Autism explained: What's sex got to do with it? Part five

Mild-mannered and understated as he is in person, Baron-Cohen is willing in print to draw big conclusions from small studies -- but he knows he needs larger studies to confirm the findings. One of his current graduate students, Rebecca Knickmeyer, is now laboriously tracking down 3,000 children who correspond to 3,000 amniotic fluid samples in that Cambridge hospital freezer. If she succeeds, she'll have a large enough group to say something firmer about fetal testosterone and social development -- and in particular, about fetal testosterone and autism. A group that large should include around 15 children with autism. Baron-Cohen's working hypothesis is that they will have had the highest exposure to fetal testosterone of all.

But fetal testosterone is just one possible biological mechanism for generating an extreme male brain; Baron-Cohen's autism theory doesn't depend on it. That theory is a psychological one, and the evidence for it is psychological. On a wide variety of tests that distinguish normal females from normal males, he says -- from eye contact to language development to understanding facial expressions to intuitive physics -- autistics of both genders lie beyond normal males, on the other side of the spectrum from females.

That holds in particular for Baron-Cohen's EQ and SQ questionnaires. Though he sometimes presents them as measures of empathizing and systemizing ability, it is perhaps more accurate to see them as measures of interest. The SQ questionnaire, for example, doesn't determine whether you are actually good at math or even at keeping football statistics and stock quotes in your head -- only whether you say you are interested in those things. But it and the EQ do separate the girls from the boys from the autistics on an X-Y graph -- at least in the relatively small studies that Baron-Cohen has done so far.

"I tend to notice details that others do not. Strongly agree? Slightly agree? Slightly disagree? Strongly disagree?" -- from the Autism Spectrum Quotient questionnaire.

People have realized for decades that autism entails a deficit in empathy; that's not what's new about Baron-Cohen's theory. He and a young clinical psychologist named Ofer Golan have come up with a novel way of helping autistic people, though: a computer program. On a CD-ROM, trained actors demonstrate the facial expressions and vocal inflections that correspond to 412 distinct emotions or mental states, arranged under 24 headings, such as "sneaky" or "happy." The idea is that people with autism can bone up on their mind-reading skills without the stress of having to attend a group-therapy session. ("One of the things they report is that they feel flooded," says Golan.) When they do well on a quiz, the software rewards them with images of things they like -- classifiable things, moving things, mechanical things or, ideally, things that are all of the above. "Stars, butterflies, things that move under a microscope," says Golan. "And trains."

What's novel about Baron-Cohen's theory of autism is how it portrays these characteristic obsessions. Autistic people and their families face enormous problems. Besides the universal social impairment, many of them suffer a devastating array of symptoms -- mental, neurological, gastrointestinal -- that may have nothing to do with their autism per se but nonetheless go along with it. What Baron-Cohen's theory says is that autistic people also have something positive: They're good at something. They're obsessed with systems, and they're good at systemizing, even when they don't happen to be mathematics professors or savants.

"You know," Baron-Cohen says, looking around his office for a ready example, "you and I just say, 'It's hot, we need a fan,' and turn it on. That isn't systemizing. A child with autism would look at the fan, and very likely would become fascinated by the rotation. What happens when light hits the blades, the kinds of reflections you get. So the child ends up staring at the fan for hours every day, because it is a form of mechanical motion that is systemizable -- and that obsession gets described as purposeless. I actually think the child is doing something very intelligent."

Which is more or less the feeling I have about Baron-Cohen as I take leave of his office and his obsession: Right or wrong, his approach to understanding autistic people and how they fit in with the rest of us is intelligent -- and empathetic.