John robinson is an authority on life with autism and the best selling author of look me in the eye, seeing different and raising cubby. He is a scholar and resident at the college of william and mary. His book details johns experiment with a dr. Led using transcranial magnetic stimulation a new experimental brain study. The hope was they could understand and address the issues at the heart of autism and aspergers. This is a truly unusual memoir. Join me in welcoming John Robinson and dr. Leon. Hello, thank you for joining us all tonight. I would like to point out that looking at us here, cant tell who is the harvard professor and who is the inmate. In fact, that is in part, one of the changes from this expansion of emotional sensitivity and range that i have experienced through this. This book of mine, this switched on, book is really a remarkable story. But one thing it is not. It is not a story of curing autism. Some people have jumped to the conclusion that is what this is about. And it is not. What this is about is a therapy, that in my opinion, is one of the most powerful tools available to neuro scientist today that no one knows about and the reason know one knows about it is because it draws electricity from the wall and sends it to your brain where it can make changes. There is no pill, no pharmaceutical company, or multimillion ad campaign. But the effects of these tms experime experiments on me, they were not treatments, they were experim t experiments and they were lifechanging. I think, although i am an autistic guy, and i talk about how the tms experiments turned on the ability to see emotions in folks like you, which for me was a magical thing. I mean it was magical and wonderful but at the same time it was devastating and overwhelming so it was both. But think of that as kind of a metaphor for what it can do elsewhere. Tms isnt just an autism therapy. They are looking at it with epil epil epilepsy and being used to treat anxiety and depression and partly remediate symptoms of intellectual disability. You might wonder how i got involved in this. It is kind of funny. I was starting to speak in public after the publication of look me in the eye. I was at a college in western massachusetts, and what looked like a grad student approached me, and she asked me if she could hand out fliers for a study she was doing. There she is. She is right there. Stand up so they can see you. There she is. This is lindsey alberman who got it all going. [applause] so lindsey announced she was a postdoc at this place world beth israel medical center. I didnt even know thought that was. By the time she told me about this i was convinced i wanted to hand out fliers but also try it myself. I had so many questions. She suggested i could come meet here boss and she told me her boss name. I didnt know who he was but i went home and looked him up and found he was a professor at harvard medical, a dean in neuro science, and heads a place at beth israel hospital, one of the top hospitals in the world. I thought shit, i hope i didnt chase them away with my rudeness. But luckily they were dealing with autistic people and were prepared for that. I guess what i will do is i will have the fellow who thought this whole thing up tell you how he described it to me when we met. Okay. Good afternoon. He were running a study and we wanted to get people to understand the goal of this study and decide whether they want to participate or not. It is a process. It is not handing out a little written thing. It involves talking with the subjects, explaining what you are doing, and when John Robinson said he wants to talk more, we thought that is part of what we are supposed to do. We met with him and told him with tms is. And briefly for you to know, tms stands for transcranial magnetic stimulation and it is a misnomer. A discovery turned into medical technology. We pass through a copper wire coil on the subjects head, a very strong current, very, very brief. 50 micro seconds. There is a rapidly changing current in the Magnetic Field that is very strong, but very brief goes through the skin, skull and into the brain and induces another current. It is electric stimulation without having to open up the skull. We settled on tms which is a name we can handle. It is essentially using electricity to modify our organs. If we know where the modify the electricity, big challenge, and how much to modify the electricity, another big challenge, we might be able to use it for therapy. But before that we can use it to understand now brain activity relates to a concern pattern. That is the study we were interested in. We were doing this at the time and lindsey was spear heading. They had to do fundamentally with the question is the mechanisms of learning, the mechanisms of brain plasticity, in Autism Spectrum Disorders normal . Abnormal . If they are abnormal, are they too low . Or too strong . How do those relate to things like ability to relate to other people, empathy, learning to speak, finding the right words, controlling their impulses how they relate to behavior were the questions. What we tried to do was modify activity for a little bit of time, a few minutes, use those minutes as a window to test him, or other subjects, and they would say the effect is gone and it is a transient disruption. We know that is the case in some subjects and we were applying it to autism. We told him what it will look like. You will come into the lab and we will do tasks on the computer. We will use this tms on different parts of the brain. We will not tell you where. But we have specific reasons to target those different areas. And afterwards, we expect some multi areas will have some effects and others have other effects. We want to capture those effects. We make sure by the time we are done in the lab the effect is gone and we will follow enough to make sure that is the case. So, we had this kind of dry, emotion emotionalless description of what would happen. They had me look at stick faces, eyes and different patterns. Before doing the stimulation i would see the figures flash by on a computer monitor and push a button if it was happy, sad or angry. I looked at those things and i had no idea what i was seeing. I said to the scientist who was testing me, it was really upsetting to me because i could not get any of them right. I said if i get any of these right it is random chance because i have no idea what i am seeing. They tried to reassure we saying there is no right and wrong answers and i thought that is crazy, of course there is right answers, no one makes a test without right answers. It made me feel broken in a sense to see that. I sat down and they started firing the tms into the my head. What does feel like getting zapped by tms . They have a coil that is the size maybe smaller than a baseball and they hold it up to your head and have cameras looking at me after they shot a birch of mri images of my brain so they had a precise map and they could locate the coil exactly where they wanted to stimulate. They turned the coil on and it started firing energy into me one pulse a second. Every time there was a pulse i would feel a little tap on the top of my head. It wasnt painful, it wasnt pleasurable but it put my mind in neutral. They assured me i would not feel anything in my head from this because it wasnt so. What happened was i was thinking about what i was going to do when the left and the thoughts wouldnt stay in my mind. I would try to count, one, two, three, four and lose my train of thought. So then i kept sitting there and all of a sudden the fan went off, it stopped, and half an hour had passed. They rushed me over and had me do the looking at the faces and stuff again. I didnt really think i did any better. Then it is time to hand me to the neurologist to ask questions. And he asks he what day is it and i said it is tuesday. And he looks at me and he said it is thursday. I said i am selfemployed so i dont Pay Attention to that. I could see me screwing it up and head to a locked cage in beth israel. But i answered the rest of the questions good enough and he let me go. I started out driving home and i had been at the hospital for four hours. I thought what kind of crazy fool was i to think they would zap me like that and i was going to walk out different or anything. I thought, well, you know, i said i was going to do this because it was going to advance science and i believe in advancing science to help autistic people. But nothing happened. I turned on my ipod and was playing music from right here. Back in the 70s, as a sound engineer i used to play all clubs up and down here, i had a recording of a soul broadband known for singing part of the sound track for saturday night fever back then. I listened to them sing and it was alive again and like i heard when i was 18 years old. It was so overpowering it made me cry. I listened to that music all the way home and i could see the performances, it was so vivid, i could see the musicians on the stage and listen to each individual instrument and singer. I havent had that ability in 30 years. But that was what made me a star in producing music back then. You know, i wrote and said that is perful mojo you have in that thing and i asked him why he thought that happened and nobody knew. We did more these experiments. Some didnt change me at all. Some made me happy, some fear fearful, some anxious. And he said we should be happy when a good thing happens because it could be bad. And i said will i see monsters . He said no, you could be unsettled. Over a period of four years when he did this, there were pour stimulations where i saw into people just like seeing into the their souls. Those experiences were temporary but they changed me forever. You know, something that people find hard to believe is they think how can a momentary experience in a Scientist Lab change you forever. Let me give you an example. Imagine you are somebody who is colorblind and all of your life you get to be my age and hear about the beautiful blue sky and pretty green grass and you see shades of gray. After a while you get what they called maladaptive behavior. You start to think this is making me mad. This is bull shit. I dont know what the evidence of my eyes say and you go into a lab like his and they switch on colors. And all of a sudden you realize they were not bullshitting you. You walk out of the lab and a few days later the color fades away but you will never be the same because you will conduct the rest of your life with the full knowledge of what color was and you will know what color means to everyone else and when people talk about color to you you will not be bad because you will know about the thing they were talking about and you will be different forever. How could seeing emotions change me in the same way . You know i wrestled for years with the answer to that question. I asked myself, i like to emphasize, i thought did i imagine i saw emotions . But, no, the changes in my life are too striking to be my imagination and other people have had the same affect now. How is it i came out changed and i will ask alvero to explain that even though we dont know for sure. Why interrupt with me . You are the guy with the answers. I wish. I realized in doing this we were pushing the limits of known science in this. You are closer than me. I am the guy with the question. We put a lot of time into trying to figure out what accounts for what affects. I am in neurology and i take care of the patients. If my patient is better because of me, or despite me, it doesnt matter. If you walk out of there and go what a jerk, but i feel great, i did my job. It is leveraging anything you can bring to the table from biology to the medicine and the art of medicine to the art of interacting with somebody. If i am the medicine and you get better that is right. When i am a scientist, it is a different role. If you walked out of my lab and said it changed me and what changed is the tapping senati sensation, or the fear of doing an ex experiment, or the twitching of my face, that is interesting but not what i am after. What we are after is are the mechanisms of plasticity normal, different or how are they . Is it this part of the brain . That is part of the study. We spent a lot of time blinding him so we didnt know where we were stimulating or what we were predicting. Reading the story gives you a very different perspective because he is all of a sudden in a very articulate way from someone who is the participant and telling you things you would not think of asking. I know what i want to find and it is given time in the lab but for the most part we forget that that moment in time in the lab may have effects that we can capture that will change you, that will have an impact on who you are in a lasting way. So you have do an ex experiment and because of these 15 minutes of time you make somebody able to realize i can forget the meaning of intention. If you were trying to kill me but didnt that is okay. What are the consequences of that insight on the people that have it and realize i may come to terms with that and we dont ask those questions. Frankly, we didnt here them. It is all about the person. It is the person that had a stroke and cant walk. It is not autism. It the person. In an experiment, human experiments even, we try to identify what is coming across all of my participants and blur the differences and dont focus on the individual different char characteristics. This is a call to action for all of us to realize participating in a study has opportunities we dont know all about. It has consequences that may go far longer, much more transformative than what you expect. What you expect, plasticity would be abnormal and it is. In autism disorder it is actually better than normal. It last certain times and it last longer. They cannot acquire knowledge or skills they can better. But the first thing you learn and the withe next one and next one. So depending on the setting and Life Experience it can be a disruptive way of the brain junctions. William james said you want a brain with the right amount of plasticity. You want you dont want to walk out of the room permanently changed forever. We want things to impact our brain a little bit but not change us forever. We didnt expect to have that effect but the mechanisms of plasticity are better than normal in at least some people with autism spectrum disorder. So i could change more than anyone ever anticipated because i am autistic. That ablg that actually makes me think of something i owe a great debt to. When we first met, he had read by book, look me in the eye, and he told me that he was drawn to talking to me in part because of my descriptions of how i became a digital engineer, disciping sound effects at melton bradley. I was an engineer working for the pink floyd sunday company designing sound effects for rock and roll. That was analog circuits. The world was in that time going digital. Everything was micro processor based and i didnt know anything about that. I knew the Old Technology of the 50s and 60s because that is what we used on stage and amplfiers. But i had a chance to get a job at micro bradley but they wanted a micro processor familiar engineer and a digital engineer who could design digital effects. I thought they would not have anyone Better Qualified to define this than me. All i have do is be a digital designer. So i went to the University Research center and i just looked at some books on digital design, studied them for a couple weeks, and went down there to Milton Bradley and told them i was a digital designer and they hired me. All of my life, i had sort of lived with the feeling that well, i just bullshitted my way into a job and i quit Milton Bradley ultimately because i felt i was a fraud. And actually it was this fellow here who was the first person to tell me different. He said that is not a story of being a fraud but that is the kind of thing you see in descriptions of autistic savant behaviors that you learn this skill in two weeks. He said maybe you didnt know as much as some other people but you knew enough to do the job. He said if it was just luck and bullshit you would have failed. But instead you made yourself analog engineer and succeeded and then a digital engineer and then you made yourself other things and succeeded. That was the first time in my life i ever really had somebody recognize that it was a gift and not just some cheap trick to get a job. But also i realized what a remarkable gift some of us autistic people have. You know, he said to me a little later, he said we have no way of going how many other people there are with abilities like that. For all we know, they are tilling fields in india and china and we will never find out. It was a most remarkable story. If you read the medical Journal Articles these folks published about the studies i took part in and you read this book of mine, you would never know they were the same. The only points of comparison are both articles describe things like looking at faces and stick figures and all. But beyond that the experiences are totally different. I think what was alluded to was when they setup an ex experiment in medical research, it is a tightly defined thing. Smooimz sometimes there are affects that are almost magical. The thing is he wasnt an autism therapist. He wasnt a doctor treating me. He was a fellow engaged in research i believed in and the effect on me was a stunning affect side effect none of us expected. I think the lesson to take away from that is that sometimes scientist may structure studies and the outcome of the study that is meaningful may be something out of the bounds of what they expected. What would you say about that . I think it is really a human presentation and humans are an active par advertise participant. If they fail to give us insight, i think that is absolutely the case. You have the number question. You had no idea what would happen to me like that. Fair enough. That is exactly the point. I agree. I think there is another aspect. I think there is a great responsibility coming from it. The potential in consequences and they are important to be aware of. That often gets packed away in a way. Of course the things we just dont know. But we dont make sure that the person quite understands what that really means in terms of transforming peoples lives and that is important. It makes it very, very clear. So i think that is important to realize. I think there is another important take home lesson. I love the similar story of seeing the colors. The notion there are moments of insight, and they maybe brief, but you become aware of something and seeing the experiences for all of us like that in chance is one opportunity. It takes a moment of insight led your brain to function in a different way that was more adaptive and therefore quite liter literally the brain improved itself in a way it would not have been able to do without that moment of insight. So affected by this compare to other people in the study and of course i think that i am the only one who went into the study who was one kind of an engineer and then theres another kind of engineer. Then i was an automobile restore and that i was a book writer and a photographer. Ive done all these Different Things successfully. As it was said to me, i would not be likely to have been successful at all of those things on an ongoing basis if i had just be asked my way through. So somehow i have this gift of acquiring this skill so may i am uniquely changeable or more changeable than others. I think it is something that we say abnormally good if you think about it that way. In an individuals way. They have high iqs, so at least for them you are not unique. So why is it that you are able to then do that moment of insight, changing the way you live to have a greater impact than others. Because there is been a moment of insight but the effect was much less than it was on you. At the very least it illustrates the fact that views it for therapy one has to either make a lot more like ways that we are doing functional or surgery or couple the stimulation with the behavior. With the intervention. Maybe by chance that would happen in your case. We dont know, we sure did not design it that way. You are able to come up with the right behaviors may be by yourself into situations that lead you to realize peoples emotions and tell stories and get peoples reaction and that behavioral intervention was benefiting from the moment of insight. One thing i speculated about was that maybe some of the young people in our study who were on the autism spectrum who were not very social, they may have been stimulated in the same way as me. They may have had stimulations that switched on their ability to see emotion and people too. But they went home and read books, they did video games and talked on the internet, and the stimulation affects worn off and it was as if nothing ever happened. Im completely the opposite. As both of these folks said to me on a number of times, i am the most introspective, talkative and acquisitive subject they ever had. So i am like completely the opposite. When i thought something was happening i would send them detailed descriptions and ask why. So even though i did not receive counseling like one might intrigue me, what i did receive was expert advice and thought from the most knowledgeable people on the subject at the time. Maybe that allowed me to change myself by the same mechanism that i used to turn myself into a digital engineer 20 years earlier. It is really a good question because there is a time when i worked in electronics and i had performance reviews and companies and people told me, you are not a team player, you cant work in a group, you would sell people in a group, udall these things. At the same time they said you are are really smart guy, really are a really smart guy, really smart engineer, if only you could do the social things you would be successful. Ultimately i quit working in group environments and electronics because i cannot handle social situations. I go into the lab with these folks and they do this various experience with me and a year later my social skills are such that im invited by the director of the National Institute of health to get more involved in government service. Six years later i serve on the Interagency Office according to committee where we produce the Strategic Plan for autism for the u. S. Government. I am a leader now, and their words. In a government bureaucracy of 30 some 30 some people. How could i make that transformation from being so socially inept i cannot working companies to being able to be a key player in such an environment is that . That is the magical thing about this. You know, it came came at a high cost. It came at the cost of having my marriage parts, losing many of my friends, being more emotionally insightful than these guys told me that was a goal i thought what theyre essentially talking about is changing emotional intelligence. The story in me is really one of that. It is something scientists have not done. Yet, i thought what could that be except for good thing . You know when it happened to me . The morning after the first experiment they did with me when i had the feeling, i walked into the waiting room of my car company and i saw these emotions just coming at me like a flood. I looked in peoples eyes i saw happiness in fear, anxiety, and worry. You know, i talked to people and i had to go step outside because it was almost reducing me to tears. The idea that i was disabled, that not just a normal giveandtake at the car dealership, i realized its not just a gift, it can crush you. To see the people i thought were my friends were laughing at me, to think that to see people who came in to see me at work that i thought looked at me like i was some kind of lesser animal, how do do you think that made me feel . So what is may be wonderful because of what i could do in government service, it was incredibly painful in other parts of my life. I realize that maybe being autistic and being oblivious that had been a protective thing to me all of these years. One of the other participants in the study when i wrote the the book and i sent him a copy of it he said you know i never told you but im just like you in reading magazines, i used a look forward to the New York Times magazine and now i dread it. I i took pick up a magazine and i read stories and they make me want to cry and i cant read them anymore. But you know the power, just think of that. Sitting in a lab for half an hour and they did not even expect that would happen. And and we are changed forever by that. It is a remarkable thing. Should we ask for questions . Absolutely. They are used for a for depression and in a specific tool, and they are different from what they are indicative of john and the studies that were taken about. In these instances you have stimulation daily for several weeks and you had that for four to six weeks so what is really remarkably different in this case is its effect for something from the effects and it was a very short effect. And so for the lab testing we did. So the question of whether the brain stimulation was very short with appropriate behavior one could if you think about it, get away with less or have a similar kind of effect. That idea which in the case of the subject is reporting of his life, incredibly eloquently named the book. So therefore there is a number of studies that have been done to combine brain stimulation with behavior for things like recovery after a stroke, or improving cognitive function in the setting of dementia and alzheimers disease. So there are lessons that one can extract from the general sharing of insight from participants that go beyond what you expect. Scientist listen to those things that i shared and convert them onto appropriate questions of a new experiment. In doing that again be careful with the potential of implications. Can you tell them what else they are studying because it is a lot more. Yes so basically we think of disorders of the brain both neurologically and psychiatrically increasingly as the brain develops rather than thinking of parkinsons disease you can think of different movements, difficulty moving quickly or difficulty controlling your movements and having tremors or rigidity. They are symptoms that make up neurological or psychiatric behaviors. Hearing voices and things like that. With brain stimulation allows us to do is modify activity in braids and so therefore as long as we know what were talking about we can target it. We can ask the question where it might be helpful. And if people are looking at a for schizophrenia, depression, migraine, for pain and for other types of pain and its been explored for different cognitive conditions in the setting of dementia. Its very powerful for epilepsy if we know where the seizures are coming from. So the list is quite long but its not that it is being done the same way, in fact its not. Medications are used for a lot of diseases. So i can also be used depending on what brain surgery or what the situation is like. So lets go first two questions. Please wait for the microphone. [inaudible] [inaudible question] [inaudible question] [inaudible] [inaudible question] one of the things that i have learned from being around the scientist is that there have been a number of studies that show that autistic people have a deeper and longer lasting emotional reactions than non autistic people, but our reactions are often not visible to the watcher. In addition, our responses we may not have something that we see that triggers a reaction to someone else we have strong notions but we do not a lot of times have the expected responses and what you may be touching on their is when i write something in words, i have all of my ability to convey emotion and feeling and when i put it on the printed page you read it. But i do not have the ability, or i didnt at least at the time to convey emotion to you in my spoken facetoface conversation. So i scenes may be more detached and aloof than i was actually feeling. People often thought that i was indifferent, disconnected or uncaring and it would hurt my feelings they would say that stuff about me because in fact, i was the opposite. Indeed i think what happened to after the the tms experiences is i was better able to connect with people and convey that. I do do not believe that i feel more so much as i connect better but with respect to feeling more something that is really curious is in my photography. I started printing things with a brighter, more intense color and sharper contrast sense tms, why that is is a mystery. But that is curious. Theres the fellow with the microphone. My question is about the difference between temporary insight that results in learning versus something that changes your functioning. You are describing, i think you have called it temporary insight and i can understand how that would work because i have had similar experiences on medication. But, you are also talking about going places like seeing people and it sounds as though your actual folk should be is different. Like like you are actually able to see emotions that you did not see before which sounds different than just knowing, like understanding better that the emotions are there. You seem to actually be able to pick up on them better. So better. So i am wondering if there is, if both things are going on. My ability to meet people ive never met before and say and do the right things to establish a relationship with them is undoubtedly strikingly improved. Over what i was before. Even though i was successful as an engineer and i was successful in my technical work, i was more respected for being smart and technically capable than i was embraced as a guy you would want to be friends with because a lot of times i cannot say and do the right things. I certainly had friends, but my friends accepted me before tms they thought i was okay. So if i became a little more sensitive, little more caring that was good but they liked me anyway. The place. The place where tms made a striking difference in my opinion was the people i would have met before the would have talked to me for two or three minutes and thought he was a jerk and gone away. So those were people i would call failed interactions before and i dont have anywhere near as many failed interactions after tms. There was as i described a time when i felt there was like an esp ability that faded away. When that ability faded away i was kind of terrified for a little while because i thought it made me smarter and now i am getting dumber and where is it going to stop. Am i going to come out of this with less emotional insight than i had when i started . What happened is over the following summer and ability seems to build to connect with people and it is almost like they stimulated me and it wasnt a fact of the treatment and that dissipated and may be the lesson my mind got from the treatment allowed me to build something that i could sustain on my own. Would you say that as a sort of a, what the you think . In moments of insight it definitely happened. So in multiplying the results that can lead to a moment of insight. How long that moment last and the effect on the brain it could well be related to the last thing in more difficult subjects. What i found is the effects that are there beyond what you would expect on the inside alone will be moments for our brains to use in a Different Society and therefore function in a different way. And truthfully learn. So you think of what may be blocking better behavior from anyone of us, and being rooted in indifferent changes, changes that limits our ability to function in a more productive way. A moment of insight major. Host we need to it allow allow the brain to go in its own way. So we dont know ultimately and i think it is possible that what tms does is disrupt the the past which has become so ingrained that they actually are think of it as bad habits. So it forces the brain to come out a different way to do it and maybe be better for one. I will take that one and then we will get the one in back. The way you describe this is almost like you get the entirety of being able to feel a response from what people saw a day or so after the tms treatment. I guess what im asking is the way you said you improved was almost like your building skills based on memory of what that feeling was like, my question to you would be which you ever repeat that experience in order to get that feeling back . When i started the tms study i felt there was something broken in me. I felt i was really held back in my life by not being able to make that initial connection with people. To not say the right thing and that form friendships. I had a small number of friends but i felt there was a universe that i cannot connect with because i cannot say or do the right thing. Anything that happened to me was as i got older i realized that i could easily internalize bad stuff people said. Youre no good, youre cheating me, you tricked me. I felt me. I felt that the moment i heard that kind of stuff. But all of my life i would hear, we love you and your so smart, youre so great and all of the stuff we have heard our parents, husbands and wives would say to us. I would hear those things, they didnt make me feel good, but all the vats to people and say to me that made me feel bad immediately. I thought maybe thats whats broken in this mechanism in me, maybe there is a whole world of sleekness and bite out there and if something happens to make me more sensitive to that maybe i get these happy, sweet sweet messages and i would be happier. I said to you when i came out the first night and i thought what kind of fool i was to be changed until i turn the music on. I thought the same after emotional insight came alive in me temporarily. I thought how could i have been so foolish as to think theres all this beauty and light in the world and im looking in the waiting room of a car company and i see fear, anger, upset and distress and every negative emotion you can imagine and beauty and fight and warm was nowhere to be seen. I realize that is why i that stuff dominates the news because those are the emotions that are out there. I said that had been a protective shield for me, be an artistic that i didnt pick that stuff up. The year after doing the tms, the economy collapsed and i absorbed so much negativity that i became suicidal. I thought my life was going to end. I had survived several economic downturns in my business and i would just sail through them because i was artistic and oblivious. People could come in and say youre there to foreclose on your house tomorrow and i would say well today were gonna put a water pump on. May be it wasnt compassionate but it was logical and real. But i did did not absorb those peoples fears. But all of a sudden i did and it was devastating. So today i dont feel broken and that way. I know that if i were to go back to the lab, we could most likely reactivate those areas and i could look in your eyes and know what youre thinking, but no, i dont feel feel a need for it anymore because i know that i can go out there and have a conversation with you and i can engage you in i can be my autistic self and it will be okay. You know what tms was for me . It was a tool where these brief demonstrations changed my life. They did the job. I dont feel any now. I think if you ask what kind of an outcome could we hope for, i cannot think of a better one than that. I think its really remarkable, as have its ups and downs but this book is the first story that i think anybody has ever written about a transformative change like that and medical research. Its enough. There is a question in the back. A couple more. We will get the ones back there. Okay will do yours and then that one. Thank you for an interesting conversation. I want to make the comment that your description of yourself feels very much like myself that has changed over time and i learn how to read peoples emotions in my late twenties. It was fascinating to me to hear what it mustve been like for you to have that happen overnight. My question our technical questions. One is what difference in postcranial dcs and why would you use one or the other. And the other is you talk about brain circuits and so on, but you have to wait and you really dont know whats happening at individual neurons or transmitters. We can enter those questions in humans. As their Ongoing Research on the effects of tms in animal models . Thank you that is a great question. So it trans cranial stimulation were tcs is another form of brain simulation and also going back the difference is that you apply very low currents one or two of current instead of thousands of amps of current. You do so for some 20 or 30 minutes between two electrodes and a negative in a positive one. And it passes through it three floating ions and brain cells as we think have shifted as a level of activity in such a way that they are less likely to fire. Tms makes the neurons fire and they activate them or deactivate them and it makes it artificially different. So even if its a similar tms is more precise, they have to go smaller, we can direct it its purely modular. It is clear as to what exactly is this stimulating. So thats for the first question. Now it is true that in terms of the animal models it is the case in humans that we cannot get at the level of the effects. At the same time, they cannot tell you how things happen over time. So it is very different. These are big challenge as to how to bridge the animal models from the human models. What that change amounts how to find its way and using the emotion but they are both important. There are ongoing ongoing studies going on scaling down tms to apply to a model animal. And to be able to record a method and so on so is imogene and Different Things you can do with animals. We start start to see some insight into the mechanisms and how they got there. Theres more that we need to know in order to optimize it for humans. There is a person in the back where the question. She was the one, hold on for the microphone. Is this our last question or are we taking another . Okay big thinking about the last one it better be good whoever asks it. You describe tcs as setting up a roadblock or firing something or putting up a roadblock. My question is then does that mean that you are creating a new connection that would never made before or are you inspiring the brain to take roads that were already there that it might not if taken . My sense of that and we have talked about this at some length, when i had the experience of first scene into people, remember that they said they would stimulate me for half an hour and the direct effects of that would last about half as they stimulated me. We know course thats not right, matt lasted much longer. But they tested me and within 15 minutes i sat around and ultimately left and went home. I did not know anything was going on. When i went to go to bed it was as if the world was spinning and i had hallucinations, they were so incredibly vivid and i felt like the world was spinning all around me. I became scared that i was having a stroke or something by two or three in the morning i got up and i wrote this in 1500 word mission telling about the weird stuff that was happening to me that night and then i fell asleep. It was when i woke up eight hours later, i woke up at noon, i, i went to work and i walked in the back door night looked at one of the fellows in the car Company Going down the aisle and i thought he has the most beautiful brown eyes. And for an autistic person, what autistic person has ever said here she has any kind of ice at all. We dont notice. And then i turned the corner and i went into the waiting room and it was like a flood of emotion. So i guess what i asked, i said what does that mean and does it mean that those paths were always inside my brain because there is no way my brain could build new paths in the space of ten or 12 hours or was there . So what did you say to that. There wasnt. There you go. I think it is a very good question and remember ultimately you need a cable and so if there are no connections in the brain than humans would restore them. So in fact part of the reason were doing this study was because of a hypothesis that the function at the behavioral level are not because of the lack of existence of connections or cells, but because those connections are not properly utilize. Why, for, for whatever reason it may be some people because of support, behavior, and, and say whatever it is theyre able to learn to do better. The other extreme is the number of connections and their machine together become so overwhelming that the loss of iq and not much can be done. There is is a very complex spectrum of disorders. Buffer brain stimulation to work unique connections brain simulation can promote it to become better, stronger, or but without it there its not going to work. So what it says is that even if we as autistic people we think i would like to be able to see emotional signals from other people i cant do that but id like that. The idea that these experiments showed that the the networks to do that were in me all my life even if i cannot access them. That is tremendously inspiring to me because i did not go into this thinking i wanted to cure autism. I went into this thinking i want to make myself better in a specific way just as others of you might think im going to work out im going to be a faster runner im going to be smarter, gonna do memory exercises, amenity things to make myself better and thats how he thought this. What he has just showed us is that there are perhaps tremendous abilities locked in our minds that we cannot access that are there. For me, tms turned turned it on. That is what facilitated change in me and it was always in me. Its really remarkable. Two caveats though. The the first is, and we have spoken about this to know how big it is in the brain may come at the cost of losing others. Therefore it needs to be done carefully and under experimental conditions. In your book talks about that and because of that you have made the point that its one thing to do interventions to learn about the brain, gain new insights, is very different to say that we now know that these are useful their p for autism. We dont. Now make a very special i have a nephew on the autism spectrum and i wish you could tell stories like john can. He is nowhere near as wellfunctioning. And he is keeping a job, he is an engaging, lovely, caring person with definite emotion. If we knew that tms was a therapy for him it would make his life better he is the first person that i would do the stimulation on. I havent. Not because im just plain nasty, im doing the work i do because of helping individuals with disorders. Thats what moves me. But we dont know the cost of the stimulation with low iq in lower functioning like john and the things that were doing are very controlled studies and exploring and that has not stopped people from taking their testimonies of john and others in saying what you are using autism for what treatment and i think its dangerous. It needs to be done carefully and theres a potential downfall. When you are switched on youre going to see it with as much as i say there is tremendous promise, this was not a free ride. There were significant costs. But im really proud that i did it and im really proud. If if he asked me if i would do it again and i said i dont think i needed that does not mean for a second that im not really proud of what i was able to do to help with the advance of science. I believe in the promise of what tms is going to do not just for autistic people but for many other people. Of course i see the cost and i see the gains in myself. On balance i think that is hard as it has been i am better off now than before i did it. But you have to read the story, it is the most complex book ive ever written. It is not simple at all. So who has got the best, last question here . The person with the microphone is going to pick. He has got you. With the book you had mentioned that you conducted some off procedures after the study. And what was really interesting was there is a procedure, i dont know know who did this if it was surely your the other lady, but where the area was simulated to activate speech, thought it was really interesting because you also discuss that there are also other studies to further develop new applications for this type of technology for instance to help people who suffered a stroke or parkinsons disease. There have been enough developments to actually apply this as treatment for depression yet even gone as far as suggesting it might even be applicable as a diagnostic tool for autism and so i was wondering the question is has there been any more explanation regarding that . That was a really interesting thing. Lindsay actually and alvaro worked on that. What they did was they did a study where they hooked electrodes to my thumb and forefinger and then they fired tms points into the cortex, the area on top of my head that triggered the muscles in my hand. They turn the tms machine up slowly from zero until the muscles started to activate. And they could see it on the monitor. That was a really weird thing because youd be watching the monitor and you could see a little blip but my hand would not move. They would turn it off a little bit and my hand would jump like a frog off table. It was weird because i wasnt thinking of moving my hand but the tms made me move my fingers. So they would establish the threshold if you will that made my fingers twitch. Then, they would apply a burst of tms that was designed to suppress the function of that area and the first lasted a few seconds. They would fire the polls that would twitch my fingers into me again and nothing would happen. They would turn it up and up, and eventually my finger would twitch again. So maybe it was 50 when it twitched at first and after they suppressed me maybe it took 75 to make it twitch. Then they would wait ten minutes or 15 minutes and do it again. Then wait and do it again. And so on until my finger twitches would turn to the baseline and what they found was that the autistic people experienced more change in that test and we stayed changed longer than non autistic people. What was quite remarkable in my opinion was that they collected participants for this study in the hospital, some of which were diagnosed with autism like me and some were not. They were able to separate by the test results on the test, by how fast the people recovery. There were two clear groups. The non autistic group and the artistic group. They separated them clearly with as much precision as the best autism Screening Test we have today. I thought that was amazing really. And i thought no thats not possible. Tms is not that good, we must be missing something. And we agreed that we needed to take another group of people and not know the diagnosis and do these tests and figure out whether we could correctly classify them and the effects were amazing with 98 sensitivity. But extremely good in allocating two different cohorts. So the beauty of that is that it does not require somebody being able to talk to multiple years of performance are right now we diagnose the same behavior certain amount of time and it takes time