Myths that Persist: Savant Syndrome 2008

Darold Treffert MD

Some Substantial Progress

It is 157 years since the first case of savant syndrome appeared in a scientific journal in Germany, and it is 121 years since Dr. J. Langdon Down first described savant syndrome as a distinct condition.

There has been much progress since that time, including substituting the term “savant syndrome” for the understandable at its time, but now regrettable term, “idiot savant.” In a 1988 paper in the American Journal of Psychiatry, and in my Extraordinary People book in 1989, I suggested using the term “savant syndrome” to cover this “range of abilities that occurs in several conditions” and I am pleased to say that there has been fairly universal adoption of “savant syndrome” to replace the outdated, now pejorative term, “idiot savant.”

Then that same year came the movie Rain Man, which made the term “autistic savant” household words, providing a great deal of public information about, and acceptance of, this remarkable condition.

And, as documented on this website, there has been a great deal of other progress as well such as better answering the “how do they do it?” question; better understanding the types of savant syndrome, including the “acquired” savant; better recognizing the overlap between prodigy, genius and savant syndrome; better acknowledging the important role that families and caretakers play in discovering and nurturing the special gifts; better realizing the benefits that “training the talent” can bring; and focusing increasingly on a-bility rather than dis-ability in all persons with handicaps or limitations.

Much more research remains to be done, certainly, to fully utilize the special opportunity that savant syndrome provides, given the unique window into the brain that savant syndrome affords. Those efforts are accelerating now with new tools to assess not only brain structure, but brain function as well.

Some Lingering Myths

Yet in spite of this considerable progress certain myths about savant syndrome remain (or perhaps because of this progress certain myths have been exposed). These are those myths.

Myth # 1: The “Nadia” effect and the “dreaded trade-off”

In 1978 Dr. Lorna Selfe described the case of Nadia, a prolific childhood artist, whose special abilities disappeared after she was sent away to school to increase language acquisition, socialization abilities and daily living skills. Without doubt the account of Nadia’s once present, then absent prodigious drawing skills is an accurate one. The question arises, though, whether other factors contributed to what I call the “dreaded trade-off”—loss of special savant skills when formal education efforts are directed, instead, at better language acquisition, improved socialization abilities, and increased daily living skills, all of which are deficits in autistic disorder particularly. Some have suggested that indeed other factors did account for the loss of those special skills in Nadia.

I don’t know exactly what did happen with Nadia and why those special skills disappeared. I never met or interviewed her. 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” simply does not occur in those instances when more formal education or training efforts were instituted. 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 abilities without any “dreaded trade-off” of special skills. And, even when more formal education and training are instituted, side-by-side with “training the talent,” again there is no “dreaded trade-off” of those special skills. Sometimes a savant may lose interest in a particular activity as new skills emerge, but once resurrected, that skill remains undiminished.

The myth of the “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. Such a fear is, in my experience, unfounded and should not prevent presenting the savant with more formal education and training. If such efforts are done correctly, adequately recognizing some of the special learning patterns of the savant such as auditory learning in the musical savant, for example, not only are the special savant skills enhanced, but increased language acquisition, improved social ease and increased daily living skills accompany the advance in savant skills.

Nadia lost her magnificent drawing ability in spite of, not because, of efforts to help her. That being the case, parents and teachers can continue 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.

In short, the “dreaded trade-off” suggested by the case of Nadia is, in my experience, an aberration and not a particular risk or the usual outcome in all the cases I am familiar with and those that have been reported by others as well.

Myth #2: Savant syndrome is always associated with low IQ

A second “myth” is that all savants have IQ levels below 70, and one cannot be a savant with an IQ score at a normal or elevated level. While it is true that most savants have measured IQs between 50 and 70, in some instances IQ can be as high as 114, 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 for that matter, 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 we term “IQ.” Savants tend to do poorly on that particular measure of “intelligence.” But savants point out forcefully, to me at least, that there are multiple forms of “intelligence” within us all, and IQ measures only one such “intelligence.” IQ tests do measure something, and we quantify that as “IQ.” But IQ tests fail to measure some of the other forms of “intelligence” that savants, and the rest of us, 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.”

These “islands of genius” that savants demonstrate so vividly have led me to conclude that within all of us there resides a series of separate intelligences, rather than a single “intelligence.” Others as well have postulated multiple intelligences, and debate rages on amonst psychologists regarding general intelligence vs. multiple intelligence theories. But my work with savants has convinced me, at least, that the concept of multiple intelligences is a valid one. And the existence of multiple intelligences has profound implications not just for better understanding and approaching savant syndrome, but also for implementing more effective, individualized 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 measurement of “IQ.” These individuals, whether savants or not, “function” as if “retarded,” but their abilities in certain other areas of function belie a below average IQ score. We call that “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 edition of the Stanford-Binet, the Tactual Performance Test, the American Association for Mental Deficiency Adaptive Behavioral Scale, and the Animal List Selective Reminding 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 35-55.

But I have a videotape of a concert Leslie gave in Texas that belies that level of intelligence overall. 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 as he usually does. The other pianist began playing. Leslie waited about three seconds and then did indeed play the piece with the other pianist, separated only by those three 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 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 possible if the IQ level of 35-55 was an accurate barometer of his overall 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 complex performance.

In summary, some savants do have IQ scores above average. Most do not. Therefore IQ level is not a sole determinant as to whether an individual is a savant or not. Savant syndrome exemplifies “islands of genius” superimposed on an underlying developmental or other disability that can be associated with sub-normal, normal or elevated IQ as measured by formal IQ testing as one single measure of “intelligence.” And in assessing the meaning of IQ scores with respect to “retardation,” one has to be careful to differentiate “functional” retardation for “actual” retardation. IQ scores assess only the latter.

Myth #3: Genius and Prodigy is always Asperger’s or high functioning autism

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. Yet it seems popular these days to apply the diagnosis of Asperger’s Disorder to almost everyone generally considered to be a prodigy or genius in the past. Names such as Einstein, Rembrandt, Mozart and many others are bandied about. That’s possible I suppose. But I haven’t personally interviewed or examined them to reach my own conclusions, and historical accounts are not specific clinically, nor comprehensive, and they do vary.

But somewhere in this disease de jour culture in which we exist, we have begun, in my view, to apply the diagnosis of Asperger’s disorder or autism much too easily to persons who are in fact, prodigies or geniuses. That trend notwithstanding, “Prodigy” and “Genius” do exist as real entities. They are not alway closet Asperger’s or unrecognized autism.

Beyond that, some “normal” (neurotypical is the proper word now) children simply read very early, for example. Some have advanced musical ability. Some draw with impressive talent. Some do math problems precociously. Some have attention-grabbing memory. My posting on hyperlexia on this website outlines several kinds of early word recognition abilities and precocious reading skills that range, diagnostically, from normal, to autistic-like (for a time) to autism itself. Not all hyperlexic children are autistic. Some are perfectly normal children who happen to read very early. That posting on hyperlexia points out the importance of accurate diagnosis before terms such as autism are applied with all that such a diagnosis inplies with respect to treatment, prognosis and outcome.

And then there is prodigy and genius. Some outrageously bright, but not autistic, children have composed symphonies by age 7, or have mastered instruments, sometimes multiple instruments, by age 3. 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. In contrast to savants, prodigies and geniuses have special, spectacular abilities in absence of any underlying disability. And, in counterdistinction to savants, typically, rather than there being an “island”of genius, the special skills of the prodigy or genius are associated with a generally consistently high measured IQ in all areas of functioning.

In short, prodigy and genius do exist as separate entities. Not all such persons are savants nor do they all have Asperger’s disorder or Autistic disorder.

Why is that distinction important? Because many parents, based on the “I’ve got a son or daughter who…” e-mails that I get from this website regularly, are concerned that their child who reads at 18 months, or draws at 2years, or hums back all the melodies he or she hears, or likes to line up railroad cars, resists certain foods, or memorizes license plate numbers, or insists on routine, or has certain fears “could” be autistic. They look up autism on the web and are both convinced, and frightened, that their son or daughter has “autism.” But not every child who likes to line up railroad cars, or plays tunes quite prolifically and precociously on the toy piano, or excels in drawing is autistic, any more than every hyperlexic child has Asperger’s.

There is wide variation in the range of “normal” childhood behaviors, as any parent with several children can tell you, and there is a wide range, and overlap as well, between normal, gifted and talented, prodigy and savant syndrome classifications in children. Such differential diagnosis requires skill, and caution. While I support early identification of autism in youngsters, those efforts need to be balanced with sensible caution lest parents be unnecessarily frightened and overwhelmed by premature, and erroneous, diagnosis. In my experience, except in truly “classic” cases, often some time of watchful observation needs to elapse before the “natural history of the disorder” reveals the real diagnosis. And I have had some very pleasant surprises along the way with such “watchful observation” and diagnostic caution.

In like manner I get a certain number of e-mails from adults—very successful, immensely bright, married with children, leaders in their profession, but with some idiosyncratic ideas or behaviors— who, based on what they now see or read, wonder if they might have had “Asperger’s” all along. On the one hand they seem almost relieved to find out other persons have some of these same preoccupations and eccentricities and still have been very successful, but on the other hand they wonder if their “genius” stems from Asperger’s or autism, and if so, what does that explain of the present traits and behaviors, and what might that mean for the future? Does that explain their social awkwardness or more solitary behaviors and, if so, can those be modified if they stem from autism or Asperger’s?

Those persons also respond to some simple reassurance that genius, or even a gifted and talented level analogous to that in children, does exist, separate from autism, Asperger’s and savant syndrome. Not every “absent-minded professor” has Asperger’s disorder. Instead genius, sometimes with generous eccentricities, can exist separate from any underlying disability disorder. The temptation to classify all geniuses as having autism or Asperger’s is, in my view, part of the disease de jour phenomenon quite rampant these days, and, as with prodigies, needs to be resisted in favor of careful analysis lest continued “diagnosis 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 normal, gifted and talented, prodigy and genius. The important thing is to know the difference.

Myth #4: 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 Extraordinary 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 about that. In the epilogue portion of the 2006 version of my book, I corrected the answer to my question about savant creativity this way: “My initial impression was that savants, spectacular as their individual skills are, as a group in general were not very creative. I was mistaken about that.”

What changed my mind? Some additional years of observation. In all of medicine there is tremendous advantage in having a longitudinal view of a patient and his or her “natural history” of wellness or disease, compared to a one-time, snapshot consultation. I have observed some savants for many years now, including Alonzo Clemons, Richard Wawro or Leslie Lemke, for example. And there are also many others.

In observing the “natural history” of how the savant skills emerge and develop, I have witnessed now, over sufficient time, a predictable sequence of steps in an adequate number of cases to identify a regular pattern of that development that proceeds forth from imitation, to improvisation, to creation. Let me expand on that, using Leslie Lemke as an example.

When I first met Leslie in 1980 his 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 and can do that now to this day on request. After several more years of contact with Leslie, however, I began to notice that some improvisational skills were developing.

At a 1989 concert in Neenah, Wisconsin, for example, 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 as he had heard it. But toward the end of the piece he began to look a bit restless, sat up more straightly 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 five-minute improvisation that could be called I guess “Variations on a theme of Mississippi Hotdog.” It was beautiful. He changed pitch, changed tempo and demonstrated convincingly that he does indeed have innate access to all the “rules of music,” just as suspected. The piece had a huge ending (Leslie loves huge endings). The audience loved and appreciated that wonderful improvisation, judging from the applause.

Several years later Mary told me Leslie was composing some of his own songs. Some that he played and sang for me sounded fairly familiar though, although the words were new. As time went on, though, his songs were more original, and truly new. One such song he called “Down Home on the Farm in Arpin,” and another he called “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, which he loves to do.

Each time I see Leslie now he plays and sings new songs, and they are original. Leslie is creating.

I have seen the same sequence now 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 improvisation begins to appear—a telephone deleted here, or a new tree there different from the original put in place. Next may come some free form or entirely new creation in some manner or other.

One can see that sequence of literal copying, to improvisation to free form creation in the works of Stephen Wiltshire. Matt Savage has traversed that same route from early literal play back, to jazz improvisation, to creation of his own jazz pieces. One musical savant, Hikari Oe, has composed a number of beautiful pieces for several CDs that have been internationally distributed. Interestingly Hikari prefers composing to performing, which is just the opposite of most musical savants.

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 two 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 an mean IQ of 59) were also superior to the control group.

Hermelin and her coworkers 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.

Also, I participated along with Hermelin, O’Connor and Lee (1989) in a study of improvisations by Leslie Lemke compared to a professional, non-savant musician after each had heard the same musical pieces, one lyric (Grieg) and one atonal (Bartok). Leslie’s improvisations were described as “virtuoso embellishments 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 preferences as well as their respective personality characteristics.” In improvisational style on the Bartok, atonal 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 learn more about the brain from the study of savants, we may also learn much more about talent and creativity itself. That is my hope, and one of my objectives.

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