 but the noise is okay. Do you know where you're from? I have some that are clear. Well, good afternoon. My name is Dr. Freddie Weinstein. I'm Chief Medical Officer at Dominican Hospital in Santa Cruz, and I get to be the panel moderator for our last hour here. Like to start by, first of all, what do you guys think of the morning session? So we'll, of course, be welcoming back Dr. Bookheimer, as well as Professor Willie. But we have two new additional panel members joining. We have Dr. Cheryl Bowers, who's a local expert. And we're also honored to be joined by Mr. George Mellon, who's a local resident living on the spectrum. So we thought we'd maybe kick off this last hour with Mr. Mellon sharing some thoughts that he has. Maybe speak a little bit about this morning or just some ideas he wanted to get across to you in preparation. So Mr. Mellon? Everyone could hear me right. Well, the thought that struck me that's come up on other things when I've heard about how people talk about people on the spectrum or what it's like on the spectrum or just things relate to autism. And yeah, there are a lot of things about it that can be really difficult and really unpleasant. But that's not what I'm here to talk about. Everyone here knows that part. But it just strikes me that we talk about out as if it's something that we should cure or treat or remedy or somehow or another as if it was something that if people become normal, that would be the same as functional. And while I'm here to say as someone who is on the spectrum and someone who is at least able to act as if they're functional, I am not convinced of this theory. It's deeply disturbing, actually, that it's presented as if being neurotypical as opposed to being autistic is healthy and happy. And you don't have this anxiety that's going to attack you at any minute. Well, I don't have even a single college class to my credit. I'm just an enthusiastic reader here. But from what I know of how people think and how people deal with the world, no, that's not how it works. And I think that if autism is, as far as how it produces anxiety and aggravation and frustration, is treated as if dealing with it as a problem of you're different than the less different you are or you'll be, I don't think that's going to help anyone. I don't mean to wish anyone ill who's spoken about this, but it would be like if we had people who are capable of using psychic powers, but I also got a terrible headache. And our solution was, let's get rid of the psychic powers then they won't have headaches anymore. That would be perfectly happy. And we're just going to forget that normal people get headaches too. So I just feel that we need to remember this and we need to not just talk about how people on the spectrum can be better able to deal with the world, but how people not on the spectrum can be better able to deal with us. I just thought that had to be said. So thank you for listening to me there. Thank you so much. All right, well thank you. Before we get to the questions, perhaps we can have Dr. Bowers tell us a little bit about herself, about her practice here. When we put these panels together, we try to have our speakers as well as a local consumer and a local content expert. And so Dr. Bowers is filling that role here. So thank you. I'm a pediatric neuropsychologist. So we share the same training, but I did not go into research. And I'm very pleased to be part of this panel today. It's an absolute honor. It's just been a tremendous learning experience for me today from everyone. And I would like to also say that as a neuropsychologist, my job is to help with both the diagnosis, but also the treatment planning and the life planning and looking at where are we going from here and how do we build upon the strengths and the beauty that you bring to the world. And I so agree with what you said. We all have challenges and we just look at each challenge individually to say how can we make life better and richer for all of us. And since I have the microphone for a minute, I'm also going to say that I'm a member of both the Monterey Bay Psychological Association and the California Psychological Association. I'm an officer on both of those boards. And this is a really powerful opportunity for us as a group today to know that there are legislators that want to hear from us. They want to hear from us as a unified group. If everybody in this room were to somehow communicate, I don't know how that could be possible, but if there was a way that anybody who wanted to, that was in this room today, to send an email to someone, perhaps even me, saying I want you to know who I am and what I'm doing in the world to serve autism, that we would then have one unified voice that we could take to our local legislators and say, hey, here's a group of people who want to see more done legislatively and financially for an underserved population. And so I would encourage either someone on the, someone to step up and take that opportunity if they would, but it's been great to see everyone here today and thank you very much. Thank you. So the first question is one that we get every year, no matter what the topic is, if it's bullying, cyberbullying, depression, autism, and because it's Santa Cruz, the role of medical marijuana in autism. I guess we could sort of expand on it a little bit, maybe talk about the impact of substance abuse as either a form of self-medication or perhaps something that will trigger off or unmask a genetic predisposition. This was written the entire panel, but maybe we can begin with Professor Walate addressing that one or not. All right, anyone want to take a first swing on it, sure. I'll be happy to. So I happen to have strong and unusual feelings on this subject. First of all, there are no controlled trials of marijuana in autism. There's no evidence to suggest it is either good or bad. And as a scientist, we always want to make sure that they're good randomized controlled trials before we make any recommendations for treatment. That said, marijuana has a peculiar effect on the developing brain. It is selectively affecting particularly neurons in the hippocampal area during development. It actually has much less of an effect after the brain is fully developed. So if you start smoking pot when you're 25 or 26, probably be okay later on in life as long as you don't overdo it. But if you smoke pot when you have a developing brain, there are lifelong and very serious consequences which are only now coming to light because the cohort that began smoking marijuana in the 60s is now aging. We've been studying these aging brains and I will tell you as my other job is as an aging researcher are shocked at the magnitude of the effect of marijuana on the developing brain. So I would say there's, first of all, there's no evidence in favor of marijuana or against helping symptoms of autism. There's no evidence either way. But any use of marijuana products in the developing brain is extremely dangerous. And I can't say anything about its use in adults but I would have extreme cautions about that. As a thoughts or comments on the topic from anyone? I would say as a person who indulged in both prescription and non-prescription medications, I feel much healthier, much safer and much more moderated on prescription medications that go through my position. So I had to know from me. Sorry. Several people had questions related to a topic that was touched upon briefly and that had to do with sort of cultural differences in autism, issues around frequency, acceptance and outcomes. I know it was touched upon but perhaps maybe elaborating on how you would work with a family who from a cultural standpoint has difficulty accepting autism. That's such a good question about the cultural differences and I think that part of the role of, for all of us is educating the community to understand what, not just what is autism but how does it affect your family and how does your family interact with your developing child or spouse to see autism as something that goes across cultures, it goes across genders, it goes across economies and that it's not so much a cultural difference as it is an individual difference and to help people look at it individually but also from a cultural perspective to take away the fear that it might have a stigma attached to it and to make sure and educate people so that they know more about A, what services are available but also to find the strengths of people without looking so much at how that might change but I also need to recognize that in some cultures having a psychiatric illness can be seen as perhaps something that someone else in the family has done wrong and that's a big stigma to work against but I think it's important to consider that when we're working with cultural differences. Thank you. Different versions of a question of sort of nature versus nurture and the impact of our obsessions with smartphones, video games, the use, the immersion in those types of technology whether sort of that being a symptom or that could increase symptomatology or perhaps once again kind of unmask a genetic predisposition for the disorder. Yeah, I'm not sure that there's any direct data on that but these days a lot of people are talking about it as I think we talked about earlier what you do with your brain shapes your brain it shapes brain development it shapes what pathways will be reinforced and what will not so there has been an increasing amount of data recently on video game use primarily among individuals with ADHD not so much in autism showing that other pros and cons actually showing that some video games can teach kids to focus better but it also very much narrows the range of focus so I think the jury is out on what the long term effects are going to be but it's so clear that our access to technology is changing the way our brains develop and in ways that we really just do not understand right now and I think it's something that has to be studied quite a bit. I think that a lot of times with video game a lot of time with video games keeps people away from face to face contact and that face to face contact is essential for developing good social skills and if kids are spending all of their time staring at a screen and essentially engaging in parallel play which normally stops in the early toddler years but now is continuing well into the teens for these kids that I can't imagine that that's good. Sure. I'm gonna take a slightly opposing view and I should start off by saying I don't know how to play Minecraft yet but almost every child that I see is an expert in it and at first I really wanted to learn and now I'm kind of afraid but I think it's important that when we're looking at things like video games and our concern that they isolate us from other social interactions we all need time to kick back to relax to find our own comfort zone and if my comfort zone happens to be something that is not socially demanding and does allow me to connect with other people in a way that works with me I think that there needs to be some time during the day that that's acknowledged as an okay thing and yes and it worries me when I hear a parent say that they wanna restrict that and to use that as a form of punishment and yeah I get that we don't wanna have somebody spend their entire lives isolated from other people but I also think it's important to respect that for some people just like lights can be too loud and voices can be too loud and smells can be too loud that too many people can be too loud too and it's nice just to be able to have one friend that doesn't demand that I read their nonverbal cues in order to have a connection with them so I think that it has a beneficial purpose as well I don't, these are the Brainiacs I feel that I'm inadequate discussing this but I do like to play video games because I like isolation and while I know I have to be careful because I'll become too much of an isolationist I do enjoy playing them and what I've noticed is that it's brought me a group of friends that I can relate to and so for me it is not an important part of my life but something that I do spend a few hours a day doing however what does concern me is when I've spent too much time on the video game my hand hurts, my arthritis is worse, my neck hurts so physiologically in other areas the brain aside and the socializing aside I am a sore person at the end of gaming so I think as my father used to say everything in moderation is okay but once we get over to the extremes, who knows? I'd like to echo this and my opinion is someone who pretty much grew up in the electronic games are taking over our youth generation yes I think we should be cautious about anything that has an impact on developing brains but I think that we should also keep in mind not only is it good to have a situation in which you can unwind away from social activity we might want to consider whether or not encouraging social activity is actually in a given situation having a positive outcome on people or socializing I mean if you put me in a situation in which I'm tired and grumpy and just plain frustrated and you expect me to socialize not only am I not going to enjoy it not only are the people who are having to deal with me not going to enjoy it it's just not going to accomplish anything it's going to be going to associate socializing with the unpleasant feelings and we don't want to do that we want to encourage socializing to be a chance that not as something that is as opposed to being relaxed but as something that one can be relaxed and doing it at the same time and that cannot be done by saying no get off your game whatever they call them these days and do whatever it is that people did 30 years ago because we all know that no one actually remembers what they did 30 years ago it was one of those you know we were kids we ran around the block six times and then we went up and we but you didn't have cell phones that could play Minecraft of course you didn't do that every afternoon so how do you know anything I don't want to say that we should encourage the video game generation to become addicted to electronics even as someone who spends a lot of their time on the computer I would say that's a bad thing but I think that we need to look at why the video game generation is doing that not just on the spectrum but just video games in general and then start worrying about whether or not people are doing it as opposed to socializing or if this is just another medium I mean a lot of the games that the quote kids these days unquote play are social activities of a sort even if it's not face-to-face contact and I would imagine that has a different effect than if someone was say playing Tetris as far as maybe not yeah you're still not learning how to read people's faces but you have to respond to other people expressing themselves and be able to express yourself to other people for a particular so I would definitely say that it should be looked into more before and judged less not so much to this audience is just okay so kids are playing a lot of video games and what exactly is this are these effects when went that I think it needs to be addressed first and we can worry about what to do with the fact that it's doing things later because the kids these days ruining their lot lives has been a complaint since the recall out of caves and our ancestors are saying all of the kids these days they're not eating rocks like their grandparents and you know do you really want to sound like the people who thought that eating rocks was such a good idea that the fact that kids these days and wrapping things like fire and the wheel that's just wrong i don't think we do all right george well thank you for that so this next one could perhaps be for uh... sure was a provider and and and george is a consumer in terms of questions related to sort of insurance coverage uh... local resources both in the public and private sector uh... maybe comment your experiences and and suggestions for what is available locally start with that one show i am not an expert in insurance uh... i do know that uh... i just reviewed legislation uh... that's going to be uh... seen before uh... sacramento this year uh... as far as increasing some of the expectations for insurance coverage for uh... the diagnosis of autism which is another reason for me to say make your voices heard uh... local resources uh... sanacrus does not have the luxury uh... that san jose has uh... being uh... a much smaller community uh... so we sometimes do look to san jose for some of the services that sanacrus cannot afford or does not have uh... i think that sanacrus has a pretty good job in many areas of supporting uh... the diagnosis of autism but i think we also have some major holes in our services my experience right now is that the schools are working hard to uh... step up to the plate and are probably being uh... overwhelmed with the requests at this point uh... as more and more people are being identified uh... but the biggest hole that i'm aware of right now is once we hit graduation from high school where do we go and how do we support people who have been adequately supported throughout uh... k through twelve uh... and then the funding seems to stop and the services seem to disintegrate and um... i think that's a really uh... underserved area and i'm not sure what our next steps should be and i would look to uh... all of the audience and and our panel to say this is a big hole that we need to address uh... i would like to see uh... even within this room people getting together to say as a group we would like to uh... a meeting to talk about this we would like to have some sort of a consensus we would like to have some sort of a statement a written statement that could represent our community uh... to the larger voices and larger uh... community that would be able to fund these services so i would think that uh... that would be important for us to consider today as a group but uh... again i think our most underserved population is the population that is post high school and in george or experience in terms of accessing treatment in the community would basically just say yes it does seem like there's not a lot out there and a lot of what is steered and my understanding and towards people with autism and helping them get jobs is a lot more on the people who are more on the low-functioning and which is understandable and i would not say so but as someone who is on the higher functioning and so what exactly do we do do i could i am described as a smart thoughtful etc etc person but because i will as of reasons related to factors that i don't particularly feel like going into i was a lousy student high high school and and that definitely is an impact but i don't fall into the category of let's have this guy pick up track trash in the parking lot and i don't fall in the category of this guy is so fantastically brilliant let's get him a scholarship because i've said bad performance in high school so i would say that i think that needs to be addressed i don't think it's a as major a problem but i think it's definitely another whole we don't it's an awkward okay these people are perfectly capable of achieving why aren't they achieving and that we don't have any good answers and by we i mean the people in that category with i can say that this is frustrating and tedious but i can't necessarily say and if you may made it in sparkles that would be different it was that simple i wouldn't be glad to expound on that but it's not so that would be my personal concern certain where do we deal with this if we somehow do manage to have enough of an effort to deliver to the state okay stop doing whatever it is that you're doing wrong start funding this thank you next question for doctor bookheimer so if indeed there were to sort of come to pass it was a definitive medical intervention for a quote-unquote eliminating a sd your thoughts about how far off in the future it might be would it be looking to address issues sort of at the gene expression level or or correcting connectivity issues what you're sort of looking into the crystal ball of the future i think in the crystal ball of the future first of all i think it's important to note that as what am i speakers here on the panel said if you've seen one case of autism you've seen one case of autism everyone is very very different from one another so there's not going to be a single answer to that question i think that what we're hoping for is to get enough of an understanding of all the contributions and also to get tools to measure what is happening dynamically in the brain early in development and i mean by early i mean in the first year of life to be able to look at uh... aspects of behavior which might be so subtle that you can't really see them by looking at them but we might be able to measure with other tools like imaging or with ee g and and so forth and uh... uh... it is very unlikely that there's going to be one intervention or two interventions or three interventions even if we got the medications or the or gene therapies or something that would affect certain categories of genes there's not going to be one that's going to work for everybody because everybody has a different genetic background and different pathways that might lead to the same outcome and of course i think that it's important to note that uh... as has been already pointed out we don't necessarily want to treat all of this either if we start to treat uh... individual differences and start making everybody identical that's probably a bad idea i think that what will really be wanted to focus on is trying to intervene for those individuals who are very likely to be in the worst outcome categories at a very early age so what do i think in the long term what is our prospect i think that within the next five years we will know a great deal about gene expression in the first year of life probably enough to start creating animal models of intervention and uh... i hate to be too optimistic but the field of autism has uh... moved forward so quickly in the last twenty years due to uh... a lot of very active parents insisting that congress start paying for autism research which they didn't use to do so you know perhaps optimistically in ten or fifteen years we might have some interventions for some forms of autism uh... that might that we might be able to use in the first year of life i think there's also some good prospects for interventions coming up in the next couple of years that will improve certain symptoms in certain individuals uh... there are new long-acting oxytocin drugs that are coming out right now that i think will particularly be beneficial for that subset of individuals with autism who have reward processing deficits uh... at the neural level so you know maybe that's you know fifteen percent or twenty percent but that's a significant number of people who might be uh... uh... impacted and i think those drugs will be ready very very soon so i think it's a mixed picture but i am personally maybe i'm just an always an optimist but i'm personally optimistic that we're gonna make great progress in the next of five to fifteen years question for the practitioners uh... several treatment modalities were addressed this morning uh... there was a specific question about biofeedback as a treatment modality uh... its use any data out there on if it's been effective or beneficial in any way that's you that's you you know uh... i recently gave a presentation to a small group of people uh... in the communities uh... the consumers uh... with attention deficit hyperactivity disorder and that question came out as well and uh... to the best of my understanding the research is still vague and uns and unclear there is some robust literature to say that uh... that uh... there are some benefits and that we are seeing some impact uh... and i think when i look at the drawbacks uh... the drawbacks are still the questions of generalizability uh... and in some instances they're they're they are finding some generalizability where if you can learn to concentrate or focus or benefit in this area it will translate but i think the big danger in looking at uh... the sort of biofeedback uh... systems is the uh... the implied notion that it's going to solve many more problems than it solves uh... i think if it's targeted to solve the certain problems that it's capable of solving or when i say problems i mean aid and development it probably is efficacious in that regard it's never going to help with uh... executive functioning that says where did i leave my car keys did i say that out loud instead of keeping it to myself did i uh... remember to say thank you just now uh... those aren't things that probably are going to benefit and and i do worry that uh... some consumers are uh... being convinced that uh... spending a lot of money a great deal of money on a service that can help a narrow uh... part of a of a learning process is being asked to be generalized into too much of an area uh... i heard on npr i guess that's one of my sources of study uh... of a man who had learned he he was a journalist and he went to a convention in which people were having contests about memory he surprised himself by actually becoming so good that he won the contest amongst all these people who were champions at remembering and at the end of this he realized that there was he was still not going to remember to take the chicken out of the freezer the night before and he was still not going to remember all other kinds of things that he needed to remember because memory is more than just one type of memory uh... and i think that would be my my uh... caution about that those systems also along the lines of just treatment modality this one would be for a professor willy those interest in hearing a little bit more about uh... uh... equine assisted activities uh... as well as the work uh... at kirkshire farms well thanks for that plug i'm on the board of some equine assisted therapy groups and uh... it's there that we do the therapy for any age i mean as soon as they can you know pet a horse up through their nineties we have patients in their nineties who everything from cp to autism to anxiety disorders to eighty htm everything and we do find in there is some good nice literature out there to support the fact that hippotherapy and and a lot of therapy with dolphins of all things has resulted in speech has resulted in some muscle movement extra uh... muscle movement that wasn't there before i don't know maybe you guys do but i don't know the whys of it so far but we do see good results before and after the simple t-tests are showing some nice results so that's very exciting and i'm and i'm actually i'm writing a book with with some things on that in my mind the horses saved my life socially because it was always when my first pet was a horse and it was uh... through a horse you can have friends elicit did uh... into being a friend because you said i have a horse imagine how many girls want to be your friend because you have a horse and i think that there was that part but there was also the responsibility like you said learning to remember things if you didn't have the the saddle since just right you would fall down so the reward of writing a horse gives you the motivation to do things fine motor muscle big motor muscle i hand contact that i normally wouldn't have done but i was so motivated to ride that i learned those skills and just you know the past seven years i learned how to tie my shoe quickly which seems sort of silly in the age of velcro and you know floppy shoes but it's i don't longer have to ask a kid to come you know lace mrs willie shoes i can do it myself pretty darn quick now so even that little thing has helped me with my my hand dexterity uh... at kirkshire it's just my barn we board twenty two horses and i have my own four horses there i enterprise being blind horses and pregnant horses and i have two that i ride regularly so we don't have those kind of horses there it takes a certain horse to be a therapeutic horse certain equipment certain kinds of instructors uh... mine would just be for the kids that needs self-esteem or want to learn to ride or want to compete so it's i'm i'm foot in both doors thank you uh... next question perhaps coming from a a concerned parent uh... what would be sort of the observable factors of behaviors uh... that you would see in in a baby to sort of feel of the uh... that child was at risk for uh... developing a sd so uh... uh... officially we're not supposed to do a diagnosis till the age of two and there are many studies uh... currently that are showing that before the age of six months there aren't any noticeable signs of autism personally believe that's probably not the case is just that the signs are so subtle and very hard to see but the first sign that that most people will uh... point to is uh... failing to engage in mutual eye gaze with the parent uh... uh... and as the first year and second year of life develops failure to engage in joint attention and particularly in initiating joint attention so that would mean uh... for example uh... pointing to an object and sharing a gaze with your uh... with your child about that object and so the two of you together are jointly attending to something when a child initiates that look at this mommy uh... that's a really good sign of health and the absence of a behavior is often hard to measure but that's one of the things that you would look for another thing is of course in a delayed language development delayed motor development irritability and failure to respond to one's name is also a a a big one uh... failure to engage in social smiles that would be another big one so those are the things that you would look for particularly in the first year of life show a few more things and and uh... i'm i'm not speaking as a parent because i'm not a parent uh... but uh... at even very very young in infancy uh... there's a sense of connectedness that we expect uh... a very young baby a very young baby to learn to smile when they see a smile but also to make uh... make a contact when they experience a smile when they see someone else making a smile but that will uh... direct their attention toward that smiling face uh... babbling uh... the absence of babbling is another one of those early cues that we can look for uh... that uh... it can be uh... you know it's not it's a what we would call a uh... a marker it's not a definitive diagnostic sign it's one of those uh... diagnostic markers that say pay more attention to that so those would be some of the things that i would add i'll just add one other or two other things in an experimental test that we do one is uh... we do tests where we create uh... an environment where a child could look at a uh... person or an animal or could uh... look at an object or a mechanical object that's moving and if you just look at the eye preference the gays preference uh... individuals with autism tend to gaze more at the inanimate object and typically developing children uh... and this is true of very young children six months and even younger tend to gaze towards the um... uh... animate the person or the animal uh... and the other test that experimentally has turned out to be very successful in uh... the baby love at UCLA uh... is is part of a broader battery where uh... the experimenter uh... pretends is playing with a toy hammer and pretends to hit themselves and get hurt and they say oh and they give all the things you know pain gestures and uh... we've got some great videos of children with autism they they just go on with their business like nothing has happened but even a very young child uh... six months eight months old when they see uh... somebody screaming in pain or crying or showing signs of distress will stop what they're doing and they orient and they'll look for their mom and so forth so it's it's really an early measure of empathy I would also add two things you guys isn't there uh... a lot of studies where kids have a failure to thrive like a failure to suckle failure to connect with their parent and I know with one of my daughters for example this is not just a study of one but the one that I know she was very rigid you couldn't comfort her she didn't relax in your arm she was very standoffish and only really wanted attention from one of us marked difference between that and her sisters yeah and one one of the things I hear from uh... parents a lot when I'm doing my history as I've learned over the years I think has a lot more to do with sensory and sensory motor than we have previously considered or appreciated and when you talk about that whole latching there's uh... sometimes that oral motor that's delayed and so we can't make our mouths do those things we want to do but and there's that stiffening uh... and the crying the really chronic crying and I think that when we really begin to look more closely in the future what we're going to see is this this sensory sensitivity doesn't emerge at age five it's probably there from birth and we're sometimes overwhelming these little infants with too many close faces too much noise too much touch the wrong kind of blanket and I think that a lot of those things will eventually become not as problematic when we can say look here's three different kinds of blankets to try for your infant or swaddling or yeah some some babies want really tight some want not so tight some babies like a very light touch and for other babies that like touch is like fingernails on a blackboard and helping a parent to recognize which one works in which one doesn't is I think going to be really important thank you uh... I know we've largely avoided the eye word and have not talked about immunizations but there are a number of questions uh... sort of uh... asking about exposure to various environmental issues including prenatal exposure to drugs uh... and alcohol uh... being uh... risk factors or triggers uh... what anyone want to take on some of those uh... somewhat controversial topics not me I have to have to have this conversation a lot uh... so with regards to toxins there have been some epidemiological studies that there's so many toxins in the environment that it's very hard to look at the effect of anyone toxin so there have been some epidemiological studies looking at people who globally are simply exposed to more toxins people in the Central Valley in California for example people who live near freeways and uh... there is some evidence that the incidence of autism is slightly higher among those individuals uh... it's it's not a huge effect but it probably is there uh... but we don't know what they are the uh... the one uh... well documented environmental uh... I think we can say contributor significant contributor to autism is actually age of the father uh... that is the one validated well validated contributor to increased autism risk uh... that the immunization and so forth vaccines uh... has was a seemed like a perfectly plausible hypothesis uh... that has been studied uh... very very extensively and uh... with um... many tens and tens and tens of millions of dollars put into uh... trying to find uh... mechanisms evidence etc there is just simply no evidence uh... for uh... immunization uh... causing uh... autism with the exception of a single disorder which is a uh... genetic accident disorder that can't metabolize certain vaccines and it's extremely rare and it should be picked up prior to vaccinate vaccination anyway uh... and uh... that seems to be very clear and it turns out the person who uh... came up with the initial theory uh... was forging his data and his lost his medical license thank you well we usually like to take the last ten minutes or so sort of for sort of summary comments uh... words of wisdom to our community uh... observations suggestions and and maybe we can just sort of go down the row and uh... and start with that as we look to wrap up the wrap up the day so uh... instead of talking about neurobiology because you're probably all sick of the brain by now i'll just say that uh... when i think about uh... genes and autism i'm reminded of a couple of factors we for example all have genes for the knee right we all have a knee gene there is no variation in our genome in the knee gene and it's because every human being needs uh... a knee so there's no variation but whenever we have variation in the genome then that means that those genes are there for a reason uh... that means they confer some advantage so every risk gene that we have for autism is a gene that for some reason is important that it's good and i think it's important for us to recognize that i think that we've in our society we've increasingly moved towards having narrower and narrower definitions of what is okay behavior and i think that it's very important for us to recognize that and to leave a lot more room for what used to be called eccentricity uh... but we now give a diagnostic label to because those same genes that might in an extreme case uh... lead to maybe severe autistic behaviors in even slightly less extreme cases lead to uh... brilliance in in uh... in some areas of of uh... cognitive functioning that are are absolutely necessary and so i think that it behooves all of us to appreciate that these behaviors have an adaptive value and it's important for us to appreciate that i'm stumped i have no uh... i think that that especially this end of the panel has spoken so beautifully today about uh... the experience of life of seeing the beauty of life from a different lens and i i i benefit everyday when i go to work and i see the world from somebody else's eyes and somebody else's point of view and so one of the things that i'm trying to do every day in my life is to ask the question of what what is it like to be you what is it really like to be you uh... before i go into my uh... impatience in the grocery line or uh... my uh... my uh... sometimes that prejudices that sneak in in which i say that's not how it should be done uh... and allowing myself to say what is it like to be you what do you bring to the table what i'm how am i supposed to see the world from a different point of view and i i love my job absolutely love my job because in my job i get to watch the same task being performed by hundreds and hundreds and hundreds of people and i'm astounded by the creativity that i see and the uh... the different forms of joy and so i've been asked questions such as can my child love me can my child experience love can my child experience happiness uh... and my definition of that has so altered uh... and i no longer start with the premise of a prince charming and a glass slipper uh... and uh... i now realize that for some people happiness is not the same as it is for me uh... and that for some of the people i work with happiness is taking apart a lego toy and putting it together in a new way a hundred times uh... and i and i have come to appreciate the beauty of watching that happen and uh... so that's something i'm hoping to incorporate more and more into my own life is just saying how do i help help me to see the world from your perspective professor uh... i was like lost what i was supposed to say uh... as i get older i request that each and every one of you do something to help we old folks i think of my dad in his last days in the hospital and i think of other elderly people and we were talking a little about sensory things and what think of the folks in the nursing home that are uh... complaining about their blanket and kicking it on the floor playing about their food and spitting it out and the folks in the hallway are saying oh that's a crudgy old person with dementia and what they really don't realize is that it was tapioca and that's a disgusting texture or it was um... you know uh... a wool blanket and and and like we said the sensory issues were involved and i i worry that uh... uh... those of us that grow up not only do we not have the services but uh... what does our brain do when we get older how does it change then what sort of uh... synaptic responses are no longer answering the call to survival and what are not just you know what we can't golf anymore so we're going to you know play shuffleboard the big issues the romantic issues the friendship issues that we don't know anything in my publisher recently asked me to do something on the elderly which i i think was a bit of an insult but um... i really don't know when it scares me my dad had me i'll have my daughter who's gonna have my daughter you know and so i wish we paid much more attention to the elderly in general and i also wish that we did focus more on the females i have to say that you know represent we we do know that autism is a spread out among the female uh... population it is more obvious oftentimes in the males because we uh... explore it in different ways and we show it in different ways and we're far much more subtle and that ends up in a lot of us with a lot of the females with severe comorbid uh... issues and then so we come to the doctor and we're diagnosed as simply a depressive well that's not the route the route if it's uh... you know a result of self-esteem cause because what came first the chicken of the adult autism or uh... depression so i think between the females and the elderly and the minority groups if we could just capture those three little things we'd really be uh... on the path of something really cool so that would be my thoughts i think i'm going to say in the vein of the last comment maybe it's not the problem is not that people on the spectrum have trouble communicating maybe the problem is that people not on the spectrum have trouble understanding our communication and both for the people here who already are doing it and the people who are not here but are going to be told about this please remember if you're not sure if you understood what someone said are you listening to them i think we need i think we would all be better off spectrum or non-spectrum older you you have minority or not not if people said just thought i didn't understand this because i have trouble understanding rather than this person is just talking funny because yes people will at times talk funny but if we have to have to learn earn out a communicate other people have to learn how to listen or no one is going to understand anyone all right well thank you once again to our to our panel members uh... couple of quick announcements before we break one is please leave your appropriate continuing education forms and suggestions for next year as we exit through the front uh... the other is you guys can fight over the bubble bowl that's on your table and feel free to take that but it would be remiss for us to not to give a special thanks to the man behind all this mister george jero there's your bubble ball i'll say i'll see you next year thank you all very much for coming thank you i hope you do more well yeah thank you we need more voices yeah i really thought that emanation