Q&A: Dr. Daniolos on treating autism

Peter T. Daniolos, M.D., Associate Professor of Psychiatry and Pediatrics at the University of Iowa Hospitals and Clinics, child and adolescent psychiatrist, and member of the Autism Center of Excellence, visited Grinnell on Wednesday to deliver a lecture entitled “Psychosocial Interventions for Autism Spectrum Youth.” He discussed the various changes the diagnostic spectrum for autism is currently undergoing as well as the broad and evolving social implications of the diagnosis.

Peter T. Daniolos, Associate professor of Psychiatry and Pediatrics speaks during his Wednesday's lecture "Psychosocial Interventions for Autism Spectrum Youth" in Noyce. Photo taken by Radka Slamova.

You spoke about autistic children’s trouble with empathizing and how you address that by teaching them to read social cues and to respond accordingly. Is that teaching them to act a certain way or is that teaching them the concept of empathy?
The theory is that kids with autism struggle with empathizing for a lot of reasons. One of them is this thing called the “theory of mind,” which basically means that you or I can put ourselves in another person’s shoes in terms of feeling what they feel momentarily. And you can’t train that innate ability. It’s a neuropsychological function that some people have naturally. But having said that, it’s been said that with repetition, if you can somehow repeat over and over some of the various strategies that they’ll try to do in therapy with these kids, they can actually take on that capacity and become much more effective. Interestingly, once when I gave this lecture, a medical student came up to me afterwards and said “I’ve been diagnosed with autism since I was a child. I had 40 hours of ABA therapy a week since I was three through high school.” I would never have known. He was using good hand gestures, he was looking at me, he was using good tone, he seemed sensitive to the things I was saying, which is empathy. So, I think with time and practice, with the right therapist, it’s possible to do a lot. To me, it often seem a little stilted and practiced. The kids don’t react quite as spontaneously.

There’s one other theory called the mirror neuron theory that’s kind of a hot topic, because some people are connecting that to autism, too. They’re a subset of neurons in our brain that fire when we watch someone do something. So if I watched someone pick up this spoon, the same neurons that help that person pick up this spoon would go off in my head as if I were picking up the spoon. Which is so wild! Now the theory is that maybe mirror neurons also work for feelings. Like the phrase “I feel your pain” is literally true. So when I see someone really sad, I feel deep sadness in myself that I can, hopefully, use effectively when I’m doing my work. But the theory is that kids with autism have a harder time with that, and the mirror neurons aren’t as effective in them. So yes, the long answer is I think it’s trainable, but it doesn’t feel quite as spontaneous and is a little more stilted. There’s an immediate jumping into showing concern. One of my favorite stories is that a mother was changing a light bulb and she fell off a ladder and really badly hurt her back. She was lying on the floor, and her nine-year old boy with high-functioning autism walks into the kitchen and steps over her. There’s a ladder. She’s wincing in pain. He goes to the refrigerator, gets something to eat, and goes downstairs. And it’s not that he’s cruel. But he didn’t read any of the social cues or facial expressions. It just didn’t come naturally. Now, with someone kind of scripting or guiding him, he probably wouldn’t have done that. When you work with these kids, you try to train it, but it takes a while for it to get to that natural, fluid point. But some people do catch on.

You seem to enjoy immensely and have such passion for working with and interacting with these kids. But how can people who aren’t trained in this type of interaction try to befriend those with autism?
I think … that’s hard. Because these kids can be disarming. They will bump into you; they’ll act as if you’re not there; they’ll totally dismiss you. You might experience them as rude, willful, badly mannered, poorly parented. I think the best thing you can do is to become well aware, so that when we see that quirky kid in a store, you think twice about how they ended up that way. And then be more careful about the way you approach that person. Because for someone to sort of come into your physical space, it’s really intrusive when you struggle with social connection. So you want to be much more indirect, I think. When I’m at functions where I sense someone very much in that world, I want to not just come and chatter and smile and overwhelm them. But then the other thing I think people need to remember is that many of these people really want friends. It’s a myth that they’re happy on their own, and loners. They want to connect, they don’t know how. I find that just reading some of these [autistic autobiographies] like “Look Me in the Eye,” where you get to experience some of their lives, increases the ability to be sensitive to who these kids are. Because they’re misunderstood. They’re targeted all the time. We’re adults! I’ll find myself at gatherings where people are very clearly put off by an obnoxious adult in the room who’s being really insensitive with their comments. And I’ll wonder … well, some people are just obnoxious because they’re obnoxious. But some people are just obnoxious because they’re misreading every cue. I can think of a family friend, who was clearly an older man with Asperger’s that was missed his whole life, and everyone thought that he was a bad father, a bad this, a bad that. When in fact … his family thinks he’s just trying to come up with an excuse for being a bad dad, but I know this person. He clearly struggles to read social cues, and he’s infamous at dinner parties for saying something that insults at least half the room. It can be an ethnic comment or a racial comment … and he’s not racist. But he will inevitably say something that will deeply offend someone in the room. When that happens, because I have a sense of what this person is, I am much more forgiving of that.

Another thing that you spoke about which really struck me was that people who are minorities or of the lower-class, particularly black men, often go undiagnosed or misdiagnosed with other disorders like psychosis. How would you propose we address that?
Girls too, because we tend to focus more on boys in dealing with autism.

Yes, but when girls have autism, they tend to be more impaired. We don’t know why. More boys than girls get it. The theory is that girls’ brains are protected somehow against it. It’s such a sexist theory, but it rings true—it’s the male systematizing mind versus the empathizing female mind. And yes, there are cultural factors to that, but there’s some evidence that it’s also biological. There are a lot of feminist scholars that refute that, but the theory is that the autistic mind is the male, systematizing mind gone to the extreme … so that the person is so analytic that they lose touch with emotional things. So women’s minds have already been programmed, theoretically, to be sort of … anti-autical. The females that do have autism, boy. It’s broken through a protective barrier, for a lack of a better word. So the girls I work with that have autism tend to be more severely impacted than the boys. So, going back to your question about diagnosing minority kids, I just think there needs to be an awareness. That this is not a depressive battle or a psychotic child. People with less money and less financial needs know less about this and seek it out less frequently. They fear the diagnosis because it’s stigmatizing in their minds. Whereas, a more educated family would grab it, not that they would want it, because it would inform their world about why their child acts a certain way and how they could get services for their kid.