Temple Grandin

Temple Grandin

An Inside View of Autism.....................................................3

INTRODUCTION--------------------------------------------------------------------------3
LACKOF SPEECH-------------------------------------------------------------------------3
RHYTHM AND MUSIC--------------------------------------------------------------------4
AUDITORY PROBLEMS------------------------------------------------------------------4
TACTILE PROBLEMS---------------------------------------------------------------------5
APPROACH-AVOID-----------------------------------------------------------------------5
SQUEEZE MACHINE----------------------------------------------------------------------5
ANXIETY AT PUBERTY-------------------------------------------------------------------6
MEDICATION-----------------------------------------------------------------------------6
SLOW IMPROVEMENT-------------------------------------------------------------------7
FAMILY HISTORY------------------------------------------------------------------------7
SENSORY DEPRIVATION SYMPTOMS--------------------------------------------------8
DIRECT FIXATIONS----------------------------------------------------------------------8
VISUALIZATION-------------------------------------------------------------------------9
SAVANT SKILLS------------------------------------------------------------------------11
DEFICITS AND ABILITIES-------------------------------------------------------------12
LEARNING TO READ--------------------------------------------------------------------12
MENTOR---------------------------------------------------------------------------------13
WHO HELPED ME RECOVER-----------------------------------------------------------14
AUTISM PROGRAMS--------------------------------------------------------------------14
REFERENCES ---------------------------------------------------------------------------15

My Experiences with Visual Thinking Sensory Problems and

Communication Difficulties................................................18
INTRODUCTION------------------------------------------------------------------------18
SOUND AND VISUAL SENSITIVITY---------------------------------------------------18
TACTILE EXPERIENCES----------------------------------------------------------------19
COGNITIVE VERSUS SENSORY--------------------------------------------------------21
WHAT IS VISUAL THINKING?---------------------------------------------------------22
COMMUNICATION----------------------------------------------------------------------25
AUTISM SUBTYPES---------------------------------------------------------------------25
EDUCATIONAL STRATEGIES AND SUBTYPES----------------------------------------28
CAUSE OF AUTISM---------------------------------------------------------------------29
CONCLUSIONS--------------------------------------------------------------------------30

My Mind is a Web Browser: How People with Autism Think 33

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 Temple Grandin

My mind is a Web browser------------------------------------------------------------33

Unmasking Talent----------------------------------------------------------------------34
I see the decision process------------------------------------------------------------35
Animal decision making---------------------------------------------------------------35
Thinking in audio tapes----------------------------------------------------------------35
Piecing the details together-----------------------------------------------------------35
Disturbing sounds----------------------------------------------------------------------36
Proportional thinking------------------------------------------------------------------36
References------------------------------------------------------------------------------37

Thinking In Pictures...........................................................38
Different Ways of Thinking------------------------------------------------------------41
Processing Nonvisual Information---------------------------------------------------42
Abstract Thought-----------------------------------------------------------------------44
Visual Thinking and Mental Imagery-------------------------------------------------46

Teaching Tips for Children and Adults with Autism.............49

Frequently Asked Questions about Autism ........................53
Choosing the Right Job for People with
Autism or Asperger's Syndrome ........................................57
Evaluating the Effects of Medication..................................60
Social Problems: Understanding Emotions
and Developing Talents .....................................................62
Making the Transition from the World
of School into the World of Work ......................................66
Genius May Be an Abnormality: Educating Students with
Asperger's Syndrome, or High Functioning Autism ............69
Evaluating the Effects of Medication..................................73

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 Temple Grandin

An Inside View of Autism

Temple Grandin, Ph.D.
Assistant Professor
Colorado State University
Fort Collins, CO 80523, USA

INTRODUCTION

I am a 44-year old autistic woman who has a successful international career designing
livestock equipment. I completed my Ph.D. in Animal Science at the University of Illinois in
Urbana and I am now an Assistant Professor of Animal Science at Colorado State University.
Early intervention at age 2 1/2 helped me overcome my handicap.
Two of the subjects covered in this chapter are the frustration of not being able to speak and
sensory problems. My senses were oversensitive to loud noise and touch. Loud noise hurt my
ears and I withdrew from touch to avoid over-whelming sensation.
I built a squeezing machine which helped me to calm my nerves and to tolerate touching. At
puberty, horrible anxiety "nerve" attacks started and they became worse with age.
Antidepressant medication relieved the anxiety. In the last section of the chapter directing my
fixations into constructive activities and a career will be discussed along with the importance of
a mentor. My skill and deficit areas are covered in detail. All my thinking is visual, like videos
played in my imagination. Even abstract concepts such as getting along with other people are
visualized through the use of door imagery.

LACKOF SPEECH

Not being able to speak was utter frustration. If adults spoke directly to me I could understand
everything they said, but I could not get my words out. It was like a big stutter. If I was
placed in a slight stress situation, words would sometimes overcome the barrier and come out.
My speech therapist knew how to intrude into my world. She would hold me by my chin and
made me look in her eyes and say "ball." At age 3, "ball" came out "bah," said with great
stress. If the therapist pushed too hard I threw a tantrum, and if she did not intrude far
enough no progress was made. My mother and teachers wondered why I screamed. Screaming
was the only way I could communicate. Often I would logically think to myself, "I am going to
scream now because I want to tell somebody I don't want to do something."
It is interesting that my speech resembled the stressed speech in young children who have had
tumors removed from the cerebellum. Rekate, Grubb, Aram, Hahn, and Ratcheson (1985)
found that cancer surgeries that lesioned the vermus, deep nuclei, and both hemispheres of
the cerebellum caused temporary speech loss in normal children. Vowel sounds were the first
to(1) return, and receptive speech was normal. Courchesne, Yeung-Courchesne, Press,
Hesselink, and Jernigan (1988) reported that 14 out of 18 high- to moderate- functioning
autistics had undersized cerebellar vermal lobules VI and VII. Bauman and Kemper (1985) and
Ritvo et al. (1986) also discovered that brains from autistics had lower than normal Purkinje
cell counts in the cerebellum. In my own case an MRI scan revealed cerebellar abnormalities. I
am unable to tandem walk (the standard "walk the line" test done by the police for drunken
drivers). I end up toppling sideways, but my reactions are normal for other simple motor tests
of cerebellar dysfunction.
Vestibular stimulation can sometimes stimulate speech in autistic children. Slowly swinging a
child on a swing can sometimes help initiate speech (Ray, King, & Grandin, 1988). Certain
types of smooth, coordinated movements are difficult for me, even though I appear normal to
the casual observer. For example, when I operate hydraulic equipment that has a series of
levers, I can operate one lever at a time perfectly. Coordinating the movement of two or three

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levers at once is impossible. This may explain why I do not readily learn a musical instrument,
even though I have innate musical talent for pitch and melody. The only musical instrument I
mastered is whistling with my mouth.

RHYTHM AND MUSIC

Throughout elementary school my speech was still not completely normal. Often it took me
longer than other children to start getting my words out. Singing, however was easy. I have
perfect pitch and I can effortlessly hum back the tune of a song I have heard only once or
twice.
I still have many problems with rhythm. I can clap out a rhythm by myself, but I am unable to
synchronize my rhythm with somebody else's rhythm. At a concert I am unable to clap in time
with the music with the rest of the people. A lack of rhythm during autistic piano playing is
noted by Park and Youderian (1974). Rhythm problems may be related to some autistic speech
problems. Normal babies move in synchronization with adult speech (Condon & Sander, 1974).
Autistics fail to do this. Condon (1985) also found that autistics and, to a lesser extent,
dyslexics and stutterers have a defective orienting response. One ear hears a sound sooner
that the other. The asynchrony between ears is some- times over one second. This may help
explain certain speech problems. People still accuse me of interrupting. Due to a faulty rhythm
sense, it is difficult to determine when I should break into a conversation. Following the
rhythmic ebb and rise of a conversation is difficult.

AUDITORY PROBLEMS

My hearing is like having a hearing aid with the volume control stuck on "super loud." It is like
an open microphone that picks up everything. I have two choices: turn the mike on and get
deluged with sound, or shut it off. Mother reported that sometimes I acted like I was deaf.
Hearing tests indicated that my hearing was normal. I can't modulate incoming auditory
stimulation. Many autistics have problems with modulating sensory input (Ornitz, 1985). They
either overreact or under-react. Ornitz (1985) suggests that some cognitive deficits could be
caused by distorted sensory input. Autistics also have profound abnormalities in the
neurological mechanisms that control the capacity to shift attention between different stimuli
(Courchesne, 1989).
I am unable to talk on the phone in a noisy office or airport. Everybody else can use the
phones in a noisy environment, but I can't. If I try to screen out the background noise, I also
screen out the phone. A friend of mine, a high-functioning autistic, was unable to hear a
conversation in a relatively quiet hotel lobby. She has the same problem I have, except worse.
Autistics must be protected from noises that bother them. Sudden loud noises hurt my ears
like a dentist's drill hitting a nerve. A gifted, autistic man from Portugal wrote, "I jumped out of
my skin when animals made noises" (White & White, 1987). An autistic child will cover his ears
because certain sounds hurt. It is like an excessive startle reaction. A sudden noise (even a
relatively faint one) will often make my heart race. Cerebellar abnormalities may play a role in
increased sound sensitivity. Research on rats indicates that the vermus of the cerebellum
modulates sensory input (Crispino & Bullock, 1984). Stimulation of the cerebellum with an
electrode will make a cat hypersensitive to sound and touch (Chambers, 1947).
I still dislike places with confusing noise, such as shopping malls. High-pitched continuous
noises such as bathroom vent fans or hair dryers are annoying. I can shut down my hearing
and withdraw from most noise, but certain frequencies cannot be shut out. It is impossible for
an autistic child to concentrate in a classroom if he is bombarded with noises that blast
through his brain like a jet engine. High, shrill noises were the worst. A low rumble has no
effect, but an exploding firecracker hurts my ears. As a child, my governess used to punish me
by popping a paper bag. The sudden, loud noise was torture.
Even now, I still have problems with tuning out. I will be listening to a favorite song on the
radio, and then realize I missed half of it. My hearing just shuts off. In college, I had to
constantly keep taking notes to prevent tuning out. The young man from Portugal also wrote

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that carrying on a conversation was very difficult. The other person's voice faded in and out
like a distant radio station (White & White, 1987).

TACTILE PROBLEMS

I often misbehaved in church, because the petticoats itched and scratched. Sunday clothes felt
different than everyday clothes. Most people adapt to the feeling of different types of clothing
in a few minutes. Even now, I avoid wearing new types of underwear. It takes me three to four
days to fully adapt to new ones.
As a child in church, skirts and stockings drove me crazy. My legs hurt during the cold winter
when I wore a skirt. The problem was the change from pants all week to a skirt on Sunday. If I
had worn skirts all the time, I would not have been able to tolerate pants. Today I buy clothes
that feel similar. My parents had no idea why I behaved so badly. A few simple changes in
clothes would have improved my behavior.
Some tactile sensitivities can be desensitized. Encouraging a child to rub the skin with different
cloth textures often helps. The nerve endings on my skin were supersensitive. Stimuli that
were insignificant to most people were like Chinese water torture. Ayres (1979) lists many
good suggestions on methods to desensitize the tactile system.

APPROACH-AVOID

In my book Emergence: Labeled Autistic (Grandin & Scariano, 1986), I describe craving
pressure stimulation. It was an approach-avoid situation. I wanted to feel the good feeling of
being hugged, but when people hugged me the stimuli washed over me like a tidal wave.
When I was 5 years old, I used to daydream about a mechanical device I could get into that
would apply comforting pressure. Being able to control the device was very important. I had to
be able to stop the stimulation when it became too intense. When people hugged me, I
stiffened and pulled away to avoid the all- engulfing tidal wave of stimulation. The stiffening up
and flinching was like a wild animal pulling away. As a child, I used to like to get under the
sofa cushions and have my sister sit on them. At various autism conferences, I have had 30 or
40 parents tell me that their autistic child seeks deep pressure stimuli. Research by Schopler
(1965) indicated that autistic children prefer (proximal) sensory stimulation such as touching,
tasting, and smelling to distal sensory stimulation such as hearing or seeing.

SQUEEZE MACHINE

At age 18 I built a squeezing machine. This device is completely lined with foam rubber, and
the user has complete control over the duration and amount of pressure applied. A complete
description of the machine is in Grandin (1983, 1984), and Grandin and Scariano (1986). The
machine pro- vides comforting pressure to large areas of the body.
It took me a long time to learn to accept the feeling of being held and not try to pull away
from it. Reports in the literature indicate that autistics lack empathy (Bemporad, 1979;
Volkmar & Cohen, 1985). I feel that the lack of empathy may be partially due to a lack of
comforting tactual input.
One day about 12 years ago, a Siamese cat's reaction to me changed after I had used the
squeeze machine. This cat used to run from me, but after using the machine, I learned to pet
the cat more gently and he decided to stay with me. I had to be comforted myself before I
could give comfort to the cat (Grandin, 1984).
I have found from my own experiences with the squeeze machine that I almost never feel
aggressive after using it. In order to learn to relate to people better, I first had to learn how to
receive comfort from the soothing pressure of the squeeze machine. Twelve years ago I wrote,
"I realize that unless I can accept the squeeze machine I will never be able to bestow love on
another human being" (Grandin, 1984). During my work with livestock, I find that touching the
animals increases my empathy for them. Touching and stroking the cattle makes me feel
gentle towards them. The squeeze machine also had a calming effect on my nervous system.

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Squeeze machines have been in use in clinics working with autistic and hyperactive children
(Figures 6-1 and 6-2). Lorna King, an occupational therapist in Phoenix, Arizona, reports that it
has a calming effect on hyperactive behavior. Therapists have found that deep pressure
stimulation has a calming effect (Ayres,, 1979). Both animal and human studies have shown
that pressure stimulation reduces nervous system arousal (Kumazawa, 1963; Melzack, Konrad,
& Dubrobsky, 1969; Takagi & Kobagasi, 1956). Pressure on the sides of the body will induce
relaxation in pigs (Grandin, Dodman, & Shuster, 1989).

ANXIETY AT PUBERTY

As a child I was hyperactive, but I did not feel "nervous" until I reached puberty. At puberty,
my behavior took a bad turn for the worse. Gillberg and Schaumann (1981) describe behavior
deterioration at puberty in many autistics. Shortly after my first menstrual period, the anxiety
attacks started. The feeling was like a constant feeling of stage fright all the time. When
people ask me what it is like I say, "Just imagine how you felt when you did something really
anxiety provoking, such as your first public speaking engagement.
Now just imagine if you felt that way most of the time for no reason." I had a pounding heart,
sweaty palms, and restless movements.
The "nerves" were almost like hypersensitivity rather than anxiety. It was like my brain was
running at 200 miles an hour, instead of 60 miles an hour. Librium and Valium provided no
relief. The "nerves" followed a daily cycle and were worse in the late afternoon and early
evening. They subsided late at night and early in the morning. The constant nervousness
would go in cycles, with a tendency to be worse in the spring and fall. The "nerves" also
subsided during menstruation.
Sometimes the "nerves" would manifest themselves in other forms. For weeks I had horrible
bouts of colitis. When the colitis attacks were active, the feeling of "stage-fright" nerves went
away.
I was desperate for relief. At a carnival I discovered that riding on the Rotor ride provided
temporary relief. Intense pressure and vestibular stimulation calmed my nerves. Bhatara,
Clark, Arnold, Gunsett, and Smeltzer (1981) have found that spinning in a chair twice each
week reduces hyperactivity in young children.
While visiting my aunt's ranch, I observed that cattle being handled in a squeeze chute
sometimes relaxed after the pressure was applied. A few days later I tried the cattle squeeze
chute, and it provided relief for several hours. The squeeze machine was modeled after a
squeeze chute used on cattle. It had two functions: (1) to help relax my "nerves" and (2) to
provide the comforting feeling of being held. Prior to building the squeeze machine, the only
other way I could get relief was strenuous exercise or manual labor. Research with autistics
and mentally retarded clients has shown that vigorous exercise can decrease stereotypies and
disruptive behavior (McGimsey & Favell, 1988; Walters & Walters, 1980). There are two other
ways to fight the nerves: fixate on an intense activity, or withdraw and try to minimize outside
stimulation. Fixating on one thing had a calming effect. When I was livestock editor for the
Arizona Farmer Ranchman, I used to write three articles in one night. While I was typing
furiously I felt calmer. I was the most nervous when I had nothing to do.
With age, the nerves got worse. Eight years ago, I had a stressful eye operation that triggered
the worst bout of "nerves" in my life. I started waking up in the middle of the night with my
heart pounding and obsessive thoughts about going blind.

MEDICATION

In the next section, I am going to describe my experiences with medication. There are many
autism subtypes, and a medication that works for me may be useless for another case. Parents
of autistic children should obtain medical advice from professionals who are knowledgeable of
the latest medical research.
I read in the medical library that antidepressant drugs such as Tofranil (Imipramine) were
effective for treating patients with endogenous anxiety and panic (Sheehan, Beh, Ballenger, &
Jacobsen, 1980). The symptoms described in this paper sounded like my symptoms, so I

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decided to try Tofranil. Fifty mg of Tofranil at bedtime worked like magic. Within a week, the
feelings of nervousness started to go away. After being on Tofranil for four years I switched to
50 mg Norpramin (desipramine), which has fewer side effects. These pills have changed my
life. Colitis and other stress-related health problems were cured.
Dr. Paul Hardy in Boston has found that Tofranil and Prozac (fluoxetine) are both effective for
treating certain high-functioning autistic adolescents and adults. Both Dr. Hardy and Dr. John
Ratey (personal communication, 1989) have learned that very small doses of these drugs must
be used. These doses are usually much lower than the dose prescribed for depression. Too
high a dose can cause agitation, aggression, or excitement, and too low a dose will have no
effect. My "nerve" attacks would go in cycles, and I have had relapses while on the drug. It
took will power to stick with the 50 mg dose and let the relapse subside on its own. Taking the
medicine is like adjusting the idle screw on a car's carburetor. Before taking the drug, the
engine was racing all the time. Now it runs at normal speed. I no longer fixate, and I am no
longer "driven." Prozac and Anafranil (clomipramine) have been very effective in autistics who
have obsessive-compulsive symptoms or obsessive thoughts which race through their heads.
The effective doses for Prozac have ranged from two 20 mg capsules per week to 40 mg per
day. Too high a dose will cause agitation and excitement. If an autistic person becomes
agitated the dose should be lowered. Other promising drugs for aggressive autistic adolescents
and adults are beta blockers. Beta blockers greatly reduce aggressive behavior (Ratey et al.,
1987).

SLOW IMPROVEMENT

During the eight years I have been taking antidepressants, there has been a steady
improvement in my speech, sociability, and posture. The change was so gradual that I did not
notice it. Even though I felt relief from the "nerves" immediately, it takes time to unlearn old
behavior patterns.
Within the last year, I had an opportunity to visit an old friend who had known me before I
started taking antidepressants. My friend, Billie Hart, told me I was a completely different
person. She said I used to walk and sit in a hunched-over position and now my posture is
straight. Eye contact had improved and I no longer shifted around in my chair. I was also
surprised to learn that I no longer seemed to be out of breath all the time, and I had stopped
constantly swallowing.
Various people I have met at autism meetings have seen steady improvement in my speech
and mannerisms throughout the eight-year period I have taken the medicines. My old friend,
Lorna King, also noticed many changes. "Your speech used to seem pressured, coming in
almost explosive bursts. Your old tendency to perseverate is gone" (Grandin & Scariano,
1986).
I had a odd lack of awareness of my oddities of speech and mannerisms until I looked at
videotapes. I think videotapes could be used to help many high-functioning autistics with
speech and social skills.

FAMILY HISTORY

There is much that can be learned from family history. During my travels to autism
conferences, I have found many families with affective disorder in the family history. The
relationship between autism and affective disorder has also been reported in the literature
(Gillberg & Schaumann, 1981). Family histories of high-functioning autistics often contain
giftedness, anxiety or panic disorder, depression, food allergies, and learning disorders. In
many of the families I have interviewed the disorders were never formally diagnosed, but
careful questioning revealed them.
My own family history contains nervousness and anxiety on both sides. My grandmother has
mild depression, and Tofranil has also worked wonders for her. She is also very sensitive to
loud noise. She told me that when she was a little girl, the sound of coal going down the chute
was torture. My sister is bothered by confusing noise from several sources. On my father's side
there is explosive temper, perseveration on one topic, extreme nervousness, and food

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allergies. Both sides of my family contain artists. There are also signs of immune system
abnormalities in myself and my siblings. I had shingles in my thirties, and my brother had
them at age 4. My sister had serious ear infections similar to the ear infections in many young
autistics. My dad, brother , and myself all have eczema.

SENSORY DEPRIVATION SYMPTOMS

Animals placed in an environment that severely restricts sensory input develop many autistic
symptoms such as stereotyped behavior, hyperactivity, and self-mutilation (Grandin, 1984).
Why would an autistic and a lion in a barren concrete zoo cage have some of the same
symptoms? From my own experience I would like to suggest a possible answer. Since
incoming auditory and tactile stimulation often overwhelmed me, I may have created a self-
imposed sensory restriction by withdrawing from input that was too intense. Mother told me
that when I was a baby I stiffened and pulled away. By pulling away, I did not receive the
comforting tactile input that is required for normal development. Animal studies show that
sensory restriction in puppies and baby rats has a very detrimental effect on brain
development. Puppies raised in a barren kennel become hyper-excitable, and their EEGs (brain
waves) still contain signs of overarousal six months after removal from the kennel (Melzack &
Burns, 1965). Autistic children also have a desynchronized EEG, which indicates high arousal
(Hutt, Hutt, Lee, & Ounstead, 1965). Trimming the whiskers on baby rats causes the parts of
the brain that receive input from the whiskers to become oversensitive (Simons & Land,
1987). The abnormality is relatively permanent; the brain areas are still abnormal after the
whiskers grow back. Some autistics also have overactive brain metabolism (Rumsey et al.,
1985).
I often wonder, if I had received more tactile stimulation as a child would I have been less
"hyper" as an adult? Handling baby rats produces less emotional adults who are more willing
to explore a maze (Denenbert, Morton, Kline, & Grota, 1962; Ehrlich, 1959). Tactile
stimulation is extremely important for babies and aids their development (Casler, 1965).
Therapists have found that children who withdraw from comforting tactile stimulation can learn
to enjoy it if their skin is carefully desensitized. Rubbing the skin with different cloth textures
often helps. Deep pressure stimulation also reduces the urge to pull away.
I was born with sensory problems (due to cerebellar abnormalities), but perhaps secondary
neurological damage is caused by withdrawal from touching. Autopsies of five autistic brains
indicated that cerebellar abnormalities occur during fetal development, and many areas of the
limbic systems were immature and abnormal (Bauman, 1989). The limbic system does not
fully mature until two years after birth. Maybe withdrawal from touching made some behavior
problems worse. In my book, I describe stupid " bathroom" fixations that got me into a lot of
trouble. An interesting paper by McCray (1978) shows a link between a lack of tactual
stimulation and excessive masturbation. Masturbation stopped when the children received
more affection and hugging. Perhaps the "bathroom" fixation would never have occurred if I
could have enjoyed affection and hugging.
Lately there has been a lot of publicity about holding therapy, where an autistic child is forcibly
held and hugged until he stops resisting. If this had been done to me I would have found it
highly aversive and stressful. Several parents of autistic children have told me that a gentler
form of holding therapy is effective and it improved eye contact, language, and sociability.
Powers and Thorworth (1985) report a similar result. Perhaps it would be beneficial if autistic
babies were gently stroked when they pulled away. My reaction was like a wild animal. At first
touching was aversive, and then it became pleasant. In my opinion, tactual defensiveness
should be broken down slowly, like taming an animal. If a baby could be desensitized and learn
to enjoy comforting tactile input, possible future behavior problems could be reduced.

DIRECT FIXATIONS

Today I have a successful career designing livestock equipment because my high school

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science teacher, Mr. Carlock, used my fixation on cattle chutes to motivate me to study
psychology and science. He also taught me how to use the scientific indexes.
This knowledge enabled me to find out about Tofranil. While the school psychologist wanted to
take my squeeze machine away, Mr. Carlock encouraged me to read scientific journals so I
could learn why the machine had a relaxing effect. When I moved out to Arizona to go to
graduate school, I went out to the feedlots to study the reactions of the cattle in squeeze
chutes. This was the beginning of my career.
Today I travel all over the world designing stockyards and chutes for major meat-packing
firms. I am a recognized leader in my field and have written over 100 technical and scientific
papers on livestock handling (Grandin, 1987). If the psychologists had been successful in
taking away my squeeze machine, maybe I would be sitting somewhere rotting in front of a TV
instead of writing this chapter.
Some of the most successful high-functioning autistics have directed childhood fixations into
careers (Bemporad, 1979; Grandin & Scariano, 1968; Kanner, 1971). When Kanner (1971)
followed up his original 11 cases, there were two major successes. The most successful person
turned a childhood fixation on numbers into a bank teller's job. The farmer who reared him
found goals for his number fixation; he told him he could count the corn rows if he plowed the
field.
Many of my fixations initially had a sensory basis. In the fourth grade, I was attracted to
election posters because I liked the feeling of wearing the posters like a sandwich man.
Occupational therapists have found that a weighted vest will often reduce hyperactivity.
Even though the poster fixation started out with a sensory basis, I became interested in the
election. My teachers should have taken advantage of my poster fixation to stimulate and
interest in social studies. Calculating electoral college points would have motivated me to study
math. Reading could have been motivated by having me read newspaper articles about the
people on the posters. If a child is interested in vacuum cleaners, then use a vacuum-cleaner
instruction book as a text.
Another one of my fixations was automatic glass sliding doors. Initially I was attracted to the
doors because I liked the sensation of watching them move back and forth. Then gradually the
doors took on other meanings, which I will talk about in the next section. In a high-functioning
adolescent, and interest in sliding doors could be used to stimulate science interests. if my
teacher had challenged me to learn how the electronic box that opened the door worked, I
would have dived head first into electronics. Fixations can be tremendous motivators. Teachers
need to use fixations to motivate instead of trying to stamp them out. A narrow, fixated
interest needs to be broadened into constructive activities. The principle can also be used with
lower- functioning children; Simons and Sabine (1987) list many good examples.
Fixations need to be differentiated from stereotypies, such as hand flapping or rocking. A
fixation is an interest in something external, such as airplanes, radio, or sliding doors.
Engaging in stereotypic behavior for long periods of time may be damaging to the nervous
system. In one experiment, pigs in a barren pen that engaged in large amounts of stereotyped
rooting on each other had abnormal dendritic growth in the somatosensory cortex (Grandin,
1989).

VISUALIZATION

All my thinking is visual. When I think about abstract concepts such as getting along with
people I use visual images such as the sliding glass door. Relationships must be approached
carefully otherwise the sliding door could be shattered. Visualization to describe abstract
concepts is also described by Park and Youderian (1974). As a young child I had visualizations
to help me understand the Lord's Prayer. The "power and the glory" were high-tension electric
towers and a blazing rainbow sun. The word "trespass" was visualized as a "No Trespassing"
sign on the neighbor's tree. Some parts of the prayer were simply incomprehensible. The only
non-visual thoughts I have are of music. Today I no longer use sliding doors to understand
personal relationships, but I still have to relate a particular relationship with something I have
read - for example, the fight between Jane and Joe was like the U.S. and Canada squabbling

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over the trade agreement. Almost all my memories relate to visual images of specific events. If
somebody says the word "cat," my images are of individual cats I have known or read about. I
do not think about a generalized cat.
My career as a designer of livestock facilities maximizes my talent areas and minimizes my
deficits. I still have problems handling long strings of verbal information. If directions from a
gas station contain more than three steps, I have to write them down. Statistics are extremely
difficult because I am unable to hold one piece of information in my mind while I do the next
step. Algebra is almost impossible, because I can't make a visual image and I mix up steps in
the sequence. To learn statistics I had to sit down with a tutor and write down the directions
for doing each test. Every time I do a t-test or a chi-square, I have to use the notes. I have no
problem understanding the principles of statistics, because I can see the normal or skewed
distributions in my head. The problem is I cannot remember the sequence for doing the
calculations. I can put a regression line on a graph full of dots visually. The first time I tried it,
I was off only a few degrees. I also have many dyslexic traits, such as reversing numbers and
mixing up similar-sounding words such as "over" and "other." Right and left are also mixed up.
Visual thinking is an asset for an equipment designer. I am able to "see" how all parts of a
project will fit together and see potential problems. It never ceases to amaze me how
architects and engineers can make so many stupid mistakes in buildings. The disastrous
accident where the catwalks at the Hyatt Regency fell and killed 100 people was caused by
visualization errors. All the calculations were correct, but the architect's original design was
impossible to build. Further visualization errors made during construction resulted in doubling
the load on poorly designed fasteners. Academic requirements probably keep many visual
thinkers out of these professions. Designing a piece of equipment with a sequential mind may
be just as difficult for an engineer as statistics equations are for me. The sequential thinker
can't see the whole. I have observed many incidents in industry where a brilliant maintenance
man with a high school education designs a piece of equipment after all the Ph.D. engineers
have failed. He may be an unrecognized visual thinker. There may be two basic kinds of
thinking, visual and sequential. Farah (1989) concluded that "thinking in images is distinct
from thinking in language." I have also had the opportunity to interview brilliant people who
have very little visual thought. One professor told me that facts just come out of his mind
instantly. To retrieve facts, I have to read them off a visualized page of a book or "play a
video" of some previous event.
There is however, one area of visualization I am poor in. I often fail to recognize faces until I
have known a person for a long time. This sometimes causes social problems, because I
sometimes don't respond to an acquaintance because I fail to recognize them. Einstein was a
visual thinker who failed his high school language requirement and relied on visual methods of
study ((Holton, 1971-1972). The theory of relativity was based on visual imagery of moving
boxcars and riding on light beams. At an autism meeting I had the opportunity to visit some of
Einstein's relatives. His family history has a high incidence of autism, dyslexia, food allergies,
giftedness, and musical talent. Einstein himself had many autistic traits. An astute reader can
find them in Einstein and Einstein (1987) and Lepscky (1982).
In my own family history, my grandfather on my mother's side was co-inventor of the
automatic pilot for airplanes, and on my father's side my great-grandfather was a maverick
who started the largest corporate wheat farm in the world. My two sisters and one brother are
all visual thinkers. One sister is dyslexic and is brilliant in the art of decorating houses. My
brother can build anything but had problems with calculus when he tried to major in
engineering. He is now a very successful banker and did well in all other subjects in college.
My youngest sister is a sculptress and did well in school. My mother and grandparents on the
mother's side were all good at higher math, and many people on my mother's side were well-
known for intellect.
Drawing elaborate drawings of steel and concrete livestock stockyards is easy (Figure 6-3). I
am able to visualize a motion picture of the finished facility in my imagination. However,
drawing realistic human faces is very difficult. Figure 6-4 illustrates a buffalo-handling facility I
designed. Since it was a government low-bid contract, every piece of steel had to be visualized
and drawn on 26 sheets of detailed drawings. I am very proud of this job because I was able
to accurately visualize everything prior to construction except for one little ladder. When I was

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a child, my parents and teachers encouraged my artistic talent. It is important to nurture

talents.
Discussions with other high-functioning autistics have revealed visual methods of thinking on
tasks that are often considered non-visual. A brilliant autistic computer programmer told me
that he visualized the program tree in his mind and then just filled in the code on each branch.
A gifted autistic composer told me that he made "sound pictures."
I was good at building things, but when I first started working with drawings it took time to
learn how the lines on a drawing related to the picture in my imagination. When I built a house
for my aunt and uncle, I had difficulty learning the relationship between symbolic markings on
the drawings and the actual construction. The house was built before I learned drafting. Now I
can instantly translate a drawing into a mental image of a finished structure. While agonizing
over the house plans, I was able to pull up pictures out of my memory of a house addition that
was built when I was eight. Mental images from my childhood memory helped me install
windows, light switches, and plumbing. I replayed the "videos" in my imagination.

SAVANT SKILLS

Studies have shown that when autistic savants become less fixated and more social they lose
their savant skills such as card counting, calendar calculation, or art skills (Rimland & Fein,
1988). Since I started taking the medication I have lost my fixation, but I have not lost my
visualization skill. Some of my best work has been done while on the medication.
My opinion is that savants lose their skill because they lose the fixated attention. Card
counting (shown in the Rain Man movie) is no mystery to me. I think savants visualize the
cards being dealt onto a table in a pattern, like a series of clocks or a Persian rug pattern. To
tell which cards are still in the deck, they simply look at their patterns. The only thing that
prevents me from card counting or calendar calculation is that I no longer have the
concentration to hold a visual image completely steady for a long period of time. I speculate
that socialized savants still retain their visualization skills. I still have the perfect pitch skill,
even though I don't use it. If I had greater concentration, I could sing back much longer songs
after hearing them once.
In my own case the strongest visual images are of things that evoked strong emotions, such
as important big jobs. These memories never fade and they remain accurate. However, I was
unable to recall visual images of the houses on a frequently traveled road until I made an
effort to attend to them. A strong visual image contains all details, and it can be rotated and
made to move like a movie. Weaker images are like slightly out-of-focus pictures or may have
details missing. For example, in a meat-packing plant I can accurately visualize the piece of
equipment I designed but I am unable to remember things I do not attend to, such as the
ceiling over the equipment, bathrooms, stairways, offices, and other areas of little or not
interest. Memories of items of moderate interest grow hazy with time.
I tried a little memory experiment at one of my jobs. After being away from the plant for 30
days, I tried recalling a part of the plant that I had attended to poorly, and another part I had
attended to intently. I had not designed either of these places. The first place was the plant
conference room, and the other was the entrance to the room that housed my equipment. I
was able to draw a fairly accurate map of the office, but I made major mistakes on
conference-room furniture and ceiling covering. The room I visualized was plain and lacked
detail. On the other hand, I visualized the entrance door to the equipment room very
accurately, but made a slight mistake on the door-handle style. The visualized door had much
greater detail than the visualized conference room. The conference room was not attended to
even though I negotiated with the plant managers in that room.
Talents need to be nurtured and broadened out into something useful. Nadia, a well-known
autistic case, drew wonderful perspective pictures as a child (Seifel, 1977). When she gained
rudimentary social skills, she stopped drawing. Possibly the talent could have been revived
with encouragement from teachers. Seifel (1977) describes how Nadia drew pictures on
napkins and waste papers. She needed proper drawing equipment. Treffert (1989) reported on

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several savants who did not lose their savant skills when they became more social. Use of
savant skills was encouraged.
At the age of 28, my drafting drastically improved after I observed a talented draftsman
named David. Building the house taught me how to understand blueprints, but now I had to
learn to draw them. When I started drawing livestock facilities I used David's drawings as
models. I had to "pretend" I was David. After buying a drafting pencil just like David's, I laid
some of his drawings out and then proceeded to draw a loading ramp for cattle. I just copied
his style, like a savant playing music, except my ramp was a different design. When it was
finished I couldn't believe I had done it.

DEFICITS AND ABILITIES

Five years ago I took a series of tests to determine my abilities and handicaps. On the Hiskey
Nebraska Spatial Reasoning test, my performance was at the top of the norms. On the
Woodcock-Johnson Spatial Relations test, I only got an average score because it was a timed
speed test. I am not a fast thinker; it takes time for the visual image to form. When I survey a
site for equipment at a meat-packing plant, it takes 20 to 30 minutes of staring at the building
to fully imprint the site in my memory. Once this is done, I have a "video" I can play back
when I am working on the drawing. When I draw, the image of the new piece of equipment
gradually emerges. As my experience increased, I needed fewer measurements to properly
survey a job. On many remodeling jobs, the plant engineer often measures a whole bunch of
stuff that is going to be torn out. He can't visualize what the building will look like when parts
of it are torn out and a new part is added.
As a child I got scores of 120 and 137 on the Wechsler. I had superior scores in Memory for
Sentences, Picture Vocabulary, and Antonyms-Synonyms on the Woodcock-Johnson. On
Memory for Numbers I beat the test by repeating the numbers out loud. I have an extremely
poor long-term memory for things such as phone numbers unless I can convert them to visual
images. For example, the number 65 is retirement age, and I imagine somebody in Sun City,
Arizona. If I am unable to take notes I cannot remember what people tell me unless I translate
the verbal information to visual pictures. Recently I was listening to a taped medical lecture
while driving. To remember information such as the drug doses discussed on the tape I had to
create a picture to stand for the dose. For example, 300mg is a football field with shoes on it.
The shoes remind me that the number is 300 feet, not yards.
I got a second-grade score on the Woodcock-Johnson Blending subtest where I had to identify
slowly sounded-out words. The Visual Auditory Learning subtest was another disaster. I had to
memorize the meaning of arbitrary symbols, such as a triangle means "horse," and read a
sentence composed of symbols. I could only learn the ones where I was able to make a picture
for each symbol. For example, I imagined the triangle as a flag carried by a horse and rider.
Foreign languages were almost impossible. Concept Formation was another test with fourth-
grade results. The name of this test really irks me, because I am good at forming concepts in
the real world. My ability to visualize broad unifying concepts from hundreds of journal articles
has enabled me to outguess the "experts" on many livestock subjects. The test involved
picking out a concept such as "large, yellow" and then finding it in another set of cards. The
problem was, I could not hold the concept in my mind while I looked at the other cards. If I
had been allowed to write the concept down, I would have done much better.

LEARNING TO READ

Mother was my salvation for reading. I would have never learned to read by the method that
requires memorization of hundreds of words. Words are too abstract to be remembered. She
taught me with old-fashioned phonics. After I laboriously learned all the sounds, I was able to
sound out words. To motivate me, she read a page and then stopped in an exciting part. I had
to read the next sentence. Gradually she read less and less. Mrs. David W. Eastham in Canada
taught her autistic son to read in a similar manner, using some Montessori methods. Many

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teachers thought the boy was retarded. He learned to communicate by typing, and he wrote
beautiful poetry. Douglas Biklen at Syracuse University has taught some nonverbal autistic
people to write fluently on the typewriter. To prevent perseveration on a single key and key
targeting mistakes the person's wrist is supported by another person.
A visualized-reading method developed by Miller and Miller (1971) would also have been
helpful. To learn verbs, each word has letters drawn to look like the action. For example, "fall"
would have letters falling over, and "run" would have letters that looked like runners. This
method needs to be further developed for learning speech sounds. Learning the sounds would
have been much easier if I had a picture of a choo-choo train for "ch" and a cat for hard "c"
sound. For long and short vowels, long "a" could be represented by a picture of somebody
praying. This card could be used for both "pr" and long "a" by having a circle around "pr" on
one card and the "a" on another.
At first, reading out loud was the only way I could read. Today, when I read silently, I use a
combination of instant visualization and sounding words. For example, this phrase from a
magazine - "stop several pedestrians on a city street" - was instantly seen as moving pictures.
Sentences that contain more abstract words like "apparent" or "incumbent" are sounded out
phonetically.
As a child, I often talked out loud because it made my thoughts more "concrete" and "real."
Today, when I am alone designing, I will talk out loud about the design. Talking activates more
brain regions than just thinking.

MENTOR

"A skilled and imaginative teacher prepared to enjoy and be challenged by the child seems
repeatedly to have been a deciding factor in the success and educational placement of high-
functioning, autistic children" (Newson, Dawson, & Everard, 1982). Bemporod (1979) also
brings forth the mentor concept. My mentor in high school was Mr. Carlock, my high school
science teacher. Structured behavior modification methods that work with small children are
often useless with a high-functioning older child with normal intelligence.
I was lucky to get headed on the right path after college. Three other high-functioning autistics
were not so fortunate. One man has a Ph.D. in math and he sits at home. He needed
somebody to steer him into an appropriate job. Teaching math did not work out; he should
have obtained a research position that required less interaction with people. The other lady has
a degree in history and now works doing a boring telephone-sales job. She needs a job where
she can fully utilize her talents. she al so needs a mentor to help her find an appropriate job
and help open doors for her. Both these people needed support after college, and they did not
receive it. The third man did well in high school and he also sits at home. He has a real knack
for library research. If some interested person worked with him, he could work for a
newspaper researching background information for stories. All three of these people need jobs
where they can make maximum use of their talents and minimize their deficits.
Another autistic lady I know was lucky. She landed a graphic-arts job where she was able to
put her visualization talents to good use. Her morale was also boosted when her paintings
received recognition and were purchased by a local bank. Her success with the paintings also
opened up many social doors. In my own case, many social doors opened after I made scenery
for the college talent show. I was still considered a nerd, but now I was a "neat" nerd. People
respect talent even if they think you are "weird." People became interested in me after they
saw my drawings and pictures of my jobs. I made myself an expert in a specialized area.
High-functioning autistics will probably never really fit in with the social whirl. My life is my
work. If a high- functioning autistic gets an interesting job, he or she will have a fulfilling life. I
spend most Friday and Saturday nights writing papers and drawing. Almost all my social
contacts are with livestock people or people interested in autism. Like the Newson et al.
(1982) subjects, I prefer factual, non-fictional reading materials. I have little interest in novels
with complicated interpersonal relationships. When I do read novels, I prefer straightforward
stories that occur in interesting places with lots of description.
The mentor needs to be somebody who can provide support on several different fronts.
Employment is only one area. Many high-functioning autistics need to learn about budgeting

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money, how to make claims on health insurance, and nutritional counseling. As the person
becomes more and more independent the mentor can be phased out, but the mentor may still
be needed if the autistic loses his job or has some other crisis.

WHO HELPED ME RECOVER

Many people ask me, "How did you manage to recover?" I was extremely lucky to have the
right people working with me at the right time. At age 2, I had all the typical autistic
symptoms. In 1949, most doctors did not know what autism was, but fortunately a wise
neurologist recommended "normal therapy" instead of an institution. I was referred to a
speech therapist who ran a special nursery school in her home. The speech therapist was the
most important professional in my life. At age 3, my mother hired a governess who kept me
and my sister constantly occupied. My day consisted of structured activities such as skating,
swinging, and painting. The activities were structured, but I was given limited opportunities for
choice. For example, on one day I could choose between building a snowman or sledding. She
actually participated in all the activities. She also conducted musical activities, and we
marched around the piano with toy drums. My sensory problems were not handled well. I
would have really benefited if I had had an occupational therapist trained in sensory
integration.
I went to a normal elementary school with older, experienced teachers and small classes.
Mother was another important person who helped my recovery. She worked very closely with
the school. She used techniques that are used today in the most successful mainstreaming
programs to integrate me into the classroom. The day before I went to school, she and the
teacher explained to the other children that they needed to help me.
As discussed earlier, puberty was a real problem time. I got kicked out of high school for
fighting. I then moved on to a small country boarding school for gifted children with emotional
problems. The director was an innovative man and considered a "lone wolf" by his psychologist
colleagues. This is where I met Mr. Carlock. Another extremely helpful person was Ann, my
aunt. I visited her ranch during the summer.
In high school and college, the people that helped me the most were the creative,
unconventional thinkers. The more traditional professionals such as the school psychologist
were actually harmful. They were too busy trying to psychoanalyze me and take away my
squeeze machine. Later when I became interested in meat-packing plants, Tom Rohrer, the
manager of the local meat-packing plant, took an interest in me. For three years I visited his
plant once a week and learned the industry. My very first design job was in his plant. I want to
emphasize the importance of a gradual transition from the world of school to the world of
work. The packing plant visits were made while I was still in college. People with autism need
to be gradually introduced to a job before they graduate. The autistics I discussed earlier could
have excellent careers if they had a local businessperson take an interest in them.

AUTISM PROGRAMS

During my travels I have observed many different programs. It is my opinion that effective
programs for young children have certain common denominators that are similar regardless of
theoretical basis. Early, intense intervention improves the prognosis. Passive approaches don't
work. My governess was sometimes mean, but her intense, structured intervention prevented
me from withdrawing. She and my mother just used their good instincts. Good programs do a
variety of activities and use more than one approach. A good little children's program should
include flexible behavior modification, speech therapy, exercise, sensory treatment (activities
that stimulate the vestibular system and tactile desensitization), musical activities, contact
with nor mal children, and lots of love. The effectiveness of different types of programs is
going to vary from case to case. A program that is effective for one case may be less effective
for another.

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My Experiences with Visual Thinking Sensory

Problems and Communication Difficulties
by Temple Grandin, Ph.D.
Assistant Professor
Colorado State University
Fort Collins, Colorado 80523, USA
(Updated June 2000)

INTRODUCTION

In this paper, I will describe my experiences with autism. The main areas I will cover are visual
thinking, sensory problems, and difficulties with communication. After I describe my
experiences, I will discuss the similarities and differences between myself and other people
with an autism diagnosis. There is probably a continuum of autism subtypes that vary in the
pattern of neurological abnormality and the severity of neurological problems.

SOUND AND VISUAL SENSITIVITY

My hearing is like having a sound amplifier set on maximum loudness. My ears are like a
microphone that picks up and amplifies sound. I have two choices: 1) turn my ears on and get
deluged with sound or 2) shut my ears off. Mother told me that sometimes I acted like I was
deaf. Hearing tests indicated that my hearing was normal. I can't modulate incoming auditory
stimulation. I discovered that I could shut out painful sounds by engaging in rhythmic
stereotypical autistic behavior. Sometimes I "tune out". For example, I will be listening to a
favorite song on the car radio and then later realize that I tuned out and missed half of the
song. In college, I had to constantly take notes to prevent tuning out.
I am unable to talk on the telephone in a noisy office or airport. Other people can use the
telephones in a noisy airport, but I cannot. If I try to screen out the background noise, I also
screen out the voice on the telephone. Autistic people with more severe auditory processing
problems are unable to hear a conversation in a relatively quiet hotel lobby.
Autistic people must be protected from noises that hurt their ears. Sudden loud noises hurt my
ears--like a dentist's drill hitting a nerve (Grandin 1992a). A gifted, autistic man from Portugal
wrote: "I jumped out of my skin when animals made noises" (White and White 1987). An
autistic child will cover his or her ears because certain sounds hurt. It is like an excessive
startle reaction. A sudden noise (even a relatively faint one) will often make my heart race.
I still dislike places with many different noises, such as shopping centers and sports arenas.
High-pitched continuous noise, such as bathroom vent fans or hair dryers, are annoying. I can
shut down my hearing and withdraw from most noise, but certain frequencies cannot be shut
out. It is impossible for an autistic child to concentrate in a classroom if he or she is
bombarded with noises that blast through his or her brain like a jet engine. High-pitched, shrill
noises are the worst. A low rumble has no affect, but an exploding firecracker hurts my ears.
As a child, my governess used to pop a paper bag to punish me. The sudden, loud noise was
torture.
The fear of a noise that hurts the ears is often the cause of many bad behaviors and tantrums.
Some autistic children will attempt to break the telephone because they are afraid it will ring.
Many bad behaviors are triggered due to anticipation of being subjected to a painful noise. The
bad behaviors can occur hours before the noise. Common noises that cause discomfort in
many autistic individuals are school bells, fire alarms, score board buzzers in the gym,

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squealing microphone feedback and chairs scraping on the floor. When I was a child, I feared
the ferry boat that took us to our summer vacation home. When the boat's horn blew, I threw
myself on the floor and screamed. Autistic children and adults may fear dogs or babies
because barking dogs or crying babies may hurt their ears. Dogs and babies are unpredictable,
and they can make a hurtful noise without warning.
Children and adults with extreme sound sensitivity may also fear the sound of water flowing or
waves (Stehli 1991). Children with less severe auditory sensitivity problems may be attracted
to sound and visual stimuli that more severely impaired children tend to avoid. I liked the
sound of flowing water and enjoyed pouring water back and forth between orange juice cans;
whereas another child may avoid the sound of flowing water. I liked the visual stimulation of
watching automatic sliding doors; whereas another child might run and scream when he or she
sees an automatic sliding door. A loud vacuum cleaner may cause fear in one autistic child and
may be a pleasurable fixation to another child. When I look at moving sliding doors, I get the
same pleasurable feeling that used to occur when I engaged in rocking or other stereotypical
autistic behaviors. Some autistic individuals can see the flicker of florescent lights. Coleman et
al. (1976) found that florescent lights increased repetitive behavior in some autistic children.

TACTILE EXPERIENCES

During my travels to many autism conferences, several parents have reported to me that
holding therapy was beneficial. It is not the "cure" that some of its proponents tout, but it has
a beneficial affect on some children. In my opinion, the benefits of holding therapy could be
obtained through less stressful methods. I cringed when I watched the BBC show, "The Visit,"
and I am glad I did not have to endure forced holding. Fisher (1989) describes a gentler
approach to holding that worked with her daughter.
One mother told me that she gently encouraged her child to tolerate more and more holding,
and he responded with increased affection and improved eye contact. Powers and Thorworth
(1985) found that eye contact and interest in people improved after a gentler behavioral
method was used. In one case, a young boy was held in a light hug until crying lessened. As
soon as crying was reduced, the boy was released. Gradually, the amount of holding time was
increased.
I believe that the beneficial effects of holding in some children are due to desensitization to
touch of the autistic child's nervous system. It is a physiological sensory process that has
nothing to do with mother bonding or anger. I completely disagree with Welch (1983) that the
child has to become severely distressed for holding to be effective. The sensory problems of
autism are often overlooked. Many autistic people are over sensitive to both sound and touch.
Autistic children have problems modulating sensory input (Ornitz 1985).

Autistic Tactile Problems

I pulled away when people tried to hug me, because being touched sent an overwhelming tidal
wave of stimulation through my body. I wanted to feel the comforting feeling of being held,
but then when somebody held me, the effect on my nervous system was overwhelming. It was
an approach-avoid situation, but sensory over stimulation caused the avoidance, not anger or
fear as Richer and Zappella (1989) suggest. An autistic man, interviewed by Cesaroni and
Garber, stated that touching was not painful, but it was overwhelming and confusing.
Small itches and scratches that most people ignored were torture. A scratchy petticoat was like
sand paper rubbing my skin raw. Hair washing was also awful. When mother scrubbed my
hair, my scalp hurt. I also had problems with adapting to new types of clothes. It took several
days for me to stop feeling a new type of clothing on my body; whereas a normal person
adapts to the change from pants to a dress in five minutes. New underwear causes great
discomfort, and I have to wash it before I can wear it. Many people with autism prefer soft
cotton against the skin. I also liked long pants, because I disliked the feeling of my legs
touching each other.

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Sensory Therapy
Therapists have helped many autistic children through gently applying tactile and vestibular
stimulation (Ayres 1979; King 1989). One effect of this stimulation is to desensitize the tactile
system. This is not a cure, but it has increased speech, affection, and eye contact in some
children. It also helps to decrease stereotypical and self-injurious behaviors. The sensory
activities are done gently as fun games and are never forced. Strong encouragement and some
intrusiveness may be used, but a good therapist knows how far he or she can intrude before
the stimulation becomes so overwhelming that the child starts crying. Even intrusive activities
are kept fun. During the activities, the therapist will also work on improving speech and
establishing eye contact.
Ray et al. (1988) found that a mute child will often start making speech sounds while he or she
is swinging in a swing. Swinging stimulates the vestibular system and the defective
cerebellum. Spinning in a chair twice a week helps to reduce hyperactivity (Bhatara et al.
1981); and non-contingent vibration will reduce stereotypical behavior (Murphy 1982).
Research has also shown that vigorous aerobic exercise reduced maladaptive and stereotypic
behavior (Elliot et al. 1994).
Hypersensitivity to touch can be desensitized through firmly but gently stroking a child with
different cloth textures (Ayres 1979). The pressure must be firm enough to stimulate deep
pressure receptors. Very light touch should be avoided because it increases arousal and excites
the nervous system. Vestibular and sensory stimulation also have a beneficial affect on
improving affection and social behavior.
Deep pressure stimulation is also calming (Ayres 1979; King 1989) Therapists often roll the
children up in mats. Many autistic children will seek deep pressure. Many parents have told me
that their children get under the sofa cushions or mattress. A slow, steady application of
pressure had a calming affect on me; and a sudden jerky motion tended to cause arousal
(Grandin 1992b). Self stimulatory behaviors can be reduced by having an autistic child wear a
garment that applies pressure (McClure et al 1991; Zisserman 1992).
Good results can often be obtained with less than an hour of sensory treatment per day.
Spending hours and hours each day is not required. If a treatment method is going to be
effective with a particular child, it will bring about improvement with reasonable amounts of
effort. The effectiveness of sensory treatment will vary from child to child.

Tactile Research
Both human and animal studies indicate that deep pressure is calming and reduces arousal in
the nervous system. Takagi and Kobagas (1956) found that pressure applied to both sides of a
person's body decreased metabolic rate, pulse rate, and muscle tone. Gently pinching a
rabbit's skin with padded clips creates a deactivated EEG reading, relaxed muscle tone, and
drowsiness (Kumazawa 1963). Pressure gently applied to both sides of a pig in a padded V
trough will induce sleep and relaxation (Grandin et al. 1989). Rubbing and gently pinching a
cat's paw will decrease tonic activity in the dorsal column nuclei and the somatosensory cortex
(part of the brain that receives touch sensation) (Melzack et al. 1969).

Squeeze Machine
I craved deep pressure stimulation, but I pulled away and stiffened when my overweight aunt
hugged me. In my two books (Grandin and Scariano 1986 and Grandin 1995), I describe a
squeeze machine I constructed to satisfy my craving for the feeling of being held. The machine
was designed so that I could control the amount and duration of the pressure. It was lined with
foam rubber and applied pressure over a large area of my body.
Gradually I was able to tolerate the machine holding me. The over sensitivity of my nervous
system was slowly reduced. A stimulus that was once overwhelming and aversive had now
become pleasurable. Using the machine enabled me to tolerate another person touching me. A
partial explanation for the lack of empathy in autism may be due to an oversensitive nervous
system that prevents an autistic child from receiving the comforting tactile stimulation that
comes from being hugged. I learned how to pet our cat more gently after I had used the
squeeze machine. I had to comfort myself before I could give comfort to the cat. When I
handle cattle, I often touch the animals because it helps me to feel gentle towards them. It is
important to desensitize an autistic child so that he/she can tolerate comforting touch. I have

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found that if I use my squeeze machine on a regular basis that I have nicer images in my
dreams. Experiencing the comforting feeling of being held makes nasty or mean thoughts go
away.
Several squeeze machines are now in use at sensory integration clinics in the United States.
Therapists have found that some hyperactive and autistic children will immediately use the
machine, and others are so oversensitive to touch that they initially avoid the machine and
other activities involving touch, such as finger painting or being rubbed with different cloth
textures. Over sensitive children are gently encouraged to engage in tactile activities that they
initially avoided. An activity that was initially aversive and overwhelming gradually becomes
pleasurable. Activities involving touch become pleasurable when the nervous system becomes
desensitized. For example, children who cannot tolerate tooth brushing can be desensitized
through gently rubbing them around the mouth.

Animal Reactions
My reaction to being touched was like a wild horse flinching and pulling away. The reactions of
an autistic child to touch and a wild horse may be similar. The process of taming a wild animal
has many similarities to an autistic child's reaction to touch.
There are two methods that can be used tame a wild horse: 1) forced holding and 2) gradual
taming. Both methods work. Forced holding is quicker and more stressful than the somewhat
slower gradual taming process. Good horse trainers only use forced holding on extremely
young horses.
When forced holding is used on animals, care is taken to avoid excitement. The procedure is
done as quietly and gently as possible. The animal is securely tied or held in a livestock
restraint device. It is held tightly and is unable to kick or thrash. During the restraint period,
the trainer pets and strokes all parts of the animal's body and talks gently to it. Touching
every part of the animal's body is an important component of the taming procedure. The
animal is released when it is not resisting. Sessions seldom last more than one hour. A
disadvantage of this procedure is that forced restraint is stressful.
The taming approach is done more gradually. I have trained sheep to enter a device similar to
my squeeze machine repeatedly (Grandin, 1989). The sheep were gradually introduced to the
device. At first they just stood in it and then pressure was applied for increasing amounts of
time. Horse trainers have found that nervous horses become easier to handle if they are
rubbed and brushed frequently. At first the horse may flinch, but gradually it will start relaxing
when stroked. Like the autistic child, touching that was initially aversive becomes pleasurable.
A stimulus that was once actively avoided is now actively sought out.

COGNITIVE VERSUS SENSORY

In this paper I have concentrated on the sensory aspects of autism and have not discussed
behavioral and cognitive (thinking) factors. Cognitive and behavioral aspects are important,
but I concentrated on the sensory aspects because these are often neglected.
Sensory processing problems may explain some autistic behaviors, and differences in cognitive
processes may explain others. Cerebellar and brain stem abnormalities are a probable
explanation of many sensory problems, but they would not explain cognitive differences, such
as concrete thinking and unusual visual spatial skills. The cognitive differences between autistic
and normal children are probably due to other brain abnormalities. Autopsies of nine autistic
brains revealed abnormalities in the cerebellum, hippocampus, amygdala, and other parts of
the limbic system (Bauman 1991, and Bauman and Kemper 1994). These areas are involved
with learning and memory. Brain wave (EEG) studies indicated that autistic children have
severe abnormalities in their capacity to shift attention between visual and auditory stimuli
(Courchesne et al. 1989). Brain structures that control attention shift are connected to the
cerebellar vermis. Abnormalities in attention shifting may be the basis of perseverate
(repetitive) behavior and some social deficits. This may possibly explain why treatments that
stimulate the cerebellum and certain sensory treatments often improve overall behavior.
Further research has shown that the amygdala (emotion center) in the brain is
underdeveloped. This may explain some of the social deficits of autism. Brain scans have

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revealed that some of the circuits between the frontal cortex and amygdala are not functioning
normally (Haznader et al., 1997). This may force a person with autism to use intellect and
logic to make social decisions instead of emotion cues.

Sensory Deprivation Symptoms

The symptoms of sensory deprivation in animals and many autistic symptoms are similar.
Animals confined to a barren environment are excitable and engage in stereotypies, self-injury,
hyperactivity, and disturbed social relations (Grandin 1989b; Mason 1960; Harlow and
Zimmerman 1959). An animal in a barren environment engages in stereotypies in an attempt
to stimulate itself.
Why would a leopard in a concrete cell at the zoo and autism have similarities? From my own
experience, I would like to suggest a possible answer. Auditory and tactile input often
overwhelmed me. Loud noise hurt my ears. When noise and sensory over stimulation became
too intense, I was able to shut off my hearing and retreat into my own world. Possibly the
autistic child creates his or her own self-imposed sensory deprivation.
In pulling away, I may not have received stimulation that was required for normal
development. Possibly there are secondary central nervous system abnormalities that happen
as a result of the autistic child's avoidance of input. The initial sensory processing
abnormalities that the child is born with cause the initial avoidance. Autopsy studies indicate
that cerebellar abnormalities occur before birth (Bauman 1991, Bauman and Kemper 1994).
However, the limbic system which also has abnormalities is not mature until the child is two
years old. The possibility of secondary damage to the central nervous system may explain why
young children in early intervention education programs have a better prognosis than children
who do not receive special treatment.
Animal and human studies show that restriction of sensory input causes the central nervous
system to become overly sensitive to stimulation. The effects of early sensory restriction are
often long lasting. Placement of a small cup on a person's forearm for one week to block tactile
sensations will cause the corresponding area on the opposite arm to become more sensitive
(Aftanas and Zubeck 1964). Puppies reared in barren kennels become hyperexcitable, and
their brain waves (EEG) still showed signs of over arousal six months after removal from the
kennel (Melzack and Burns 1965). The brain waves of autistic children also show signs of high
arousal (Hutt et al. 1965). Trimming the whiskers on baby rats will cause the parts of the brain
that receive input from the whiskers to become oversensitive (Simon and Land 1987). This
abnormality is relatively permanent. The brain areas were still abnormal after the whiskers had
grown back.
Perhaps it would be beneficial if autistic babies were gently stroked and "tamed" when they
stiffen and pull away. I often wonder if I had received more tactile stimulation as a child, if I
would have been less "nervous" as an adult. Handling baby rats produces calmer adults which
are more willing to explore a maze (Denenberg et al. 1962; Ehrlich 1959). Tactile stimulation
is vital for babies and aids in their development.

WHAT IS VISUAL THINKING?

Thinking in language and words is alien to me. I think totally in pictures. It is like playing
different tapes in a video cassette recorder in my imagination. I used to think that everybody
thought in pictures until I questioned many different people about their thinking processes.
I have conducted an informal little cognitive test on many people. They are asked to access
their memory of church steeples or cats. An object that is not in the person's immediate
surroundings should be used for this visualization procedure. When I do this, I see in my
imagination a series of "videos" of different churches or cats I have seen or known. Many
"normal" people will see a visual image of a cat, but it is a sort of generalized generic cat
image. They usually don't see a series of vivid cat or church "videos" unless they are an artist,
parent of an autistic child, or an engineer. My "cat" concept consists of a series of "videos" of
cats I have known. There is no generalized cat. If I keep thinking about cats or churches I can
manipulate the "video" images. I can put snow on the church roof and imagine what the
church grounds look like during the different seasons.

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Some people access their "cat" knowledge as auditory or written language. For me, there is no
language based information in my memory. To access spoken information, I replay a "video" of
the person talking. There are some brilliant people who have little visual thought. One totally
verbal professor told me that facts just come to his mind instantly with no visual image. To
retrieve facts, I have to read them off a visualized page of a book or "replay the video" of
some previous event. This method of thinking is slower. It takes time to "play" the videotape
in my imagination.
Research findings indicate that verbal thought and visual thinking work via different brain
systems (Farah 1989; Zeki 1992). Studies of patients with brain damage indicate that one
system can be damaged, while another system may be normal. The brain is designed with
modular systems. These systems may work either together or separately to perform different
tasks. For example, people with certain types of brain damage can recognize objects with
straight edges, but they cannot recognize objects with irregular edges. The brain module that
recognizes irregular shapes has been damaged (Weiss 1989). In autism, the systems that
process visual-spatial problems are intact. There is a possibility that these systems may be
expanded to compensate for deficits in language. The nervous system has remarkable
plasticity; one part can take over and compensate for deficits in language. The nervous system
has remarkable plasticity; one part can take over and compensate for a damaged part
(Huttenlocher 1984). A functional MRI study by Ring et al. (1999) indicates that people with
autism depend more on the visual parts of the brain on an embedded figures test.

Using Visualization
Visual thinking is a great asset in my career as a livestock equipment designer, and I have
become internationally recognized in this field. Drafting elaborate drawings of steel and
concrete livestock stockyards and equipment is easy. I can visualize a video of the finished
equipment in my imagination. I can run test simulations in my imagination of how the systems
would work with different size cattle.
Discussions with other autistic people have revealed visual methods of thinking on tasks that
are often considered sequential and nonvisual. A brilliant autistic computer programmer told
me that he visualized the entire program tree in his mind and then filled in the program code
on each branch. A gifted autistic composer told me that he made "sound pictures". In all these
cases, a hazy whole or gestalt is visualized, and the details are added in a non-sequential
manner. When I design equipment, I often have a general outline of the system, and then
each section of it becomes clear as I add details.
When I solve a scientific problem or review the scientific literature, I do it non- sequentially.
The process is like trying to figure out what the picture on a jig saw puzzle is, when only some
of the pieces are put together. A piece is put on one corner and then another corner and after
about one fourth of the pieces are in place, a person can tell that the puzzle has a picture of a
house on it.
As a child and as a young adult, I was good at building things, but it took time to learn how
the symbolic lines on a set of engineering drawings related to the "video" of a house or a piece
of equipment that was in my imagination. After I learned to read engineering drawings, I could
then instantly translate the symbols on the drawings into a visualization of the finished
structure. When I was 28, my drafting ability suddenly improved after I watched a skilled
draftsman. I bought a pencil just like his, and then I copied his style, but the drawing I made
was a new design. When the drawing was finished I could "play the video" and "test" the
equipment to see if it would work. Visual thinking is not a fast method of thinking. It takes
time to "play" the "video." I am unable to instantly access my memory. An accountant with
autism wrote to me and explained that he had to think slowly at his desk, but he could solve
problems that were difficult for other accountants.
Visual thinking is also associated with being intellectually gifted. Albert Einstein was a visual
thinker who failed his high school language requirement and relied on visual methods of study
(Holton 1971-72). His theory of relativity was based on visual imagery of moving boxcars and
riding on light beams. Einstein's family history includes a high incidence of autism, dyslexia,
food allergies, high intellectual aptitude, and musical talent, and he himself had many autistic
traits - an astute reader can find evidence of them in Einstein and Einstein (1987). Other great
scientists such as Leonardo de Vinci, Faraday and Maxwell were visual thinkers (West 1991).

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Intellectual giftedness is common in the family histories of many persons with autism. In my
own family history, my great grandfather on my father's side was a pioneer who started the
largest corporate wheat farm in the world. One sister is dyslexic and is brilliant in the art of
decorating houses.
When I think about abstract concepts, such as relationships with people, I use visual images,
such as a sliding glass door. Relationships must be approached gently because barging forward
too quickly may shatter the door. Thinking about the door was not enough; I had to actually
walk through it. When I was in high school and college, I had actual, physical doors that
symbolized major changes in my life, such as graduations. At night, I climbed through a trap
door on the roof of the dormitory to sit on the roof and think about life after college. The trap
door symbolized graduation. The doors were a visual language for expressing ideas that are
usually verbalized.
Park and Youderian (1974) also report use of visual symbols, such as doors, to describe
abstract concepts. Visualization enabled me to understand the Lord's Prayer. "The power and
the glory" were high-tension electric towers and a blazing rainbow sun. I visualize the word
trespass as a "No Trespassing" sign on the neighbor's tree.
I no longer use sliding doors to understand personal relationships, but I still have to relate a
particular relationship with something I have read or experienced. For example, a fight
between my neighbors was like the United States and Europe fighting over customs duties. All
my memories are visual images of specific events. New thoughts and equipment designs are
combinations and rearrangements of things I have previously experienced. I have a need to
see and operate all types of livestock equipment because that programs the "visual computer."
Park (1967) also explained that her daughter learned nouns first. Nouns are easy because they
can be associated with pictures in one's mind. Inappropriate words are often used. For
example, the name Dick was used to refer to painting. This happened because Park's daughter
saw a picture of Dick painting furniture in a book. Park (1967) also describes why her daughter
had problems with pronoun reversal and won't use the word I. She thinks her name is you
because that's what people call her. Charlie Hart summed up autistic thinking with this
statement about his autistic son Ted: "Ted's thought precesses aren't logical, they are
associational" (Hart 1989). The autistic person's visual thinking methods may explain some of
the "Theory of Mind" problems that Frith (1989) outlines. Visual and associational thinking
would explain Frith's observation that a child may say "French toast" when he or she is happy.
I still have difficulty with long strings of verbal information. If verbal directions contain more
than three steps, I have to write them down. Many autistics have problems with remembering
the sequence of a set of instructions. Children with autism perform best with written
instructions that they can refer to, compared to verbal instructions or a demonstration of a
task, which require remembering a sequence of steps (Boucher and Lewis 1989).
Algebra is almost impossible, because I can't make a visual image, and I mix up steps in the
sequence of doing a problem. I have many dyslexic traits, such as reversing numbers and
mixing up similar sounding words such as over and other. Learning statistics was extremely
difficult, because I am unable to hold one piece of information in my mind while I do the next
step. I had to work with a tutor and write down the directions for doing each test. Every time I
do a statistical test, I have to use notes. It is easy to understand the principles of statistics,
because I can visualize the normal or skewed population distributions. The problem is, I cannot
remember the sequence for doing the calculations.
Donna Williams (1992), an autistic woman from Australia, describes similar difficulties. She
was unable to learn math until she watched the teacher write out each step. Like me, she had
to see every step written on paper. If the smallest step is left out, the autistic mind will be
stumped. The visual image of all the written steps is essential. Donna also became frustrated
because her calculator did not have an "of" button for finding percents. Words that have no
concrete visual meaning such as "put" or "on" need to be seen in written form in order to be
heard and remembered (Park 1967). Written language is easier to understand than verbal
language. Word processors should be introduced early to encourage writing. Typing is often
easier than hand writing. Many autistics have motor control problems that result in messy
illegible writing. Even highly verbal people with autism can often express themselves better
using the written or typed word. When I want to describe how I really feel about something, I
can express myself better in writing.

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COMMUNICATION

I screamed because it was the only way I could communicate. When adults spoke directly to
me, I could understand everything they said. When adults talked among themselves, it
sounded like gibberish. I had the words I wanted to say in my mind, but I just could not get
them out; it was like a big stutter. When my mother wanted me to do something, I often
screamed. If something bothered me, I screamed. This was the only way I could express my
displeasure. If I did not want to wear a hat, the only way I could communicate my desire not
to wear the hat was to throw it on the floor and scream. Being unable to talk was utter
frustration. I screamed every time my teacher pointed the pointer towards me. I was afraid
because I had been taught at home never to point a sharp object at a person. I feared that the
pointer would poke out my eye.
The speech therapist had to put me in a slight stress state so I could get the words out. She
would gently hold me by the chin and make me look at her and then ask me to make certain
sounds. She knew just how much to intrude. If she pushed too hard, I would have a tantrum;
if she did not push enough, there was no progress. During recent visits to autism programs, I
have observed this technique being used in many different types of programs. When I started
to speak, my words were stressed with an emphasis on vowel sounds. For example, "bah" for
ball. My speech therapist stretched out the hard consonant sounds to help my brain to
perceive them. She would hold up a cup and say ccc u ppp. Vowels are easier to hear than
consonants. My speech and language problems were similar to the loss of speech that occurs
in children who have had brain surgery to remove tumors in the cerebellum and cerebellar
vermis (Rekate et al. 1985). The children lost speech and then regained their ability to speak a
few stressed words at a time. The ability to understand speech remained normal. Courchesne
et al. (1988) and Murakami et al. (1989) found that in moderate to high-functioning autistics,
a high percentage had either an undersized cerebellum or abnormalities of the cerebellar
vermis. In my own case, MRI brain scans revealed that my cerebellar hemispheres are smaller
than normal.

AUTISM SUBTYPES

What is the difference between PDD (Pervasive Developmental Disability), Autism, Asperger's
Syndrome, etc.? It is doubtful that there are black and white boundaries between the different
diagnostic categories. It is likely that there is a continuum where each diagnostic category
merges into the next one in many varied shades of gray. Even though the different types of
autism are on a continuum the characteristics of the different types can be different. It is well
known that different types of autism respond differently to various drugs. From a treatment
standpoint, they are apples and oranges, but from a neurological standpoint, the differences
may be less distinct. The different subtypes of autism may also differ from an emotional
standpoint as well. As one moves from one end of the subtypes spectrum to the other,
emotions may vary from a lack of affect to more normal emotions.
During talks with hundreds of parents and reading in scientific literature I have divided autism
diagnosis into two broad categories: 1) Kanner/Asperger Types (named after the doctors who
discovered autism) (Kanner 1943 and Asperger 1944) and 2) the Epileptic/Regressive Types.
Fragile X, Retts Syndrome, known fetal damage and damage due to high fevers are not
included.
Both types probably have a strong genetic basis. Talks with parents indicate that they both
have the same family history profile (Grandin 1992a). An interview with Margaret Bauman
indicated that both types have the same pattern of brain abnormalities (Bauman 1991, and
Bauman and Kemper 1994). During her autopsy studies, she examined both types. Possibly
the different clinical symptoms between the two types can be explained in subtle variations of
brain abnormality within the larger framework of a basic abnormality in the limbic system,
hippocampus, amygdala, and cerebellum.

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Kanner/Asperger Type
Asperger's Syndrome is probably a milder type of traditional Kanner type high- functioning
autism. People with Asperger's syndrome can often function better in the community and have
more normal speech and thinking patterns. Research by Bowler (et al. 1992) at the University
of London indicates that they can solve a simple "Theory of Mind" problem that traditional
high-functioning autistics fail. An example of Theory of Mind problem is: "Peter thinks that
Jane thinks etc." Both the Kanner and Asperger types have deficits in flexible problem solving,
facial recognition, and fine motor speed coordination. Testing at the University of Denver by
Ozonoff (et al. 1991) indicates that both types do poorly on the Wisconsin Card Sorting Test
which is a test of flexible problem solving. Most people with autism are visual thinkers, but
there are some people with Asperger's syndrome who are good with numbers and have poor
visual skills.
Kanner/Asperger types can range from individuals with rigid thinking patterns and a relatively
calm temperament to people with more normal thinking patterns with lots of anxiety and
sensory sensitivity problems. Many of the individuals have flat affect. Charlie Hart's (1989)
excellent book, Without Reason, describes examples of the first type and my book, Thinking in
Pictures(1995), and Annabelle Stehli's (1991) book, Sound of a Miracle, describes the second
type.

Medications for Kanner/Asperger Types

At puberty, I had severe problems with anxiety, nervousness, and sensitivity to touch and
sound. The anxiety felt like a constant state of stage fright for no reason. On the worst days I
felt like I was being stalked by a gunman. Proper use of the right medication changed my life.
My speech became more modulated, and I became more social when the anxiety eased. The
individuals with anxiety and nervousness problems are likely to respond well to small doses of
antidepressant drugs such as clomipramine (McDougal et al. 1992 and Gordon et al. 1993) and
fluoxetine (Cook et al. 1992). Low doses of antidepressant drugs must be used to prevent
problems with agitation and irritability.
Several papers I have read on the use of antidepressants in autism have stated that the
beneficial effect of the drug wore off in several weeks or months. When the dose was raised,
there were problems with insomnia, restlessness, and agitation. These side effects are caused
by an overdose of the antidepressant; and if they occur, the dose must be immediately
lowered. I have been on the same low dose for twenty years. When I first stated taking
antidepressants, the effect wore off in four months and the anxiety returned. I remained on
the same dose and the drug started to work again several weeks later. If the effect of an
antidepressant appears to wear off and anxiety or bad behaviors returns do not raise the dose.
Remain on the same dose and the antidepressant will usually start working again after the
relapse period passes. Find the lowest dose that works effectively and NEVER raise it.
Fluoxetine is recommended if the EEG shows abnormalities because it is less likely to cause an
epileptic seizure. Another advantage of fluoxetine is it has fewer uncomfortable side effects.
Anecdotal reports from other adults with autism indicate that fluoxetine improved their lives.
Fluoxetine and other antidepressants should be used very sparingly in children.
The use of powerful medications in young children is a controversial area. Medications given
when the brain is developing may possibly have a permanent effect on the development of
neurotransmitter systems. Some medications may be very harmful, but there is also a
possibility that some may be beneficial. One must always balance risk versus benefit. A good
rule of thumb is that a medication should have an obvious, fairly dramatic effect. Research has
shown that very young autistic children have abnormally low levels of serotonin in their brain
compared to normal children (Chugani et al., 1999). Medications such as fluoxetine and other
serotonin reuptake inhibitors will increase serotonin levels in the brain. Maybe this would be
good for the young autistic brain. Rat research has now shown that fluoxetine may promote
the development of serotonin circuits in the brain (Wegerer et al., 1999). At this time nobody
knows if fluoxetine is good or bad for young autistic children.

Regressive/Epileptic Type
These individuals often have more obvious neurological problems, and their ability to
understand speech is often poor. Even though they may pass a standard pure tone hearing

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 Temple Grandin

test, they may not be able to hear complex speech sounds. Some of them cannot follow a
simple command like "put the book on your head." Volkmar and Cohen (1989) were the first
researchers to identify the regressive or "late onset" form of autism. Many of these children
have signs of subtle epileptic seizure activity, such as staring and "spacing out." Some of these
individuals may have sensory jumbling and mixing; whereas Kanner/Asperger Types have
good receptive speech and can understand what people are saying. Regressives may just hear
a jumble of noise. Sands and Ratey (1986) describe this as the concept of noise. Allen and
Rapin 1993) state that children with autistic behavior that are totally mute, with no receptive
speech, have to be introduced to language through the visual modality. Some of these children
may learn to speak when they are taught to read.
Many regressive/epileptic children are labeled low functioning and have low IQ scores. Some
may be retarded, but others may receive a low-functioning label because their sensory
processing problems make communication difficult. Conversations with many parents indicate
that this group is most likely to have a favorable response to vitamins B6, magnesium,
(Rimland 1988) or DMG supplements (Rimland 1990). Researchers in France have documented
that B6 and magnesium supplements are effective (Martineau et al. 1985, 1986).
Anticonvulsants such as valproic acid or ethosuximide may be useful in improving speech and
the ability to understand speech in three to five year old nonverbal autistic children (Plioplys
1994, Gillberg, 1991). Fankhauser et al. (1992) and Jaselskis et al. (1993). Both report that
clonidine is beneficial for behavior problems. Recently there has been a concern about the
safety of clonidine in children. Dr. Ed Cook reports that clonidine wears off in several months if
it is given continually. He recommends using it only when needed to help a child or an adult
sleep and not giving it during the day. One must always balance risk versus benefit. Both
reports from parents and a report by Ricketts (1993) indicate that fluoxetine is useful for
reducing self-injury. Serious behavior problems sometimes occur at puberty and autistic
teenagers and adults may have severe rage or aggression. Beta blockers such as propranolol
are effective for reducing severe aggression in adults (Ratey et al. 1987). Dr. Ratey has also
found that risperidone will control aggression and rages which may not respond to other
medications.
Dr. Joe Huggins has been working for years with teenagers and adults to find effective
medication regimes for very severe aggression and rage. Dr. Huggins reports that risperidone
must be give in very low doses to be most effective. This medication affects both the serotonin
and dopamine systems in the brain. Very low doses, which may be as low as one quarter of
the normal starting dose, are recommended. An extremely low dose will only affect the
serotonin system, and it will stay out of the dopamine system. One bad side effect of
risperidone, in some people with autism, is high weight gain. Xyprexe (olanzapine) has worse
weight gain.
An interview with Dr. Huggins indicated that he has three basic medications that he uses in
low-functioning adults and teenagers who have difficulty managing aggression, rage or self-
injury. They are risperidone, valproic acid and propranolol. He uses these three medications
either singly or in various combinations. Dr. Huggins recommends very low doses of 0.5 to 1.5
mg of risperidone for controlling rage in autistic teenagers and adults. Risperidone is most
effective for alpha type rage where the rage is directed at a specific person. The maximum
dose of risperidone is 2 mg. to prevent it from getting into the dopamine system. Too high a
dose is less effective for reducing anxiety. For beta type rage which is diffuse and not directed
at a specific target, Dr. Huggins has had success with beta blockers such as propranolol.
People that are hot and sweaty often respond well to propranolol. In non-verbal or poorly
verbal people with autism, Dr. Huggins avoids most of the SSRIs, such as Prozac (fluoxetine),
due to problems with interactions with risperidol. Paroxetine (Paxil) and fluvoxamine (Luvox)
interact badly with risperidone. Dr. Huggins prefers celexa (citalopram) if an SSRI has to be
mixed with risperidone because it is the SSRI with the fewest problems with interaction.
If the aggressive outburst follows a cycle where they come and go, Dr. Huggins will often
prescribe valproic acid. For the lower functioning people with autism, his basic choices for
medication for controlling severe behavior are: one low dose risperidone, valproic acid and
propranolol. For high functioning teenagers and adults with autism, one of the SSRIs, such as
fluoxetine or one of the other SSRIs, is often the best medication to use where a single
medication can be used to control both depression and anxiety. Many high functioning people

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 Temple Grandin

are doing very well on a single SSRI such as Prozac (fluoxetine). Dr. Huggins has also reported
that a combination of a reduced sugar diet and propranolol was more effective than
propranolol alone.
Dr. Huggins publications can be ordered by calling 416-449-5511 or 416-445-3032 (also,
www.Bitemarks.com). His spiral bound booklet titled `Diagnostic and Treatment Model for
Managing SIB, Rage and other Hyperadrenergic Behaviors in the Autistic, PDD, and DD
Populations' can be obtained by contacting: Kerry's Place, 34 Berczy St., Suite 190, Aurora,
Ontario, Canada, L4G 1W9; Fax: 905-841-1461.
Outbursts of aggression in autistic teenagers and adults are sometimes caused by frontal or
temporal lobe seizures. These seizures (epileptic episodes) are often difficult to detect on an
EEG (Gedye 1989, 1991). Seizures should be suspected if the rages occur totally at random.
Most other types of aggression or rage are usually triggered by some event such as frustration
with communication, painful sensory stimuli or an unexpected change in routine. If epilepsy is
suspected, the teenager may respond positively to either carbamazepine, valproic acid or
divalproex sodium (Gedye et al. 1989, 1991). Calcium supplements may help prevent severe
self-abuse such as eye gouging (Coleman 1994).
When a medication is used, careful observations should be made to determine if it is really
effective. As I stated before, one must balance the risk against the benefit. To avoid dangerous
drug interactions consult, consult Graedon and Graedon (1995). Grapefruit juice should be
avoided. It interacts badly with certain medications. One must ask the question: Does this
medication provide sufficient benefit to make it worth the risk? In a nonverbal individual, a
careful medical examination is recommended to look for hidden painful medical problems
which could be causing either self-injury or aggression. Look for ear infections, tooth aches,
digestive problems, headaches and sinus problems.

EDUCATIONAL STRATEGIES AND SUBTYPES

A teaching and therapy program that worked well for me may be painful and confusing to
some nonverbal lower functioning, regressive/epileptic people with autism. My speech
therapist forced me to look at her. I needed to be jerked out of my autistic world and kept
engaged. Some children with more severe sensory problems may withdraw further because
the intrusion completely overloads their immature nervous system. They will often respond
best to gentler teaching methods such as whispering softly to the child in a room free of
florescent lights and visual distractions. Donna Williams (1994) explained that forced eye
contact caused her brain to shut down. She states when people spoke to her, "their words
become a mumble jumble, their voices a pattern of sounds" (Painter 1992). She can use only
one sensory channel at a time. If Donna is listening to somebody talk, she is unable to
perceive a cat jumping up on her lap. If she attends to the cat, then speech perception is
blocked. She realized a black thing was on her lap, but she did not recognize it as a cat until
she stopped listening to her friend talk.
She explained that if she listens to the intonation of speech, she can't hear the words. Only
one aspect of incoming input can be attended to at a time. If she is distracted by the visual
input of somebody looking in her face, she can't hear them. Other people with autism have
explained that they had a difficult time determining that speech was used for communication.
Kins, a man with autism, further explained that if somebody looked him in the eye, "My mind
went blank and thoughts stop; it was like a twilight state." Cesaroni and Garber (1991) also
describe confusing and mixing of sensory channels. Jim, a man with autism, explained,
"Sometimes the channels get confused, as when sounds came through as color." He also said
that touching the lower part of his face caused a sound- like sensation. Donna told me that she
sometimes has difficulty determining where her body boundary is. Cesaroni and Garber (1991)
also noted problems with locating a tactile stimulus. The tendency of some autistic people to
constantly touch themselves and objects around them may be an attempt to stabilize body and
environmental boundaries. Therese Joliffe, an autistic woman, explained that it was easier to
learn by touch because touch was her most accurate sense (Joliffe et al. 1992). Donna told me
that sensory integration treatment, consisting of rubbing her skin with brushes, has helped.
Even though she disliked the tactile input from the brushes, she reported that it helped her

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 Temple Grandin

different sensory systems to work together and become more integrated. Her sensory
processing also becomes more normal when she is relaxed and is focusing on only one sensory
channel. Donna may be half way along the continuum between the Kanner/Asperger Type and
the Regressive Epileptic Type.

Patterns of Neurological Abnormalities

Both Kanner/Asperger Types and the Regressive/Epileptic Types have abnormalities of the
cerebellum (Bauman 1991, Bauman and Kemper 1994). Cerebellar abnormalities may explain
the sound and touch sensitivity problems observed in most forms of autism. Research on rats
indicates that the vermis of the cerebellum modulates sensory input (Crispino and Bullock
1984). Stimulation of the cerebellum with an electrode will make a cat hypersensitive to both
sound and touch (Chambers 1947). The cerebellum may act as a volume control for hearing,
vision, and touch. Courchesne et al. (1988) found that many high-functioning Kanner/Asperger
autistic people have abnormalities of the cerebellar vermis. Kanner/Asperger Types may also
have a smaller than normal cerebellum. MRI scans of my own brain indicated my cerebellum is
20 percent smaller than normal; and an autistic computer genius with ultra classical Kanner
Type autism has a cerebellum that is 30 percent smaller than normal.
As discussed previously, the more severely impaired Regressive/Epileptic Type autistic people
have much greater sensory processing problems. Most Kanner/Asperger Types do not
experience sensory jumbling, and they can attend to simultaneous visual and auditory input.
In more severe cases, such as Williams (1993) and Cesaroni and Garber (1991), sensations
from the eyes and ears can mix together. Individuals with autism process information very
slowly, and they must be given time to respond. Nonverbal adults will process sensory input
more slowly than verbal adults. Some individuals with very severe sensory processing
problems may take several hours to recover after experiencing sensory overload. Gillingham
(1995) contains an excellent review of autistic sensory problems. Parents often ask, how can I
tell how severe my childs sensory problems are? Children and adults that have tantrums
every time they go in a large supermarket or shopping mall usually have severe sensory
processing problems. Children and adults who enjoy shopping in big stores usually have less
severe sensory problems. The degree of sensory processing problems will vary greatly from
case to case. It can vary from mild sound sensitivity to sensory jumbling and mixing. Lewis
(1993) describes her son who may be mid-way between Kanner Type and Regressive/Epileptic
Type. He does not have the rigid thinking of a typical Kanner Type, and he understands the
give and take of conversations. However, he has signs of serious sensory processing problems,
because he does self-stimulatory behaviors in nearly every sensory modality. Possibly, this
may be due to brain stem abnormalities in addition to the cerebellar abnormalities. Hashimoto
et al. (1992) found that low-functioning autistic people with low IQ scores had smaller brain
stems. McClelland et al. (1992) also found that low-functioning individuals were more likely to
have abnormal results on a central conduction time test, which is a measure of brain stem
function.
McClelland et al. (1992) believe that autistic people have a defect in myelinization. This would
account for the frequent occurrence of epilepsy and abnormal brain stem- evoked potentials in
older autistic children. Myelin forms the fatty sheaths around neurons. It is like insulation on
electrical wires. The lack of myelinization may also account for the mixing of sensory input
from the eyes and ears and mind blank outs that occur when an autistic person becomes
excited. The "space out" and jumbling may be due to miniature epileptic seizures that occur
between the poorly myelinated neurons. Jim, one of the autistic people that Cesaroni and
Garber (1991) interviewed, theorizes that certain frightening sounds can act as a trigger for
disorganization of processing, similar to epileptic seizures that a flashing light can trigger.

CAUSE OF AUTISM

Autism is a neurological disorder that is not a result of psychological factors. A complex

inheritance of many interacting genetic factors cause most cases of autism. There is a
continuum from normal to abnormal. Autistic traits often show up in a mild degree in the
parents, siblings, and close relatives of an autistic child (Narayan et al. 1990; Landa et al.

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 Temple Grandin

1992). Some of the traits that seemed to be associated with autism are: intellectual prowess,
shyness, learning disabilities, depression, anxiety, panic attacks, Tourettes (tic disorder), and
alcoholism (Narayan et al. 1990; Sverd 1991). There is a high correlation between Asperger's
syndrome and manic depression (Delong and Dyer 1988). Possibly a small amount of these
genetic traits confers an advantage, such as high intelligence or creativity; too many of the
traits will cause problems (Clark 1993) Other causes of autism are the Fragile X gene, insults
to the fetus, such as Rubella or other viruses, and high fevers at a young age.
Brain autopsy research (Bauman 1991, Bauman and Kemper 1994) and MRI studies
(Courchesne et al. 1988; Hashimoto et al. 1992) indicate that people with autism have
structural abnormalities in the brain. Certain areas of the brain, such as the limbic system and
cerebellum are immature. Other studies have shown that lower functioning people with autism
also have abnormally slow transmission of nerve impulses through the brain stem (McClelland
et al. 1993) and immature EEG patterns (Cantor et al. 1986). Dr. Patricia Rodier (2000)
explains that the brain abnormalities that cause autism occur very early in the developing
embryo. Her research has shown that there are defects in the developing brain stem that
happened near the end of the first month of pregnancy. A structure called the superior olive is
missing in the brain stem. This may explain the lack of cerebellum development in autism. In
summary, autism is a disorder in which some parts of the brain are underdeveloped and other
parts may be overdeveloped. This may be a possible explanation for why some autistic people
have enhanced visual and savant skills.

CONCLUSIONS

Teachers, therapists and other professionals who work with autistic people need to recognize
and treat sensory processing problems in autism. Treatment programs that are appropriate
and beneficial for one type of autism may be painful for other types. At ages two to four, many
autistic children will probably respond well to gently intrusive programs where the child is
required to maintain eye contact with the teacher. Lovaas (1987) has documented that roughly
half of young children will improve sufficiently so they can be enrolled in a normal first grade
at age six or seven. It is likely that the children who did not improve in the Lovaas program
were experiencing sensory overload. They may respond better to a gentler approach using
only one sensory channel at a time. As children get older they tend to separate into two
groups. Children like me who can be "jerked" out of the autistic world and asked to pay
attention, and individuals like Donna Williams and Therese Joliffe who require a gentler
approach. The prognosis of both types of children will be improved if they receive a minimum
of 20 hours a week of good educational programming between the ages of two and five. Both
types of young autistic children MUST be prevented from shutting out the world. They have to
be kept engaged so that their brains can develop more normally. For one type of child the
teacher can "jerk open the front door;" and for the other type, the teacher must "sneak quietly
through the back door."

Page 30 of 74

Table 1
Autism Subtypes
These subtypes are on a continuum that merges together. Information in the table is based on
scientific literature and interviews with autistic people, teachers and parents.
/------------------------------\
| |
| Kanner/Asperger Type
| (High Functioning)
| |
| |
\------------------------------/
1. No obvious motor problems,
but some Asperger Types tend to
be clumsy.
2. Have receptive speech and can
understand what is said to them
(Grandin, 1986). Many children
with partial receptive speech
are echolaic. They repeat
phrases because they only hear
parts of them.
3. Sensory over-sensitivity to
sound, touch, or visual stimuli
(Grandin and Scariano 1986;
Grandin 1992, 1995; Stehli 1991;
Volkmar and Cohen 1985; Bemporad
1979).
4. Seldom have epileptic seizures
and EEG readings are usually
normal, but may have cerebellar
abnormalities (Courchesne et al.
1988; Bauman 1991). Brain stem
development is more normal.
5. Rigid concrete thinking, no
common sense, and lack of affect
(Kanner 1943; Asperger 1944;
Hart 1989; Bemporad 1179).
6. Young children respond well
to gently intrusive teaching
methods, such as forced eye con-
tact; and some three-year-old
children respond well to intense
intrusive methods (Lovaas 1989;
Temple Grandin
/---------------------------------\
| |
| | Regressive/Epileptic Type |
| | (Often Low Functioning) |
| |
| |
\---------------------------------/
| 1. Sometimes have obvious body
| movement problems or difficulty
| with stopping and starting hand
| movements.
|
| 2. No receptive speech (Allen
| and Pain, 1992), or incoming
| speech sounds may fade in and
| out. In severe cases, incoming
| speech may be a jumble of sound.
| More likely to be mute (Volkmar
| and Cohen 1989). May have dif-
| ficulty determining speech is
| used to communicate (Joliffe 1992).
|
| 3. Sensory information from the
| different senses my jumble and
| mix together into noise or pat-
| terns (Sands and Ratey 1986;
| Cesaroni and Garber 1991; Painter
| 1992). Very slow sensory processing
| (Gillingham 1995). May learn best by
| touch. Give them letters and objects
| to feel.
|
| 4. Often have epileptic sei-
| zures, abnormal EEG readings,
| undersized brain stems, and imma-
| ture central nervous system de-
| velopment (Gedye 1991; Hashimoto
| et al. 1992; McClelland et al.
| 1992; Bauman 1991; Bauman and Kemper
| 1994; Canter et al. 1986).
|
| 5. May have more normal thinking
| and emotions (Cesaroni and
| Garber 1991; Williams 1992, 1994).
|
|
| 6. Respond poorly to intrusive
| methods due to sensory overload
| (Williams, 1993). When they be-
| come stressed or overstimulated,
| incoming stimuli becomes jumbled
| and mixed together. Intrusive
Page 31 of 74
 Temple Grandin

1993). | teaching methods that work with

7. Afraid of certain noises be-
cause they hurt the ears, but
may be attracted to other sounds
and visual stimuli, such au-
tomatic sliding doors or flush-
ing the toilet.
8. Some individuals may have
severe anxiety problems (Grandin
1986; 1992l 1995; Volkmar and
Cohen 1985), while others are
calm (Hart 1987).
9. Teenagers and adults often
respond to low doses of anti-
depressant drugs, such as clomi-
pramine and fluoxetine. Clomi-
pramine is the recommended first
choice if the individual has
severe obsessive-compulsive
symptoms. Fluoxetine has fewer
uncomfortable side effects and is |
preferred by many individuals.
These medications are usually not |
recommended in children unless
there is a severe behavior problem |
that does not respond to sensory
or behavioral interventions.
| young Kanner/Asperger children
| may cause confusion and pain.
|
| 7. May be able to attend to only
| one sensory channel at a time.
| During teaching, distractions
| should be minimized and informa-
| tion should be presented to only
| one sensory modality (Cesaroni
| and Garber 1991; Williams 1993).
| Will actively avoid sounds and
| stimuli that may be attractive
| to less severely afflicted indi-
| viduals.
|
| 8. Some individuals have severe
| anxiety problems.
|
|
|
|
| 9. Teenagers and adults with rage
| and aggression tend to respond best
| to inderal, clonidine, fluoxetine
| and buspirone. Epilepsy medications
| such as carbamazepine and valproic
| acid are also helpful. In children,
| B6 and magnesium and DMG are some-
| times helpful. If speech fails to
develop by age four, ethosuximide or
| valproic acid may helpful. (Pliophys
1994, Gillberg 1991).
|
|
|

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 Temple Grandin

My Mind is a Web Browser: How People with

Autism Think
by Temple Grandin
Cerebrum, 2000
Winter Vol. 2, Number 1, pp. 14-22
The Charles A. Dana Foundation, New York, NY

The struggle that made possible Temple Grandin's early development, graduate education, and
notable career as a professor of animal behavior, designer of animal facilities worldwide, and
celebrated writer, speaker, and researcher on autism, is told in her books, Emergence: Labeled
Autistic (1986) and Thinking in Pictures and Other Reports From My Life With Autism * (Vintage
Books) 1996.
*
Voted a Cerebrum "Great Brain Book," Spring 1999.

Since writing Thinking in Pictures, which described my visual way of thinking, I have gained
further insights into how my thought processes are different when compared to those of people
who think in language. At autism meetings, I am often asked, "How can you be effective at
public speaking when you think in pictures that are like video tapes in your imagination?" It is
almost as though I have two levels of consciousness that operate separately. Only by
interviewing people did I learn that many of them think primarily in words, and that their
thoughts are linked to emotion. In my brain, words act as a narrator for the visual images in
my imagination. I can see the pictures in my memory files.
To use a computer analogy: The language part of my brain is the computer operator, and the
rest of my brain is the computer. In most people, the brain's computer operator and the
computer are merged into one seamless consciousness; but in me they are separate. I
hypothesize that the frontal cortex of my brain is the operator and the rest of my brain is the
computer.
When I lecture, the language itself is mostly "downloaded" out of memory from files that are
like tape recordings. I use slides or notes to trigger opening the different files. When I am
talking about something for the first time, I look at the visual images on the "computer
monitor" in my imagination, then the language part of me describes those images. After I have
given the lecture several times, the new material in language is switched over into "audio
tape-recording files." When I was in high school, other kids called me "tape recorder."
A Web browser finds specific words; by analogy, my mind looks for picture memories that are
associated with a word. It can also go off on a tangent in the same way as a Web browser.
Non-autistic people seem to have a whole upper layer of verbal thinking that is merged with
their emotions. By contrast, unless I panic, I use logic to make all decisions; my thinking can
be done independently of emotion. In fact, I seem to lack a higher consciousness composed of
abstract verbal thoughts that are merged with emotion. Researchers have learned that people
with autism have a decreased metabolism in the area in the frontal cortex that connects the
brain's emotional centers with higher thinking (the anterior cingulate). 1 The frontal cortex is
the brain's senior executive like the CEO of a corporation. Brain scans indicate that people with
autism use problem-solving circuits in social situations. Unlike non-autistic people, the emotion
center in their amygdala is not activated, for example, when they judge expressions in another
person's eyes.2

My mind is a Web browser

Now let me explain how the language part of my brain and the "thinking in pictures" part of
my brain seem to interact. My mind works just like an Internet Web browser. A Web browser
finds specific words; by analogy, my mind looks for picture memories that are associated with

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 Temple Grandin

a word. It can also go off on a tangent in the same way as a Web browser, because visual
thinking is non-linear, associative thinking.
To demonstrate how my mind works, at an autism meeting I asked a member of the audience
to name a thing for me to invent. I wanted to show how the visual part of my brain and the
language part worked separately. Somebody said, "invent a better paper clip." The language
part of my brain said, "I can do that," and pictures immediately started flashing into my
imagination of all kinds of paper clips I have seen. My "Web browser" searched the picture
memory files; many paper clip pictures flashed through my imagination like slides. I could stop
on any one picture and study it. I saw an odd, plastic paper clip that was on a scientific paper
from Europe. At this point, I got off the subject and saw pictures of the first scientific meeting I
had attended in Spain. The language voice inside me said, "Get back on the subject of paper
clips." The language part of me is a manager who uses simple non-descriptive language to tell
the rest of my brain what to do.
Often, the best ideas for inventing things come just as I am drifting off to sleep. The pictures
are clearer then. It is as though I can access the most concrete, vivid memory files with the
most detailed images. The language part of my brain is completely shut off at night.
To get ideas for new paper clip designs, I can pull up pictures of clothes pins and other clip-like
things, such as mouse traps and C clamps used in woodworking. I start thinking that inventing
a better clip for holding a thick pile of papers together might be more marketable than a new
paper clip design. Existing spring binder clips tend to rip envelopes when papers are mailed,
because the clips have protruding edges. When I think about this, I see ripped envelopes. The
language part of my mind says, "Design a flat binder clip for thick documents." When I say
this, I see a mailed document in an undamaged envelope. My visual imagination then sees a
large plastic clip that I saw in Japan. Japanese apartment dwellers who do not have clothes
dryers use large, plastic clips to hold blankets and other laundry on balcony railings. A small
version of the Japanese balcony clip may make a better paper clip for holding many pages.
When I was responding to the paper clip inquiry, I knew that I could visually associate all day
about paper clips. The language part of my mind then said, "That is enough," and I resumed
my lecture. But as I corrected the first draft of this article, I saw a one-piece molded plastic
binder clip that would lay flat on a thick bunch of papers.
I do have the ability to control the rate at which pictures come onto the "computer screen" in
my imagination. Some people with autism are not able to do this. One person with autism told
me that images explode into a web of a pictures that are interrelated. The decision-making
process can become "locked up" and over-loaded with pictures coming in all at once.

Unmasking Talent
I have been fascinated with research indicating that the detailed, realistic pictures that autistic
savants -- autistic individuals with extraordinary talent in a specific area -- make may be
created by directly accessing primary memory areas deep in the brain. Researchers in
Australia hypothesize that autistic savants may have privileged access to lower levels of
information.3 A study with a non-autistic "human calculator," who could solve multiplication
problems twice as quickly as a normal person, indicated that his brain had enhanced low-level
processing.4 EEG recordings of his brain waves showed that brain activity was greatest, as
compared with a normal person, when the multiplication problem was first flashed on the
screen.
I hypothesize that I am able to access primary visual files in my brain. When designing
livestock equipment in my business, I can do three-dimensional, full motion videos of
equipment and can test-run the equipment in my imagination. I can walk around it or fly over
it. My ability to rotate the image is slow. I move my mind's eye around or over the image.
When I read an article in Neurology about frontal temporal lobe dementia, I became extremely
excited. It provided a scientific foundation for the idea of hidden visual thinking under a layer
of verbal thinking. Research on frontal temporal lobe dementia, an Alzheimer's-like condition
that destroys language and social areas in the brain, demonstrated that, as the condition
progressed, visual skills in art emerged in people who had no interest in art. The increase in
creativity was always visual, never verbal. Brain scans found the highest activity in the visual

Page 34 of 74
 Temple Grandin

cortex. As the patient's cognitive abilities deteriorated, the art became more photo realistic.
Artwork published with the journal article looks like the art of autistic savants.

I see the decision process

I see the decision-making process in my mind in a way most people do not. When I tried to
explain this to a person who thinks in language, he just didn't get it. How my decision-making
works is most clearly seen in an emergency.
On a bright, sunny day, I was driving to the airport when an elk ran into the highway just
ahead of my car. I had only three or four seconds to react. During those few seconds, I saw
images of my choices. The first image was of a car rear ending me. This is what would have
happened if I had made the instinctive panic response and slammed on the brakes. The second
image was of an elk smashing through my windshield. This is what would have happened if I
had swerved. The last image showed the elk passing by in front of my car. The last choice was
the one I could make if I inhibited the panic response and braked just a little to slow the car. I
mentally "clicked" on slowing down and avoided an accident. It was like clicking a computer
mouse on the desired picture.

Animal decision making

I speculate that the decision-making process I used to avoid the accident may be similar to the
process animals use. From my work with animals, I've come to believe that consciousness
originally arose from the orienting response. When a deer sees a person, it will often freeze
and look at him. This is the deer's orienting response. During this time, it decides either to run
away or to keep grazing. It does not act as a programmed robot, governed by instinct or
reflexes; it has the flexibility to make a decision. One of the things that has helped me to
understand animals is that, more than most people, I think and feel like one. The more
"animal" parts of the normal human brain may be covered by layers of language-based
thinking.

Thinking in audio tapes

In connection with my lectures, I have talked with autistic people who are not visual thinkers.
They seem to think in audio tape clips. Audio tape thinking does not have to involve language;
instead of using visual images to form memories, these people store very specific audio clips. I
suspect that, for them, hearing is easier than seeing. Dr. John Stein and his colleagues at
Oxford University have discovered that some people have difficulty seeing rapidly changing
visual scenes. They find reading is difficult because the print appears jumbled. 6 This results
from defects in brain circuits that process motion. 7 The eye is fine; the circuits between brain
and eyes malfunction.
One person I know who is expert at training animals told me that she hears the animal's
behavior instead of seeing it. She has audio tapes in her memory with little sound details. For
example, she knows that the animal is relaxed or agitated by listening to its breathing or
footsteps. She reads audio signals instead of body posture.

Piecing the details together

People with autism, and animals as well, pay more attention to details. As I described in
Thinking in Pictures, all my thinking goes from the specific to the general. I look at lots of little
details and piece them together to make a concept. The first step in forming an idea is to make
categories. For example, the most primary level is sorting objects by color or shape. The next
step is sorting things by less obvious features, as when we categorize cats and dogs. When I
was five years old, I figured out that a miniature dachshund was not a cat because it had a
dog's nose; all dogs had certain features that were visually recognizable.
My mind seeks these categories amidst an array of little details. In problem solving, my
thinking process is like that of an epidemiologist tracking down a disease. The epidemiologist
collects lots of little pieces of information and finally figures out the common factor that caused

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certain people to fall ill. For example, they may all have eaten strawberries from a certain
place.
Also, I understand concepts visually. For example, all objects classified as keys will open locks.
I realize that the word "key" can also be used metaphorically, when we say, "the key to
success is positive thinking." When I think about that phrase, I see Norman Vincent Peale's
book, The Power of Positive Thinking, and I see myself back at my aunt's ranch reading it. I
then see a stage where a person is getting an award and I see a large cardboard key. Even in
this situation, the key still unlocks the door to success. The ability to form categories is the
beginning of the ability to form concepts. Keys in their physical form open physical locks but
abstract keys can open many things, such as a scientific discovery or career success.
In teaching people to understand animal behavior, I have to help them to learn how to observe
details that seem insignificant. Animals notice details in their environment that most people do
not see, such as a branch that moves slightly or a shadow. In my work with livestock facilities,
I try to get the language-based thinkers of the crowd to be more observant of little details that
spook cattle. A cow may balk at entering a vaccination chute because it sees a piece of jiggling
chain that most people ignore, but which is significant in the cow's environment.
That little chain attracts the cow's attention because it moves quickly. Rapid movement
activates the amygdala, the brain's emotion center. In a prey species such as cattle, rapid
movement elevates fear because, in the wild, things that move rapidly are often dangerous.
Something moving quickly in the bushes may be a lion. On the other hand, a predatory animal
such as a dog, is attracted to rapid movement. This may explain why some dogs attack
joggers. Rapid movement triggers chasing and attacking in a predatory animal, but it triggers
flight in a prey species such as deer or cattle.
Objects that move rapidly also attract the attention of people with autism. When I was
younger, I liked to play with automatic doors at supermarkets. I enjoyed watching the rapid
opening movement. Elevator doors were not interesting; they did not move fast enough to be
pleasurable to watch. Tests of my visual tracking indicate that I have a slight abnormality in
my eye's ability to track a moving object. Children and adults with autism who never learn to
speak have graver defects in their nervous system. The automatic doors that I liked to watch
cause many nonverbal autistics to put their hands over their eyes. The rapid movement of the
doors hurts their eyes. Possibly, a small defect in eye tracking makes rapidly moving things
attractive to me, while a more serious neurological defect makes them unpleasant to other
autistics. As a child, my favorite things all made rapid movements. I liked flapping flags, kites,
and model airplanes that flew.

Disturbing sounds
I have always felt that my senses were more like those of an animal. Does my brain have
deeper access to the ancient anti-predator circuits that humans share with animals? At night, I
cannot get to sleep if I hear high-pitched, intermittent noise such as a backup alarm on a truck
or children yelling in the next hotel room; they make my heart race. Thunder or airport noise
does not bother me, but the little high-pitched noises cannot be shut out. Recent research with
pigs has confirmed that intermittent sounds are more disturbing to them than steady sounds. 9
Why are high-pitched sounds disturbing to animals (and to me), while airport noises and
thunder are not? I speculate that in nature the rumble of thunder is not dangerous but a high-
pitched noise would be an animal's distress call. Beeping backup alarms and car alarms are
electronic distress calls, which activate my nervous system even though I know they are
harmless. It is almost as though these animal circuits in my brain have been laid bare.

Proportional thinking
A recent report in Science indicated that activities involving numbers are processed in at least
two different parts of the brain.10 Precise calculations are dependent on language and are
processed in the frontal areas; proportional figuring is processed in visual areas. Proportional
thinking is figuring out if one object is less or more than another. For example, three marbles
are more than one marble. Animals can do proportional thinking. They can easily determine

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that 10 pieces of food are more than two. It is likely that proportional thinking is the kind of
number processing that humans share with animals.
In school, math was a tough subject for me. Finding the precisely correct answer is difficult
because I mix up numbers. On the other hand, I am very good at proportional thinking,
coming up with an accurate approximate answer. In my scientific work, I often convert
numerical differences between my control and experimental groups to percentage differences.
Percentage differences can be visualized on a pie chart. When I present data, I like to use
charts and graphs so I can see the proportional differences between different sets of data.
When I did cost estimating for cattle industry construction projects, I never tried to calculate
projects to the penny. Instead, I estimated the cost of a new job by figuring out its
proportional cost in relation to other finished projects. This was mainly a visual process. I
would look at the drawing and build the entire project in my imagination. I then would put it
up on the video screen in my imagination and compare it in size to other completed projects
that had complete cost figures. In my mind, I could compare four or five completed projects
with the drawing I was estimating. The project being estimated might be equal to two-thirds of
a cattle-handling facility that I designed at Red River Feedlot and about 25 percent bigger than
a corral I designed for Lone Mountain Ranch.
For money to have meaning to me, it must be related to something I can buy with it,
otherwise it is too abstract. For example, $3 is equal to lunch at McDonald's, $20 is a tank of
gas, and $1000 can buy a computer. Big tables full of figures make little sense to me. Some
more severely autistic people do not understand money at all. For me to understand a billion
dollars, I have to have a picture in my mind of something that cost a billion dollars. One billion
is one quarter of the cost of the new Denver Airport. When President Clinton announced part
way through the war in Kosovo that it had cost $2 billion, I figured that half a Denver Airport
worth of money had been spent. Different amounts of money have different visual values. It is
interesting that proportional thinking for numbers is in the visual parts of the brain.
In proportional thinking, as in creating something new, making a decision, and forming
concepts, my thinking relies on more direct access to the primary visual memory areas in my
brain. There is a whole higher level of abstract thinking seamlessly linked to emotion that I do
not have.

References
1. Haznedar MM, Buchsbaum MS, Metzer M, et at. Anterior cingulate gyrus volume and glucose
metabolism in autistic disorder. American Journal of Psychiatry. 1997: 154:1047-1050.
2. Baron-Cohen S, Ring HA, Wheelwright S. Social intelligence in the normal and autistic brain:
an FMRI study. European Journal of Neuroscience. 1999: 11:1891.1898.
3. Snyder AW, Mitchell JD. Is integer arithmetic fundamental to mental processing? The mind's
secret arithmetic. Proceedings of the Royal Society of London. 1999:266:-587-592.
4. Birbaumer N. Rain Man's revelations. Nature. 1999:399:211-212.
5. Miller BL, Cummings J, Mishkin F. Emergence of artistic talent in froniotemporal dementia.
Neurology. 1998:51:978-982.
6. Clayton J. Lost for Words. New Scientist. April 24, 1999. pp.27-30.
7. Eden GF, Van Meter JW, Ramsey J, et al. Abnormal processing of artistic talent in dyslexia
revealed by functional brain imaging. Nature. 1996: 382:66-69.
8. LeDoux J. The Emotional Brain. Simon and Schuster; 1996.
9. Talling JC, Waran NK, Wathes CM. Sound avoidance by domestic pigs depends on the
characteristics of the signal. Applied Animal Behavior Science. 1998:58: 255-266.
10. Dehaene S, Spelke E, Pinel P, Stanescu R, Tsivkin S. Sources of mathematical thinking:
Behavioral and brain imaging evidence. Science. 1999: 284:970-973.

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Thinking In Pictures

Chapter 1: Autism and Visual Thought

Dr. Temple Grandin

I THINK IN PICTURES. Words are like a second language to me. I translate both spoken and
written words into full-color movies, complete with sound, which run like a VCR tape in my
head. When somebody speaks to me, his words are instantly translated into pictures.
Language-based thinkers often find this phenomenon difficult to understand, but in my job as
an equipment designer for the livestock industry, visual thinking is a tremendous advantage.
Visual thinking has enabled me to build entire systems in my imagination. During my career I
have designed all kinds of equipment, ranging from corrals for handling cattle on ranches to
systems for handling cattle and hogs during veterinary procedures and slaughter. I have
worked for many major livestock companies. In fact, one third of the cattle and hogs in the
United States are handled in equipment I have designed. Some of the people I've worked for
don't even know that their systems were designed by someone with autism. I value my ability
to think visually, and I would never want to lose it.
One of the most profound mysteries of autism has been the remarkable ability of most autistic
people to excel at visual spatial skills while performing so poorly at verbal skills. When I was a
child and a teenager, I thought everybody thought in pictures. I had no idea that my thought
processes were different. In fact, I did not realize the full extent of the differences until very
recently. At meetings and at work I started asking other people detailed questions about how
they accessed information from their memories. From their answers I learned that my
visualization skills far exceeded those of most other people.
I credit my visualization abilities with helping me understand the animals I work with. Early in
my career I used a camera to help give me the animals' perspective as they walked through a
chute for their veterinary treatment. I would kneel down and take pictures through the chute
from the cow's eye level. Using the photos, I was able to figure out which things scared the
cattle, such as shadows and bright spots of sunlight. Back then I used black-and-white film,
because twenty years ago scientists believed that cattle lacked color vision. Today, research
has shown that cattle can see colors, but the photos provided the unique advantage of seeing
the world through a cow's viewpoint. They helped me figure out why the animals refused to go
in one chute but willingly walked through another.
Every design problem I've ever solved started with my ability to visualize and see the world in
pictures. I started designing things as a child, when I was always experimenting with new
kinds of kites and model airplanes. In elementary school I made a helicopter out of a broken
balsa-wood airplane. When I wound up the propeller, the helicopter flew straight up about a
hundred feet. I also made bird-shaped paper kites, which I flew behind my bike. The kites
were cut out from a single sheet of heavy drawing paper and flown with thread. I
experimented with different ways of bending the wings to increase flying performance.
Bending the tips of the wings up made the kite fly higher. Thirty years later, this same design
started appearing on commercial aircraft.
Now, in my work, before I attempt any construction, I test-run the equipment in my
imagination. I visualize my designs being used in every possible situation, with different sizes
and breeds of cattle and in different weather conditions. Doing this enables me to correct
mistakes prior to construction. Today, everyone is excited about the new virtual reality
computer systems in which the user wears special goggles and is fully immersed in video game
action. To me, these systems are like crude cartoons. My imagination works like the computer
graphics programs that created the lifelike dinosaurs in Jurassic Park. When I do an equipment
simulation in my imagination or work on an engineering problem, it is like seeing it on a
videotape in my mind. I can view it from any angle, placing myself above or below the
equipment and rotating it at the same time. I don't need a fancy graphics program that can
produce three-dimensional design simulations. I can do it better and faster in my head.

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I create new images all the time by taking many little parts of images I have in the video
library in my imagination and piecing them together. I have video memories of every item I've
ever worked with -- steel gates, fences, latches, concrete walls, and so forth. To create new
designs, I retrieve bits and pieces from my memory and combine them into a new whole. My
design ability keeps improving as I add more visual images to my library. I add video-like
images from either actual experiences or translations of written information into pictures. I can
visualize the operation of such things as squeeze chutes, truck loading ramps, and all different
types of livestock equipment. The more I actually work with cattle and operate equipment, the
stronger my visual memories become.
I first used my video library in one of my early livestock design projects, creating a dip vat and
cattle-handling facility for John Wayne's Red River feed yard in Arizona. A dip vat is a long,
narrow, seven-foot-deep swimming pool through which cattle move in single file. It is filled
with pesticide to rid the animals of ticks, lice, and other external parasites. In 1978, existing
dip vat designs were very poor. The animals often panicked because they were forced to slide
into the vat down a steep, slick concrete decline. They would refuse to jump into the vat, and
sometimes they would flip over backward and drown. The engineers who designed the slide
never thought about why the cattle became so frightened.
The first thing I did when I arrived at the feedlot was to put myself inside the cattle's heads
and look out through their eyes. Because their eyes are on the sides of their heads, cattle have
wide-angle vision, so it was like walking through the facility with a wide-angle video camera. I
had spent the past six years studying how cattle see their world and watching thousands move
through different facilities all over Arizona, and it was immediately obvious to me why they
were scared. Those cattle must have felt as if they were being forced to jump down an airplane
escape slide into the ocean.
Cattle are frightened by high contrasts of light and dark as well as by people and objects that
move suddenly. I've seen cattle that were handled in two identical facilities easily walk through
one and balk in the other. The only difference between the two facilities was their orientation
to the sun. The cattle refused to move through the chute where the sun cast harsh shadows
across it. Until I made this observation, nobody in the feedlot industry had been able to explain
why one veterinary facility worked better than the other. It was a matter of observing the
small details that made a big difference. To me, the dip vat problem was even more obvious.
My first step in designing a better system was collecting all the published information on
existing dip vats. Before doing anything else, I always check out what is considered state-of-
the-art so I don't waste time reinventing the wheel. Then I turned to livestock publications,
which usually have very limited information, and my library of video memories, all of which
contained bad designs. From experience with other types of equipment, such as unloading
ramps for trucks, I had learned that cattle willingly walk down a ramp that has cleats to
provide secure, non slip footing. Sliding causes them to panic and back up. The challenge was
to design an entrance that would encourage the cattle to walk in voluntarily and plunge into
the water, which was deep enough to submerge them completely, so that all the bugs,
including those that collect in their ears, would be eliminated.
I started running three-dimensional visual simulations in my imagination. I experimented with
different entrance designs and made the cattle walk through them in my imagination. Three
images merged to form the final design: a memory of a dip vat in Yuma, Arizona, a portable
vat I had seen in a magazine, and an entrance ramp I had seen on a restraint device at the
Swift meat-packing plant in Tolleson, Arizona. The new dip vat entrance ramp was a modified
version of the ramp I had seen there. My design contained three features that had never been
used before: an entrance that would not scare the animals, an improved chemical filtration
system, and the use of animal behavior principles to prevent the cattle from becoming
overexcited when they left the vat.
The first thing I did was convert the ramp from steel to concrete. The final design had a
concrete ramp on a twenty five-degree downward angle. Deep grooves in the concrete
provided secure footing. The ramp appeared to enter the water gradually, but in reality it
abruptly dropped away below the water's surface. The animals could not see the drop-off
because the dip chemicals colored the water. When they stepped out over the water, they
quietly fell in, because their center of gravity had passed the point of no return.

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Before the vat was built, I tested the entrance design many times in my imagination. Many of
the cowboys at the feedlot were skeptical and did not believe my design would work. After it
was constructed, they modified it behind my back, because they were sure it was wrong. A
metal sheet was installed over the non slip ramp, converting it back to an old-fashioned slide
entrance. The first day they used it, two cattle drowned because they panicked and flipped
over backward.
When I saw the metal sheet, I made the cowboys take it out. They were flabbergasted when
they saw that the ramp now worked perfectly. Each calf stepped out over the steep drop-off
and quietly plopped into the water. I fondly refer to this design as "cattle walking on water."
Over the years, I have observed that many ranchers and cattle feeders think that the only way
to induce animals to enter handling facilities is to force them in. The owners and managers of
feedlots sometimes have a hard time comprehending that if devices such as dip vats and
restraint chutes are properly designed, cattle will voluntarily enter them. I can imagine the
sensations the animals would feel. If I had a calf's body and hooves, I would be very scared to
step on a slippery metal ramp.
There were still problems I had to resolve after the animals left the dip vat. The platform
where they exit is usually divided into two pens so that cattle can dry on one side while the
other side is being filled. No one understood why the animals coming out of the dip vat would
sometimes become excited, but I figured it was because they wanted to follow their drier
buddies, not unlike children divided from their classmates on a playground. I installed a solid
fence between the two pens to prevent the animals on one side from seeing the animals on the
other side. It was a very simple solution, and it amazed me that nobody had ever thought of it
before.
The system I designed for filtering and cleaning the cattle hair and other gook out of the dip
vat was based on a swimming pool filtration system. My imagination scanned two specific
swimming pool filters that I had operated, one on my Aunt Brecheen's ranch in Arizona and
one at our home. To prevent water from splashing out of the dip vat, I copied the concrete
coping overhang used on swimming pools. That idea, like many of my best designs, came to
me very clearly just before I drifted off to sleep at night.
Being autistic, I don't naturally assimilate information that most people take for granted.
Instead, I store information in my head as if it were on a CD-ROM disc. When I recall
something I have learned, I replay the video in my imagination. The videos in my memory are
always specific; for example, I remember handling cattle at the veterinary chute at Producer's
Feedlot or McElhaney Cattle Company. I remember exactly how the animals behaved in that
specific situation and how the chutes and other equipment were built. The exact construction
of steel fenceposts and pipe rails in each case is also part of my visual memory. I can run
these images over and over and study them to solve design problems.
If I let my mind wander, the video jumps in a kind of free association from fence construction
to a particular welding shop where I've seen posts being cut and Old John, the welder, making
gates. If I continue thinking about Old John welding a gate, the video image changes to a
series of short scenes of building gates on several projects I've worked on. Each video memory
triggers another in this associative fashion, and my daydreams may wander far from the
design problem. The next image may be of having a good time listening to John and the
construction crew tell war stories, such as the time the backhoe dug into a nest of rattlesnakes
and the machine was abandoned for two weeks because everybody was afraid to go near it.
This process of association is a good example of how my mind can wander off the subject.
People with more severe autism have difficulty stopping endless associations. I am able to stop
them and get my mind back on track. When I find my mind wandering too far away from a
design problem I am trying to solve, I just tell myself to get back to the problem.
Interviews with autistic adults who have good speech and are able to articulate their thought
processes indicate that most of them also think in visual images. More severely impaired
people, who can speak but are unable to explain how they think, have highly associational
thought patterns. Charles Hart, the author of "Without Reason", a book about his autistic son
and brother, sums up his son's thinking in one sentence: "Ted's thought processes aren't
logical, they're associational." This explains'~ Ted's statement "I'm not afraid of planes. That's
why they fly so high." In his mind, planes fly high because he is not afraid of them; he
combines two pieces of information, that planes fly high and that he is not afraid of heights.

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Another indicator of visual thinking as the primary method of processing information is the
remarkable ability many autistic people exhibit in solving jigsaw puzzles, finding their way
around a city, or memorizing enormous amounts of information at a glance. My own thought
patterns are similar to those described by A. R. Luria in The Mind of a Mnemonist. This book
describes a man who worked as a newspaper reporter and could perform amazing feats of
memory. Like me, the mnemonist had a visual image for everything he had heard or read.
Luria writes, "For when he heard or read a word, it was at once converted into a visual image
corresponding with the object the word signified for him." The great inventor Nikola Tesla was
also a visual thinker. When he designed electric turbines for power generation, he built each
turbine in his head. He operated it in his imagination and corrected faults. He said it did not
matter whether the turbine was tested in his thoughts or in his shop; the results would be the
same.
Early in my career I got into fights with other engineers at meat-packing plants. I couldn't
imagine that they could be so stupid as not to see the mistakes on the drawing before the
equipment was installed. Now I realize it was not stupidity but a lack of visualization skills.
They literally could not see. I was fired from one company that manufactured meat-packing
plant equipment because I fought with the engineers over a design which eventually caused
the collapse of an overhead track that moved 1,200-pound beef carcasses from the end of a
conveyor. As each carcass came off the conveyor, it dropped about three feet before it was
abruptly halted by a chain attached to a trolley on the overhead track. The first time the
machine was run, the track was pulled out of the ceiling. The employees fixed it by bolting it
more securely and installing additional brackets. This only solved the problem temporarily,
because the force of the carcasses jerking the chains was so great. Strengthening the
overhead track was treating a symptom of the problem rather than its cause. I tried to warn
them. It was like bending a paper clip back and forth too many times. After a while it breaks.

Different Ways of Thinking

The idea that people have different thinking patterns is not new. Francis Galton, in Inquiries
into Human Faculty and Development, wrote that while some people see vivid mental pictures,
for others "the idea is not felt to be mental pictures, but rather symbols of facts. In people
with low pictorial imagery, they would remember their breakfast table but they could not see
it.''
It wasn't until I went to college that I realized some people are completely verbal and think
only in words. I first suspected this when I read an article in a science magazine about the
development of tool use in prehistoric humans. Some renowned scientist speculated that
humans had to develop language before they could develop tools. I thought this was
ridiculous, and this article gave me the first inkling that my thought processes were truly
different from those of many other people. When I invent things, I do not use language. Some
other people think in vividly detailed pictures, but most think in a combination of words and
vague, generalized pictures.
For example, many people see a generalized generic church rather than specific churches and
steeples when they read or hear the word "steeple." Their thought patterns move from a
general concept to specific examples. I used to become very frustrated when a verbal thinker
could not understand something I was trying to express because he or she couldn't see the
picture that was crystal clear to me. Further, my mind constantly revises general concepts as I
add new information to my memory library. It's like getting a new version of software for the
computer. My mind readily accepts the new "software," though I have observed that some
people often do not readily accept new information.
Unlike those of most people, my thoughts move from video like, specific images to
generalization and concepts. For example, my concept of dogs is inextricably linked to every
dog I've ever known. It's as if I have a card catalog of dogs I have seen, complete with
pictures, which continually grows as I add more examples to my video library. If I think about
Great Danes, the first memory that pops into my head is Dansk, the Great Dane owned by the
headmaster at my high school. The next Great Dane I visualize is Helga, who was Dansk's
replacement. The next is my aunt's dog in Arizona, and my final image comes from an
advertisement for Fitwell seat covers that featured that kind of dog. My memories usually

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appear in my imagination in strict chronological order, and the images I visualize are always
specific. There is no generic, generalized Great Dane.
However, not all people with autism are highly visual thinkers, nor do they all process
information this way. People throughout the world are on a continuum of visualization skills
ranging from next to none, to seeing vague generalized pictures, to seeing semi-specific
pictures, to seeing, as in my case, in very specific pictures.
I'm always forming new visual images when I invent new equipment or think of something
novel and amusing. I can take images that I have seen, rearrange them, and create new
pictures. For example, I can imagine what a dip vat would look like modeled on computer
graphics by placing it on my memory of a friend's computer screen. Since his computer is not
programmed to do the fancy 3-D rotary graphics, I take computer graphics I have seen on TV
or in the movies and superimpose them in my memory. In my visual imagination the dip vat
will appear in the kind of high quality computer graphics shown on Star Trek. I can then take a
specific dip vat, such as the one at Red River, and redraw it on the computer screen in my
mind. I can even duplicate the cartoonlike, three-dimensional skeletal image on the computer
screen or imagine the dip vat as a videotape of the real thing.
Similarly, I learned how to draw engineering designs by closely observing a very talented
draftsman when we worked together at the same feed yard construction company. David was
able to render the most fabulous drawings effortlessly. After I left the company, I was forced
to do all my own drafting. By studying David's drawings for many hours and photographing
them in my memory, I was actually able to emulate David's drawing style. I laid some of his
drawings out so I could look at them while I drew my first design. Then I drew my new plan
and copied his style. After making three or four drawings, I no longer had to have his drawings
out on the table. My video memory was now fully programmed. Copying designs is one thing,
but after I drew the Red River drawings, I could not believe I had done them. At the time, I
thought they were a gift from God. Another factor that helped me to learn to draw well was
something as simple as using the same tools that David used. I used the same brand of pencil,
and the ruler and straight edge forced me to slow down and trace the visual images in my
imagination.
My artistic abilities became evident when I was in first and second grade. I had a good eye for
color and painted watercolors of the beach. One time in fourth grade I modeled a lovely horse
from clay. I just did it spontaneously, though I was not able to duplicate it. In high school and
college I never attempted engineering drawing, but I learned the value of slowing down while
drawing during a college art class. Our assignment had been to spend two hours drawing a
picture of one of our shoes. The teacher insisted that the entire two hours be spent drawing
that one shoe. I was amazed at how well my drawing came out. While my initial attempts at
drafting were terrible, when I visualized myself as David, the draftsman, I'd automatically slow
down.

Processing Nonvisual Information

Autistics have problems learning things that cannot be thought about in pictures. The easiest
words for an autistic child to learn are nouns, because they directly relate to pictures. Highly
verbal autistic children like I was can sometimes learn how to read with phonics. Written words
were too abstract for me to remember, but I could laboriously remember the approximately
fifty phonetic sounds and a few rules. Lower-functioning children often learn better by
association, with the aid of word labels attached to objects in their environment. Some very
impaired autistic children learn more easily if words are spelled out with plastic letters they can
feel.
Spatial words such as "over" and "under" had no meaning for me until I had a visual image to
fix them in my memory. Even now, when I hear the word "under" by itself, I automatically
picture myself getting under the cafeteria tables at school during an air-raid drill, a common
occurrence on the East Coast during the early fifties. The first memory that any single word
triggers is almost always a childhood memory. I can remember the teacher telling us to be
quiet and walking single-file into the cafeteria, where six or eight children huddled under each
table. If I continue on the same train of thought, more and more associative memories of
elementary school emerge. I can remember the teacher scolding me after I hit Alfred for

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putting dirt on my shoe. All of these memories play like videotapes in the VCR in my
imagination. If I allow my mind to keep associating, it will wander a million miles away from
the word "under," to submarines under the Antarctic and the Beatles song "Yellow Submarine."
If I let my mind pause on the picture of the yellow submarine, I then hear the song. As I start
humming the song and get to the part about people coming on board, my association switches
to the gangway of a ship I saw in Australia.
I also visualize verbs. The word "jumping" triggers a memory of jumping hurdles at the mock
Olympics held at my elementary school. Adverbs often trigger inappropriate images --
"quickly" reminds me of Nestle's Quik -- unless they are paired with a verb, which modifies my
visual image. For example, "he ran quickly" triggers an animated image of Dick from the first-
grade reading book running fast, and "he walked slowly" slows the image down. As a child, I
left out words such as "is," "the," and "it," because they had no meaning by themselves.
Similarly, words like "of," and "an" made no sense. Eventually I learned how to use them
properly, because my parents always spoke correct English and I mimicked their speech
patterns. To this day certain verb conjugations, such as "to be," are absolutely meaningless to
me.
When I read, I translate written words into color movies or I simply store a photo of the
written page to be read later. When I retrieve the material, I see a photocopy of the page in
my imagination. I can then read it like a Teleprompter. It is likely that Raymond, the autistic
savant depicted in the movie Rain Man, used a similar strategy to memorize telephone books,
maps, and other information. He simply photocopied each page of the phone book into his
memory. When he wanted to find a certain number, he just scanned pages of the phone book
that were in his mind. To pull information out of my memory, I have to replay the video.
Pulling facts up quickly is sometimes difficult, because I have to play bits of different videos
until I find the right tape. This takes time.
When I am unable to convert text to pictures, it is usually because the text has no concrete
meaning. Some philosophy books and articles about the cattle futures market are simply
incomprehensible. It is much easier for me to understand written text that describes
something that can be easily translated into pictures. The following sentence from a story in
the February 21, 1994, issue of Time magazine, describing the Winter Olympics figure-skating
championships, is a good example: "All the elements are in place -- the spotlights, the swelling
waltzes and jazz tunes, the sequined sprites taking to the air." In my imagination I see the
skating rink and skaters. However, if I ponder too long on the word "elements," I will make the
inappropriate association of a periodic table on the wall of my high school chemistry
classroom. Pausing on the word "sprite" triggers an image of a Sprite can in my refrigerator
instead of a pretty young skater.
Teachers who work with autistic children need to understand associative thought patterns. An
autistic child will often use a word in an inappropriate manner. Sometimes these uses have a
logical associative meaning and other times they don't. For example, an autistic child might
say the word "dog" when he wants to go outside. The word "dog" is associated with going
outside. In my own case, I can remember both logical and illogical use of inappropriate words.
When I was six, I learned to say "prosecution." I had absolutely no idea what it meant, but it
sounded nice when I said it, so I used it as an exclamation every time my kite hit the ground. I
must have baffled more than a few people who heard me exclaim "Prosecution!" to my
downward-spiraling kite.
Discussions with other autistic people reveal similar visual styles of thinking about tasks that
most people do sequentially. An autistic man who composes music told me that he makes
"sound pictures" using small pieces of other music to create new compositions. A computer
programmer with autism told me that he sees the general pattern of the program tree. After
he visualizes the skeleton for the program, he simply writes the code for each branch. I use
similar methods when I review scientific literature and troubleshoot at meat plants. I take
specific findings or observations and combine them to find new basic principles and general
concepts.
My thinking pattern always starts with specifics and works toward generalization in an
associational and nonsequential way. As if I were attempting to figure out what the picture on
a jigsaw puzzle is when only one third of the puzzle is completed, I am able to fill in the
missing pieces by scanning my video library. Chinese mathematicians who can make large

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calculations in their heads work the same way. At first they need an abacus, the Chinese
calculator, which consists of rows of beads on wires in a frame. They make calculations by
moving the rows of beads. When a mathematician becomes really skilled, he simply visualizes
the abacus in his imagination and no longer needs a real one. The beads move on a visualized
video abacus in his brain.

Abstract Thought
Growing up, I learned to convert abstract ideas into pictures as a way to understand them. I
visualized concepts such as peace or honesty with symbolic images. I thought of peace as a
dove, an Indian peace pipe, or TV or newsreel footage of the signing of a peace agreement.
Honesty was represented by an image of placing one's hand on the Bible in court. A news
report describing a person returning a wallet with all the money in it provided a picture of
honest behavior.
The Lord's Prayer was incomprehensible until I broke it down into specific visual images. The
power and the glory were represented by a semicircular rainbow and an electrical tower. These
childhood visual images are still triggered every time I hear the Lord's Prayer. The words "thy
will be done" had no meaning when I was a child, and today the meaning is still vague. Will is
a hard concept to visualize. When I think about it, I imagine God throwing a lightning bolt.
Another adult with autism wrote that he visualized "Thou art in heaven" as God with an easel
above the clouds. "Trespassing" was pictured as black and orange NO TRESPASSING signs.
The word "Amen" at the end of the prayer was a mystery: a man at the end made no sense.
As a teenager and young adult I had to use concrete symbols to understand abstract concepts
such as getting along with people and moving on to the next steps of my life, both of which
were always difficult. I knew I did not fit in with my high school peers, and I was unable to
figure out what I was doing wrong. No matter how hard I tried, they made fun of me. They
called me "workhorse," "tape recorder," and "bones" because I was skinny. At the time I was
able to figure out why they~ called me "workhorse" and "bones," but "tape recorder" puzzled
me. Now I realize that I must have sounded like a tape recorder when I repeated things
verbatim over and over. But back then I just could not figure out why I was such a social dud.
I sought refuge in doing things I was good at, such as working on reroofing the barn or
practicing my riding prior to a horse show. Personal relationships made absolutely no sense to
me until I developed visual symbols of doors and windows. It was then that I started to
understand concepts such as learning the give-and-take of a relationship. I still wonder what
would have happened to me if I had not been able to visualize my way in the world.
The really big challenge for me was making the transition from high school to college. People
with autism have tremendous difficulty with change. In order to deal with a major change such
as leaving high school, I needed a way to rehearse it, acting out each phase in my life by
walking through an actual door, window, or gate. When I was graduating from high school, I
would go and sit on the roof of my dormitory and look up at the stars and think about how I
would cope with leaving. It was there I discovered a little door that led to a bigger roof while
my dormitory was being remodeled. While I was still living in this o1d New England house, a
much larger building was being constructed over it. One day the carpenters tore out a section
of the o1d roof next to my room. When I walked out, I was now able to look up into the
partially finished new building. High on one side was a small wooden door that led to the new
roof. The building was changing and it was now time for me to change too. I could relate to
that. I had found the symbolic key.
When I was in college, I found another door to symbolize getting ready for graduation. It was
a small metal trap door that went out onto the flat roof of the dormitory. I had to actually
practice going through this door many times. When I finally graduated from Franklin Pierce, I
walked through a third, very important door, on the library roof.
I no longer use actual physical doors or gates to symbolize each transition in my life. When I
reread years of diary entries while writing this book, a clear pattern emerged. Each door or
gate enabled me to move on to the next level. My life was a series of incremental steps. I am
often asked what the single breakthrough was that enabled me to adapt to autism. There was
no single breakthrough. It was a series of incremental improvements. My diary entries show

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very clearly that I was fully aware that when I mastered one door, it was only one step in a
whole series.
April 22, 1970

Today everything is completed at Franklin Pierce College and it is now time to

walk through the little door in the library. I ponder now about what I should
leave as a message on the library roof for future people to find. I have reached
the top of one step and I am now at the bottom step of graduate school. For
the top of the building is the highest point on campus and I have gone as far as
I can go now. I have conquered the summit of FPC. Higher ones still remain
unchallenged. - Class 70

I went through the little door tonight and placed the plaque on the top of the
library roof. I was not as nervous this time. I had been much more nervous in
the past. Now I have already made it and the little door and the mountain had
already been climbed. The conquering of this mountain is only the beginning for
the next mountain.

The word commencement means beginning and the top of the library is the
beginning of graduate school. It is human nature to strive, and this is why
people will climb mountains. The reason why is that people strive to prove that
they could do it.

After all, why should we send a man to the moon? The only real justification is
that it is human nature to keep striving out. Man is never satisfied with one
goal he keeps reaching. The real reason for going to the library roof was to
prove that I could do it.
During my life I have been faced with five or six major doors or gates to go through. I
graduated from Franklin Pierce, a small liberal arts college, in 1970, with a degree in
psychology, and moved to Arizona to get a Ph.D. As I found myself getting less interested in
psychology and more interested in cattle and animal science, I prepared myself for another big
change in my life -- switching from a psychology major to an animal science major. On May 8,
1971, I wrote:
I feel as if I am being pulled more and more in the farm direction. I walked
through the cattle chute gate but I am still holding on tightly to the gate post.
The wind is blowing harder and harder and I feel that I will let go of the gate
post and go back to the farm; at least for a while. Wind has played an
important part in many of the doors. On the roof, the wind was blowing. Maybe
this is a symbol that the next level that is reached is not ultimate and that I
must keep moving on. At the party [a psychology department party] I felt
completely out of place and it seems as if the wind is causing my hands to slip
from the gate post so that I can ride free on the wind.
At that time I still struggled in the social arena, largely because I didn't have a concrete visual
corollary for the abstraction known as "getting along with people." An image finally presented
itself to me while I was washing the bay window in the cafeteria (students were required to do
jobs in the dining room). I had no idea my job would take on symbolic significance when I
started. The bay window consisted of three glass sliding doors enclosed by storm windows. To
wash the inside of the bay window, I had to crawl through the sliding door. The door jammed
while I was washing the inside panes, and I was imprisoned between the two windows. In
order to get out without shattering the door, I had to ease it back very carefully. It struck me
that relationships operate the same way. They also shatter easily and have to be approached
carefully. I then made a further association about how the careful opening of doors was related
to establishing relationships in the first place. While I was trapped between the windows, it

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was almost impossible to communicate through the glass. Being autistic is like being trapped
like this. The windows symbolized my feelings of disconnection from other people and helped
me cope with the isolation. Throughout my life, door and window symbols have enabled me to
make progress and connections that are unheard of for some people with autism.
In more severe cases of autism, the symbols are harder to understand and often appear to be
totally unrelated to the things they represent. D. Park and P. Youderian described the use of
visual symbols and numbers by Jessy Park, then a twelve-year-old autistic girl, to describe
abstract concepts such as good and bad. Good things, such as rock music, were represented
by drawings of four doors and no clouds. Jessy rated most classical music as pretty good,
drawing two doors and two clouds. The spoken word was rated as very bad, with a rating of
zero doors and four clouds. She had formed a visual rating system using doors and clouds to
describe these abstract qualities. Jessy also had an elaborate system of good and bad
numbers, though researchers have not been able to decipher her system fully.
Many people are totally baffled by autistic symbols, but to an autistic person they may provide
the only tangible reality or understanding of the world. For example, "French toast" may mean
happy if the child was happy while eating it. When the child visualizes a piece of French toast,
he becomes happy. A visual image or word becomes associated with an experience. Clara
Park, Jessy's mother, described her daughter's fascination with objects such as electric blanket
controls and heaters. She had no idea why the objects were so important to Jessy, though she
did observe that Jessy was happiest, and her voice was no longer a monotone, when she was
thinking about her special things. Jessy was able to talk, but she was unable to tell people why
her special things were important. Perhaps she associated electric blanket controls and heaters
with warmth and security. The word "cricket" made her happy, and "partly heard song" meant
"I don't know." The autistic mind works via these visual associations. At some point in Jessy's
life, a partly heard song was associated with not knowing.
Ted Hart, a man with severe autism, has almost no ability to generalize and no flexibility in his
behavior. His father, Charles, described how on one occasion Ted put wet clothes in the
dresser after the dryer broke. He just went on to the next step in a clothes-washing sequence
that he had learned by rote. He has no common sense. I would speculate that such rigid
behavior and lack of ability to generalize may be partly due to having little or no ability to
change or modify visual memories. Even though my memories of things are stored as
individual specific memories, I am able to modify my mental images. For example, I can
imagine a church painted in different colors or put the steeple of one church onto the roof of
another; but when I hear somebody say the word "steeple," the first church that I see in my
imagination is almost always a childhood memory and not a church image that I have
manipulated. This ability to modify images in my imagination helped me to learn how to
generalize.
Today, I no longer need door symbols. Over the years I have built up enough real experiences
and information from articles and books I have read to be able to make changes and take
necessary steps as new situations present themselves. Plus, I have always been an avid
reader, and I am driven to take in more and more information to add to my video library. A
severely autistic computer programmer once said that reading was "taking in information." For
me, it is like programming a computer.

Visual Thinking and Mental Imagery

Recent studies of patients with brain damage and of brain imaging indicate that visual and
verbal thought may work via different brain systems. Recordings of blood flow in the brain
indicate that when a person visualizes something such as walking through his neighborhood,
blood flow increases dramatically in the visual cortex, in parts of the brain that are working
hard. Studies of brain-damaged patients show that injury to the left posterior hemisphere can
stop the generation of visual images from stored long-term memories, while language and
verbal memory are not impaired. This indicates that visual imagery and verbal thought may
depend on distinct neurological systems.
The visual system may also contain separate subsystems for mental imagery and image
rotation. Image rotation skills appear to be located on the right side of the brain, whereas
visual imagery is in the left rear of the brain. In autism, it is possible that the visual system

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has expanded to make up for verbal and sequencing deficits. The nervous system has a
remarkable ability to compensate when it is damaged. Another part can take over for a
damaged part.
Recent research by Dr. Pascual-Leone at the National Institutes of Health indicates that
exercising a visual skill can make the brain's motor map expand. Research with musicians
indicates that real practice on the piano and imagining playing the piano have the same effect
on motor maps, as measured by brain scans. The motor maps expand during both real piano
playing and mental imagery; random pushing of the keys has no effect. Athletes have also
found that both mental practice and real practice can improve a motor skill. Research with
patients with damage to the hippocampus has indicated that conscious memory of events and
motor learning are separate neurological systems. A patient with hippocampal damage can
learn a motor task and get better with practice, but each time he practices he will have no
conscious memory of doing the task. The motor circuits become trained, but damage to the
hippocampus prevents the formation of new conscious memories. Therefore, the motor circuits
learn a new task, such as solving a simple mechanical puzzle, but the person does not
remember seeing or doing the puzzle. With repeated practice, the person gets better and
better at it, but each time the puzzle is presented, he says he has never seen it before.
I am fortunate in that I am able to build on my library of images and visualize solutions based
on those pictures. However, most people with autism lead extremely limited lives, in part
because they cannot handle any deviation from their routine. For me, every experience builds
on the visual memories I carry from prior experience, and in this way my world continues to
grow.
About two years ago I made a personal breakthrough when I was hired to remodel a meat
plant that used very cruel restraint methods during kosher slaughter. Prior to slaughter, live
cattle were hung upside down by a chain attached to one back leg. It was so horrible I could
not stand to watch it. The frantic bellows of terrified cattle could be heard in both the office
and the parking lot. Sometimes an animal's back leg was broken during hoisting. This dreadful
practice totally violated the humane intent of kosher slaughter. My job was to rip out this cruel
system and replace it with a chute that would hold the animal in a standing position while the
rabbi performed kosher slaughter. Done properly, the animal should remain calm and would
not be frightened.
The new restraining chute was a narrow metal stall which held one steer. It was equipped with
a yoke to hold the animal's head, a rear pusher gate to nudge the steer forward into the yoke,
and a belly restraint which was raised under the belly like an elevator. To operate the
restrainer, the operator had to push six hydraulic control levers in the proper sequence to
move the entrance and discharge gates as well as the head- and body-positioning devices. The
basic design of this chute had been around for about thirty years, but I added pressure-
regulating devices and changed some critical dimensions to make it more comfortable for the
animal and to prevent excessive pressure from being applied.
Prior to actually operating the chute at the plant, I ran it in the machine shop before it was
shipped. Even though no cattle were present, I was able to program my visual and tactile
memory with images of operating the chute. After running the empty chute for five minutes, I
had accurate mental pictures of how the gates and other parts of the apparatus moved. I also
had tactile memories of how the levers on this particular chute felt when pushed. Hydraulic
valves are like musical instruments; different brands of valves have a different feel, just as
different types of wind instruments do. Operating the controls in the machine shop enabled me
to practice later via mental imagery. I had to visualize the actual controls on the chute and, in
my imagination, watch my hands pushing the levers. I could feel in my mind how much force
was needed to move the gates at different speeds. I rehearsed the procedure many times in
my mind with different types of cattle entering the chute.
On the first day of operation at the plant, I was able to walk up to the chute and run it almost
perfectly. It worked best when I operated the hydraulic levers unconsciously, like using my
legs for walking. If I thought about the levers, I got all mixed up and pushed them the wrong
way. I had to force myself to relax and just allow the restrainer to become part of my body,
while completely forgetting about the levers. As each animal entered, I concentrated on
moving the apparatus slowly and gently so as not to scare him. I watched his reactions so that
I applied only enough pressure to hold him snugly. Excessive pressure would cause discomfort.

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If his ears were laid back against his head or he struggled, I knew I had squeezed him too
hard. Animals are very sensitive to hydraulic equipment. They feel the smallest movement of
the control levers.
Through the machine I reached out and held the animal. When I held his head in the yoke, I
imagined placing my hands on his forehead and under his chin and gently easing him into
position. Body boundaries seemed to disappear, and I had no awareness of pushing the levers.
The rear pusher gate and head yoke became an extension of my hands.
People with autism sometimes have body boundary problems. They are unable to judge by feel
where their body ends and the chair they are sitting on or the object they are holding begins,
much like what happens when a person loses a limb but still experiences the feeling of the limb
being there. In this case, the parts of the apparatus that held the animal felt as if they were a
continuation of my own body, similar to the phantom limb effect. If I just concentrated on
holding the animal gently and keeping him calm, I was able to run the restraining chute very
skillfully.
During this intense period of concentration I no longer heard noise from the plant machinery. I
didn't feel the sweltering Alabama summer heat, and everything seemed quiet and serene. It
was almost a religious experience. It was my job to hold the animal gently, and it was the
rabbi's job to perform the final deed. I was able to look at each animal, to hold him gently and
make him as comfortable as possible during the last moments of his life. I had participated in
the ancient slaughter ritual the way it was supposed to be. A new door had been opened. It
felt like walking on water.

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Teaching Tips for Children and Adults with

Autism
Temple Grandin, Ph.D.
Assistant Professor
Colorado State University
Fort Collins, CO 80523, USA
(Revised: December 2002)
Good teachers helped me to achieve success. I was able to overcome autism because I had
good teachers. At age 2 1/2 I was placed in a structured nursery school with experienced
teachers. From an early age I was taught to have good manners and to behave at the dinner
table. Children with autism need to have a structured day, and teachers who know how to be
firm but gentle.
Between the ages of 2 1/4 and 5 my day was structured, and I was not allowed to tune out. I
had 45 minutes of one-to-one speech therapy five days a week, and my mother hired a nanny
who spent three to four hours a day playing games with me and my sister. She taught 'turn
taking' during play activities. When we made a snowman, she had me roll the bottom ball; and
then my sister had to make the next part. At mealtimes, every-body ate together; and I was
not allowed to do any "stims." The only time I was allowed to revert back to autistic behavior
was during a one-hour rest period after lunch. The combination of the nursery school, speech
therapy, play activities, and "miss manners" meals added up to 40 hours a week, where my
brain was kept connected to the world.
1.) Many people with autism are visual thinkers. I think in pictures. I do not think in language.
All my thoughts are like videotapes running in my imagination. Pictures are my first language,
and words are my second language. Nouns were the easiest words to learn because I could
make a picture in my mind of the word. To learn words like "up" or "down," the teacher should
demonstrate them to the child. For example, take a toy airplane and say "up" as you make the
airplane takeoff from a desk. Some children will learn better if cards with the words "up" and
"down" are attached to the toy airplane. The "up" card is attached when the plane takes off.
The "down" card is attached when it lands.
2.) Avoid long strings of verbal instructions. People with autism have problems with
remembering the sequence. If the child can read, write the instructions down on a piece of
paper. I am unable to remember sequences. If I ask for directions at a gas station, I can only
remember three steps. Directions with more than three steps have to be written down. I also
have difficulty remembering phone numbers because I cannot make a picture in my mind.
3.) Many children with autism are good at drawing, art and computer programming. These
talent areas should be encouraged. I think there needs to be much more emphasis on
developing the child's talents. Talents can be turned into skills that can be used for future
employment.
4.) Many autistic children get fixated on one subject such as trains or maps. The best way to
deal with fixations is to use them to motivate school work. If the child likes trains, then use
trains to teach reading and math. Read a book about a train and do math problems with trains.
For example, calculate how long it takes for a train to go between New York and Washington.
5.) Use concrete visual methods to teach number concepts. My parents gave me a math toy
which helped me to learn numbers. It consisted of a set of blocks which had a different length
and a different color for the numbers one through ten. With this I learned how to add and
subtract. To learn fractions my teacher had a wooden apple that was cut up into four pieces
and a wooden pear that was cut in half. From this I learned the concept of quarters and
halves.
6.) I had the worst handwriting in my class. Many autistic children have problems with motor
control in their hands. Neat handwriting is sometimes very hard. This can totally frustrate the

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child. To reduce frustration and help the child to enjoy writing, let him type on the computer.
Typing is often much easier.
7.) Some autistic children will learn reading more easily with phonics, and others will learn
best by memorizing whole words. I learned with phonics. My mother taught me the phonics
rules and then had me sound out my words. Children with lots of echolalia will often learn best
if flash cards and picture books are used so that the whole words are associated with pictures.
It is important to have the picture and the printed word on the same side of the card. When
teaching nouns the child must hear you speak the word and view the picture and printed word
simultaneously. An example of teaching a verb would be to hold a card that says "jump," and
you would jump up and down while saying "jump."
8.) When I was a child, loud sounds like the school bell hurt my ears like a dentist drill hitting
a nerve. Children with autism need to be protected from sounds that hurt their ears. The
sounds that will cause the most problems are school bells, PA systems, buzzers on the score
board in the gym, and the sound of chairs scraping on the floor. In many cases the child will
be able to tolerate the bell or buzzer if it is muffled slightly by stuffing it with tissues or duct
tape. Scraping chairs can be silenced by placing slit tennis balls on the ends of the legs or
installing carpet. A child may fear a certain room because he is afraid he may be suddenly
subjected to squealing microphone feedback from the PA system. The fear of a dreaded sound
can cause bad behavior. If a child covers his ears, it is an indicator that a certain sound hurts
his ears. Sometimes sound sensitivity to a particular sound, such as the fire alarm, can be
desensitized by recording the sound on a tape recorder. This will allow the child to initiate the
sound and gradually increase its volume. The child must have control of playback of the sound.
9.) Some autistic people are bothered by visual distractions and fluorescent lights. They can
see the flicker of the 60-cycle electricity. To avoid this problem, place the child's desk near the
window or try to avoid using fluorescent lights. If the lights cannot be avoided, use the newest
bulbs you can get. New bulbs flicker less. The flickering of fluorescent lights can also be
reduced by putting a lamp with an old-fashioned incandescent light bulb next to the child's
desk.
10.) Some hyperactive autistic children who fidget all the time will often be calmer if they are
given a padded weighted vest to wear. Pressure from the garment helps to calm the nervous
system. I was greatly calmed by pressure. For best results, the vest should be worn for twenty
minutes and then taken off for a few minutes. This prevents the nervous system from adapting
to it.
11.) Some individuals with autism will respond better and have improved eye contact and
speech if the teacher interacts with them while they are swinging on a swing or rolled up in a
mat. Sensory input from swinging or pressure from the mat sometimes helps to improve
speech. Swinging should always be done as a fun game. It must NEVER be forced.
12.) Some children and adults can sing better than they can speak. They may respond better if
words and sentences are sung to them. Some children with extreme sound sensitivity will
respond better if the teacher talks to them in a low whisper.
13.) Some nonverbal children and adults cannot process visual and auditory input at the same
time. They are mono-channel. They cannot see and hear at the same time. They should not be
asked to look and listen at the same time. They should be given either a visual task or an
auditory task. Their immature nervous system is not able to process simultaneous visual and
auditory input.
14.) In older nonverbal children and adults touch is often their most reliable sense. It is often
easier for them to feel. Letters can be taught by letting them feel plastic letters. They can
learn their daily schedule by feeling objects a few minutes before a scheduled activity. For
example, fifteen minutes before lunch give the person a spoon to hold. Let them hold a toy car
a few minutes before going in the car.
15.) Some children and adults with autism will learn more easily if the computer key-board is
placed close to the screen. This enables the individual to simultaneously see the keyboard and
screen. Some individuals have difficulty remembering if they have to look up after they have
hit a key on the keyboard.
16.) Nonverbal children and adults will find it easier to associate words with pictures if they
see the printed word and a picture on a flashcard. Some individuals do not under-stand line

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drawings, so it is recommended to work with real objects and photos first. The picture and the
word must be on the same side of the card.
17.) Some autistic individuals do not know that speech is used for communication. Language
learning can be facilitated if language exercises promote communication. If the child asks for a
cup, then give him a cup. If the child asks for a plate, when he wants a cup, give him a plate.
The individual needs to learn that when he says words, concrete things happen. It is easier for
an individual with autism to learn that their words are wrong if the incorrect word resulted in
the incorrect object.
18.) Many individuals with autism have difficulty using a computer mouse. Try a roller ball (or
tracking ball) pointing device that has a separate button for clicking. Autistics with motor
control problems in their hands find it very difficult to hold the mouse still during clicking.
19.) Children who have difficulty understanding speech have a hard time differentiating
between hard consonant sounds such as 'D' in dog and 'L' in log. My speech teacher helped me
to learn to hear these sounds by stretching out and enunciating hard consonant sounds. Even
though the child may have passed a pure tone hearing test he may still have difficulty hearing
hard consonants. Children who talk in vowel sounds are not hearing consonants.
20.) Several parents have informed me that using the closed captions on the television helped
their child to learn to read. The child was able to read the captions and match the printed
works with spoken speech. Recording a favorite program with captions on a tape would be
helpful because the tape can be played over and over again and stopped.
21.) Some autistic individuals do not understand that a computer mouse moves the arrow on
the screen. They may learn more easily if a paper arrow that looks EXACTLY like the arrow on
the screen is taped to the mouse.
22.) Children and adults with visual processing problems can see flicker on TV type computer
monitors. They can sometimes see better on laptops and flat panel displays which have less
flicker.
23.) Children and adults who fear escalators often have visual processing problems. They fear
the escalator because they cannot determine when to get on or off. These individuals may also
not be able to tolerate fluorescent lights. The Irlen colored glasses may be helpful for them.
24.) Individuals with visual processing problems often find it easier to read if black print is
printed on colored paper to reduce contrast. Try light tan, light blue, gray, or light green
paper. Experiment with different colors. Avoid bright yellow--it may hurt the individual's eyes.
Irlen colored glasses may also make reading easier. (Click here to visit the Irlen Institute's
web site.)
25.) Teaching generalization is often a problem for children with autism. To teach a child to
generalize the principle of not running across the street, it must be taught in many different
locations. If he is taught in only one location, the child will think that the rule only applies to
one specific place.
26.) A common problem is that a child may be able to use the toilet correctly at home but
refuses to use it at school. This may be due to a failure to recognize the toilet. Hilde de Clereq
from Belgium discovered that an autistic child may use a small non-relevant detail to recognize
an object such as a toilet. It takes detective work to find that detail. In one case a boy would
only use the toilet at home that had a black seat. His parents and teacher were able to get him
to use the toilet at school by covering its white seat with black tape. The tape was then
gradually removed and toilets with white seats were now recognized as toilets.
27.) Sequencing is very difficult for individuals with severe autism. Sometimes they do not
understand when a task is presented as a series of steps. An occupational therapist
successfully taught a nonverbal autistic child to use a playground slide by walking his body
through climbing the ladder and going down the slide. It must be taught by touch and motor
rather than showing him visually. Putting on shoes can be taught in a similar manner. The
teacher should put her hands on top of the childs hands and move the childs hands over his
foot so he feels and understands the shape of his foot. The next step is feeling the inside and
the outside of a slip-on shoe. To put the shoe on, the teacher guides the childs hands to the
shoe and, using the hand-over-hand method, slides the shoe onto the childs foot. This enables
the child to feel the entire task of putting on his shoe.
28.) Fussy eating is a common problem. In some cases the child may be fixated on a detail
that identifies a certain food. Hilde de Clerq found that one child only ate Chiquita bananas

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because he fixated on the labels. Other fruit such as apples and oranges were readily accepted
when Chiquita labels were put on them. Try putting different but similar foods in the cereal box
or another package of a favorite food. Another mother had success by putting a homemade
hamburger with a wheat free bun in a McDonalds package.

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Frequently Asked Questions about Autism

Temple Grandin, Ph.D.
Assistant Professor
Colorado State University
Fort Collins, CO 80523, USA
1. How do I know if my child has problems with sensory over sensitivity?
Sounds or visual stimuli that are tolerated by normal children may cause pain, confusion
and/or fear in some autistic children. Sensory over sensitivity can vary from very slight to
severe. If your child frequently puts his hands over his ears, this is an indicator of sensitivity to
noise. Children who flick their fingers in front of their eyes are likely to have visual sensitivity
problems. Children who enjoy a trip to a large super-market or a shopping mall usually have
relatively mild sensory sensitivities. Autistic children with severe sensory sensitivities will often
have tantrums and other bad behavior in a shopping mall due to sensory overload. These
children are the ones who will most likely need environmental modifications in the classroom.
Older children and adults, who remain nonverbal and have very little language, often have
more severe sensitivities than individuals with good language. Children with auditory or visual
sensitivity will often have normal hearing and visual acuity tests. The problem is in the brain,
whereas the ears and eyes are normal.

2. What sights and sounds are most likely to cause sensory overload or confusion in
the classroom?
Every autistic child or adult is different. A sound or sight, which is painful to one autistic child,
may be attractive to another. The flicker of fluorescent lighting can be seen by some children
with autism and may be distracting to them. It is mostly likely to cause sensory overload in
children who flick their fingers in front of their eyes. Replacing fluorescents with incandescent
bulbs will be helpful for some children. Many children with autism are scared of the public
address system, the school bells or the fire alarms, because the sound hurts their ears.
Screeching electronic feedback from public address systems or the sound of fire alarms are the
worst sounds because the onset of the sound canNOT be predicted. Children with milder
hearing sensitivity can sometimes learn to tolerate hurtful sounds when they know when they
will occur. However, they may NEVER learn to tolerate UNexpected loud noise. Autistic children
with severe hearing sensitivity should be removed from the classroom prior to a fire drill. The
fear of a hurtful sound may make an autistic child fearful of a certain classroom. He may
become afraid to go into the room because he fears that the fire alarm or the public address
systems may make a hurtful sound. If possible, the buzzes or bell should be modified to
reduce the sound. Sometimes only a slight reduction in sound is required to make a buzzer or
bell tolerable. Duct tape can be applied to bells to soften the sounds. If the public address
system has frequent feedback problems, it should be disconnected.
Echoes and noise can be reduced by installing carpeting -- carpet remnants can sometimes be
obtained from a carpet store at a low cost. Scraping of chair legs on the floor can be muffled
by placing cut tennis balls on the chair legs.

3. Why does my child avoid certain foods or always want to eat the same thing?
Certain foods may be avoided due to sensory over sensitivity. Crunchy foods such as potato
chips may be too loud and sound like a raging forest fire to children with over sensitive
hearing. Certain odors may be overpowering. When I was a child I gagged when I had to eat
slimy foods like jello. However, some limited food preferences may be bad habits and are not
due to sensory problems. One has to be a careful observer to figure out which foods cause
sensory pain. For example, if a child has extreme sound sensitivity, he should not be required
to eat loud, crunchy foods; but he should be encouraged to eat a variety of softer foods. When
I was a child my parents made me eat everything except the two things which really made me
gag. They were under-cooked slimy egg whites and jello. I was allowed to have a grilled

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cheese sandwich everyday for lunch, but at dinnertime I was expected to eat everything that
was not slimy.
To motivate a child to eat something he does not like, it is recommended to have a food he
really likes such as pizza right in front of him along with the food he dislikes. He is then told
that he can have the pizza after he eats a few bites of peas. It is important to have the pizza
right there in front of him to motivate eating something he does not like.

4. How do I toilet train my autistic child?

There are two major causes of toilet training problems in children with autism. They are either
afraid of the toilet or they do not know what they are supposed to do. Children with severe
hearing sensitivity may be terrified of the toilet flushing. The sound may hurt their ears.
Sometimes these children can learn if they use a potty chair which is located away from the
frightening toilet. Due to the great variability of sensory problems, some children may like to
repeatedly flush the toilet but they are still not trained. The thinking of some autistic children
is so concrete that the only way they can learn is to have an adult demonstrate to them how to
use the toilet. They have to see someone else do it in order to learn. Some children with very
severe sensory processing problems are not able to accurately sense when they need to use
the bathroom. If they are calm they may be able to feel the sensation that they need to
urinate or defecate, but if they experience sensory overload they cannot feel it. This may
explain why a child will sometimes use the toilet correctly, and other times he will not.

5. Why do some autistic children repeat back what an adult has said or sing TV
commercials?
Repeating back what has been said, or being able to sing an entire TV commercial or children's
video is called 'echolalia.' Echolalia is actually a good sign because it indicates that the child's
brain is processing language even though he may not be understanding the meaning of the
words. These children need to learn that words are used for communication. If a child says the
word 'apple,' immediately give him an apple. This will enable the child to associate the word
'apple' with getting a real apple. Some autistic children use phrases from TV commercials or
children's videos in an appropriate manner in other situations. This is how they learn language.
For example, if a child says part of a breakfast cereal slogan at breakfast, give him the cereal.
Autistic children also use echolalia to verify what has been said. Some children have difficulty
hearing hard consonant sounds such as "d" in dog or "b" in boy. Repeating the phrase helps
them to hear it. Children who pass a pure tone hearing test can still have difficulty hearing
complex speech sounds. Children with this difficulty may learn to read and speak by using
flash cards that have both a printed word and a picture of an object. By using these cards they
learn to associate the spoken word with the printed word and a picture. My speech therapist
helped me to learn to hear speech by lengthening hard consonant sounds. She would hold up a
ball and say "bbbb all." The hard consonant sound of "b" was lengthened. Some autistic
children learn vowel sounds more easily than consonants.

6. How should educators and parents handle autistic fixations on things such as lawn
mowers or trains?
Fixations should be used to motivate schoolwork and education. If a child is fixated on trains,
use his interest in trains to motivate reading or learning arithmetic. Have him read about trains
or do arithmetic problems with trains. The intense interest in trains can be used to motivate
reading. It is a mistake to take fixations away, but the child needs to learn that there are some
situations when talking about trains is not appropriate.
The idea is to broaden the fixation into a less fixated educational or social activity. If a child
likes to spin a penny then start playing a game with the child where you and the child take
turns playing with the penny. This also helps to teach turn taking. A train fixation could be
broadened in studying history. A high-functioning child would be motivated to read a book
about the history of the railroad. One should build and broaden fixation into useful activities.
My career in livestock equipment design started as a fixation on cattle chutes. My high school
science teacher encouraged me to study science to learn more about my fixation.
High functioning autistic and Asperger teenagers need mentors to help them develop their
talents into a career skill. They need somebody to teach them computer programming or

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graphic arts. A local computer professional could serve as a mentor or the individual may be
able to take a programming class at a community college. Many parents wonder where they
can find a mentor for their teenager. Try posting a notice on a bulletin board at a university
computer science department or strike up a conversation with the man in the supermarket
checkout line who is wearing a badge with the name of a computer company on it. I found one
of my mentors in the business world when I met the wife of his insurance agent.

7. What is the difference between PDD and autism?

Autism and PDD are behavioral diagnoses. At the present time there are no medical tests for
autism. Autism is diagnosed based on the child's behavior. Both children diagnosed with
autism and PDD will benefit from education programs designed for autistics. It is essential that
children diagnosed as PDD receive the same education as children diagnosed with autism. Both
autistic and PDD children should be placed into a good early education program immediately
after diagnosis. Children diagnosed with PDD tend to fall into two groups: (1) very mild autistic
symptoms, or (2) some autistic symptoms in a child who has other severe neurological
problems. Therefore, some children diagnosed as PDD may be almost normal; and others have
severe neurological problems such as epilepsy, microencephaly or cerebral palsy. The problem
with the autism and PDD diagnoses is that they are NOT precise. They are based only on
behavior. In the future, brain scans will be used for precise diagnosis. Today there is no brain
scan that can be used for diagnosing PDD nor autism.

8. Why is Early Intervention important?

Both scientific studies and practical experience have shown that the prognosis is greatly
improved if a child is placed into an intense, highly structured educational program by age two
or three. Autistic children perform stereotypic behaviors such as rocking or twiddling a penny
because engaging in repetitive behaviors shuts off sounds and sights which cause confusion
and/or pain. The problems is that if the child is allowed to shut out the world, his brain will not
develop. Autistic and PDD children need many hours of structured education to keep their
brain engaged with the world. They need to be kept interacting in a meaningful way with an
adult or another child. The worst things for a young two to five year old autistic child is to sit
alone watching TV or playing video games all day. His brain will be shut off from the world.
Autistic children need to be kept engaged; but at the same time, a teacher must be careful to
avoid sensory overload. Children with milder sensory problems often respond well to Lovaas-
type programs. However, children with more severe sensory processing problems may
experience sensory overload. There are two major categories of children. The first type will
respond well to a therapist who is gently intrusive and pulls them out of their world. I was this
type. My speech therapist was able to "snap me out of it" by grabbing my chin and making me
pay attention. The second type of child has more neurological problems, and they may respond
poorly to a strict Lovaas program. They will require a gentler approach. Some are 'mono-
channel' because they cannot see and hear at the same time. They either have to look at
something or they have to listen. Simultaneous looking and listening may result in sensory
overload and shutdown. This type of child may respond best when the teacher whispers quietly
in a dimly illuminated room.
A good teacher needs to tailor his/her teaching method to the child. To be successful, the
teacher has to be gently insistent. A good teacher knows how hard to push. To be successful,
the teacher has to intrude into the autistic child's world. With some children the teacher can
jerk open their "front door;" and with other children, the teacher has to sneak quietly in their
"back door."

9. Why does my child want to wear the same clothes all the time?
Stiff scratching clothes or wool against my skin is sandpaper ripping off raw nerve endings. I
am not able to tolerate scratching clothes. Autistic children will be most comfortable with soft
cotton against their skin. New underwear and shirts will be more comfortable if they are
washed several times. It is often best to avoid spray starch or fabric softeners that are placed
in the dryer. Some children are allergic to them. [Note: Caretakers and teachers should also
avoid the use of perfume because some children hate the smell and/or they are allergic to it.]

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Even today at the age of 49, I have had to find good clothes and work clothes that feel the
same. It takes me up to two weeks to habituate to the feeling of wearing a skirt. If I wear
shorts during the summer, it takes at least a week before long pants become fully tolerable.
The problem is switching back-and-forth. Switching back-and-forth can be made more
tolerable by wearing tights with skirts. The tights make the skirt feel the same as long pants.

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Choosing the Right Job for People with

Autism or Asperger's Syndrome
Temple Grandin, Ph.D.
Assistant Professor
Colorado State University
Fort Collins, Colorado 80523, USA
(November, 1999)
Jobs need to be chosen that make use of the strengths of people with autism or Asperger's
syndrome. Both high and low functioning people have very poor short-term working memory,
but they often have a better long-term memory than most normal people. I have great
difficulty with tasks that put high demands on short-term working memory. I cannot handle
multiple tasks at the same time. Table 1 is a list of BAD jobs that I would have great difficulty
doing. Table 2 is a list of easy jobs for a visual thinker like me. I have difficulty doing abstract
math such as algebra and most of the jobs on Table 2 do not require complex math. Many of
the visual thinking jobs would also be good for people with dyslexia.
The visual thinking jobs on Table 2 put very little demand on fast processing of information in
short-term working memory. They would fully utilize my visual thinking and large long-term
memory. Table 3 is a list of jobs that non-visual thinkers who are good with numbers, facts
and music could do easily. They also put low demands on short-term working memory and
utilize an excellent long-term memory. Table 4 shows jobs that lower functioning people with
autism could do well. For all types of autism and Asperger's syndrome, demands on short-term
working memory must be kept low. If I were a computer, I would have a huge hard drive that
could hold 10 times as much information as an ordinary computer but my processor chip would
be small. To use 1999 computer terminology, I have a 1000 gigabyte hard drive and a little
286 processor. Normal people may have only 10 gigabytes of disc space on their hard drive
and a Pentium for a processor. I cannot do two or three things at once.
Some job tips for people with autism or Asperger's syndrome:
Jobs should have a well-defined goal or endpoint.
Sell your work, not your personality. Make a portfolio of your work.
The boss must recognize your social limitations.
It is important that high functioning autistics and Asperger's syndrome people pick a college
major in an area where they can get jobs. Computer science is a good choice because it is very
likely that many of the best programmers have either Asperger's syndrome or some of its
traits. Other good majors are: accounting, engineering, library science, and art with an
emphasis on commercial art and drafting. Majors in history, political science, business, English
or pure math should be avoided. However, one could major in library science with a minor in
history, but the library science degree makes it easier to get a good job.
Some individuals while they are still in high school should be encouraged to take courses at a
local college in drafting, computer programming or commercial art. This will help keep them
motivated and serve as a refuge from teasing. Families with low income may be wondering
how they can afford computers for their child to learn programming or computer aided
drafting. Used computers can often be obtained for free or at a very low cost when a business
or an engineering company upgrades their equipment. Many people do not realize that there
are many usable older computers sitting in storerooms at schools, banks, factories and other
businesses. It will not be the latest new thing, but it is more than adequate for a student to
learn on.
In conclusion: a person with Asperger's syndrome or autism has to compensate for poor social
skills by making themselves so good in a specialized field that people will be willing to "buy"
their skill even though social skills are poor. This is why making a portfolio of your work is so
important. You need to learn a few social survival skills, but you will make friends at work by

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sharing your shared interest with the other people who work in your specialty. My social life is
almost all work related. I am friends with people I do interesting work with.

Table 1
Bad Jobs for People with High Functioning Autism or Asperger's Syndrome: Jobs that require
high demands on short-term working memory
Cashier -- making change quickly puts too much demand on short-term working
memory
Short order cook -- Have to keep track of many orders and cook many different things
at the same time
Waitress -- Especially difficult if have to keep track of many different tables
Casino dealer -- Too many things to keep track of
Taxi dispatcher -- Too many things to keep track of
Taking oral dictation -- Difficult due to auditory processing problems
Airline ticket agent -- Deal with angry people when flights are cancelled
Future market trader -- Totally impossible
Air traffic controller -- Information overload and stress
Receptionist and telephone operator -- Would have problems when the switch board got
busy

Table 2
Good Jobs for Visual Thinkers
Computer programming -- Wide-open field with many jobs available especially in
industrial automation, software design, business computers, communications and
network systems
Drafting -- Engineering drawings and computer aided drafting. This job can offer many
opportunities. Drafting is an excellent portal of entry for many interesting technical
jobs. I know people who started out at a company doing drafting and then moved into
designing and laying out entire factories. To become really skilled at drafting, one needs
to learn how to draw by hand first. I have observed that most of the people who draw
beautiful drawings on a computer learned to draw by hand first. People who never learn
to draw by hand first tend to leave important details out of their drawings.
Commercial art -- Advertising and magazine layout can be done as freelance work
Photography -- Still and video, TV cameraman can be done as freelance work
Equipment designing -- Many industries, often a person starts as a draftsman and then
moves into designing factory equipment
Animal trainer or veterinary technician -- Dog obedience trainer, behavior problem
consultant
Automobile mechanic -- Can visualize how the entire car works
Computer-troubleshooter and repair -- Can visualize problems in computers and
networks
Small appliance and lawnmower repair -- Can make a nice local business
Handcrafts of many different types such as wood carving, jewelry making, ceramics,
etc.
Laboratory technician -- Who modifies and builds specialized lab equipment
Web page design -- Find a good niche market can be done as freelance work
Building trades -- Carpenter or welder. These jobs make good use of visual skills but
some people will not be able to do them well due to motor and coordination problems.
Video game designer -- Stay out of this field. Jobs are scarce and the field is
overcrowded. There are many more jobs in industrial, communications business and
software design computer programming. Another bad thing about this job is exposure
to violent images.
Computer animation -- Visual thinkers would be very good at this field, but there is
more competition in this field than in business or industrial computer programming.

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Businesses are recruiting immigrants from overseas because there is a shortage of

good programmers in business and industrial fields.
Building maintenance -- Fixes broken pipes, windows and other things in an apartment
complex, hotel or office building
Factory maintenance -- Repairs and fixes factory equipment

Table 3
Good Jobs for Non-Visual Thinkers: Those who are good at math, music or facts
Accounting -- Get very good in a specialized field such as income taxes
Library science -- reference librarian. Help people find information in the library or on
the Internet.
Computer programming -- Less visual types can be done as freelance work
Engineering -- Electrical, electronic and chemical engineering
Journalist -- Very accurate facts, can be done as freelance
Copy editor -- Corrects manuscripts. Many people freelance for larger publishers
Taxi driver -- Knows where every street is
Inventory control -- Keeps track of merchandise stocked in a store
Tuning pianos and other musical instruments, can be done as freelance work
Laboratory technician -- Running laboratory equipment
Bank Teller -- Very accurate money counting, much less demand on short-term working
memory than a busy cashier who mostly makes change quickly
Clerk and filing jobs -- knows where every file is
Telemarketing -- Get to repeat the same thing over and over, selling on the telephone.
Noisy environment may be a problem. Telephone sales avoids many social problems.
Statistician -- Work in many different fields such as research, census bureau, industrial
quality control, U.S. Dept. of Agriculture, etc.
Physicist or mathematician -- There are very few jobs in these fields. Only the very
brilliant can get and keep jobs. Jobs are much more plentiful in computer programming
and accounting.

Table 4
Jobs for Nonverbal People with Autism or People with Poor Verbal Skills
Reshelving library books -- Can memorize the entire numbering system and shelf
locations
Factory assembly work -- Especially if the environment is quiet
Copy shop -- Running photocopies. Printing jobs should be lined up by somebody else
Janitor jobs -- Cleaning floors, toilets, windows and offices
Restocking shelves -- In many types of stores
Recycling plant -- Sorting jobs
Warehouse -- Loading trucks, stacking boxes
Lawn and garden work -- Mowing lawns and landscaping work
Data entry -- If the person has fine motor problems, this would be a bad job
Fast food restaurant -- Cleaning and cooking jobs with little demand on short-term
memory
Plant care -- Water plants in a large office building

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Evaluating the Effects of Medication

Temple Grandin, Ph.D.
Assistant Professor
Colorado State University
Fort Collins, CO 80523, USA
(February, 1998)
When a medication is being evaluated to modify the behavior of a person with autism, one
must assess the risks versus the benefits. The benefits of the medication must outweigh the
risks. Some medications can damage the nervous system and other internal organs, such as
the liver. These risks are greatest in young children because an immature nervous system may
be more sensitive to harmful side effects. A good general principle is that the use of powerful
drugs should be avoided in young children when the risk is great. The younger the child the
greater the risk. For example, it would be justified to give a young child Prozac to stop severe
self-injury, but it would probably not be justified if the only effect was that it made him slightly
calmer. If a medication improved language, its use would probably be recommended.
The brain of a teenager or an adult is fully formed and the risk is less. Many teenagers and
adults with autism may benefit from Prozac or Zoloft. See my book, Thinking in Pictures, or
other papers I have written for this Internet web site (www.autism.org). There is a possibility
in some cases that if too many drugs are given to young children they may not work when the
child needs them when he becomes a teenager. This may be a problem especially with drugs
such as Haldol or other neuroleptics. Practical experience has shown that the nutritional
supplement DMG is safe for young children.
A medication that works to change behavior should have an obvious and dramatic effect. One
of the best ways to evaluate a medication is a blind evaluation. A simple way to do this is to
start the medication and do NOT tell the teacher at school. If the teacher says "WOW, your
son's behavior has improved remarkably," then you know that the medication works. To
evaluate a medication, it is important that the other therapies are not changed at the same
time. Change only one thing at a time so you can see the effects. A new medication cannot be
properly evaluated if the child goes to a new school around the same time that the medication
is tried. If a medication does not show enough benefit to outweigh the risk then you should get
rid of it. Medications should work. If the change is not obvious and is not dramatic, it probably
is not worth giving the medication. It is also important to start only one medication at a time
so that its effects can be evaluated.
Many people with autism are taking too many different things. If the person has been on the
medication for a long time, it must never be abruptly stopped. The dosage should be reduced
slowly. If you try a new drug for a few days or weeks and decide you do not like it, you can
usually stop it; but it is best to check with your child's doctor.
There are many different brands of medications. For example, Prozac, Paxil and Zoloft are very
similar, but there is just enough difference between them that some people will do better on
Prozac and others will do better on Zoloft. If you do not like one then try another. If you are
using a generic, do NOT switch brands. Find a brand that works and stay with it.
People with autism have very sensitive nervous systems. Some individuals may require much
lower doses of medications than people with a normal nervous system. This will vary from
individual to individual. If some individuals are given too high a dose of either an older tricyclic
antidepressant or one of the newer medications, such as Prozac or Zoloft, there may be side
effects. Antidepressants have a dosage window. Too little will not work and too much causes
side effects. The first sign of too high a dose of an antidepressant is early morning awakening.
This can usually be corrected by lowering the dose. If the excessive dosing continues, the
person will escalate into insomnia, irritability, agitation and aggression. To determine the
correct dose, you must be a good observer. Enough must be given to be effective but too
much can have almost the opposite effect. Both parents and doctors have reported that when
the antidepressant was first given, the person became calmer and then about two weeks later,

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he went berserk. This is due to a slow buildup in the system. This is especially a problem with
Prozac. The dose must be lowered at the first indication of insomnia.
In this article I have not discussed the full range of medications that can be used for autism.
The basic principles of assessing risk versus benefit and using a blind evaluation should be
used with all types of medications which are used to improve a child's behavior and/or
language development.

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 Temple Grandin

Social Problems: Understanding Emotions

and Developing Talents
Temple Grandin, Ph.D.
Assistant Professor
Colorado State University
Fort Collins, Colorado 80523, USA
(February, 1999)
I did not know that eye movements had meaning until I read Mind Blindness by Simon Baron-
Cohen. I had no idea that people communicated feelings with their eyes. I also did not know
that people get all kinds of little emotional signals which transmit feelings. My understanding of
this became clearer after I read Descartes Error by Antonio Damasio. From the book I learned
that, in most people, information in memory is seamlessly linked with emotion. I have
emotions which can be very strong when I am experiencing them, but information stored in
memory can be scanned at will without emotion. It is like surfing the Internet of web pages in
my mind.
Social relationships have been learned solely by intellect and use of my visualization skills. All
my thoughts are in pictures, like videotapes in my imagination. When I encounter a new social
situation I can scan my data banks for a similar situation that I can use as a model to guide
me in the new situation. My data banks in social skills are also filled with news articles about
diplomatic relationships between different countries and an archive of previous experiences. I
use these scenarios to guide me in different situations. I then run videotapes in my
imagination of all the possible ways to predict how the other person might act. It is all done
using my visual mind. I have great difficulty with new social situations if I cannot recall a
similar situation to use as a guide.
It is easy for me to pass a simple 'theory of mind' test because I visualize what the other
person would be seeing. For example, if John sees Sally put a candy in a jar and then Sally
eats the candy when John leaves the room and replaces it with a pen, I know that John
expects to find a candy because he did not see the candy replaced by the pen. I have difficulty
with more complex 'theory of mind' problems which involve two or three people doing several
different things. I do not have sufficient short-term memory to remember the sequence of
events. My problem is due to a poor short-term working memory. Difficulties with short-term
working memory should not be confused with a lack of understanding of 'theory of mind.' I can
solve more complex 'theory of mind' tests if I am allowed to write down the sequence of
events. Over time, I have built up a tremendous library of memories of my past experiences,
TV, movies, and newspapers to spare me the social embarrassments caused by my autism;
and I use these to guide the decision process in a totally logical way. I have learned from
experience that certain behaviors make people mad. Earlier in my life, my logical decisions
were often wrong because they were based on insufficient data. Today they are much better,
because my memory contains more information. Using my visualization ability, I observe
myself from a distance. I call this my little scientist in the corner, as if I'm a little bird watching
my own behavior from up high. This idea has also been reported by other people with autism.
Dr. Asperger noted that autistic children observe themselves constantly. They see themselves
as an object of interest.
According to Antonio Damasio, people who suddenly lose emotions because of strokes often
make disastrous financial and social decisions. These patients have completely normal
thoughts, and they respond normally when asked about hypothetical social situations. But their
performance plummets when they have to make rapid decisions without emotional cues. It
must be like suddenly becoming autistic. I can handle situations where stroke patients may fail
because I never relied on emotional cues in the first place. At age 51, I have a vast data bank;
but it has taken me years to build up my library of experiences and learn how to behave in an

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appropriate manner. I did not know until very recently that most people rely heavily on
emotional cues.
After many years I have learned - by rote - how to act in different situations. I can speed-
search my CD-ROM memory of videotapes and make a decision quickly. It is like surfing the
Internet in my mind. Doing this visually may be easier than doing it with verbal thinking. I try
to avoid situations where I can get into trouble. As a child, I found picking up social cues
impossible. When my parents were thinking about getting divorced, my sister felt tension; but
I felt nothing because the signs were subtle. My parents never had big fights in front of us. The
signs of emotional friction were stressful to my sister, but I didn't even see them. Since my
parents were not showing obvious, overt anger toward each other; I just did not comprehend
the tension.
Social interaction is further complicated by the physiological problems of attention shifting.
Since people with autism require much more time than others to shift their attention between
auditory and visual stimuli, they find it more difficult to follow rapidly changing, complex social
interactions. These problems may be part of the reason why Jack, a man with autism, said, "If
I relate to people too much, I become nervous and uncomfortable." Learning social skills can
be greatly helped with videotapes. I gradually learned to improve my public speaking by
watching tapes and by becoming aware of easily quantifiable cues, such as rustling papers that
indicate boredom. It is a slow process of continuous improvement. There are no sudden
breakthroughs.
Figuring out how to interact socially was much more difficult than solving an engineering
problem. I found it relatively easy to program my visual memory with the knowledge of cattle-
dipping vats or corral designs. Recently, I attended a lecture where a social scientist said that
humans do not think like computers. That night at a dinner party I told this scientist and her
friends that my thought patterns resemble computing and that I am able to explain my
thought processes step by step. I was kind of shocked when she told me that she is unable to
describe how her thoughts and emotions are joined. She said that when she thinks about
something, the factual information and the emotions are combined into a seamless whole. I
finally understood why so many people allow emotions to distort the facts. My mind can always
separate the two. Even when I am very upset, I keep reviewing the facts over and over until I
can come to a logical conclusion.
Over the years, I have learned to be more tactful and diplomatic. In my freelance livestock
equipment design business, I have learned never to go over the head of the person who hired
me unless I have his or her permission. From past experiences I have learned to avoid
situations in which I could be exploited and to stroke egos that may feel threatened. To master
diplomacy, I read about business dealings and international negotiations in the Wall Street
Journal and other publications. I then used them as models.
I know that things are missing in my life, but I have an exciting career that occupies my every waking hour. Keeping
myself busy keeps my mind off what I may be missing. Sometimes parents and professionals worry too much about the
social life of an adult with autism. I make social contacts via my work. If a person develops her talents, she will have
contacts with people who share her interests.

Develop Talents
I cannot emphasize enough the importance of developing a talent area such as drafting,
commercial art, custom cabinetwork, fixing cars or computer programming. These things will
provide an intellectually satisfying career. My life would not be worth living if I did not have intellectually satisfying
work. My career is my life. Sometimes professionals working with people with autism become so concerned about the
person's social life that developing intellectually satisfying employment skills is neglected.
When high functioning autistic or Asperger's children reach 8th or 9th grade, they need mentor
teachers to teach them skills such as computer programming. I had a wonderful high school
science teacher who taught me to use the scientific research library. Computers are a great
field because being weird is okay. A good programmer is recognized for his/her skills. I know
several very successful autistic computer programmers.
To make up for social deficits autistic people need to make themselves so good that they are
recognized for brilliant work. People respect talent. They need mentors who are computer
programmers, artists, draftsmen, etc. to teach them career skills. I often get asked "How does
one find mentors?" You never know where a mentor may be found. He or she may be standing

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in the checkout line at the supermarket. I found one of my first meat industry mentors when I
met the wife of his insurance agent at a party. She struck up a conversation with me because
she saw my hand embroidered western shirt. I had spent hours embroidering a steer head on
the shirt. Post a notice on the bulletin board at the local college in the computer science
department. If you see a person with a computer company name badge, approach him or her
and show the person work that the person with autism has done.
Since people with autism and Asperger's are inept socially, they have to sell their work instead
of their personality. I showed my portfolio of pictures and blueprints to prospective customers.
I never went to the personnel office. I went straight to the engineers and asked to do design
jobs.
Freelance work is really great. It avoids many social problems. I can go in and design the
project and then get out before I get in social problems. There have been several sad stories
where an autistic draftsman or technician has been promoted to a management position. It
was a disaster which ended up with the person being fired or quitting. Employers need to
recognize the person's limitations. An excellent draftsman, commercial artist, technician or
computer programmer may lose their career when promoted to management. They should be
rewarded with more pay or a new computer instead of a management job.

Sins of the System

I developed this rule system to guide social interactions and my behavior.
Really Bad Things - examples: murder, arson, stealing, lying in court under oath,
injuring or hitting other people. All cultures have prohibitions against really bad things
because an orderly civilized society cannot function if people are robbing and killing
each other.
Courtesy Rules - Examples: not cutting in on a line at the movie theater or airport,
table manners, saying 'thank you' and keeping oneself clean. These things are
important because they make the other people around you more comfortable. I don't
like it when somebody else has sloppy table manners so I try to have decent table
manners. It annoys me if somebody cuts in front of me in a line so I do not do this to
other people.
Illegal But Not Bad - examples: slight speeding on the freeway and illegal parking.
However, parking in a handicapped zone would be worse because it would violate the
courtesy rules.
Sins of the Systems (SOS) - examples: smoking pot and being thrown in jail for ten
years and sexual misbehavior. SOS's are things where the penalty is so severe that it
defies all logic. Sometimes the penalty for sexual misbehavior is worse than killing
somebody. Rules governing sexual behavior are so emotionally based that I do not dare
discuss the subject for fear of committing an SOS. An SOS in one society may be
acceptable behavior in another; whereas rules 1, 2, 3 tend be more uniform between
different cultures.
I have learned never to do a sin of the system. This is one of the reasons I chose celibacy. It
avoids a lot of problems. People with autism have to learn that certain behavior will not be
tolerated period. You will be fired no matter how good your work is if you commit an SOS at
work. People with autism and Asperger's need to learn that if they want to keep a job they
must not commit an SOS at work. The social knowledge required is just too complex.
Attempting to date at work is too hazardous to one's job. If they want to date they should do it
outside of work. The most successful marriages that people with autism have involved partners
with shared work interests.

Conclusion
I put a great deal of emphasis on employment because I see so many very intelligent people
with autism and Asperger's syndrome without satisfying jobs. A satisfying profession made life
have meaning for me. I am what I do and think instead of what I feel.
Last year the library at my university was flooded and almost a million books drowned. I cried
and cried about this. I grieved for the drowned books. It upsets me so much because the
thoughts were dying. Nobody would ever read these books again. However, it turned out that

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the books could be saved by freeze drying; but at the time I did not know that this was
possible. To me, knowledge is something very precious, and the destruction of knowledge is
really terrible. Using my intellect to do work that is useful and make the world a better place is
very important to me. Knowledge is more important to me than emotion.

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Making the Transition from the World

of School into the World of Work
Temple Grandin, Ph.D.
Assistant Professor
Colorado State University
Fort Collins, Colorado, 80523, U.S.A.
During my travels to many autism conferences I have observed many sad cases of people with
autism who have successfully completed high school or college but have been unable to make
the transition into the world of work. Some have become perpetual students because they
thrive on the intellectual stimulation of college. For many able people with autism college years
were their happiest (Szatmari et al., 1989).
I would like to stress the importance of a gradual transition from an educational setting into a
career. I made the transition gradually. My present career of designing livestock facilities is
based on an old childhood fixation. I used that fixation to motivate me to become an expert on
cattle handling. Equipment I have designed is in all the major meat plants. I have also
stimulated the meat industry to recognize the importance of humane treatment of livestock.
While I was in college I started visiting local feedlots and meat packing plants. This enabled
me to learn about the industry.
Many successful people with autism have turned an old fixation into the basis of a career. I
was lucky to find Tom Rohrer, the manager of the local Swift Meat Packing plant, and Ted
Gilbert, the Manager of the Red River Feedlot (John Wayne's feedlot). They allowed me to visit
their operations every week. They recognized my talents and tolerated my eccentricities.
These people served as important mentors. Educators who work with autistic students need to
find these people in the business community. I finished up at Arizona State University with a
Master's Thesis on cattle handling and chute design. At the same time I did some freelance
writing for the Arizona Farmer Ranchman Magazine. This enabled me to further learn about the
livestock industry and develop expertise.
My next step was to get hired for my first job at a large feedlot construction company. Emil
Winnisky, the construction manager, recognized my talents in design. He also served as a third
important mentor to force me to conform to a few social rules. He had his secretaries take me
out to buy better clothes. At the time I really resented this, but today I realize that he did me
a great favor. He also told me bluntly that I had to do certain grooming niceties such as
wearing deodorant. I had to change. I was most interested to read this passage in one of
Kanner's papers about people with autism that make a successful adaptation: "Unlike most
other autistic children they become uneasily aware of their peculiarities and they begin to
make a conscious effort to do something about them." (Kanner et al. 1972).
Emil was an eccentric guy himself and that may explain why he hired me. About six months
after I was hired, Emil was fired. I continued to work for about a year, and I quit because I
was asked to participate in some highly questionable business practices. While I was at the
construction company I learned drafting from Davy, their wonderful draftsman. Davy and I got
along, he was a shy loner who drew the most beautiful drawings. From contacts I made at the
construction company I started doing freelance design work. I started my independent
consulting and design business one job at a time. People respect talent, and I soon developed
a reputation for being an expert. While I was slowly building up my business I had enough
financial resources so I did not have to take a job at McDonald's to pay the bills.
The freelance route has enabled people with autism to be successful and exploit their talent
area. Computer programming is often a good area. To get the business started people with
autism need someone to help them get some of their initial jobs. A freelance business also
helps avoid some of the social problems with a job in one place. I can go in, do the design job,
and then get out before I get involved in a social situation where I could get into trouble. Other
freelance businesses which can work well for people with autism are piano tuner, motor repair,

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and graphic arts. These jobs all make use of skills that many people with autism have, such as
perfect pitch, mechanical ability and artistic talent.

Lack of Social Understanding

I soon developed a reputation in Arizona for being an expert in my field, but I got into trouble
socially. I caused a big bunch of trouble for Tom Rohrer, Manager of the Swift plant. I did not
understand that people have egos, and that protecting their egos was often more important
that loyalty to the company. I naively believed that all Swift employees would always act in the
best interests of their employer. I assumed that if I was loyal and always worked for the good
of Swift's, I would be rewarded. The other engineers resented me. They sometimes installed
equipment wrong, and they never consulted me. They did not like this "nerd" telling them how
to do it. Technically, I was right but socially wrong.
I caused trouble for Tom Rohrer after I wrote a letter to the President of Swift about a bad
equipment installation which caused cattle to suffer. The President was embarrassed that I had
found a fault in his operation. I thought he would be pleased if I informed him of the mistake,
instead he felt threatened and told Tom to get rid of me. Fortunately, Tom did not kick me out.
Over the years I have learned to be more tactful and diplomatic. I have learned to never go
over the head of the person that hired me unless I have their permission. From past
experiences, I have learned to avoid situations where I could be exploited or my employers
might feel threatened. I learned diplomacy by reading about international negotiations and
using them as models.
Getting in trouble over the social aspects of work is a problem area for many people with
autism. Learning the work part of the job is easy. Many people with autism expect all people to
be good. It is a rude awakening to learn that some people are bad, and they may try to exploit
them. This is a lesson that an independent person with autism must learn. For people with
autism who take lower level manufacturing jobs, the other employees should be involved and
trained to help the person. The co-workers need to be trained to understand autism. A higher
functioning person with autism can avoid trouble by keeping his mind on his work. One man
worked for five years in a lab, and his employer was happy with his work. One day he got into
trouble when he went drinking with the guys and got fired. He would have been better off if he
had declined. To avoid problems, I keep my contacts with clients in the technical department.
Attempting to date or flirt with people in my client's work places would cause many problems,
so I just don't do it.

Autism Follow-Up Studies

There have been two major studies on the follow up of adults with autism who have made a
satisfactory adjustment. Szatmari et al. (1989) described six high functioning adults who
graduated from college and were able to live independently. One of those people became a
perpetual student, and the other five have jobs. There is a tendency for people with autism to
become perpetual students because they like the stimulating but structured college setting.
Two of the people in Szatmari's study became salesmen and two worked in a library. The fifth
person became a physics tutor. Physics tutor would be a good job to do on a freelance basis.
People with autism are often good at teaching others in their areas of special skills. Jason Utley
from Kentucky mastered the skills to become an Eagle Scout, and the other scouts liked him
because he teaches them to tie knots. Teaching and being a salesman involve social
interaction but it is often one-way interaction where the person with autism gets to talk about
his area of interest. It does not require a complex understanding of social relations.
Kanner et al. (1972) followed up nine high functioning cases where a good adjustment had
been made. Five of these people had jobs. The jobs were bank teller, lab chemist, blue collar
Agricultural Experiment Station worker, accountant, and library page. One of these people
bounced from job to job due to social problems. The job placements that were successful did
not involve complex social interactions. A bank teller's interactions can be routine and
stereotyped.
The person who became the lab chemist originally had a nursing job. This job was a disaster
because she did not know how to be flexible. She learned from the nursing text book that
mothers should nurse their babies for only 20 minutes. When she abruptly took the babies

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away from the mothers in the obstetrics ward they became angry. She could not understand
why. When she switched to the chemistry lab, she was appreciated for her knowledge of
chemistry. The person who is now an accountant got dismissed from a previous job after he
was promoted to a supervisory position. I heard about another sad case where a man with
autism had been a successful draftsman for many years in an architectural firm. When he was
promoted and had to be involved with clients he was fired. He should have been left working
on his drawing board.
In summary, a person with autism can make a successful transition into a job or career.
1. Gradual Transitions - Work should be started for short periods while the person is still in
school.
2.Supportive Employers - Parents and educators need to find employers who will be willing
to work with people with autism.
3. Mentors - People with autism, especially the higher functioning, need mentors who can be
both a special friend and help them learn social skills. The most successful mentors have
common interests with the person with autism.
4. Educate Employers and Employees - Both employers and employees need to be
educated about autism so they support the person with autism and help him. They also need
to understand an autistic person's limitations with complex social interactions to help him
avoid situations which could cause him to lose his job.
5. Freelance Work - Freelance work is often a good option for very high functioning people
who have a special skill in computers, music, or art. The person with autism will need someone
to help him get the business started and possibly educate clients about autism. Successful
freelance businesses have been started in computer programming, piano tuning and graphic
arts.
6. Make a Portfolio - People with autism have to sell their skills instead of their personality.
They should make a portfolio of their work. Artists can make color photocopies of their work,
and computer programmers can make a demonstration disc. The portfolio of the person's work
should be shown to the people in the art or computing department. In all of my jobs, I had to
get in the "back door." Since people with autism do not interview well, the personnel
department should be avoided. Technical people respect talent, and a person with autism has
to sell his talent to an employer.

References
Kanner, L., Rodriguez, A., and Ashenden, B. (1972). How far can autistic children go in
matters of social adaptation? Journal of Autism and Childhood Schizophrenia (Now titled:
Journal of Autism and Developmental Disorders), 2: 9-33.
Szatmari, P., Bartolucci, G., Bond, S., and Rich, S. (1989). A follow-up study of high
functioning autistic children. Journal of Autism and Developmental Disorders, 19: 213-225.
Revised February, 1996. An earlier version of this article appeared in The Advocate, Summer,
1992.

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 Temple Grandin

Genius May Be an Abnormality: Educating

Students with
Asperger's Syndrome, or High Functioning
Autism
Temple Grandin, Ph.D.
Assistant Professor
Colorado State University
Fort Collins, CO 80523, USA
I am becoming increasingly concerned that intellectually gifted children are being denied
opportunities because they are being labeled either Asperger's or high functioning autism.
Within the last year I have talked to several parents, and I was disturbed by what they said.
One mother called me and was very upset that her six-year-old son had Asperger's. She then
went on to tell me that his IQ was 150. I replied that before people knew about Asperger's
Syndrome, their child would have received a very positive label of intellectually gifted.
In another case the parents of an Asperger teenager called and told me that they were so
concerned about their son's poor social skills that they would not allow him to take computer
programming. I told her that depriving him of a challenging career in computers would make
his life miserable. He will get social interaction by shared interests with other computer people.
In a third case, a super smart child was not allowed in the talented and gifted program in his
school because he had an autism label. Educators need to become aware that intellectually
satisfying work makes life meaningful.
It is essential that talented children labeled either high functioning autism or Asperger's be
trained in fields such as computer programming, where they can do intellectually satisfying
work. Click here to read my paper entitled 'Choosing the Right Job for People with Autism or
Asperger's Syndrome.' For many people with Asperger's, and for me, my life is my work. Life
would not be worth living if I did not have intellectually satisfying work. I did not fully realize
this until a flood destroyed our university library. I was attending the American Society of
Animal Science meetings when the flood occurred. I first learned about it when I read about it
on the front page of USA Today, a national newspaper. I grieved for the "dead" books, the
same way most people grieve for a dead relative. The destruction of books upset me because
"thoughts died." Even though most of the books are still in other libraries, there are many
people at the university who will never read them. To me, Shakespeare lives if we keep
performing his plays. He dies, when we stop performing them. I am my work. If the livestock
industry continues to use equipment I have designed, then my "thoughts live" and my life has
meaning. If my efforts to improve the treatment of cattle and pigs make real improvements in
the world, then life is meaningful.
I have been reading, with great satisfaction, the many articles in magazines about Linux free
software. People in the business world are not able to comprehend why the computer people
give their work away. I am unable to think about this without becoming emotional. It is no
mystery to me why they download their intellectual ideas into the vast, evolving and
continually improving computer operating system. It is because their thoughts will live forever
as part of the "genetic code" of the computer program. They are putting themselves into the
program and their intellectual DNA" will live forever in cyber-space. As the program evolves
and changes, the code they wrote will probably remain hidden deep within it. It is almost like a
living thing that is continually evolving and improving. For both me and for the programmers
that contribute to Linux, we do it because it makes our lives more meaningful.

Continuum of Traits
There is a continuum of personality and intellectual traits from normal to abnormal. At what
point does a brilliant computer programmer or engineer get labeled with Asperger's. There is

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no black and white dividing line. Simon Baron-Cohen, an autism researcher at the University of
Cambridge, found that there were 2 times as many engineers in the family history of people
with autism. I certainly fit this pattern. My grandfather was an engineer who was co-inventor
of the automatic pilot for an airplane. I have second and third cousins who are engineers and
mathematicians.
At a recent lecture, Dr. Baron-Cohen described three brilliant cases of Asperger's Syndrome.
There was a brilliant physics student, a computer scientist, and a mathematics professor. It is
also likely that Bill Gates has many Asperger's traits. An article in Time Magazine compared me
to Mr. Gates. For example, we both rock. I have seen video tapes of Bill Gates rocking on
television. Articles in business magazines describe his incredible memory as a young child.
There is evidence that high functioning autism and Asperger's Syndrome have a strong genetic
basis. G. R. DeLong and J. T. Dyer found that two thirds of families with a high functioning
autistic had either a first or second degree relative with Asperger's Syndrome. Sukhelev
Naragan and his co-workers wrote, in the Journal of Autism and Developmental Disorders, that
educational achievement of the parents of an autistic child with good language skills were
often greater than those of similar parents with normal children. Dr. Robert Plomin at
Pennsylvania State University states that autism is highly heritable.
In my book, Thinking in Pictures, I devote an entire chapter to the link between intellectual
giftedness and creativity to abnormality. Einstein himself had many autistic traits. He did not
learn to speak until he was three, and he had a lack of concern about his appearance. His
uncut hair did not match the men's hairstyles of his time.

Genius is an Abnormality?
It is likely that genius in any field is an abnormality. Children and adults who excel in one area,
such as math, are often very poor in other areas. The abilities are very uneven. Einstein was a
poor speller and did poorly in foreign language. The brilliant physicist, Richard Feynman, did
poorly in some subjects.
A review of the literature indicates that being truly outstanding in any field may be associated
with some type of abnormality. Kay Redfield Jamison, from Johns Hopkins School of Medicine,
has reviewed many studies that show the link with manic depressive illness and creativity.
N.C. Andreason at the University of Iowa found that 80 percent of creative writers had mood
disorders sometime during their life. A study of mathematical giftedness, conducted at Iowa
State University by Camilla Persson, found that mathematical giftedness was correlated with
being near-sighted and having an increased incidence of allergies. I recently attended a lecture
by Robert Fisher at Barrow Neurological Institute in Phoenix, Arizona. He stated that many
great people had epilepsy, people such as Julius Ceasar, Napoleon, Socrates, Pythagoras,
Handel, Tchaikovsky, and Alfred Nobel. An article in the December 2001 issue of Wired
magazine discussed the link between autism and Aspergers, and engineer and computer
programming. The incidence of autism and Aspergers has increased in the children of
technology company employees. A little bit of autism genes may provide an intellectual
advantage and too much of the genetic may cause a severe case of autism.

Types of Thinking
There appear to be two basic types of thinking in intellectually gifted people who have
Asperger's or high functioning autism. The highly social, verbal thinkers who are in the
educational system need to understand that their thought processes are different. The two
types are totally visual thinkers like me; and the music, math and memory thinkers which are
described in Thomas Sowell's book, Late Talking Children. I have interviewed several of these
people, and their thoughts work in patterns in which there are no pictures. Sowell reports that
in the family histories of late talking, music math and memory children, 74 percent of the
families will have an engineer or a relative in a highly technical field such as physics,
accounting, or mathematics. Most of these children also had a relative that played a musical
instrument.
Every thought I have is represented by a picture. When I think about a dog, I see a series of
pictures of specific dogs, such as my student's dog or the dog next door. There is no
generalized verbal 'dog' concept in my mind. I form my dog concept by looking for common

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features that all dogs have, and no cats have. For example, all of the different breeds of dogs
have the same kind of nose. My thought process goes from specific pictures to general
concepts, where as most people think from general to specific. I have no vague, abstract,
language-based concepts in my head, only specific pictures.
When I do design work, I can run three-dimensional, full motion "video" images of the cattle
handling equipment in my head. I can "test run" the equipment on the "virtual reality"
computer that is in my imagination. Visual thinkers who are expert computer programmers
have told me that they can see the entire program "tree," and then they write the code on
each branch.
It is almost as if I have two consciences. Pictures are my real thoughts, and language acts as a
narrator. I narrate from the "videos" and "slides" I see in my imagination. For example, my
language narrator might say, "I can design that." I then see a video of the equipment I am
designing in my imagination. When the correct answer pops into my head, it is a video of the
successful piece of equipment working. At this point, my language narrator says, "I figured out
how to do it." In my mind there is no subconscious. Images are constantly passing through the
computer screen of my imagination. I can see thought processes that others have covered up
with language. I do not require language for either consciousness or for thinking.
When I learned drafting for doing my design work, it took time to train my visual mind to
make the connection between the symbolic lines on a layout drawing and an actual building.
To learn this I had to take the set of blueprints and walk around in the building, looking at the
square concrete support columns, seeing how the little squares on the drawing related to the
actual columns. After I had "programmed" my brain to read drawings, the ability to draw
blueprints appeared almost by magic. It took time to get information in, but after I was
"programmed," the skill appeared rather suddenly. Researchers who have studied chess
players state that the really good chess players have to spend time inputting chess patterns
into their brains. I can really relate to this. When I design equipment I take bits of pictures and
pieces of equipment I have seen in the past and re-assemble them into new designs. It is like
taking things out of the memory of a CAD computer drafting system, except I can re-assemble
the pieces into three-dimensional, moving videos. Constance Mibrath and Bryan Siegal at the
University of California found that talented, autistic artists assemble the whole from the parts.
It is "bottom up thinking," instead of "top down thinking.

Teachers and Mentors

Children and teenagers with autism or Asperger's need teachers who can help them develop
their talents. I cannot emphasize enough the importance of developing a talent into an
employable skill. The visual thinkers like me can become experts in fields such as computer
graphics, drafting, computer programming, automotive repair, commercial art, industrial
equipment design, or working with animals. The music, math, and memory type children can
excel in mathematics, accounting, engineering, physics, music, translating engineering and
legal documents, and other technical skills. Unless the student's mathematical skills are truly
brilliant, I would recommend taking courses in library science, accounting, engineering, or
computers. Learning a technical skill will make the person highly employable. There are few
jobs for mediocre mathematicians or physicists.
Since social skills are weak, the person can make up for them by making themselves so good
at something that people will hire them. Teachers need to council individuals to go into fields
where they can easily gain employment. Majoring in history is not a good choice because
obtaining a job will be difficult. History could be the person's hobby instead of the main area of
study in school.
Many high functioning autistic and Asperger teenagers get bored with school and misbehave.
They need mentors who can teach them a field that will be beneficial to their future. I had a
wonderful high school science teacher who taught me to use the scientific research library.
Computers are a great field because being weird or a "computer geek" is okay. A good
programmer is recognized for his/her skills. I know several very successful autistic computer
programmers. A bored high school student could enroll in programming or computer-aided
drafting courses in a local community college.

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To make up for social deficits, autistic individuals need to make themselves so good that they
are recognized for brilliant work. People respect talent. They need mentors who are computer
programmers, artists, draftsmen, etc., to teach them career skills. I often get asked, "How
does one find mentors?" You never know where a mentor teacher may be found. He may be
standing in the checkout line in a supermarket. I found one of my first meat industry mentors
when I met the wife of his insurance agent at a party. She struck up a conversation with me
because she saw my hand embroidered western shirt. I had spent hours embroidering a steer
head on the shirt. Post a notice on the bulletin board at the local college in the computer
science department. If you see a person with a computer company name badge, approach him
and show him work that the person with autism has done.

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Evaluating the Effects of Medication

Temple Grandin, Ph.D.
Assistant Professor
Colorado State University
Fort Collins, CO 80523, USA
(February, 1998)
When a medication is being evaluated to modify the behavior of a person with autism, one
must assess the risks versus the benefits. The benefits of the medication must outweigh the
risks. Some medications can damage the nervous system and other internal organs, such as
the liver. These risks are greatest in young children because an immature nervous system may
be more sensitive to harmful side effects. A good general principle is that the use of powerful
drugs should be avoided in young children when the risk is great. The younger the child the
greater the risk. For example, it would be justified to give a young child Prozac to stop severe
self-injury, but it would probably not be justified if the only effect was that it made him slightly
calmer. If a medication improved language, its use would probably be recommended.
The brain of a teenager or an adult is fully formed and the risk is less. Many teenagers and
adults with autism may benefit from Prozac or Zoloft. See my book, Thinking in Pictures, or
other papers I have written for this Internet web site (www.autism.org). There is a possibility
in some cases that if too many drugs are given to young children they may not work when the
child needs them when he becomes a teenager. This may be a problem especially with drugs
such as Haldol or other neuroleptics. Practical experience has shown that the nutritional
supplement DMG is safe for young children.
A medication that works to change behavior should have an obvious and dramatic effect. One
of the best ways to evaluate a medication is a blind evaluation. A simple way to do this is to
start the medication and do NOT tell the teacher at school. If the teacher says "WOW, your
son's behavior has improved remarkably," then you know that the medication works. To
evaluate a medication, it is important that the other therapies are not changed at the same
time. Change only one thing at a time so you can see the effects. A new medication cannot be
properly evaluated if the child goes to a new school around the same time that the medication
is tried. If a medication does not show enough benefit to outweigh the risk then you should get
rid of it. Medications should work. If the change is not obvious and is not dramatic, it probably
is not worth giving the medication. It is also important to start only one medication at a time
so that its effects can be evaluated.
Many people with autism are taking too many different things. If the person has been on the
medication for a long time, it must never be abruptly stopped. The dosage should be reduced
slowly. If you try a new drug for a few days or weeks and decide you do not like it, you can
usually stop it; but it is best to check with your child's doctor.
There are many different brands of medications. For example, Prozac, Paxil and Zoloft are very
similar, but there is just enough difference between them that some people will do better on
Prozac and others will do better on Zoloft. If you do not like one then try another. If you are
using a generic, do NOT switch brands. Find a brand that works and stay with it.
People with autism have very sensitive nervous systems. Some individuals may require much
lower doses of medications than people with a normal nervous system. This will vary from
individual to individual. If some individuals are given too high a dose of either an older tricyclic
antidepressant or one of the newer medications, such as Prozac or Zoloft, there may be side
effects. Antidepressants have a dosage window. Too little will not work and too much causes
side effects. The first sign of too high a dose of an antidepressant is early morning awakening.
This can usually be corrected by lowering the dose. If the excessive dosing continues, the
person will escalate into insomnia, irritability, agitation and aggression. To determine the
correct dose, you must be a good observer. Enough must be given to be effective but too
much can have almost the opposite effect. Both parents and doctors have reported that when
the antidepressant was first given, the person became calmer and then about two weeks later,

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he went berserk. This is due to a slow buildup in the system. This is especially a problem with
Prozac. The dose must be lowered at the first indication of insomnia.
In this article I have not discussed the full range of medications that can be used for autism.
The basic principles of assessing risk versus benefit and using a blind evaluation should be
used with all types of medications which are used to improve a child's behavior and/or
language development.

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