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Another weakness of the study is that it was short term, only four weeks. It therefore did not test if the effect of hyperbaric treatment survives much beyond the treatment itself. Even if the effect in this study is real, it may represent only a temporary symptomatic benefit - not altering the course of autism itself. Therefore longer followup studies are needed as well.

It is not impossible that hyperbaric oxygen may have some benefit in some children with autism.

The biggest risk of the treatment now is that it is expensive - costing 150-900 dollars per treatment or 14-17 thousand dollars for a chamber.

But one thing is clear - any future studies should be very tightly controlled, or they will be counterproductive.

Einstein researchers contend that scientific evidence directly points to the locus coeruleus–noradrenergic (LC-NA) system as being involved in autism. “The LC-NA system is the only brain system involved both in producing fever and controlling behavior,” says co-author Dominick P. Purpura, M.D., dean emeritus and distinguished professor of neuroscience at Einstein.

The locus coeruleus has widespread connections to brain regions that process sensory information.

It is also involved in a variety of complex behaviors, such as attentional focusing (the ability to concentrate attention on environmental cues relevant to the task in hand, or to switch attention from one task to another).

“What is unique about the locus coeruleus is that it activates almost all higher-order brain centers that are involved in complex cognitive tasks,” says Dr. Mehler.

Drs. Purpura and Mehler hypothesize that in autism, the LC-NA system is dysregulated by the interplay of environment, genetic, and epigenetic factors (chemical substances both within as well as outside the genome that regulate the expression of genes). They believe that stress plays a central role in dysregulation of the LC-NA system, especially in the latter stages of prenatal development when the fetal brain is particularly vulnerable.

Drs. Purpura and Mehler believe that, in autistic children, fever stimulates the LC-NA system, temporarily restoring its normal regulatory function.

the future of autism treatment probably lies in drugs that selectively target certain types of noradrenergic brain receptors or, more likely, in epigenetic therapies targeting genes of the LC-NA system.

“You can’t take a complex neuropsychiatric disease that has escaped our understanding for 50 years and in one fell swoop have a therapy that is going to reverse it — that’s folly. On the other hand, we now have clues to the neurobiology, the genetics, and the epigenetics of autism. To move forward, we need to invest more money in basic science to look at the genome and the epigenome in a more focused way.”

Savant skills included more fully developed talents, such as being able to name the elevation of both the sun and the moon at any time of day, on any specified date; being able to name the day of the week for any date in the distant past or future (a talent known as calendrical calculation) and perfect pitch. Importantly, the abilities and the skills had to be exceptional by the standards of the general population, but also well above the individual's overall level of ability. In total, roughly 30 per cent had some kind of special ability (Philosophical Transactions of the Royal Society B, vol 364, p 1359).

For musical savants like Paravicini, Happé suggests that a bias towards small details might have led their developing brains to focus more on the exact notes than the overall melody, leading to perfect pitch and an exceptional musical memory. In art, a focus on small regions of a picture could lead to accurate perspective drawing.

Most people find this harder when they are shown an unsegmented version of the pattern versus a segmented one, but people with autism don't have this preference, demonstrating their skill at seeing a whole in terms of its parts even if there are no obvious dividing lines (see diagram). "It shows they are able to do the segmentation in their minds," says Winner. The precocious realists did not have this preference either, indicating a talent for realistic drawing may arise from this isolated trait commonly found in autism (Philosophical Transactions of the Royal Society B, vol 364, p 1449).

Although these results help to pinpoint exactly what it is about autism that predisposes people to talent, it's still not clear why an eye for detail is more common in autistic people in the first place. Clues might lie in the work of Simon Baron-Cohen from the University of Cambridge, which suggests that people with autism are "hypersensitive" to sensory information

Daniel Tammet, a prodigious savant who has memorised pi to 22,514 digits, believes his own talents have arisen from a special ability to connect different pieces of information together. "Savant abilities are linked to a highly associative type of thinking, an extreme form of a kind that everyone does - examples would include daydreaming, puns and the use of metaphors," he says.

The few studies of savant brains certainly suggest they are physically different from the average brain. For example, when Happé and Wallace studied the brain of a savant gifted at art, calendrical calculation and memory, they found his cortex was thicker in the areas associated with visuospatial processing and calculation and thinner in other regions associated with social cognition, compared with people who were neither savants nor autistic. But whether these differences were innate or grew with lifelong practice was still unclear.

The answer to that question may come from an unlikely source - a study of London taxi drivers who have acquired an encyclopedic memory of the streets of London known as "the Knowledge". Given that taxi drivers must remember the layout of 25,000 streets and the location of thousands of places of interest, and retrieve the information instantaneously, some researchers like Happé believe the Knowledge qualifies as a savant-like skill.

Eleanor Maguire and colleagues at the Institute of Neurology at University College London and colleagues found that drivers with the Knowledge have a bigger rear hippocampus than bus drivers and adults who do not drive taxis. In addition, the hippocampus appears to be larger the longer a taxi driver has been working, and shrinks once they retire (Philosophical Transactions of the Royal Society B, DOI: 10.1098/rstb.2008.0288).

In fact, it seems the remaining mystery is not so much how savants achieve their talents, but what drives them in the first place. "Motivation is a big unknown," says Wallace. "It's an enormous driving force in giftedness and in savants, but we don't know a lot about it."

One person who has something of an inside view on what contributes to savant ability is Paravicini's mentor, Adam Ockelford, a professor of music at Roehampton University in London who has watched Paravicini's talent blossom since the age of 4. When they first met, Paravicini was entirely self-taught and bashed at his plastic keyboard with his fists and elbows to reproduce the sounds he was hearing. It was only after years of practice that his technical skills developed.

But as researchers like Wallace have suggested, Paravicini seemed motivated way beyond the average music student. In fact, he seemed to be playing as if his life depended on it, and Ockelford thinks it's this that truly sets savants apart from their peers. "The survival instinct gets turned with extraordinary force into something else - in Derek's case music," says Ockelford. "When people see Derek, they think it is amazing, almost religious. But to me, it's mainly just hard work."

This study documented that autistic children experience behavior changes during fever.

Einstein researchers contend that scientific evidence directly points to the locus coeruleus–noradrenergic (LC-NA) system as being involved in autism. "The LC-NA system is the only brain system involved both in producing fever and controlling behavior," says co-author Dominick P. Purpura, M.D., dean emeritus and distinguished professor of neuroscience at Einstein.

The locus coeruleus has widespread connections to brain regions that process sensory information. It secretes most of the brain's noradrenaline, a neurotransmitter that plays a key role in arousal mechanisms, such as the "fight or flight" response. It is also involved in a variety of complex behaviors, such as attentional focusing (the ability to concentrate attention on environmental cues relevant to the task in hand, or to switch attention from one task to another). Poor attentional focusing is a defining characteristic of autism.

"What is unique about the locus coeruleus is that it activates almost all higher-order brain centers that are involved in complex cognitive tasks," says Dr. Mehler.

autism, the LC-NA system is dysregulated by the interplay of environment, genetic, and epigenetic factors

They believe that stress plays a central role in dysregulation of the LC-NA system, especially in the latter stages of prenatal development when the fetal brain is particularly vulnerable.

a higher incidence of autism among children whose mothers had been exposed to hurricanes and tropical storms during pregnancy.

autistic children, fever stimulates the LC-NA system, temporarily restoring its normal regulatory function. "This could not happen if autism was caused by a lesion or some structural abnormality of the brain," says Dr. Purpura.

future of autism treatment probably lies in drugs that selectively target certain types of noradrenergic brain receptors or, more likely, in epigenetic therapies targeting genes of the LC-NA system.

If the locus coeruleus is impaired in autism, it is probably because tens or hundreds, maybe even thousands, of genes are dysregulated in subtle and complex ways," says Dr. Mehler. "The only way you can reverse this process is with epigenetic therapies, which, we are beginning to learn, have the ability to coordinate very large integrated gene networks."

"You can't take a complex neuropsychiatric disease that has escaped our understanding for 50 years and in one fell swoop have a therapy that is going to reverse it — that's folly. On the other hand, we now have clues to the neurobiology, the genetics, and the epigenetics of autism. To move forward, we need to invest more money in basic science to look at the genome and the epigenome in a more focused way."

all the success stories related inside the pages of EPSS are accompanied by fortuitous exposure to various forms of structured material, clearly marking out the most promising path for autistic development and growth.

And of course these discussions fly in the face of the current clamor for early intervention in autism, where it would seem the goal is always to yank the autistic child away as early as possible from his or her preferred method of engaging the world, and substitute instead an intense bombardment of socially based indoctrination, hoping to turn the child around while there is still time for the “malleable” brain to be re-molded.

In my opinion, it is no mere coincidence that the very same elements that stand at the core of the Mottron team's affirmative description of autistic perception and cognition are also the very same elements that stand at the core of humanity’s sudden departure off the savannah and leap into the modern world.

Admittedly, a thorough discussion of such a topic would be much too large for inclusion in an academic research paper such as EPSS, but the fact that the Mottron team does not mention, or even hint at, the connection between the features of autistic perception and the features of human cognitive history leave it unclear whether the team has ever considered such a connection.

At this point in time, the Mottron team seems to be the only autism research team heading in a positive and enlightening direction—a direction that is constructive for autistic individuals everywhere—and I look forward to all their future contributions.