Chapter

15The paradox of autism whydoes disability sometimes giverise to talentSimon Baron-Cohen Emma Ashwin Chris AshwinTeresa Tavassoli and Bhismadev Chakrabarti

SummaryWe explore why people with autism spectrum conditions (ASC) not only show deficits butalso areas of intact or even superior skill The deficits are primarily social the areas of intactor superior skill involve attention to detail and systemizing Systemizing is the drive toanalyse or build a system We review the evidence related to systemizing in ASC and discussits association with sensory hypersensitivity We close by considering the evolution andadaptive features of systemizing and how ndash taken to an extreme ndash this can also give rise todisability

IntroductionParadoxes emanating from human brain functioning have long been noted ndash patients withamnesia who cannot explicitly recall information but who nevertheless reveal implicitly thatthey do recall information patients with reported blindness who nevertheless demonstratesome lsquounconsciousrsquo vision (lsquoblindsightrsquo) Brazilian street children who fail academic math-ematics tests but who are lightening quick in performing calculations in the market placeand individuals who experience perceptions in one sensory modality when a differentsensory modality is stimulated (lsquosynaesthesiarsquo) In some sense paradoxes in brain function-ing should perhaps not be so surprising given the number of different lsquomodulesrsquo andpathways in the brain such that some functions may be impaired whilst others maysimultaneously be either intact or even superior

Whilst we are familiar with syndromes where most if not all cognitive functions areimpaired (such as in certain forms of learning disability or dementia) this chapter focuseson what can be learnt from syndromes displaying uneven cognitive profiles At the mostgeneral level such syndromes may constitute evidence for neurological lsquodissociationsrsquo andmay reveal alternative strategies the brain can employ to solve a task In this chapter wefocus on autism spectrum conditions (ASC) in which individuals characteristically show amix of lsquodeficitsrsquo alongside lsquointactrsquo cognitive skills and where in some individuals there areeven lsquoislets of abilityrsquo that constitute talent ndash so-called lsquosavantismrsquo

Savantism describes a cognitive profile where an individual shows an area of skill that issignificantly superior relative to their other skills Savantism stands out most clearly inindividuals who have a general developmental delay (lsquolearning difficultiesrsquo) where IQ isin the below-average range and this nicely sums up the idea of the lsquoparadoxical brainrsquo sincein such cases it is clear that IQ cannot explain the individualrsquos level of functioning in all

The Paradoxical Brain ed Narinder Kapur Published by Cambridge University Press CambridgeUniversity Press 2011

274

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areas Savantism is found more commonly in ASC than in any other neurological groupand the majority of those with savantism have an ASC (Hermelin 2002) ASC entailssignificant social and communication disability alongside narrow and repetitive interests(APA 1994) This lsquoco-morbidityrsquo shows us that these two profiles are associated well abovechance This forces us to ask why the link between talent and autism And how is thisparadox (a disability at times associated with talent) to be explained (cf Treffert 2010) Inthis chapter we argue that whilst savantism defined as prodigious talent is only seen in asubgroup of people with ASC (eg Baron-Cohen et al 2007) a universal feature of theautistic brain is excellent attention to detail (Shah and Frith 1993 Jolliffe and Baron-Cohen1997 OrsquoRiordan et al 2001) Further we argue that excellent attention to detail exists inASC because of evolutionary forces positively selecting brains for strong systemizing ahighly adaptive human ability (Baron-Cohen 2008)

Strong systemizing requires excellent attention to detail and in our view the latter is inthe service of the former Attention occurs at an early level of cognition whilst systemizingis a fairly high-level aspect of cognition Next we argue that one can trace excellentattention to detail to its basis in sensory hypersensitivity in ASC (see Figure 151) Finallywe review our research programme exploring this in different sensory modalities But firstwhat is systemizing

SystemizingTalent in autism comes in many forms but a common characteristic is that the individualbecomes an expert in recognizing repeating patterns in stimuli We call this systemizingdefined as the drive to analyse or construct systems These might be any kind of systemWhat defines a system is that it follows rules and when we systemize we are trying toidentify the rules that govern the system in order to predict how that system will behave(Baron-Cohen 2006) These are some of the major kinds of system

collectible systems (eg distinguishing between types of stones or wood) mechanical systems (eg a video-recorder or a window lock) numerical systems (eg a train timetable or a calendar) abstract systems (eg the syntax of a language or musical notation) natural systems (eg the weather patterns or tidal wave patterns)

Visual

Auditory

Tactile

Olfactory

Gustatory

SensoryHypersensitivity

Enhancedattentionto detail

Systemizing

Figure 151 A proposed heuristic continuum suggesting how a multimodal irregular profile of sensoryhypersensitivity could lead to enhanced attention to detail This in turn could lead to a drive for categorizing theexternal world on the basis of highly exact perceptual details and a systemizing bias in cognition An alternativemodel (dotted line) suggests that hyper-systemizing is also linked to sensory hypersensitivity without necessarilybeing mediated through enhanced attention to detail (all lines represent a bidirectional flow) Current research inour lab is testing these two models At top of first of four drawings (Figure 2) Taken from Myers et al (2004)

275

S Baron-Cohen E Ashwin C Ashwin T Tavassoli and B Chakrabarti

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social systems (eg a management hierarchy or a dance routine with a dance partner) motoric systems (eg throwing a Frisbee or bouncing on a trampoline)

In all these cases you systemize by noting regularities (or structure) and rules The rulestend to be derived by noting if p and q are associated in a systematic way The generalformulation of what happens during systemizing is one looks for laws of the form lsquoif pthen qrsquo If we multiply 3 by itself then we get 9 If we turn the switch to the down positionthen the light comes on When we think about the kinds of domains in which savantstypically excel it is those domains that can be readily systemized

Examples might be from numbers (eg spotting if a number is a prime number)calendrical calculation (eg telling which day of a the week a given date will fall) drawing(eg analysing space into geometric shapes and the laws of perspective and perfecting anartistic technique) music (eg analysing the sequence of notes in a melody or the lawfulregularities or structure in a piece) memory (eg recalling long sequences of digits or listsof information) or even learning foreign languages (eg learning vocabulary or the laws ofgrammar) In each of these domains there is the opportunity to repeat behaviour in orderto check if one gets the very same outcome every time Multiplying 3 by itself alwaysdelivers 9 the key change in this specific musical piece always occurs in the 13th barthrowing the ball at this particular angle and with this particular force always results in itlanding in the hoop

Systemizing the Rubikrsquos CubeLetrsquos take a real cardinal example of savantism a non-conversational child with autism whocan solve the Rubikrsquos Cube lsquoproblemrsquo in 1 minute and 7 seconds This is a nice examplebecause it illustrates several things First that the childrsquos non-verbal ability with the RubikrsquosCube is at a much higher level than either his communication or social skills or indeedwhat one would expect of his age Second it prompts us to ask what are the processesinvolved in solving the Rubikrsquos Cube At a minimum it involves analysing or memorizingthe sequence of moves to produce the correct outcome It is a series of lsquoif p then qrsquo stepsThis child with autism appeared to have lsquodiscoveredrsquo the layer-by-layer method to solve the3 3 3 Rubikrsquos Cube problem which takes a minimum of 22 moves (Note he was not asfast as the current 2008 World Champion Erik Akkersdijk who in the Czech Openchampionship solved the Rubikrsquos Cube in 708 seconds)

Systemizing in autism spectrum conditionsWhat is the evidence for intact or even unusually strong systemizing in ASC First suchchildren perform above the level that one would expect on a physics test (Baron-Cohenet al 2001) Children with Asperger Syndrome (AS) as young as 8ndash11 years scored higherthan a comparison group who were older (typical teenagers) Second using the SystemizingQuotient (SQ) people with high functioning autism or AS score higher on the SQcompared to general population controls (Baron-Cohen et al 2003) Third children withclassic autism perform better than controls on the picture sequencing test where the storiescan be sequenced using physicalndashcausal concepts (Baron-Cohen et al 1986) They alsoscore above average on a test of how to figure out how a Polaroid camera works eventhough they have difficulties figuring out peoplersquos thoughts and feelings (Baron-Cohenet al 1985 Perner et al 1989) The Polaroid camera test was used as a mechanical

276

Chapter 15 The paradox of autism why does disability sometimes give rise to talent

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equivalent to the False Belief test since in the former all one has to do is infer what will berepresented in a photograph given the lsquoline of sightrsquo between the camera and an objectwhereas in the latter one has to infer what belief (ie mental representation) a person willhold given what they saw and therefore know about (A Polaroid camera was used becausethen the experimenter could state their prediction about the content of the photo and havethis verified within minutes)

Strong systemizing is a way of explaining the non-social features of autism the narrowinterests repetitive behaviour and resistance to changeneed for sameness This is becausewhen you systemize it is best to keep everything constant and to only vary one thing at atime That way you can see what might be causing what and with repetition you can verifythat you get the very same pattern or sequence (lsquoif p then qrsquo) every time renderingthe world predictable One issue is whether hyper-systemizing only applies to the high-functioning individuals with ASC Whilst their obsessions (with computers or maths forexample) could be seen in terms of strong systemizing (Baron-Cohen et al 1999) when wethink of a child with low-functioning autism many of the classic behaviours can be seen asa reflection of their strong systemizing if looked at through this theoretical frameworkSome examples are listed in Box 1

Systemizing and Weak Central CoherenceLike the Weak Central Coherence (WCC) theory (Frith 1989) the hyper-systemizingtheory is about a different cognitive style (Happe 1996) Like that theory it also positsexcellent attention to detail (in perception and memory) since when you systemize you haveto pay attention to the tiny details This is because each tiny detail in a system might have afunctional role leading to new information of the form lsquoif p then qrsquo Excellent attention todetail in autism has been repeatedly demonstrated (Shah and Frith 1983 1993 Jolliffe andBaron-Cohen 2001 OrsquoRiordan et al 2001 Mottron et al 2003 Baldassi et al 2009 Josephet al 2009)

One difference between these two theories is that the WCC theory sees people with ASCas drawn to detailed information (sometimes called a local processing bias) either fornegative reasons (an inability to integrate was postulated in the original version of thistheory) or because of stronger local processing (in the later version of this theory) Incontrast the hyper-systemizing theory sees this same quality (excellent attention to detail)as being highly purposeful it exists in order to understand a system Attention to detail isoccurring for positive reasons in the service of achieving an ultimate understanding of asystem however small and specific that system might be

We can return to the Rubikrsquos Cube problem to see the difference between these twotheories more clearly At one level the Rubikrsquos Cube is a 3D Block Design Test butwhere the cubes are all connected Recall that the Block Design Test is the subtest onWeschler IQ tests on which people with autism perform at their best (Shah and Frith1993 Happe 1996) The Rubikrsquos Cube contains 21 moveable connected cubes (since the5 central cubes do not move) with different coloured faces in the 3 3 3 versionAccording to WCC theory the reason why people with autism show superior perform-ance on the Block Design Test is that their good local processing enables them to lsquoseersquoeach individual cube even if the design to be copied is not lsquopre-segmentedrsquo (Shah andFrith 1983) It is clear how good local processing would lead to faster lsquoanalysisrsquo of thewhole (design) into constituent parts (the individual cubes) but to solve the Rubikrsquos

277

S Baron-Cohen E Ashwin C Ashwin T Tavassoli and B Chakrabarti

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Cube (or the Block Design problem) more than just good local processing is neededA strength in lsquoif p then qrsquo type reasoning is also required On the classic Block Designsubtest you need to mentally or manually rotate the cube to produce the relevant outputThat is you need to perform an operation on the input to produce the relevant outputThe same is true (but with more cubes and therefore more complexity) in the RubikrsquosCube problem lsquoIf the red cube with the green side is positioned on the top layer on theright side and I rotate the top layer anticlockwise by 90 then this will complete the toplayer as all one colourrsquo

Box 1 Systemizing in classic autism andor Asperger Syndrome

Type ofsystemizing

Classic autism Asperger Syndrome

Sensorysystemizing

Tapping surfaces or letting sand runthrough onersquos fingers

Insisting on the same foodseach day

Motoricsystemizing

Spinning round and round or rockingback and forth

Learning knitting patterns or atennis technique

Collectiblesystemizing

Collecting leaves or football stickers Making lists and catalogues

Numericalsystemizing

Obsessions with calendars or traintimetables

Solving maths problems

Motionsystemizing

Watching washing machines spinround and round

Analysing exactly when aspecific event occurs in arepeating cycle

Spatialsystemizing

Obsessions with routes Developing drawing techniques

Environmentalsystemizing

Insisting on toy bricks being lined up inan invariant order

Insisting that nothing is movedfrom its usual position in theroom

Socialsystemizing

Saying the first half of a phrase orsentence and waiting for the otherperson to complete it

Insisting on playing the samegame whenever a child comesto play

Naturalsystemizing

Asking over and over again what theweather will be today

Learning the Latin names ofevery plant and their optimalgrowing conditions

Mechanicalsystemizing

Learning to operate the VCR Fixing bicycles or taking apartgadgets and reassembling them

Vocalauditoryverbalsystemizing

Echoing sounds Collecting words and wordmeanings

Systemizingactionsequences

Watching the same video over andover again

Analysing dance techniques

278

Chapter 15 The paradox of autism why does disability sometimes give rise to talent

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In earlier formulations of systemizing the key cognitive process was held to be in termsof [inputndashoperationndashoutput] processing (Baron-Cohen 2002 2006) In mathematics if theinput frac14 3 and the operation frac14 cubing then the output frac14 27 In the Rubikrsquos Cube notionalexample above the input frac14 [the red cube with the green side is positioned on the top

Figure 152 Symbolic impressions MK-79

Figure 153 Peterrsquos Hand MK-VII

279

S Baron-Cohen E Ashwin C Ashwin T Tavassoli and B Chakrabarti

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layer on the right side] the operation frac14 [rotate the top layer anticlockwise by 90] andthe output frac14 [complete the top layer as all one colour] Notice that WCC makes no mentionof the key part of this that is noting the consequences of an operation Simply seeing the partsin greater detail would not by itself lead to understanding the operations (the moves) neededto solve the Rubikrsquos Cube

Another difference between the WCC theory and the hyper-systemizing theory is thatthe latter (but not the former) predicts that over time the person may achieve an excellentunderstanding of a whole system given the opportunity to observe and control all thevariables (all the lsquoif p then qrsquo rules) in that system WCC would predict that even given allthe time in the world the individual will be forever lost in the detail The existence of

Figure 154 Untitled [AuthorrsquosNote ndash lsquoA development of thewell-known smiley face symboldesignrsquo]

Figure 155 Mazewandering

280

Chapter 15 The paradox of autism why does disability sometimes give rise to talent

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talented mathematicians with AS like Richard Borcherds is proof that such individuals canintegrate the details into a true understanding of the system (Baron-Cohen 2003) In therule lsquoif p then qrsquo the terms lsquoifrsquo and lsquothenrsquo are how the details become integrated albeit onesmall step at a time The idea at the neurological level that ASC involves an abundance oflocal short-range connectivity (Belmonte et al 2004) may explain this cognitive style ofidentifying one specific link between two details

Hyper-systemizing implications for educationTeachers whether of children with autism or adults with AS need to take into account thathyper-systemizing will affect not only how people with ASC learn but also how they shouldbe assessed IQ test items essays and exam questions designed for individuals who arelsquoneurotypicalrsquo may lead to the person with ASC scoring zero when their knowledge isactually greater deeper and more extensive than that of most people What can appear as aslow processing style may be because of the massively greater quantity of information that isbeing processed

A man with AS reported recently lsquoI see all information in terms of links All infor-mation has a link to something and I pay attention to these links If I am asked a question inan exam I have great difficulty in completing my answer within the allocated 45 minutes forthat essay because every fact I include has thousands of links to other facts and I feel myanswer would be incorrect if I didnrsquot report all of the linked facts The examiner thinks he orshe has set a nice circumscribed question to answer but for someone with autism orAsperger Syndrome no topic is circumscribed There is ever more detail with ever moreinteresting links between the detailsrsquo

When asked about the concept of apple for example he could not give a short summaryanswer such as lsquoan apple is a piece of fruitrsquo (ie referring to the prototypical level lsquoapplersquo aslinked to the superordinate level lsquofruitrsquo) but had to continue by also trying to link it to the7500 different species of apple (the subordinate level concepts) listing many of each typeand the differences in terms of the history of each species how they are cultivatedwhat they taste and look like etc When asked about the concept of beetle he could notjust give a summary answer such as lsquoa beetle is an insectrsquo but had to mention as many of the350000 species of beetle that he knew existed If he was asked to be less long-winded hecould not do it since all facts to him seemed important and it made him feel anxious toleave any out If asked to just include the important facts and to exclude the unimportantfacts he could not decide which fell into the lsquoimportantrsquo category

This cognitive style is understandable in terms of the hyper-systemizing theory becausea concept is a system A concept is a way of using an lsquoif p then qrsquo rule to define what toinclude as members of a category (eg if it has scales and gills then it is a fish)Furthermore concepts exist within a classification system which are rules for howcategories are related to one another So the question lsquowhat is a beetlersquo is trivial for aneurotypical individual who simply answers in terms of a crude imprecise and fuzzycategory lsquoit is an insectrsquo It may however require a very long exhaustive answer fromsomeone with autism lsquobeetles are members of the category of animal (kingdom) arthro-pods (phylum) insects (class) pterygota (sub-class) neoptera (infra-class) endopterygota(super-order) coleoptera (order) and could be in one of 4 sub-orders (adephaga archo-stemata mycophaga and polyphaga) each of which has an infra-order a super-familyand a familyrsquo Even the previous sentence would for this man with AS be a gross

281

S Baron-Cohen E Ashwin C Ashwin T Tavassoli and B Chakrabarti

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violation of the true answer to the question because so much important factual infor-mation has been left out But for the hyper-systemizer getting these details correctmatters because the concept ndash and the classification system linking concepts ndash is a systemfor predicting how this specific entity (this specific beetle) will behave or will differ fromall other entities

Hyper-systemizing theory vs Executive Dysfunction theoryThe Executive Dysfunction (ED) theory (Rumsey and Hamberger 1988 Ozonoff et al1991 Russell 1997) is the other major theory that has attempted to explain the non-socialfeatures of ASC and particularly the repetitive behaviour and narrow interests that charac-terize ASC According to this theory aspects of executive function (action control) involvedin flexible switching of attention and planning are impaired leading to perseveration TheED theory like the WCC theory has difficulty in explaining instances of good understand-ing of a whole system such as calendrical calculation since within the well-defined system(calendar) attention can switch very flexibly The ED theory also predicts perseveration (so-called lsquoobsessionsrsquo) but does not explain why in autism and AS these should centre onsystems (Baron-Cohen and Wheelwright 2004) Finally the ED theory simply re-describesrepetitive behaviour as an instance of executive dysfunction without seeing what might bepositive about the behaviour

So when the low-functioning person with classic autism has shaken a piece of stringthousands of times close to his eyes whilst the ED theory sees this as perseveration arisingfrom some neural dysfunction which would normally enable the individual to shiftattention the hyper-systemizing theory sees the same behaviour as a sign that theindividual lsquounderstandsrsquo the physics (ie recognizes the patterns) behind the movementof that piece of string He may be able to make it move in exactly the same way everytime Or to take another example when he makes a long rapid sequence of sounds hemay lsquoknowrsquo exactly that acoustic pattern and get some pleasure from the confirmationthat the sequence is the same every time A mathematician might feel an ultimate sense ofpleasure in the lsquogolden ratiorsquo (that (a thorn b)a frac14 ab and that this always comes out as161803399) Similarly a child ndash even one with low-functioning autism ndash may produce thesame outcome every time with their repetitive behaviour and appear to derive someemotional pleasure at the predictability of the world This may be what is clinicallydescribed as lsquostimmingrsquo (Wing 1997) where an individualrsquos attention is wholly focusedon their current actions or thoughts and they lapse into a trance-like state and mayexperience a surge of excitement that manifests as a sudden lsquoexplosionrsquo of movementAutism was originally described as involving lsquoresistance to changersquo and lsquoneed for samenessrsquo(Kanner 1943) and here we see that important clinical observation may be the hallmarkof strong systemizing Recent neuroimaging studies suggest that there might be aberrantprocessing of rewards in people with ASC (Schmitz et al 2008 De Martino et al 2008)and it will be important for future neuroimaging studies to test if the reward systems inthe brain (eg the dopaminergic or cannabinoid systems) are active during such repetitivebehaviour

If we return to the Rubikrsquos Cube example an executive dysfunction would predict thatan inability to lsquoplanrsquo should make solving a Rubikrsquos Cube impossible for a savant withautism In contrast as we saw earlier the hyper-systemizing theory has no difficulty inexplaining such talent

282

Chapter 15 The paradox of autism why does disability sometimes give rise to talent

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Sensory hypersensitivityRather than assuming that the strong systemizing in ASC is ultimately reducible to excellentattention to detail in this section we pursue the idea that the excellent attention to detail isitself reducible to sensory hypersensitivity In 2001 Mottron and Burack postulated thelsquoenhanced perceptual functioningrsquo (EPF) model of ASC characterized by superior low-levelperceptual processing (Mottron and Burack 2001) To what extent is this a feature of basicsensory physiology

Studies using questionnaires such as the Sensory Profile have revealed sensory abnor-malities in over 90 of children with ASC (Leekam et al 2001 Kern et al 2006 Tomchekand Dunn 2007) In vision Bertone et al found individuals with ASC are more accurate atdetecting the orientation of first-order gratings (simple luminance-defined) but less accur-ate at identifying second-order gratings (complex texture-defined) (Bertone et al 2003) Inthe auditory modality superior pitch processing has been found in ASC (Mottron et al1999 Bonnel et al 2003 Heaton et al 2008) In a case study Mottron et al reportedexceptional absolute judgement and production of pitch (Mottron et al 1999) Bonnel et alfound superior pitch discrimination and processing abilities in individuals with high-functioning autism (Bonnel et al 2003) OrsquoRiordan and Passetti (2006) also reportedsuperior auditory discrimination ability in children with ASC and Jaevinen-Parsley et al(2002) showed superior perceptual processing of speech in children with autism

In the tactile modality Blakemore et al (2006) showed hypersensitivity to vibrotactilestimulation In addition the ASC group rated supra-threshold tactile stimulation as signifi-cantly more tickly and intense than did the control group Tommerdahl et al (2007)reported that participants with ASC outperformed controls in tactile acuity after shortadaptation to a vibrotactile stimulus period of 05 s (Note that this hypersensitivity is notalways observed On a tactile discrimination task OrsquoRiordan and Passetti (2006) found nodifferences in children with autism compared to controls) Cascio et al (2008) investigatedtactile sensation and reported increased sensitivity to vibrations and thermal pain in ASCwhile detection to light touch and warmthcold were similar in both groups

Only two previous studies have been reported investigating olfaction in ASC and unlikethe research into the other senses which consistently find hypersensitivity both of thesestudies reported deficits in identifying odours despite intact odour detection (Bennetto andKuschner 2007 Suzuki et al 2003) Looking more closely at the two previous studies intoolfaction in ASC both required participants to explicitly identify the odour from a choice ofresponses a methodology likely to involve both executive function and memory Forexample the study by Bennetto and Kuschner (2007) required participants to decide whichof four possible responses an odour matched A simpler task might provide a purer test oflow-level olfactory discrimination in ASC

An experiment from our lab examined vision in ASC in terms of basic sensory detectionthresholds (acuity ndash Ashwin et al 2009 cf Bach and Dakin 2009) Ongoing studies fromour lab are also testing sensory detection thresholds in other modalities (touch auditionand olfaction) Full details of these experiments are reported elsewhere (Ashwin et al 2008Ashwin et al submitted Tavassoli et al submitted) Results from these and other experi-ments demonstrated greater sensory perception in ASC across multiple modalities In thecontext of the earlier discussion of hyper-systemizing and excellent attention to detail wesurmise that these sensory differences in functioning may be affecting information process-ing at an early stage (both in terms of sensationcognition and in terms of development) in

283

S Baron-Cohen E Ashwin C Ashwin T Tavassoli and B Chakrabarti

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ways that could both cause distress but also predispose to unusual talent These results ofhypersensitivity confirm previous findings and mirror anecdotal reports of individualswith ASC (Grandin 2000) For example Temple Grandin writes that lsquooverly sensitive skincan be a big problem Shampooing actually hurt my skin To be lightly touchedappeared to make my nervous system whimper as if the nerve ends were curling uprsquo Interms of increased sensitivity to certain types of auditory stimuli (high frequencies) thereare anecdotal reports that individuals with autism tend to avoid certain sounds Grandinstates lsquoI can shut out my hearing and withdraw from most noise but certain frequenciescannot be shut out High pitched shrill noises are the worstrsquo Mottron et al (1999)reported the case of a woman with autism who was hypersensitive to frequencies from 1 to5 kHz at 13 years of age and to 4 kHz at 18 years

Enhanced sensitivity may be specific to certain stimuli in all modalities In visionBertone et al (2003) pointed out the importance of specific stimuli in investigating visualdifferences in ASC In the case of touch Blakemore et al (2006) reported hypersensitivityfor higher frequency (200 Hz) vibrotactile stimulation but not for lower (30 Hz) Pinpoint-ing the precise stimuli in which enhanced sensitivity occur in ASC will be important forfuture research To our knowledge the highest frequency that has been used to investigatehearing in ASC is 8 kHz (Bonnel et al 2003) Our ongoing study investigates very highfrequencies up to 18 kHz (Tavassoli et al submitted) The reported hypersensitivitythrough frequencies above 16 kHz is especially important since some environmental soundsoperate at or above this range of frequencies Grandin reported lsquoSome of the sounds thatare most disturbing to autistic children are the high-pitched shrill noises made by electricaldrills blenders saws and vacuum cleanersrsquo

Hypersensitivity could result from a processing difference at various sensory levelsincluding the density or sensitivity of sensory receptors inhibitory and exhibitory neuro-transmitter imbalance or speed of neural processing Belmonte et al (2004) suggested localrange neural overconnectivity in posterior sensory parts of the cerebral cortex is respon-sible for the sensory lsquomagnificationrsquo in people with ASC Whilst our lab and others havetested sensory profiles in ASC using fMRI (Gomot et al 2006 2008 Belmonte et al2010) the combination of imaging and genetic approaches to study sensory perception infMRI may lead toward a more complete picture We conclude that the search for theassociation between autism and talent should start with the sensory hypersensitivitywhich gives rise to the excellent attention to detail and which is a prerequisite forhyper-systemizing

Finally excellent attention to detail may exist in ASC because of evolutionary forcespositively selecting brains for strong systemizing a highly adaptive human ability (Baron-Cohen 2008) Without systemizing Homo sapiens would not have developed new stonetools in the Stone Age or ornaments metal tools weapons through smelting and the use offorges in the Iron Age Nor would humans have developed mathematics in Greece in thesixth century BC or in China in 300 BC and India in 100 AD Nor would we have seen thesupreme achievements of suspension bridges or machines in the Industrial Revolution orcomputers in the Digital Revolution There is little question that humans have dominatedthe planet because of their remarkable ability to transform their environment throughinvention and at the heart of such fabrication of new tools is systemizing ndash understandinghow things work The lsquoparadoxical brainrsquo is thus a phrase that neatly sums up how an abilitythat has been extraordinarily useful across human evolution can ndash when taken to extremes ndashalso be associated with disability

284

Chapter 15 The paradox of autism why does disability sometimes give rise to talent

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Future challenges and questionsThis view outlined in this chapter nevertheless raises new questions and challenges Whyshould systemizing in classic autism focus on more concrete repetitive actions whilstsystemizing in Asperger Syndrome might focus on more abstract repeating patterns (suchas mathematics) Can IQ alone explain these different manifestations of strong systemiz-ing And why should strong systemizing give rise to social disability Is it simply becausethe social world is hard if not impossible to systemize Or is it because innate socialmodules are also impaired How can the strong systemizing in ASC and evidence ofenhanced memory (Hillier et al 2007) be harnessed to facilitate education and interven-tion to reduce disability Teaching social skills via computers and in other systematicformats may be one such approach but there is clearly an opportunity for much more inthis area Finally what are the neural mechanisms underlying enhanced functioning inconditions such as those described in this chapter ndash for example is altered connectivitybetween brain structures the key (Boso et al 2010) or can neuronal hypertrophy oranomalous forms of cell migrationcell structure be part of the explanation (cf Conacher1990 Lee et al 2006 Casanova et al 2007 Huang 2009)

AcknowledgementsTT was supported by the Pinsent Darwin Trust and Autistica during the period of thiswork EA CA BC and SBC were supported by the MRC UK Parts of this article arereproduced from Baron-Cohen (2008) Ashwin et al (2008) and Baron-Cohen et al (2009)with permission

ReferencesAPA (1994) DSM-IV Diagnostic and Statistical

Manual of Mental Disorders 4th EditionWashington DC American PsychiatricAssociation

Ashwin C Ashwin E et al (submitted)Olfactory hypersensitivity in autismspectrum conditions

Ashwin C Ricciardelli P Baron-Cohen Set al (2008) Positive and negativegaze perception in autism spectrumconditions Social Neuroscience4 153ndash64

Ashwin E Ashwin C Rhydderch D HowellsJ amp Baron-Cohen S (2009) Eagle-eyedvisual acuity an experimental investigationof enhanced perception in autism BiologicalPsychiatry 65 17ndash21

Bach M amp Dakin S (2009) Regardingeagle-eyed visual acuity an experimentalinvestigation of enhanced perceptionin autism Biological Psychiatry66 e19ndash20

Baldassi S Pei F Megna N et al (2009)Search superiority in autism within but notoutside the crowding regime VisionResearch 49 2151ndash6

Baron-Cohen S (2002) The extreme male braintheory of autism Trends in CognitiveSciences 6 248ndash54

Baron-Cohen S (2003) The EssentialDifference Men Women and the ExtremeMale Brain London Penguin

Baron-Cohen S (2006) The hyper-systemizingassortative mating theory of autism Progressin Neuropsychopharmacology and BiologicalPsychiatry 30 865ndash72

Baron-Cohen S (2008) Autismhypersystemizing and truth QuarterlyJournal of Experimental Psychology 61 64ndash75

Baron-Cohen S amp Wheelwright S (2004) Theempathy quotient an investigation of adultswith Asperger Syndrome or high functioningautism and normal sex differences Journalof Autism and Developmental Disorders 34163ndash75

285

S Baron-Cohen E Ashwin C Ashwin T Tavassoli and B Chakrabarti

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Baron-Cohen S Leslie A M amp Frith U(1985) Does the autistic child have a lsquotheoryof mindrsquo Cognition 21 37ndash46

Baron-Cohen S Aswhin E Ashwin C et al(2009) Talent in autism hyper-systemizinghyper-attention to detail and sensoryhypersensitivity Philosophical Transactionsof the Royal Society of London B BiologicalSciences 364 1377ndash83

Baron-Cohen S Bor D Billington J Asher JWheelwright S amp Ashwin C (2007) Savantmemory in a man with colour form-numbersynaesthesia and Asperger Syndrome Journalof Consciousness Studies 14 237ndash51

Baron-Cohen S Leslie A M amp Frith U(1986) Mechanical behavioural andIntentional understanding of picture storiesin autistic children British Journal ofDevelopmental Psychology 4 113ndash25

Baron-Cohen S Richler J Disarya B et al(2003) The Systemising Quotient (SQ) aninvestigation of adults with AspergerSyndrome or High Functioning Autism andnormal sex differences PhilosophicalTransactions of the Royal Society 358 361ndash74

Baron-Cohen S Wheelwright S Spong AScahill V amp Lawson J (2001) Are intuitivephysics and intuitive psychologyindependent Journal of Developmental andLearning Disorders 5 47ndash78

Baron-Cohen S Wheelwright S Stone V ampRutherford M (1999) A mathematician aphysicist and a computer scientist withAsperger Syndrome performance on folkpsychology and folk physics test Neurocase5 475ndash83

Belmonte M Gomot K M Gomot M ampBaron-Cohen S (2010) Visual attention inautism families lsquounaffectedrsquo sibs sharedelayed and prolonged fronto-cerebellaractiviation but not decreased functionalconnectivity Journal of Child Psychology ampPsychiatry 51 259ndash76

Belmonte M K Cook E H Anderson G Met al (2004) Autism as a disorder of neuralinformation processing directions forresearch and targets for therapy MolecularPsychiatry 9 646ndash63

Bennetto L amp Kuschner E S (2007) Olfactionand taste processing in autism BiologicalPsychiatry 62 1015ndash21

Bertone A Mottron L Jelenic P amp Faubert J(2003) Motion perception in autism alsquocomplexrsquo issue Journal of CognitiveNeuroscience 15 218ndash25

Blakemore S J Tavassoli T Calo S et al(2006) Tactile sensitivity in Aspergersyndrome Brain and Cognition 61 5ndash13

Bonnel A Mottron L Peretz I Trudel MGallun E amp Bonnel A M (2003) Enhancedpitch sensitivity in individuals with autism asignal detection analysis Journal of CognitiveNeuroscience 15 226ndash35

Boso M Emanuele E Prestori F Politi PBarale F amp DrsquoAngelo E (2010) Autism andgenius is there a link The involvement ofcentral brain loops and hypotheses forfunctional testing Functional Neurology 2527ndash32

Casanova M Switala A Trippe J ampFitzgerald M (2007) Comparativeminicolumnar morphometry of threedistinguished scientists Autism 11 557ndash69

Cascio C McGlone F Folger S et al (2008)Tactile perception in adults with autism amultidimensional psychophysical studyJournal of Autism amp DevelopmentalDisorders 38 127ndash37

Conacher G (1990) Childhood autism as adisturbance of neuronal migrationPsychiatric Bulletin 14 744

De Martino B Harrison N Knafo SBird G amp Dolan R (2008) Explainingenhanced logical consistency during decisionmaking in autism Journal of Neuroscience28 10746ndash50

Frith U (1989) Autism Explaining the EnigmaOxford Basil Blackwell

Gomot M Belmonte M K Bullmore E TBernard F A amp Baron-Cohen S (2008)Brain hyper-reactivity to auditory noveltargets in children with high-functioningautism Brain 131 2479ndash88

Gomot M Bernard F A Davis M H et al(2006) Change detection in children withautism an auditory event-related fMRIstudy NeuroImage 29 475ndash95

Grandin T (2000) My Experiences with VisualThinking Sensory Problems andCommunication Difficulties The Center for

286

Chapter 15 The paradox of autism why does disability sometimes give rise to talent

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the Study of Autism wwwautismcomind_temple_experiencesasp

Happe F (1996) Autism London UCL Press

Heaton P Davis R E amp Happe F G E(2008) Research note Exceptional absolutepitch perception for spoken words in an ableadult with autism Neuropsychologia 462095ndash8

Hermelin B (2002) Bright Splinters of the MindA Personal Story of Research with AutisticSavants London Jessica Kingsley

Hillier A Campbell H Keillor J Phillips N ampBeversdorf D (2007) Decreased falsememory for visually presented shapes andsymbols among adults on the autismspectrum Journal of Clinical andExperimental Neuropsychology 29 601ndash16

Huang Z (2009) Molecular regulation ofneuronal migration during neocorticaldevelopment Molecular and CellularNeuroscience 42 11ndash22

Jaervinen-Pasley A Wallace G L Ramus FHappe F amp Heaton P (2002) Enhancedperceptual processing of speech in autismDevelopmental Science 11 109ndash21

Jolliffe T amp Baron-Cohen S (1997) Arepeople with autism or Aspergerrsquos Syndromefaster than normal on the Embedded FiguresTask Journal of Child Psychology ampPsychiatry 38 527ndash34

Jolliffe T amp Baron-Cohen S (2001) A test ofcentral coherence theory can adults withhigh functioning autism or AspergerSyndrome integrate fragments of anobject Cognitive Neuropsychiatry 6193ndash216

Joseph R Keehn B Connolly C Wolfe J ampHorowitz T (2009) Why is visual searchsuperior in autism spectrum disorderDevelopmental Science 12 1083ndash96

Kanner L (1943) Autistic disturbance ofaffective contact Nervous Child 2 217ndash50

Kern J K Trivedi M H Garver C R et al(2006) The pattern of sensory processingabnormalities in autism Autism 10 480ndash94

Lee K Choi Y Gray J et al (2006) Neuronalcorrelates of superior intelligence strongerrecruitment of posterior parietal cortexNeuroimage 29 578ndash86

Leekam S R Neito C Libby S J Wing L ampGould J (2001) Describing the sensoryabnormalities of children and adults withautism Journal of Autism and DevelopmentalDisorders 37 894ndash910

Mottron L amp Burack J A (2001) EnhancedPerceptual Functioning in the Development ofAutism Mahwah NJ Erlbaum

Mottron L Burack J A Iarocci GBelleville S amp Ennis J T (2003) Locallyoriented perception with intact globalprocessing among adolescents with high-functioning autism evidence from multipleparadigms Journal of Child Psychology andPsychiatry 44 904ndash13

Mottron L Burack J A Stauder J E ampRobaey P (1999) Perceptual processingamong high-functioning persons withautism Journal of Child Psychology ampPsychiatry 40 203ndash11

Myers P Baron-Cohen S amp Wheelwright S(2004) An Exact Mind An Artist withAsperger Syndrome London Jessica KingsleyPublishers

OrsquoRiordan M amp Passetti F (2006)Discrimination in autism within differentsensory modalities Journal of Autism andDevelopmental Disorders 36 665ndash75

OrsquoRiordan M Plaisted K Driver J amp Baron-Cohen S (2001) Superior visual search inautism Journal of Experimental PsychologyHuman Perception and Performance 27719ndash30

Ozonoff S Pennington B amp Rogers S J(1991) Executive function deficits in high-functioning autistic children relationship totheory of mind Journal of Child Psychologyand Psychiatry 32 1081ndash106

Perner J Frith U Leslie A M ampLeekham S R (1989) Exploration of theautistic childrsquos theory of mind knowledgebelief and communication ChildDevelopment 60 689ndash700

Rumsey J amp Hamberger S (1988)Neuropsychological findings in highfunctioning men with infantile autismresidual state Journal of Clinical andExperimental Neuropsychology 10 201ndash21

Russell J (1997) How Executive Disorders canbring about an Inadequate Theory of Mind

287

S Baron-Cohen E Ashwin C Ashwin T Tavassoli and B Chakrabarti

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Autism as an Executive Disorder OxfordOxford University Press

Sacks O (1995) An Anthropologist on MarsLondon Picador 232

Schmitz N Rubia K van Amelsvoort TDaly E Smith A amp Murphy D (2008)Neural correlates of reward in autism BritishJournal of Psychiatry 192 19ndash24

Shah A amp Frith U (1983) An islet of ability inautism a research note Journal of ChildPsychology and Psychiatry 24 613ndash20

Shah A amp Frith U (1993) Why do autisticindividuals show superior performance onthe block design test Journal of ChildPsychology and Psychiatry 34 1351ndash64

Suzuki Y Critchley H D Rowe AHowlin P amp Murphy D G (2003) Impairedolfactory identification in AspergerrsquosSyndrome Journal of Neuropsychiatry andClinical Neuroscience 15 105ndash07

Tavassoli T Ashwin E et al (submitted)Multimodal hypersensitivity in individualswith autism spectrum conditions

Tomchek S D amp Dunn W (2007)Sensory processing in children with andwithout autism a comparative studyusing the short sensory profileAmerican Journal of Occupational Therapy61 190ndash200

Tommerdahl M Tannan V Cascio C JBaranek G T amp Whitsel B L (2007)Vibrotactile adaptation fails to enhancespatial localization in adults with autismBrain Research 1154 116ndash23

Treffert D (2010) Islands of Genius TheBountiful Mind of the Autistic Acquired andSudden Savant London Jessica KingsleyPublishers

Wing L (1997) The Autistic Spectrum OxfordPergamon

288

Chapter 15 The paradox of autism why does disability sometimes give rise to talent

terms of use available at httpswwwcambridgeorgcoreterms httpsdoiorg101017CBO9780511978098017Downloaded from httpswwwcambridgeorgcore Pendlebury Library of Music on 02 May 2017 at 105910 subject to the Cambridge Core