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O R I G I N A L P A P E R

Savant Syndrome: Realities, Myths and Misconceptions

Darold A. Treffert

Published online: 6 August 2013

� Springer Science+Business Media New York 2013

Abstract It was 126 years ago that Down first described

savant syndrome as a specific condition and 70 years ago

that Kanner first described Early Infantile Autism. While as

many as one in ten autistic persons have savant abilities,

such special skills occur in other CNS conditions as well

such that approximately 50 % of cases of savant syndrome

have autism as the underlying developmental disability and

50 % are associated with other disabilities. This paper sorts

out realities from myths and misconceptions about both

savant syndrome and autism spectrum disorders (ASD) that

have developed through the years. The reality is that low

IQ is not necessarily an accompaniment of savant syn-

drome; in some cases IQ can be superior. Also, savants can

be creative, rather than just duplicative, and the skills

increase over time on a continuum from duplication, to

improvisation to creation, rather than diminishing or sud-

denly disappearing. Genius and prodigy exist separate from

savant syndrome and not all such highly gifted persons

have Asperger’s Disorder. This paper also emphasizes the

critical importance of separating ‘autistic-like’ symptoms

from ASD especially in children when the savant ability

presents as hyperlexia (children who read early) or as

Einstein syndrome (children who speak late), or have

impaired vision (Blindisms) because prognosis and out-

come are very different when that careful distinction is

made. In those cases the term ‘outgrowing autism’ might

be mistakenly applied when in fact the child did not have

ASD in the first place.

Keywords Savant syndrome � Autism � Autism spectrum disorder � Hyperlexia � Einstein syndrome

Realities

Savant Syndrome Defined

Savant syndrome is a rare but spectacular condition in

which persons with developmental disabilities, including

but not limited to autism, or other CNS disorders or disease

have some spectacular ‘islands of genius’ that stand in

jarring juxtaposition to overall limitations. (Treffert 2010)

The condition can be present from birth and evident in

early childhood (congenital) or develop later in life after

CNS injury or disease (acquired). It affects males 4–6 times

more frequently than females. Typically the skills occur in

five general areas—music, art, calendar calculating,

mathematics or mechanical/visual-spatial skills. Other

skills occur less frequently including language (polyglot),

unusual sensory discrimination, athletics or outstanding

knowledge in specific fields such as neurophysiology, sta-

tistics, navigation or computers, for example. Skills are

usually single skills, but multiple skills can occur as well.

Whatever the skill it is always associated with massive

memory of a habit or procedural type—very narrow but

exceedingly deep within the confines of the special skill. In

some cases massive memory is the special skill.

Savant Syndrome is Not a New Disorder (Nor is

Autism)

It is over 200 years ago since the first case of savant syn-

drome appeared in a scientific journal in Germany (Moritz

1783). And it is 126 years since Dr. J. Langdon Down first

D. A. Treffert (&) Agnesian HealthCare, 430 East Division Street, Fond du Lac,

WI 54935, USA

e-mail: [email protected]

123

J Autism Dev Disord (2014) 44:564–571

DOI 10.1007/s10803-013-1906-8

described savant syndrome as a distinct condition. (Down

1887). In his 1887 lectures Down described ten cases of

savant syndrome, including a boy who had memorized The

Rise and Fall of the Roman Empire verbatim and could

recite it backward or forward. Interestingly, in those same

lectures Down described a form of mental retardation later

named Down’s syndrome, and he described as well a form

of ‘‘developmental retardation’’ that unmistakably con-

sisted of cases of what we now would term early onset and

late onset autistic disorder. (Treffert 2006) And in Kanner’s

description of early infantile autism cases in 1944 there are

several individuals who would now be considered cases of

savant syndrome.

Down coined the term ‘idiot savant’. He did not intend

that term be degrading or insulting. At the time ‘idiot’ was

an accepted scientific word for persons with an IQ below

25 and ‘savant’ was derived from the French word savoir,

meaning ‘to know’. Because of its pejorative connotation, a

1988 paper suggested it was time to discard that archaic

term and substitute ‘savant syndrome’ instead. (Treffert

1988) Then in 1989 the movie Rain Man made the term

‘‘autistic savant’’ household words.

Not All Savants are Autistic, and Not All Autistic

Persons are Savants

Rain Man was a marvelous movie. It was accurately and

sensitively done. Yet some persons came away from the

movie assuming that, like Raymond Babbitt, all savants are

autistic. Not so. Approximately one in ten persons with

autism has savant skills; so nine out of ten do not.

Approximately 1 out of 1,400 persons with mental retar-

dation or CNS deficits other than autism do have savant

skills so such abilities are not limited to autistic disorder.

(Saloviita 2000) Hence not all autistic persons are savants,

and not all savants are autistic.

Savant Skills Represent a Spectrum of Abilities

While admittedly a subjective scale at this point, savant

skills lie on a spectrum of abilities. Most common are

splinter skill savants who have obsessive preoccupation

with and memorization of music & sports trivia, birthdays,

license plate numbers, historical facts, train or bus sched-

ules, navigation abilities, or maps for example. Talented

savants are those in whom musical, art or other special

abilities are more conspicuous not only in contrast to

individual limitations, but also in contrast to peer group

abilities whether disabled or not. And prodigious savant is

an extremely high threshold term reserved for those

extraordinarily rare individuals in whom the special skill is

so outstanding that were it to be seen in a non-impaired

person such a person would be termed a ‘‘prodigy’’ or

‘‘genius’’.

The Acquired Savant: ‘‘Accidental Genius’’

In 1923 Minogue reported a case in which musical genius

appeared in a three-year old child following meningitis. In

1980 Brink described the case of Mr. Z who demonstrated

savant mechanical skills and traits at age nine after a bullet

wound to the left brain produced muteness, deafness and

left sided paralysis, but precipitated the newly surfaced

savant skills. Dorman in 1991 published a case in which an

8 year old boy began to show exceptional calendar calcu-

lating skills following a left hemispherectomy.

But it was Miller’s reports on 12 individuals with fronto-

temporal dementia who developed exceptional savant art

and musical skills that really brought the ‘acquired savant’

to prominent attention. (Miller et al. 1996, 1998, 2000)

Miller had done SPECT imaging on these 12 patients, and

he also did SPECT imaging on a 9 year old autistic, artistic

savant. In these instances there was left anterior temporal

dysfunction and evidence of what Kapur called ‘‘para-

doxical functional facilitation’’–dysfunction in one area of

the brain which uncovered, or facilitated ‘paradoxical’

function in some other area of still intact brain capacity

(Kapur 1996).

Since that time there have been numerous reports of

what might be called ‘‘acquired savant syndrome’’ fol-

lowing a cerebral insult from stroke, a blow to the head,

dementia or other CNS disease or injury accompanied by

the emergence of savant skills, sometimes at a prodigious

level (Treffert 2010). In most of these cases there was some

sort of ‘trade-off’ of cognitive or other abilities for the new

found savant skills. Yet in other cases, more aptly called

‘accidental genius’ (following being struck by lightning in

one instance) there has been no trade off at all with the

emergence of new found skills. These instances raise many

interesting questions about dormant capacity within us all,

and raise the even more challenging question of how to tap

those buried abilities without enduring some CNS catas-

trophe. These cases of acquired savant syndrome are pre-

sented in much more detail on the savant syndrome web

site at www.savantsyndrome.com.

The Most Important Question of All: How do They

do It?

There have been many theories put forth to try to explain

savant syndrome ranging from early heredity theories to

present day Quantum theory. (Treffert 2010). Some of the

neuropsychological theories such as weak central coher-

ence, mind blindedness are interesting as they apply to the

autistic savant. But 50 % of savants are not autistic. The

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role of heredity is no doubt a contributor and the search for

a savant ‘gene’ is underway, one study finding such a gene,

but another not confirming that finding. Compensatory

learning, reinforcement and repetition-compulsion may

also play a role, but then, if those dynamics produce savant

syndrome, why wouldn’t that apply to all persons with

autism or other CNS limitations?

The theory I favor is that what I have come to call the

‘‘three R’s’’ and reflects the process Kapur termed ‘‘para-

doxical functional facilitation’’ in 1996 in which one area

of the brain in released from the inhibiting influence of

some other brain area. In the case of savants, both con-

genital and acquired, there is brain damage in one area,

frequently the left hemisphere, with recruitment of still

intact brain tissue in another area of the brain, rewiring of

circuitry to that new area, and release of dormant capacity,

through a disinhibiting process, of information and skills

already stored in that newly recruited area.

It is genetic memory—the genetic transfer of knowledge

and skills—that accounts for the already stored dormant

capacity tapped by the recruitment, rewiring and release. I

address genetic memory much more fully in Islands of

Genius as well, and on the savant syndrome web site at

www.savantsyndrome.com. Genetic memory is based on

the fact that some savants, particularly those severely

limited in other ways, clearly ‘‘know things they never

learned’’. The only possible way to know things one never

learned—sometimes at complex levels—is for that

knowledge to be factory installed, genetically transmitted.

But there is one other important element that contributes

to the ‘‘how do they do it?’’ question. That is the role of the

family or other caregivers, teachers or mentors in first

discovering the special gift in the savant, then tenderly

nurturing and encouraging that gift, and supporting and

reinforcing it by praise coupled with copious unconditional

love.

Some Mysteries Remain

There are many scientific mysteries still about savant

syndrome. But two are especially intriguing. First is the

conspicuous regularity in which the triad of mental

impairment (often from autism) ? impaired vision ?

musical genius occurs. Savant syndrome is rare but the

frequency of this triad is very conspicuous and dispropor-

tionate throughout the history of savant cases combining

blindness and mental disability with prodigious musical

skills. The first of such persons was Thomas Bethune,

better known as ‘‘Blind Tom’’, who was born in 1850 and

gave his first public piano concert at age 8. From then on he

became an international celebrity and was the most cele-

brated black concert artist of the nineteenth century. His

repertoire was in the thousands of pieces including many of

his own compositions, the first of which he created at age

five.

Since that time a number of such cases with this triad are

glaringly over-represented in savant syndrome, in itself a

rare condition. Leslie Lemke in the United States, Derek,

Paravicini in the United Kingdom and Hikari Oe in Japan

are present day representatives of this amazing combina-

tion of ability and disability. In addition to those examples,

a number of other such cases are documented in detail in

Islands of Genius. The savant syndrome web site provides

further video evidence and documentation of this extraor-

dinary triad of mental impairment ? blindness ? musical

genius.

A second mystery is the why calendar calculating, an

obscure skill in neurotypical persons, is seemingly almost

universally present in persons with savant syndrome. This

ability is a clear example of how savants, sometimes

severely impaired, innately ‘‘know things they never

learned’’. Yes, there are formulas for calendar calculating.

And yes, if any person puts his or her mind to it, he or she

can learn (laboriously) how to calendar calculate. But

savants seem to have this algorithm or formula ‘uncon-

sciously’ inscribed or inculcated in their brain and in most

such individuals there simply has not been any ‘study’ of

the calendar nor the ‘learning’ of any formula. Why cal-

endar calculating? And why is that so prominent in savant

syndrome but generally not seen in other brain diseases or

disorders? Some imaging studies are underway with cal-

endar calculating savants, comparing them to neurotypical

‘expert’ calendar calculators and control groups.

Myths and Misconceptions

Savants are Not ‘Creative’

Some observers, while extolling the eidetic-like ability and

memory of savants, point out that in contrast to such

astonishing imitative ability, savants, as a group are not

very creative. In fact I was one of those observers who

wrote just that in the original 1988 version of Extraordi-

nary People:Understanding Savant Syndrome. I raised the

question there ‘‘Is the savant creative?’’ I answered it this

way: ‘‘In my experience, not very’’.

I was wrong and have corrected that perception in my

later writings. What changed my mind? Some additional

years of observation. There is always a tremendous

advantage in having a longitudinal view of a patient and his

or her ‘natural history’ of illness or disorder, compared to a

one-time, snapshot consultation. And now, having the

opportunity to observe the ‘natural history’ of how the

savant skills emerge and develop over many years, I have

noted predictable and replicable sequence of steps that

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progresses from imitation, to improvisation, to creation in

savant syndrome. Let me expand on that, using Leslie

Lemke as an example.

Leslie Lemke’s ability to store and replicate music, even

after only a single hearing, was spectacular. Indeed at age

14 he was able to play back Tchaikovsky’s First Piano

concerto flawlessly having heard it for the first time as a

theme song to a television movie.

Over time, however, Leslie began to show improvisa-

tional skills in a addition to replication abilities. For

example at a 1989 concert a young girl came up to the

stage in the challenge portion of the concert and played

‘‘Mississippi Hotdog’’. Leslie listened and then, when

asked, dutifully played back the piece exactly as he had

heard it. But toward the end of the piece he began to look a

bit restless, and seemed more excited and more eager to

play. After the initial playback of Mississippi Hotdog was

completed, flawlessly as usual, Leslie then launched into a

5 min improvisation which could be called ‘‘Variations on

a Theme of Mississippi Hotdog.’’ He changed pitch,

changed tempo and demonstrated convincingly that he

does indeed have innate access to the ‘rules of music’,

confirmed by a number of professional musicians who have

observed him.

Adding to the improvisation skill now is creation and

composing of entirely new pieces. One such song he calls

‘‘Down Home on the Farm in Arpin’’, and another he

names ‘‘Bird Song’’. In that latter piece he duplicates, by

whistling softly as he plays his new tune, the bird songs he

hears as he sits for hours outside his farm home.

That same sequence from replication to improvisation to

creation occurs in other savants whether musicians or

artists. The artists begin their ‘career’ with striking replicas

of what they have seen and stored, usually requiring no

model or constant reference piece. Then some improvisa-

tion begins to appear—a telephone pole deleted here, or a

new tree there—slightly different from the original. Then

comes creation of entirely new pieces, maybe now free-

form or in an entirely different art style.

So the savant can be creative. Some savants prefer to

stay with replication, but many have gone beyond literal

copying, as stunning as that can be, to improvisation and

then creation of something entirely new.

These clinical impressions regarding creativity in the

savant have been bolstered by several formal research

projects. A 1987 study by Hermelin, O’Connor and Lee

looked at musical inventiveness in five musical savants

compared to six non-savant children who had musical

training over a period of 2 years but who had not been

exposed to compositional or improvisational instruction.

Five tasks were used to grade for ‘‘musical inventiveness’’.

On those tests the savant group was superior to the control

group. Similarly, on tests of musical competence—timing,

balance and complexity—the savants (with a mean IQ of

59) were also superior to the control group.

Hermelin and her co-workers indicated this study was

consistent with earlier findings—that a series of separate

intelligences, of which music is but one, exist in each

person rather than a single, consistent intelligence that

permeates all the skills and abilities of each person. With

respect to music, they concluded that savants were able to

show some creativity and improvisation in addition to

mimicry.

Hermelin et al. (1989) conducted a study of improvi-

sations by Leslie Lemke compared to a professional, non-

savant musician after each had heard the same musical

pieces, one lyric (Grieg) and one a-tonal (Bartok). Leslie’s

improvisations were described as ‘‘virtuoso embellish-

ments with a considerable degree of musical inventiveness

and pianistic virtuosity.’’ That study concluded that ‘‘both

subjects’ attempts at improvisation show a high degree of

generative musical ability, and what distinguishes them

from each other is not so much a differential degree of

musicianship but rather their own, different musical pref-

erences as well as their respective personality characteris-

tics.’’ In improvisational style on the Bartok, a-tonal piece,

both musicians resembled each other as well.

In summary, savants can be creative. Most savants travel

along a route of first replication, then improvisation, and

finally creation. As we learn more about the brain from the

study of savants, we may also learn much more about talent

and creativity itself through the unique window into the

brain and special skills savant syndrome provides.

The ‘‘Nadia’’ Effect and the ‘‘Dreaded Trade-Off’’

In 1977 Dr. Lorna Selfe described the case of Nadia, a

prolific childhood artist, whose special abilities disap-

peared after she was sent away to school to increase lan-

guage acquisition, socialization abilities and daily living

skills. With the publication of Dr. Selfe’s 2011 book—

Nadia Revisited—we now have the benefit of long term

follow-up on Nadia. Selfe describes the loss of skills this

way: ‘‘In the years following my first study, and throughout

her school days, Nadia was given intensive help with lan-

guage development and her ability to communicate

improved with the production of two/three word sentences.

She also started to draw like an infant so that, for a period,

two styles coexisted and sometimes on the same piece of

paper. Gradually and inexorably she lost the ability to draw

realistically. Unlike some savant artists such as Stephen

Wiltshire, who has maintained the strength of his drawing

ability, Nadia’s ability appeared to peter out. She is now

middle-aged and lives in a specialist care home but for

many years she has simply refused to draw.’’ But, in spite

of the loss of art skills, Selfe points out, importantly, that

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even though now Nadia is not interested in art and is totally

dependent on others in that supervised setting there is also

the ‘‘optimistic story of the love and care of the family that

raised her and of the people who now care for Nadia. She is

in the safe and competent hands of dedicated staff who

devote themselves to the care of people who are unable to

look after themselves.’’

We don’t seem to know exactly what did happen with

Nadia and why those special skills disappeared. But what I

do know is that in the many, many savants with whom I

have worked, or know about, such a ‘‘dreaded trade-off’’,

or loss of skills, does not occur as the savant gets older or

when exposed to more formal education and training. To

the contrary, in my experience vigorously ‘‘training the

talent’’, whatever that special skill is, leads, in and of itself,

to increased language, social and daily living skills without

any ‘‘dreaded trade-off’’ of special skills. So Nadia’s

experience is the exception, not the rule.

Putting aside the fear of a ‘‘dreaded trade-off’’ is

important because parents, teachers or therapists are

sometimes reluctant to venture forth with more formal

education or training efforts lest the ‘‘Nadia’’ effect occur.

The good news is that such a fear is, in my experience,

unfounded and should not prevent presenting the savant

with more formal education and training within his or her

area of specialty, as well as in a more general educational

sense. That being the case, parents and teachers can con-

tinue not only to applaud and reinforce the special skills as

they surface, but can confidently add teaching and training

in a more formal sense as well without fear of loss of talent,

ingenuity or enthusiasm on the part of the savant.

Savant Syndrome is Always Associated with Low IQ

Perhaps stemming from Down’s original description

regarding low IQ and the presence of savant skills, a

misconception continues that low IQ is a necessary

accompaniment of savant syndrome. That in fact is not the

case. While it is true that most savants have measured IQ’s

between 50 and 70, in some instances IQ can be as high as

125, or even higher. Thus an IQ level above 70 does not

‘disqualify’ someone from having savant syndrome.

One reason that many savants, or many autistic persons,

have IQ scores below 70 is that IQ measurement depends

so heavily on verbal scales, and many autistic individuals,

including those with savant syndrome, have language

(verbal) deficits as an intrinsic part of the underlying

disorder.

A second reason for low IQ scores among savants is the

fact that IQ tests measure only one facet of ‘‘intelligence’’,

something termed ‘‘IQ’’. Savants tend to do poorly on that

particular measure of ‘‘intelligence’’. But savants point out

forcefully that there are multiple forms of ‘‘intelligence’’

and IQ measures only one such ‘‘intelligence’’. IQ tests do

measure something defined as ‘‘IQ’’. But IQ tests fail to

measure some of the other forms of ‘‘intelligence’’ that

savants possess in greater or lesser measure as well. Some

of the savants are profoundly disabled in capacities as

measured by IQ, but yet they are astoundingly ‘intelligent’

within their ‘‘island of genius’’.

There is much debate among psychologists regarding

single v. multiple intelligence theories. But savant syn-

drome, with sometimes extraordinary ability co-existing

with profound disability in the same individual argues

forcefully for the concept of multiple intelligence. And the

fact of multiple intelligences has profound implications not

just for better understanding and approaching savant syn-

drome, but also for implementing more effective, individ-

ualized and targeted education efforts for all segments of

the population.

Thirdly, in all developmental disabilities, and savant

syndrome, one has to make a distinction between ‘‘actual

retardation’’, as classified by IQ scores, from ‘‘functional

retardation’’—instances in which persons with presumably

normal or high IQ (if it could be accurately measured)

function at levels more consistent with sub-normal IQ. In

such instances, either the language and verbal deficits, or

behavioral traits and symptoms, prevent accurate mea-

surement of ‘‘IQ’’. These individuals, whether savants or

not, ‘‘function’’ as if ‘‘retarded’’, but their abilities in cer-

tain other areas of function belie a below average IQ score.

That is termed ‘‘functional retardation.’’

Leslie Lemke provides an example of how misleading

IQ levels can be as a single measure of intelligence. Leslie

has a measured IQ of 58 on the WAIS-R test, based solely

on verbal scores; performance tests were not done because

such testing relies heavily on vision, and Leslie is blind.

Other tests were carried out as well including the 4th edi-

tion of the Stanford-Binet; the Tactual Performance Test;

the American Association for Mental Deficiency Adaptive

Behavioral Scale; and the Animal List Selective Remind-

ing Test. By looking at the scores on these tests as a whole,

the neuropsychologist concluded Leslie was functioning in

the moderately retarded range of intelligence, defined as an

IQ level between 35 and 55.

Yet a videotape of one of Leslie’s concerts challenges

the accuracy of such a low level of intelligence figures. At

this particular concert Leslie was asked to play a piece he

had never heard before with the other pianist, rather than

waiting for the piece to conclude and then play it back after

hearing it as he usually does. The other pianist began

playing. Leslie waited about 3 seconds and then did indeed

play the piece with the other pianist, separated only by

those 3 seconds. In that three second delay Leslie was

taking in what he heard, processing it, and simultaneously

outputting the music as he played along with the other

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pianist. Leslie was parallel processing, just as some very

intelligent, but rare, interpreters are able to translate what a

speaker is saying into another language simultaneously,

rather than having the speaker pause from time to time

while the interpreter ‘catches up’.

Leslie was parallel processing. That would not be pos-

sible if the IQ level of 35–55 was an accurate barometer of

his over-all intelligence. He exceeds that level by far with

the parallel processing of music which signals that more

than a single ‘intelligence’ was at work during that com-

plex performance.

In summary, measured IQ levels in savants can range

from sub-normal to exceptional and low IQ is not a pre-

requisite to being classified as a ‘savant’. While many

savants have measured IQ levels below 70, some have

measured IQ’s above normal which can range as high as

125 or above. In assessing IQ scores, one has to differen-

tiate’actual’ retardation from ‘functional’ retardation

All ‘‘Geniuses’’ and ‘‘Prodigies’’, Past and Present are

Really ‘‘Aspies’’

With increased interest in autism and Asperger’s, and

especially with the visibility given to the extraordinary skills

seen in savant syndrome, it seems popular these days to

apply the diagnosis of Asperger’s disorder particularly to

anyone considered to be a ‘genius’ or ‘prodigy’ past or

present. Names such as Einstein, Rembrandt, Mozart,

Jefferson and many others are bandied about in such dis-

cussions. It is difficult enough to make accurate diagnoses of

autism or Asperger’s disorder in real life, with face-to-face

interviews and comprehensive testing, let alone trying to

apply post-mortem diagnoses, sight unseen. Retrospective

medical diagnoses are always problematical and suspect.

And then there are present-day prodigies and geniuses.

Some, outrageously bright, but not autistic children, have

composed multiple symphonies by age seven, or have

mastered instruments, sometimes multiple instruments, by

age three. Others show astonishing artistic, mathematical,

prose or poetry skills well beyond their years. If children,

we call them prodigies. They are neither autistic, nor

Aspergers. If adults, we call them geniuses. They also are

neither Asperger’s nor autistic. Prodigies and geniuses

have special, spectacular abilities in absence of any

underlying disability. Typically, rather than there being

simply one ‘‘island’’of genius as is often the case with

savants, whatever the skills of the prodigy or genius, they

are associated with a high measured IQ in all areas of

functioning.

In short, not every gifted child, nor every ‘absent

minded professor’, has Asperger’s disorder. Instead,

‘‘prodigy’’ and ‘‘genius’’ do exist as independent conditions

separate from any underlying disability or disorder The

temptation to classify all prodigies and geniuses as having

autism or Asperger’s seems to be part of the disease de jour

phenomenon quite rampant these days and needs to be

resisted in favor of careful analysis lest continued ‘diag-

nosis creep’ deletes all meaningful classification, all the

disorders lose their specificity, and the ‘spectrum’ engulfs

us all.

The beginning of wisdom is to call things by their right

name. Asperger’s, autism, and savant syndrome surely do

exist. But so do the categories of ‘‘normal’’, ‘‘gifted’’,

‘‘prodigy’’ and ‘‘genius’’. The important thing is to know

the difference lest every parent of a gifted child for

example, whether mildly gifted or profoundly gifted, fear

their child is autistic.

‘‘Outgrowing’’ Autism: Separating ‘Autistic-Like’

Traits from Autistic Disorder in Children Who Read

Early, Speak Late, or are Blind

I get many ‘‘I’ve got a son or daughter who……..’’ emails from the savant syndrome web site in which parents describe

various accelerated skills in their children and inquire whe-

ther those might be forms of savant syndrome, and if so, how

should those special skills, and that child, be approached

educationally and otherwise. Among those many inquiries

are children who read early (hyperlexia) or speak late

(Einstein Syndrome). Often children in both those groups are

automatically, and mistakenly, assumed to be autistic when

in fact they only have ‘autistic-like’ behaviors and traits with

very different causes and outcomes than Autistic Disorder.

They tend to ‘outgrow’ their autism (their choice of terms),

which was not autism in the first place.

Based on a number of such cases brought to my atten-

tion separating ‘‘autistic-like’’ behaviors and traits from

‘‘Autistic Disorder’’ in children who read early, or speak

late, or who are blind, is a critical differential diagnosis

with vast causal, treatment and outcome ramifications.

Hyperlexia I, II and III

Some neurotypical children simply read early. They may

be reading, instead of the teacher, to their nursery school

class, or reading at a 7th grade level at age 3 for example.

There are no associated autistic or autistic-like traits or

behaviors. They are entirely ‘normal’ (neurotypical) chil-

dren. Eventually their classmates catch up with reading

skills but in the meantime the advanced, precocious read-

ing ability at such an early age draws considerable atten-

tion. I describe several such examples on the ‘‘Hyperlexia’’

posting on the savant syndrome web site at www.

savantsyndrome.com I refer to this type of early reading

ability as Hyperlexia I.

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Hyperlexia II is when early reading ability presents as a

‘splinter skill’ as part of an Autistic Spectrum Disorder.

These children read voraciously along with astonishing

memory for what they read. They often have other mem-

orization abilities sometimes linked with fascination with

numbers or calendar calculating skills. These children

show other characteristic language, social and behavioral

symptoms seen in autistic spectrum disorder, including

traits such as withdrawal, poor eye contact, lack of interest

in seeking or giving affection, insistence on sameness, and

obsessive compulsive behavior, for example. They usually

carry a formal diagnosis of Autistic Disorder, Asperger’s

Disorder, or pervasive developmental disorder (PPD/NOS)

with intense fascination with words and numbers present-

ing as a ‘splinter skill’.

Hyperlexia III is a less frequently recognized form of

early reading ability. It is not an autistic spectrum disorder

even though there are some ‘‘autistic-like’’ traits and

behaviors that gradually fade as the child gets older. Some

times this is referred to as ‘‘outgrowing autism’’. These

children read early and have striking memorization abilities

sometimes coupled with precocious abilities in other areas

as well. They may show unusual sensory sensitivity, ech-

olalia, pronoun reversals, intense need for sameness, spe-

cific fears or phobias, have lining/stacking rituals and

demonstrate strong visual and auditory memory. Unlike

children with ASD, however, they are often very outgoing

and affectionate with family, even though reserved and

distant with peers and would be playmates. They do make

eye contact and can be very interactive with persons close

to them, especially adults. These children present as being

very bright, inquisitive and precocious overall. Indeed

these ‘autistic-like’ traits and behaviors do fade as the child

gets older, but in the meantime parents are exposed to

unnecessary fear and dread because the diagnosis of

‘‘autism’’ has been prematurely and inappropriately applied

without ‘‘hyperlexia III’’ being considered in the differen-

tial diagnosis. Space precludes an extensive discussion of

Hyperlexia III, but the savant syndrome website as www.

savantsyndrome.com provides a number of example of

such cases with respect to characteristics and outcome.

Einstein Syndrome: Children Who Speak Late

In his 1997 book Late Talking Children Thomas Sowell

pointed out how often ‘‘autistic-like’’ symptoms, as

opposed to Autistic Disorder itself, appeared in children

with delayed speech based on parental reports in a group of

46 such children. In a follow-up book 4 years later—The

Einstein Syndrome:Bright Children Who Talk Late—

Sowell expanded that group to 239 late talking children

who were exceptionally late in beginning to speak but were

also exceptionally bright. (Sowell 2001). His book is

replete with examples. As with Hyperlexia III, Sowell

found in his correspondence with parents that many of the

children with delayed speech had been given a diagnosis of

ASD along the way but that the ‘‘autistic-like’’ symptoms

in these children were transient, and like with the Hyper-

lexia III children, those traits and behaviors faded over

time. He recommended careful professional evaluation for

children who speak late by clinicians familiar with the

various parameters and conditions involved with such

children, sparing parents unnecessary worry, concern

and pessimism that always accompanies a diagnosis of

‘‘autism’’. This condition is also discussed in more detail

on the savant syndrome website.

Blindisms

Teachers and parents of visually impaired children often

refer to what are called ‘‘blindisms’’ in such children. Ek

and co-workers point out that ‘‘blindisms’’—stereotypical

movements, language problems and certain other behav-

iors—are common in children with congenital or other

types of blindness. (Ek et al. 1998). Hobson described the

similarities in development during pre-school age

(3–4 years) between blind children and those with autism

(Hobson 1993). In both groups impairments in symbolic

play, confusion in the use of language and stereotypes were

frequent. Many of the autistic features in the young, blind

child without cerebral damage disappeared with age. As the

child acquired a better understanding of the surrounding

world, and with the development of language, a basis for

sharing experiences and feelings with other people devel-

oped. Hobson noted ‘‘blindness seems to delay rather than

prevent development in these respects.’’ In 2010 Hobson

and Lee did an 8 year follow-up study on nine congenitally

blind and seven sighted children who met formal diag-

nostic criteria for autism. Follow-up of the nine congeni-

tally blind children with ‘autism’ revealed that, in

adolescence, only one such child satisfied the criteria for

that disorder. In contrast, all of the seven sighted children

still did meet the Autistic Disorder criteria. For the group

with what turned out to be autistic-like symptoms, in the

title of his report Hobson uses the interesting term

‘‘reversible autism’’.

Autism, autistic-like symptoms and blindisms can be

confused with each other in visually impaired children. But

just as with children who read early or speak late, differ-

entiation between Autistic Disorder and ‘‘autistic-like’’

symptoms is critical with these children if parents are to be

spared unnecessary distress from an autism diagnosis

improperly applied and, equally important, if the right

treatment is to be applied to the right patient.

570 J Autism Dev Disord (2014) 44:564–571

123

Summary

With all the emphasis by some on the autism ‘epidemic’

and with it the need for early identification and a prolif-

eration of programs, it is important to remember that not

every child who reads at 18 months, draws at 2 years,

hums back all the melodies he or she hears, or likes to line

up railroad cars, resists certain foods, insists on routine,

memorizes license plates and birthdays, has certain fear

and phobias or is very late in speaking is on the autistic

spectrum. If one looks up ‘‘hyperlexia’’ on the internet,

though, most often the site links hyperlexia to autism. That

simply is not so in all cases as pointed out above. That

same link to autism is likewise often made for children who

speak late, or are blind.

Again, not so in all cases. While early identification of

autism in affected children is important, those efforts need

to be balanced with sensible caution lest parents be

unnecessarily frightened and overwhelmed by premature,

and erroneous, diagnoses. Except in truly ‘classic’ cases,

often some time of watchful observation needs to elapse

until the ‘natural history of the disorder’ reveals the real

diagnosis. Such ‘watchful observation’, diagnostic caution

and separation of ‘autistic-like’ behaviors from Autistic

Disorder can provide example of what some have called

‘‘reversible autism’’.

References

Brink, T. L. (1980). Idiot savant with unusual mechanical ability: An

organic explanation. American Journal of Psychiatry, 137,

250–251.

Dorman, C. (1991) Exceptional calendar calculating ability after early

left hemispherectomy. Brain and Cognition 15, 26–36 London:

Churchill.

Down, J.L. (1887). On some of the mental affections of childhood and

youth. London, Churchill.

Ek, U., Fernello, E., Jacobson, L., & Gillberg, C. (1998). Relation

between blindness due to retinopathy and autistic spectrum

disorders: A population study. Developmental Medicine and

Child Neurology, 40, 297–301.

Hermelin, B., O’Connor, N., & Lee, S. (1987). Musical inventiveness

of five idiot-savants. Psychological Medicine, 17, 685–694.

Hermelin, B., O’Connor, N., Lee, S., & Treffert, D. A. (1989).

Intelligence level and musical improvisational ability. Psycho-

logical Medicine, 19, 447–457.

Hobson, R.P. (1993). Autism and the development of the mind. Hove:

Lawrence Erlbaum.

Hobson, R. P. (2010). Reversible autism in congenitally blind

children? A controlled study Journal of Child Psychology and

Psychiatry, 51(11), 1235–1241.

Kanner, L.:217-25055-58 (1944) Early infantile Autism Journal of

Pediatrics 25, 200–217.

Kapur, N. (1996). Paradoxical functional facilitation in brain-

behavior research. Brain, 119, 1775–1790.

Miller, B., et al. (1996). Enhanced artistic creativity with temporal

lobe degeneration. Lancet, 348, 1744–1745.

Miller, B., et al. (1998). Emergence of artistic talent in frontotemporal

dementia. Neurology, 51, 978–982.

Miller, B., et al. (2000). Functional correlates of musical and visual

ability in frontotemporal dementia. British Journal of Psychia-

try, 176, 458–463.

Minogue, B. M. (1923). A case of secondary mental deficiency with

musical talent. Journal of Applied Psychology, 7, 349–357.

Mortiz, K. P. (1783). Gnothi Sauton oder magazin der erfahrungs-

seelenkunde als ein lesebuch fur gelehrte and ungelehrte. Berlin,

Germany: Mylius.

Selfe, L. (1977). Nadia: A case of extraordinary drawing ability in an

Autistic child. London: Academic Press.

Selfe, L. (2011). Nadia revisited: A longitudinal study of an Autistic

Savant. New York: Psychology Press.

Sowell, T. (1997). Late talking children. New York: Basic Books.

Sowell, T. (2001). The Einstein syndrome: Bright children who talk

late. New York: Basic books.

Treffert, D.A. (1988). The idiot savant: A review of the syndrome.

American Journal of Psychiatry 145563–145572.

Treffert, D.A. (1989). Extraordinary people: Understanding savant

syndrome. Lincoln, Nebraska: iUniverse.com.

Treffert, D. A. (2006). Dr. Down and ‘‘developmental disorders’’.

Autism and Developmental Disabilities, 36, 965–966.

Treffert, D. A. (2010). Islands of genius: The bountiful mind of the

Autistic acquired and sudden savant. London: Jessica Kingsley.

J Autism Dev Disord (2014) 44:564–571 571

123

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