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Opinion / Viewpoint

Powerful memory system may compensate for autism’s deficits

by ,  /  17 March 2015
The Expert:

Michael Ullman

Autism has been the focus of intensive research, especially in the past few years. Not surprisingly, most of this research has targeted the impairments found in autism, and their underlying causes.

However, what remains unimpaired can also be important. Relative strengths can play a crucial role in helping individuals compensate for deficits, leading to a more productive and fulfilling life. People without hands may learn to use their feet to grasp objects, and even to write and paint. Blind people can learn to read using touch. Compensation can also take place within the brain. For example, the right hemisphere may compensate for some left hemisphere damage, helping individuals recover from language impairments.

We have proposed — as outlined 15 January in Neuroscience and Biobehavioral Reviews — that a single brain system can compensate for numerous and diverse deficits in autism and related neurodevelopmental disorders1. This brain system is declarative memory.

Rooted in the hippocampus and nearby structures in the medial temporal lobe, declarative memory is what we refer to when we talk about learning and memory in broad terms. It’s what we use to remember our first-grade teacher or what’s on the shopping list or the yummy risotto we had for dinner last night. It’s important for learning language, concepts, images and much more. In fact, it may allow us to learn just about anything.

Declarative memory can be thought of as the brain’s superstar for learning and memory. By contrast, other brain systems for learning and memory, such as those that help us learn movements or acquire emotional memories, appear to be more specialized.

Given its flexibility, declarative memory is a potentially powerful engine for compensation across diverse deficits and disorders. Importantly, evidence suggests that it remains largely untouched in multiple neurodevelopmental disorders, including obsessive-compulsive disorder (OCD), Tourette syndrome, dyslexia and specific language impairment (SLI). It also remains in working order in both high- and low-functioning autism, though it seems to be generally better in people with high-functioning autism2,3. Individuals across the autism spectrum can also have enhanced or even savant-like memory.

Scripts and stories:

Because declarative memory generally remains intact and is so powerful, we expect it to help individuals compensate for multiple deficits in autism and other disorders. This appears to be the case. Declarative memory seems to help individuals with autism compensate for social deficits by memorizing scripts for navigating social situations. It supports the learning of strategies to overcome language or reading difficulties not only in autism, but also in SLI and dyslexia. And it appears to help people with OCD or Tourette syndrome learn to control compulsions and tics.

Evidence for compensation by declarative memory comes from several sources. Behavioral evidence suggests that individuals with autism or other disorders often learn compensatory strategies explicitly, by consciously mastering the steps involved — a process that requires declarative memory4,5.

Temple Grandin, a noted scientist with autism, said in a 2010 interview for The Wall Street Journal, “The thing about being autistic is that you gradually get less and less autistic because you keep learning, you keep learning how to behave. It’s like being in a play.” Individuals with autism seem to instinctively turn to explicit strategies to better communicate and understand the world around them.

In fact, therapies that rely on explicit knowledge — such as scripts and stories that guide children through different social situations — seem to be particularly effective in autism and other neurodevelopmental disorders6-13.

What’s more, many people with autism use phrases and sentences that are memorized in declarative memory. Often referred to as ‘formulaic speech,’ this tactic may help people compensate for both linguistic and social deficits14-16. For example, they may learn stock phrases to help them interact with others in social contexts.

Similarly, children with SLI seem to memorize phrases to help compensate for their difficulties with grammar. For example, they may memorize ‘the mouse’ rather than combining ‘the’ and ‘mouse’ grammatically17-19.

Brain evidence from techniques such as functional magnetic resonance imaging (fMRI) also supports a role for declarative memory in compensation. A number of studies have found that people with autism, OCD or SLI, but not controls, show activation in regions of the brain responsible for declarative memory when performing tasks involving social skills, planning or grammar20-26. In some tasks that show this pattern, individuals with these disorders actually perform as well as controls, suggesting that their compensation is successful.

What’s more, correlational evidence has shown that people with SLI, dyslexia, OCD or Tourette syndrome who seem to have better declarative memory have fewer or milder deficits — such as obsessions, tics, grammar or reading problems — than those whose declarative memory is weaker27-31. We are not aware of any studies examining this type of correlation in autism. But the declarative memory weaknesses seen in people with low-functioning autism might help explain why this group is more severely affected in the first place.

Treatment tool:

Knowing that individuals with autism or other disorders may be able to use declarative memory to compensate could inform treatment. First, designing new therapies that expressly rely on declarative memory, or that improve learning in this system, might enhance compensation and thus reduce symptoms. For example, drugs known to improve declarative memory — such as acetylcholinesterase inhibitors or memantine32,33 — might ameliorate symptoms, particularly if paired with behavioral therapies that depend on explicit knowledge.

Second, designing interventions that prevent individuals from using declarative memory to compensate for their deficits might strengthen the dysfunctional circuitry. This strategy is akin to therapies that prevent stroke patients from using their good hand so they are forced to use their bad one, which can improve its functionality.

Declarative-memory-based compensation also has implications for diagnosis. Good declarative memory might mask symptoms of a disorder. Understanding that such compensation exists makes it possible to work around it. For example, diagnostic instruments could target symptoms and deficits that cannot easily be compensated for by declarative memory. Note that individuals who avoid diagnosis due to strong compensation could still benefit from diagnosis and therapy.

Underdiagnosis resulting from compensation may also help explain a major conundrum: why diagnoses of autism and related developmental disorders are more common in boys than in girls. Declarative memory seems to be better, on average, in girls and women than it is in boys and men34. As a result, girls may be better able to compensate than boys, even compensating themselves out of diagnosis more often than boys do.

Compensation by declarative memory may also be found in other disorders, including attention deficit hyperactivity disorder and debilitating adult-onset disorders such as Parkinson’s disease and aphasia, in which damage to the brain’s language centers leads to severe communication difficulties. Given the power and flexibility of declarative memory, it may play compensatory roles in a wide range of disorders.

Declarative-memory-based compensation might plausibly be widespread and could have important therapeutic, diagnostic and other implications. Further research on exactly how and when people depend on this powerful memory system could yield substantial benefits.

Sometimes it behooves us to look not where problems lie, but where they do not.

Michael Ullman is professor of neuroscience at Georgetown University in Washington, D.C. Mariel Pullman is a medical student at the Icahn School of Medicine at Mount Sinai in New York.


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5 responses to “Powerful memory system may compensate for autism’s deficits”

  1. Ian Cooper says:

    Very technical so how do use it and develop it to help people with autism, my son 13 has autism .

    • Planet Autism says:

      It cannot be used like you suggest. It’s a question of the individual recalling things that are either memorable to them, that they learned from experience with etc. the same as anyone else, it may just be more developed in autistics and is something that will be used naturally. Autistics are not circus monkeys.

  2. Planet Autism says:

    As an autistic I can vouch for this being true. However, it is long-term memory, short-term/working memory can be very impaired no matter how high-functioning you are – especially if you are stressed, hence executive dysfunction. I also have quite a photographic memory and visualise somewhere particular I read something (such as the document or book) to recall the information on it. I disagree with this though. Temple Grandin says a lot that I disagree with actually:

    “The thing about being autistic is that you gradually get less and less autistic because you keep learning, you keep learning how to behave. It’s like being in a play.”

    You don’t become less autistic, you just learn to cover it up with techniques (in other words compensating like this article states) but you are as autistic as you ever were.

  3. Miilanna says:

    It is sad commentary on society that those who are famous, wealthy or published authors are automatically assumed to be experts. I admire Dr. Grandin, and appreciate that she may understand her own autism experience and has had opportunity to have contact with other autistics, but she has repeatedly demonstrated ignorance about autism in general, and has actually offended a large portion of the autistic community with her ignorant and sweeping generalizations about autism.

    Unlike many of us, she had a great deal of support while growing up and studying for her degrees, and has successfully navigated the book publishing maze in a way that is unavailable to most of us with autism. She is outspoken in her sweeping generalizations, but her validity is poor.

    However, it IS so that many autistics store and retrieve memory in ways that are said to be eidetic. That is very obvious to us and to those living with us. It is important to remember, that even eidetic memories are not always all encompassing, and vary in scope and intensity from person to person. I myself have proven to my husband that my photographic (and other types of) recall is precise, even over long periods of time in such ways as telling him where on the page the sentence he is reading is located (of books that I have previously skimmed) or by remembering exact starting pitches, melodies and harmonic sets for months and even years after having heard them. This does not mean that I have a perfect memory, or have savant capabilities (since I do not) only that that is the way my information is stored and retrieved.

    The storage and retrieval of information seems to be very different for us autistics than it is for non-autistics. It may take longer to store and organize the information when we initially process a particular subject or category, but once the basic structure is established, the storage and retrieval is more immediate and long-term than it seems to be for non-autistics. Just because we are initially delayed in some categories does not mean we are not learning. We may actually be learning better than you are.

    Most of the research and available information about autism has been by non-autistics interpreting us by their own non-autistic perspectives, or occassionally by those with very unusually supportive families such as with Dr Grandin. It is time for adult autistics to be given opportunity to offer our own perspectives on how and why we do various things, and for the misinformation to be allowed to dissipate.

  4. Philip Miesbauer says:

    I am autistic myself I and agree that declarative memory gives the ability to compensate for a difference in perception.
    I believe you missed cause and effect on the the relation between “high/low-functioning” autism and declarative memory, though.

    “…though [declarative-memory] seems to be generally better in people with high-functioning autism.” I am, what is referred to as, a “high-functioning autist” and I do not believe declarative-memory seems to be generally better in people with high-functionin autism.
    I believe the conclusion should be: “Autists with better declarative-memory seem to generally function better in a non-autistic society.”

    I also want to bring to your attention, that compensating, as you call it, is not like reading braille, as mentioned in the article. Reading braille is a necessity due to the inability to read through vision. It is something I would want to do to be able to read, not because somebody else forces me to it.

    Changing your natural repsonses in conversations and memorising scripts when talking to people (as I for sure do) is different, because I am capable of holding a conversation, but it’s people’s inability be happy with the way I communicate that forces me to change myself.
    So, when autists use memory to compensate they are not compensating for anything they are not capable to do, but they are compensating, for society’s inability to be happy with their natural repsonse.

    It is very emotionally straining and can become very lonely to always have to pretend to be some you are not.

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