Dr. Helen Tager-Flusberg, Boston University

Dr. Helen Tager-Flusberg is the Director of the Lab of Developmental Cognitive Neuroscience at Boston University. She is also the newly elected president of the International Society for Autism Research (INSAR). In May 2011, ASF intern Max Rolison interviewed Dr. Tager-Flusberg about her research and her INSAR presidency.

Max Rolison: How did you get involved with autism research?

Helen Tager-Flusberg: I had been very interested when I was an undergraduate when I was still in England. I was introduced to the earliest research by Uta Frith that she had done for her dissertation under the directorship of Neil O’Connor and Beate Hermelin. And these were the people who were the pioneers doing cognitive research of autism back in the 1970s. I found the work really interesting. I had been interested in pursuing graduate studies in language development. I moved to the United States and when I was looking around for a dissertation topic, I came back to the idea that we could apply the methods that the theory of language acquisition and psycholinguistics to explore the nature of the problems in children with autism. So I began with my dissertation. That’s where I got interested.

MR: I read some of your evaluation of “Theory of Mind”. How has that shaped your interest and direction in the field?

HTF: When I began my research on language development in children with autism, I started out asking the question, “What is really uniquely different about language and language development in this population?” I began looking at grammatical development and then semantic development, and while certainly the majority of verbal children with autism are impaired in those aspects of language, they really didn’t seem different from other language impaired children, so that was clearly not what was unique to autism. Of course, by then others had begun to explore the idea that it was in the aspects of pragmatic development—the ability to use language effectively in different social contexts—that was the heart of what was uniquely impaired in autism. And I began to work on that and then I came across the paper by Simon Baron-Cohen and his colleagues in England. I was working in the States by then. I came across this paper and I said to myself, “This is something interesting and important for trying to understand why children with autism are impaired in pragmatics, particularly.” So I got interested in Theory of Mind. Early on I was visiting in England and I visited with Simon Baron-Cohen. So that’s how I got started editing the books with him and pursuing my own line of research investigating the interaction and interconnection between language and theory of mind in autism.

MR: How did you get involved in the baby sibs research?

HTF: Well, I think I realized very early on in my career that although I was very interested in autism, I would have loved to work in infancy research as well. I thought infants were fascinating. And of course at some level it is interesting and important for autism. One always wonders, “What are the origins of this? Where does this all get started?” I always thought that working with babies and thinking about using methods for tapping into a preverbal individual. How do you know what’s going on in the mind of a baby. I had many colleagues working in that field using both behavioral as well as beginning to use brain imaging tools to do so. So I was always an infancy wannabe. And then the work in high risk infants began and I found it very interesting and wanted very much to get into it. But to do work on infancy requires major specialization and expertise, which of course, having followed a different career path, I didn’t have, but I was incredibly fortunate in that, maybe five years ago, Chuck Nelson moved from University of Minnesota to Children’s Hospital in Boston. And while I didn’t know him personally, we had some mutual friends and colleagues and I knew that he had come to Children’s with the expressed mandate of beginning a research program in infancy. He had world class expertise in that field. I had the interest and of course the knowledge of autism and so we met after he arrived and we immediately realized that this was something we ought to try to develop together. And that’s how I got involved. And we began by getting some pilot funding both from the NIH and NAAR, and that was really crucial because it is very complicated work and without the pilot funding in hopes that you get started in this, it would not have been possible for us to do the major research program that we’ve got now. So we have been doing this for a few years. We have our one grant from the NIH, which was awarded at the end of our second year. And I would say we are now in the field very actively collecting data and expanding the scope of the project. But we have an incredible team of staff, collaborators, graduate students and post docs working on the analyses and we are beginning to get pieces of manuscripts ready for this project and looking at the next phase.

MR: Why is studying baby sibs so important for autism research?

HTF: I think baby sibs research has already taught us an enormous amount. We already know that contrary to I think everyone’s hunch or hypothesis, as well as anecdotal reports, that these babies are not different from other babies very early on in development. Through six months of age, we really don’t see differences in the proud majority of these babies. I’m not excluding rare anecdotal reports. This is obviously an extremely heterogeneous population. But by and large these are infants who start out life developing normally and then something changes and it’s the change in trajectory of development that is really defining this disorder. That is hugely important because it tells us what kinds of systems we need to go after in order to understand the fundamental biology. What are the types of genes that are involved. It’s not the genes that build the brain prenatally. But it’s the genes that are responsible for building the brain postnatally. What’s going on there and how genes and environment interact over the course of development towards the end of the first year of life and through the course of the second year. That’s the heart of the onset of autism spectrum disorder. It then gives us real optimism that if we identify at risk infants just like we have done with cardiovascular disease, where we no longer wait for people to have a heart attack to decide they are at risk for one, but rather we now identify the pre-risk factors like hypertension, high levels of cholesterol, and we can target those symptoms. They are not cardiovascular disease itself. They are actually just risk factors. And we target them for treatment and we no longer have as much in the way of heart attacks or early mortality. We have really made a difference in that way of medicine. I think autism is really the same but we are talking about a brain disorder. And the goal now is that we can identify a risk. We know that they come into this world following a typical pathway. What can we do to keep them on that pathway and divert them from going down the autism pathway, which is what they are sort of predestined to do if we do not put them on some sort of intervention. And the point I want to make is that I think the baby sibs research has confirmed clearly that prevention is possible. This is the direction that we can optimistically pursue for this population.

MR: Can you explain the use of eye tracking in baby sibs research and your opinions on that?

HTF: I think there are lots of provocative findings out there right now. I know Ami Klin has a new paper coming out finding differences in the first six months of life. We are also doing eye tracking to faces. We don’t see quite as striking findings, although we have not got the kind of dense early data that he has to draw those conclusions. What we have found in our work is that there are some subtle differences in the way babies are looking at faces. And I think that’s true in other people’s research. But in our work its distinguishing infants who are at risk, not necessarily those who are going to have an autism outcome. And that’s something else that I think is being highlighted quite a bit by the infant sib research because there are developmental differences in the high risk babies that don’t necessarily signal “ah here’s a baby who will have autism in another year”. We have many differences in our high risk babies that do not lead to an autism outcome. And that’s true for our eye tracking data as well. So I think what we need to know more clearly is what is differentiating these high risk babies who also show these differences looking at faces from those who do have an autism outcome compared to those who do not.

MR: What are you currently researching in your lab?

HTF: I have two major lines of work going on. One of course is the baby sibs work that is one of my major passions. The second line of work started out a little differently. I’m a language person. So I began to think about well how can we use new technology to tap into language processing in children with autism. And I’ve been pursuing this for the last two or three years. In the field of psycholinguistics, eye tracking has become a very important measure of how we process language. To give clues to what kinds of cues we look at, how we anticipate meaning in sentences, from eye tracking data. And I thought, why can’t we apply this to autism, and in particular think about this in a way of asking the question, well what do children with autism understand about language. And we started with some higher functioning more verbal children because we could more easily validate their performance on eye tracking with their performance on standardized language tests. And we saw that indeed children with autism, like typically developing children, will look longer at a picture that matches either a word or phrase or sentence that they hear and understand that we know they understand from other measures that we can do. It was a very quick leap then to ask the question could we use eye tracking as a way of tapping into language comprehension in children with autism who have very minimal or no spoken language. And so that’s where I’ve gone with this work. Sometimes I think I have been influenced by the fact that this has emerged as a priority for the autism community. I’m also very aware that over thirty years of research on language in autism, I never did study the nonverbal children. I think they are the neglected end of the population. In defense of researchers, I think until the last five to ten years, we really did not have the tools to begin to be able to do the kind of work that we can now. And so we are pursuing this using eye tracking measures that are completely noninvasive that do not require any understanding to become calibrated on the machine. They don’t have to wear a hat. They don’t have to do anything that bothers them. And that has been very exciting. We are now moving in, and this again has been in collaboration with Chuck Nelson and Children’s, to see if we can use electrophysiology to tap language and other information processing in minimally verbal children with autism.

MR: I would like to congratulate you on your new presidency of INSAR.

HTF: Thank you so much. I haven’t quite realized what I was getting myself into, but I am terribly excited. I think it is a wonderful organization and I am very, very proud of how the past presidents have worked very hard to develop close relationships that have been there for the last fifteen years between the foundations, the parent groups, and other stakeholders as well as the research community and I see that as being one of the important things to enhance, to maintain, to foster, and think about how we can expand that connection. Ultimately we are all in this together and I think researchers are here to make a difference in the lives of the children of families that have a child with autism. I think INSAR is a wonderful opportunity to foster that.

MR: Do you have any goals for what you want to do with INSAR over the next two years?

HTF: I would very much like to continue on the path that we have been taking. I think the conference is a centerpiece of the organization. We have a journal, Autism Research. I’m looking forward to enhancing that to make sure that it receives the kind of attention that it deserves. I think building out international connections. So I think in this country we’ve been very successful at fostering the relationships between the research community at INSAR and the foundations and other parent groups. I don’t think we have done that so much in other countries and if we are going to be an international group that’s something that we need to be doing. And we are hoping to launch, before the end of my two year term, a summer institute that is going to promote the training of the next generation of researchers for the field.

MR: What did you think of IMFAR this past year?

HTF: I thought it was terribly exciting. I thought it was an amazingly well organized meeting. I thought everything was just fantastically done. The speakers were outstanding. I just thought it had a wonderful buzz. I think we managed to really have a pretty high profile in the publicity both before and during the meeting. I have to say I get my Google alerts on autism and they’re still coming through based on presentations at the meeting. So that was very exciting. I just thought it was an excellent conference. I am optimistic that Toronto will be just as good next year.