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The Savant Syndrome: Islands of Genius

By Darold Treffert, MD

Savant Syndrome is a rare, but spectacular, condition in which persons with various developmental disabilities, including Autistic Disorder, have astonishing islands of ability or brilliance that stand in stark, markedly incongruous contrast to the over-all handicap.

In some, savant skills are remarkable simply in contrast to the handicap (talented savants). In others, with a much rarer form of the condition, the ability or brilliance is not only spectacular in contrast to the handicap, but would be spectacular even if viewed in a normal person (prodigious savant).

There are fewer than 100 reported cases of prodigious savants in the world literature. The condition was first named Idiot Savant in 1887 by Dr. J. Langdon Down (better known for having named Down's Syndrome).

He chose that term because the word "idiot" at that time was an accepted classification level of mental retardation (IQ below 25) and the word "savant" meant knowledgeable person derived from the french word savoir, meaning "to know".

The term idiot savant has been largely discarded now, appropriately, because of its colloquial, pejorative connotation and has been replaced by Savant Syndrome.

Actually Idiot Savant was a misnomer since almost all of the reported cases have occurred in persons with IQs of 40 or above. The condition can be congenital or acquired in an otherwise normal individual following CNS injury or disease. It occurs in males more frequently than in females in an approximate 6:1 ratio.

Savant skills occur within a narrow but constant range of human mental functions, generally in six areas: calendar calculating; lightening calculating & mathematical ability; art (drawing or sculpting); music (usually piano with perfect pitch); mechanical abilities; and spatial skills.

In some instances unusual language abilities have been reported but those are rare. Other skills much less frequently reported include map memorizing, visual measurement, extrasensory perception, unusual sensory discrimination such as enhanced sense of touch & smell, and perfect appreciation passing time without knowledge of a clock face. The most common savant skill is musical ability.

A regularly re-occurring triad of musical genius, blindness and autism is particularly striking in the world literature on this topic. Premature birth history is commonly reported in persons with Savant Syndrome.

In some cases of Savant Syndrome a single special skill exists; in others there are several skills co-existing simultaneously. The skills tend to be right hemisphere in type--nonsymbolic, artistic, concrete, directly perceived--in contrast to left hemisphere type that tend to be more sequential, logical, and symbolic including language specialization.

Whatever the special skills, they are always linked with phenomenal memory. That memory, however, is a special type--very narrow but exceedingly deep--within its narrow confines.

Such memory is a type of "unconscious reckoning"--habit or procedural memory--which relies on more primitive circuitry (cortico-striatal) than higher level (cortico-limbic) cognitive or associative memory used more commonly and regularly in normal persons.

Approximately 10% of persons with Autistic Disorder have some savant abilities; that percentage is much greater than in other developmental disabilities where in an institutionalized population that figure may be as low as 1:2000.

Since other developmental disabilities are much more common than autism, however, the actual percent of persons with Savant Syndrome turns out to be approximately half Autistic Disorder and half other Developmental Disabilities.

Theories to explain Savant Syndrome include eidetic imagery, inherited skills, concrete thinking and inability to think abstractly, compensation & reinforcement, and left brain injury with right brain compensation.

Newer findings on cerebral lateralization, and some imaging and other studies that do show left hemisphere damage in savants, suggest that the most plausible explanation for Savant Syndrome to be left brain damage from pre-natal, peri-natal or post-natal CNS damage with migratory, right brain compensation, coupled with corresponding damage to higher level, cognitive (cortico-limbic) memory circuitry with compensatory take over of lower level, habit (cortical-striatal) memory.

This accounts for the linking of predominately right brain skills with habit memory so characteristic of Savant Syndrome (Treffert, 1989). In talented savants, concreteness and impaired ability to think abstractly are locked in a very narrow band but, nevertheless, with constant practice and repetition can produce sufficient coding so that access to some non-cognitive structure or unconscious algorithms can be automatically attained.

In prodigious savants, some genetic factors any be operative as well, since practice alone cannot account for the access to vast rules of music, art or mathematics that seems innate in these persons.

Once established, intense concentration, practice, compensatory drives and reinforcement by family, teachers and others play a major role in developing and polishing the savant skills and memory linked so characteristically and dramatically by this unique brain dysfunction.

One of the pre-natal CNS injury mechanisms, which has implications not only for Savant Syndrome but other disorders as well in which male sex in over-represented, is the neurotoxic effect of circulating testosterone on the left hemisphere in the male fetus based on observations and reported by Geschwind and Galaburda.

Since the left brain completes its development later than the right brain, it is at risk for CNS damage for a longer period of time to circulating-testosterone (which can be neurotoxic) in male fetuses and that left CNS damage, with right brain compensation, may account for the high male:female ratio not only in Savant Syndrome, but in autism, stuttering, hyperactivity and learning disabilities as well.

The movie Rain Man depicted an autistic savant and that term became almost a household word. It is important to remember, however, that not all autistic persons are savants, and not all savants are autistic.

What one sees in Rain Man are savant skills (lightening calculating, memorization etc.) grafted on to autism (narrowed affect, obsessive sameness, rituals etc).

It is also important to point out that the savant in the movie is a high functioning person with autistic disorder, but the disorder consists of an entire spectrum of disabilities ranging from profoundly disturbed to high functioning; not all autistic savants function at such a high level.

For many years it was feared that helping the savant achieve a higher level of functioning with treatment--"eliminating the defect"--would result in a loss of special skills, i.e. there would be a trade-off of right brain special skills for left brain language acquisition, for example.

That has not turned out to be the case. Quite to the contrary, "training the talent" is a valuable approach toward increasing socialization, language and independence.

Thus the special skills of the savant, rather than being seen a odd, frivolous, trivial or distracting, become a useful treatment tool as a conduit toward normalization in these special persons.

Some schools have begun to include persons with Savant Syndrome into classes for the gifted and talented as a method of enhancing further this conduit toward normalization.

There are probably fewer than 25 prodigious savants living at the present time. Some of those include Leslie Lemke (music), Alonzo Clemens (sculpting), Richard Wawro (painting), Stephen Wiltshire (drawing), Tony DeBlois (music) to name some.

Other prodigious savants more recently described are in England, Austrailia and Japan. A 1983 60 minutes program on Savant Syndrome was particularly useful in bringing this remarkable condition to more general attention and of course the move Rain Man catapulted the condition to national prominence.

There have been a number of other television specials and several movies about Savant Syndrome over the past 10 years. My book Extraordinary People: Understanding Savant Syndrome reviews the condition in depth.

Information on the above can be obtained by request from:

    Darold A. Treffert, M.D.
    St. Agnes Hospital, Fond du Lac, Wisconsin
    Clinical Professor, Department of Psychiatry
    University of Wisconsin Medical School, Madison
    Personal Web site: http://www.daroldtreffert.com
    e-mail: savants@charter.net

The following reference materials listed below are available upon request, or they can be consulted in libraries where available.

   1. An Extensive, up-dated Savant Syndrome bibliography

   2. Materials by Dorold A. Treffert, M.D.

      EXTRAORDINARY PEOPLE: Understanding Savant Syndrome by Dr. Treffert has now been re-issued, with an epilogue update.

          A comprehensive sourcebook on Savant Syndrome with history, case examples, theories, research findings and future directions. 155 references

      The Idiot Savant: A review of the syndrome American Journal of Psychiatry 145:563-572 (1988). A readily available resource article on history, theories, case examples, and recent research findings on Savant Syndrome in autistic and other Developmental Disabilities, both congenital and acquired

      An Unlikely Virtuoso: Leslie Lemke and the Story of Savant Syndrome The Sciences January/February 1988 pp 28-35. An overview article on Savant Syndrome particulary musical savants

   3. Musical Savants: Exceptional skills in the Mentally Retarded Leon Miller (1989) Hillsdale, NJ Lawrence Erlbaum Publishers. A detailed review of childhood musical genius, savant as well as non-savant

   4. Rimland, B and Fine, D. "Special talents of autistic savants" in The Exceptional Brain, New York, Guilford Press (1988). Study and documentation of savant skills in autistic persons.

   5. Sunday, The Chicago Tribune Magazine, A special kind of genius--Exploring the mystry of the savant syndrome, August 28, 1988
An illustrated, detailed easily readable account of the story of Leslie Lemke, musical savant, with a very comprehensive review of some history and current findings in savant syndrome.

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See the Savant Syndrome site for more information and articles
http://www.wisconsinmedicalsociety.org/savant/default.cfm

Article published here with kind permission of the author.

Extraordinary People

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