Saturday, February 20, 2010

The Emergence of Early Behavioral Signs of an Autism Research Disorder

It looks as though I will to need to interrupt my blogging break before it has had much of a chance to begin:

The occasion for this interruption is the online publication of A Prospective Study of the Emergence of Early Behavioral Signs of Autism (Ozonoff et al., 2010). Note that I have recently posted my thoughts regarding a different paper from this same general group of researchers, Play and Developmental Outcomes in Infant Siblings of Children with Autism (Christensen et al., 2010), a paper I generally decried as containing too much researcher bias and too much reliance upon the use of concocted measures. But as luck would have it, Christensen et al. (2010) was apparently only the warm-up act: when it comes to researcher bias and concocted measures, surely nothing can hold a candle to Ozonoff et al. (2010).

And I am starting to worry. Observations of infants and toddlers who are at high risk for autism (because they have older siblings who have already been diagnosed with autism) carry the potential of providing some valuable insight into the nature of the condition; but this will only happen if those observations arrive mostly unfiltered. Based upon what I have seen so far in Christensen et al. (2010) and Ozonoff et al. (2010), and given that a good portion of the research wherewithal directed towards at-risk children has been entrusted to this one tight-knit, rather homogeneous group of researchers, it appears as though these observations are not only going to arrive filtered, they are going to arrive after having been passed through a very distorting lens.

Let me begin by summarizing my complaints and concerns about Ozonoff et al. (2010).

1. The study is based almost entirely on made-up measures—measures designed to give the appearance of science when in fact those measures are not scientific at all. And as if that were not bad enough, those measures are then used, quite falsely, to create the illusion of comparable data, when in fact no such comparison is warranted. The findings of Ozonoff et al. (2010), while not entirely without merit, are based far too much upon a constructed fiction.

2. This particular group of researchers has been displaying a consistent bias in how it regards autism—etiology, preferred treatments, etc.—a bias that is strongly coloring the group's research methodology, and more importantly, is causing the group to overlook and dismiss data that does not fit into its preconceived notions. The findings of Ozonoff et al. (2010), while not entirely without merit, have been rendered needlessly incomplete through researcher bias.

3. For a so-called prospective study, Ozonoff et al. (2010) seems to have had a good portion of its structure retrospectively decided. While this is not sinister in and of itself, given the background of the researchers and given their potential interest in having the findings of these studies turn out in certain ways, it would seem that a greater premium would be placed upon methodological transparency and fair-mindedness. The findings of Ozonoff et al. (2010), while not entirely without merit, raise questions about general approach and about potential conflicts of interest.

Made-up Measures. There is a reason that much of science has been built up around the consistency of the yardstick and stop watch. I realize not all experiments can be conducted with quite the same degree of measurement consistency as is provided by distance and time—including within the field of autism research—and thus some leeway towards the use of broader techniques can at times be tolerated. But that leeway should not extend to complete freedom in making up measurement tools on an as-needed basis.

The measures upon which Ozonoff et al. (2010) relies are spelled out in the section “Measures Used to Track Behavioral Symptom Emergence,” a section surely deserving of a creativity award, but just as surely not deserving of the name science. Although I cannot do justice to the section myself—it really needs to be read to understand just how much measurement construction is actually going on—let me say that in essence it lays out various observer count and judgment statistics that are re-grouped and massaged together into categories freely labeled as face gazes, social smiles and directed vocalizations—“yardsticks” that I doubt have ever been employed in quite this way before, and quite likely will never be used this way again. True, these methods do allow for some crude observational comparisons between autistic and non-autistic individuals at similar ages—and so they are not completely worthless—but think about trying to repeat this experiment. Think about another research group having to train a set of observers to count face gazes or different types of vocalizations in precisely the same way as in Ozonoff et al. (2010), and you will realize there are no legitimate means by which to replicate this study, because the study has been based almost entirely on measures more fuzzy than a cotton ball.

But it gets much worse. Note that these made-up measures are applied to the study subjects at 6 months of age, 12 months, 18 months, 24 months, and 36 months, with the researchers then implying, straight faced, that these measurements can then be directly compared across all these ages. This is just the height of folly! Take face gazes for instance. Think about what might be counted as a face gaze coming from a six month-old, and then think about what might be counted as a face gaze emanating from a 36 month-old. I am not an expert on infants and toddlers, but I do not hesitate to say that the quality and characteristics of a face gaze from a six month-old are not going to be anything like those from a 36 month-old. That does not stop the Ozonoff et al. (2010) researchers, however—not one bit. There you can find them, plotting out these measurements across all ages in the graphs of Figure 1, alongside corresponding conclusions about how autistic and non-autistic children have “gained” or “lost” skills over time; there is never the slightest hint that these across-age comparisons are instead a massive instance of placing 6 month-old apples next to 36 month-old oranges. And if you have the slightest doubt about the non-comparability of face gazes over time, think about how much more absurd are the comparisons of directed vocalizations. These are the summation of nonverbal vocalizations, word verbalizations and phrase verbalizations that can be corresponded to face gazes. But tell me, exactly how many word and phrase verbalizations do we expect from a 6 month-old, and in contrast, how many word and phrase verbalizations might we expect from a 36 month-old? Once again, the so-called directed vocalizations of 6 month-olds are demonstrably nothing like the directed vocalizations of 36 month-olds, and yet the researchers act as though giving these measurements the same name is all that is needed to justify their direct comparison.

This research behavior is inexcusable, because after all it was the Ozonoff et al. (2010) researchers who made up the measures in the first place. They as well as anybody would know that comparing these measurements across child ages is ludicrous, and I would have to seriously question the intelligence or integrity of anyone who would insist on doing so. But note that this is precisely what happens when scientists start relying on measurement schemes that stray too far from objectivity—it is not all that large a step from made-up measures to made-up use of those measures. As I said in my comments regarding Christensen et al. (2010), concocted measures are the calling card of a concocted science.

Researcher Bias. There is never much doubt about where this research group stands in its description of autism. Both Ozonoff et al. (2010) and Christensen et al. (2010) are literally littered with phrases describing autism as a social deficit disorder, one best approached through early intervention directed towards getting autistic children to adopt social behaviors more in line with those of non-autistic children. This philosophy precedes any attempt at observation.

Of course, there is nothing unusual or wrong about researchers having a point of view. But when that point of view colors nearly every aspect of their research methodology, and when that point of view causes the researchers to consistently overlook important pieces of information that do not fit neatly into their preconceived notions, then there is indeed a problem. My comments regarding Christensen et al. (2010) already noted that these researchers' dismissive attitude towards autistic-like behaviors in infants and toddlers has caused them to turn a blind eye to the characteristics of these behaviors, and thus the researchers are overlooking valuable information, namely that early autistic behaviors are indeed quite structured, predictable and purposeful, characteristics that would be obvious to anyone willing to take a closer look. But this theme of willful blindness is continued unabated right through Ozonoff et al. (2010). First, note the influence of the researchers' point of view on research design: all the measures these authors decide to use are directed solely towards their theory of autism as a social deficit disorder—face gazes, social smiles, directed vocalizations, examiner ratings of social engagement. This would be a lovely set of statistics if all we were interested in is what the authors want to tell us, but surely a much broader set of statistics would be more helpful if we what we are interested in is what the infants and toddlers have to tell us.

And then there is the curious case of the unused statistic. The researchers start out by measuring a category called gaze to objects, but note the problem already contained within the description of that measure—“infant's gaze is directed toward an object that the examiner is presenting to the child or to another object visible in the frame”—anyone with even a modicum of understanding about autism could tell you that there is a world of difference between attention paid to an object presented by another person and attention paid to an object through independent motivation. But this research group, so caught up in its social deficit model, fails to untangle that distinction, and when its further efforts to fit this already mangled statistic into its thesis fail to gain significance, the authors decide to drop all further mention of the measure. Thus orientation to objects and structure, potentially one of the more valuable pieces of information that might have been gathered from this study, ends up getting so messed up by researcher bias that there ends up being no information at all. This is clearly a disservice to science, and a disservice to autistic individuals.

It is easy to see what one wants to see, but the trick in science is to overcome this tendency long enough to see instead as broadly as one can. Ozonoff et al. (2010) does not rise to the level of that standard.

Questions about Approach. Although Ozonoff et al. (2010) does not spell out its overall approach in great detail or with much clarity, one can still piece together enough information from its pages to realize that what was prospective about this study was the gathering of much raw data from a rather large group of participants, while what was retrospective about this study was the harvesting of subsets of this data—as well as subsets of participants—from the initial study group. Of course, this approach raises some key questions about the timing and purpose of various study technique decisions, but these questions go largely unanswered.

I would not mention this but for the fact it must be realized that the circumstances of these at-risk infant studies, as well as the circumstances of the researchers who have been entrusted to conduct them, by necessity invite greater scrutiny. Lists of researchers given the means to conduct at-risk infant studies reveal a consistent and like-minded set of names: names such as S. Rogers, S. Ozonoff, M. Sigman and G. Dawson are associated with these studies again and again. These are researchers who are close colleagues, and who have built careers around a similar social-deficit view of autism, and who are holding mostly high-paying positions at organizations that espouse nearly identical views of autism, and who have been associated with a self-promoted and perhaps proprietary intervention technique (the Early Start Denver Model); so I do not think I am revealing any state secrets in suggesting that this group of researchers might have a vested interest in having the results of their at-risk infant studies turn out in a certain way. There is nothing necessarily sinister in this, and I certainly do not see any evidence of fraudulent results, but under these circumstances, and given the rather narrow focus of both study methodology and study results we have been seeing so far from this group, I think some healthy skepticism and a polite call for greater transparency are certainly warranted.

And I would also think the autism research community might want to reconsider the wisdom of entrusting such a new and potentially valuable line of research to such an homogeneous-minded set of researchers. While there is no easy way to eliminate conflicts of interest entirely from the autism research community, at the very least, if we had some competing interests engaged in conducting some of these studies, we might be more successful in broadening our view.

Allow me to borrow a page from these researchers' storybook and suggest that early diagnosis of their autism research disorder is actually a good thing, because it opens the door to some early intervention. The intervention need not be all that intensive in this case—I think some straightforward occupational therapy will do. For instance, we might try a few sessions where when the researchers attempt to invent novel and fuzzy measures by which to conduct their studies, they are immediately re-directed to consider measures a bit more objective, broadly scoped and possibly repeatable. When the researchers begin to perseverate on their biases, we might present them with a series of PECS cards, for instance, that demonstrate how data and information can get easily overlooked when scientists walk around with blinders on. And when the researchers insist on arranging their studies to suit only their particular interests, we might enroll them in some structured play dates—friendship classes, if you will—opportunities for these researchers to practice taking turns, sharing, playing by the rules, opportunities to experience the good feeling that comes from allowing others to express their interests too.

I am half tempted to package this form of intervention and market it under a catchy phrase—say, the Early Start Indianapolis Model. But of course I know I would never get away with such a scheme, everyone would see at once through my ruse. After all, I am only suggesting that these researchers associated with Ozonoff et al. (2010) and Christensen et al. (2010) merely follow what has actually been available to them all along, merely follow the well understood principles of logic, mathematics and science.

Ozonoff, S., Iosif, A., Baguio, F., Cook, I.C., Moore Hill, M., Hutman, T., Rogers, S.J., Rozga, A., Sangha, S., Sigman, M., Steinfeld, M.B., & Young, G.S. (2010). A Prospective Study of the Emergence of Early Behavioral Signs of Autism Journal of the American Academy of Child & Adolescent Psychiatry DOI: 10.1016/j.jaac.2009.11.009

Christensen, L., Hutman, T., Rozga, A., Young, G.S., Ozonoff, S., Rogers, S.J., Baker, B., & Sigman, M. (2010). Play and Developmental Outcomes in Infant Siblings of Children with Autism Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-010-0941-y

Sunday, February 14, 2010

Early Spring Break

It's time to recharge my batteries, so I'm going to be taking another break from blogging—probably until around early April or so. Feel free to check back then.

Saturday, February 6, 2010

The Autistic Perceptual Difference

I want to draw your attention to a paper recently published online in the Journal of Autism and Developmental Disorders: Play and Developmental Outcomes in Infant Siblings of Children with Autism (Christensen, Hutman, Rozga, Young, Ozonoff, Rogers, Baker, Sigman, 2010; hereafter referred to as PDO). There is much I might criticize about this paper—for instance, its prejudicial insistence on describing everything autistic as an impairment, and also its abundant use of pseudo measures to create the veneer of science (that is, an observer “counting” the number of functional play activities in a four minute session is not the same thing as measuring the distance from Mars to Neptune, no matter how much statistical massaging is applied thereafter—concocted measures are the calling card of a concocted science). In truth, however, these criticisms would apply to almost every instance of current autism research, so they do not of themselves distinguish the paper. What does distinguish the paper is that after one filters out all the fuzzy science, and after one overlooks all the prejudicial assumptions emanating from the paper's authors, the residue that remains still provides some useful insight into the nature of autism, including strong evidence for what I believe to be the nearest thing we currently have to that much sought-after prize, an actual cause of autism. Since the paper's authors have preemptively blinded themselves to these fertile possibilities (because of their prejudicial insistence on seeing everything autistic as an impairment), allow me to step in and try to shed a more productive light on their work.

The study described in PDO centers on observational data of infant siblings of autistic children, alongside similar observational data of non-autistic controls. Since a fair portion of these infant siblings will later be recognized as autistic themselves, these observations allow for a relatively large number of comparisons of autistic and non-autistic behaviors at early ages, well before outside interventions and influences begin to obscure the source of such behaviors. This particular study observed children at the age of eighteen months, and although both autistic and non-autistic behaviors are fairly limited at this age, it is not unreasonable to assume that whatever behaviors do exist at eighteen months, they are for the most part naturally and spontaneously derived.

To cut to the chase, a major finding from PDO is that the infant siblings who will eventually be identified as autistic are observed to display fewer functional play behaviors and more non-functional repetitive play behaviors than do non-autistic controls. The terms “functional” and “non-functional” are unfortunate choices (I will have more to say about these terms later), but within the context of PDO, it becomes apparent that the term “functional” is intended to describe play activity that is considered “appropriate” vis-a-vis the activities and expectations of other humans, and thus another, less prejudicial way of describing this particular finding is to say that non-autistic children engage more frequently in human-centric or human-derived play behaviors, whereas autistic children tend to engage, relatively speaking, in more object-centric or object-repetitive behaviors. Indeed, when the authors get around to discussing the observed differences between autistic and non-autistic behaviors at eighteen months of age, they concentrate precisely on this people versus non-people aspect of perception and activity. The authors' own words:

Examination of the subtypes of functional play revealed that the ASD [autistic] sibling group showed fewer self-directed and other-directed play behaviors than the TD [typically developing] controls. However, the ASD sibling group did not show fewer object-directed functional play acts. This finding is of particular interest because it suggests that children with ASD may not understand people as potential recipients of a play action and/or are not motivated to direct play behaviors to people (self or other) even before many of them are diagnosed.

Although PDO's science behind the above statement is far from precise, nonetheless, on a crudely observational level, the authors are actually onto something here; indeed, the above statement crystallizes perhaps the most useful aspect of their study. With it, PDO becomes yet another instance in a growing body of evidence, much of it dealing with children at a very young age, that demonstrates the fundamental, early-observable distinction between autistic and non-autistic individuals, namely that each group perceptually focuses on an entirely different class of sensory targets. Non-autistic individuals focus primarily on humans and human-centric activities, whereas autistic individuals focus primarily on objects and activities that are non-biological and non human-centric but that are often rich in concepts such as pattern, structure, symmetry and form. For another much-publicized example of this phenomenon, see the study Two-Year-Olds with Autism Orient to Non-Social Contingencies Rather than Biological Motion (Klin, Lin, Gorrindo, Ramsay, Jones, 2009), which demonstrates that two year-old non-autistic children focus primarily on point light displays that depict biological motion, whereas two year-old autistic children focus primarily on point light displays that depict some form of non-biological pattern.

This repeatedly observable distinction between autistic and non-autistic perception and behavior is so important and so significant that I believe it needs to be highlighted and given a name. Therefore, let me dub it the autistic perceptual difference and let me define it in the following way:

Non-autistic individuals perceptually orient primarily to humans and to human-related activities, whereas autistic individuals do not.

There are several items to note about this definition of the autistic perceptual difference. In the first place, the autistic perceptual difference is not the same thing as a social deficit model of autism. A social deficit model of autism would imply that autistic individuals readily perceive other humans—just as non-autistic individuals do—but that autistic individuals, through a neurological defect or some other mechanism, are somehow unable to respond correctly to social inputs or to social situations. I will not go into detail here about the paucity of evidence in support of the social deficit model of autism, but I would note that the mere fact many autistic individuals do mature to the point of being quite capable and quite sophisticated in social circumstances later in life is enough all by itself to make the idea of an inherent social deficit highly improbable. By contrast, the definition of the autistic perceptual difference implies no such deficit—it posits only the perceptual distinction. All the autistic behaviors commonly portrayed by autism researchers as social shortcomings are in fact behaviors that can be expected—that is to say, they are behaviors that are quite healthy within the context of autistic perception. Autistic social behaviors are simply the natural response arising from a form of perception that does not spontaneously orient to the other members of the species.

A second point to note about the definition of the autistic perceptual difference is that it also provides an affirmative description of non-autistic perception. This is an area conspicuously absent in the current state of autism research. Although considerable research dollars are spent and considerable ink is spilled on describing what is presumably wrong about autistic individuals, scarcely one penny is deployed or one drop of ink is applied to describing what is supposedly right about non-autistic individuals. Or to put it more fundamentally, no one ever bothers to address the question, what makes non-autistic individuals non-autistic? The definition of the autistic perceptual difference provides an answer to that question in a fundamental way, by highlighting the species-specific focus of non-autistic perception, and it should be noted that while this species-specific focus aligns non-autistic individuals with the perceptions and behaviors of the remainder of the animal kingdom, oddly enough it leaves non-autistic individuals somewhat atypical with respect to the current state of civilization and mankind. It is my belief that a wealth of anthropological information is just waiting to be gleaned from the contrast and blending of our respective knowledge about autistic and non-autistic forms of perception, and at any rate, there can be no question autism research will never arrive at an accurate, comprehensive and meaningful description of the nature of autism without also arriving at a correspondingly accurate, comprehensive and meaningful description of the nature of non-autism. The autistic perceptual difference provides an excellent place from which to begin that investigation.

The final thing to note about the definition of the autistic perceptual difference is that it states the primary characteristic of autistic perception. The other observable characteristics—such as the tendency towards repetition, and the natural attraction towards objects and activities embodying pattern, structure, etc.—these remaining observable characteristics, although they follow immediately and necessarily from the lack of a human-specific orientation, they must still be described, technically speaking, as secondary characteristics. What is happening here is that because autistic individuals do not have a species-specific focus to serve for cognitive grounding (as is the case for non-autistic individuals), autistic individuals find themselves in the near grip of a sensory chaos, and must overcome this chaos by engaging with the few features in their sensory environment that inherently stand out. When we reflect upon what kinds of features in a sensory environment would inherently stand out from the remainder, we are led immediately to those features rich in concepts such as symmetry and pattern. And viewed in this light we quickly realize that autistic behaviors—repetitive, structure-focused, symmetry-intense—are once again the expected behaviors arising from their particular form of perception. Far from being deficit driven, such behaviors are indeed quite healthy and quite necessary under the given circumstances of the autistic perceptual difference.

It is possible that one day advances in neuroscience, genetics, or some yet-unknown field will uncover a material cause of autism. Nonetheless, it must be admitted that today, currently—despite all the self-congratulatory press releases and despite Geraldine Dawson's annual pompom efforts—despite all this, the autism research community's current efforts towards uncovering a specified material cause of autism still stands at essentially square zero. The autistic perceptual difference is of course not a material cause of autism; but it is, as far as I can tell, the most fundamental piece of information we currently possess regarding autism, and thus stands as the closest thing we currently have to an actual explanation for autistic characteristics. As more and more studies are performed and published regarding autistic children at extremely young ages, my prediction is that the autistic perceptual difference will continue to emerge as the one consistent thread running throughout all those studies. Strip away their concocted science, strip away their researchers' preconceived notions, strip away the medical community's insistence that autism must be a devastating medical disorder, and what will remain in paper after paper is the same observable fact: non-autistic individuals perceptually orient primarily to humans and to human-related activities, whereas autistic individuals do not. Within that unfolding body of evidence can be found a deep and wonderful scientific story that is badly in need of being told; now if we can only get the researchers compiling that evidence to drop their prejudices for just a moment, and open their eyes.

Let me conclude by discussing in greater detail PDO's usage of the terms “functional” and “non-functional” to describe various types of observed play activity in very young children.

At one point in their paper, the authors do offer some examples to help explain their employment of these terms, noting for instance that a child who puts a toy spoon to the mouth of a doll would be counted as performing a functional play activity because that activity is considered “appropriate” with regard to the functional use of a spoon, whereas a child who repeatedly puts various items into and out of a pot would be counted as engaging in a non-functional repetitive play activity, since such activity does not coincide with the expected usage of a pot. I would have preferred, however, if the authors had stuck with the example of the doll and toy spoon when explaining non-functional play activity, noting for instance that if a child were to line up these items into a regular pattern—say, spoon doll spoon doll—that child would be counted as engaging in a repetitive non-functional play activity, just as with the example of the pot. By keeping the context of their contrasting examples more homogeneous, the authors would have revealed more clearly that their usage of the terms “functional” and “non-functional” has far more to do with their own preconceived judgments of these various play activities, rather than having anything to do with the inherent value of the activities themselves.

Think about it. From the perspective of an eighteen month-old child, the functional value of the many activities possible with a doll and toy spoon must seem rather arbitrary, and indeed would be arbitrary if not for one thing, namely that the “feeding” activity is clearly a human-centric activity. An eighteen month-old child who performs such activities is doing so because he or she has seen other humans make similar motions with a doll and toy spoon (quite likely) or has begun to match human actions with real spoons to the feigned actions with toys (perhaps less likely at eighteen months, but still conceivable). Therefore, what actually makes these activities “functional”—both in the eyes of the child and in the judgments of the researchers—is their human-specific nature. But does it follow therefore that only human-specific activities are functional? And is it wise to describe other classes of play activity as “non-functional”?

Note that the so-called non-functional play activity of autistic children is not random activity. If play activity actually were the result of some kind of impairment, then what we might expect to observe is play activity that is highly chaotic or unstructured in nature; but the play activity of autistic children is anything but. Repetition itself belies the notion of chaotic behavior, since repetition is the embodiment of temporal pattern, and when we consider the nature of activities such as lining up toys, spinning objects and selves, staring at ceiling fans, running back and forth in repeated patterns, flapping arms over and over, etc., we realize that far from being random or chaotic, such activities center almost exclusively on concepts rich in pattern, structure, symmetry and form. While it is true that autistic play activities are generally repetitious, object-oriented and non human-centric, it is not therefore true that such activities are “impaired” or “non-functional,” and to insist on saying so is to admit to having turned a blind eye to what these activities actually consist of. The researchers in PDO need to be reminded that their task was to observe autistic play activities, not prejudge them.

Looked at without prejudice, autistic play activities are seen to be functional in at least two very critical aspects. In the first place, autistic play activities are functional towards the development of autistic cognition. As we have already noted, without primary perception of species-specific influences, autistic individuals must obtain their cognitive grounding through their engagement with the few elements in their sensory environment that inherently stand out from the remainder, elements humanity has now come to recognize through the concepts of pattern, symmetry, structure and form. Viewed in this light, autistic play activities are seen as not only essential, but indeed healthy towards the developmental progress appropriate for an autistic form of perception, and another prediction I will readily make is that when all is said and done, it will come to be recognized that it is the lack of understanding towards these autistic perceptual and cognitive needs—along with the many mindless attempts to intervene and thwart such needs—that accounts for the large majority of poor outcomes in autistic individuals.

Just as importantly, autistic play activities are functional in another, much broader sense, one that the scientific community has sadly ignored through the present day, but one that is literally stunning in its overall size, scope and impact.

Humanity currently faces an outstanding riddle regarding the origin and nature of its sudden transformation from biologically limited primate to collective architect of landscapes now thoroughly drenched in such concepts as abstraction, symmetry, pattern and form. The irrational bleatings of the sociobiologists notwithstanding, no plausible explanation has yet to be offered as to the source of this sudden transformation. But in point of fact, the source of that transformation actually exists right before our very eyes. If you are in need of an example, I would note that several instances could have been found engaged in the four-minute play sessions of the PDO study.

Whereas no material cause for autism has yet to be uncovered, the material cause of humanity's remarkable cultural transformation exists in abundance all around us, exists in the embodiment of a form of cognition that focuses primarily on the non-biological concepts of pattern, structure, symmetry and form—the distinguishing hallmarks of modern civilization, and the distinguishing hallmarks of autistic perception. The atypical play activity of autistic children is indeed functional, functional in a way we have hardly begun to conceive.