Don’t trust Putin

Steve Silberman, who this week won the Samuel Johnson Prize for his book on autism, explains why he believes the brain disorder has become so prevalent

AFEW YEARS ago, after someone mentioned to me about the supposed rise of autism in Silicon Valley, I started reading every news story about autism I could find and downloading journal articles by the score. It soon became clear that the mysterious rise in diagnoses was not restricted to California, where I live. The same thing was happening all over the world.

To put the rising numbers in context, I familiarised myself with the basic time-line of autism history, learning the story of how this baffling condition was first discovered in 1943 by a child psychiatrist named Leo Kanner, who noticed that 11 of his young patients seemed to inhabit private worlds, ignoring the people around them.Theycouldamusethemselves for hours with little rituals like spinning pot lids on the floor, but they were panicked by the smallest changes in their environments, such as a chair or favourite toy being moved from its usual place without their knowledge. Some of these children were unable to speak, while others only repeated things they heard said aroundthemorspokeof themselves detachedly in the third person.

Claiming that their condition differed “markedly and uniquely” from anything previously reported in the clinical literature, Kanner named their condition autism — from autos the Greek word for self — because they seemed happiest in isolation.

A year later, in an apparent synchronicity, a Viennese clinician named Hans Asperger discovered four young patients of his own who seemed strangely out of touch with other people, including their parents. Unlike Kanner’s young patients in Baltimore, these children spoke in elaborate flowery sentences while displaying precocious abilities in science and mathematics. Asperger affectionately dubbed them his “little professors”.

He also called their condition autism, though it’s still a matter of dispute if what he saw in his clinic was the same syndrome that Kanner described. For decades, estimates of the prevalence of autism remained stable at just four or five children in 10,000. But that number started to snowball in the 1980s and 1990s, raising the frightening possibility that a generation of children was in the grips of an epidemic of unknown origin. My research was facilitated by the fact that our apartment in San Francisco is located just down the hill from the University of California, which boasts one of the best medical libraries in the country. I became a regular browser in the stacks, poring through articles on epidemiology, paediatrics, psychology, genetics, toxicology, and other relevant subjects.

Meanwhile, my shelves at home filled up with books like Clara Claiborne Park’s The Siege, Oliver Sacks’s An Anthropologist on Mars, and Temple Grandin’s Thinking in Pictures. Each offered a view of the diverse world of autism from a unique vantage point.

Then my real reporting began. I interviewed an 11-year-old boy named Nick, who told me that he was building an imaginary universe on his computer. Chubby, rosy-cheeked, and precociously articulate, he informed me that he had already mapped out his first planet: an anvil-shaped world called Denthaim that was home to gnomes, gods, and a three-gendered race called the kiman. As he told me about the civilisation he was creating on his desktop, he gazed up at the ceiling, humming fragments of a melody over and over. The music of his speech was pitched high, alternately poetic and pedantic, as if the soul of an Oxford don had been awkwardly reincarnated in the body of a boy.

“I’m thinking of making magic a form of quantum physics but I haven’t decided yet, actually,” he said. I liked him immediately.

But Nick’s mother broke down in tears as she told me that he didn’t have a single friend his own age. She recalled one terrible day when his classmates bribed him to wear a ridiculous outfit to school.

Because autistic people struggle to make sense of social signals in real time, Nick didn’t realise that his schoolmates were setting him up for humiliation. I wondered what would become of this bright, imaginative, trusting boy as he got older and his peers became obsessed with social status and dating.

Other parents shared the ingenious strategies they developed to help their children learn to cope with a world full of unavoidable changes and surprises. A family event like a first trip on an aircraft required months of careful planning and preparation. Marnin told me about the steps that he and his wife, Margo, an intern in the Bay Area, took to help their daughter Leah feel comfortable on her first visit to a new dentist. “We took pictures of the dentist’s office and the staff, and drove her past the