Note that this page was published in 1999.

By Darold Treffert, MD

Searching for the Savant Within Using rTMS

Three Australian researchers have used rTMS (repetitive transcranial magnetic stimulation) to test the theory that higher cortical mechanisms and cognitive processing which normal persons use in day to day functioning are such that they over-lay and bury access to lower level savant circuitry and processes that might lie in all of us. That idea is explored also on the "Is there a little 'Rainman' in each of us" portion of this web site. By temporarily disabling these higher level processes, using rTMS, the researchers designed tests and procedures to search for such buried circuitry in 17 non-savant volunteers. The theory behind that research, and its results, are summarized in a section on this site entitled: In Search of the Savant Within Us Using rTMS.

Savant Syndrome in Autism

The Savant Syndrome in Autism is an up to date review chapter by Dr. Treffert in a new book entitled AUTISM:CLINICAL AND RESEARCH ISSUES edited by Accardo, Magnusen and Capute, York Press, Baltimore, 2000. This chapter summarizes early descriptions, present knowledge of this condition in Autistic Disorder, some well known autistic savants, theories to explain the savant, Williams Syndrome and Autistic Disorder, and present day research on the interface between autistic disorder and savant syndrome. It contains as well an up to date bibliography.

Blindness, Autism and Prematurity

1. The association of blindness, autism and autistic-like symptoms, and savant syndrom, especially musical genius, is striking given the rarity of each of those conditions singly. A number of such savants including Tony, Leslie and Blind Tom, just to name several, share that remarkable triad of handicap and special abilities. Shedding some light on the association of the retinopathy of prematurity (ROP), formerly known as retrolental fibroplasia, is an article by Ulla Ek and others from Sweden, which appeared in Developmental Medicine and Child Neurology 1998 40:297-301. Several conclusions from that study are pertinent to savant syndrom: The researchers compared 27 children with retinopathy of prematurity (ROP) to 14 children with total blindness due to hereditary retinal disease, and entirely different entity. 15 of the 27 ROP patients (7 boys/7 girls) had Autistic Disorder (according to DSM-IV criteria) and four children (3 boys/1 girl) had autistic-like conditions. 18 of the children had IQs below 79; 8 of the children had cerebral palsy. In the comparison group with hereditary retinal diesease 2 of the 14 met criteria for Autistic Disorder but their development differed markedly from the other 12 children, all of whom had normal IQ's and all of whom were in mainstream classes. Thus, there is a decided link between blindness from ROP and autism, compared to ther causes of blindness.
2. As I have indicated elsewhere on this site, the same damage to the retina (which is brain tissue) in ROP, from the same causes, is suspected of producing damage elsewhere in the central nervous system and could play an important role in the production of autistic disorder. Rimland had raised such a possibility in his work as early as 1950. This study confirms that speculation in that the researchers conclude in this study that ROP was associated with strong clinical evidence of brain damage, and, autistic disorder is linked to cerebral damage/dysfunction and is not primarily an effect of blindness per se.
3. I have made the distinction between Autistic Disorder (autism) as an illness and autism (autistic like behaviors) as a symptom. The latter, autistic-like behaviors, occur in a number of persons with brain damage who are not autistic in terms of the specific illness of Autistic Disorder. This study goes beyond that finding and adds another very important and pertinent observation. Many of the children with blindness from hereditary retinal disease, who are not autistic and had normal IQ's, showed what are called "blindisms", or behaviors which could be mistakenly interpreted as "autistic". These included stereotyped behavior such as rocking, swaying and hand waving. These were more frequent earlier in life, increased with boredom, emotion, or new and unfamiliar settings. These behaviors were seen as "adaptive" in the non-brain injured blind child, and define an additional category of autistic-like behaviors that are not Autistic Disorder as such.

Artistic Savants

In work that continues to support left hemisphere dysfunction in savant syndrome, Miller and his co-workers revisit six savant artists of the past (Mind, Yamashita, Yamamoto, Yamamura and Nadia) and compare those historical accounts to the careful analysis, including brain imaging (SPECT) and neuropsychological findings, of a present day nine year old savant artist (DB). The researchers conclude that the six artistic savants of the past all either did have diagnostic features of autism itself or at least one of the spectrum illnesses of Pervasive Developmental Disorder (PDD) which includes autistic disorder. Each of the six also had features characteristic of savant artists: restricted variation in art themes; the preferred use of a single medium on a single topic; repetitive behaviors; realistic renderings of objects or animals; the compulsive need to perform; the ability to focus on a specific theme for long periods of time; and extraordinary degree of visual and kinetic knowledge of their topics; and neither the interest nor capacity to study art theory. All of these skills, abilities and behaviors coalesced finally to produce a beautiful product. With respect to these characteristics the authors state: "These features reflect disproportionate dysfunction of the left hemisphere, although right hemisphere deficits are also present in autism."

DB, the only savant in whom functional imaging was performed, showed "increased perfusion in frontal areas, an imaging feature of patients with obsessive-compulsive disorder." He also showed "hypoperfusion in the region of the left amygdala on SPECT."

Of particular interest is this article's documentation of "remarkable parallels" between these savants and the individuals that these researchers reported earlier (see Miller et al above in this section) who had the onset of new, savant artistic abilities as a fronto-temporal dementia began and progressed. In those individuals the "degeneration of the anterior temporal lobes facilitates, or even precipitates new visual artistic skills. In some of these patients artistic interest developed only when the left sided anterior temporal degeneration was clinically manifest."

Overall the authors conclude "the anatomic substrate for the savant syndrome may involve loss of function in the left temporal lobe with enhanced function of posterior neocortex." The citation for this article is: Hou, C, Miller, BL et al. Artistic Savants. Neuropsychiatry, Neuropsychology & Behavioral Neurology 2000m Jan: 13(1)29-38.

Grand Rounds Section of CNS SPECTRUMS

The Grand Rounds section of the December, 1999 issue of CNS SPECTRUMS: The International Journal of Neuropsychiatric Medicine (Volume 4, No. 12 pages 57-60) presents a review article on savant syndrome by Dr. Treffert entitled "The Savant Syndrome and Autistic Disorder". It is a concise synopsis of past and current research findings. The color artwork illustrating savant artistic talent as a part of that article is one of Richard Wawro's wax oil crayon drawings entitled The Island of Scilly.

Blind Tom

During his lifetime from 1849 to 1908 'Blind Tom' Bethune was referred to as "the eighth wonder of the world" and "the greatest musical prodigy of his age". At age 11 he played at the White House and at age 16 began a piano concert tour that took him around the world. His vocabulary was less than 100 words but his musical repertoire was over 7000 pieces, including about 100 of his own compositions. In Philadelphia a panel of 16 outstanding musicians of the day signed a statement that "whether in his improvisations of performances of composition by Gottschalk, Verdi and others; in fact in every form of musical examination--and the experiments too numberous to mention--he showed a capacity ranking him among the most wonderful phenomena in musical history."

The story of Blind Tom, and his incredible musical savant abilities, is documented in detail in Extraordinary People in Chapter Two based on descriptions by Edward Sequin and other observers of that time. A March 5, 2000 New York Times article entitled "The Legacy of a Prodigy Lost in Mystery" provides a detailed account of Blind Tom's life as well. Now a number of Blind Tom's original compositions such as "The Balle of Manassas", "Water in the Moonlight" and "Oliver Galop" have been recorded by John Davis on a Newport Classic CD entitled "John Davis Plays Blind Tom" (NPD 85660). It is available from www.Newport-cd.com or other CD vendors.

A National Public Radio's Performance Today program has an hour long audio program on Blind Tom, including some of his compositions as played by John Davis, which can be accessed on the internet at http://npr.org/programs/pt/news/features/990827.blindtom.html.

For more on 'Blind Tom,' read his profile on this site by clicking here.

The Extreme Male-Brain Theory of Autism

In a book chapter entitled "The Extreme Male-Brain Theory of Autism" (Neurodevelopmental Disorders, Helen Tager-Flusberg (Ed.) MIT Press, Cambridge, MA, 1999) Simon Baron-Cohen discusses in depth the recent male brain/female brain research, and its relationship to autism which can, in some 'pure' cases of autism, can have male-female ratios as high as 9:1. Beyond autism, the data in that chapter has some interesting implications for understanding savant syndrome. The chapter provides evidence of biologically based psychological gender differences and the 'male brain' is defined.

While male brain/female brain models are not synonomous with right brain/left brain lateralization, there are some interesting correlations significant, perhaps, in savant syndrome which is also much more common in males that females (approximately 4:1 to 6:1 depending on the study). In cognition studies women (as a group) are superior to men in language tasks, tests of social judgement, measures of empathy and cooperation, ideational fluency and pretend play, to name some of the areas. In contrast men (as a group) are superior to women in mathematical reasoning, some spatial skills and target-directed motor skills, also to name just some of the areas. These skills have some interesting correlations with right brain/left brain savant skills.

In terms of neural substrate of the Male and Female Brain, precisely which structures distinguish these two brains is still controversial. However there is evidence for differences in cerebral lateralization in these two brain types with some evidence showing the right hemisphere cortex in the human male fetus is thicker than the left. Some reports show that the corpus callosum is larger in female subjects which might account for female superiority in verbal fluency.

Newly acquired artistic skills in the setting of dementia

Dr. Bruce Miller and coworkers of the University of California Los Angles School of Medicine report in the October, 1998 Journal Neurology on five patients with frontotemporal dementia (FTD) who acquired new artistic skills in the setting of that particular type of dementia. While the emergence of new savant skills following brain damage from trauma or disease (acquired savantism) early in life has been reported as seen elsewhere on this web site, the uncovering and unfolding of such new savant skills in some older adults raises interesting new questions about buried potential in all of us. As with other savants, in FTD the creativity was visual, not verbal; the images were meticulous copies that lacked abstract or symbolic qualities; episodic memory was preserved by semantic memory devastated; and there was intense, obsessive preoccupation with art skills. Like other savants, imaging studies showed a predominance of left-brain injury. The researchers here proposed that decreased inhibition of visual systems involved with perception enhanced artistic interest and abilities. Another researcher, Kapur, named such a process "paradoxical functional facilitation," a process operative not only in these five patients, but perhaps one operative in savant syndrome overall.

Miller, BL, Cummings J, Mishkin F, et al. Emergence of artistic talent in frontotemporal dementia Neurology 1998;51:978-982 Kapur N. Paradoxical facilitated function in brain-behavior research Brain 1996;119:1775-1790

Evidence of Left Hemisphere Serotonin Deficits in Autistic Disorder

As pointed out elsewhere on this web site savant syndrome can be explained, in part, by left hemisphere brain dysfunction resulting in right brain compensation. In acquired savant syndrome, such left hemisphere brain damage can generally be documented on various imaging studies. However, about half of the savant cases occur in persons with Autistic Disorders and prior imaging studies did not document left hemisphere structural defects. Nevertheless, Autistic Disorder, as Savant Syndrome itself, is four to six times as frequent in males than females, and some of the testosterone/left hemisphere damage theories may be operative. In an article appearing in the March, 1999 journal Neurology, a researcher reported that PET brain studies (which document brain function rather than only brain structure) suggest low serotonin (a neurotransmitter) synthesis in left hemisphere of persons with autistic disorder, and that neuropsychological tests in these autistic individuals also suggest left hemisphere deficits. These findings are interesting and relevant in that they are consistent with left hemisphere dysfunction theories with respect to savant syndrome. The article goes on to suggest the manner in which left hemisphere serotonin deficits alter brain development and brain circuit pathways early in development, and such dysfunction might be linked to changes in brain lateralization functions with respect to the learning and memory patterns so characteristic of autism (and savant syndrome).

Delong, RG. Autism: New data suggest a new hypothesis. Neurology, 19699 52:911-916

Cerebral "Refreshment"

Could it be that Alzheimer's Disease, or other age-related neurodegenerative conditions, are not due to a deterioration or loss of a fixed population of existing brain cells, but rather are due to a deterioration or loss of the brain's ordinary capacity to make new cells? That intriguing possibility is raised in a brief article entitled "Fresh Horses" by Jeff Victoroff, MD in the January, 2000 issue of Psychiatric Times (pp. 17-18). In that article Dr. Victoroff summarizes various animal and human studies that provide a basis for a very significant paradigm shift in our thinking about brain cell renewal and plasticity. He points out that recent discoveries that neurogenesis (continous production of new neural cells in the brain) "might be a routine part of the ongoing remodeling of the brain throughout human adulthood has prompted major rethinking of our models for postnatal development. Instead of imagining a battle between deterioration (e.g. apoptosis) and cellular repair, we might imagine a contest between cell loss and cell replacement." After much more exploration of the background research for such speculation, he concludes: "We must revise our concept of cerebral refreshment right now. Lifestyle factors (learning, exercise, and stress avoidance) and neurorehabilitation may not just sculpt synapses, reduce the risk of erosion of a fixed population of postmitotic cell or recruit old neighbor cells to new tasks. They may rebuild our brains." What might that mean for savant syndrome? I have indicated that right brain 'recruitment', following left hemisphere damage, is felt to be an important etiologic factor in savant syndrome in some instances. The concept of a continually renewing stream of neurons, or a nest of neural stem cells "awaiting awakening into functional adult neurons" from injury or other stimulus, rather than a fixed reservoir of brain cells (in the right brain hemisphere or anywhere else) that has been generally the accepted concept until now, would have implications not only for some possible etiologic mechanisms of savant syndrome, but also for understanding brain physiology and pathology overall, especially with respect to brain plasticity and repair. The information in that brief report is too detailed to adequately summarize here. It is very well written and easily understood, though, and contains a wealth of information on this important paradigm shift, along with pertinent references.

Leslie Lemke (image)

Uncommon Genius
A Savant Documentary

The Australian Broadcasting Company (ABC) has recently released a documentary video on Savant Syndrome which was filmed in the United States in April, 2000. In 1993 Robyn Young visited a number of savants in the U.S. as part of a group of 52 savants world-wide she eventually was able to study using a uniform psychological history and test protocol. This film captures her trip cross-country in the U.S revisiting these savants seven years later, along with interviewing various experts on savant syndrome familiar with these particular persons. The savants Dr. Young visited included George, Tony, Leslie, Alonzo, Kim (who are described in greater detail on this site) and several others. Experts interviewed included Drs. Treffert, Rimland and Bruce Miller.

The video is exceptionally well done artistically showing beautiful glimpses of United States scenery from coast to coast along with glimpses at savant abilities in these remarkable persons. Uncommon Genius was shown in a 30 minute abbreviated version on the Learning Channel in the United States in March, 2001. It was shown on Australian Public Television in May, 2001. It is available for purchase from the Australian Broadcasting Company through inquiry at this e-mail address: progsales@your.abc.net.au or by inquiry at this link: http://www.abc.net.au/programsales.

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EXTRAORDINARY PEOPLE: Understanding Savant Syndrome by Dr. Treffert has now been re-issued, with an epilogue update, by iuniverse.com through an arrangement with Author's Guild backinprint.com. The book is available through the www.iuniverse.com Web site. At that Web site there is a graphic of, and additional information about, the book. The book is also available through Barnes and Noble.com at www.bn.com and through Amazon.com at www.amazon.com.


For more information, please contact:
Darold A. Treffert, MD
St. Agnes Hospital, Fond du Lac, Wisconsin
Clinical Professor, Department of Psychiatry
University of Wisconsin Medical School, Madison
Personal Web site: http://www.daroldtreffert.com
e-mail: savants@charter.net