New Hope for Autistic Children and Their Parents
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Lindau Nobel Laureate Meetings121 / 340
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Transcript: English(auto-generated)
00:12
Mr. Chairman, ladies and gentlemen, for the first four decades of my scientific career,
00:23
I have indulged in the hobby of birdwatching and in trying to fool little sticklebacks into courting mayonets instead of their own females. I had no idea at that time that one day the methods we learned to develop in that period
00:53
would become relevant to some serious problems of modern society, particularly of problems of mental disorders and in particular, again, mental disorders in children.
01:09
Autism is a form of abnormal behaviour development. It's only since 1943, when Connor described the syndrome very clearly,
01:22
that this deviation has come to the attention of the scientific world. The main descriptive characteristics of this relatively well-defined syndrome, which is rare for a mental disorder, are the following.
01:43
First of all, these children show a failure to make social contacts. Worse, they avoid social contacts. Secondly, they don't venture out into an unfamiliar world, as normal children do from a certain age on.
02:02
We find in most of the severe autists, and they are no longer so rare, non-development or regression of speech. And many autists are completely mute, which incidentally doesn't mean that they don't understand verbal communications of others.
02:22
Further, we see an enormous number of what's in the literature called stereotypes or mannerisms, monotonous, very often repeated simple movements, which are not often understood, but which are labelled by the word bizarre,
02:44
which is a negative statement, of course. Further, these children have a tremendous resistance against changes in the social and in the physical world, and also against changes in routine in time.
03:01
Sameness is the catch word for this kind of attitude. Finally, they are overall retarded in the development. The older they are, the longer this deviation has developed, the more they get overall retarded. But there is the curious problem that many of the experts comment on,
03:24
that in this overall picture of retardation, there are curious islands of good, even excellent performance. I'll return to that later. Finally, although this is not so well known to most of the physicians who have to deal with these children,
03:41
they suffer from insomnia. They are often awake during a larger part of the night. Now, the prognosis for autistic children is at the moment considered to be very poor. The figure that's often mentioned is that 15% of those diagnosed as autistic
04:01
have a chance of more or less normal recovery, not quite normal. The other 85% do not recover, but as they go up, they receive a different label. They are often called schizophrenics. Many of them end up in institutions because the families can no longer cope with them.
04:28
They are so difficult to cope with. Now, there is a growing body of research which probably reflects the belief that my wife and I hold that autism is actually on the increase in modern society.
04:43
But in all the reports, many books, special journals on the subject, we haven't met a single overall theory. The literature is extremely bitty and we even miss attempts at arriving at an overall hypothesis,
05:03
let alone a theory. That covers the entire spectrum of the phenomena that we can observe. Just one example is at the moment fashionable in Britain under the influence of one of the specialists, Dr. Michael Rutter, to see autism as the consequence of the central cognitive defects
05:25
that these children are supposed to have. But we miss in this, the whole literature that adheres to this view, any attempt to try and explain other aspects of the overall syndrome from this so-called central defect.
05:46
What about the stereotopies, this continuous mentalism? What about the islands of good performance? What about the avoidance of unfamiliar surroundings and of social contacts? And at the same time, what about this excellent understanding that some of these children have
06:04
for the speech of others even though they are mute themselves? That doesn't follow from the catch phrase, a cognitive defect. Part of it is even in contradiction with it. The same is true of some of the other theories in quotes.
06:21
We consider that there is not an overall theory. Now my wife and I together began to study this phenomenon around 1970. We had an interruption of a couple of years, have now resumed our studies and at the moment engaged in writing up
06:41
what we have found out since I reported very briefly in Stockholm in 1974. Our approach, which is partly supplementary to conventional approaches found in child psychiatry, partly have to replace, we think, the methods at the moment applied, can be characterized as follows.
07:04
First of all, since so many autists don't speak, we have to rely on their non-verbal behavior in order to understand them. And that's where the animal ethologist comes in. Because, although in the past we have said what a pity our animals don't speak,
07:25
we now say how wonderful that they don't speak because they can't deceive us, deliberately or unwittingly. Could I have the, Davide's first, first bill, please? I will show you very briefly in only two slides the kind of things we use in trying to understand these autistic children.
07:48
I cannot analyze these pictures, I can just give you one impression. This shows two facial expressions, which can be analyzed in numerous components, shown by the same girl in the same spring, but photographed by two different people under different circumstances.
08:08
The picture on the left was taken at school by the school photographer. The picture on the right was taken with a box camera by her elder sister. And those of you who know children will of course know both expressions very well,
08:24
although the one on the left is not so well known. That's an expression, let's briefly call it, I call it, of suspicion. Another point I wanted to show you is the overlap in non-verbal behavior between autistic children and quite normal children.
08:52
A little shy perhaps. On the left you see a boy who has grown up since, has been quite normal if anything above average, who makes a curious gesture with the left hand.
09:06
On the right side you see exactly the same gesture with the left hand drawn by John and Corinne Hutt from the movie picture of a serious autist. This gesture, which incidentally you do not find described in the literature of human behavior,
09:24
is very common defense, protective gesture. This should illustrate the overlap which is total between autists, severe autists on the one hand and perfectly normal children on the other hand.
09:43
The second aspect of our approach is that we study the child in the context of its natural environment, the family, the social environment, the physical environment. We also try to correlate short term and long term changes in the behavior of the children with outside events.
10:08
We distinguish conceptually between diagnosis, between trying to understand the autistic state, being autistic at any given moment,
10:21
the question of how does a child become autistic, ontogeny question, and the question of therapy, how to treat autistic children, how to educate them. Of course these are all interrelated, but conceptually it's important, we think, to distinguish between these questions, particularly because in the literature, in the child psychiatry literature, one finds them mixed up and not distinguished.
10:48
And finally, apart from comparing autistic behavior with normal development, behavior of normal children, we try, at any rate, to check the internal consistency of whatever conclusions, tentative conclusions, we are at the moment drawing.
11:07
More, we try deliberately to hunt for exceptions or contradictions and try whether or not they will fit with the ideas that we have gradually developed. This list of characteristics of our approach to this problem implies a pretty severe criticism of the approach,
11:30
as at the moment, applied in child psychiatry to the extent that they are concerned with early childhood autism. I won't be as aggressive as I have been before in my earlier publications and spell out this criticism.
11:48
It's implied in the list of the point of our approach that I try to present a little more constructively. Now, as to the autistic state at any given moment, when you read the non-verbal signs of expressions,
12:09
as we have seen them in one little example on the slide, then you see, first of all, clear, immediate signs of avoidance of social contact
12:21
and of unfamiliar surroundings and unfamiliar routines. This expresses itself primarily into not approaching, into interrupting, halting an approach, and in even running away, or showing the intention movements of these behavior patterns, such as turning a little way, above all gaze aversion.
12:43
These children won't make contact. That's already a well-known phenomenon. It's an incipient behavior of total withdrawal. If these children can't escape, and usually in the normal environment these poor children cannot escape, either social contact or unfamiliar surroundings or unfamiliar routines,
13:05
then they behave exactly the same way as a cornered animal and a cornered child, a normal child, they throw a tantrum, they can't get away, and they scream, throw themselves on the floor, and kick. Those are called temper tantrums in the literature. In most cases we believe they could be better called panic tantrums.
13:29
Apart from this avoidance of unfamiliar social and physical surroundings, they also show the immediate straightforward behavior of positive responses to other people and to new environments.
13:45
When left in peace, these children will slowly but definitely make social contacts and will explore. In other words, we see in these children two behavior systems, two sets of behavior systems,
14:01
both activated, which are in conflict with each other. They're incompatible. You cannot at the same time approach people on new situations and flee from it. And the result is that we observe what we call in ethology conflict behavior, expressions of motivational conflict.
14:21
In normal situations, this conflict is dominated by withdrawal. But, as you have seen, involved in this situation is not just in withdrawal, also the rather opposite behavior patterns of exploitative behavior and of social approach and social interaction.
14:42
Now, when this conflict is seen as central, and here we make a jump, a speculative jump, comparable to Rutter's jump when he says this is primarily a cognitive effect, we say no, this is primarily a motivational conflict effect. Let's now try and see, even when we see this conflict as central,
15:05
whether the other details that we know of the behavior of autistic children do fit in better than they do when you look at it another way. First of all, the refusal to speak becomes understandable. Of course, speaking is a social activity.
15:26
There is also no overt response to the speech by others. But there are internal responses, as we not only do well from the phenomenon of latent learning, when sometimes years afterwards, when these children begin to recover, as many of them do,
15:42
then they have learned not only to understand a great deal of speech, but they can suddenly speak without having received speech therapy. We see numerous expressions of conflict in the form of these stereotypes, in the form of over-arousal, in the form of insomnia.
16:02
Typical of these stereotypes, and I cannot unfortunately go into detail, is that they almost always are monotonous movements quite near the body. Even the hands don't venture out much in the outside world. But you find these children do a lot of scratching, up to the point that they injure themselves,
16:22
they bite themselves a great deal, they masturbate a great deal. There is not much that you can do as an expression of a motivational conflict if you don't venture outside your own body. One of the intellectually very stimulating jobs in studying these mannerisms, these stereotypes,
16:43
is quite comparable to the challenge that's offered by ritualized signal movements, ritualized means adapted to the signaling function in the course of genetic evolution. Now here in the course of the individual development, you see these stereotypes gradually becoming more and more monotonous,
17:06
more and more stereotyped, formalized. Through, to look through the formalized mantle, back to the origin of these stereotypes, is a very similar exercise as recognizing the origin of ritualized movements.
17:27
It is easier to do because you can develop, you can follow the development of these stereotypes during the life of the individual. And you can, if you are lucky enough and you see a child recover,
17:40
you can see the opposite effect as well, the gradual disappearing of these stereotypes. Let me give you one example. Many of these autistic children show a very curious stereotype, which is called twirling. They turn round and round and round on their own axis. As an animal histologist, I had already suspected for a long time,
18:04
the origin of this must be combined, a combination of two intention movements, one of going forward a little, then inhibited, then of withdrawing a little, which often takes the term of sideways movement, the form of sideways movement.
18:22
One day, a girl, an autistic girl, was recovering from her condition and who always had until then showed this twirling whenever she entered the house of friends, for instance, a slightly strange situation, suddenly didn't make this continuous series of turns,
18:44
but made one of exactly 360 degrees, then stopped, facing the door and went in. When that was described to us for the first time, my immediate response was, as Jewish would be, was there any irregularity in this circular movement?
19:02
I didn't ask a leading question, no more than this. And it turned out, yes, the child had slowed down and stopped a little, exactly 180 degrees away from the door. That was what I really expected, of course. And in this way, when you follow the recovery, in this case, or you follow the origin, the development of such a scenario,
19:23
you can quite clearly show that this is indeed a combination, a succession of two incipient movements of the two parts of the conflict involved. The one thing we couldn't explain was why shouldn't that girl do this, this, or this, this, but go on?
19:41
Probably a question of inertia, but we don't know that yet. Just an illustration of how it can be exciting to trace one understood, bizarre movement after another and try and find its origin. Does the origin, as we find them, fit with our overall hypothesis?
20:00
Then we are, of course, happy. If it doesn't fit, well, in the course of 40, 50 years, one learns to be even happy with that because we know by experience that those data that don't fit your preconceived ideas are the most fertile in the long run. Now, the islands of good performance are also understandable
20:20
when you look at the Antarctic in this way. What are the things that these children learn well? They are all things that they can learn when alone. The understanding of speech included, which they learn while they may be crouching under a table,
20:40
avoiding contact with other people. They listen joy well and they act on what is said. Only the psychiatrist, as he is trained, hasn't really learned to observe these effects in the behavior of the child, perhaps delayed effects to what has been said before.
21:02
And I think they've missed a great deal. There are a number of these islands of good performance and they can be very exceptional indeed. For instance, many of these autistic children are, for some reason that we don't understand, very much interested in music. And we have known mild autists who were very clumsy in the overall movements,
21:26
which is another characteristic of autists, but who when alone had the run of a gramophone, could put on not only the record on the gramophone, but could put the needle exactly on the place
21:40
where they knew a certain theme would occur. And they would tell, now I'm going to let you hear this or that theme. And within seconds they did get hold of the theme. A number of these children cannot only understand speech,
22:01
but they can read, they can write. And they've taught themselves that to say nobody has instructed them, but they have done some observational learning and imitation. And some of these children are quite sophisticated and well ahead of the age. But in a test situation, when they are taken to the psychiatrist's office
22:22
and they are being run through a number of psychological tests, then they don't show any of this because then they are greatly intimidated and the imbalance swings towards over-anxiety and they don't perform at all and they get very low IQ readings and so on.
22:41
Yet we know from patient observation in their own homes that they can achieve these highly sophisticated skills, often before the normal time. Now there are also long-term consequences apart from these immediate signs.
23:02
One of them is, and that makes things very difficult for anybody who studies them, that these children manage to avoid very soon any situation of which they suspect that it might elicit a temper tantrum themselves, might elicit fear, immediate fear.
23:21
And they are extremely clever in avoiding such situations. This includes a form of behaviour which looks like social contact. They may come quite near to you, but then they have a curiously blank expression in their eyes and look either past you or through you. What that actually means, we haven't analysed yet,
23:42
but we think it is a matter of eye axes. When they are parallel, they look through you. That's how you react to them. The second difficulty I've already discussed, these stereotypes become in the long run highly formalised and stereotyped
24:00
and become unrecognisable. Most important perhaps of all in terms of long-term effects is the fact that these children cut themselves off from being instructed, also from social play and from exploratory play.
24:21
And those are the main channels through which a normal child learns and develops. And so much of course in our development is learned that when these important channels are cut off by the children themselves and they have to rely entirely on practice when alone and on observational learning, both by ear and eye,
24:43
then no wonder that they lag behind in a number of basic skills. And the longer they have cut off themselves, the more delayed they are. This means that when you want to understand a severe artist of about ten years old,
25:01
you mustn't look for movements normal to a ten year old, although the structures of the hands, of the face may be the same, they're not entirely the same, a little retarded too. But you must look for much younger behaviour patterns. When you do that, you may see in a ten year old,
25:20
typically babyish exploratory behaviours such as sniffing and chewing and feeling rubber, a hot water bottle or something. A little later stage, if and when they recover, they will switch on and off the light as so many children do. Most children do that for a short time. They look at the light and after a little while, they've got the feedback,
25:42
they've learned when you do this, you get light. Now these children go through such a phase much later, if and when they recover, and the feedback is not processed, they learn so much more slowly. So without going into more details, it would be difficult anyway to stay within my time,
26:05
our conclusion about the nature of the autistic state is that these children suffer primarily from a motivational imbalance which is dominated by anxiety. And if we consider that essential, many of the little symptoms can be understood.
26:27
Tentatively still, but quite plausibly. Much is still not understood. For instance, some of these autists sometimes suddenly run away from home. It's not running away really, we have interviewed a few recovered children.
26:43
They suddenly explore and we still don't know why that is. They may be away from home for an hour, for two hours. They know the way about in the town very well and find their way back. A surprising accuracy. It is not running away from an unpleasant home, that's what these recovered children claim.
27:05
But they keep saying, we suddenly got into our head to explore, to see something of the external world. Why that should suddenly happen in such an unhappy state, we still don't know. So there are many things that we still don't understand, yet we claim that what I've presented now about the autistic state
27:24
accommodates far more of the isolated phenomena than any of the other views that we have encountered in the literature. Now this interpretation can be supported by a little experimentation.
27:40
We can either reduce or increase the anxiety component. The increasing of it becomes increasingly difficult for us, because the better you understand these children, the earlier you know that you're being very cruel when you increase the anxiety. But the reduction of anxiety is extremely interesting.
28:03
I've described in my previous papers how we, my wife and I together, tame both normal, shy normal and autistic children. I can't repeat that here. I would like to mention though that our colleague Corinne Hutt
28:21
has done a typical, it's a logical, as distinct from a psychological thing. She tested a number of autistic children in a familiar room, but faced with an unfamiliar object, and observed and recorded for five minutes, what did the child do, and what did normal children do.
28:41
Well, of course, normal children were at once interested in the new object and began to explore it within the five minutes. The autistic children always reported to ignore it, did nothing of that kind. They always avoided the object and sat down within the five minutes with their backs entirely towards the object.
29:03
So it's not ignoring. Corinne Hutt had the sense of waiting a couple of times beyond the five minutes. She waited for an hour to see what will this autistic child do when they give it time. And then she describes that all these autists showed a completely normal explorative behaviour
29:22
with respect to this new object, only much more delayed, much more slowly, and probably not taking in the feedback from which normal children learn a great deal, and by which normal children consider such an object very soon familiar. About the increase, experimental increase of the anxiety,
29:46
I would like to mention one, make one very severely critical remark. In the American literature, particularly in the work of Lovaas and some of his co-workers, there are curious experiments arguing that behaviour modification techniques
30:06
might well cure a child from self-injury, from biting, in this case, biting its finger until it bleeds. They gave an electric shock to an autistic child every time they did this.
30:20
They did report that when they did it over a fortnight, they got a reduction in this self-biting in this finger, but they got an increase of the overall pattern of self-injury movements. That's of course to be expected in terms of our interpretation.
30:40
In effect, what these people have done is something very cruel. They didn't know it, but it is very cruel. What is curious, and this is that in the discussion of these papers, they came to the conclusion that because this child went on with injuring itself, that the electric shock must have been very rewarding.
31:01
Now that to us is a kind of circular argument, one of the worst examples not only of scientific arguing, but of a type of attitude that leads to real cruelty, which is rather upsetting. I would like to say at the end of this little chapter of the autistic state,
31:24
all this is not based on extrapolation of facts found in animals but merely on the application of a few methods developed in our intercourse with animals. Now a few brief remarks about the etiology. What makes a child autistic?
31:44
Now, practically all the experts, with the exception of a few analysts, say these children are irreparably damaged. And they are either purely genetically damaged or, as often lumped with this,
32:04
they suffer from some organic damage such as gross brain damage, structural brain damage in the gross sphere. Lorna Wing, one of the leading experts in Britain, has written down very specifically at any rate these children are not the victim of educational regimes.
32:26
And this word irreparable, ineducable, one meets time and again in the literature of the, well, what we would like to call the child psychiatric establishment.
32:41
We think that for the argument for the interpretation of a purely genetic origin of autism, on a line with, say, Down's disease with Klinefelter's and other XY differences, there is no evidence. To the contrary, there is a little evidence that doesn't fit with this.
33:04
If this were true, you couldn't have identical twins of whom one was autistic and the other not. What we think is the genetic component of this whole story is that they probably, just as we all are genetically different and vulnerable to a different degree,
33:22
to certain infections, to all kinds of other external influences, so many children have different vulnerability to the conditions that I'm going to discuss that we think bring on autism. If you reject the idea of purely genetic origin, you must, of course, accept that this is mainly environmental,
33:44
given the fact that some children are more vulnerable than others. Some of the environmental factors may be so-called organic, and we have some indication in the literature now that's good for under this heading. For instance, when a pregnant mother has had rubella in certain times of the pregnancy,
34:03
the chances that she will produce an autistic child are significantly, although slightly higher than for those mothers who have not had rubella. But there is no evidence for gross structural brain damage. For one thing, there are very few autopsies.
34:22
Food, both of the mother and of the child, is now being considered as a possible contributing factor by Dr. Rimland in America in cooperation with Linus Pauling, but as far as I know, as far as we are informed, there are no results yet.
34:42
When one, to the contrary, digs into the history of autism, and this must be done by individual first-hand contacts, because the literature is very uninformative about this, then one does find strong evidence of environmental damage, environmental hurt.
35:03
And most of these could not really be called organic in the way in which it is generally understood, but should be called psychogenic, i.e. direct behavioral responses to the environment without the intermediary of other parts of the body.
35:23
That's a crude definition, but that's usually what psychogenic means. Now, we have systematically tried to study case histories and to see whether before the parents got an autistic child,
35:41
which is of course important because what happens afterwards can be a secondary effect on the parent, that one finds then a number of either possible or probable or even demonstrated external influences that can contribute to the onset of autism. And I will list a few of them. I have already mentioned in utero, rubella in the mother,
36:03
obviously can bias the development of the child a little bit in this direction. At birth, we think that very crude forceps deliveries may do damage, not just structural damage to the brain, but may frighten the child tremendously,
36:21
such as may be the slapping by the doctors, as was done for a long time immediately after the birth. We think that it's possible that during some difficult births, the child may suffer a little more anoxia and that you may get a certain amount of brain damage from this.
36:41
Has not been demonstrated though. What we do believe in very strongly is that when the mother gets an overall anesthetic during birth, as has been the fashion for a long time, that then mother and child are both dopey after the child has been born and that we know interferes grossly with the first seconds, first minutes,
37:06
first hours of interaction between mother and child, during which they program each other mutually to a very great extent, as only gradually being discovered. After birth, and here I would like to stress that when I speak of environmental influences
37:23
and even of influences that originate in the parents, that this is something quite different from blaming the parents. Many of us interfere with the development of our children, make mistakes and cannot be blamed for that because we've done our best and our best may have been a poor best.
37:42
For instance, the interaction between mother and child already perhaps damaged in the first few seconds, minutes and hours by an overall anesthetic, a dopey baby, can deteriorate even further. You get mutual disappointments between mother and baby
38:03
because both build up the relationship which is the beginning of socialization later by receiving the expected feedback from the other. There's a continuous conversation, non-verbal conversation between mother and child and if that doesn't click, if these two do not learn to adjust to each other,
38:24
then the normal affiliation followed by normal socialization suffers. Then we know that there can even be conditioning against what should be a very satisfying mutual relationship,
38:42
namely the sucking of the baby. When babies that don't suck well for some reason, either morphological difficulty with the mother or the baby is a little dopey, when they are forced to the breast, as was often done, by pushing the head and the breast, then what often happens,
39:02
as Mavis Gunter has pointed out 20 years ago, is that the nostrils of the baby become blocked, pressed against the breast and the poor baby is asphyxiated and kicks and can be conditioned against not only being suckled but against being taken up for sucking in a very short time, one or two days.
39:25
Hospitalization of either baby or mother in several forms can have a very bad effect. The birth of a sibling soon after the birth of the child in question can have a very bad effect and can actually trigger off suddenly an autistic state in the elder child.
39:44
Moving house, often with stressed and harassed parents, is much more traumatic than is generally recognized and we know children that have suddenly become autistic and shown the full syndrome after having moved house, together with a few other things.
40:01
Perhaps food is involved. Quality of food is not as it should be, as we know. There are accidents. We know of accidents that have triggered off autism in some children. And then there are some qualities in parents that we begin to recognize gradually.
40:21
For instance, there are numerous over-anxious mothers and I speak of the mothers mainly because the early socialization of course is a matter of interaction between mother and child. There are inexperienced mothers and that I think is very important at the moment. And I couldn't disagree less with Sir Hans Krepp when he pointed out
40:42
that at the moment there is a danger of real cultural loss of mothercraft, of parentcraft. Why is that? That's because, contrary to what we thought in the past, a great deal of mothercraft is learned in our species and that's learned not by being instructed.
41:02
This is the second best that we do now. But it's learned in a playful atmosphere. A. When young girls see younger siblings being nursed. B. When they take part in mothering younger children in the mixed age groups of a group of extended families.
41:25
That's where we ought to grow up. Now that disappears in modern urban society and you get an increasing number, and we know a number of them, of inexperienced mothers. Then over serious parents are curiously enough traumatizing to children.
41:45
There must be, we are convinced, in a good family a lot of fun and games from which children in a playful atmosphere learn an enormous number of skills. I can't develop this further.
42:02
Parents can be over ambitious on behalf of the children, particularly on behalf of their sons and put the children under pressure together with what the school already does. And that can have a bad influence on, particularly on boys. Another external factor, chaotic household.
42:22
No routines at all. The child can't predict at any moment what will happen. No discipline either. And we begin of course to know that it's totally wrong to think that children shouldn't be disciplined. To the contrary, certain forms of discipline are required
42:40
and the child feels secure when there are a set of certain rules. Within limits of course. When both parents are preoccupied with outside work, that can have a bad influence on children because it's very difficult, particularly for the mother, to switch off when she returns home
43:01
and to interact with the children. Instead, she may still be thinking of interesting aspects of her work, maybe worrying about the office, and yet she has to prepare the meal at the same time. The consequence is that the children are packed off towards the TV and that either the parents have their drinks upstairs,
43:23
as Bronfenbrenner has pointed out, or that the mother has to do the household chores in a tearing rush. Another aspect in the environment which our colleague Dr. Faye Hall in London has pointed out does a lot of emotional damage to children is when father and mother in a family speak different languages.
43:45
This particular form of bilingualism is confusing to the child and makes children very unhappy. And of course, broken homes. Broken homes do a great damage to children.
44:02
So our hypothesis is that with a vulnerable child, whether on genetic grounds or on the grounds of early history, we think that any, say, five or six out of this long list of environmental circumstances, different for different children, may put the child, push it over the brink.
44:25
Whatever the causation, the overall, the central result is this curious emotional imbalance that I've described, but the output in terms of abnormal behaviour is again different depending on the personality of the children that in turn depends on its early history and on its genetic makeup.
44:44
So you get a very curious picture of an enormous number of environmental circumstances, of which only a few need to be realized, all converging on a distortion of the emotional motivational condition and then branching out again in its output in different forms of these emotional disturbances,
45:04
of which I should like to add the officially labeled early childhood autism is only one. There are many more forms of very similar emotional disturbances which express themselves in a totally different way. And you get an idea of that when you try to understand the many children
45:25
that are channeled into education of normal schools for education of normal children and in schools for disturbed children. Then only a portion of those artists, the other have other labels, but the disorder is very similar.
45:44
What about the treatment, the education of these children? I'm not speaking of prevention, I will come back to that in a moment. A few words about the therapy that we think is required. We think that both from theoretical grounds, as I've tried to explain it, to sketch this now,
46:05
and from the proof of the pudding is in eating, from judging the results of different educational regimes, that what is important is that autistic children are first of all subjected to a regime that aims at the restoration of the emotional balance,
46:27
in other words, the creation of security. By all means instruct them, even apply certain forms of behavior modification, but we think that must always be subordinate to the overall aim, the primary aim of restoring the emotional balance.
46:41
When one does that, then it's astonishing how much these children turn out to have learned latently what a rich inner life they have had and how little skill instruction is really necessary, although the more they recover and the more sturdy they become emotionally, the more one can do in this context.
47:04
Now that conclusion comes, as I said, both from theoretical considerations and from the judgement, from the assessment of the results of the very many different regimes that are applied in different institutions, centers for autistic children and in different families.
47:24
I should like to end with a plea, a plea aimed at prospective parents. First of all I should like to say, once you have a child or children, remember that you are responsible above all things for its happiness and its growth to responsible citizens.
47:49
Second, ensure a happy family life, enjoy, take delight in your children. Then the interaction, the social interaction in the family and following that in society will be so much better.
48:10
Take also the development very seriously and avoid the trend that we have in society towards battery children. There's really a danger that we are going to raise battery children.
48:25
A third point is if we don't do this, we will do more social damage, not only create more autistic children but more other emotionally disturbed children. This will lead to a cultural loss and ultimately to a sick society.
48:41
And this is really the message that I believe we have to give to the younger generation. Take all this possibility of a sick society through sick family life very seriously in the interest of the future of your own children and grandchildren,
49:02
people whom you will meet and know and love. Thank you very much.
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