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See Inside November 2006

Broken Mirrors: A Theory of Autism

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At first glance you might not notice anything odd on meeting a young boy with autism. But if you try to talk to him, it will quickly become obvious that something is seriously wrong. He may not make eye contact with you; instead he may avoid your gaze and fidget, rock his body to and fro, or bang his head against the wall. More disconcerting, he may not be able to conduct anything remotely resembling a normal conversation. Even though he can experience emotions such as fear, rage and pleasure, he may lack genuine empathy for other people and be oblivious to subtle social cues that most children would pick up effortlessly.

In the 1940s two physicians--American psychiatrist Leo Kanner and Austrian pediatrician Hans Asperger--independently discovered this developmental disorder, which afflicts about 0.5 percent of American children. Neither researcher had any knowledge of the other's work, and yet by an uncanny coincidence each gave the syndrome the same name: autism, which derives from the Greek word autos, meaning "self." The name is apt, because the most conspicuous feature of the disorder is a withdrawal from social interaction. More recently, doctors have adopted the term "autism spectrum disorder" to make it clear that the illness has many related variants that range widely in severity but share some characteristic symptoms.

Ever since autism was identified, researchers have struggled to determine what causes it. Scientists know that susceptibility to autism is inherited, although environmental risk factors also seem to play a role [see "The Early Origins of Autism," by Patricia M. Rodier; Scientific American, February 2000]. Starting in the late 1990s, investigators in our laboratory at the University of California, San Diego, set out to explore whether there was a connection between autism and a newly discovered class of nerve cells in the brain called mirror neurons. Because these neurons appeared to be involved in abilities such as empathy and the perception of another individual's intentions, it seemed logical to hypothesize that a dysfunction of the mirror neuron system could result in some of the symptoms of autism. Over the past decade, several studies have provided evidence for this theory. Further investigations of mirror neurons may explain how autism arises, and in the process physicians may develop better ways to diagnose and successfully treat the -disorder.

Explaining the Symptoms
Although the chief diagnostic signs of autism are social isolation, lack of eye contact, poor language capacity and absence of empathy, other less well known symptoms are commonly evident. Many people with autism have problems understanding metaphors, sometimes interpreting them literally. They also have difficulty miming other people's actions. Often they display an eccentric preoccupation with trifles yet ignore important aspects of their environment, especially their social surroundings. Equally puzzling is the fact that they frequently show an extreme aversion to certain sounds that, for no obvious reason, set off alarm bells in their minds.

The theories that have been proposed to explain autism can be divided into two groups: anatomical and psychological. (Researchers have rejected a third group of theories--such as the "refrigerator mother" hypothesis--that blame the disorder on poor upbringing.) Eric Courchesne of U.C.S.D. and other anatomists have shown elegantly that children with autism have characteristic abnormalities in the cerebellum, the brain structure responsible for coordinating complex voluntary muscle movements. Although these observations must be taken into account in any final explanation of autism, it would be premature to conclude that damage to the cerebellum is the sole cause of the disorder. Cerebellar damage inflicted by a stroke in a child usually produces tremors, swaying gait and abnormal eye movements--symptoms rarely seen in autism. Conversely, one does not see any of the symptoms typical of autism in patients with cerebellar disease. It is possible that the cerebellar changes observed in children with autism may be unrelated side effects of abnormal genes whose other effects are the true causes of the disorder.

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