First Symposium of the Evolutionary Psychiatry Special Interest Group of the Royal College of Psychiatrists, Oct 4th 2016 in London.
Lecture by Professor Simon Baron-Cohen from Cambridge University Autism Research Centre.
Presentation available here:Evolutionary Psychiatry Special Interest Group (EPSIG) of Royal College of Psychiatrists, UK:
http://www.rcpsych.ac.uk/workinpsychi…32:07
with with Asperger’s syndrome age 12
32:10
outperform typical 12 year olds in
32:12
solving these kinds of mechanical
32:14
reasoning problems suggesting that
32:17
despite their social difficulties in
32:19
certain aspects of the environment their
32:22
understanding is actually precocious so
I’m located at Cambridge
so opportunistically we decided to look
at the rate of autism amongst the math
students at Cambridge University so we
just asked them that very straight
question do you have autism and you see
you see the results show a much higher
rate of diagnosed autism in students at
I would say this a very good University
in the field of mathematics compared to
the humanities so again reinforcing this
idea that there might be a link between
a lot of autistic traits or even a
clinical diagnosis of autism and talent
at understanding systems including
mathematics and again just taking
advantage if you like of students thing
on the doorstep we gave the aq that
measure of autistic traits to students
working in Sciences or in the humanities
finding that the scientists didn’t have
a higher rate of autism they just had
more autistic traits compared to those
working in the humanities so again those
individuals who are attracted by the
more predictable world that can be
systemized which is what we do in
science where we try to understand
lawful relationships between variables
might end up in science it may have
higher number of autistic traits than
those who can deal with the less lawful
world of people the unpredictability of
people and the way we write about people
for example in literature where this
link comes from between autism and
scientific talent is likely to be
genetic because years ago we looked at
the occupations of fathers of children
with autism just asking them about where
they work and finding a disproportionate
number of fathers of children with
autism work in the field of engineering
compared to fathers of typically
developing children obviously
engineering is a very good case of where
you need to be good at understanding
systems but to get the job you may not
have been selected on the basis of your
social skills more your understanding of
how things work so looking back where
there’s a child with autism in the
family at the genetics if you like
what’s been positively selected perhaps
in evolutionary terms is not autism
itself but
absent aptitude for understanding
systems which would be an advantage in
fields where you’re either building a
system like engineering or trying to
understand the system we found the same
pattern amongst the grandfathers of
children with autism on both sides of
the family so this led to the prediction
35:16
is autism more common in places like
35:19
Silicon Valley so Silicon Valley
35:21
obviously obviously been attracting
35:23
people who have an aptitude for systems
35:26
for quite a few years and they moved
35:28
there and they work there and they
35:31
potentially start a family there and
35:33
have children so if there’s a genetic
35:35
link between scientific aptitude or
35:37
technical intelligence and risk of
35:40
autism in the offspring we should see it
35:43
in places like Silicon Valley so Silicon
35:46
Valley is quite a long way away from
35:48
London so we went to a Silicon Valley a
35:51
bit closer to home in the Netherlands
35:53
and looked particularly at the city of
35:56
Eindhoven Eindhoven has got the
35:59
Eindhoven Institute of Technology a bit
36:01
like MIT it’s also had the Philips
36:04
Factory there for over a hundred years
36:06
attracting people to go and work there
36:08
in the fields of electronics and more
36:11
recently IT so that now a third of jobs
36:14
in Eindhoven are in the IT sector
36:16
we compared the rate of autism in
36:19
Eindhoven to to other Dutch cities
36:22
Utrecht and Harlem selected because
36:25
there are a similar size and similar
36:27
demographic and found that the rate of
36:29
autism in Eindhoven was more than twice
36:32
as high as in those two other Dutch
36:34
cities this was based on school records
36:37
contacting every school in each of these
36:39
three cities to ask them for the number
36:41
of kids who already have a diagnosis of
36:44
autism we don’t know much about the
36:47
parents this was a school-based study
36:49
where the inference is that this may be
36:52
something to do with the parents
36:54
occupations so and to try to make sense
37:00
of all of the data that I’ve shown you
37:03
this afternoon and to try and make it
37:06
more relevant to an evolutionary
37:08
perspective I just want to mention
37:11
the model that was mentioned at the
37:13
introduction this empathy systemising
37:16
model the idea is that in the population
37:18
in the general population these are two
37:22
dimensions along which we see individual
37:25
differences so along the y-axis we’ve
37:29
got empathy and if you’re at zero it
37:32
means you’re absolutely average for the
37:34
population as you go up the y-axis
37:38
you’re above average at empathy or the
37:40
ability to read other people’s thoughts
37:43
and feelings but also respond emotion
37:45
with an appropriate emotion if you’re
37:48
below zero it means you’ve got
37:49
difficulties in that domain and on the
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x-axis we’ve got systemising the ability
37:56
to UM like to understand a system but
38:00
also build a system by identifying the
38:03
rules that govern the system and so you
38:05
can predict how the system works again
38:07
towards the right so the positive values
38:11
you’re above average on systemizing and
38:13
over to the left you’re below average
38:16
the idea is that we all fall somewhere
38:18
in this space these two dimensions what
38:22
we found in our research is that in the
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dark blue quadrant up at the top left
38:27
more women in the population fall in
38:29
that area where they’ve got
38:31
above-average empathy but there
38:34
systemising could be anywhere from
38:36
average through to below average
38:40
sorry that’s in the light blue part of
38:43
the graph in the white part of the graph
38:46
are individuals who are equally good at
38:49
systemising or empathy so they may be
38:53
equally talented or equally challenged
38:56
but they don’t show much of just of a
38:58
discrepancy in their aptitudes or
39:01
abilities in both areas the pink area is
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where most men on average fall in the
39:07
population where their systemising is at
39:10
a slightly higher level than their
39:12
empathy and what we were predicting is
39:14
that people with autism would fall in
39:17
the bottom right hand quadrant that dark
39:19
red zone where their systemising may be
39:22
anywhere from average to
39:24
above average but their empathy would be
39:27
less than minus one so in the below
39:29
average range which is often the trigger
39:31
for needing a diagnosis that they’re
39:33
struggling with relationships so that
39:37
was the model and what we did was we
39:39
went out into the population we gave
39:41
people these two questionnaires the
39:44
empathy quotient which measures your
39:46
empathy the systemising quotient which
39:49
measures your systemizing and just sort
39:55
of helping you read the data here in
39:58
yellow are females in the population and
40:02
you might be able to see them clustering
40:04
in the top left-hand quadrant of the
40:06
graph in green are males in the
40:09
population where you might see them
40:11
clustering more in the center and in
40:15
purple and red are males and females
40:20
with autism who you might be able to see
40:22
clustering in the lower right-hand
40:24
quadrant so each data point here is an
40:28
individual and and of course all we can
40:32
do is look at groups males females
40:34
people with autism on average because
40:37
individuals may be typical or atypical
40:39
for their group so you know we can see
40:45
we can see a little green dot up here of
40:47
a man who’s well up in the female range
40:49
on his empathy and we can see you know a
40:54
woman all the way down here who’s in the
40:56
so-called autistic range so individuals
41:00
may not fit the trends for their groups
41:03
well we can talk about is statistical
41:05
averages but if we do account for these
41:09
different brain types and this is my
41:11
last slide so we can leave time for
41:13
discussion this is what we find that if
41:16
we look at individuals whose empathy is
41:20
at a higher level than their systemising
41:22
we find more women than men in that have
41:26
that profile if we look at the opposite
41:30
profile individuals whose systemising is
41:33
at a higher level than their empathy
41:36
this is percentages we find more
41:38
men than women show that cognitive
41:41
profile and if we look at it at it at an
41:43
extreme of this one so systemizing is
41:48
either intact or above-average but
41:51
empathy is below average well this is
41:53
where we find the majority of people
41:55
with autism or Asperger’s syndrome so
41:58
the data and are in line with the
42:02
directions predicted by the model but
42:05
really the reason for leaving this up as
42:07
my final slide is to show that diversity
42:10
that exists in the population we all
42:12
fall in one or other of these five brain
42:15
types if you like defined in cognitive
42:17
terms although increasingly we’re
42:19
starting to map their neural substrate
42:22
and the both environmental and
42:25
biological determinants of these
42:28
different brain types but we might well
42:31
imagine that natural selection has
42:35
favored one type of brain over another
42:38
for different kinds of evolutionary
42:40
niches over thousands hundreds of
42:44
thousands of years or millions of years
42:45
in primate evolution some of which fall
42:49
out along and sex differences but
42:53
actually are nothing to do with your sex
42:55
because it turns out that prenatal
42:58
hormones and genes play a much bigger
43:00
role than your actual sex and that
43:03
people with autism may just be showing
43:05
an extreme of the variation that we see
43:07
in the population selected potentially
43:11
for their bare talents being very good
43:15
at spotting patterns being very good at
43:17
innovation at understanding new machines
43:20
or new tools that will help us even if
43:24
they find the social world more
43:26
challenging so I’m going to stop there
43:28
thank our funders and particularly the
43:32
autism research trust that supports our
43:34
work and we can open it up for
43:35
discussion thank you
43:43
Thank You Simon I’m sure there’d be
43:46
quite a number of questions but could I
43:47
just ask you a flea I’ve had reason to
43:50
work with large numbers of transgender
43:54
patients over the years and what the
43:56
observations I have is that there are
43:58
certainly some trans women who will say
44:01
you know I always socialized with women
44:03
and the reason I liked doing that was
44:04
that they didn’t just kind of thump and
44:06
kick each other they talk to each other
44:07
at school for example and it was a safer
44:10
and better place to be
44:11
which seems fine and fixed with the
44:13
model as it were there another group of
44:15
people though who appear to describe a
44:18
kind of subject to change when they
44:19
start to take when they begin estrogen
44:22
hormone treatment and I got a very vivid
44:26
recollection of one patient in
44:27
particular who talked about you know the
44:29
sort of revelatory experience of being
44:31
amongst the girls and finally feeling at
44:33
home as it were which was very striking
44:35
at the time I’m not aware of that should
44:39
be but not aware of literature looking
44:42
specifically at that group of people and
44:44
particularly at hormone exposure for
44:47
transgender patients so I just wonder if
44:49
you’ve got any knowledge of that area to
44:51
comment on or just a brief comment and
44:54
which is that the and the the area of
44:58
research of autism and gender is just
45:01
beginning to open up and including
45:03
transgender so we’re now becoming a bit
45:06
more aware that instead of asking people
45:09
for their sex and giving them a binary
45:10
choice male or female we need to be a
45:13
bit more sort of fluid because a lot of
45:19
people with autism don’t want to
45:20
identify as either male or female and
45:23
they prefer to tick the other box and
45:25
that increasingly a lot of people with
45:28
autism are identifying as either
45:30
transgender or discussing how their
45:34
gender doesn’t fit neatly into
45:36
traditional categories so whether
45:38
there’s a hormonal element to this or
45:40
some other factor but there’s this is a
45:43
new area of research certainly evident
45:45
for hire and expected number of trans
45:49
male patients with autistic traits and
45:52
that would certainly be our clinical
45:53
experience and okay so you have the
45:56
furry microphone somewhere pause can I
46:01
ask a question please do engineers that
46:05
marry have as many children as others
46:07
two engineers marry and have as many
46:10
children yes because the evolutionary
46:12
theory yeah would be about reproduction
46:15
Shawn so presumably people with autistic
46:18
traits it does an evolutionary advantage
46:21
some would have as many children not
46:24
less because it’s difficult to explain
46:26
autism in evolutionary terms yeah if it
46:29
decreases Fitness sure and so I don’t
46:35
know the data on fertility fertility
46:38
rates amongst engineers versus other
46:40
groups and the population maybe other
46:42
someone else does and but you know if
46:46
you think again about um for the
46:49
fertility in relation to resources an
46:52
engineer could be someone who ends up
46:55
with considerable resources if they have
46:57
the skills and the tools that other
47:00
people need in the community
47:02
so if engineering skill is related to
47:06
resources we know that you know there is
47:09
a connection between wealth economic
47:12
status and fertility rates that may
47:14
explain the persistence of the range
47:17
realistic engineering
47:20
Jeanne’s yeah I mean the puzzle always
47:23
was that you know back in the old days
47:25
the kind of autism we saw in the clinic
47:27
we couldn’t really imagine this person
47:29
ever growing up to have a relationship
47:31
let alone an intimate relationship that
47:34
might result in children so why were the
47:36
genes for autism persisting in the gene
47:38
pool
47:39
now we’ve broadened autism into a
47:41
spectrum and we can look at Asperger
47:44
syndrome and we see what’s called the
47:47
broader phenotype amongst the parents of
47:50
children with autism which might include
47:53
skills in engineering or in technical
47:56
intelligence we can see that actually
47:58
there’s plenty of scope for these
47:59
individuals not only having married and
48:02
had children so passing on their genes
48:03
but maybe even being selected positively
48:06
selected by a mate for those positive
48:10
traits well Bill Gates is a really
48:14
interesting example so everyone
48:15
speculates that he’s got autism he
48:18
resists the idea so anytime a journalist
48:21
a journalist tries to sort of thrust a
48:23
microphone into his into his face and
48:25
say you know mr. gates do you have
48:27
autism Lord and it kind of they’re sort
48:30
of a blunt way that journalists
48:31
sometimes do he gets sort of irritated
48:34
but those people who’ve worked with
48:36
games a sort of report that actually
48:40
he’s got a lot of those behaviors and
48:41
he’s done quite well yeah what are you
48:46
thoughts about the contention that
48:50
autism
48:51
represents a slow life history strategy
48:54
or is associated with a slow life
48:57
history strategy and that their
49:00
reproductive success or niche is with a
49:04
state of intense monogamy and long term
49:08
relationships and investment in a single
49:11
relationship as opposed to psychosis
49:15
which is claimed to be a fast life
49:17
history strategy and that I mean there
49:20
has been this research and these claims
49:23
I don’t know what your thoughts are
49:24
about that yeah I don’t I don’t know
49:25
that research but I mean it makes sense
49:27
the way you’re describing it slow life
49:29
and fast life certainly there’s quite a
49:32
lot of data that’s
49:33
accumulating showing that fathers of
49:36
children with autism tend to marry late
49:40
so maybe that fits in with the slow life
49:42
is that right and you know it’s been
49:46
kind of open to interpretation as to why
49:48
that’s the case and some people suggest
49:51
well that could just be because their
49:54
social skills are not as great they’ve
49:56
got some of the genes for autism because
49:58
we see it coming out in the next
49:59
generation so maybe they’ve just taken
50:01
longer to find a partner because of
50:04
reduced social skills but I mean you
50:08
know I guess you’re talking about slow
50:10
life and fast life trajectories which
50:13
may not be sort of under the within the
50:16
awareness of the individual these are
50:17
just sure but it’s very interesting from
50:22
one Simon to another I’m Simon Forester
50:24
from red car and yet I’m a child
50:27
psychiatrist so I’m fascinated by autism
50:29
I heard you talk 20 years ago and you’re
50:31
just as accessible and entertaining as
50:34
you were then so it’s great to hear you
50:36
again what I’m wondering is did the
50:40
extent of genetic or the the extent that
50:46
the genes are distributed amongst the
50:49
chromosomes doesn’t that suggest that
50:51
autism is very old it’s been with us for
50:55
a long time have you got any thoughts on
50:57
that and that might be one implication
51:02
and so you know the one one view about
51:07
the genetics of autism is that it’s not
51:10
about disease two genes or you know
51:12
mutations rare mutations although there
51:15
are rare mutations that can give rise to
51:17
so-called syndromic autism but autism
51:21
may also be the result of common
51:22
variants in the population and that
51:25
these common variants may be distributed
51:27
in you know right across the genome
51:29
each of these common variants may be
51:32
contributing very small effects so it
51:35
may be combinations of particular
51:38
variants that are not disease genes they
51:41
just contribute in different ways to
51:46
two skills whether its language or
51:48
whether its mechanical skills or or any
51:51
other now you’re sort of suggesting that
51:53
because we see those dots right across
51:55
all 23 pairs of chromosomes that that
51:59
means it’s very old another view might
52:01
be that actually the epigenetic factors
52:04
are more important that actually maybe
52:07
the Apple genetic factors cannot can
52:10
influence a lot of gene expression and
52:13
that when we pick up genetic findings
52:16
we’re kind of we’re not looking at the
52:18
epigenome so there’s different ways of
52:21
interpreting it and I just think that
52:25
the first person that picked up a
52:26
burning stick or a bit of half half
52:30
burnt flesh from a thunder and lightning
52:33
storm and thought this is tasty
52:36
maybe we can reproduce this effect
52:38
ourselves were they systematizes sure
52:43
well I mean I think I think you’re sort
52:45
of raising the question about and about
52:48
when an evolution did some of some of
52:51
these very human attributes first emerge
52:55
and I think if you look at the evidence
52:57
from tools for example the fossil
53:01
evidence from tools in evolution you’d
53:04
probably go back at least 70,000 years
53:07
in terms of when tool-making already
53:10
took off and where you can see the
53:12
evidence of a very systematic mind at
53:16
varying their tools which you didn’t
53:18
really see much before 70,000 years ago
53:22
spiritualness I make cansado adult
53:25
psychiatrist I’ve been and I have been
53:28
seeing people with autistic spectrum in
53:30
the clinics over the years and one of
53:33
the things that they impressed me it was
53:36
in the what I had in my mind the
53:39
difference between Asperger’s and autism
53:41
and that the autistic people they did
53:46
not want to be with people where the
53:49
Asperger’s wanted to be with people and
53:51
it seems that that that has it’s as if
53:55
it’s not so much important but it for me
53:58
in the clinical practice and especially
54:00
how you can deal with the people you
54:02
know a huge amount of difference yeah
54:05
sure I mean it’s not an binary that you
54:09
either want to be with people or don’t
54:10
want to it’s probably about the kind of
54:12
dose of social interaction that each of
54:15
us enjoys so some of us enjoy seeing a
54:19
friend once a week other people need to
54:21
see a friend once a day you know so
54:24
there’s an individual differences in
54:26
social motivation and social behavior
54:30
and and you know whether it’s a kind of
54:34
discriminated between autism and
54:35
Asperger’s I’m not sure because even
54:38
within the group called Asperger’s you
54:40
see quite a variation that some people
54:43
are very content just being solitary and
54:47
they actually sleep during the day
54:49
they’re awake at night because then
54:51
they’re not they’re not having to have
54:54
any social contact and others you know
54:58
do want the social contact but don’t
55:00
have the social skills to know how to
55:01
have those relationships and so feel
55:04
very lonely and isolated so I think
55:06
there’s kind of this individual
55:07
difference is even within Asperger’s
55:09
syndrome do you ever feel that events
55:13
will a pre-submission a predisposition
55:16
to autism to a more florid form and if
55:20
so what sort of in a bed I see and so I
55:25
think of the word florid as the word
55:28
that sort of adult psychiatrists use in
55:31
relation to psychosis you know that kind
55:34
of uni you suddenly see all the symptoms
55:36
you know blossoming whereas in autism I
55:40
don’t know that we kind of really think
55:41
about the manifestation of symptoms in
55:44
this kind of Florida way I think it’s
55:46
much more sort of and that if you look
55:49
back you can see a particular pattern of
55:52
behavior that was there right from the
55:53
earliest point so in I work in a clinic
55:57
NHS clinic for adults with suspected
56:00
Asperger’s syndrome but we ask the
56:02
parents to come along with their 40 year
56:05
old son so that we can get a
56:07
developmental history of was the pattern
56:10
of behavior there even
56:11
at primary school and so it’s not so
56:14
much this kind of Florida explosion of
56:16
symptoms where there’s a trigger it’s
56:19
more that actually right from the
56:22
earliest point this was a child who
56:24
didn’t really socialize in the same way
56:26
they were more focused on objects than
56:29
on people maybe they didn’t need a
56:32
diagnosis in primary school or even
56:34
secondary school because they somehow
56:36
sort of managed in primary school maybe
56:40
they were focused on their academic work
56:42
didn’t really mix with kids in the
56:44
playground in secondary school we often
56:47
see a kind of more difficult picture
56:50
where suddenly the adolescent teenage
56:54
group is much more demanding of you know
56:58
and if you don’t have social skills it’s
57:00
much harder to navigate that so a lot of
57:02
the kids get their diagnosis for the
57:04
first time in secondary school but some
57:06
of them have managed to get through till
57:07
they leave home and they go to college
57:09
and then they need their diagnosis or
57:12
when they are not functioning well at
57:14
work so in midlife so it’s not about
57:17
particular triggers it’s about what you
57:20
know what niche they’re in who’s
57:23
protecting them whether it’s their
57:25
family up until a certain point who’s
57:27
concerned about the child or the
57:29
individual and at what point do they –
57:32
they’re symptoms they’re autistic traits
57:33
start to interfere with their where
57:35
they’ve been one point I was told as a
57:38
student that a number of children became
57:41
autistic when their fathers came back
57:44
from the war right and you the
57:47
association between mother and child was
57:50
interrupted right so I would say that
57:54
probably theories of autism have changed
57:58
a little bit I mean we used to have all
58:01
sorts of theories about autism to do
58:03
with how the mothers were cold and
58:05
unemotional or maybe over involved with
58:08
the child and you know so I can imagine
58:09
this kind of event of the father coming
58:12
back from war might have fitted in to
58:14
certain kinds of theories of autism but
58:16
I think nowadays we kind of understand
58:18
autism as this biomechanical
58:20
neurodevelopmental condition which I’ve
58:24
hoped I’ve shown is is just a different
58:26
pattern of the relative sort of focus
58:31
that the the individual has on the
58:33
social world versus the non social world
58:35
and that sort of events that might
58:39
happen in the child’s life about whether
58:40
the father is absent or present as
58:42
they’re probably less important than the
58:44
genetic predisposition and there are
58:48
there must be environmental factors but
58:50
we’re not very good at identifying what
58:51
those are yet I guess if dad comes home
58:54
with PTSD imitates takes to whisky a big
58:57
wave starts knocking mum around that
58:58
might have an impact on the social scale
59:00
well but for a fairly child
59:02
yeah that’s right it may be a creation
59:04
of show phenotypes as yeah yeah that’s
59:07
just a it’s a good question I think on
59:10
the David guinea retired psychiatrist
59:12
from Oxford
59:14
could I ask you a little bit about the
59:16
group at the other end of the spectrum
59:19
that is individuals who are very high
59:22
empathize yes and low in system
59:25
systematizing yeah
59:28
what are they what is this group like Oh
59:31
clinically so I see well the word
59:35
clinically is probably the most
59:36
important word here because they may not
59:38
come to clinics so these people have got
59:40
very good empathy so we might infer that
59:43
they’ve got good social network and good
59:46
relationships friends and you know
59:49
community so actually there may be
59:51
protected from needing to go to a clinic
59:54
it’s probably the people who have below
59:57
average empathy who struggle with
59:58
relationships who might then develop
60:01
secondary depression because they’re
60:03
isolated who end up coming to clinical
60:06
attention so the people up at the top
60:08
left-hand quadrant with super empathy
60:11
maybe doing just fine we don’t know too
60:13
much about them we know that they exist
60:15
because you can see them there we can
60:17
see more yellow dots so there’s more
60:19
females but you can see the odd green
60:21
dot and we know also that they may
60:26
struggle with systems so maybe at school
60:30
they didn’t enjoy mathematics or the
60:33
Natural Sciences and went for other
60:36
kinds of subjects and that when the
60:39
computer goes wrong they just phone the
60:41
helpdesk so you know I don’t think that
60:44
these individuals would necessarily have
60:47
problems they just are part of the
60:51
variety we see in the population I
60:53
suppose I was wondering whether they
60:55
were the group that one does see from
60:58
time to time people who are do seemed
61:01
deeply empathic but really very
61:03
disorganized and that the sort of term
61:05
I’m not sure this at all PC the term
61:08
that springs to mind is scatty
61:10
and just not a clinical diagnosis which
61:13
is them okay it’s a it’s a non clinical
61:15
term but its description of what of how
61:19
a person may be like that and I’m here
61:21
I’m thinking wow how that fits into the
61:25
evolutionary picture right if you think
61:28
that is that could characterize what
61:31
that sort of person might be like right
61:33
so as I say we don’t we don’t there
61:36
hasn’t been much research into the
61:38
people who are at the opposite end of
61:41
autism so we know a lot about people
61:43
with autism because they come to
61:44
clinical attention and then they make it
61:46
into research studies the group at the
61:49
other end of that dimension if we think
61:50
of the diagonal we know less about maybe
61:54
they’ve got sort of executive type
61:56
problems and in being very systematic
61:59
and organizing things but I think that
62:02
may be a bit too simplistic because
62:03
people with autism can also have those
62:05
executive type organizing difficulties
62:08
and we just say no but I think it’d be
62:11
good to have more research into that
62:13
other group
62:14
I just wonder whether those of us who
62:17
might ask you that question have tend to
62:18
be male I just got to two daughters both
62:24
of gone through adolescence that I’ve
62:26
seen both shockingly empathic and I
62:27
found it very difficult to comprehend at
62:29
times women we’re sort of a coffee time
62:34
I think really I’m necessarily really
62:36
pressing questions so so I think first
62:39
of all just to thank you very much for a
62:41
really enlightening and beautifully
62:44
flowing presentation which i think is
62:45
just you know been excellent for us as
62:49
clinicians and and to think about in
62:51
terms of the evolutionary background to
62:53
these conditions choosing my words
62:56
carefully there so thank you very much