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WSJ: Mysteries of the 'Faceblind' Could Illuminate the Brain
IDENTITY PROBLEM
Mysteries of the 'Faceblind' Could Illuminate the Brain Strange Deficit Impairs Ability to Recognize; 'Are You My Mommy?' By HEATHER WON TESORIERO The Wall Street Journal July 5, 2007; Page A1 Several years ago, when Margaret Mitchell picked up her son Duncan from his Seattle school, he looked at her curiously and asked, "Are you my mommy?" Ms. Mitchell, an attorney by training, was taken aback. When she answered, " 'Yes, I'm your mommy,' " he recognized her voice and was reassured. MEDICAL MYSTERY · What's New: Research into 'faceblindness' is examining links to brain functions, as well as improved ways to test for the condition. · Coping: Patients say they compensate by recognizing people by their speech, hair or walking gait. · Treatment Possibilities: Exercises used with autistic children are now being tested with prosopagnosia. A short while later, Duncan, then 4 years old, was diagnosed with prosopagnosia -- a so-called selective developmental condition often referred to as "faceblindness." Although his eyesight is perfectly fine, he can't always identify people by their faces. In school, for instance, Duncan has trouble matching the faces and names of teachers and pupils. Like many other prosopagnosics, Duncan, now 8, has a memory that functions normally in other ways. He can visually distinguish between cars and houses and toys. He knows his dog and cat and other neighborhood pets. He's a sociable child and likes being around people. But the frustration of not being able to discern faces has made everyday life -- from attending school to making friends -- unbearably difficult. His parents engineer much of his social life around one-on-one playdates so he can try to remember classmates. An elusive and unsettling medical mystery, prosopagnosia may offer clues to the delicate interworkings of personality and the brain. Some researchers believe that studying it could help illuminate other developmental aberrancies that scientists haven't yet identified. Research into the condition "has legitimized the search for other brain mechanisms that may also be designed to process information about very specific aspects of the world," says Brad Duchaine, a cognitive neuroscientist at University College London. "It's possible that these selective deficits are sometimes major contributors to people's personalities and may even account for the little personality quirks that so many of us have." Prosopagnosia was first coined in 1947 by a German neurologist who observed that a young man who suffered a bullet wound to the head lost his ability to recognize people. But it's only in the past decade that researchers began focusing on developmental prosopagnosia, or people born without the ability to recognize faces. Studies suggest that up to 2.5% of the population might suffer from some degree of faceblindness. As faceblind children get older, their challenges shift. Toby Scheib, 14 years old, says he's reluctant to tell his peers about his condition. "Either they ask, 'Are you making this up?' They're like, 'I've never even heard of this.' At first they don't believe me," he says. Toby and his mother, Elaine, who is also faceblind, once lost each other at an Easter egg hunt. Eventually, the police had to look for Toby because mother and son couldn't recognize each other in the sea of parents and children. Adult prosopagnosics say that their condition can be socially alienating. Nicky Hoberman, 39, is an Oxford graduate and an accomplished London artist whose work, ironically, includes paintings of faces. She says one time she was at the gym and noticed a man staring intently at her. "He just stood there staring at me while I'm doing my ab crunches and I thought, 'You pervert,'" she says. She ignored him. Shortly after the incident, her brother mentioned that his best friend saw her at the gym, wanted to say hello and was waiting for her to finish her exercises. "I'd met him countless times," she says. Like other prosopagnosics, Ms. Hoberman relies on other characteristics to recognize people, including their hair and walking gait. She's also a very keen listener. "I never forget a thing anyone ever tells me," she says. Much of the research on faceblindness takes place at the University College London's Institute of Cognitive Neuroscience. There, Dr. Duchaine runs the Social Perception Lab, where he and his staff are working to identify prosopagnosics. Those diagnosed with the disorder are asked to come back for more advanced tests that look at their ability to perceive identity, emotion and gender while looking at faces. Dr. Duchaine's early work sought to establish that parts of the brain specialize in face processing. Through a series of experiments, some involving scanning people's brains while showing them images, researchers identified two regions in the brain's temporal lobe, the fusiform face area and the occipital face area, that appear to be critical for face recognition. "The best way for normal people to have a sense of how a prosopagnosic sees faces is to look at images of inverted faces," Dr. Duchaine says. His research shows that normal people can identify upright faces, but do very poorly identifying upside-down ones. Prosopagnosics, on the other hand, often score the same on both. As a student, Dr. Duchaine was always interested in face processing. When he was in graduate school at the University of California at Santa Barbara, a family friend mentioned a teenager who was unable to identify faces. "I put together a bunch of tests, hopped in my car and drove to Los Angeles to test the kid," he recalls. Even using the crude tests he'd developed, Dr. Duchaine was confident the teenager was prosopagnosic. He went on to do a four-year postdoctoral fellowship with Harvard psychologist Ken Nakayama, an expert in visual perception. The duo developed the Cambridge Face Memory Test, which was published in 2006 in the journal Neuropsychologia and has become a standard face test. It is now recognized as a standard diagnostic tool for the condition. (Take the test1.) During a recent hospital lecture, Dr. Duchaine showed a slide of Elvis Presley, with the hair cropped off. During his talk, he said he once asked a woman if she could identify the image and she replied, "Is it Brooke Shields?" Research also suggests that developmental faceblindness is often genetic and comes in degrees. Last year, Dr. Duchaine and Dr. Nakayama flew to Las Vegas to screen 19 members of Toby Scheib's family, ranging in ages from 13 to 76. Of the group, seven were prosopagnosic, but not equally so. Toby's grandmother, an aunt and he were the three most severe cases; his mother, Elaine, scored near the middle of the afflicted. A common question is whether prosopagnosia is somehow related to autism, since people with that disorder can also often struggle with faces -- in both recognizing them and reading people's emotional facial expressions. Based on some early tests, Dr. Duchaine says he believes that the research will show that facial identity, emotional facial expression and social cognition aren't consistently linked. "A lot of our prosopagnosics also have trouble with facial expression, but they do well in everyday life and show no hint of autistic traits," he says. "The only reason they have trouble in social interactions is because they have trouble extracting information from the face." Before learning that Duncan was prosopagnosic, his mother recalls a number of incidents that offered clues into his condition. As soon as Duncan learned to talk, he would often ask people he'd seen many times before, "How do you know me?" or "How do you know my name?" When he was 3 and attending a Montessori school, his teacher told Ms. Mitchell that Duncan didn't call any of the children in the class by their names. "I thought it was odd that he would refer to another kid as 'that guy or that person over there,' " recalls Gina Lauvstad, his former teacher. While he struggled to place his classmates, he was learning other things on schedule, singing songs and recognizing numbers. The following year, Duncan still couldn't name the children in his class. His vision and hearing were tested, and found to be fine. He scored high on an IQ test. A psychologist who saw Duncan three times first used the term "faceblind." Ms. Mitchell says that she went online to find information. "I just started to cry and cry," she says. Duncan at first did well in kindergarten last year at his local public elementary school largely because a special-education aide worked with him, Ms. Mitchell says. But last February, the school brought in a new aide, explaining they didn't want Duncan to become dependent on one person. "Things went bad really fast," says Ms. Mitchell. Within a week, she started getting calls about Duncan's behavior and was often summoned to pick him up from school. Since November, Duncan has been attending a small private school with roughly 40 children. On a recent day, he could name two children in a group, a girl with long brown hair and boy with a shaggy haircut. He said he couldn't remember the other children's names. While researchers are looking to study prosopagnosia in children, other efforts are being made to understand how children with autism process faces, since they often struggle with face recognition and emotional expression. Psychologists Jim Tanaka of the University of Victoria and Robert Schultz of Yale Child Study Center are wrapping up a five-year National Institutes of Health study of a computer game they created for children with autism to try to improve their face recognition skills. Dr. Tanaka says he's eager to see if the game can help prosopagnosic children. After initial face-recognition tests, autistic children ages 7 to 18 played games on a computer program called "Let's Face It" for 20 hours. Half participated in the game and half didn't. The ones who did saw improvement. The researcher likened the experiment to giving patients a drug in a clinical trial. "I won't say it's a slam dunk, but we're getting good results," says Dr. Tanaka. The key, he says, is early intervention. "The earlier, the better, because of what we know about the plasticity of the brain." Ms. Mitchell says she's open to allowing Duncan to participate in research, and the family plans to send Duncan to a one-day "Face Camp" that Dr. Tanaka is sponsoring for children. URL for this article: http://online.wsj.com/article/SB118359798047457714.html |
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