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Dame Uta Frith was the neuroscientist who first recognised autism as a condition of the brain rather than the result of cold parenting. Here she takes Lance Workman on a journey through her collection of memories.

Lance Workman: I believe you initially began your studies with history of art in Germany, but then became interested in psychology, and autism in particular.

Uta Frith: At school I was not particularly good at science subjects and much better arts and languages. No wonder these were the subjects I was expected to study at university. But looking back, this is a common situation for girls to be in, and it was a bit of a trap. Actually, I had many diverse interests. So, one thing I love to tell girls in a similar situation is that you can escape the trap. You can change your mind about what you’d like to study. The school I went to in Germany gave me a nice all-round education, including nine years of Latin and six years of Greek. I absolutely loved it. I dreamt my future would be to study ancient civilisations – finding treasures and deciphering texts in some long-lost language! By comparison, art history is far more down-to-earth. The art history courses offered at my university were fascinating. They allowed me to explore different artists, different times, places and materials. But I was very curious about what was on offer elsewhere. I went to lots of different lectures and remember my timetable being completely full up. This seemed to me the best thing about being a student: soaking up learning while being inspired by the commitment that eminent scholars bring to their subjects.

Uta Frith

At that point I only had a very nebulous and indeed misguided idea of what psychology was about. But I happened to drift into a lecture on analysis of variance. Far from being put off, the idea that you could use stats to measure psychological abilities strangely appealed to me. For the first time I learned that it was possible to do experiments about how people remember things, and how they solved problems, or rather how they failed to solve them. So I went to the psychology department and asked if they would take me on as a student. I ended up doing more and more psychology and less and less art history, mainly because the psychology course was well structured with an exam at the end. This certainly gave me some focus. It occurred to me gradually that it was the mind I was interested in, and even more gradually that this included the brain. As part of the psychology course I took similar courses to the medics. I have to admit that the physiology lab classes were rather tough for me. There were some alarming moments involving spinal frogs. Better by far were the lectures and case demonstrations in the university psychiatric clinic. This was more than exciting – it was the most intellectually thrilling experience that I ever had. The professor was renowned for his ability to present cases to students. He clearly enjoyed himself in these demonstrations, and the patients he selected played along good-naturedly. I very much wanted to understand what was the matter with them, why they suffered from invisible and intangible phenomena. So, if anything, that was what got me totally hooked into psychology.

Lance Workman: You came to England around this time. How did that come about?

Uta Frith: Well, I needed to learn English to read the textbooks and journals – and so I came to London. I found I liked it even more than Paris, and that was saying something. I went to visit the Institute of Psychiatry, because I had heard of Hans-Jürgen Eysenck, who was the head of department. I was extremely taken with his books that were debunking the woolly end of psychology and psychoanalysis. Like everyone else I had read Freud and swallowed it wholesale. But Eysenck’s books threw a different light on things. Where was the evidence for Freud’s theories? If the evidence was in the patients that were cured, then it was very thin indeed. If the patients did not get better, then apparently this was because they resisted. Something was not quite right here. It seemed a suspiciously circular argument. I saw Professor Eysenck only very briefly, but he seemed happy enough for me to stay around to see if I could do odd jobs. One of the lecturers, Reg Beech, gave me some data to analyse from an experiment he had done with patients who had obsessive compulsive disorder.

My job was quite basic – correlations, that sort of thing – but I enjoyed doing it. It was an exciting environment where psychologists tested hypotheses, and treated patients, not with psychotherapy, but with methods based on learning theory. I found out that there was a unique course in clinical psychology, and I was longing to be able to do this course. So I went to the head – Monte Shapiro – and asked if he would take me on. Amazingly, he did, and I am for ever grateful to him. Then I had to tell my parents. I knew I imposed a heavy financial burden on them, because the exchange rate between the pound and the Deutschmark was extremely poor at that time. However, they were always unbelievably supportive of me and of anything I decided to do. So they accepted my sudden change of plan.

At some point during the course I found out about autism. I was completely fascinated as soon as I met the first autistic child, and have been ever since. By sheer luck, the Institute of Psychiatry was the place to be for anyone interested in autism – Mike Rutter, Lorna Wing, Neil O’Connor and Beate Hermelin; all these heroes were there at that time.

Lance Workman: Things were really very different then. What was the prevailing view on autism during the 1960s and 70s in terms of causes?

Uta Frith: The prevailing view was that something in psychosocial relations had gone wrong during early development, and that this caused the state of autism. Still, at the Institute there was also the view that autism should be seen in the context of mental deficiency. This was a term for conditions thought to be due to brain pathology. To me, however, the autistic children didn’t look like other children with mental disabilities. Was there a hidden intelligence? Many of the children I met had no language. Could they perhaps learn to speak? Would they then grow out of their autism? The children with Down’s syndrome I met did have language and were quite social – but the autistic children were so strange, so different.

Lance Workman: You once described autistic children as being like the ones in John Wyndham’s The Midwich Cuckoos – later made into the film Village of the Damned.

Uta Frith: This is one of the romantic images about autistic children I have toyed with. I freely admit that some of my fascination was fed by romantic notions. At first I thought it would be very difficult to study autistic individuals in a strict experimental fashion. Perhaps case studies were the only way. Then I happened to read a paper by Beate Hermelin and Neil O’Connor and realised that it was after all possible to do experiments with these children. I plucked up courage and managed to talk to them a couple of times. One day they asked me whether I would like to do a PhD. I didn’t hesitate for a second. I immediately knew that this is what I wanted to do.

This whole area of research into disorders of cognitive development was only just beginning, and I happened to be in the right place. When people asked what I was doing and I said I studied autistic children, they invariably thought I was studying artistic children! When I did explain about autism, they generally thought it was odd to study something that was so very rare.

Lance Workman: Things changed radically, with you as one of the people that suggested autistic children couldn’t mentalise. Did that happen overnight or was it an idea that gradually emerged?

Uta Frith: The ground for the idea was well prepared in many ways. The rigorous experimental approach to autism pioneered by Hermelin and O’Connor was one thing, and so was the finding that the really critical feature of autism was not people’s aloofness, but their strange failure in reciprocal communication. ‘Theory of mind’ was an idea which just then surfaced and inspired developmental psychologists Heinz Wimmer and Josef Perner. It only needed these strands bringing together. There was a sort of insight moment: If young children needed a ‘theory of mind’ in order to understand pretend play, as Alan Leslie argued, then it was possible that autistic children who had recently been found to lack pretend play, did not have a ‘theory of mind’. Simon Baron-Cohen started his PhD at this time and carried out the critical experiments. One of them has become a classic experiment with the Sally-Ann False Belief Task. Simon found that autistic children aged 9–10 years failed this task when children with Down’s syndrome and ordinary five year-olds succeeded. John Morton suggested the novel term ‘mentalising’, short for ‘the ability to use mental states such as intentions and beliefs to predict behaviour of others and self’. So we all continued to work on the idea that mentalising failure might be key to the social impairments in autism.

Autistic Teen

Lance Workman: You found that specific deficit?

Uta Frith: Yes we did find a specific deficit in social cognitive processing, and we designed other tests to show that there was no general cognitive impairment that would explain the results. But it was very difficult to get these ideas accepted. We wanted to claim that there was a neural basis to this specific deficit and that this might help us to identify a cause of autism in the brain. At the time brain imaging had just emerged. It was almost like science fiction. Here was an amazing technique that promised to make thinking in the brain visible. What about thinking about mental states? Of course, I could not have dreamt of doing brain imaging studies on my own. But fortunately [my husband] was very much involved in the early development of functional imaging techniques, and he was brave enough to give it a go. His colleagues have told me since that, at the time, they thought he was completely mad to do this. It took about 10 years for other centres to take up these crazy ideas and pursue them further. Today it is taken for granted that there is a mentalising system in the brain. What we still don’t know, however, is in what way this system is or is not working in autism. This has proved very elusive. I still remember that we expected to get an immediate and clear answer to this question. How naive!

Lance Workman: You have also suggested that autistic individuals might have some cognitive advantages?

Uta Frith: At least 10% have outstanding talents, and possibly as many as 30% have superior abilities in quite specific areas, and it is important to explain these. My hope was that one single cause might explain these special abilities and at the same time the undeniable weaknesses that show up in tests such as ‘Comprehension’. That’s how I arrived at the theory of weak central coherence. Weak central coherence is when you can’t see the wood for the trees. This can be both an advantage and a disadvantage. There are tasks where it is important to resist the pull of the big picture, for example when you need to find a hidden object. Amitta Shah, another of my brilliant PhD students, showed that autistic children are good at finding hidden figures, and can easily see how to segment a picture in the Block Design Test. On the other hand, they may often miss the main point of a question in the ‘Comprehension’ test. Then Francesca Happé came along and showed that you don’t have to be autistic to have a detail-focused processing style. Sarah White, a more recent PhD student, found that it is only a subgroup of autistic children who show weak central coherence. To my mind these are the children I used to see long ago, very much like the ones Kanner described. They are the classic cases that still exist, but now they are only a small part of  the whole autism spectrum. We still don’t know how to explain the amazing talent seen in some autistic individuals, but one ingredient may be the ability to zoom in easily on a small detail and stay there until it is mastered by countless repeats.

Lance Workman: The film Rainman brought autism to the attention of the public in the 1980s. Do you think that was a good portrayal of an autistic individual?

Uta Frith: It was an outstanding portrayal, even though the character of Rainman was based on a composite of a number of autistic people. Apparently, Dustin Hoffman studied these people carefully, and managed to convey for the first time their endearing naivety and their charming social faux pas. The film increased the awareness of the condition, especially in adults. It may also have increased the unrealistic expectation of outstanding talent. Most importantly, it helped to lessen any feelings of fear and dread about autism.

Lance Workman: You mentioned your husband earlier, Chris Frith. When I interviewed him, one question I asked was How do you feel about working with your wife? I’m curious if I ask you the same question about him to see whether you give the same answer?

Uta Frith: It’s a marvellous feeling. We have always talked to each other about our work and have read each other’s papers in early drafts. We have always been interested in each other’s work, and it helped that it was different. It was no accident that we were in separate departments and were pursuing different projects. It is only really in recent years that we have been working together. We found that we enjoy it! I think writing together has worked very much to my advantage. Chris often starts drawing out a structure and puts down rough ideas. Then I just have to do a bit of editing and expanding. It seems like a free ride.

A version of this article originally appeared in The Psychologist.

Uta Frith is a developmental psychologist working at the Institute of Cognitive Neuroscience at University College London. She is author of Autism and Talent, Autism: A Very Short Introduction, and Autism: Mind and Brain.

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Image credit: (1) Uta Frith at an Ada Lovelace Day editathon in the Royal Society. Photo by Katie Chan. CC-BY-SA-3.0 via Wikimedia Commons. (2) Autistic Teenage Girl. Photo by Linsenhejhej. CC-BY-SA-3.0 via Wikimedia Commons.

The post From art to autism: a Q&A with Uta Frith appeared first on OUPblog.

        

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By Adam Ockelford

I spend around 12 hours a week – every week – sharing thoughts, feelings, new ideas, reminiscences and even jokes with some very special children who have extraordinary musical talents, and many of whom are severely autistic. I’m Professor of Music at the University of Roehampton, and the children come to see me in a large practice room in Southlands College where there are two pianos, so we don’t have to scrap over personal space. My pupils usually indicate what piece they would like us to play together, and they tell me when they’ve had enough. Sometimes, they tease me by seeming to suggest one thing when they mean another. We share many jokes and the occasional sad moment too.

But the children rarely say a word. They communicate everything through their playing. For them, music is a proxy language.

On Sunday mornings, at 10.00 a.m., I steel myself for Romy’s arrival. I know that the next two hours will be an exacting test of my musical mettle. Yet Romy, aged 11, has severe learning difficulties, and she doesn’t speak at all. She is musical to the core, though: she lives and breathes music – it is the very essence of her being. With her passion comes a high degree of particularity: Romy knows precisely which piece she wants me to play, at what tempo and in which key. And woe betide me if I get it wrong.

When we started working together, four years ago, mistakes and misunderstandings occurred all too frequently, since (as it turned out), there were very few pieces that Romy would tolerate: the theme from Für Elise (never the middle section), for example, the Habanera from Carmen, and some snippets from ‘Buckaroo Holiday’ (the first movement of Aaron Copland’s Rodeo). Romy’s acute neophobia meant that even one note of a different piece would evoke shrieks of fear-cum-anger, and the session could easily grow into an emotional conflagration.

So gradually, gradually, over weeks, then months, and then years, I introduced new pieces – sometimes, quite literally, at the rate of one note per session. On occasion, if things were difficult, I would even take a step back before trying to move on again the next time. And, imperceptibly at first, Romy’s fears started to melt away. The theme from Brahms’s Haydn Variations became something of an obsession, followed by the slow movement of Beethoven’s Pathetique sonata. Then it was Joplin’s The Entertainer, and Rocking All Over the World by Status Quo.

Over the four years, Romy’s jigsaw box of musical pieces – fragments ranging from just a few seconds to a minute or so in length – has filled up at an ever-increasing rate. Now it’s overflowing, and it’s difficult to keep up with Romy’s mercurial musical mind: mixing and matching ideas in our improvised sessions, and even changing melodies and harmonies so they mesh together, or to ensure that my contributions don’t!

As we play, new pictures in sound emerge and then retreat as a kaleidoscope of ideas whirls between us. Sometimes a single melody persists for 15 minutes, even half an hour. For Romy, no matter how often it is repeated, a fragment of music seems to stay fresh and vibrant. At other times, it sounds as though she is trying to play several pieces at the same time – she just can’t get them out quickly enough, and a veritable nest of earworms wriggle their way onto the piano keyboard. Vainly I attempt to herd them into a common direction of musical travel.

So here I am, sitting at the piano in Roehampton, on a Sunday morning in mid-November, waiting for Romy to join me (not to be there when she arrives is asking for trouble). I’m limbering up with a rather sedate rendition of the opening of Chopin’s Etude in C major, Op. 10, No. 1, when I hear her coming down the corridor, vocalising with increasing fervour. I feel the tension rising, and as her father pushes open the door, she breaks away from him, rushes over to the piano and, with a shriek and an extraordinarily agile sweep of her arm, elbows my right hand out of the way at the precise moment that I was going to hit the D an octave above middle C. She usurps this note to her own ends, ushering in her favourite Brahms-Haydn theme. Instantly, Romy smiles, relaxes and gives me the choice of moving out of the way or having my lap appropriated as an unwilling cushion on the piano stool. I choose the former, sliding to my left onto a chair that I’d placed earlier in readiness for the move that I knew I would have to make.

I join in the Brahms, and encourage her to use her left hand to add a bass line. She tolerates this up to the end of the first section of the theme, but in her mind she’s already moved on, and without a break in the sound, Romy steps onto the set of A Little Night Music, gently noodling around the introduction to Send in the Clowns. But it’s in the wrong key – G instead of E flat – which I know from experience means that she doesn’t really want us to go into the Sondheim classic, but instead wants me to play the first four bars (and only the first four bars) of Schumann’s Kleine Studie Op. 68, No. 14. Trying to perform the fifth bar would in any case be futile since Romy’s already started to play … now, is it I am Sailing or O Freedom. The opening ascent from D through E to G could signal either of those possibilities. Almost tentatively, Romy presses those three notes down and then looks at me and smiles, waiting, and knowing that whichever option I choose will be the wrong one. I just shake my head at her and plump for O Freedom, but sure enough Rod Stewart shoves the Spiritual out of the way before it has time to draw a second breath.

From there, Romy shifts up a gear to the Canon in D ­– or is it really Pachelbel’s masterpiece? With a deft flick of her little finger up to a high A, she seems to suggest that she wants Streets of London instead (which uses the same harmonies). I opt for Ralph McTell, but another flick, this time aimed partly at me as well as the keys, shows that Romy actually wants Beethoven’s Pathetique theme – but again, in the wrong key (D). Obediently I start to play, but Romy takes us almost immediately to A flat (the tonality that Beethoven originally intended). As soon as I’m there, though, Romy races back up the keyboard again, returning to Pachelbel’s domain. Before I’ve had time to catch up, though, she’s transformed the music once more; now we’re hearing the famous theme from Dvorak’s New World Symphony.

I pause to recover my thoughts, but Romy is impatiently waiting for me to begin the accompaniment. Two or three minutes into the session, and we’ve already touched on 12 pieces spanning 300 years of Western music and an emotional range to match.

Yet here is a girl who in everyday life is supposed to have no ‘theory of mind’ ­– the capacity to put yourself in other people’s shoes and think what they are thinking. Here is someone who is supposed to lack the ability to communicate. Here is someone who functions, apparently, at an 18-month level.

But I say here is a joyous musician who amazes all who hear her. Here is a girl in whom extreme ability and disability coexist in the most extraordinary way. Here is someone who can reach out through music and touch one’s emotions in a profound way.

Click here to view the embedded video.

I explore the science of how Romy and her peers are able to do what they do in my new book Applied Musicology, which uses a theory of how music makes sense to all of us to explore intentionality and influence in children who use little or no language. If music is important to us all, it is truly the lifeblood of many children with autism. Essential brain food.

Adam Ockelford is Professor of Music and Director of the Applied Music Research Centre at the University of Roehampton in London. He is the author of Applied Musicology: Using Zygonic Theory to Inform Music Education, Therapy, and Psychology Research (OUP, 2012).

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