Titans of Science: Simon Baron-Cohen
In this edition of The Naked Scientists, Titans of Science continues with Autism research pioneer, Simon Baron-Cohen...
In this episode
00:52 - Simon Baron-Cohen: What is autism?
Simon Baron-Cohen: What is autism?
Simon Baron-Cohen, University of Cambridge
In this edition of The Naked Scientists, Titans of Science continues as Chris Smith chats with autism research pioneer, Simon Baron-Cohen...
Chris - Simon Baron-Cohen was born in Hampstead in London in 1958. He read Human Sciences at the University of Oxford before studying Clinical Psychology at the Institute of Psychiatry and the Cognitive Development Unit at UCL. He's currently Professor of Developmental Psychopathology at the University of Cambridge and he's a Fellow of Trinity College, where we are right now enjoying a nice cup of rooibos tea in his room on this beautiful May day. Simon’s also the Director of the Autism Research Centre here in Cambridge. Over a career spanning more than three decades, Simon has become one of the most influential voices in autism research. He's best known for his groundbreaking work on theory of mind, empathy and the extreme male brain theory of autism. His groundbreaking work on the subject has included hundreds of research papers and books like The Essential Difference and The Pattern Seekers. He was knighted for services to autistic people in 2021. Welcome to Titans of Science, Simon.
Simon - Thank you very much for inviting me, and it's a pleasure to be seeing you again after 20 years.
Chris - Yeah, we worked out that, I mean, you were among the first people to come on The Naked Scientist, and I jokingly said I took The Essential Difference, your book, with me on my honeymoon. I was sent it for review actually, and you said I was a sad person for reading it—but it was much better than the other person's book I got sent, so you won.
Simon - Well, I would have hoped you had other things to do on your honeymoon, but I'm very honoured, thank you.
Chris - But how did you end up going down the psychology path in the first place? Was this something you always wanted to do or did it find you?
Simon - Yeah, I mean, as you mentioned in the introduction, I studied a degree called Human Sciences, which included psychology, but it's broadly Biological and Social Sciences at Oxford. It is a very broad degree, and what I wanted to do was specialise after that. Of all the different parts of that degree, psychology really attracted me, so I went on to do a PhD studying autism. But in between that I taught in a school for autistic kids. That's really where I got my hands-on experience for a whole year, and it was a really interesting school.
This was 1981, when we didn't know a lot about autism, so it was an experimental school and we were just really trying to see what worked and what didn’t work by filming every interaction and reviewing all of the lessons in the day, just to sort of develop methods when there really weren't any.
Chris - I first heard the word autism, I think I was at primary school, and a teacher was doing an event to raise some money for this thing, which was a foreign word to me. I had no idea what it meant, and I never really had heard it before that. I wasn't very old obviously, but it now seems that it's very, very common. Now, is that because it's just been communicated well and people like you have raised awareness? Has it always been there, or has something happened and the prevalence is now a lot higher than it was before?
Simon - Yeah, no, you're absolutely right that it is more common. So when I started, all the textbooks said that autism was four in 10,000—so very rare—and today the statistics on prevalence say it's one in 31 children, and we assume adults too. So over that period you're asking, is it simply that we're better at recognising it? And I think that's part of it. There has been an increase in awareness and a growth in services, so that back then you had to go to a specialist centre to get your child diagnosed. Today, any child development centre in any town, big or small, could diagnose it. But there have been other changes too along the way. So back then, three-quarters of people who got the diagnosis of autism also had a learning disability—so we were seeing a kind of different section of that spectrum. Today, it's the mirror opposite: three-quarters of people getting a diagnosis do not have a learning disability. So it's that kind of opening up the diagnosis to the general population, broadening the category—and by itself that could also account for some of that increase.
Chris - To your mind then, this has always been the case but we've changed the definition and we're better at recognising who fits it. So really, we haven't seen a big increase in cases—or have we? Has something else changed so that we've got both things going on?
Simon - I think we should assume that autism has always been there and that it was under-detected, under-diagnosed, and that now we're just getting closer to the true rate in the population.
Chris - Who is Asperger and why do we use that—or do we still use that word? Or do we now just use the word autism and regard it as a range or a spectrum?
Simon - So Asperger—Hans Asperger—was a paediatrician working in Vienna in the 1940s, and that's already giving listeners a clue about that kind of historical context. But he was writing about autism, and in the mid-1990s—1994—the diagnosis of Asperger’s syndrome became available. It was included in the American Psychiatric Association classification system, and Asperger’s syndrome was meant to pick out autistic people without a learning disability. So it was meant to contrast with classic autism, where kids—or people—may not just be autistic but also have a learning disability. And now we're getting into kind of controversial hot water, because although the term Asperger’s syndrome was really useful—it basically allowed us to have two subgroups within the autism spectrum, with and without learning disability—it turned out in 2018 that a historian of medicine uncovered that Hans Asperger had collaborated with the Nazis by referring children to a clinic that was known for compulsory euthanasia during the Holocaust.
So our clinic used to be called the Cambridge Lifespan Asperger Syndrome Service. Overnight we decided to drop the term Asperger, so now we just use the word autism, because who wants a diagnosis named after somebody who—even if it was in a few cases, we don’t know how many—contributed to the deaths of vulnerable people?
Chris - In terms of who's getting it or who’s got it, what do we know about the statistics of who it affects?
Simon - We know that autism is more commonly diagnosed in boys or men compared to females—girls and women. Back in the day—so we're talking about over my career, you know, 30 years or more—the sex ratio used to be about four males for every one female. Today it's still skewed towards males, but people say it's closer to three to one, male to female—maybe even two to one—so still more common in males. And we think that that shift reflects that more girls and women are seeking a diagnosis, and that many females may have been overlooked simply because our concept of autism was kind of shaped by what autism looks like in a male profile.
Chris - And what does it look like? I mean, what do we use as the sort of definition of the characteristics that we associate with this particular set of traits?
Simon - The American Psychiatric Association published this thing called the DSM, the Diagnostic and Statistical Manual. But, you know, over the years, they've basically focused on social and communication difficulties, and difficulties with adjusting to unexpected change. So that's the kind of disability side. But what we now recognise is that autistic people are not just defined by disability; they also show differences. And this is relevant to the relatively new concept of neurodiversity – just differences in how they process information. And those differences can include strengths, and even talents. So, examples would be – although it's not part of the diagnostic criteria – but we see it psychologically: excellent attention to detail, excellent memory for detail, excellent pattern recognition skills. So, just listening to that list, you can start to imagine a person who might struggle socially – maybe making friends and coping in a crowded social environment – but, left in a calmer, quieter environment, might be able to show that their differences are actually assets.
And we might come back to how that could be harnessed really for their own good.
Chris - Why more men, though?
Simon - Yeah, so the male bias could have reflected under-diagnosis. That’s really down to clinicians just not recognising autism in females as easily. It could also reflect masking or camouflaging, because there might be more stigma towards autism in females, such that a young girl who feels autistic may nevertheless feel a greater social pressure to hide it – to act non-autistic – even from a very early age in primary school. Our society tends to expect that females will have better social and communication skills, and be able to cope in small or larger social groups, and just navigate those easily. But that kind of camouflaging or masking often comes at a cost to the person's mental health. Because if you're pretending to be something other than who you are, that can be very stressful. And we hear accounts of girls and women who are autistic and eventually get their diagnosis because, whilst they can mask for some hours in the day – perhaps when they’re at school or at work – by the time they get home, it’s been so exhausting, it’s taken a toll on their mental health.
11:19 - Simon Baron-Cohen: Is autism passed on through genes?
Simon Baron-Cohen: Is autism passed on through genes?
Simon Baron-Cohen, University of Cambridge
In this edition of The Naked Scientists, Titans of Science continues as Chris Smith chats with autism research pioneer, Simon Baron-Cohen...
Chris - But you were one of the first people, and it was actually in your book, that impressed upon me the difference when one compares the empathic abilities of women and men, for example. You show in your book slices of a person’s face – just the eyes – with a word at each corner of the oblong, and say what emotions are the eyes showing. And I failed all of them. My wife got 100%. She’s very, very empathic. That brought it home to me that women tend to perform much better on this sort of task – that there does appear to be a clear difference empathically between men and women. And you’re arguing that this is a manifestation of that.
Simon - Yes. So we talked about limitations of clinicians, and also masking or camouflaging as a response to social pressures. But I think another factor we haven't talked about yet might be the role of biology. And the biology of sex differences – or gender differences – is, of course, very controversial. But the test you’ve just described – we call it the Eyes Test for short – the long name is the Reading the Mind in the Eyes Test, where you just have to decode someone’s facial expression from photographs of the eye region of the face. Reliably, across cultures, we see gender differences – that women, on average (and those two words are really critical), score higher on this test of empathy than men do. The reason I underline those two words – on average – is, of course, because all we’re really doing is comparing groups of men and groups of women, and you can easily find individuals who are atypical for their gender. But that sex or gender difference, we recently showed in a publication, holds true across cultures. We studied it in 57 different cultures. It suggests that there might be a universality – that it’s not just about how we raise our daughters compared to our sons – that there might be a role for prenatal biology. And that took our research group into looking at the obvious biological mechanism, which is the sex steroid hormones, like testosterone and oestrogen. So we were able to measure these hormones prenatally and then follow up the children. We measured them during pregnancy, waited for the child to be born, and looked to see whether there was any relationship between your exposure to these hormones – partly because these hormones are produced at higher levels in male foetuses than in female foetuses – and that’s exactly what we found: that the higher your prenatal testosterone, for example, the more difficulties you have on these social tests of empathy when you're eight years old. But conversely, we found that if you had higher levels of these prenatal hormones like testosterone, the better your skills at pattern recognition. So this is kind of confirming something that we’ve known from animal research for decades – namely that these sex steroid hormones, the androgens and oestrogens, shape brain development prenatally. And we went on to test the next obvious prediction: do autistic people – so people with a diagnosis – have elevated androgens and oestrogens? And we did that in collaboration with the Danish Biobank, because that was the opportunity. They had thousands – tens of thousands – of samples of amniotic fluid. That’s the fluid that surrounds the baby during pregnancy. And in women who chose to have a procedure called amniocentesis, where some of that fluid is extracted for clinical reasons, we were able to measure the hormone levels in that fluid and look to see whether individuals who have a known diagnosis years later of autism had elevated prenatal sex steroid hormones – and indeed, they do.
Chris - This is the basis really of your argument that autism is a sort of shifting towards a more male brain pattern, in that respect.
Simon - That’s right.
Chris - It’s very difficult to get the language right. You can see I’m struggling slightly, but you know what I’m saying – it’s almost extreme maleness, isn’t it? That’s what you’re arguing.
Simon - Yes. So at various times, I’ve called this the extreme male brain theory, but it’s very open to misunderstanding. Because, in people’s minds, when they hear the word male, and certainly the phrase extreme male, they might have all kinds of connotations that don’t apply. So, for example, some people might think of male characteristics as aggression.
That’s not the relevant dimension here, because we’ve been talking about empathy and also pattern recognition – or what I call systemising – being able to understand a system according to the rules and patterns that govern that system. But either way, if we shift to the level of biology, we’ve known that these hormones masculinise the body and the brain prenatally.
Chris - Can you see that reflected in structure, though? Has anyone done the study where you can do what you’ve done for the steroid exposure – the oestrogens and the testosterone exposure – and then looked at brain structure to see if there is a correlation?
Simon - Mike Lombardo, when he was here in Cambridge, did that very experiment. So, the children whose mothers had had amniocentesis – where we knew their prenatal testosterone levels – when they were eight years old, we invited them in for an MRI scan. And we looked at grey matter volume in different regions of the brain, and found that different brain regions – particularly language areas, and parts of the brain associated with social skills – some of those brain regions were larger, showing a positive correlation with prenatal testosterone.
Chris - We know that there is a familial aspect to autism. It definitely runs in families, in so much as we can say scientifically the word definitely. How does that tie up with this hormone story then? Have you found a link?
Simon - So I'm glad you've mentioned genetics because it's the missing part of our discussion so far. Autism runs in families, that's true. So if you've got one child who's autistic in the family, the chances of the next child also being autistic are higher than the general population. The other clue that autism is genetic is from twin studies. If one twin is autistic and the pair are identical twins, there's a much higher likelihood that the co-twin will also be autistic compared to when you look at non-identical or dizygotic twins. So these are genetic designs, family genetic designs, which give clues to genetics. And since probably the year 2000, there's been a big push to also look at the molecular genetics. And what's been found is that autism is associated with over 100 rare genetic variants. So that just means mutations, for example, that are rare in the general population, but they're more common in autistic people. So we're just kind of beginning to crack our understanding of the genetics of autism. But let's bring this back to your question about how do the hormone findings relate to the genetics? Well, what we know is that when you have identical twins, you can also find discordant twin pairs. So one is autistic and one isn't. So it means that genetics can't explain autism 100%. Otherwise, if one had autism, they should both have autism if autism was 100% genetic. So we think that the hormones are interacting with the genetic predisposition. And to understand the cause of autism, and maybe that gender bias we talked about earlier, we need to factor in genetics, hormone exposure, and then of course, your early experience postnatally.
Chris - When one looks at the structure of the brain, and how different bits of the brain talk to each other and how well they talk to each other, can we see consistent pictures that explain why people with autism have the traits and characteristics that they do? Can we marry those things together yet?
Simon - I think we've still got a long way to go. So some of the evidence is inconsistent. So MRI studies, for example, over the last few decades, have tended to be fairly small scale studies, 30 autistic people compared to 30 non-autistic people, that kind of scale. Whereas these days, as you know, neuroscience is moving towards big data. And I've got a colleague here in Cambridge, Richard Bethlehem, who's put together a huge collection of MRI scans, I think the last count, he's got 200,000 MRI scans, across ages, across development, across gender. I think that's the kind of data set that you need to start looking at how autistic people might differ in their rate of brain development, and then very regionally different parts of the brain. But also, because autism itself is so heterogeneous, we need to start doing studies, which, for example, tease apart autism with intellectual disability and autism without intellectual disability, autism with ADHD, autism without ADHD, the whole sort of range of different manifestations, as you said. So still lots of work to be done.
21:17 - Simon Baron-Cohen: Do autistic people get enough support?
Simon Baron-Cohen: Do autistic people get enough support?
Simon Baron-Cohen, University of Cambridge
In this edition of The Naked Scientists, Titans of Science continues as Chris Smith chats with autism research pioneer, Simon Baron-Cohen...
Chris - One other interesting characteristic, I remember watching a Horizon programme years and years ago when I was smaller, being absolutely transfixed because it was showing individuals like Stephen Wiltshire, the child who could take a look at a London skyline and reproduce that down to a level of detail that only a photograph could really capture. And individuals who could listen to a piece of music once, and they had it, people who could predict the day of the week it was given a date, way back 100 years ago, and they do it in seconds, faster than a guy with a calculator. That's savantism, isn't it? And that seems to be tied up with autism as well. Why? Do we have any insights into how people develop these incredible traits and abilities? What is it about the way their brain is working, endowing them with that ability?
Simon - Yeah, we've just started to study looking at the brain basis of savantism in autistic people. So savantism, you know, classically was most clearly seen in individuals who have autism and a learning disability, and yet they have one area of their cognition, which is at an exceptional level. And it might be music, as you said, or it might be drawing, might be learning languages or mathematics. But that level of skill is not only exceptional for the general population, but it's out of keeping with the rest of that person's skills. And, you know, my best guess is that systemising, which I talked about earlier, it's a psychological process where the brain analyses patterns in the world might be playing a part because most of the areas of skill that are associated with savantism involve pattern recognition, mathematics and music being the clearest examples. But we need to sort of understand where systemising takes place in the brain. And we can break down systemising into sort of more granular parts like attention to detail. And it may be that autistic people who become exceptional just have greater attention to detail and much faster recognition of those patterns.
Chris - Can we see that reflected in brain scans, for example, do they have a richer connectivity between the bit of the brain that decodes sound and the region that would generate the movements to move your fingers on a computer keyboard or a piano keyboard or the visual cortex to process an image and connect that to your memory? Can we see that reflected in functional imaging?
Simon - Yeah, so that's exactly what's needed. It's functional imaging so that we're not just looking at brain structure, but which parts of the brain are being used whilst they're doing a task. As I said, so far, the studies in the past have been probably too small, underpowered to detect those differences. So we're trying to do something at a larger scale to really try to understand it better. But you know, I'm glad you've mentioned savantism for two reasons. One is that it reminds us that autism isn't just a disability, it can be associated with strengths. But I suppose there are dangers with this too, because there'll be lots of people out there listening, parents, for example, or autistic people themselves saying, well, those individuals who are autistic and are savants, they often get all the publicity, because what they can do is often quite sensational. But that's not necessarily representative of most autistic people. So we just need to remember that, you know, this is a reminder really, to all of us, that autism is really quite varied. And maybe we'll come on to this, but we need far better support services for autistic people, because at the moment, it's woefully inadequate.
Chris - I was just going to say, it's fair to say, we have a crisis of diagnosis and support, don't we? Because the number of people queuing up to say, I feel like there's something going on with me. And I don't know what it is, but I would be enormously reassured to get it investigated. And they can't access that. And parents are the same. And the number of people is out the door around the street. So that's one problem. But having that almost label, I mean, we're careful with that word, but having that label, why does that help people?
Simon - So on the first point about the long waiting lists, so we talked at the beginning of our conversation about how autism has gone from rare to very common. And actually, it's been estimated that there's been an 800% increase in prevalence over the last 20 years. So that has led to a crisis in diagnostic services, the services just can't keep up. And it may be a reflection that autism isn't prioritised by the NHS and social care. But then you brought up the other point, which is even if you're lucky enough to get a diagnosis, and many people are being forced to go privately, you know, what then? You've got, we've got the label and the label can be a huge relief to a person, if they've been struggling, they've experienced a sense of being an outsider, a sense of exclusion, just not fitting in, you know, knowing that it's for reasons to do with your genetic makeup, for example, can be a huge relief that there's a word for it. But ideally, the diagnosis should be your stepping stone into support services. And those are again, I mean, it's very, very concerning how lacking they are. And it's probably the explanation for why three quarters of autistic people are not only autistic, but have poor mental health, depression and anxiety. Those are you're not born with depression and anxiety in the way that you're born with a likelihood for autism. But the depression and anxiety probably flow from not having the right support.
27:27 - Simon Baron-Cohen: Autistic people can do wonderful things
Simon Baron-Cohen: Autistic people can do wonderful things
Simon Baron-Cohen, University of Cambridge
In this edition of The Naked Scientists, Titans of Science continues as Chris Smith chats with autism research pioneer, Simon Baron-Cohen...
Chris - Evolutionarily speaking, usually things which are preserved in the population are beneficial to a population things which are deleterious to an individual or a population are slowly selected out. So the fact that this is so common, this must argue that there must be benefits conferred somewhere to either keep it in circulation, or keep allowing it to evolve without being selected out. So are there any good things you can point to that say that this is why nature keeps autistic people in the gene pool?
Simon - I mean, I'm very sort of attracted by evolutionary explanations, including for disabilities and neurodivergence. So I wrote a book in 2020, called The Pattern Seekers, where I argued that autistic people have an aptitude for pattern recognition, and systemising as I defined it earlier. And that that was that ability is also the basis of human invention. So if we bring this back to your question, are there any advantages to having a brain that is good at pattern recognition, good at understanding how systems work, so that you can change the patterns, you can experiment with the patterns to innovate? Well, according to this theory, that has driven human progress. So why are the genes for autism still in the population? It's because some of those individuals, we think about people like Elon Musk, who came out as autistic, Bill Gates, who has also now come out as autistic. But many people, particularly in places like Silicon Valley, are using their autistic traits.
Chris - Cambridge University, you didn't mention that diplomatically, perhaps?
Simon - Well, you know, we have our own Silicon Fen, as it's called. But they're using their autistic traits to solve problems that are potentially really important for wider society. So you know, there's on the one hand, there's this view that autistic people might have contributed to the evolution of human progress. But on the other hand, we've got this picture where 85% of autistic adults today are unemployed. That's a statistic that comes from the National Autistic Society. So if autistic people have played such an important part in human progress, and we could count, we could look at lots of other famous scientists and musicians and artists, who biographically, they look like they have a lot of autistic traits, like Newton and Einstein, for example. You know, if they've played such an important part, and we owe them such a huge debt, why is society treating autistic people as if they don't matter, leaving them unemployed, and therefore at risk of poor mental health. And just to sort of really drive home this point, something like one in four autistic adults have planned or attempted suicide. That's a statistic that came out of our research. But it really underlines how autistic people, many of them feel like there isn't a place for them in our society. So under the Equality Act, we need to see autism as a disability and a difference. But we need to make reasonable adjustments for those disabilities and differences to make sure that autistic people enjoy the same human rights as everyone else.
Chris - Thank you for the wonderful conversation. It's very illuminating. And it's been really interesting to hear how 20 years ago, we had a similar sort of conversation, but a lot of the data were not there at that time. And now you've been able to fill in an enormous number of those gaps. Your knighthood is very well deserved. I'm delighted that you are now Sir Simon. But what do you do to relax? Because this has been a huge lifelong passion. You've driven a huge amount of this. But you can't do this all the time, surely. There must be another Simon Baron-Cohen who lets his hair down occasionally.
Simon - Yeah, we've got a phrase in our lab, which is 'science never sleeps.' But in answer to your question, I do take time off. I love music and I play music. I'm in a band locally, which is just a group of friends and we meet every Tuesday night in my kitchen. So you know, that's very kind of important just to kind of do something that's not science. And just to hang out with friends and enjoy company.
Chris - Have you got any recordings?
Simon - Not for The Naked Scientists. But do come along to one of our gigs.
Chris - You're on.
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