To many, Temple Grandin is the public face of autism. A professor of animal science at Colorado State University, Grandin's story has significantly increased autism awareness around the world, and has increased society's appreciation of the unique and positive characteristics of the autistic mind. Therefore, it is with immense respect, enthusiasm, and attention to detail that I read her new book The Autistic Brain. Unfortunately, I was left feeling deeply frustrated by a book that felt to me like it was written by a few different people who frequently contradict each other.*

One voice that runs through The Autistic Brain is that of the cautious scientist, rightfully pointing out the limitations of brain scanning and genetic fishing, and highlighting the importance of taking into account contextual and environmental factors when attempting to understand the development of autistic symptoms. It's this voice that:

  • Cautions that "if you ever hear that fMRI can tell us people's political preferences, or how they respond to advertising, or whether they're lying, don't believe it. Science is nowhere near that level of sophistication yet-- and may never be."
  • Rightly notes that the very same behavior can arise from very different brain activations, warning that "just because you have an enlarged amygdala doesn't mean that you're autistic."
  • Reviews evidence that "every [autistic] child showed a different disturbance in a different gene."
  • Points out the enormous potential for plasticity, including brain repurposing.
  • Notes that the number of children identified with autism spectrum disorder changes dramatically from one community to the the next, and one ethnicity to the next.
  • Reviews research showing that people with autism show a significant reduction in their symptoms if placed in an educational context well suited to their areas of special interest.
  • Acknowledges that neuroanatomy and genetics isn't destiny.

Then... there's a very different voice whose main argument is that autism is "all in the brain and in the genes." It's this voice that

  • Downplays environmental factors and deeply personal life experiences, stating that it's the "overall complex relationship between the various parts of the brain that make us each who we are".
  • Highlights the fact that the sizes of particular brain structures are correlated with autistic symptoms, without acknowledging the fact that correlation doesn't equal causation. In fact, we now know that experience substantially alters not only the connections between brain areas, but also the structure of particular regions.
  • States that "all the hard work in the world won't overcome a brain-based deficit (like a cerebellum that's 20 percent smaller than normal)."
  • Confidently argues that we've "reached a point in our research that we can match symptoms and biology (genetic and brain evidence)."

See my confusion?

But the contradictions don't stop there. We get yet another voice that raises the truly important distinction between the "acting self"-- what autism looks like on the outside-- and the "thinking self" -- what autism feels like on the inside. It's this deeply humane voice that

  • Points out the potential value of self-report.
  • Argues for the need to appreciate "individual interests, strengths, and hopes."
  • Notes the importance of looking past labels.
  • Argues that autism is not a one-size-fits-all disorder.
  • Rightfully points out that "label-locked" thinking can obscure individual symptoms, and what it feels like to be autistic.
  • Gives the following wonderful advice for parents of autistic children: "Ideally, you want to prepare the child for employment that is not only productive but also a source of energy and joy."

But then, in the very same book, we return to that earlier voice that

  • Declares "Throw em' both in a scanner and let's see what lights up," to identify common brain activation patterns among two people with similar symptoms, but who differ in their labels (i.e., a person who hasn't been identified as autistic vs. someone who has been diagnosed with autism).**
  • Argues that the equation nurture=success does a disservice to the "naturally ungifted" since it "raises hope to an unrealistic level." Which, oddly enough, is an extremely label-locked statement.

Don't get me wrong, there is important information in this book. Grandin's review of the latest findings in neuroscience and genetics does give us an idea of where we are, and just how far still have to go. Also, Grandin introduces a "new" kind of mind: pattern thinkers. I think she's quite right that there is a large subset of people with autism who are good pattern thinkers. But I'm less convinced that this is really a new discovery. While Grandin doesn't mention it, I could see the connection between what she describes as pattern thinking and the construct of “fluid intelligence” that intelligence researchers have spent over a century investigating. Indeed, Grandin reviews evidence showing that people with autism tend to do really well on the Raven’s Advanced Progressive Matrices Test— which is an excellent measure of fluid intelligence and conscious pattern detection. Which actually had me wondering: Why not just identify her additional kind of mind as “fluid reasoning,” and link it to the very large literature that already exists on the topic? I do admit, however, that the label "fluid reasoning” isn’t as sexy as “pattern thinking.” Heck, maybe intelligence researchers ought to change the label fluid intelligence to pattern thinking!

Also, when Grandin argues that “patterns seem to be part of who we are,” it occurred to me that her argument is very similar to the argument Daniel Bor makes in his 2012 book “The Ravenous Brain: How the New Science of Consciousness Explains Our Insatiable Search for Meaning.” In his stimulating book, Bor makes the persuasive case that humans are meaning making machines, and links consciousness to a particular form of information processing associated with selective attention and chunking. In fact, Bor explicitly makes the same connection that Grandin does-- between chunking and pattern thinking in autism. So it was neat to see such convergence across very different books.

So there is certainly a lot of value in Grandin's book. Which is precisely what made it so frustrating to read, because it had so much potential. There was a very real opportunity to move our understanding of autism from the cold, impersonal level of group generalizations and symptomatology to an emphasis on the individual's particular patterns of strengths and weaknesses. Indeed, I believe this was Grandin's intention. As she notes,

"I have confidence that whatever the thinking about autism is, it will incorporate a need to consider it brain by brain. DNA strand by DNA strand, trait by trait, strength by strength, and, maybe most important of all, individual by individual."

Grandin's focus on the individual is very worthy, and I stand by Grandin in her cause to look past the labels, appreciate the existence of the various subtypes of autism, and to take into consideration individual needs. I even can get onboard with using the latest neuroscience and genetic techniques to inform (not solely determine) individual interventions. I just don't see how a complete understanding of individual interests, strengths, hopes, desires, values, and dreams will ever be found by opening up the head and looking inside the brain. It seems to me that requires, at the very least, listening to people with autism talk to us from their hearts.

© 2013 Scott Barry Kaufman, All Rights Reserved

* As Richard Panek, the co-author of The Autistic Brain pointed out to me after I wrote this review, the book was indeed written by two different people, and both did contribute to the intellectual property of the book. I wonder to what extent the coordination between the two in writing the book caused the seeming contradictions I point out in this review.

** Co-author Richard Panek also pointed out to me after I wrote this review that the self-report and brain scan perspectives aren't necessarily mutually exclusive:

"Self-reports can tell you that among the many symptoms of autism, this person has X and Y and Z specifically. Then you can take non-autistic people with X and look for brain imaging commonality with the autistic subject, and non-autistic people with Y and look for brain imaging commonality with the autistic subject, and so on. So rather than saying, "This is what autism is," you can say, "This is what this autistic person is experiencing, which might not be generalizable to all people with autism, so let's compare this person to a non-autistic person with a similar symptom." Both ideas--self-reports and "throwing 'em in a scanner"--arise from the idea of recognizing the individual as an individual."

Fair enough, but I still don't see how this confluence of approaches allows us to really understand the whole person, including his or her hopes, dreams, and desires.