Autism is a disabling developmental disorder. It can be diagnosed in children as young as eighteen months. Most often the diagnosis does not come until the child is three years of age or older. The movie does not specifically state when Raymond was diagnosed as an autistic savant.
The symptoms of autism itself are marked impairment in several areas of development such as social interaction and communication. Raymond was seen to have problems with making eye contact with anyone which is a distinct trait of those with Autism. One of the characters, Vern, comments to Susanna that even though he is closer to Raymond that just about anyone in the world, Raymond probably would not notice if Vern walked out with out saying good bye. Susanna is confused by this but Vern tells her that he doesn't think people are Raymond's main concern. This is the impaired social skills that result from Autism. Most people with Autism prefer to be alone and do not seem to need any contact with people. Some children will even actively avoid it like Raymond did with Susanna.
Raymond also showed two of the symptoms listed in communication. "Marked impairment in the ability to initiate or sustain a conversation with other; stereotyped and repetitive use to language or idiosyncratic language. (Butcher, Mineka, Hooley, 549, 2010). When Raymond speaks his voice is flat and robot like. He also engages in echolalia which is "the parrot like repetition of a few words (Butcher, Mineka, Hooley, 547, 2010) when he speaks. He repeats the word definitely constantly when he's talking which annoys Charlie.
Most children with autism also display a need for patterns in their life. They will repeat the same routines over and over. Raymond must watch People's Court and Jeopardy at the same time each day. At one point when they are on their road trip, Charlie stops at a strange woman's house and explains to her that unless they are allowed in so that Raymond can watch his show he will have a fit. This is common with Autistic children who have their routines interrupted in anyway. Some of Raymond's other routines such as going to bed at a certain time could have been caused by the fact that he has spent a good deal of his life in an institution. They would have had a strict schedule for everyone to keep them in line. Raymond might have picked up these patterns and kept them all his life. "Time perception of large units is intact for children and adolescents with ASD (Happe and Wallace, 447, 2007). They also will engage in stereotyped behaviors like hand waving or twisting their bodies in some odd way.
People who are classified as savants have skills that go above and beyond even those of normal functioning. Raymond's skills are some of the most common savant abilities. He has incredible mathematic abilities. He can tell his brother the exact number of seconds until Charlie will visit him in two weeks. Charlie tries to use this ability in Vegas to have Raymond count cards for him. He can also perform memory feats. He can spout off reams of trivia about the most random topics. Raymond remembers all sorts of baseball facts and trivia. He also can remember a waitress's phone number after he spends the night reading telephone book.Rule Outs
The problem with language is what rules out things like Obsessive Compulsive Disorder because most people diagnosed with OCD do not have language delays. It also rules out selective mutism because people that have that diagnosis can understand the spoken language. Those with Autism can understand the spoken language but on a far lower level than their peers.
The prevalence of savant abilities in those with Autism is believed to be around 10%. The prevalence of these abilities in people who do not have Autism, including those that are mentally retarded, is less than 1%. Males tend to out number females in this group as they do in Autism. In the case of savant syndrome, males are six times more likely to be diagnosed than females.
The prevalence of Autism in the world at large according to the DSM-IV is between 0.2% and 0.5%. Males are almost five times more likely to develop Autism than females. There has been an increase in the number of reported diagnoses for Autism in recent years. This could be due to heightened awareness for the condition. It could also be due to the changing criteria for having the disorder which allows it to be applied to a broader range of patients.Development
Autism comes on very early in ones life and is very aggressive. Raymond most likely showed signs of Autism Spectrum Disorder when he was very young. He probably did not want to be held as a baby nor did he reach out to be held. He almost certainly would have had a delay in his development of language skills. By the age of two he would have shown learning problems. He might not have been able to talk even then.
His savant skills most likely developed a little later in life. According to a study done on savants their gifts appear "unbidden, apparently untrained and at the age of somewhere between 5 and 8 years" (O'Connor, 1989, pg. 4). By this time Raymond would have definitely already been diagnosed with Autism.
In the movie it was said that Raymond was sent to live at the institution after he burned his younger brother badly by putting him in hot water. We know that Charlie was very young when this happened because he does not remember Raymond when they first meet. It can be inferred that the incident involved Raymond's Autism in some way. Most likely it had to do with the impaired social skills that are associated with Autism Spectrum Disorder.
There is also the possibility that Raymond's time in the institution impeded his social development even further. He probably was not receiving any real one on one interaction such as a child normally gets with their primary caregiver. This has been shown to stunt a child's emotional and social growth. Since his exact age at the time of the incident is not given, there is no way to know if he had displayed savant qualities yet or if those came about while he was in the care of the institution.Continuity
Though Autism Spectrum Disorder develops early in a child's life because it is a developmental disorder it remains consistent through out a person's lifetime. Vern notes at one point in the movie that he has known Raymond for nine years and he is still not allowed to touch him. While Raymond's savant abilities would have manifested themselves by age eight, it has not been shown that these abilities would have increased in anyway. He would have continually been able to do large math problems but his math skills in general would not have risen as he got older.Comorbidity
Savant syndrome is comorbid with Autism Spectrum Disorder and mental retardation. Savants have also been known to suffer from blindness, Fragile X syndrome and other disorders. When Raymond first meets Charlie his brother is told that Raymond is an Autistic savant.
Autism is comorbid with many different disorders. Mental retardation is the highest of these. It is clear from the fact that Raymond did not even understand the concept of money that he was mentally retarded. Anxiety is also common. Raymond was anxious several times in the film but only when his schedule is interrupted. This is due to his Autism rather than an actual anxiety disorder.
Depression, Bipolar disorder and Attention Deficit Hyperactivity Disorder have been seen in children with Autism Spectrum Disorder. Raymond is a very withdrawn individual which makes Bipolar and ADHD unlikely to be present. He shows very little emotion other than fear and anxiety when his schedule does not run smooth. Because of this he likely does not have depression.
Fragile X, seizures and tuberous sclerosis have also been linked to Autism Spectrum Disorder. Raymond is never shown having a seizure and the other two disorders are never mentioned. It is unlikely that any of them were present.Cultural Differences
Autism Spectrum Disorder is seen in all races and ethnicities. Socioeconomic standing does not seem to haven an impact either. However, there are some differences when speaking of Far East cultures. In China, for example there are more criteria that must be met before a diagnosis of Autism Spectrum Disorder can be made. In other countries it is identified as a different disorder, most notably Reactive Attachment Disorder.
There have also been children from other cultures over represented in cases of Autism Spectrum Disorder when they come to the United States. This could be due to the fact that their home cultural is much different than here. What is identified as Autism Spectrum Disorder is actually normal where they are originally from.
Savant syndrome is seen in very little of the population as a whole. However since it is most commonly found in those with Autism Spectrum Disorder, one can infer that many of the same culture standards apply in both cases. The only one that might not be applicable is the over representation. Savant syndrome is easier to diagnose than Autism Spectrum Disorder. Therefore is not likely that one group's culture would have a significant impact on them being placed in the savant category.
Famility is a piece of Autism Spectrum Disorders but not likely a very large piece. First degree relatives of children with Autism Spectrum Disorder have been seen to have milder forms of many of the symptoms. They may be shy or aloof and have a slower time learning language rather than severe developmental impairment. It is possible that one of the boys' parents had these symptoms. Some studies have seen that paternal age when the child is conceived can have an impact on whether or not they develop Autism Spectrum Disorder. The age of Raymond's father is not discussed so it is hard to tell if that had an impact on his son developing Autism Spectrum Disorder.
There are some that "argue savant skills are latent in us all" (Snyder, 2009, 1399). But most will argue that these skills are not actually found in everyone nor can they be induced. With little research having been done there is no way to tell what role famility plays in savant syndrome.Heritability/Biological
Genes are a high factor in Autism Spectrum Disorder. Twin studies show that in monozygotic twins there is up to a ninety five percent chance that if one twin has Autism Spectrum Disorder, the other twin will develop it as well. In dizygotic twin the chances are lower, only up to 23%, but still rather high.
Sibling studies have found that "there is a 3 to 5 percent" (Butcher, Mineka, Hooley, 549, 2010) risk of a child developing Autism Spectrum Disorder if they have a sibling with this disorder. This seems low in a general sense but when looked into the Autism population it is on average a risk of 30-100%. Since Autism is a spectrum disorder the sibling could develop a milder form Autism than the original child.
The exact mode of transmission is unknown other than it is most likely genetic. Most studies need to be done before a conclusion can be drawn. There is however the possibility that it has to do with genetic variations which would be due to neurotransmitters.Environmental Risk Factors
While genetics are the most motivating cause behind Autism Spectrum Disorder there is some research to substantiate that environment can play a role. It has been theorized by some that severe deprivation can cause autism to develop in normally healthy children. However no real consensus has been reached on that.
The common neurotransmitters involved in Autism Spectrum Disorder are serotonin, dopamine and norepinephrine. These are often involved in disorders of the brain. There is the suggestion that the "glutamate neurotransmitter system is involved in autism" (Butcher, Mineka, Hooley, 549, 2010). This leads to the possibility that autism is linked to bad wiring in the brain.Brain Structures
Savant syndrome has been shown to be linked with some sort of deficiency in the left brain which forces the right brain to make up the difference. This has also been seen in Autism Spectrum Disorder. The right brain has traditionally been seen as the creative side of the brain. This would imply that since they can not function on an intellectual level that their creativity is increased.
People with Autism Spectrum Disorder have also been shown to have larger brains than normal. This is attributed to a lack of pruning as they grow older. This leaves many pathways open that most people do not use. It could provide another reason why autism is so often linked to savant syndrome.Neuroimaging
Neuroimaging of individuals with Autism Spectrum Disorder has shown that they have different brains from those of normal individuals. It has been shown that they have a harder time processing certain things. This is why they have trouble in social situations. They have a less coordinated processing style as well. This leads to them being slower at certain tasks.
The deficits in imitating are why many individuals with Autism Spectrum Disorder have problems with social actions and language. This leads to a lack of connection with their caregiver. This was compounded in Raymond's case as he was sent to an institution. This would have further impeded his social growth and he would have been unable to relate to those his own age. Because his peers at the institution would have also had impairments it would have been even harder for them to understand one another.
It has been shown that treatment for people with Autism Spectrum Disorder is focused mainly on helping them become productive members of society. The most common treatment therefore is behavioral therapy. In an institutional setting, like the one where Raymond was placed, this treatment has been shown to stop autistic individuals from hurting themselves and give them some social skills. (Charlop-Christie et al., 1998).
When Raymond was in the institution they probably tried to teach him things like how to have a conversation. Dr. Burner would have worked with Raymond one on one for a good period each day to help develop these skills. Since the prognosis of Autism Spectrum Disorder is low, Charlie's decision to leave Raymond in the institution is the best option.Prevention
Prevention in this case starts with early intervention and identification. Raymond was certainly diagnosed early but his father chose to keep him at home. It is likely that if Raymond had been sent somewhere like the institution earlier he would have been better developed.
- Butcher, J., Hooley, J., & Mineka, S. (2010). Abnormal psychology, fourteenth edition. Boston: Allyn & Bacon.
- Charlop-Christie, M.H., Schreibman, L., Pierce, K., & Kurtz, P.F. (1998). Childhood Autism. The practice of child therapy, 271-302.
- Happe, F., & Wallace, G. (2007). Time perception in autism spectrum disorders. Research in Autism Spectrum Disorders, 2, 447-455.
- O'Connor, N.O. (1989). The performance of the 'idiot-savant'. Implicit and explicit. British Journal of Disorders of Communication, 24, 1-20. doi: 10.3109/13682828909011943
- Snyder, Allan. (2009). Explaining and inducing savant skills: Privileged access to lower level, less-processed information. Philosophical Transactions of the Royal Society B, 364, 1399-1413.