Laurent Mottron, M.D., Ph.D., DEA, is a psychiatrist and researcher who specializes in the study of autism in the Department of Psychiatry at the Université de Montréal. Find out more about Dr. Mottron here.
Q. DR MOTTRON, CAN YOU TELL ME WHAT AUTISM IS? IS IT AN ILLNESS OR DISEASE?
MOTTRON: The main thing is that nobody knows what it is. We know that a society decided to call it autism. So, autism is a definition currently. It is a DSMIV. It groups certain numbers of people who have in common, who share, atypicalities at the social level, at the communication level, and in the variety of interests. So they may be in some ways quite different, but they all share these peculiarities. Autism is currently included in psychiatric diseases. This is a sociological fact. It doesn’t mean that it is psychiatric. It means that it is incorporated in psychiatric books which list all the variations of typical development, for example.
Q. HOW DOES AUTISM SHOW ITSELF OR MANIFEST ITSELF IN TERMS OF SYMPTOMS?
MOTTRON: Autism can be described as an atypical development – begins probably before birth, but what can be seen, the difference that can be seen begins usually in the middle of the second year of life, on average. It’s manifested by language delays and atypicalities in communication and also an apparent disinterest in social manifestation and increased interest in objects or physical aspects of the world. And the play also is quite different in the sense that typical children have play which incorporates a large number of objects. They do a large number of things with different objects, and autistics do more repetitive actions with more repetitive objects.
Q. NOW WHAT ABOUT COMMUNICATION? IT SEEMS THAT THERE ARE A SIGNIFICANT NUMBER OF AUTISTIC PEOPLE WHO HAVE DIFFICULTY WITH VERBAL COMMUNICATION. CAN YOU EXPLAIN THIS?
MOTTRON: The difficulties autistics have in communications are extremely different in terms of magnitude. So, on the other hand, you have possibly 10% - that’s the usual number – who don’t present oral speech at all. A certain number of these non-speaking autistics are able to write, read and to understand language. So it’s not that they don’t communicate completely, but their oral language, speech, is quite frustrated. Then you have a certain number of autistics who have language but use it quite differently. So, they may use echolalia – they may use language that’s more repetitive than other people’s language, which here again doesn’t mean that they do not understand language, but when they speak their speech is more repetitive. And then you have a certain number of autistics who, even if, in their head, it’s possibly quite different in terms of the way that they feel and use language, the result is very able people in terms of communication.
Q. ANECDOTALLY, MANY AUTISTIC PEOPLE SEEM TO REPORT HYPERSENSITIVITY TO SOUNDS, COLOURS, SMELL, THIS KIND OF THING...
MOTTRON: First, hearing and vision are quite different. Most autistics seem to be disturbed by certain types of sounds, not specially loud sounds but sounds which contain variation in frequencies, like trucks changing their gears, or like blenders, or vacuum cleaners. In the vision domain, it’s more that they are atypically attracted by certain types of visual information like moving objects or repetitive visual stimulation. At the tactile level, it’s more complex. A person with Aspberger’s, which is a subtype of pervasive developmental disorders, a large family which includes autism, seems to have more tactile problems and for autistics it’s – they can have, they cannot have.
Q. CURRENTLY, PSYCHIATRISTS IDENTIFY AUTISM AS A MENTAL DISORDER, WHICH ESSENTIALLY POSITIONS AUTISM AS SOMETHING DEVIANT AND ABNORMAL. DO YOU AGREE THAT IT IS A MENTAL DISORDER AND THAT PSYCHIATRISTS SHOULD VIEW IT THIS WAY OR DO YOU HAVE AN ALTERNATIVE CONCEPT OF HOW AUTISM SHOULD BE VIEWED?
MOTTRON: The way we interpret and qualify autism in terms of adaptation to the standard world is an extremely complex issue in the sense that we have to take examples from other conditions than autism. Let’s go back for example to deafness. A deaf person is completely different for his or her adaptation according to his or her access to sign language. So you may have somebody who is considered who has a disease, who has a handicap, which result in a handicap, then this handicap has a huge effect on adaptation. If the person is not able to communicate, or lesser effect if she’s able to communicate. So, if we take this analogy for autism, the way we consider it as a disease or not depends what we call a disease. If disease is considered as a defect with only negative consequences, clearly it’s more complex than that. What can be, what is obvious, is that you have less people who are autistic than people who are non-autistic, so it’s a variation in the typical development of human beings, but because this condition is not homogeneous you have people who have this condition of autism who show increased abilities in a certain number of domains, which is quite unusual for something that you would call a disease. But the problem is, I will take another analogy that is now quite a cliché in the domain of homosexuality. Homosexuality has been considered as a disease and it has been considered as preventing people to have normal sexuality. Then people considered that it’s different, that it’s not detrimental for typical sexuality, it’s just the need to have another kind of sexuality. So we see now not the negative or positive aspect, just that it’s irrelevant to consider homosexuality as positive or negative. And now the society changed (unclear) for homosexuality and accepts that. There is something to take from this analogy for autism in the sense that it’s different, it’s a minority, then it’s – the decision that it’s a disease that it has to be cured is not related to what it actually provides as benefit or inconvenient to people – it’s just a decision of the majority of people that humanity would have to be homogeneous. Because it would be possibly a mistake to consider that the human condition is homogeneous, in the sense that you have a lot of ethnic backgrounds, you have a lot of physical differences, and you have a certain number of variations and where it’s just indecent to consider that you should make a cut-off. So, we just, I say we because it’s all these new (unclear) issues, we just want that the idea that it’s a disease no more be considered as something that’s obvious. You would have asked people 15 years ago if homosexuality was a disease, you would have possibly 90% of people saying yes it is. Now, let’s say you have 90% of people who say that autism is a disease. It’s changing, it’s changing according to the changing of ideology in society and that’s a point we underline. I would like to try at least one sentence about the disease. One fascinating paradox about the idea of disease is that on the one hand, we know that species evolve and they are supposed to evolve through genetic mistakes, and these mistakes may have some adaptive values. This is an old Darwinian cliché. So, on the one hand, we can see that variation in a species is good – it’s good because it (unclear) information, because men are, seems to be able to do more things than, say, snakes. So, when we have a species (humanity) which shows variation, curiously science in general considers these variations as bad. As something to be cured. So, science has two discourses: on the one hand, variation is good, is progress, even if it’s a very strange variation. And, on the other hand, variations are bad and even small variations are considered even at an aesthetic level to be something that has to be cured and brought back to the majority. I’m fascinated by this contradiction and I think that autism is an example of a variation that has to be respected, first at an ethical level, but which does not have scientifically the status of a disease. I have developed informally this analogy of species which I first must say can be extremely dangerous because if we say that autistics are an other species it’s, it could authorize a kind of reject of oh, they are so different. I know that it’s kind of a dangerous word, but the idea of species is that the abilities and even the behaviour that are typical and adaptative in one species are not adaptative and typical in another species. So you cannot reproach to a dog not to be able to climb a tree. It doesn’t belong to his behaviour and you cannot reproach to an autistic to have certain types of repetitive movement if this repetitive movement have an adaptation value for this person, even if they are supposed to make him look like an autistic. We don’t reproach to a cat to look like a cat, so the analogy I always use is the blind stick of blind people, the white stick of blind people. If it’s white, it’s not for them, they don’t care. They are blind. It’s in order that other people recognize that they are blind. So, when you have somebody who appears as autistics, it may have an adaptative value in the sense that it warns other people that this person is autistic. So, in the Nazi period, this was enough to have people killed. In our civilization, which is more human, I hope, to know that somebody is autistic helps us to behave with him with a certain number of expectations or absence of expectations like we have for blind people. So, at various levels, these repetitive behaviours may have an adaptative value. You see, this is a point of view that you don’t have with a disease. You don’t say that the tremor of Parkinson’s disease has an adaptative value. And I would say that Parkinson’s is a disease. Okay?
Q. SO, IF AUTISM IS A “DIFFERENCE”, IS IT DIFFERENT LIKE LEFT-HANDEDNESS IS DIFFERENT – NOT BETTER OR WORSE, JUST DIFFERENT?
MOTTRON: No, the level of difference is very important. Because it, that was (unclear) society of pervasive developmental. Pervasive at the beginning meant that this difference could be observed in a lot, lot of different domains. But on the other hand, when you look at how an autistic brain works, it works of course very similar to a non-autistic brain. But that you have differences that involve most processing of information. For example, you have differences at the motor level, at the perceptual level, at the language level
MOTTRON: Something I would like to add is that we try to develop in this group and in another I think also, this paradox that is saying that it’s only if we say that autistics are different that we save their humanity. That we maintain that they are human. The paradox is that people who deny it’s a difference has a tendency to reject autistics out of humanity. And saying that they are an error is literally putting autism out of humanity.
Q. I WANT TO ASK YOU A QUESTION ABOUT PARENTS. TYPICALLY PARENTS LOVE THEIR CHILDREN AND PARENTS WANT THE BEST FOR THEIR CHILDREN AND WANTING THE BEST FOR THEIR CHILDREN USUALLY MEANS THAT THEY WANT TO AVOID HARDSHIP FOR THEIR CHILDREN. AND IF THEIR CHILD IS AUTISTIC THEY REASONABLY EXPECT THAT THEIR CHILD WILL HAVE A MORE DIFFICULT LIFE THAN IF THEIR CHILD IS NOT AUTISTIC. SO IN THAT CONTEXT DO YOU UNDERSTAND PARENTS’ DESPERATELY SEEKING A CURE FOR AUTISM BECAUSE THEY WANT THEIR CHILDREN TO BE RICH, FAMOUS, SUCCESSFUL, GET GREAT JOBS, GO TO UNIVERSITY - THEY WANT THEIR LIVES TO BE AS EASY AS POSSIBLE?
MOTTRON: I have seen about 800 autistics and their families and I have announced that I know this from about the same number of people and my main purpose in this situation is to convince the parents that the expectations they should have for their son and daughter are what is the best for the autistic and not for somebody who looks like them. So, it’s quite obvious every parent wants the best for their child. In this precise situation, the best is not the same best as their best. So, when parents consider automatically that the best for their child is a cure, in the current state of science and practice, and I hear entirely skips the ethical aspect of is it good or not – I just talk in terms of efficiency. All the methods that are presented as cure does not work, in the sense that it does not transform the atypical way that (unclear) process information. So, it does not help autistic – in fact it creates a kind of superficial adaptation to the world which may be painful. Most of the time that’s not really efficient. And that would be quite beneficially replaced by an adaptation of the world to their peculiarities. Why is that obvious that people who are paralyzed who are in a wheelchair first have to learn to jump in the streets. The streets are modified according to their need, because people accept that this cannot be cured. So, if we say to parents that a certain number of peculiarities of their child are just the nature of their child, that do the best for this child is to give him access to language, to culture, to play, even to socialization, but according to his way, not according to their way. So, this is why you don’t have an easy answer to the question of do we have or not to cure? The autism is I would say, mainly a question of education in the sense that these are typical or atypical children are nothing without education. I mean, we typical people are nothing without tool, machine, language and good care. We just say that autistics cannot have a good autistic life without access to language according to his way, access to play according to his rules, and access to machine, and access to culture in general. But if we don’t adapt the way we transmit culture to the autistic brain, it just does not work. It’s entirely false that the person with typical intelligence on the one hand and typical intelligent plus typical achievement does not belong to autism. At the very beginning of the description of autism Kanner, the guy who “invented” autism, describes this population as being extremely marginal in terms of behaviour but most of the time of typical intelligence. And you had quite an important proportion of the 11 children described by Kanner who had a good achievement. At the very beginning people said that 75% of autistics only were retarded. Now we say that 50, and we have a lot of things to say, even of these 50%. But at least you have the other 50% who are of typical intelligence. It’s true that the level of adaptation is quite low if you don’t do something special, but we have to state very strongly that having a good achievement can belong to autism. It does not make you less autistic.
Q. HOW MANY AUTISTIC PEOPLE ARE THERE IN CANADA?
MOTTRON: Currently autism is what you label autism so depending on the precision of the (unclear) of criteria you may absolutely multiply by two or by four the number of people. So, there's an important study in England that has demonstrated one year ago is that if you change a few words in the way you define, you have two times more autistic so the epidemic is I would say is a result of the increase of interest towards autism, the increase of benefits at least what families could benefit so uh to have more support at school to have more support in the pre school years. But of course there's no epidemic and the, you have epidemiology call a word a very, very good quality that show that there is no increase in the number of autistics.
Q. DOCTOR, GIVE ME AN OVERVIEW OF THE OF RESEARCH YOU'RE DOING WITH AUTISM AT THE MOMENT.
MOTTRON: It’s a Montreal group because we are now quite a large number of people, we are working in within two different domains. The first one is about what's called information processing, so how do autistics perceive, store and manipulate any kind of information. Can be social information like faces like emotions. It can be language information uh so we are doing a kind of inventory of the differences with a neutral view about the fact that it’s beneficial or detrimental. We are looking how autistic brain works. We are doing some by brain imaging.
Q. HAVE YOU ANY RESULTS YET?
MOTTRON: Yes. So most result we have, we have put it together in a (unclear) model of a enhanced (unclear) functioning which is a kind of a collection of heterogeneous principles describing that the perception is more important, efficient and has a different role in autism than in non autistics. So it can be quite technical if we go deeper in that and the, the other aspect of Montreal autism research group which is lead by Dr. Gil (unclear) it’s not a genetic hue of autism, and you have (unclear) group in the world but our group is one among others which is interested in what at the genetic level, molecular level what are the differences between the autistic genome and non autistic one.
Q. DR MOTTRON, WHAT DO YOU THINK THAT THE PUBLIC MOST MISUNDERSTANDS ABOUT AUTISM?
MOTTRON: I think that what the public most misunderstands in autism is the idea that specific achievements have to be determined for specific populations, that you shouldn’t have a common gold standard to define what is a successful life. That a successful life for an autistic person and a successful life for a non autistic one are the same, of course at the general level it’s the same, I mean it’s not to suffer at the psychological level, to be useful to society, this is absolutely common to autistic and non autistics. But the way you obtain these goals may be quite different. So the idea of the diversity of humanity and the idea that autism is one of the… on sexuality for example is one of the main , Iwould say dimension on which humanity can vary, this is clearly misunderstood. And clearly we are a minority in this group, to think that way. I will never say that we are a majority.
Q. YOU ARE SAYING THAT AUTISM IS A “DIFFERENCE” FROM WHAT IS MOST TYPICAL AMONG PEOPLE: IS IT A DISABILITY ALSO, OR NOT?
MOTTRON: I would agree with a certain aspect of the disability issue. As long as for any other disability we know the disability is related to the way it’s accepted or not. In the society.
Q. SO IN OTHER WORDS WHAT YOU'RE SAYING IS, IF AUTISM WERE ACCEPTED IT WOULD NOT BE A DISABILITY?
MOTTRON: For some part, there may be in the autism sign, aspects that are clearly detrimental. I would accept to say that, for example, the motor aspects may be quite detrimental, it’s clear now that some autistics would have spoke without some kind of motor problem. And here it’s, it would just be stupid to say that it’s beneficial, I think it’s a much broader view that autism (unclear) a fact of being autistic, is entirely detrimental, so disability is quite, maybe a quite good word and a lot of progress has been made in consideration with being disabled.