cc  >> Cathy Vrentas: Welcome to  Wednesday Nite at the Lab, here  at the Biotechnology Center.  This week we'll have Lynn  Gilbertson speaking.  She is a graduate student in the  field of communicative disorders  here at UW.  And she also received her  bachelor's degree  from UW-Madison in 2008.  During her undergraduate  research, she was awarded a  Hilldale Award for her research  project on the auditory  preferences of children with  autism.  And she's continued that work  for her graduate studies, and  that's what she'll be talking  about today.  So join me in welcoming her  to Wednesday Nite at the Lab.  (applause)  >> Lynne Gilbertson: Thank you.  I'm very excited to be here.  As she mentioned I am a graduate  student. 

 I'll be starting my second year  this coming fall.  And the person I owe a lot of  credit to is Robert -- he's my  advisor and was very influential  in helping me in my undergrad as  well.  So I want to start off by  thanking him and also the work  that I'll be presenting was done  in collaboration with Susan  Ellis Weismer, who's at the  Waisman Center, and Roman Arora,  who just finished his PhD  in computer engineering.  So I want to thank them right  away.  Today my talk is going to cover  a little bit of everything.  I'll start off by just getting  us all on the same page with  what autism is, and then I'll  touch very briefly on some of  the hot topics that surround the  diagnosis of autism.  And then I'll go into a little  bit of what's going on here at  UW, and then my favorite part,  what I've been doing.  So let's get started.  So just to get us all on the  same page, I'm sure everyone in  the audience has heard the word  autism at some point, either in  the media or from your  relatives, co-workers or family  members.  So just to put us on the same  page I'd like to just discuss  some of the diagnostic criteria. 

 And it is a spectrum disorder.  So what that means is there's a  varying range of severity of  behavioral manifestations.  And they kind of categorize  those behaviors into a couple  different groups.  The first group that there needs  to be a deficit in or some  impairment would be social  interactions.  And that would be the child has  some trouble relating to peers  or family members.  And it's atypical compared to  what other children are doing at  their age group.  The second major area is  impairments in communications so  that would be gestures or  speech, anything of that nature  where they just aren't quite  communicating typically the way  children their age would.  And then there's the repetitive  and stereotyped behaviors.  And an example of one of the  many would be hand flapping.  That would be a repetitive  behavior that maybe a child  would do that's on the autism  spectrum. 

 Then there are these other three  categories which are pretty  similar that psychologists or  pediatricians look at and that's  again the social interaction,  the social communication and  then, of course, the play skills  of the children.  And they evaluate those and  there should be at least a delay  or abnormal function in at least  one of those groups before age  three because this is something  they diagnose prior to age  three.  So that's kind of the diagnostic  criteria that people use.  Unfortunately how they evaluate  these behaviors is something  that's not completely  standardized across all  pediatricians and psychologists.  So there's a wide array of  different tests that are used to  assess these behaviors and not  all of them are used by every  pediatrician or psychologist.  So there's a little bit of kind  of ambiguity in diagnosis there.  If there are any questions, by  the way, as I'm going please  feel free for ask.  Yeah?  >> Does it extend into  adulthood?  >> Gilbertson: Okay,  the question was does  autism spectrum disorder  extend into adulthood.  And that is something that I  believe is the case, but a lot  of times with interventions a  lot of the atypical behaviors or  nonfunctional behaviors will be  kind of mediated or decrease as  the child ages.  So it really depends on the  person but indeed some of these  behaviors can last a lifetime. 

 Okay?  Now the question is why is this  such a hot topic?  Why are we hearing so much about  it?  And the first thing that comes  to my mind as to why we hear so  much about it is because it  affects very young children and  people are very passionate about  young children.  And being a parent myself I know  anything that involves my son,  I'm very passionate about.  So that's one thing that I think  causes us to hear so much about  it in the media and from our  family and friends because it  involves young children.  Now the second thing, as you see  the rate of diagnosis is pretty  high, one out of 150 individuals  will be diagnosed with autism  spectrum disorder.    And that's not at all low  compared to other disorders that  are affecting children in that  age range.  So I think that high diagnostic  rate is something that's really  peaked the attention of parents  and caregivers and researchers  so that's one of the reasons.  Another reason, as you see up  there, is we don't have a lot of  definitive answers.  There's a lot to be questioned  when it comes to autism and the  spectrum.  And so things like, what causes  it and what interventions are  specific, we don't have answers  to yet.  We have ideas as far as what  risk factors are for a child who  might develop autism and we have  some ideas as to what types of  intervention might be helpful  but we don't know exactly the  answers to a lot of questions. 

 So I think that's what leads it  to be a hot topic.  Yes?  >> You said a child, what causes  a child to, but isn't it genetic  and it's from birth?  >> Gilbertson: I will cover  that in just a minute.  She asked if it's genetic and  from birth and I will cover that  in just a minute.  >> How does autism relate to  similar types of problems like  Tourette's or Asperger's?  >> Gilbertson: The question  was how does autism relate  to other types of syndromes  like Tourette's and Asperger's.  And Tourette's is a different  syndrome altogether, but  Asperger's syndrome is currently  thought of as a type of autism  on the spectrum.  So there's a range of different  abilities and Asperger's at this  point is thought of being a  high-functioning sort of autism  behavioral set.  And so right now there's  actually a movement to eliminate  the different classifications on  the spectrum because there's not  a very standardized way of  diagnosing those.  So a lot of people will call  Asperger's something else  than the next physician will.  So they're trying to eliminate  the different categories and  just call it a spectrum.  So a child would be diagnosed  with autism spectrum instead of  Asperger's or Rett syndrome or  PDD-NOS which are all on the  spectrum. 

 Yes?  >> What are the risk factors?  >> Gilbertson: I will get  to that in just a little bit.  So one of the hot topics  surrounding this disorder is  genetics and that was already  brought up.  There is believed to be a very  strong genetic link in this  disorder.  Now what that is, is a little  shady at this point.  But we do know it's genetically  linked.  Genetics does play a large part,  environment does as well.  But you can see some of the  factors that play into our clues  that genetics are in the mix  here is that boys are four times  more likely than girls to have  autism and so that leads us to  believe there might be a sex  link gene that could cause this  disorder.  Also, it runs in families.  So if a family has their first  child diagnosed with autism, the  second child is much more likely  to also have the disorder.  So it runs in families. 

 And you are see also in twins,  we know mono zygotic twins which  are identical twins, they share  100% of their DNA makeup, and  they're much more likely to both  have autism than dizygotic  twins, which only share 50% of  their genetic makeup just like  other siblings would.  So that leads again to another  clue that there's genetics at  work.  Now there have been lots of  studies identifying genes that  link a risk to autism and so  right now researchers have  developed a multigene model.  And what that basically means is  there's no one gene, like we  know, for example, in  Down Syndrome there's a trisomy  in chromosome 21.  So we know that there's that one  specific cause or one chromosome  that causes that.  But in autism spectrum there's  so many different genes that  play a factor and whether  they're turned on or turned off  might be a factor in  environment.  So there's a multiple gene  component in this disorder so  it's very hard to pinpoint down  the actual cause.  Okay.  Now the next hot topic, this is  an epidemic.  There are so many kids being  diagnosed all of the sudden,  what's going on?  And we aren't quite sure yet,  but in my opinion I don't  believe there's an epidemic  per se. 

 Why I believe that is because  for one it's a spectrum disorder  so people are kind of given  a liberty to assess those  behaviors and place that on the  spectrum.  So because there's not a very  nailed down way to diagnose this  disorder, I think that we can  lump kids into this category and  they might not necessarily all  have autism, per se.  Maybe we're lumping in some  other disorder that we don't  know a lot about yet.  So that's one factor.  Also early identification,  there's a big push for early  identification.  And with early identification  you're trying to track a child  before they're even 18 months  to see if their behaviors are  falling along the spectrum.  So something that a child might  be doing before 18 months  might resolve itself.  So we don't know necessarily if  that's true autism or not  because we're assessing them at  such a young age.  And it's very hard to assess  itty bitty children if you've  ever tried it.  It's very hard. 

 They don't cooperate, they can't  tell you what they're thinking  so it's very hard to identify  any sort of disorder at a very  young age.  And since there's a push for  early identification in this age  group I think we're seeing more  and more diagnosis from that as  well.  And there's a lot of parent  advocacy out there for kids with  autism to get services because  in our country, especially in  our state, you have to have a  label for a child before they  can actually receive services to  help them, before they can get  interventions or insurance help.  And I think now that Governor  Doyle signed the act making sure  that insurance coverage was  available for autism  interventions I think we're  going to see another spike, at  least here in Wisconsin, for  children on that autistic  spectrum diagnosis.  And then to be sure if it's an  epidemic or not the CDC is  actually doing a study right now  to determine if it is indeed an  epidemic or if these other  factors are coming into play.  So if you're interested in  following along that saga  continue to check on the CDC  website and they should have  information for us soon.  There is a question, yes?  (inaudible)  >> ...I found that the ears  were very big.  My question is this a  phenotype, or you have other--?  >> Gilbertson: Okay, the  question was about my initial  slide in the beginning, and how  the child on that picture  had large ears, and if that was  a phenotype of autism.  And that for me was just  a fun picture of a child that  emphasized my interest which was  sound and it's not at all a  picture of someone who has  autism.  So it was just more of a  character that I found that was  cute and kind of emphasized my  initial interest and point. 

 So if that confused anyone about  children with autism having  large ears I apologize, but they  don't necessarily.  Good question.  The next hot topic, and this is  something that people feel very  passionate about is vaccines.  Vaccines may be causing autism.  Since it's a passionate subject  I'm going to err on the side of  good science and say vaccines  have no causal link.  I know some people really  believe that but I'm going to go  with the side of good science  and say since the original study  that I believe was done in 1998,  there have been many studies  that have looked into the causal  link between vaccines and autism  and they haven't found that same  result that the original study  did.  And the original study was on 12  participants and they linked  this vaccine to a stomach upset  which caused the children to  have lack of nutrients and then  developed autism.  So it's kind of shady, not  necessarily good science.  So I'm just hesitant to even  talk about that study because it  wasn't really a valid study, in  my opinion.  But some things that we can look  at to say why vaccines, besides  the research, don't have a link  is that Thimerosal, which was  the component in the vaccines  linked with mercury that had  this causal link, was taken out  of vaccines for children and we  haven't seen a decrease in  diagnosis. 

 Also, there's kind of a  correlation between the time  that children received the  measles, mumps and rubella  vaccine with when we start  seeing symptoms or behaviors  that are characteristic of  autism.  And because those timing of  events are correlated that  doesn't necessarily mean there's  a causation there, it's just the  same time period in a child's  life when we see those behaviors  and when they get that shot.  And lastly children who never  received vaccines also will be  diagnosed with autism.  Yes?  >> Has there been any research  on the vaccines, and not the  Thimerosal, but the idea of all  of the vaccines being grouped  into one injection now which  could be an assault on the  child's immune system that if  they had the tendency, some  genes for autism, that that  could be, has there been any  good research to show that  that's true or not true?  >> Gilbertson: The question  was about vaccines being  packaged into one lump shot  instead of isolated  into different ones and then  being kind of an attack on the  immune system and then  triggering possible genes that  are linked to autism.  And I am not an expert in the  vaccine research so I'm not  going to the expert to tell you  this.  But I have looked at the CDC  website and they have said that  the immune system is actually  better in children that received  these vaccines so they don't  believe at this point that that  has anything to do with the rise  of autism.  But again if you're interested  the CDC website does have a lot  of information on vaccines,  a lot.  So if you're interested in that  topic at all, go to that  website.  Yeah?  >> I mean, wouldn't it make  sense though if they don't know  for sure that it doesn't cause  it, wouldn't it make sense for  families with maybe the gene in  the family to get the injections  separately?  What's the big disadvantage  other than having to take them  to the doctor more often?  >> Gilbertson: Again, I'm not  sure the answer to that.  So I'm sorry. 

 Yes?  >> You mentioned that the CDC  website, we know the last eight  years a lot of science has been  politicized and not allowed to  come out, are you sure that the  website has been corrected with  some of the errors that might  have occurred in the last eight  years?  >> Gilbertson: To my knowledge,  that's the best place  I can refer you to since that  not my entire area of expertise.  There's a lot out there and I  wish I was versed in all the  research in all aspects, but one  person right now can just not  know all of the things there are  to know.  So I'm not sure.  >> What about European websites?  >> Gilbertson: What was that?  >> What about European websites?  >> Gilbertson: The question  was about European websites,  and I'm not familiar with any  of those either.  So I apologize again.  Yes?  >> You mentioned that it occurs  in families, does it occur each  generation?  Are there examples of skipping  generations?  Like could you say maybe a great  grandparent had it, and it's  a generation or two later.  Has any work been done on that  type of tracking?  >> Gilbertson: Okay, the  question was, as I mentioned  it was in families,  is there a generational link  to autism as well.  So grandparents and then  children and then grandchildren.  And my answer to that is I don't  know of any research that has  looked into that because that  would be a very long study and  that costs a lot of money, and I  don't know if the awareness and  advocacy was there yet to first  off diagnose grandparents as it  kind of something that's come to  the forefront lately.  And so I think that might be the  answers to the questions but for  sure I can't say. 

 But that would be my assumption.  Another hot topic is the  interventions and what works for  kids.  What can we do to help mediate  some of these behaviors.  And the answer is we don't  really know.  Because there's not a lot of,  again, research or empirical  testing of the many therapies  that are available.  But the one thing that people do  agree on now is that early  intervention does seem to be the  most beneficial.  The earlier we can diagnose,  the earlier we can get them into  behavioral therapies and things  of that nature, and then the  more likely their symptoms are  to change.  So that's the one thing we do  know.  And the reason that I think  we're not going to see a  specific therapy that works for  kids with autism is because it's  a spectrum and there's a wide  variety of manifestations of  behaviors, there's a wide  variety of communication styles  and abilities, so again as in  many syndromes and in many  diseases and many disorders, you  have to tailor that specific  intervention to the child.  So I really don't think we'll  see a specific intervention  that's the magic bullet for  this. 

 Now jumping to what's kind of  happening at the UW because I'm  sure you're all dying to know  what we're doing with all of  this tax money that's being  thrown around.  So just to cover very briefly  what some of the researchers are  doing we have Marsha Seltzer and  Jan Greenberg, they are studying  kind of a longitudinal family  study to see how families are  doing with members that have  autism spectrum disorder.  So they're looking at their  services, their relationships  that they're receiving and what  their future outlook is as far  as what that child will be doing  in the future, what they're  setting up now to get them to be  functional adults, things of  that nature.  So it's a longitudinal study  that will be coming soon,  hopefully.  Then Kim Dalton and Richard  Davidson, they are doing a brain  imaging study that's looking at  the activity patterns through  functional magnetic resonance  imaging.  And they're going to see,  hopefully, if there's a  difference in brain activity  from children, actually they're  using 10 to 25 year olds.  So teens and early adults,  to see if their brain pattern  of activity is different that  typical young adults.  And they're using faces and  voices in social settings  because this is kind of a social  disorder.  Then Morton Gernsbacher,  she's studying child language  development in this population.  She also is in large  collaboration on projects with  professor Hill Goldsmith. 

 And they have a twin study  that's following these children.  And he's also looking at  identifying some subtypes of  autism, and one that he believes  might exist is one that has  minimal verbal skills.  And so they've kind of coined  the term developmental verbal  dyspraxia as a subtype of  autism.  So that's one thing he's looking  at to see if you can identify  different features or different  groups of kids on the spectrum.  And he's also looking at the  genetic influence and how that  plays into heredity.  And then again the twin study  with the neural imaging and  seeing if twins have different  patterns in brain activity.  And then Leonard Abbeduto is  looking at children with fragile  X syndrome.  And the reason he's looking at  children with fragile X syndrome  is because people with that  syndrome often have autism  spectrum disorder or there is a  high likelihood that they do.  So he's studying the language  and then again the family,  parent/child interaction.  >> Excuse me?  >> Gilbertson: Yeah?  >> Have there been any cases of  autistic people having children  and what happens?  >> Gilbertson: The question was  do people who have autism  spectrum disorder have children  and then what happens  with those children. 

 I don't know of any studies that  have looked at that.  I'm sorry, I don't know.  I don't have the answer to that  question.  Maybe this family study will  help with that, that's coming  out soon.  I'm not sure.  So to kind of conclude what's  going on at the UW, Susan Ellis  Weismer, one of my advisors,  she does a lot of studies on  language disorders, so all  different types of language  disorders.  And so she's comparing the  language kind of development  of children on the spectrum  to other disorders to see if  there's any links or differences  that might help with  interventions per se  or diagnosing.  And then finally William Schwab  is a doctor here at the UW who's  looking at identifying the  factors in the home environment  that will help identify children  early and then give them  good intervention.  So that's kind of the purpose  and goals of the research that's  going on here at UW on this  topic.  And to get to my favorite part  of this presentation, why are we  looking at sound in these  children. 

 There's so much other stuff that    we can look at.  As you've all pointed out,  there's so much that I don't  know and a lot of us don't know  so why look at sound?  Well for one, there's a very  interesting kind of anecdotal  thing that happens.  Parents report that kids on the  spectrum, they appear to be deaf  but they have normal hearing.  Right there, there's something  kind of going on maybe in their  auditory perception that we're  not completely understanding.  And this is actually used as a  red flag, if your child is not  responding when you call their  name, this is something that  people say have your child  evaluated if that happens.  So it's an anecdotal thing and  so it's kind of interesting  that's one of the reasons it  sparks my interest.  Also kids on the spectrum  have a tendency to have sound  sensitivities.  So some of the kids that I've  seen have a very high  sensitivity to high pitched  noises.  So if there's a high pitched  noise and it's a little bit too  loud or too close to their head  they kind of have a tantrum,  or can't cope with that sound.  So having heightened sensitivity  is something that links us to  sound and why that might be an  issue in these children. 

 And then sound is required for  spoken language.  If you've ever met someone who's  hard of hearing or deaf, their  language oftentimes sounds a  little bit distorted and that's  because they can't hear  themselves talk.  So one interesting kind of stat,  depending on who you cite, 25%  to 50% of children on the autism  spectrum never learn to speak  as their main mode of  communication.  So their verbal communication is  absent in many cases.  And just to explain a little bit  on how that feedback is so  crucial to language I have a  little demo for you.  So you have what we call the  auditory feedback loop, where  the child, they get to say  something.  So for example this child might  say, "mama."  And then they get to hear  what they said.  So if I said, "mama,"  does that sound right?  And so once they hear, they  process that, they can make  corrections and comparisons and  say does mama sound the same  when someone else says it as  when I say it?  And then they make corrections  and say it again.  So that's kind of how we mediate  learning language and that's how  we correct if we said something  awkward like wait a minute that  didn't sound right, let me fix  that and say it again.  So what's what we call the  auditory feedback loop, and it's  crucial in language --. 

 Now why look at preferences  for sounds.  That's my second major interest  is sound preference.  Well, let me use kind of an  analogy for music.  I love country music and so I  listen to a lot of country  music.  I know the artists.  I know what instruments are  played.  I know when the next award show  is coming up so I can watch  that.  So I know a lot about, I know  the lyrics.  I know a lot about country music  because that's what I pay  attention to, that's what I  prefer.  So if you ask me about classical  music, or you ask me about rap  music or rock, I don't know as  much. 

 So this preference is very  important for what we know and  what we learn.  And in children what they prefer  to listen to is typically speech  when they're little.  So if they prefer to listen to  speech, they learn to speak.  So this link between preference  and actual performance is  something that is really  significant in this language  acquisition as well.  So the long term goal, before I  jump into the study, is to  better understand the sound  preferences of these children so  that we can tailor interventions  for them.  So if they prefer to listen to  low pitch sounds, maybe we'll  speak to them in a very low,  manly voice.  I have no idea.  That's just an example of what  we might learn from looking at  their sound preferences.  So if the past in the research  there have been two methods for  looking at sound preference.  And the first is a head turn  method. 

 And what happens in this method  is a child is either sitting on  the lap of their parent or  they're sitting on the floor  engaging in activity directly in  front of them or they're just  kind of staring straight ahead  at say a light or something like  that in the research.  And a sound is played either to  the left or right of the child  and then the researcher looks to  see if they turn their head to  that sound.  And this method uses that head  turn as their preference for  that sound.  So there is somebody who judges  if their head turned enough and  if they turned long enough.  So they look at duration,  orientation and how often they  turn their head to that sound in  that method.  Now the second method that is  not as widely used is called the  button press method and it's  pretty self-explanatory.  A child's preference for sound  is how many times they activate  that sound with a button.  So we count the number of times  they hit that button and if they  hit it more than the other  button they prefer that sound  over the other.  So there's no judge it's simply  counting how many times the  child hit the button.  Now I have a little grievance  with the head turn method, as  you'll see, I don't think it  administers preference per se. 

 If you look at your own life  experiences and when you react  to sounds and turn your head  it's not always because you like  it.  Somebody could be snapping their  fingers or crunching behind you  in the movie theatre and you  turn and you're kind of like  knock it off.  You could be annoyed, you could  like it, you could be curious.  So there's lots of different  reasons that someone will turn  their head to sound and it's not  necessarily preference.  So in my opinion that's not the  best way to measure preference  in these children.  But it is something that is kind  of innate in young children to  turn to sound.  So that's why a lot of  researchers use it in very young  children because it's an innate  behavior that most all children  will use.  Yes?  >> When you say head turning,  what exactly do you mean?  Because you can turn your ear  toward the sound or you can turn  your eyes toward the sound, I'm  not quite sure what you mean.  >> Gilbertson: Yes, and that's  another thing you bring up.  The question was what do you  mean by head turn, you can you  turn your ear, you can turn your  eyes, and that's all up to the  discretion of the researcher  evaluating. 

 So that's the external judge,  are they allowing just a lean or  do they follow the eyes.  So that's all kind of defined by  the researcher using that  method.  The second two bullets here  explain why I don't think this  head turn method is good  for kids on the autism spectrum.  And the first is because  children on the autism spectrum  have a hard time redirecting to  a different activity, especially  if they have found something  that they enjoy doing because  part of this behavior is that  repetitive stereotyped  behaviors.  So they tend to perseverate  on what they're doing  and continue to do it.  There are actually studies of  visual attention that say they  pay attention to one thing lots  better than typically developing  kids.  So asking a child on the  spectrum to re-orient to a sound  they might not necessarily enjoy  is something that I think is  maybe a little bit over the top  of what we should be expecting  them to do if we want them to  perform and measure what we want  them to measure.  And secondly there's that  external judgment.  You have to take into account  all the different types of ways  that we can orient to a sound.  Is it our body, is it our head,  is it our ear?  And for kids that have atypical  social behavior, they might not  orient the same way that the  rest of us do. 

 So expecting them to perform the  way typically developing kids do  I think is a little over the  top.  So this method doesn't take into  account the intricacies and  uniqueness and wonderful  qualities that these children  have.  So just to look at the research  briefly there's a couple studies  I'd like to pinpoint as to why  I've looked at this topic.  And the first is by Dawson.  They did two studies using the  head turn method in the ages  three to five years, and they  used the difference between  social and nonsocial stimulus.  And what they considered a  social stimulus was something  that could be made with the  body.  So talking, clapping, patting  your thighs, calling a child's  name, those were considered  social sounds.  Their nonsocial sounds are  something that could be created  using something other than the  body.  So a beeper, a car horn, things  that a person can't necessarily  make on their own.  And they found that children on  the spectrum preferred all of  the sounds less than normal  developing children or typically  developing children and  especially the social sounds. 

 So there was kind of an idea  that maybe these children don't  even like to listen to our  social sounds and maybe that's  why they're not learning  language.  There's another study done most  recently by her Rhea Paul and  her colleagues in 2007, and they  also used the head turn method  in a younger age group from one  to three years and they found  that when they compared child  directed speech, which is that  bubbly oh, pretty baby kind of  speech, to what they called  rotated speech, which is kind of  alien atypical just off sounding  speech, the kids did not prefer,  or they preferred the child  directed speech over the rotated  speech but not as much as the  typically developing kids, and  that's what the TD stands for,  and then DD is developmentally  delayed.  So there was a difference  in preference again.  In 2005 there was a study done  by Kuhl and colleagues about  using the head turn but in a  different way because I think  they agree that we might not  necessarily be getting  preference.  And what they did is they used  the head turn to activate the  sound.  So they trained the child if you  look to your right you'll hear  perhaps this speech sound.  If you look to your left you'll  hear the nonspeech sound.  And then they let the child look  either way that they wanted.  So there was a training period  and in three to five years of  age sometimes these training  periods I don't think worked as  well, they ended up eliminating  a lot of their subjects.  So although they're getting  closer to my preferred method  I think still that training  period might have influenced  their findings a little bit. 

 But again the children had a  preference for the nonsocial  over the social sounds.  And Klin, he found interesting  results using the button press  method.  And that's the method that I am  most in favor of.  And he used four- to  seven-year-olds, and he had  a two-button toy.  So they had the mother's speech  in one button and then they had  this kind of noisy restaurant  sound in the other button in  their main condition.  And all of the children in the  study preferred the speech over  the noisy restaurant condition  as you can see.  But again the children on the  spectrum had a lower preference  over all.  Now the interesting thing that  they didn't give a lot of  attention to is their kind of  trial run with this device.  They program a children's song  into one side and then kind of a  buzz or hum of a 100 Hertz tone  on the other side.  And all of the kids preferred  the children's song. 

 So to me that is kind of  counterintuitive; if they're not  enjoying social sounds why would  they like this song?  So that kind of led me to  kind of ponder that thought.  What does music have that speech  doesn't and things of that  nature.  So when I looked at designing a  study that might test this, we  looked at prosody which is  something that has a lot to do  with pitch.  And a lot of times we think of  pitch as the frequency of the  sounds.  So prosody is kind of an  over-arching term that covers  the stress patterns we use,  the frequencies that we use,  the emphasis and things  of that nature.  The duration of our sounds.  So prosody is this over-arching  term and basically if something  is lacking prosody or aprosodic  it's monotoned.  Very constant, very level,  very blah.  And then something that is  prosodic is like child-directed  speech.  It has lots of different sounds  and it's bubbly and it's up and  it's down. 

 So that was one feature that we  looked at because music has a  lot of prosody.  So that might be something that  we could find that would vary in  these children.  And then we also looked again at  the social versus nonsocial.  So the speech sounds versus  nonspeech sounds.  And we came up with four  different categories of sound.  And you can see those there.  There's the aprosodic or  monotone speech.  Then the prosodic speech which  is that bubbly speech.  The monotone machine sounds  which is something again  not made with the body.  And then the bubbly machine  sounds. 

 And just to illustrate my point  on prosody, we're going to  compare these two gentlemen and  some of you might be familiar  with Ben Stein.  He's an economist right now and  he has a very aprosodic voice.  And if I can, let's see...  Pull up this video to give you  an example we'll compare these  two gentlemen.  I'm hoping you can all see this.  Okay.  So this is an example of  aprosodic or monotone speech.  >> For dry, red eyes, clear eyes  is awesome.  It removes redness and has an  ingredient to moisturize.  Wow, the difference is clear. 

 Clear eyes.  >> Gilbertson: So you can see  there's not a lot of action  in the voice.  Although there is some variation  it's very, very, very monotone.  And then we'll compare it to an  actor who is very flamboyant in  his acting style.  Jim Carey.  So this is an example of  somebody who uses a lot of  prosody in their voice.  >> You can do this.  It's all a matter of willpower.  Something small.  Red. 

 Red.  All right, now focus.  The color of this pen  is rrr...  The color of this pen  is reeee...  The color of the pen that  I hold in my hand is rrrr...  Royal blue!  One lie and I can't say it.  >> Gilbertson: All right.  So that's an example of someone  who uses a lot of prosody.  And so, if nothing else, just  for some comic relief in this  presentation, but hopefully that  helps you understand a little  bit better about prosody.  Yes?  >> Ben Stein has a very flat  affect... 

 >> Gilbertson: Yes, there's  definitely a difference  in the affect of these people.  So it kind of is reflected in  their vocal styles as well.    So hopefully that helps explain  a little bit more when we're  look at prosody those are kind  of the extremes that we're  comparing.  So I brought along the key pad  that I actually use but also  display of it is on the  projector.  So this is the device that we  used.  You can see it's a drum pad,  actually.  That's used for practicing  percussion or laying down beats.  And so what we did with this is  because we had four categories  of sound we covered all but four  keys, and again we're looking at  preference of sounds so we  counted the number of times a  child hit each key and the key  that they chose the most was  what we considered to be their  preference.  And we assigned the different  sounds to random locations in  this grid of four, and we had  ten examples of each of the four  sounds.  And so we had 40 sounds total. 

 Now what the child was exposed  to was the first set of four  sounds and then they got to play  with those four sounds that were  randomly assigned, one  representing each category in  that display.  And then once they showed that  they were kind of bored or even  if they wanted to, before they  were bored, they advanced the  key, and you can see this  advance button in the corner,  it's also on the projector in  the corner, they advanced to the  next set of sounds which were  randomly assigned different  locations but still the same  four categories of sound but a  different sound for that  category.  If that makes sense.  Hopefully that's clear.  So that's kind of what the child  saw.  And I can play, hopefully, the  examples that I have up here.  If they don't work I can also  play it on the device.  My cursor doesn't want to show  up here.  There we go.  Okay, so this is an example of  one of the sounds we use that is  aprosodic or monotone speech. 

 >> Ah.  >> Gilbertson: So that's someone  saying "ah."  Then is the prosodic  or bubbly speech.  >> Yahoo!  >> Gilbertson: Very different.  Then the monotone or aprosodic  machine or nonsocial sound.  [beep]  Just a phone tone.  And then the bubbly machine  sound which is prosodic.  § [cuckoo, cuckoo] §  A cuckoo clock.  So those are just an example of  some of the things that the  children got to play with, and  you can see they're play sounds.  It's something that should be  fun and that's one of the  reasons we made it fun is so  that they would interact with  us.  >> You said if they got bored  with the first one you moved  them on to the second and what  happened if they got bored with  the second one?  >> Gilbertson: Well, there were  ten groups of sounds. 

 So the question was if they got  bored with the first or second  group of sounds what happened?  Well, we had ten groups of  sounds and I can tell you none  of the kids got through all the  sounds and were bored.  If that makes sense.  So again, this is what the child  saw.  It's the same as here but for  those of you in the back who  might not be able to see it,  it's just the device covered  with this nice foam pad because  if you know children they get  distracted by other things that  you might not want them to be  distracted by.  So we tried to cover all the  other keys and other buttons  so that we didn't have  any of those issues.  So out of sight, out of mind,  hopefully.  Which wasn't always the case.  But this is what our results  show.  And this is really exciting to  me.  If you look at these two pie  charts, the first one is for  kids who are typically  developing and the second is for  children with autism, and if you  look at them they look exactly  the same. 

 So that to me is interesting  itself when all of these other  studies show that there's a  difference.  And if you look at these pie  charts, also just to note, the  sample size was 30 children  total.  There were 16 on the spectrum  and 14 typically developing  kids.  And the results show  that both groups enjoy  the prosodic speech,  or the bubbly speech, the most  according to our measure.  And then the least preferred is  the green wedge, which is the  aprosodic or monotone speech.  So nobody likes to listen  to Ben Stein apparently.  So you can see there's a slight  difference in the preference for  the typically developing kids  and the children with autism,  the percentage is 31% for  prosodic speech in typically  developing kids, and it's 33%  in the kids with autism spectrum  disorder.  So it's a very, very minimal  difference.  And you can see the other two  categories with the red and the  purple which is the monotone  machine sounds or the aprosodic  machine sounds and then the  prosodic machine sounds, those  two categories were slightly  flipped in the groups, but again  very minimal difference.  Yes?  >> Is the difference  significant?  >> Gilbertson: Yes. 

 The question was is the  difference significant.  And the difference between  groups of sounds is  significantly different, but the  difference between typically  developing kids and kids with  autism is the same.  So that was not significant.  Does that make sense?  So their preference for prosodic  speech over the other sounds was  significant, statistically, but  across the groups it's not  significant because they are the  same.  Okay?  And that also goes if you look  back at some of the statistical  numbers we crunched a lot of  them, but I never liked to sit  through presentations that do a  lot of statistical analysis.  So I left a lot of that out.  Hopefully you'll trust me as I  tell you, but the statistical  significance was highest in  preference for the kids on the  autism spectrum disorder which  is again counterintuitive to  what other research has found.  They said that the children with  autism spectrum preferred these  sounds less than the other  groups.  So this is a little, this is  kind of flipping it on its side  and saying that the children  with autism have a higher  preference for prosodic speech  sounds than typically developing  kids.  So they like the sounds  even more. 

 It was just a slight difference  but it was a little bit more  than the other group.  Okay?  This is something that I think  we haven't mitigated yet but as  you look at this graph, this is  the number of times a child hit  the key pad per session.  So if I was with the child who  was typically developing, the  average child in that group  hit the button 42 times while  I was playing with them  in a session.  Whereas the kids on the spectrum  they hit the button about  26 times per session.  So the different four buttons.  So there's a very large  difference in the number of  times the child interacted  with me in this activity.  And so you can also see  the range of their hits on  the key pad is highly varied.  Especially for the kids in the  autism group.  You can see the range of times  they hit the key pad  was none to 180.  And so that's actually our star  performer was in the autism  spectrum group. 

 He had 180 hits, he loved  playing with this toy.  And then the range of the number  of hits is slightly smaller for  the typically developing kids,  it was six to 81 hits.  And you can see the standard  deviation is a little bit larger  for the autism group as well.  So that shows there's a large  variance in performance for  these kids.  So we weren't successful  necessarily in increasing our  activation of the key pad  compared to other studies.  So that's something that I'll  talk about a little bit later  why I think that is.  >> Excuse me?  >> Yeah?  >> How do you figure out which  kids on the spectrum to include?  Because if there was going to be  a difference would they be  children with more severe  autism?  >> Gilbertson: Yep, the question  was how do we determine which  children to include in the  autism spectrum group.  And the inclusion was simply the  diagnosis of autism spectrum.  Because the diagnostic criteria  are leaning more now to not have  those individual spectrum  diagnoses like Asperger's and  high functioning.  >> But you still have a variance  on the spectrum. 

 >> Gilbertson: Right, and that's  part of the spectrum.  You get the variance no matter  what you do because there's a  spectrum of behavior and a  spectrum of functions.  >> So then kids who had lower or  less autistic or whatever it is  would have the same reactions on  this thing?  >> Gilbertson: We didn't  differentiate low functioning  versus high functioning kids.  It was all kids.  >> Could that have made  a difference?  >> Gilbertson: It might have.  But that's something because  they're changing the diagnoses  we're not looking at  differentiating kids on the  spectrum.  We just want to see overall  general characteristics of kids  with this diagnosis.  >> So you didn't use  Stanford-Binet intelligence  testing?  >> Gilbertson: We do.  We had intelligence measures and  compared them across groups  as well.  Just to see if there is again--  Yep, again, you're going to see  a higher variance in the kids  on the spectrum than in  the typically developing kids. 

 So the question was about IQ,  and we did measure IQ  performance in these children.  And you're going to see, because  it's a spectrum disorder and  they're widely varied in their  display of behaviors, you're  going to see a lot of variation  compared to typically developing  kids.  Now this is just a graph to kind  of depict the performance  differences that I showed in the  previous graph on how the  children on the spectrum had  about a 50% less activation  average than the typically  developing kids.  Hopefully it looks blue  to you.  It's supposed to be blue.  The little blue diamonds  are the children on the  spectrum and then the red  squares are the children who are  typically developing  that we compared against.  And you can see the variance is  here, the children on the  spectrum, they have a wide range  of performance.  There were three children  who did not perform.  So we ended up having 13 kids on  the spectrum to compare against  our 14 kids who were typically  developing.  And again the star performer who  blew everybody out of the water  was in the autism spectrum  group. 

 And you can see his performance  is way up there kind of skewing  the scale of the graph.  So that's just again the number  of hits for each individual  child is what's showed here.  Now just to summarize the  results of this preliminary kind  of pilot study, first off we did  find that the preference was  almost completely identical, if  not very, very similar, for kids  on the spectrum and typically  developing kids.  Their preference patterns were,  as I showed you in those  pie graphs, almost identical.  Secondly, the preference for  prosodic speech was much more  robust, or I guess you could say  there was a larger significance  number for the kids on the  autism spectrum group  compared to the typically  developing group.  So they had a higher preference  for that prosodic speech sound  even though they both preferred  the same sound.  >> Why the difference in  responses?  >> Gilbertson: Why the  difference in responses.  That's something hopefully  we'll get to in our next set of  studies.  And I'll touch again on that in  just a minute here.  But then again the top  preference was that prosodic  speech which was kind of  interesting finding compared to  the previous research. 

 And then that last few graphs  I showed you there's a large  difference in the number of  responses we got per group.  So that's something again we'll  hope to address in future  research.  So a little bit of explanation  for you.  I think for one, we found a lot  of differences compared to past  research and we all were asking  ourselves why did we find  such different results.  And the first is that we  measured the child playing with  a toy.  We didn't give them  instructions.  We didn't have constraints on  how they were to interact with  the toy.  They basically were able to do  whatever they wanted with the  toy.  And I can tell you some  anecdotes.  Some of the children stepped on  it to activate it. 

 If you know kids with autism,  some of them have manual motor  dexterity issues and since this  is such a young age group it was  two- to three-year-olds, some of  them used their feet instead of  their hands.  Because if you look at this  device, the buttons don't  necessarily press down on their  own.  It's a flat surface, you have to  strike to pretty hard with a  fist in the center of the button  to get it to activate.  So that takes, itself,  some skill to do that.  So that's one thing again  I think has to do with why we  didn't see the number of  responses in the kids with  autism because again the device  had a little bit of a limiting  factor for us.  And that's something again we're  hoping to mediate in the next  line of research.  So the difference there from the  head turn is that we don't have  those external judges and we're  actually measuring what we think  is more of a preference measure.  And we're allowing them to  interact in any means they like.  Standing on it, hitting it, some  of them found a toy a hammer in  the room that we were in and  banged on it with that.  So there's a lot of different  interaction styles that can be  used with such a durable piece  of equipment. 

 And secondly, the sounds that we  used are a lot more unique than  the other studies have used.  Most of the other research has  used their mother's voice which  is something a child might be  kind of habituated to.  It's less interesting maybe.  They're always hearing their mom  call their name.  And so some of the sounds we  used might have more interest to  them.  And that's why we found some  differences in why they  preferred those speech sounds  because they were more  interesting speech sounds.  Yes?  >> Did you match the samples  in terms of gender?  >> Gilbertson: Gender.  That's a good question.  The question was did we match  the samples in terms of gender.  And we didn't match for that  per se, because there's a lot  more children who are diagnosed  with autism that are boys. 

 So there was a lot more boys  in this study with autism.  But the typically developing  group was a little bit  more varied.  So that's something we didn't  get to match them on.  >> Okay, so the typically  developing children were not  necessarily four times more boys  than girls?  >> Gilbertson: No, there were  more girls than boys, but it  wasn't an exact matched ratio.  Good question.  So a little bit of a conclusion  to draw us to an end here.  For future studies I'm very  excited to be working on this  project and continuing to refine  since this was more of a pilot  study for us, we're looking to  expand it to a larger population  of kids across different states.  And also the equipment  that we're looking into we're  actually kind of collaborating  with the engineering department,  hopefully, so that they can help  design something that's  specifically for this  experiment.  So we can eliminate factors  like the key pad's sensitivity  to a little kid's hand.  So we can eliminate some of  those technical difficulties  that were found with this  drum pad that we bought  off public purchasing. 

 So having something designed  specifically for this task  I think will greatly improve our  ability to manipulate and also  increase the number of responses  that we get from these children.  And then the setting in this  study, the pilot study, was a  little bit varied for the  children.  The children on the spectrum  were in a room with other toys,  with other parents, with  researchers, sometimes siblings,  sometimes videos.  So there were a lot going on  in these rooms.  So to me that also might explain  why we had fewer responses from  the kids on the spectrum because  the typically developing kids  were in a separate room that had  other toys in it, but it was off  their classroom so there wasn't  as many distractions.  So not only do I think we'll  increase our responses if we  control the settings for the  kids on the spectrum a little  bit better, but it also shows me  that it's pretty impressive that  they even wanted to play with me  at all in that setting  because there was a lot  that they could do.  And sometimes there was snacks  in the room too so I was  competing with a lot of stuff in  that setting.  So to me that was kind of  motivation that sound is really  important to these kids, and  they still like to listen to  sounds, and we can use that as a  motivating factor for all kids.  And then we are going to be  looking at different sound  features so instead of looking  at prosody as a whole, we're  going to kind of pick out  different aspects of prosody.  And I mentioned a couple of  those which would be the stress,  the specific frequency,  the actual duration. 

 So those are all components  of that term prosody  that we're hoping to pull out  and to see if those individual  components have any factor into  what the child is paying  attention to or preferring to  listen to.  And then the over-arching  message from this research is  that children who are on the  spectrum, even though they might  not be responding to their name,  still enjoy that special speech  that their parents, or that  child-directed speech,  that their parents would use  more often I think if they were  typically developing.  But so often if you're not  getting a response from someone  you stop trying to elicit a  response or you're just like oh,  they don't like listening to my  voice so I'm just not going to  make them listen to my voice.  So this to me really tells  parents forget all that, even if  they're not listening to you  they hear what you're saying I  think and they still enjoy that  verbal reward of your bubbly,  parentese, child directed  speech.  So that to me was the most kind  of warm-fuzzy that I got from  this study.  So with that, I have several  slides of references.  We have to give everyone credit.  And again the CDC website is on  the bottom there, and then if  anyone is interested in a lot of  the autism research on campus,  the Waisman Center is well  renowned for their research and  especially right now there's a  big push for autism research.  So if you go to the Waisman  Center website you'll find a lot  of information.  Even if their there are people  who you think might be  interested in participating  in research that's a great place  to send them to as well. 

 So those are some references for  you also used in the slides.  And then all the images you saw  were from Google searches.  Yes?  >> Are all these children that  you were testing getting  the 30 hours of one-to-one?  >> Gilbertson: I'm sorry,  will you repeat that?  >> Were these children that you  were studying getting the 30  hours a week of one-to-one --?  >> Gilbertson: Okay, the  question was are the children  in this study getting  the 30 hours of one-on-one  therapy intervention that is  starting to be required,  or kind of the gold standard for  these children.  And I have to say no, because  I saw these children right as  they were getting diagnosed.  So I actually met with the  children while their parents  were getting their diagnosis.  Yep?  >> I'm wondering about pets.  I've heard about the success of  many parents with pets and  autistic children.  And I'm wondering if your  research would have some hinges  into that?  Because if you would have a  noisy pet as opposed to a quiet  pet you could have some  benefits.  A dog that would give a little  bit as opposed to one that would  be just as friendly but perhaps  not as noisy.  >> Gilbertson: Yeah, the  question was about animals  and their benefit  in intervention strategies. 

 For example, if an animal was  more boisterous, say a dog that  barks a lot, if that's better  than a chinchilla that doesn't  really say much.  I don't know if there's any  research on that.  I know there's a lot of animal  therapy advocates out there.  But again that goes back to the  interventions haven't really  been empirically tested or  researched.  So that's, I think, something  that could be coming in the  future possibly.  But I don't know.  Yes?  >> I wonder why the spectrum  of autism was broadened?  Because initially when a child  received that diagnosis there  were specific behaviors that  gave the diagnosis, and now the  diagnosis includes a lot more  than originally stated.  >> Gilbertson: Okay, the  question was why the diagnostic  criteria was expanded to include  other behaviors.  And I don't per se--  I'm not a hundred percent sure  on the diagnostic procedures and  how they've changed, but I can  tell you that I think if it was  indeed expanded it was because  of getting children services.  If you don't have a label for  some developmental disorder,  you can't get services,  especially under the  Individualized Education Plan,  the Idea Act. 

 Individuals with disabilities  get special services if they  have a label that says you have  autism, okay now you can get the  special services in the school,  in your home, I think that is  really what it might have come  to.  I'm not sure if was expanded or  contracted at all as far as  their diagnostic criteria goes  though.  >> Well, before the Americans  with Disabilities Act it was a  very narrow diagnosis so  possibly there were political  ramifications which caused this.  >> Gilbertson: Yeah, yep.  The way our red tape society  works is I think partially why  you see an expansion of that is  because these kids need services  whether they have autism or not,  something needs to happen to  help them fit into what we think  is typical behavior.  >> Weren't a lot of them  years ago diagnosed as severe  language impairment and is that  still a separate diagnosis now?  >> Gilbertson: The question is  weren't a lot of children  on the spectrum diagnosed  as having language impairments.  And that is entirely possible.  If you don't have a definition  for something, you can't label  it and give it a diagnosis.  So I think personally I think a  lot of these children were  thrown in a mental retardation  category depending on the  severity of their symptoms.  And if they didn't have any  verbal language like 25% to 50%  of the kids don't, they might  have been thrown into that  specific language impairment. 

 So they might have been grouped  into other categories and again  I think that's why we're seeing  that increase in diagnosis  because we have a label for this  now.  It's a little bit better label.  Maybe it's expanded to include  other behaviors, and so that's  why we're seeing that increase  in diagnosis.  Again that goes back to that  epidemic question.  Yes?  >> What is the history of autism  and diagnosing autism?  Is it something that's been  around 30 years, 50 years?  >> Gilbertson: The question was  about the history of diagnosis  of autism and is it something  that's been around for 30 years.  And the answer to that  is yes it has been around.  If you look back in the history,  originally it was thought to be  caused from refrigerator moms,  it called, they're cold.  They weren't caring towards  their kids and they developed  into those nonsocial children.  And that's been disproven  So in the last, I would say 40  or 50 years, we've come a long  way in how we look at behaviors  and assess them.  So yes, there's a lot of change. 

 In my knowledge the best tools  that are available right now for  diagnosis, there's a test called  the ADOS and forgive me if I get  the actual name of it wrong  but I think it's the Autism  Diagnostic Observation Schedule.  And it was designed by  researchers from Michigan in the  last few years, and to me that's  probably one of the best ways of  evaluating these children.  There's also what is used,  is a parent interview.  And then of course a clinician  will evaluate the child through  observations and things of that  nature.  So most diagnoses now include a  wide variety of different  evaluations, observations,  tests, interviews and they're  all compiled, and oftentimes  psychologists or a pediatrician  will review all of these tests  or observations and then make  the overall claim.  And some people are very, very  liberal with their diagnosis,  and some people are very  conservative with their  diagnosis.  It really depends on who your  physician is.  Kind of like every other disease  or disorder, it really depends  on the physician as if they're  going to make that claim or not.  Because sometimes,  some people believe that  giving a child a label  is kind of like  a self-fulfilling prophecy.  If you label them then they're  going to start acting like that. 

 And it's not just for autism,  it's for all types of behaviors.  So some people are very afraid  of giving people labels.  But then, on the other hand,  you have the people who want the  label to get the services.  The diagnoses really depends on  what camp you fall in and who  your physician and psychologist  is.  Yes?  >> Could you go into just a  little more detail about how you  actually did the testing?  The child's there and you have  this box, do you, how does he or  she know to push the square?  Do you go ahead and push the  four squares a few times to get  them started, and then how do  you know when the switch the  screen?  >> Gilbertson: The question  was about the study design  on how I actually interacted  with the child.  And what happened is I did,  I just went into the room  with the child.  They usually were playing with  other toys or eating a snack,  or hanging out with their mother  or their other siblings, and I  would set the device on the  floor, and I would play each  sound once, and then it was  really up to the child.  Sometimes they would come over  and play with it, or try to  activate it and if they couldn't  because they didn't have, they  weren't making a fist, I would  demonstrate, make a fist,  hit it in the middle.  But I wouldn't really give them  any instructions.  So my interaction was very  limited. 

 I just played them once and then  the only instruction I gave them  was on how to activate it  if they were having troubles.  As far as advancing to the next  set of sounds, I would do that  after the child left the device  and was like I'm done with that,  I would advance it  and play the sounds again.  They might come back,  they might not.  And then the child also  could do it themselves.  As you see there's a section of  the cover missing so that they  can advance too.  That answers your question?  Yes?  >> Is the incidence of this  spectrum disorder similar in  different parts of the world?  >> Gilbertson: Yes, the question  was, is the incidence similar  in other parts of the world.  And the answer to that is yes.  This is something that spans  all socio-economic status.  It spans all cultures, it spans  all races.  It's something that's  ubiquitous. 

 Yes?  >> I'm assuming there's a  trouble diagnosing it, that  there's no physical problems,  I mean physical aspects  like down syndrome or anything.  >> Gilbertson: The question was  are there problems diagnosing  because there's no physical  evidence like in down syndrome.  My answer to that is the trouble  diagnosing is that the behaviors  that they're looking for are  varied, and the severity of the  behaviors in a child vary as  well.  So you're including children who  maybe are let's say, to use an  example the children who are  classified as having Asperger's  syndrome right now are typically  people who are on the higher  functioning end of the spectrum.  So children with Asperger's  syndrome, they have a problem  with social interaction so  they're not quite good at maybe  understanding sarcasm  or hidden meanings in jokes.  So interactions with their  peers, especially at school,  sometimes they can get into  problems because they  misinterpret how someone said  something.  They don't hear those hidden  meanings or that sarcasm  seething from their words.  So that example that's something  that is more high functioning.  So that's included in the  spectrum.  And then the low functioning, I  hate saying this high and low  functioning because we're kind  of eliminating that now. 

 And everybody is unique but the  low functioning is what it's  characterized now, those  children per se, they have  aversive reaction to say being  in any sort of social situation.  So maybe they will start hand  flapping and having maladaptive  behavioral tantrums.  So you can see there's such a  wide array of behaviors that  fall into this category.  That's why there's, I think,  a little bit of ambiguity in  diagnosis because we're catching  so many things in this one  group.  But it boils down to children  having a problem with social  interaction and communication in  a typical setting.  Yes?  [INAUDIBLE]  >> ...some genetic cause,  my question is that do you have  any model for this kind  of -- ?  >> Gilbertson: I'm sorry,  I missed the last part,  do I have any...?  >> Do you have any more model?  It is difficult to do a genetic  study for this disease.  Do you have any more model?  [INAUDIBLE]  >> Gilbertson: Okay, the  question was as far as the  genetic link is concerned  is there a model for studying  the genetic link?  And I am not well enough versed  in the genetic literature to  answer that question,  is the best I can say.  If you look at some of the  research, do like a Google  scholar search or something if  you're interested in the genetic  side you might find in those  studies how they're modeling  that.  But there's over, I think,  11 genes or so right now that  they've linked to risk factors  for autism.  So I don't know what the models  are for studying that per se. 

 >> The question was is there an  animal model?  >> Gilbertson: An animal model?  >> Yeah.  >> Gilbertson: I do think there  is an animal model  being developed at the  Waisman Center in collaboration  with someone who I forget his  name, but I do think the animal  models are out there but I  haven't seen them, I don't know  enough about them.  I apologize.  >> Do animals have autism?  >> Gilbertson: I'm not sure.  >> Different question.  >> Gilbertson: Yeah?  >> Would you expand on the  implications of your study.  I'm thinking that traditionally  autism was viewed as a  difficulty in inputs and what  your study seems to me to  suggest is it's more difficulty  in outputs as far as a child is.  Have you done any --?  >> Gilbertson: The question was  how my study relates to  the current thinking of autism,  is it a problem with input  or is it a problem with output.  And I can say that the research  that I'm doing it's hard to say  right now what it is because the  child doesn't produce per se, a  nonverbal child doesn't produce  speech.  And so trying to look at why  that is. 

 So why are they lacking that  speech?  So we're looking at the input of  that auditory feedback loop to  see if they're getting the input  of those speech sounds.  And if they're not paying  attention to those speech sounds  then that could explain  why they're not speaking.  So this study kind of  contradicts that idea as to  they're not listening to those  speech sounds so that's why  they're not speaking.  So that's again why we're going  to parse out if there's  different aspects of that speech  signal.  Stress, pitch, frequency, that  kind of thing.  So it's hard to say what's  causing that lack of language or  verbal language, I should say,  in those children from this  study yet.  But we hope to.  [INAUDIBLE]  Yes, it's encouraging.  Again the weight of this study,  don't give a whole lot of weight  to this study because it's again  the first that's kind of found  that, it's a small sample.  So we'll hopefully have more to  share in a couple years. 

 Yes?  >> I'm wondering about the kind  of diagnosis and labeling  process that goes on if parents  are fighting the label of autism  or are they accepting it and  perhaps even embracing it  knowing that there's some money  possibly coming for education  with that label because, of  course, labeling the diagnosis  is a social and political  process.  >> Gilbertson: Okay, the  question was about how parents  and other people are reacting  to labels, versus nonlabels  for autism.  And my answer to that question  is again you have two camps.  You have people who have autism  who like to be called autistic  because they think that's who  they are, that's part of me, if  you change that then I'm not who  I am.  And then you have people who are  in the camps saying that we need  to use person first language  because they're a person,  they're not autistic.  So you say a child with autism  instead of saying I'm autistic.  So again even among people who  have autism there's a debate on  how they feel about being called  autistic or what language we  should use because a lot of  people will consider it, I'm  just neurally diverse.  I have a different way of  thinking about life.  I have a different way of  thinking about social  situations.  That's who I am, accept me as  I'm different. 

 So there's a movement for that  and there's also a movement for  accepting them as a person.  I tend to be on the side of  people who have autism that's  part of who they are, and we  need to accept some of their  behaviors as that's who they  are.  But that's my personal opinion,  there's nothing really that can  back that up by research or  anything like that.  So you do have people who have  autism when they see like autism  awareness day it kind of hurts  their feelings because I'm not  broken why are you trying to fix  me kind of a thing.  It's a hot topic.  It's a big debate and it's  really kind of personal  preference and opinion on who  you talk to.  But I think the best way to get  around it is to say this is how  I feel about it, explain why  that's why you feel about it and  then you have to agree to  disagree.  Yes?  >> Are people better able to  concentrate for a long time on  something that a lot of people  or most people consider really  boring?  >> Gilbertson: The question--  >> Can they solve problems  like most people would get tired  and give up?  >> Gilbertson: The question was  are people on the autism  spectrum better able to focus  for long periods of time,  better able to attend  to a problem that somebody might  not want to solve or something  of that nature.  My answer to that is you'll have  children who perseverate and  that's part of the diagnosis is  they'll perseverate on things.  What they perseverate on is  widely variant. 

 So if they decided to focus all  of their attention on math, like  you've probably seen the movie  Rain Man, that's somebody who's  considered an autistic savant  where they have a very highly  advanced skill and that's rare.  I would say maybe, I don't  exactly the percentage, but I  would say no more than 10% of  kids on the spectrum have a  gifted, really advance skill.  But again it depends on what the  child perseverates on.  Some children like spinning  things so they'll watch a  ceiling fan for hours because  it's really interesting to them.  Or it could be not just  interesting but it could be  soothing to them.  There's evidence that shows that  that might be them trying to  suppress all of the stimulation  that's coming from everything  around them is just focusing on  one thing.  So because there's a lot of  things we don't know and because  there's a lot of variability in  the children and their behaviors  it's hard to pinpoint exactly.  Yes, they'll focus on this or  all the kids will focus on one  thing so I can't answer  that definitively.  But there are savants that have  special skills.  A lot of people say that Bill  Gates has autism. 

 Whether that's the case I have  no idea.  Does that answer your question?  I hope so.  Yeah?  >> What are some current  theories about what might be  causing this change in the kids  at about a year, 18 months,  two years?  Kids that maintain eye contact  have been really beginning  speech sounds and it changes.  And that's why the vaccine  theory came up, I suppose, but  what are some other current  possible causes for that?  Are people working on that?  >> Gilbertson: The question  was what are some possible  causes for triggering autism?  Okay, and some of the theories,  I guess, that are out there.  And I don't know all of the  theories but I know a couple of  them.  One is believed that there is a  rapid brain growth in children  who are between 18 months,  two years, and that rapid brain  growth is what causes that  kind of limited sensory input  capabilities that if they don't  have the synaptic pruning like  many children do where the  neurons that you don't use die  off, if they don't have that  synaptic pruning they might get  sensory bombardment.  So that's one theory.  So that might be why they  perseverate on something to  minimize the sensory input that  they're receiving around them.  There is also kids with fragile  X syndrome, for example, that's  a problem with pruning again.  They don't have the pruning of  their neurons so their reaction  time is a lot slower. 

 Their brain is not as efficient  in dealing with input.  So because that's highly linked  with autism, people with fragile  X are more likely to have  autism, that's kind of where  that theory has developed.  As far as other theories go  there's been a lot of research  showing that there are brain  differences.  So a lot of effort has been  looked into neural connections,  different parts of the brain.  I think at this point we can't  really say for sure because  there hasn't been enough kind of  repeat in the literature at this  point, in the research.  We haven't really continually  found the same evidence.  And there's been some brain  research that's shown more  cortical folds in the brain.  So they have a wrinklier brain.  Or there's been a larger  hemisphere in some kids  when they do imaging studies.  So I think some of that goes  back to the variance in the  spectrum. 

 So some kids might have more  folds or some kids might have a  larger hemisphere, and so I  don't at this point if they've  been able to narrow it down to a  specific brain function but a  lot of it has to do with genes  and brain anatomy is kind of  what the theories are basing  themselves around.  Hopefully, does that answer your  question?  >> I was looking at any external  environmental things that might  be triggering it.  >> Gilbertson: Not so much.  The focus has more been on  looking at the brain and the  brain activity especially in  social situations.  And you can see some of the  research here at UW is focusing  on just that.  Trying to figure out why that  social aspect of behavior is  different in these kids.  And there have been a lot of  studies in the past looking at  that refrigerator mom concept.  And that was where they were  looking at more of a  environmental maternal input and  that's been disproven to be a  problem.  And especially since it crosses  all cultures, all socio-economic  status, all backgrounds,  that kind of eliminates your  environmental influence.  It's more what might trigger  these genes and what's going on  in the brain is what people are  looking at now. 

 Is that better?  >> Yeah.  Food, for instance, is an  external thing.  I know that some theories.  >> Gilbertson: There's some,  I don't think that's been tested  as much.  That's kind of one of those  interventions that people say,  oh, change the child's diet.  That hasn't really been studied  as much yet either.  Yes?  >> Is there a correlation  between children and adults?  Have their been studies that are  equivalent of people who have  autistic spectrum diagnosed as  adults how they would react to  different things?  Has the only testing been on --?  >> Gilbertson: Yep, the question  is about is there any testing  or research being looked at  in adults.  And I have to say that most of  the research is in teens and  adults.  It's not in the young children  that you saw here because  if they're doing brain imaging  that's a highly invasive  procedure for a person who has  sensory issues.  Even for myself, to ever be in  an MRI machine is very  claustrophobic. 

 So to even do that study you  have to use people who are more  high functioning in typical  society and they usually have to  be old enough to understand  what's going on and then they  have to be able to tolerate  what's going on.  Oftentimes, the brain research  that's going on they have a  practice room where it's just a  fake MRI and they go through the  motions and they kind of get the  child used to, or the teen most  often, used to be being in that  setting before they even worry  about going to the actual MRI  machine and wasting all that  time to have them have a  reaction to it.  So most of the research is done  on older teens and adults.  This is kind of a new thing to  look at younger children.  >> One more question.  >> Gilbertson: Yeah.  >> Other than gender and  heredity, there really aren't  any other risk factors  from what I hear.  >> Gilbertson: The question is  about risk factors, we know  there's something about gender  and there's something about  heredity, but what are other  risk factors.  And that's something that I  think will kind of come out as  more of the genetic models are  developed.  Maybe there will be an animal  model where we can study and  find specific genes and the  combinations, but because it's  a multigene risk, I think that  we'll never be able to pinpoint  exactly the cause or risk. 

 We could just say this person is  more likely to have it because  it runs in their family--  and they're a boy.  Okay.  (applause)