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April is autism awareness month—so autism and autism spectrum disorder (ASD) will be in the news. Although the recent redefinition of autism as a spectrum condition ensures that children whose disabilities were previously unrecognized and left untreated are better served; it is also important to be mindful of the boundaries for the autism spectrum to avoid potentially devastating mistakes. This is especially important as society seeks to identify autism spectrum disorder at earlier and earlier ages.
Because very young children have widely variable abilities and behavior patterns that are quite different from older children, key clinical markers of autism in school-age children are much less reliable for diagnosing toddlers and preschoolers. For example, a primary symptom of autism is disruptive behavior—and severe tantrums. In school-age children these behaviors are a very reliable indicator for autism. In contrast, nearly every two-year-old displays rather severe tantrums—after all it is called the terrible twos for a reason! It is absurd to place all two year olds on the autism spectrum because of tantrums. Skilled clinicians can indeed accurately diagnose autism in two-year-olds, but it is all too easy to mistake a naturally occurring tantrum as a symptom of autism spectrum disorder.
Similarly, it is all too easy to mistake the traits of precious, highly intelligent toddlers and preschoolers as symptoms of autism spectrum disorder. In their recent book “The Prodigy’s Cousin[1]” Joanne Ruthsatz and Kimberly Stephens provide engaging—and intriguing narratives describing prodigies. They also note that many of these children have siblings or other first-order relatives who are clearly on the autism spectrum, which is certainly true for mathematicians, engineers, and physicists[2].
Also, for the children described in The Prodigy's Cousin, it was not unusual for the prodigies themselves to be initially misidentified as having autism. One potential reason for this is that a child prodigy is quite dedicated to developing the ability that captures her interest—be it music, math, art, dance or scientific thinking. Because of this, prodigies tend to practice these talents over and over again often to the exclusion of activities other children are usually engaged in. Although it may seem simple to distinguish prodigy from autism spectrum disorder, it is noteworthy that children with autism are highly "routine preferring” and often do the same things over and over again rather obsessively. And this is precisely what Ruthsatz and Stephens see in prodigies: these children are very focused on practicing and mastering a particular ability. These authors were very straightforward in stating that prodigy behavior should not be viewed as a form of autism, but it is clear that mistakes were made.
But what if the autism spectrum were actually expanded to include the kind of focused practice required to master talent often seen in child prodigies—and in highly intelligent people? What are the consequences for society if the unique talents of prodigies, geniuses, high achievers—or anyone else with asynchronous child development or an unusual learning style—were to be redefined as symptoms of an autism spectrum disorder and eliminated? There is a very real concern that identifying prodigy as a form of autism spectrum disorder would actually end up derailing the development of extraordinary ability in precocious children. To be sure, some people on the autism spectrum are highly intelligent, but being highly intelligent doesn't necessarily mean a person is on the autism spectrum.
When autism is diagnosed, a relatively strict intervention program is often provided. One goal of this treatment is to diminish obsessive routines. If a child does indeed have autism, this intervention can be highly effective.
But what if a child does not have autism, and is a prodigy instead? Could treatment designed for autism prevent a math prodigy from developing her unique talents when she is taught to stop “obsessing” on numbers as a cure for her “autism spectrum disorder?”
Before dismissing this notion, bear in mind that many prodigies, high achievers, and highly intelligent individuals are also notoriously noncompliant in addition to being dedicated to developing their special talents. For example, when piano virtuoso Arthur Rubinstein was a child, he smashed a violin when his parents tried to shift his "obsessive" devotion to the piano to other instruments. Would his amazing abilities as a concert pianist have been derailed if his obsession with playing the piano over and over—and his dramatic refusal to comply with requests to be less obsessive —were viewed as a symptom of autism spectrum disorder rather than natural traits of a child prodigy?
Perhaps even more worrisome are recent articles implying that geniuses (and prodigies) such as Albert Einstein, Isaac Newton,[3, 4] Mozart, Bill Gates and many others display signs of autism. Many many geniuses were temperamental and, at times, difficult to get along with. In addition, perhaps in part because of their high intelligence, they may not necessarily be highly motivated to please teachers or parents or to complete schoolwork they find uninteresting. In his biography, Winston Churchill recalled that "My teachers saw me at once [as being] backwards and precocious, reading books beyond my years and yet at the bottom of the Form [class ranking]. They were offended. They had large resources of compulsion at their disposal, but I was stubborn. Where [whenever] my reason, imagination or interest were not engaged, I would not or could not learn." [5]. Because there are reports that Mr. Churchill also talked late, one can not help but wonder whether his collection of precocious traits, challenging behavior, and slowed communication development would have resulted in an Autism Spectrum diagnosis in modern times.
Perhaps the most devastating consequence of misguided efforts to retrospectively view high intelligence, prodigy, and high achievement as manifestations of autism spectrum disorder is the trivializing effect this has on the extensive impact that severe “classic” autism spectrum disorder often has on families. It is cruel to suggest that parents of children with autism could have somehow shaped the pervasive developmental challenges these children display into becoming the next Mozart, Einstein, Newton, or Gates if only the “right” treatment were provided early enough. This view of autism spectrum disorder also trivializes the Herculean efforts these families make to help their child learn to speak, to be in school, and to regularly cope with severe tantrums and meltdowns.
We can all applaud the efforts to identify—and treat—autism spectrum disorders as accurately, effectively, and as early as possible. But it is also vitally important that prodigy and genius not be redefined as disabilities requiring treatment—rather than unusual gifts to be nurtured.
[1] Ruthsatz, Joanne & Kimberly Stephens. The Prodigy’s Cousin: The Family Link Between Autism and Extraordinary Talent. Current. Mar. 2016. ISBN 9781617230189.
[2] Baron-Cohen, Simon, Patrick Bolton, Sally Wheelwright, Victoria Scahill, Liz Short, Genevieve Mead, and Alex Smith. "Autism occurs more often in families of physicists, engineers, and mathematicians." Autism, 2, no. 3 (1998): 296-301.
[3] www.newscientist.com/article/dn3676-einstein-and-newton-showed-signs-of…
[4] Claudia Kalb. "Andy Warhol Was a Hoarder: Inside the Minds of History's Great Personalities." National Geographic Books. 2016.
[5] Churchill, Winston. My Early Life:1874-1904. New York: Simon & Schuster. 2010. Quote on p. 13.
