Preface Autism will be fully understood only when the brain impairments that prevent normal development of language and social awareness are determined.   Evidence has been available for nearly half a century of what these impairments might be, though it has long been overlooked by mainstream researchers. Understanding how children learn to speak is most important.  We all become socially impaired when struggling to communicate in a foreign language.  We seek out someone who might be able to translate for us, and feel embarrassed to have to resort to use of gestures.  It is often easier to simply avoid interactions with strangers whose language we can't comprehend. Communication is the minimal need we have for language.  Creative thinking cannot begin until a wide range of word associations and flexible command of syntactic transformations are acquired. Long before I had heard of autism, I sought to understand why my son, Conrad, was speaking only in phrase fragments, and using these badly out of context.   At that time (in the 1960s) his speech was thought of as psychotic, and a reflection of his having been abused. "Want me to take your feet off?" he had been asked once when he refused to take his feet off the coffee table.   From then on, he would use this phrase whenever he thought forceful intervention might be required – shocking, without knowing the original context of getting him to take his feet off the table. Conrad suffered a traumatic birth.  He was born pale and limp, and many minutes elapsed before I heard his first weak cry.  The article on asphyxia at birth, by William Windle, in the October 1969 issue of the Scientific American showed pictures of damage within the midbrain auditory pathway, which suggested to me why decoding speech might be a problem for Conrad. Autism is associated with many different etiological factors.  Given the number of reports of perinatal problems in children with autism, it is wrong that oxygen insufficiency at birth is not a major factor under consideration as the cause in a substantial number of cases.  Auditory system impairment has been shown to result from disruption of aerobic metabolism, including events that lead to a sudden catastrophic lapse in respiration.  Intact functioning of the auditory system is obligatory for learning to speak.  How can damage caused by a brief few minutes of asphyxia at birth not be taken into consideration?  By all reports, a low Apgar score five minutes after birth is an ominous sign. The obstetric practice of clamping the umbilical cord immediately at birth has become a world-wide standard since the mid-1980s.  Textbooks traditionally taught that an infant must be breathing on its own before clamping off continuing postnatal oxygen delivery from the placenta.  Unless the infant has begun breathing, a lapse in respiration may occur and can result in brain damage. Concerns over causes of "respiratory depression" at birth are now appearing in the medical literature, and statistics for neonatal respiratory depression are similar to those for autism prevalence.  In my opinion, clamping the umbilical cord before the first breath should be viewed as a medical error that needs to be stopped.  I could be wrong, but feel strongly that this issue needs to be brought up for careful scrutiny. Eileen Nicole Simon Conradsimon.org/ Lexington, MA, USA 17-Mar-2007