Living with Autism Horizon

There are over half a million people

in Britain who experience the world very differently to the rest of us.

These are people with autism.

A puzzling condition which, 70 years after it was first given a name,

we still know very little about.

My name is Uta Frith.

I'm a psychologist and I've spent my career

trying to unravel the mysteries of the autistic mind.

By spending time with many different people on the autistic spectrum,

I want to show you what a complex condition it is.

I want you to join me as I reveal

what I've discovered about these amazing people.

23rd of May. CHILDREN SHOUT OUT

16th of August 2001.

It was a Thursday.

Kenny, how do you do it?

How is it possible to have this extraordinary ability?

And how do people with autism cope with relationships?

I don't know. Why are we together? You tell me.

You're my...required amount of social contact.

SHE CHUCKLES

These fascinating people that I've met over the years

have shown me that another kind of reality exists,

that is full of immense challenges, mysteries...

but also joy.

Mum always wears blue because of the dolphin thing.

-He thinks I'm a dolphin! Why?

-You've got the dolphin smile.

-It's the smile!

-And you love fish, like dolphins.

-I do love fish.

You like us to throw you sea bass when you're in bed.

I want to show you that by understanding their world,

we can learn more about OUR world.

In my quest to understand the autistic mind,

I've spent a lifetime conducting rigorous experiments.

OK, let's have a look.

By comparing people with autism to the rest of us,

we can start to see what autism really is.

My fascination with autism began 50 years ago

when I met some autistic children,

while I was training to be a clinical psychologist.

I was immediately fascinated of the paradox of how these beautiful,

bright-eyed children could be so detached from the world.

When I asked a question, an autistic child would repeat it

and not answer it. And I couldn't engage them in a conversation.

And I couldn't engage them with toys, either.

An autistic child might rapidly complete a jigsaw puzzle

but show absolutely no interest in a game of teddy bears' picnic.

I passionately wanted to find out what was going on here.

Back in the 1960s,

these children were being given the new diagnosis of autism.

"Autos" in Greek means "self"

and refers to their apparent self absorption.

Autism takes on many forms

and exists on a wide spectrum, from mild to severe.

It was, and still is,

characterised by the difficulty these children have

communicating and interacting with others

and by and their tendency to have very narrow interests

and to repeat activities over and over again.

What's this, Joe? What's...

One of these children was Joe Allison.

-'And this?

-Bowl.

'Bowl. And this?

-'Box.

-Box. And this?'

-Who is that?

-Yes.

-It's...

-Joe Allison.

It's Joe Allison learning to talk.

Yes.

-'What's this, Joe?

-Money.

-Money.

-'What's this, Joe?

-Money.

-Yes, money.'

Joe is now 57

and this is the first time I've seen him since he was a young boy.

-Do you remember her, Joe?

-Yes.

-She was very kind.

What is this, Joe?

HE MUTTERS What is it?

-Ba-ma.

-A barrow.

-A bu-bbow.

Back then, we thought that

if only we could teach these children to speak,

then everything would be OK and the autism would go away.

'Joe understood about the Christmas story,

'about Father Christmas and Christmas dinner.

'And it's the first time we've been able to have a tree

'and none of the ornaments have been broken.'

-And who's this?

-Mum.

-Is it Mum?

-Yes.

-'So now you have some hope for Joe?

-I certainly do.

'I don't know how far he will go but one feels if he's gone this far,

'why shouldn't he go a great deal further?'

-That's nice, isn't it?

-Yes.

'But 50 years on,

'we now know that autism is a lifelong brain abnormality.

'Half of those affected have significant learning disabilities

'and well over 80% are unable to live independently.'

When I tell people what I do, the first thing they ask about

are the autistic individuals known as savants,

who have remarkable gifts.

Many people with autism have talents

that appear to be at odds with the rest of their abilities.

And occasionally, these skills can be quite extraordinary.

Start with the easy one...

and work your way down through these operations

to get your answer at the bottom.

This is 15-year-old Kenny Mpanga,

who was diagnosed with autism when he was eight.

Unlike many other autistic children,

Kenny is able to attend a mainstream secondary school,

with a specialist autism unit.

Would anybody else be able to have a go using that method now,

Kenny's method, for doing this? 24 squared.

Watch what he did again.

Kenny has a gift for mental arithmetic...

How many could multiply 9 by 36 in your head, though?

..and constantly amazes his classmates.

-Kenny, you're too smart!

-HE CHUCKLES

You are actually too smart! You got all of them correct.

-Why are you in this set?

-Why? He's so smart! Seriously, how, how?

-What do you do?

-It's a secret?

It's an African thing!

THEY CHUCKLE

And Kenny has one very unusual talent.

-22nd of February.

-Oh, that was a Thursday.

-23rd of May.

-It was a Wednesday.

16th of August 2001.

It was a Thursday.

He's a calendrical calculator...

That was a Saturday.

..which means you can give him a date in the past or future

and he'll tell you which day of the week it falls on.

Thursday.

-..1936.

-Er, that was a Tuesday.

Kenny's of huge interest to psychologists,

who want to know how he has acquired this remarkable skill

despite his language difficulties.

He and his mum Harriet have come to

the Institute of Education in London, so that he can be assessed.

Then in 1878...

Professor Richard Cowan studies calendrical calculators, like Kenny.

-1889, it was a Wednesday.

-Yeah.

March the 14th 1985.

-I would say that was a Thursday.

-Absolutely right.

And how about April the 22nd 1977?

That was a...Friday.

Absolutely right again.

-And the 6th of July 1987?

-That was a Monday.

Brilliant, yeah.

I mean, it's remarkable, isn't it?

So you're very... It's almost like you're taking no time at all!

I mean, do you see anything in your head?

-I mean, do you have a mental image of the calendar or...?

-No, I don't.

-So it's just... You hear the date and you know the answer?

-Yeah.

It does blow you away sometimes, you know,

the way he just knocks those off.

But it can be quite an amusing party trick when, er,

he tells people these things and they all go, "What, what, what?!"

It is quite amusing but, er, yes, it does keep him busy.

It's good to have a hobby.

How did you go about working out the dates in the future?

It all started when I was about seven or eight.

I didn't look in any diaries or calendars. OK.

I just, er...

I think I just remembered that, er...

Certain dates being a certain day

and remembering that and, er,

knowing that, er, every...

Every year a day goes forward, apart from leap years.

OK, so that's the "one year, one day" rule.

That's when I also found out that, er,

in one century every 28 years are the same.

OK, so within a century every 28 years repeat.

What's remarkable is that Kenny has identified complex patterns in the calendar,

including the irregularities caused by leap years.

And he works the answers out in a second.

The 20th of December in 1994.

-That was a Tuesday.

-Yep.

And the 3rd of August in 1980?

-Er, that was a Sunday.

-Yes, again.

Kenny's excellent memory and his desire to practise obsessively

are two features of the autistic mind.

But his skill goes far beyond just memory and practice.

He's able to spot patterns and he's devised his own system

for coming up with the correct answers to date problems.

This is very creative.

Only about 10% of people with autism are as gifted as Kenny,

but as many as a third have unexpected abilities -

like perfect musical pitch

and being able to recite from memory.

Well done.

So what does Kenny think about his autism?

I see things in a different way than my other peers do and, er...

And sometimes they think I'm, sort of, weird, the way I, er...

I express my thoughts and opinions and, er,

I guess some of my peers don't understand.

I just... I think about things a different way.

Can we ever discover what it is about the autistic mind

that enables such remarkable talents to develop,

aside from memory and practice?

Hello, Peter.

'I've devised a task,

'using the popular children's game Where's Wally?,

'to help explain the way autistic minds work.

'The challenge is to find a tiny picture of Wally

'in amongst this chaotic scene.

'Peter, who doesn't have autism, struggles to find Wally.'

Yeah, where's Wally?

Come on, Wally, where are you?

OK, let's have a look.

'Paul, who is autistic, finds him really rather quickly...'

That his archenemy. I obviously know that. And his girlfriend there!

-Oh, there he is.

-Wow! That was amazingly fast! That's amazing.

'..whereas Peter's still trying to find Wally.

'Next up is Chloe, who is also autistic.'

Amazing! That was fabulously quick.

Well done! Well done!

'And then Laurie, who's also on the autistic spectrum.'

That's it! That's amazing. Yeah! Amazing!

'Peter needs some help.'

-Do you want, er, a kind of vague clue, or not really?

-Er, yes.

A vague clue. Sort of like...

Oh, he's up, is he?

The boats are a good clue.

Yes, right, OK.

-That him?

-Yeah!

'The one thing we've noticed time and time again

'is that autistic people see details that escape the rest of us.

'This gives us clues to understanding the condition,

'because it means that they often miss the bigger picture -

'focusing instead on the details that are the same whatever context they're in.'

And it doesn't just apply to Where's Wally? -

it shows us how differently autistic people experience the world.

And it explains why they get upset

when an ornament in their house has been moved a fraction,

and also why their interests seem so narrow.

This intense focus on detail

and the abilities that sometimes emerge from

it is a strange quirk of our mind -

and it's a quirk that's very frequent in autism.

But it doesn't begin to tell us what autism is really like.

Sidney, can you start it for us, sending a clap in one direction? Thank you.

The serious problems people with autism face

are when they have to interact and communicate with others.

I've come to meet acting student Jules Robertson,

who has a form of autism known as Asperger syndrome.

People with Asperger syndrome do not have language problems

and are of average or above-average intelligence.

Jules has recently enrolled on a drama course

because he wants to be an actor.

So, Sidney, can we have you sitting on the bus?

I join him and his mum, the novelist Kathy Lette,

for what turns out to be an interesting and unusual conversation.

-Jules has this idea that everybody has an animal.

-Oh!

-They have a totem animal.

-Mum always wears blue because of the dolphin.

-He thinks I'm a dolphin cos of my big...

-What about me?

-What do you think? What animal am I?

-Like a flamingo. A flamingo head.

-You've got a face like a flamingo.

-Like a flamingo!

-Why am I a dolphin?

-Why?

-You've got a dolphin smile.

-Smile.

-It's the smile!

-And you love fish.

-I do love fish!

-You love sea bass.

You like us to throw you sea bass when you're in bed.

And I jump up and catch it!

I just wanted to ask you, what is it like for you to have this chat here?

Well, yeah. Having...

I can tell you what it's like having Asperger's, as well. That's very...

-Well, please.

-So hard. Er...

It's really hard. People don't understand how hard it is.

They just... They just don't.

They just expect me to be able to...

get on with life really easily and it's not easy for me to do that.

But is that also why it's difficult just to chat and...

-You know, just to chat for no reason?

-Yeah, it's hard to...

-to, er...make effort with people. To be engaging with people.

-Yes.

It's really challenging.

THEY CHUCKLE

-Jules, do you want to go in and make...

-OK.

-..Becka disappear?

Do you like Steve Martin?

THEY LAUGH

What's remarkable about Jules

is that he's able to use his acting classes

to help him cope with the social world.

Oh!

You can leave any time you want, Jules. Well done!

What we're seeing, really, here

is a little universe of social interactions -

little miniature scenes are being enacted.

And we see how much reciprocity there is between these young people.

Freeze!

This acting class gives Jules an opportunity

to learn about social interactions and the natural flow of everyday conversation,

which is precisely what autistic people struggle with.

I was one foot from the ball!

I think that Jules really has taken advantage of this

and he's able to learn a lot about what's going on

in a very relaxed and playful way, that situations can be rehearsed.

-YOU CANNOT BE SERIOUS!

-Freeze!

Dad, you need to seriously stop wearing my clothes!

LAUGHTER

Mom's going to freak out again!

You remember she drove herself to drink last night!

-Well, I am a transvestite!

-No, but Mom doesn't need to know that.

Freeze!

Jules copes really well in his acting class

and his lack of filter helps the other students

to lose their inhibitions, too.

But it's real-life social interactions

that are the challenge for him.

I observed you being with the other drama students

and you seemed really happy there. Was that true?

I was very happy there.

I'm not so happy now but I was really happy then.

Jules will always tell the truth.

I used to try and explain to Jules that you couldn't always be truthful -

you know, that you had to be more diplomatic...

That is a problem, isn't it? Can you sometimes tell a lie?

Is it sometimes all right to tell a lie?

He used to say to me, "Are you teaching me to lie?"

And it's a hard concept, isn't it?

What do you think, Jules? Do you...

Er...

Er...

No, I think it's good to tell the truth.

So I'm always in favour of that.

Where does it come from?

-Why does it happen?

-Autism?

-Yes.

-What do you think?

-What's your explanation?

-I just think...

I just think people's brains are different.

Yes, I think you've hit the nail on the head.

-People's brains are different.

-Yeah.

And that's how the world is.

Jules is so likeable and charming, and really good company.

But it is clear that often he just does not get it.

He dances to a different tune.

What I've learned over the last 50 years is that not having

a special kind of social navigation system

is what sets autistic people apart from the rest of us.

So why can't people with autism fully share in our social world?

Is there an extra social sense beyond sound, sight and touch

that they don't have?

Here is a deceptively simple task that I helped devise in the 1980s.

It gives some insight into how most of us who don't have autism

instinctively understand the complex to and fro of social interactions.

So, I'm going to tell you a little story about these two dolls.

This one is Sally...

..and this one is Ann.

Sally has a basket

and Ann has a box.

And Sally...

..has a marble and she's putting that marble into her basket.

Keep it safe.

Now Sally wants to go out to play

and she's going right out of the room.

Now, Ann...

..naughty Ann...

..takes that marble

out of the basket...

..and puts it into her box.

There it is.

Now it's time for Sally to come back...

..and she wants to play with her marble.

Where will Sally look for her marble?

In her basket.

Of course!

-Why does she look in her basket?

-Cos she put it there.

She did, and...?

She didn't know that the other girl took it.

Yes.

Why didn't she know?

-Cos she was out.

-She was outside. She didn't see it, did she?

-No.

Ha!

Well done.

We'd expect most normally developing four-to-five-year-olds

to correctly identify where Sally will look for her marble

when she returns.

They understand that Sally has no knowledge of the marble being moved

and so she will look for it where she put it,

rather than where it really is.

What this shows is that most of us instinctively know that other people

have their separate beliefs, wishes and intentions - minds of their own.

It turns out that this is the key to understanding other people,

to explain why they're doing what they're doing.

It's our extra social sense that we haven't had a name for

but I called it "mentalising",

because beliefs, wishes and intentions are mental states.

Could you please hide that coin somewhere?

All right, I shall hide it in the special pyramid box.

-There it is.

-OK.

Back in the 1980s we discovered that autistic children

had a very different response to Sally/Ann-type tests.

This is ten-year-old Aurelius, who is autistic.

I take the coin from here...

My then colleague, Dr Alan Leslie, asks Aurelius where he thinks

I will look for my coin after it's been moved.

-And when Uta comes back in...

-Yes.

..where will Uta look for her coin?

In the triangle box.

'Aurelius says that I will look for the coin where it really is,

'rather than where I must believe it is.

'He doesn't understand that I can't know the coin has been moved

'and that I now have a false belief,

'because he doesn't take into account that I have a mind of my own

'with beliefs and thoughts that are different to his.

'And this is the key to understanding the social problems of autism.'

Well, my coin is here, isn't it?

No!

I believe that mentalising is that extra social sense

that most of us are born with and that makes us

so curious to know what's in each other's minds.

Also, it enables us to change other people's minds through persuasion

and sometimes to manipulate other people's minds through deception.

You won't find autistic people doing that.

Autistic people don't have that extra social sense

and that explains why they're often so frustrated

when we don't know already what's in their minds.

The challenges caused by the absence of this extra social sense

never go away for people with autism.

-Hello, Cathy, I'm Francesca.

-Hi, nice to meet you.

My collaborator of 20 years, Professor Francesca Happe, and I

hit on the idea of using animated cartoons

that give the compelling impression of social scenarios.

Would autistic people interpret the scenarios

in a different way from the rest of us?

You'll see two triangles moving around, interacting on the screen,

and I just want you to tell me what you think is going on.

As it unfolds, let me know

what you think's going on between the triangles.

The actors in these movies are two little triangles

and the challenge is to work out what the story is.

Try it for yourself.

Cathy is not autistic

and she has just watched this story about persuasion unfold.

The big triangle is trying to persuade the little triangle

to come somewhere with him and he's trying to encourage him

and now he's pushing him along.

The little triangle is quite reluctant, I think.

Oh, and he's just been barred from re-entering, hasn't he?

These animations invite the spontaneous use

of our extra social sense, mentalising,

and most of us immediately get the gist of what is going on.

It's almost like a parent pushing their kid out

or persuading them to leave the little pen.

Fantastic. That's lovely. OK, we've got another one now.

The second movie was about the little triangle

playing a game of knock and run.

The little blue one's coming... He's knocking on the door.

The red one's going to open the door and he's gone, hidden.

Oh, it's like a knock-knock and then hide round the corner

like a kid knocking and running on the front door of the house.

Gone back inside.

Sat down, relaxing, and the kid's knocking again.

There we go - open the door and he's gone, yep.

It's knock and run. Oh, he's going inside now.

Yeah, like a child playing a trick on their mum or dad

while they're relaxing, watching telly or something,

they get a knock on the door

-and then they're running round the corner.

-Fantastic.

..and I'll move you in on your chair

so that you're just in the shot.

Can you edge forward a little bit more..?

When the same movie is shown to autistic people,

they miss the point of what is going on.

They tell a story, but it doesn't fit the action.

Yeah, so the big, red triangle looks like it's trapped

in the big, blue square.

Then the small, blue triangle comes.

It looks like he's trying to look for a way...

He unlocked the door for the red triangle and then...

We showed these animations to people in a brain scanner

and found that autistic people had less activity in those brain regions

that are now known to be dedicated to mentalising.

I think it was a boxing ring and one of the opponents was sizing up

the other one before he'd let him in.

And then when they got in,

they decided they didn't want to fight.

It's more like an opening and closing of something

for that one.

I think that's it for that one.

Ah, that's interesting - the red one's escaped.

Oh, what's he going to do now?

Ah, I thought that would happen. The red one's slipped back in.

Maybe he's been taken prisoner

by the blue triangle.

"You will like your dungeon!"

Oh, now they're having a bit of a barney and fighting with each other.

When it comes to interpreting the triangles as agents,

they really can get hold of the wrong end of the stick and then,

of course, that leads them into a completely different kind of script.

But it's really a wonder, isn't it,

how we can actually agree with each other

about our interpretations of things that are just geometric shapes?

Yes, or particularly to think that we made up

the scripts of those animations on the train

and we thought, "How should they move?"

We made them so they looked that way to us

and when we first showed them to ordinary people,

we had no idea whether they'd see them in the way that we'd seen them.

It was amazing that even children as young as four or five

could get the gist.

We were very surprised at that.

We seem to share a way of interpreting each other's actions,

so imagine being autistic and not having this nifty piece

of mental machinery that instantly tracks social interactions.

Just watching a cartoon or listening in to a chat

can be a baffling experience.

You don't know why people say what they say

and you don't get the point of jokes and banter.

Likewise, if you don't know what's going on,

you tend to say things that others can't comprehend.

All this can make you anxious, frustrated and vulnerable.

Is anyone here anxious now?

Anybody feeling particularly anxious or worried now?

Why not?

Why aren't you anxious?

You should be.

Anxiety, really,

is the feeling that you're probably not going to be able to cope

with something that is about to happen,

-something in the future...

-This is Sarah Hendrickx.

She's an accomplished public speaker on the challenges of autism.

Anxiety is about, "I can't handle it."

When I saw that, I thought it was a penguin.

I didn't think it looked like a penguin.

I thought it was a penguin.

I thought that a penguin by the side of the road

was possible in Brighton.

Your world has got lampposts in it.

Mine's got penguins.

And she has been diagnosed with autism spectrum disorder.

It's not all bad. It's much more interesting.

Thank you very much for your time.

So how can someone with autism,

who finds social situations challenging,

get up in front of hundreds of people to give a speech?

This is a functional communication,

and I'm very good at those situations.

I'm good at doing my talks, I'm good at doing training

because it is prescribed. The topic is prescribed, it's my topic,

it's my script.

It's not two-way - you have to listen,

I've got the microphone, I've got the stage.

It's a completely different dynamic.

Just like Jules,

Sarah has no problem performing in front of others.

But off the stage, chance encounters and interactions with other people

are unbearable for her.

-INTERVIEWER:

-What are people to you in this sort of situation?

Frightening.

Most people are frightening. Most people who...

..who don't have a purpose are frightening.

If I know who they are -

so, the bar staff, or the people who organise the conference -

I know who they are, they're not frightening,

because the type of communication that we're going to have

is pretty set, is pretty limited, is pretty inflexible

and I can fairly well predict what that will be.

But a completely unknown person that I either don't know

or I fail to recognise,

I have absolutely no idea what's coming next

or what they're going to want or what they're going to say

or whether I can respond appropriately quickly enough.

Sarah is highly intelligent and is one of the rare people

who are able to describe exactly why social situations are so baffling.

This gives us a real insight into her condition.

Every day I try to wake up about an hour before

I actually need to get up

and I spend that hour running through what's likely to happen,

what types of people I might meet, if I'm having a meeting

or something like that, what kind of conversation.

I will run, re-enact a potential conversation over and over again

before I get out of bed to try and have a kind of sense

of what the whole day is going to be like.

What's amazing about Sarah is that she very consciously studies

and imitates the way people respond to each other in social situations.

That enables her to effectively mask her autism when she's in public.

What do I do? Do I sit here?

Sit there.

Sit there?

'I've had to watch people, I've had to study people,'

because it's not there intuitively and if I didn't do that,

I'd be completely lost.

But my failure rate is quite high because my learning is rote

and therefore I'm prone to not pick up the subtleties,

the nuances of situations,

so although I'm trying very hard

to apply all this stuff that I've learned,

I do get it wrong and I get it wrong with frequency.

And that's very, very stressful.

So it could be that imitation is the key to Sarah's success.

Do you like my nose?

But there are different kinds of imitation

and one kind might not be so easy for people with autism,

but might be crucial to the way most of us bond with each other

and fit into the social world.

It can be seen in an experiment by my colleague Dr Antonia Hamilton.

Here, children are asked to complete some simple tasks.

-Hi, Joel.

-Hi.

-Thank you for coming in today.

Here I've got a big box and hiding inside this box I've got a boat.

First, I'll show you how I get the boat out, then you'll get a turn.

There's my boat. It's a nice red boat, isn't it?

I'll put that back in there.

Ordinary children mimic exactly what their instructor has done,

even the pointless finger tapping.

Well done.

-Now it's your turn. Can you get the boat out?

-Yeah.

Well done.

TAPPING

There's my boat. It's quite a little boat, isn't it?

Now, autistic kids have a different approach,

cutting straight to the chase. Can you get the boat out of the box?

Well done.

Now it's your turn. Can you get the boat out of the box?

There, number three.

Well done.

So what does your experiment show?

Well, it shows us that typically developing children will copy

even actions that are silly actions

that don't contribute toward the goal.

We think the reason they're copying that is that they want

to be like the adult or they want to do everything that the adult does.

They're not just learning about how this object behaves.

They're learning to be adult-like and to be social,

but autistic children are more selective.

They will do the thing that gets the goal,

gets the boat out of the box or gets the doll out,

but they don't bother to copy all of these extra, unnecessary things.

Sarah is exceptional

and has made a point of studying social scenarios

and has learned to copy other people's behaviour.

This has help her greatly to get on in life.

Back at home here in Worthing,

she's just moved in with her partner Keith,

who is also on the autistic spectrum.

It's the top of the tree that comes from a well-known,

-reputable shop where everything costs...

-How much?

Just a pound!

Is it the top decoration that goes on last?

They're about to spend their first Christmas together in their new home.

Or do you put that on first? Oh, you might put lights on first.

I thought you put lights on first.

So how can these two people forge a relationship

when social interactions cause them crippling anxiety?

-INTERVIEWER:

-How did you find each other, meet each other?

On the internet!

Where all socially awkward people go to find each other.

Was there any rush of love at any point in the early days?

I don't really know what that means.

Erm...

I never expected to fall for him

or be particularly attracted to him or anything.

It was a really logical experiment,

to deliberately go out with someone that I didn't fancy that much

in order to see what it would be like

to have a nice friendship with somebody,

cos that wasn't my kind of history.

What was your thinking?

You wanted someone to have sex with.

-Yeah, yeah.

-And you were largely...

-I think that was my initial motivating force, yes.

-..unconcerned about who that was.

-There wasn't a huge amount of selection process.

-No.

If someone was willing, then so was I.

So why are we together, then?

I don't know. Why are we together? You tell me.

You're my...

required amount of social contact.

SARAH LAUGHS

-I'm your 5ml teaspoon a day?

-Yes, that's it.

Sarah and Keith constantly struggle to make sense of social activities.

We don't do any socialising whatsoever for Christmas.

I think you've got a Christmas works lunch

that everybody goes to in your office.

Doesn't even occur to me to even think about anything.

It doesn't feel like...

It just doesn't occur to me that we would go somewhere.

Where would we go? What would we do?

-What would you do?

-I don't know. What do you do?

-I don't know.

-No.

It wouldn't even occur to me to want to do anything like that,

not at all. I don't miss people.

I don't have the emotion of missing somebody when they're not there.

I might prefer them to be with me...

..but I don't think it's quite the same emotion

that I understand that other people have in terms of missing people.

And yet you two are in a close relationship.

Yes. We are peas in a pod.

Do you miss me when I'm not there?

I don't think you do. I think we've talked about this before,

-haven't we?

-When I have to interact with others, then yes,

because the interaction that I have with them

is never as satisfying as the interaction I have with you.

Is that "missing"?

You've always said, "I prefer it when you're there,"

which suggests to me a sort of absence of a...

I think missing involves abstract imagination. It involves...

..some kind of ability to picture

another reality other than the one you're in at the moment

and I don't think either of us are particularly capable at doing that.

Sarah and Keith get on really well just the two of them

and are committed to total honesty

in their constant reflection and analysis.

Although Sarah and Keith have restricted

their contact to other people,

they do show us that autistic people

can have meaningful social relationships.

It's often said that autistic people don't have empathy,

but that is wrong.

Sarah and Keith really care for each other.

What they find difficult is this social navigation

that the rest of us do automatically.

Since diagnosis has surged in the last two decades,

it's tempting to think of autism as a modern phenomenon.

But is there any evidence in history

to show that autism has been around for longer?

Today, people talk about an autism epidemic.

When I saw the first cases about 50 years ago,

the estimated number was about five in 10,000.

Today it is 100 in 10,000.

This is a huge increase

and yet it does not necessarily mean

that more children with autism are born now.

It does mean that we are much better at diagnosing autism.

So is autism a new condition,

or has it always been with us?

And how would we ever find out?

I've come to Dumfries & Galloway in the Scottish borders,

where historian Professor Rab Houston

has unearthed the story of a family feud

caused by the very unusual behaviour

of an 18th century Scottish laird called Hugh Blair.

This is the place where Hugh Blair was born

and where he and his family lived

for the first half of the 18th century.

Sometime during the 1740s, when Hugh would have been in his mid-30s,

his brother John and his mother had a tremendous falling out.

As a result of that, his mother cooked up a marriage -

she arranged a marriage for Hugh with the daughter of a local surgeon

who lived in Kirkcudbright, which is the main town quite near to here.

John was furious, absolutely furious,

so he took out a writ against Hugh to have his marriage annulled

on the grounds that he didn't understand what he was doing.

John, the younger son, would lose his inheritance

if there were any children from this marriage.

He needed to prove that Hugh could not be legally married

since he was mentally incapacitated.

It's because of this court case that we have an unprecedented insight

into Hugh Blair's odd behaviour

and how it relates to the modern diagnosis of autism.

It was 5th July 1747

when the case was brought before the Commissary Court of Edinburgh.

260 years on, Professor Houston discovered the documents,

which had clearly been unread since they were first written.

Transcripts of 27 witnesses are very revealing

about Hugh's mental condition and reminiscent of autism.

Here, one witness mentions a strange special interest.

It says that Hugh... "Went to all the burials about,

"whether rich or poor, and that whether he was invited or not,

"and this he did both before and after he was a man

"who arrived at the age of majority."

Oh, that's just a wonderful observation,

because that's an example of a kind of special interest, you know?

A special interest in something that other people

probably would not be interested in, and for him to be able to find out

when all these burials were taking place and then to just turn up

and go there, regardless of who it was -

I think that's extraordinarily reminiscent of autism.

Perhaps the most revealing document is Hugh Blair's written testimony.

Here he was asked questions in writing,

because the court wondered whether perhaps he was deaf and dumb.

So, the clerk of the court wrote out,

"Answer the following question - what brought you to Edinburgh?"

Hugh Blair's answer reads,

"Answer the following question - what brought you to Edinburgh?"

To me, it's really as clear an indication

of what I call a mentalising failure as you could wish for.

It's not understanding that you need to tell another person

something that only you can tell, that they want you to tell.

He just doesn't get that point.

The court was convinced that Hugh was mentally incapacitated,

and his marriage was annulled.

The Blair estate was ruined by the costs of the court case.

The case of Hugh Blair is by far the earliest that I would be confident

in diagnosing as autism, and it's astonishing that you can recognise

the condition across such vast differences of time and of culture.

What's so important to me about this is that it enables us to see

more clearly the common and enduring features of autism.

It's often said that the enduring features of autism

are present in many of us.

Today, we often say someone's "on the spectrum"

as a catch-all phrase to describe anyone who's a bit eccentric,

has unusual hobbies or is socially awkward.

Here at Trinity College Cambridge

stands a statue to one of our greatest scientists, Isaac Newton.

He certainly was eccentric,

and some people have suggested that he may have been autistic.

I'm not convinced.

'I'm here to meet Professor Simon Baron-Cohen,

'who long ago was my PhD student and is now a fellow of Trinity himself.'

There are personal anecdotes about his life.

There are. One of the stories is that his lectures were

very difficult to follow.

And the students stopped coming but he kept teaching,

-even though there were no students present.

-Oh, really?!

-Because it was in his job description.

-So he was very dutiful.

Simon is interested in autistic-like traits in the general population,

so I've come to discuss with him whether autism is in a category

by itself, or whether it's possible to be a little bit autistic.

So can you sort of make this a bit...

You can measure autistic traits, just like any metric,

like a ruler, where if you were down here at zero

-or up here at 50, you'd be either low or high or just average.

-Yeah.

So here you would have no autistic traits at all,

here you would have everything.

Most people in the population are scoring right in the middle.

That's the population average, or the mean.

And people who have a diagnosis on the autistic spectrum

tend to score right up here.

Above 30, or 32, out of a scale of 50.

And actually when you look at the whole population,

it turns out to be quite a beautiful, normal distribution.

Very few people down at zero, very few people at the maximum.

So you could almost say that there might have been a natural selection

to have an average number.

At what point, then, would the diagnosis of autism

become a sort of certainty?

Well, you get your diagnosis when you go to a clinic.

It's not about these metrics.

It's about the clinician looking at how much these traits

are interfering with your everyday functioning.

So some people are developing secondary depression,

because they've got a high number of autistic traits.

Some children are being bullied,

because they've got a high number of autistic traits.

But some people are doing just fine...

If they're doing fine, irrespective of their score, they don't need...

-They're not autistic?

-They don't need the diagnosis.

So you withhold the diagnosis,

unless there's a clear, clinical need.

So now it's not about science, it's about clinical judgment.

So there is something of a grey area where some people might

get the diagnosis if they go to one centre for the diagnostic assessment

-and not get the diagnosis if they go to another centre...

-Absolutely.

..because it is a judgment call.

The only thing that differentiates people in the general population

from people who have a diagnosis is simply

the number of autistic traits that we have.

That we're all on the same continuum.

And...part of what research needs to do is to try and determine -

is there a qualitative break there?

Or is it the case that it's simply a matter of degree?

I've often imagined myself being a bit autistic.

I'm certainly obsessively focused on my work.

And in my feelings I am often very analytical and detached.

And I certainly have said things that hurt people

without my realising this, and I'm generally baffled

by the complexities of social relationships. But here it stops.

It's easy to confuse autistic-like traits with autism,

so if you think you might be a little bit autistic,

you very probably are not.

But whether there is a precise point at which autism begins

is an open question and for now remains a mystery.

So in the right position for her, basically.

Today, most children with autism will be diagnosed before they go to school,

but some are diagnosed much later.

Like any condition, doctors and parents want to identify it as early as possible.

We know that the autistic brain must be wired differently,

and that there is a genetic reason for this,

but we don't really know the details yet.

Here at Birkbeck College in London, they're running a study to see

if they can detect very early signs of autism.

They're studying babies who have an increased genetic risk of being autistic,

because they an autistic sibling.

And they're comparing them to babies with no increased risk.

We are looking for early signs of autism, early markers.

The reason being that, at the moment, the earliest stage

that a child will possibly get a diagnosis is around two to three years of age.

So the main aim is to find an early marker to enable us

to possibly diagnose the disorder earlier.

They're looking to see how the babies' brains

react to social and non-social images.

They use equipment that gently shines light onto the baby's head

to measure the oxygen level in the blood and, therefore, brain activity.

This is where we're having the response, in this brain region.

And this one example is about visual, social cues,

so this is when the babies are watching the peek-a-boo

and the Incy Wincy Spider.

The graph here on the left is what you would typically have

as a response in infants of this age, so four to six-month-olds.

We've seen in many, many babies

that they would have an increase in oxygen in their blood,

which is this red line here, and this is the response

that we've had in the infants that have a family risk of autism.

So they have the brother or sister with autism.

And what you notice quite strikingly is that the oxygen change

in this brain region is almost absent in comparison to

the low-risk infants.

But the tantalising thing to have emerged from this study so far

is that not all the babies who have the autistic markers

go on to get a diagnosis of autism.

So, the babies we've seen who show

the possible early markers of autism,

but who actually don't go on to develop the disorder,

the ones that fall sort of either side of the line, they...

It's an interesting thing.

That's one of the questions that we hope to answer - why don't they?

Are there protective factors, be that genetic or environmental,

that kick in, or are these children programmed

in a slightly different way

that they're never going to develop the full-blown disorder,

but they may carry these subtle traits of autism

throughout their lives without anyone noticing?

Ready, steady, go!

What's he doing?

The idea of a protective factor might explain another mystery -

why many more boys than girls are diagnosed with autism.

Could it be that girls have some kind of protective factor,

perhaps for some genetic or hormonal reason,

that reduces the impact of autism?

We could even speculate that these protective factors

are why many of us grow up to have an autistic-like personality,

but not actually be autistic.

LAUGHTER

Sorry, you've got the wrong idea.

Despite the insights we've gained over the last few decades

about how people with autism perceive the world,

there are still so many questions that remain unanswered.

How does the brain create these different minds?

And why are some people autistic in the first place?

And why does autism come in so many forms?

Very good.

Joe needs constant care, and will never be able to live by himself.

Good to do. >

-Are you happy here?

-Yes.

And sometimes you go out?

Yes.

-And you can relax?

-Relax.

-You also work?

-Yes.

-'What's this, Joe?

-Money.

'Money. And what's this, Joe?

-'Butter.

-Bread.

'And this?

-'Milk.

-Milk. And this?'

Almost 50 years ago, I met a bright-eyed young boy

who had terrible difficulties interacting with the world.

-'What is it?

-Ba-ma.

-'A barrow.

-A barrow.

'What's this?'

Joe sees things very differently,

but he inspired me to dedicate a lifetime

to studying minds like his.

And in its own way, I'm glad that his life has been fulfilling too.

What flowers do you like?

Sunflowers.

Sunflowers.

Yes.

-So you just put the seed in, do you?

-Yes.

-And...a plant comes out?

-Yes.