Review of *NeuroTribes*, by Steve Silberman

This book already has done a good deal to raise the status of autistic people and also studies of autism.  Silberman is to be commended for extensive research into the lives of Hans Asperger and Leo Kanner and into the modern “neurodiversity” movement more broadly.  He has taken on a very difficult topic and turned it into what is likely to prove a commercially successful book.

That said, most reviews of this work, while positive, are not very assured.  It’s as if the reviewers know they are not well-informed about the topic and thus they stick to general praise, without delving into the details.  Or maybe they like the book’s conclusion and are reluctant to criticize the work as a whole.  I, in contrast, have a few more pointed remarks:

1. Leo Kanner, a co-discoverer of autism, is made out to be the bad guy, yet his writings are more subtle than Silberman indicates, even though one can pull some bad phrases and quotations.  Kanner in particular had a much stronger grasp of the diversity within autism (pdf) than Silberman grants.  It is hard, after reading that piece, to see how his conception of autism could be described as monolithic.

The contrast between Kanner and Asperger is much overdrawn.  The truth is closer to “they both had profound early insights and were unjustly neglected” rather than Silberman’s “sadly the Kanner approach to autism at first beat out the Asperger approach.”  The latter narrative is an over-dramatized storytelling convention of a popular book.  The real problem back then was how various minorities and “deviants” were treated, from gay individuals to lobotomized schizophrenics, rather than the dominant influence of Kanner’s ideas.

2. Silberman promotes an “along a spectrum (spectra?) model” rather than an “autistic yes or no” model.  Maybe so, but it is far from obvious that the “yes or no” model is false and in fact it explains some of the data better (pdf).  Silberman offers no scientific reason for his choice, and he doesn’t define the underlying concepts clearly enough to outline exactly what is at stake.  Silberman argues that the spectrum models are ethically superior and more humane, but that is an unjustified presumption and it also does not settle the substantive dispute.  In any case both models are capable of accommodating either respectful or disrespectful attitudes toward autistic people.

3. For a on autism, there is oddly little discussion of what autism is or might be.  That is author’s prerogative of course, but it means the book doesn’t offer much of a framework for judging the research history of autism, as it attempts to do.

4. Silberman devotes an entire chapter to the movie “Rain Man,” and in part the movie’s main role model, namely Kim Peek.  Yet the text fails to note it eventually turned out that Peek was not in fact autistic but instead probably had FG syndrome.  This is another instance of the book’s tendency to prefer a good story over the facts.  And that Peek was so ingloriously railroaded into the autism category is part of the actual story there (Dustin Hoffman played a role in doing that), yet that is a mistake which Silberman himself essentially repeats.

I hate to rain on the parade of this book because a) I love the topic, b) the author’s research is impressive, and c) the book is genuinely humane and tolerant and it will have an almost entirely positive impact on popular discourse.  Still, I think that the original organizing themes in the work are mostly wrong.

And oddly, for all its praise of autism and autistic ways of thinking, the style of the book is remarkably non-autistic.  It’s full of long stories and blah blah blah, rather than getting to the point.

Here is a review from Nature.  Carl Zimmer interviews Silberman.  Here is The Economist review.  Here is a related podcast.  Here is the Jennifer Senior NYT review.  Here is Silberman’s LATimes piece.  Here is a Morton Ann Gernsbacher review.  Here is The Guardian.  Here is The Atlantic.  Here is a PLOS interview with Silberman.

It’s an interesting read, but I don’t think you can trust what’s in there.


Professor, I have been reading your blog for only the last 6 months or so so I may have missed this being discussed before, but how is it that you manage to read so many books? Do you have a ritual? (Turn off the phone, glass of water, favorite chair?) Do you log the number of books you read in a week/month/year etc.? I’ve been curious for a while and fianlly decided I had to ask.

The glass of water is absolutely key.

I'm baffled that he reads so many books but still seems insecure on the distinction between spectrum and spectra.

I thought the "spectra" was more appropriate , implying different dimensions (multiverses?) perhaps not just a single one , along which the issues could be characterized.

Could be, but the common expression uses "spectrum". If you argue that autism maps along many spectra, people might reasonably ask whether autism is an "it" at all. Not that that's unreasonable: after all, it often makes more sense to refer to "cancers" rather than "cancer".

Recovery water, perhaps?

Due to lack of reply, I am forced to assume that he does not, in fact, drink water. I knew it.

this must be answered by prof Tyler!

I want to know this!

TC has described his reading habits, to some consternation, a few times:

Tyler, you're right, I should have been more explicit that Peek did not have autism, though many assumed that he did. Just noting that on page 363, I describe his condition by saying, "The bones of Kim Peek’s cranium had failed to fuse properly in the womb, so at birth, part of his cortical tissue protruded through a baseball-sized blister at the back of his head. His brain also lacked a corpus callosum, the thick bundle of white matter that usually coordinates communication between the left and right hemispheres. When he was nine months old, a neurologist rushing off to a golf game told his parents that Peek was hopelessly retarded, would never amount to anything, and belonged in an institution."

This was meant to register the difference between Peek's condition and autism.

...." aneurolgist rushing off to a golf game......"

Implication that the diagnosis would have been different if he wasn't into rushing off for golf?

Thank God that the blister wasn't golf-ball sized. Then he could really have sneered at the neurologist.

Tough crowd today.

I think I'll have a glass of water.

Dear Mr. Silberman,

According to the book-review in W.I.R.E.D. autistic people helped shape the modern world, could you please identify who specifically were those "autistic people" that shaped the modern world?

I have not read Silberman's book; however, I have known several autistics quite well, and am reasonably familiar with Frith, Atwood, Baron-Cohen, and Courchesne's work. My interpretation of the spectrum model of autism is that while all autistics have certain key characteristics such as social difficulty and delay, inability to read body language and facial cues, and communication delays, there is a clear continuum in communication ability from those who have almost no ability to communicate (often referred to as the low functioning end of the spectrum, the stereotype largely employed by Hollywood) to those who have facile verbal skills and score highly on verbal intelligence tests (often called the high functioning end of the spectrum, encompassing Asperger's syndrome as well). But those on the "high functioning" end of the spectrum still have profound issues with social functioning, nonverbal communication, etc.

My conclusion is that autism is a distinct group, but with a spectrum of traits within that group, especially related to verbal communication.

Yes this is how I interpret that as well. (I have not read Silberman's book either, and frankly as an autism mom I am not sure I can handle reading about how children with autism were treated in the not so distant past). Anyway, the terminology "on the spectrum" means that neurotypical people are "off the spectrum."

"while all autistics have certain key characteristics such as social difficulty and delay, inability to read body language and facial cues, and communication delays"

Just a brief note: As for the 'communication delays' above, back when Asperger's was considered a separate diagnosis one of the differences between Asperger's and classical autism was that there were 'no clinically significant delays in language' [...] or cognitive development” in people with Asperger's (Autism spectrum disorder, Lubetsky, Handen, and McGonigle). There can be significant impairments in the ability to handle non-verbal communication even among people with good verbal language skills, but I'm not sure this should be framed in the context of a 'delay', rather than a 'dis(/in-?)ability'. (Anyway it's a minor point.)

"But those on the “high functioning” end of the spectrum still have profound issues with social functioning, nonverbal communication, etc."

I think this is a point often overlooked in debates like these, so I'll talk a little bit about the numbers below because I think some people have a tendency to think of smart/'high-functioning' people on the spectrum simply as 'nerds', not as 'nerds with quite significant impairments' in some areas.

"NAS [National Autistic Society] statistics show that only six per cent of people with autism spectrum disorder (ASD) (12% of those with Asperger Syndrome (AS)) in the UK are in full-time employment. This compares with 49 per cent of people with general disabilities who are employed [...] Roughly one-third of adults with normal-range IQ scores in outcome studies are employed, inclusive of regular, full-time work, part-time or volunteer work, supported employment, and sheltered employment. [...] Most outcome studies indicate that few adults with ASD develop significant relationships outside of their families of origin. […] In terms of outcome studies to date, very few adults with ASD have been reported to have successful, long-term romantic relationships [...] in a study of “high-functioning” individuals with autism, more than 56% had never experienced a sexual relationship and only 25% had dated […] as a whole, studies repeatedly show that although individuals with ASD desire intimate relationships, few actually have them."

"A number of studies have shown that the majority of young adults continue to live at home with their parents. […] Even when adults with autism live outside the family, their families especially their mothers have extensive contact and involvement in their care. Kraus et al. (2005) reported that 50% of families visited their adult with autism at least weekly and an equal number of adults came weekly to visit at their mother’s home. […] This need for continued parental support crosses the entire spectrum of individuals with autism."

"Depressed mood may be particularly common in high functioning adults, who have insight into their social and adaptive difficulties, and who may desire to make changes but have limited success in doing so [...] adults with ASD often present with more depression and anxiety than their adolescent counterparts […]. Interestingly, higher-functioning adults with greater intelligence and less autistic symptomatology tend to experience more depression, anxiety, social isolation, withdrawal, and peer victimization […] than lower-functioning individuals. This may be due in part to greater social expectations often placed on higher-functioning adults occurring as a result of placement in less protective and more inclusive settings."

(more numbers, and sources, here:

It would be useful to have an agreed-upon term other than "autism" for the condition of high-functioning, non-pathological individuals who are simply at the opposite end of the scale from, say, Oprah Winfrey or Donald Trump.

I gravitate toward "nerdism" as that term, but I'm sure other people have other suggestions.

We could then reserve "autism" for individuals with serious problems. That would be helpful for, say, parents who disclose, "My child is autistic," only to be greeted with the response, "You mean, like Bill Gates?"

"No, not like Bill Gates."

There seem to me to be many terms which sort of fit the bill; constructs/concepts like introversion-extroversion, sociability, oddness, eccentricity, quiet and not very outgoing, socially withdrawn, ... What's wrong with those? Most people presumably don't even know all the dimensions involved in autism, so using that term if anything just confuses the issue because it seems to make further clarification necessary anyway (if someone says someone else is 'slightly autistic', does that mean he has difficulty reading body language, does it mean he displays an inflexible adherence to routines, or does it perhaps mean that he's highly sensitive to specific sensory inputs? You won't know unless they also add this information..), especially as autistics vary quite a bit in terms of which dimensions are most important.

It sometimes surprises people to learn this, but autism is already supposed to be reserved for individuals with serious problems; in the diagnostic context, the DSM-V autism spectrum disorder diagnosis requires that: "Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning." This is not new; criterion C in the older Asperger's diagnosis (supposedly 'mild' autism) for example also required that the social impairments associated with the condition "must cause clinically significant impairment in functioning (criterion C)".

(It's not like I actively dislike the term 'nerdism', I should add - the point is just that I'm not sure there's a great need for yet another neologism to refer to 'those people').

As one who fits the "nerdism" diagnosis to a T, I might recommend "abrasive" :-)

I think you have an important point here that highlights my frustration with selecting well-known people from history and saying "this person clearly had Asperger's / high functioning autism." Being a nerd is a lot different from being autistic (note that based on experience, I consider Asperger's syndrome to be a useful descriptor for a subdivision of the high functioning end of the autism spectrum). Bill Gates may be socially awkward in some respects but he is clearly not on the autism spectrum. I contend that people like Einstein and Thomas Jefferson, other targets of the retroactive diagnosis movement, don't fit the description either. Isaac Newton maybe, but I'm still not convinced.


Good point. I couldn't agree more.

Interestingly, higher-functioning adults with greater intelligence and less autistic symptomatology tend to experience more depression, anxiety, social isolation, withdrawal, and peer victimization […] than lower-functioning individuals. This may be due in part to greater social expectations often placed on higher-functioning adults occurring as a result of placement in less protective and more inclusive settings.

This may be because high-functioning people are more aware of when they are being subtly treated as inferior or socially excluded (even if in a crowd). A low functioning person is happy to be treated as the retarded nephew. A high functioning person wants to be regarded as an equal.

Better ability to model the minds of others and perceive that they're being treated badly/socially rejected is likely to be a factor. Increased focus on social interaction factors of relevance which fail due to anxiety-related effects (increased sensitivity to social cues of rejection leading to higher probability of actual rejection through the behavioural channel) may also be a factor; anxiety is common among high-functioning individuals, and anxiety tends to be bad news for social interaction outcomes. Another factor my be that they are better able to understand how their lives could be different, if not for their autism, than are people with more severe impairments in terms of cognitive functions.

I have Asperger's (formal diagnosis, not the internet kind). In some important contexts I don't care much about being treated as an equal - I'm perfectly okay with being treated as the odd uncle, as I usually am in family contexts, because I *am* the odd uncle. But I'd like a semi-normal life, and that seems completely out of reach for me - for me, personally, this part is much more depressing than the social interaction patterns of others; I'm a (semi-?)hermit (it varies...) who rarely interact with other people anyway, so how people treat me often don't enter the equation much anyway.

"a semi-normal life"

(Implying in case you were wondering mainly: Finding a romantic partner (who's not a toothless 60 year old Chinese widow who does not speak English), and finding regular employment which can lead to at least the illusion of some kind of financial security and is not at the same time of the kind that'll in the long run make me want to kill myself. Both of these goals seem to me close to impossible to achieve, and in the former case I have by now concluded that that romantic stuff's not for people like me - which is really hard, given how humans are programmed biologically to, you know, find ways to have children, like their millions/billions/... of ancestors).

As a suggestion:
If you're willing to accept that you're the odd uncle, maybe you should accept that you might have to lower your standards to find a romantic partner. Because (fact) the romantic partner is likely to have to lower her standards to accept you.
You might try combing OkCupid profiles for less-attractive women or those with mental problems of their own. (Just being blunt, not trying to be offensive.) I know you're thinking "I have enough mental problems of my own", but there's also the possibility that the social exclusion resulting from being abnormal psychologically could be a bonding factor.

If I lower standards enough for it to be likely that I'd be accepted by the other party, the individual in question will not be desirable to me (...a variant of the Groucho Marx quip: 'I don't care to belong to any club that will have me as a member'). You could say that that would again be an indication that 'my standards are still too high', but if a partner is not attractive to the other party things are not going to work out long-term, at least not in a manner which could be characterized as even remotely satisfactory (to someone who lives in a modern society in the 21st century, at least); (almost) everyone can find a partner (some young Chinese and Indian males may have trouble these days, and in the years to come), but not everyone will be able to find a partner whom they'll find attractive, despite the frequent claim to the contrary by people who've already found their partner ('there's someone for everyone' - no, there isn't). This is part of why I've given up. The realization that if I were to 'get out there' again I'd face repeated rejections by people whom I'd not even consider attractive, because the default outcome of romantic approaches is rejection, also does not help. I have some experience with online dating and I have concluded that that option is not going to be worth exploring any further.

A lot of women have mental health problems, but most of these mental problems don't go at all well with the sort of mindset autistics possess. Finding a young woman from a poor country with no better options who'd marry you for the money and the residence permit may be the best option available, but even that option is currently unavailable to me (for financial reasons as well as immigration legislation discouraging such ideas) and marrying someone who marries you for the money is not likely to lead to a happy and satisfactory relationship long-term, nor is it a smart prospect if you're a male in Western societies, given the sort of divorce legislation which usually applies.

But thanks for the shared idea/feedback.

I wonder if Autism is an accentuated psychiatric malady on account of the sensory overload that children experienced over the last couple decades? Lots of cheap glitzy toys in the crib? Constant calming music in the nursery? Using the HD TV as a baby sitter? More and more age-appropriate consumer objects presented to them?

You seem to confuse increased diagnosis with increased prevalence. We know we have the former. What is the evidence for the latter?

A lot of people were just called "retards" a hundred years ago, with no desire to be specific about their condition in any dimension.

Yes, or "simple", or "odd" or "eccentric".
A high functioning male in the 19th century, if he was in the upper class, would have been the curious bachelor with the huge insect collection.

Tyler, your link points to Kanner's famous 1943 paper. The most significant and obvious way in which Kanner's understanding of autism was monolithic is that every patient described in that paper is a child. Kanner's model of autism did not include teenagers and adults. That's not exactly his fault -- he was a child psychiatrist. But the exclusion of teenagers and adults from autism was an omission of Kanner's that Lorna Wing went on to fix with the invention of Asperger's syndrome (Wing, "Asperger's syndrome: A clinical account, 1981) and the broadening of the criteria to include all age groups (as well as the expansion of the lay concept of autism to include adults that followed "Rain Man.") And note: even in that 1943 paper, Kanner makes the surprising assertion, "There is no fundamental difference between the eight speaking and the three mute children." That's overlooking a lot of heterogeneity for the sake of delineating a category. Lorna and Judith Gould originally felt that "Kanner's autism" as a useful concept should be thrown away ("the findings of the present study bring into question the usefulness of regarding childhood autism as a specific condition" - Wing and Gould, 1979); but they ended up compromising and creating the image of the spectrum, which echoed Asperger and Georg Frankl's concept of the autistic "continuum" that included children and adults. Anyway, I'm glad the book ended up in your hands.

Every person described in Dr. Asperger's paper was a child too. As a pediatrician he was not concerned with adults. He chose the label "autism", and I quote, "in an effort to define the basic disorder that generates the abnormal personality structure of the children we are concerned with here." End of quote. Similarly, when speaking of the "persistence over time" he refers to his own recognition that the so-called characteristic manifestations of autism were not at all rare in children - all kind of children.

Psychological terms go in and out of fashion. For example, when I was young people had nervous breakdowns. Now they don't. Have people changed or just the terminology?

Similarly, the word "autism" was little used when I was very young, then it seemed to be used for high functioning nerds (like my ornery high school classmate who flunked out of Cal Tech), and now it seems to be used largely as a replacement for what people in 1970 called "mental retardation."

Presumably this has a lot to do with medical insurance categories. But I don't feel all that confident that we're carving nature at the joints very well they way we use the term "autism."

I find the term "nerdism" pretty useful. It doesn't imply pathology like "autism" does. It's possible that the growth of nerdism is the biggest change in human nature in my lifetime. Or maybe nerds were always there. I don't know.

Certainly, the emergence of nerds as a self-aware group is one of the least predicted social phenomena since the rapid changes of the late 1960s settled down.

For example, who would have expected 50 years ago that the dominant French literary figure of the early 21st century would be Michel Houellebecq, a former computer administrator who writes sci-fi novels about how guys like him just can’t win at amour?

How far back nerds go in history is uncertain. Are there any nerd characters in Shakespeare’s plays? Neal Stephenson attempted with some plausibility to project his kind of WASP nerdishness upon the age of Newton in his Baroque Cycle series, but the concept seems to have escaped the great minds of that time.

Still, it’s not at all certain whether nobody noticed nerds before the second half of the 20th century because we didn’t have a word for the category, as the Sapir-Whorf theory would suggest. Or perhaps, as Michel Foucault might have argued, nerds were socially constructed (or, more realistically, self-constructed).

Personally, I don’t recall knowing anybody I could now call a nerd until high school in about 1973 when I met a memorably ornery nerd who drove our history teacher crazy by writing the dates in his term papers in base 8 (e.g., “The Declaration of Independence was signed in 3360”). He had a difficult time socially in high school, was accepted by Caltech, and immediately flunked out.

In 1974 a freshman arrived at my high school with a more workable version of the now-classic nerd personality. As the son of a famous science fiction writer, he was confident that technology was moving in a direction suited to guys like him. I gave him a fair amount of publicity in the school newspaper I edited. Nerds were unusual back then and made good copy, plus his “tomorrow belongs to me” logic made a certain amount of sense.

The lead character of 'Of Human Bondage' is arguably a nerd. He has a club foot instead of a stammer, but the novel is supposed to be somewhat autobiographical. He seems to have no male friends and most of the book is concerned with his failed pursuits of various occupations and romantic relationships.

Polonius seems pretty nerdy, though he's a court adviser and that suggests at least some social graces. Also, his advice is comically bad.

Hamlet himself could be played as a nerd (educated, introspective, tries to be rational, awkwardly drives his girlfriend to insanity and suicide through a socially inept scheme) but I don't think that's how he is usually read.

That said, it's almost impossible to read many of the amateur and professional scientists and technicians in history as anything but nerds. Newton was clearly a socially defective savant who turned almost everything he touched to gold; There's many other examples going back at least as far as the story of Archimedes running through the streets naked shouting εύρηκα! (If the story isn't true, the tale is still telling.)

But see my comment upthread agreeing with Steve Sailer that there is a big difference between "nerd" and "high functioning autistic / Asperger's syndrome". Polonius is just a windy old bore; Hamlet is in a nasty double bind about whether to avenge his father's murder or let his mother continue to rule. Neither has one whit to do with autism.

Maybe a case can be made for Newton as an autistic; there may be a few more of the math geniuses that could fit the category (I'm not recalling the names right now though). But not Jefferson, not Einstein, despite attempts to co-opt them.

Richard II is a nerd-ish character.

Prevalence of nerds and awareness of nerdism as a personality type are different things.

Stephenson aside, a fairly high percentage of the Royal Society types probably qualify. Doing things like grinding your own lenses or doing extensive physical experiments as an amateur require quite a lot of dedication and focus and probably appeal more to introverts. This would be more pronounced as professionalism edged out dillitantism. Newton, Hooke, and Maskelyne would fit easily in the archetype.

In the US, Bowditch (1773-1838) probably qualifies on the basis of spending large portions of time working out navigational tables.

In the pre technological era, you might be better off looking at the clergy or people studying classical languages. There are plenty of men who learned Greek, Latin, and Hebrew at an early age -- Champollion learned Greek, Latin, Hebrew, Arabic, Syriac, Chaldean, and Coptic before deciphering the Rosetta Stone.

I'm with Ryan, that is I'd say nerdishness the category is socially constructed, but not the state of mind. Neal Stephenson did not have to "project" anything, his characters really where White Anglo-Saxon Protestant Nerds. Except for the one that was merely a White Saxon Prostant Nerd.

I think people did recognise them at the time, but they also found it harder to describe what they were seeing. Hence the tails of Archimedian eccentricty.

William Golding's "Piggy" might be an example. Lord of the Flies was published in 1953. Tea and Sympathy, in which the protagonist was an arty folk-singer wannabe, was published the same year.

Gussie Fink Nottle is a newt-fancying nerd.

If by "nerd" you mean "intelligent but social misfit person who is bad at sports", this seems to be a very usual type in history (both in reality and in fiction), specially if we ignore the "bad at sports" part (who is difficult to measure from people from the past). typolo

In the attempts to create typologies of human personality, we have the "melancholic" of the Ancients, the "introvert" (specially the introvert-thinker) of Jung, the "schizoid" of Kretschmer, the "cerebrotonic" of Sheldon, or the "sensible" of Heymans-La Senne-Bergier; all these types cold be considered the equivalent of "nerds".

Or look to Norbert Elias' description of German intellectuals of the end of the 18th century (in "Sociogenesis of the Antithesis between Kultur and Zivilisation, in German Usage"), living solitary lives, with little in common both with the people and with the aristocracy and dispersed by the country and with little contact with each other (in contrast with the French intellectuals, who livel all in Paris). Is not much similar to the classical high-school nerd (for many going to college is like to change from "solitary German intellectual" to "French intellectual living in Paris with his peers")?

The "inteligent but social misfit" was also one of the stock characters of the Romanticism, and some authors of the time were very close to that (for example, Holderlin, or Emily Bronte). Or, some decades later, look both to the work and to the life of solitary thinkers like Nietschze or perhaps Schopenhauer.

Or characters like "Bernard Marx" from Brave New World? Or "Gordon Comstock" from Keep the Aspidistra Flying? Very different personalities, but both in the type "intelligent, solitary and always thinking and theorizing".

Then, if by "nerdiness" we mean a combination of intellectualism and social alienation, it seems a very common thing in the history of Western Civilization (now that I think about that, perhaps "nerdiness" is what defines Western Civilization?).

Of course, these depend much of the definition of "nerd". What is perhaps the big innovation of recent times is the appearance in large scale of "hard science nerds" - traditionally "nerdiness" (as I am defining the word) was more a thing of the "soft sciences", by obvious reasons - in the hard sciences (with the exception of Mathematics) you have to interact with the world; it is in the soft sciences that you can spend your life in your room, reading and thinking; one result of the personal computer is that know there is an engineering area (computers) where you can be successful with an intellectual/reclusive personality

"one result of the personal computer is that now there is an engineering area (computers) where you can be successful with an intellectual/reclusive personality"

@steve sailer, stereotyping the entirety of the ND community as wacky 'nerdists' who go on to fail out of engineering school is almost so stupid as to not merit a response. but yet, here we are. as to the spectrum debate - and I'm aware personal anecdote is a poor substitute for data - I would say that the various members of my family all display ND qualities, but to varying degree. it'd be incredibly arbitrary to set a cut-off point.

The review makes it sound as if it should carry the Hollywood description "based on a true story".

My nephew (by marriage) has two children, both diagnosed autistic. One of my best friends is a twin, he and his brother graduates of Georgia Tech and both engineers. Everything about them is alike: they look alike, act alike, sound alike, everything. Except one has three very healthy children and the other an autistic child. The number of children diagnosed autistic is alarming. Sure, in my generation there were a few considered "mentally retarded", but today, good grief! I've read many times that it isn't an epidemic, just more cases being diagnosed. Maybe so. My nephew and his wife have adapted to their situation amazingly well - no oh woe is me from them - shifting their perspective and the expectations for their children. My friend's brother, not as much. Being around these autistic children often I can say with confidence that a common characteristic is the absence of fear, and the risk of flight. Turn your back and they are gone. Is it because they are so curious?

Re: dimensions vs clusters, you devise a diagnostic survey that is *not* biased towards the idea that autism already exists as a category. So some general survey data created to just diagnose mental health and psychological focus, with no real bias that autism exists, then you sift it through a dimensional / cluster analysis. Ideally, I think you'd also want to use data on thoughts and feelings, and not data on behaviours, because with behaviours you would seem more likely to be capturing a socialisation effect, not proving a real uninfluenced psychological trait.

If you get a clear dimension which is evenly populated and your autistic sample is at the far end, then autism exists as a spectrum, if you get a cluster with the autistic sample well separated, then its a cluster condition. If they aren't particularly separated, throw away the autistic concept.

If you do get a dimension or cluster, check out the loadings and see if it loads heavily on a particular response - that might suggest a better concept for the cluster / dimension, than autism.

(TC: And oddly, for all its praise of autism and autistic ways of thinking, the style of the book is remarkably non-autistic. It’s full of long stories and blah blah blah, rather than getting to the point.

So it blathers on and on about its "special interest" for hours and then is wrong and irrational about it anyway, in ways it could've learned not to be if it just talked to and listened to other people for a second, and it's *not* typical of people diagnosed autistic? ;) )

Haha, yes, "getting to the point" has not been my experience when working with teens / young adults with Asperger's.

First, I want to second the earlier comment that you sure do an impressive amount of reading on a wide array of topics.

But I guess I'm missing your point. I don't understand the difference between "yes or no" autism with diversity and "autism spectrum disorder." If I understand right, both include Asperger's under autism, which has been the main controversy. In other words it seems that you and Silberman are actually on the same side, resisting those who want to pull Asperger's or "high functioning" autism generally out of the autism category. Personally I sympathize a lot with resistance to the "autism" label, even though scientifically I think it's sound.

It sounds like your interest is in searching for physiological cause of autism, your hunch is there is a common one for all types, and you felt this book suggested without really saying the opposite. I think it's premature to get into a debate over that and probably beside the point of this book.

"It sounds like your interest is in searching for physiological cause of autism, your hunch is there is a common one for all types, and you felt this book suggested without really saying the opposite. I think it’s premature to get into a debate over that"

I don't want to speculate as to what TC may think about stuff, but I would note that a lot of stuff is already known about this topic, and if his thoughts go along the lines you claim, then he should read some more stuff about these things. A lot of stuff is still difficult to figure out, but much is already known, and a model with 'a common cause for all types' is completely indefensible in view of the evidence. Some related observations from Lubetsky, Handen, and McGonigle's book also mentioned above:

"15%–20 % of cases of ASD [autism spectrum disorder] are now linked to genetic or chromosomal abnormalities […] Fragile X Syndrome (FXS) [is] the most common identifiable cause of ASD and the most common inheritable cause of ID. […] Thirty percent of individuals with FXS demonstrate characteristics of ASD. [...] Seventeen to 65% [there's a great deal of uncertainty here, but either way the risk is highly elevated compared to baseline - US] of individuals with TSC [Tuberous Sclerosis Complex] demonstrate characteristics of ASD." 50-86% of children with inborn errors of cholesterol biosynthesis have ASD. 50% of children with the 2q37 deletion syndrome has ASD, as do 40% of patients with Joubert syndrome. 60-70% of patients with Timothy syndrome have ASD, as do 70% of people with Cortical dysplasia–focal epilepsy syndrome. More than 40% of people with 15q duplication Angelman/Prader Willi syndrome have ASD.

I could go on, these are not the only conditions mentioned in the book. A general distinction is made in the literature between syndromic autism spectrum disorder, and non-syndromic autism spectrum disorder. Some more general remarks on that topic:

"Syndromic ASD includes identifiable autism syndromes with known genetic causes, such as tuberous sclerosis complex, Fragile- X syndrome, Rett syndrome, and Smith-Magenis syndrome.
• Syndromic ASD is associated with a relatively higher propensity for dysmorphic features (including anatomical brain abnormalities), intellectual disability (ID), seizures, and female sex (sex ratios are almost equal).
• Syndromic ASD is also associated with a higher frequency of chromosomal abnormalities in general, many of which have been identified as part of the genome-wide microarray studies discussed below. However, it is not yet clear for many of these syndromes which features are typical of autism and which are unique.
Non-syndromic ASD is also called idiopathic autism and consists of cases with and without identifiable micro-deletions or duplications to the DNA.
• Some of these microgenetic alterations are present within the abnormal chromosomal regions in syndromic ASD cases, thus providing a link.
• Individuals with idiopathic ASD are more likely to be male, with sex ratios approximately 1:4 (F:M) but approaching 1:7 in milder cases.
The syndromic/non-syndromic ASD distinction remains a clinically valuable approach to the evaluation of patients at this time, and should serve to remind all involved with the care of individuals with ASD to examine every case for signs of tuberous sclerosis, Fragile-X syndrome, and the many other syndromes."

The point being that if you want to make a 'common-cause model that makes sense, you need to do it in a relatively broad way which most likely will not account for all the variation you see. You can argue that " findings have produced a convergent developmental neurobiological model of autism as a disorder of neuronal organization and in some cases neuronal migration, not one caused by social-information processing deficits or by environmental factors" (as Lubetsky etc. do on page 110 in their book), but much further than that you're probably not going to get - the nervous system is really complicated - and even a conclusion like that is questionable (does penetrance not depend the least bit on environmental factors? Of course it does...). You can go further than that and go more into the specifics (see for example the ERK/PI3K Pathway Model), but you'll still need in at least some sense different mechanisms to produce the variation you see in the impairments observed (in the case of ERK/PI3K, mutations occurring further 'upstream' in non-syndromic cases than in syndromic cases, leading to more subtle effects).

Thanks. From what you write the physiological side of it does seem very complicated and hard to unify. And if autism is a category of behavioral symptoms, not a specific disease, then using the term "autism spectrum disorders" seems to me to be the exact same thing as saying autism is a "yes or no" question. Either your behavior is within that spectrum or it isn't.

I'd like to comment to "US" about his earlier post. Maybe I'm just a romantic who thinks there is someone for everyone, but my husband has aspergers and I know of many others in relationships. I just wanted to say the right person is out there, so don't give up. I think in your case it may be most likely to happen through a relationship that is built over time, maybe meeting through a friend/family member or meeting through a club or church group. Just my thoughts.

And lastly, I enjoyed the review of the book.

According to Wikipedia, Kim Peek:

* Completed the high school curriculum by the age of 14 (with the help of in-home tutors visiting a couple of times a week)

* Scored below 87 in IQ testing

Suppose you run a Turing Test and try to determine if you can distinguish a diagnosed population ('autism', 'depressed', etc) from a random population. If you can't distinguish the populations maybe the diagnosis is bogus or insignificant or best ignored.

Thank you for this review. I follow the autistic community closely (as my son is autistic), and appreciate the unbiased review of this book- the reviews have been gushingly positive, and I am looking forward to reading this book, but an intelligent counterpoint is very important.

Silberman’s autistic people – those about whom he writes in his book – were classified as “autistic” (or inserted arbitrarily in the Spectrum) not because of neuro-biological causes but because the authors of the DSM, in the United States, really screwed-up when they invented a mental disorder (AS) to classify certain patients who have never been easy to classify. They did not have a clue about the social context in which Dr. Hans Asperger wrote his paper in 1944. In any case, if they (Silberman's characters) had suffered from “infantile autism” in childhood, they seemed to have completely overcome all of their symptoms and are able to appear indistinguishable from their typical peers.

Point 2 seems to represent a misunderstanding of the spectrum model of autism that is all too common these days. It was never meant to convey the notion that autism is somehow not distinct from typical neurological development. Instead it is a concept that acknowledges the high degree of diversity that exists within the condition.

In the 1990s, when autistic people (myself included) finally started finding each other on the internet, there was a strong shared sense of being deeply, fundamentally different from neurologically typical people -- so different that some of us felt as if we were from other planets. Many of the autistic people on the InLv online support group I ran[*1] never had the experience of being understood by anyone, ever, before joining it. This included people who had, though long and painful experience, learned enough tricks to mostly pass for normal (for a limited time and at great cost to themselves), so would incorrectly be considered cured by someone like Ms. Mazzucco above.

Our experience, then, suggests that autism is a condition that is both highly diverse and highly distinct from normal. It is only recently that the notion that "we're all on the autistic spectrum somewhere" started gaining traction in the popular discourse, a notion which I find quite odious because it takes us right back to forced normalization through the denial of our differences and disabilities.

When Judy Singer, inspired by discussions on InLv, coined the term "neurodiversity"[*2], she too was not denying autism was a distinct neurological condition: on the contrary, the concept of neurodiversity affirms that it is one distinct type of neurological configuration among many others.

So it is clear that I would subscribe to both the yes/no model and the spectrum model of autism, and don't see these as contradictory at all. I have seen nothing in Silberman's book that claims otherwise.

[*1] See 'Neurotribes' p. 452-453
[*2] Singer, 1998:

To Tyler Cowen

What Dr. Asperger really said.

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