. Just yesterday I spoke to the director of a school for autistic children, and she mentioned that the school tries to match a student’s strengths with internship or employment opportunities in the neighborhood. But when I asked her how they identified the strengths, she immediately started talking about how they helped students overcome social deficits. If even the experts can’t stop thinking about
what’s wrong
instead of
what could be better,
how can anyone expect the families who are dealing with autism on a daily basis to think any differently?

I’m concerned when ten-year-olds introduce themselves to me and all they want to talk about is “my Asperger’s” or “my autism.” I’d rather hear about “my science project” or “my history book” or “what I want to be when I grow up.” I want to hear about their interests, their strengths, their hopes. I want them to have the same advantages and opportunities in education and the marketplace that I did.

I find the same inability to think about children’s strengths in their parents. I’ll say, “What does your kid like? What is your kid good at?” and I can see the confusion in their faces.
Like? Good at? My Timmy?

I have a routine I follow in these cases. What’s your child’s favorite subject? Does he have any hobbies? Does she have anything she’s done—artwork, crafts,
anything
—that she can show me? Sometimes it takes a while before parents realize that their kid actually has a talent or an interest. Two parents came up to me recently and said they were concerned because they knew their son wouldn’t be able to handle the family business, a ranch. What would become of him, since that was the only world he’d ever known? Well, yes, it might be the only world he’d ever known, but the kid wasn’t nonverbal. Their kid could function. So what part of that world interested him? Fifteen minutes later, they finally said that their son liked fishing.

“So maybe he can be a fishing guide,” I said.

I could almost see the light bulbs popping to life above their heads. They now had a way to rethink the problem. Instead of thinking only about accommodating their son’s deficits, they could think about his interests, his abilities, his strengths.