The World Outside: Experiencing the world through the eyes of autism

Carly Fleischmann with her father.

The following is an excerpt from Issue 12 of Guru Magazine, a Wellcome-Trust supported digital ‘science-lifestyle’ periodical available for free at gurumagazine.org and via Apple Newsstand and Google Play.

At the age of 10, Carly Fleischmann typed a simple message on her father’s laptop, “Help. Teeth hurt.” Such a message wouldn’t normally be impressive if written by a 10 year old, but for Carly it was different—she has autism. Until that day, Carly was thought to be severely mentally handicapped. Regularly throwing temper tantrums, she would thrash her arms and slam them on the table. So the sudden message startled her parents. Before those typed words, they had no idea that Carly could hear or understand anyone. But in that instant it became apparent that she may have silently understood everything said about her, and her handicap, in the preceding years. And it turned out that she had. While Carly’s sudden communication seems remarkable, she isn’t unique. In fact, a new theory of autism now predicts that all autists are much like Carly.

The present consensus among researchers is that genes are the most important factor in the cause of autism: up to 90 percent of the risk for developing autism is due to genetic factors. For a long time it was thought that the disorder may be the result of an ‘autism’ gene, but it is now believed that a combination of causes interact to produce autistic traits—that autism occurs when a developing baby with a genetic weakness for autism suffers some kind of ‘environmental insult’ before or after birth. Quite what this insult might be, no one knows—and neither do we know which genes lead to the genetic weakness.

Based on laboratory experiments with rats, neuroscientists Henry and Kamila Markram have proposed an entirely new theory, known as the ‘Intense World Theory’, which may radically shake up the way we look at autism. This theory holds that the brains of autistic individuals are ‘hyper-connected’ and ‘hyper-excitable’. Rather than suffering from a deficit in perceptual abilities, the theory suggests that autists experience the world so vividly that it becomes painfully intense—so painful that they take refuge by turning inward and avoiding interaction with the outside world.

The ‘Intense World Theory’ emerged out of studies investigating the link between autism and the anti-epilepsy medicine valproic acid. Valproic acid has been used to treat bipolar disorder, migraine headaches and schizophrenia, but taking it during pregnancy can lead to autism and birth defects in the child. Similar effects can be seen in other animals. Rats, for example, demonstrate decreased social interactions, increased repetitive behaviour, enhanced anxiety, hyperactivity, and altered pain sensation—the same symptoms that are found in autistic humans. Valproic acid given before birth also causes damage to particular areas of the brain (the brainstem and cerebellum)—and this pattern of damage is also similar in rats.

Given these similarities, Markram and Markram believe that rats offer a particularly good way of testing various theories about autism, so they performed a series of experiments using rats to explore the ‘Intense World Theory’. Studying their brains, Markram and Markram found that certain networks of brain cells in the valproic-acid treated rats were much more sensitive—they had much more brain activity—than normal. The researchers also found the brain cells in autistic rats to have notably more connections: their brains were ‘hyperconnected’. Consequently, the flow of information throughout the brain was enhanced, possibly explaining why the autistic rats were much better at discriminating between apertures of different sizes (similar to an autistic human’s ability to focus on fine detail). Finally, they discovered that the amygdala, a part of the brain responsible for fear processing, had a tendency to form new connections, which may explain the intense fear the autistic rats developed.

It might seem counterintuitive that brain areas experiencing a loss of neurons can have excess activity. One possible explanation involves the types of nerve cells that are affected: many brain cells have an inhibitory, or ‘braking’, effect on the rest of the brain. The cerebellum (a region at the back of the head needed for co-ordination) has a high concentration of these ‘inhibitory’ nerve cells. So it wouldn’t be surprising that a loss of this type of brain cell—an easing up of the brakes—would make for an increase in brain activity overall. The remaining, unharmed, brain cells of the autistic brain would therefore form more connections with one another—perhaps increasing the ability to focus and pay attention to details.

But this degree of intensity probably also leads to a ‘system overload’ and the anxiety that autists experience. “Autists see, hear, feel, think and remember too much, too deep and process information too completely,” said Henry Markram in a recent interview with Wrong Planet, an online autism community.

“You don’t know what it feels like to be me”

Autistic individuals develop strategies to actively avoid the intense pain of perceptual experience. If that doesn’t work, they resort to repetitive movements or radical behaviour. For example, children with autism often react to new sights, sounds and sensations with temper tantrums or extreme panic.

Carly, who suddenly communicated with her dad at the age of 10, expresses a disturbing discomfort from the world around her. “You don’t know what it feels like to be me, when you can’t sit still because your legs feel like they are on fire, or it feels like a hundred ants are crawling up your arms,” she writes. Carly says that people like her engage in repetitive behaviour and throw tantrums because it soothes the intense pain felt from sights and sounds. It’s a way of turning the mind inward, away from the painful outside.

How could the ‘Intense World Theory’ influence our treatment of and care for those with autism? For one thing, it would mean that autism isn’t thought of as being caused by a deficit. Rather than lacking in ability, autists simply have too much to interpret. The problem with the autistic brain is that certain regions may develop too quickly, going on to dominate other regions—which can make rehabilitation very difficult.

To counteract this problem, we might use medicines to suppress the brain activity arising from all of the extra connections. It seems nonsensical to treat a lack of communication in autism with a drug that limits the brain’s activity, but this counterintuitive approach works with other disorders: attention deficit hyperactivity disorder—a condition where children find it hard to concentrate and stay still—is treated with a stimulant, amphetamine. It is thought that amphetamine (the same drug as in ‘speed’, albeit at a very low dose) increases the activity of the control centers of the brain. The result: children with ADHD calm down and focus.

But reducing excess brain activity may not be the best way to deal with autism. One interesting prediction of the ‘Intense World Theory’ is that all autists have an ability to perform difficult intellectual tasks with incredible ease like savants—even if they can’t communicate it. Savantism is also believed to be the result of a hyperconnected brain. So autists who are not diagnosed with savant syndrome likely still share many of the exceptional abilities of savants. Assuming that people with autism learn to utilise their brains’ hyperreactivity, they may develop exceptional talents later in life. According to Markram, if the autist’s exposure to her surroundings is controlled after birth, “It’s possible to be a genius.”

References

• Markram, H., & Markram, K. (2013). Interview: Henry and Kamila Markram about The Intense World Theory for Autism. J. S. Holman (Interviewer), WrongPlanet.net.
• Markram, K., & Markram, H. (2010). The Intense World Theory – A Unifying Theory of the Neurobiology of Autism. Frontiers in Human Neuroscience, 4.

Berit Brogaard and Kristian Marlow

Berit Brogaard, DMSci, PhD is Professor of Philosophy with joint appointments in the Department of Philosophy and the Center for Neurodynamics at the University of Missouri in St. Louis as well as the Network for Sensory Research at the University of Toronto. She directs the Brogaard Lab for Multisensory Research, a laboratory focused on synesthesia, savant syndrome and autism.

Kristian Marlow is a graduate student, member of the Center for Neurodynamics and member of the Brogaard lab. Berit and Kristian began writing about the fascinating cases they’ve studied for their forthcoming book The Superhuman Mind: True Tales of Extraordinary Mental Ability.

Guru magazine is supported by the Wellcome Trust.