Autism — what we know (and what we don't know yet) | Wendy Chung

Translator: Norzaiha Norhan Reviewer: Najibah Abu Bakar

"Why?"

"Kenapa?"

"Why?" is a question

"Kenapa?" merupakan soalan

that parents ask me all the time.

yang ibu bapa selalu tanya kepada saya.

"Why did my child develop autism?"

"Kenapa anak saya alami autisme?"

As a pediatrician, as a geneticist, as a researcher,

Sebagai pakar kanak-kanak, pakar genetik dan penyelidik,

we try and address that question.

kami cuba jawab soalan itu.

But autism is not a single condition.

Namun, autisme bukan kondisi tunggal.

It's actually a spectrum of disorders,

Sebenarnya, ia spektrum gangguan.

a spectrum that ranges, for instance,

Ia spektrum yang pelbagai, contohnya,

from Justin, a 13-year-old boy

Justin, budak lelaki 13 tahun

who's not verbal, who can't speak,

yang tidak verbal, tak bercakap.

who communicates by using an iPad

Dia berkomunikasi melalui iPad

to touch pictures to communicate

dengan menyentuh gambar untuk menyampaikan

his thoughts and his concerns,

fikiran dan kebimbangannya.

a little boy who, when he gets upset,

Dia budak kecil. Apabila ada sesuatu tak kena

will start rocking,

dia akan goyangkan tubuhnya

and eventually, when he's disturbed enough,

dan lama kelamaan jika amat runsing

will bang his head to the point

akan menghantukkan kepalanya hinggakan

that he can actually cut it open and require stitches.

kepalanya luka dan perlukan jahitan.

That same diagnosis of autism, though,

Namun, diagnosis autisme yang sama

also applies to Gabriel,

juga digunakan pada Gabriel,

another 13-year-old boy

seorang lagi budak lelaki berumur 13 tahun

who has quite a different set of challenges.

yang mempunyai cabaran berbeza.

He's actually quite remarkably gifted in mathematics.

Dia sebenarnya amat berbakat dalam subjek Matematik.

He can multiple three numbers by three numbers

Dia boleh darab tiga nombor dengan tiga nombor lain

in his head with ease,

di dalam kepalanya dengan mudah.

yet when it comes to trying to have a conversation,

Namun, apabila cuba untuk berbual

he has great difficulty.

dia menghadapi kesukaran.

He doesn't make eye contact.

Dia tak dapat pandang mata seseorang.

He has difficulty starting a conversation,

Sukar untuknya mulakan perbualan.

feels awkward,

Dia rasa kekok

and when he gets nervous,

dan apabila dia gementar

he actually shuts down.

dia terus gugup.

Yet both of these boys

Namun begitu, kedua-duanya

have the same diagnosis of autism spectrum disorder.

mempunyai diagnosis yang sama: gangguan spektrum autisme.

One of the things that concerns us

Antara yang membimbangkan kami

is whether or not there really is

adalah hakikat sama ada wujudnya

an epidemic of autism.

epidemik autisme.

These days, one in 88 children

Masa kini, seorang dalam 88 kanak-kanak

will be diagnosed with autism,

akan ada diagnosis autisme

and the question is,

dan persoalannya adalah

why does this graph look this way?

kenapa graf berbentuk begini?

Has that number been increasing

Adakah jumlahnya bertambah

dramatically over time?

dengan dramatik selama ini

Or is it because we have now started labeling

atau adakah kita berikan label

individuals with autism,

individu dengan autisme

simply giving them a diagnosis

dengan memberikan mereka diagnosis

when they were still present there before

walaupun ada simptom-simptom sama

yet simply didn't have that label?

tapi tidak dilabel begitu?

And in fact, in the late 1980s, the early 1990s,

Sebenarnya, lewat 1980-an, awal 1990-an,

legislation was passed

undang-undang telah digubal

that actually provided individuals with autism

yang memberikan individu autisme

with resources, with access to educational materials

dengan sumber dan akses kepada bahan pendidikan

that would help them.

yang akan membantu mereka.

With that increased awareness, more parents,

Dengan kesedaran yang meningkat itu, lebih ramai ibu bapa,

more pediatricians, more educators

pakar kanak-kanak, pendidik

learned to recognize the features of autism.

akan dapat mengenalpasti ciri-ciri autisme.

As a result of that, more individuals were diagnosed

Hasilnya, lebih ramai individu didiagnosis

and got access to the resources they needed.

dan dapat akses kepada sumber yang mereka perlukan.

In addition, we've changed our definition over time,

Tambahan lagi, kami juga ubah definisinya.

so in fact we've widened the definition of autism,

Hatta, definisi autime lebih luas

and that accounts for some of

dan itu antara sebab

the increased prevalence that we see.

peningkatan mendadak yang dapat dilihat.

The next question everyone wonders is,

Persoalan seterusnya adalah

what caused autism?

"Apa yang menyebabkan autisme?"

And a common misconception

Salah faham biasa adalah

is that vaccines cause autism.

vaksin menyebabkan autisme.

But let me be very clear:

Biar saya terangkan dengan jelas:

Vaccines do not cause autism.

vaksin tak menyebabkan autisme.

(Applause)

(Tepukan)

In fact, the original research study

Hakikatnya, kajian asal

that suggested that was the case

yang mencadangkannya

was completely fraudulent.

adalah satu penipuan.

It was actually retracted from the journal Lancet,

Ia telah ditarik balik daripada jurnal Lancet

in which it was published,

yang telah menerbitkannya

and that author, a physician,

dan penulis itu, seorang doktor

had his medical license taken away from him.

lesen kedoktorannya telah dibatalkan.

(Applause)

(Tepukan)

The Institute of Medicine,

Institut Perubatan,

The Centers for Disease Control,

Pusat Kawalan Penyakit

have repeatedly investigated this

telah berkali-kali menyiasat

and there is no credible evidence

dan dapati tiada bukti sahih

that vaccines cause autism.

yang menunjukkan vaksin punca autisme.

Furthermore,

Selain daripada itu,

one of the ingredients in vaccines,

salah satu bahan di dalam vaksin,

something called thimerosal,

sesuatu yang dipanggil "thimerosal",

was thought to be what the cause of autism was.

yang dianggap penyebab autisme,

That was actually removed from vaccines

dikeluarkan daripada pembuatan vaksin

in the year 1992,

pada tahun 1992.

and you can see that it really did not have an effect

Seperti yang anda boleh lihat, tiada kesan

in what happened with the prevalence of autism.

dengan peningkatan autisme.

So again, there is no evidence

Jadi sekali lagi, tiada bukti

that this is the answer.

yang ini adalah jawapannya.

So the question remains, what does cause autism?

Jadi persoalannya tetap sama, apakah punca autisme?

In fact, there's probably not one single answer.

Sebenarnya, tidak ada satu jawapan pasti.

Just as autism is a spectrum,

Sama seperti autisme satu spektrum,

there's a spectrum of etiologies,

terdapat spektrum etiologinya,

a spectrum of causes.

spektrum punca-puncanya.

Based on epidemiological data,

Berdasarkan data epidemiologi

we know that one of the causes,

kita tahu bahawa salah satu puncanya

or one of the associations, I should say,

atau salah satu punca yang boleh dikaitkan

is advanced paternal age,

adalah usia lanjut si bapa.

that is, increasing age of the father

Maksudnya, kelanjutan usia si bapa

at the time of conception.

pada waktu kehamilan.

In addition, another vulnerable

Selain daripada itu, satu lagi waktu lemah

and critical period in terms of development

dan kritikal dalam aspek perkembangan

is when the mother is pregnant.

adalah waktu si ibu mengandung.

During that period, while the fetal brain is developing,

Pada waktu itu, semasa otak bayi sedang berkembang

we know that exposure to certain agents

kita tahu ada pendedahan terhadap agen tertentu

can actually increase the risk of autism.

yang dapat meningkatkan risiko autisme.

In particular, there's a medication, valproic acid,

Secara spesifiknya, terdapat ubat, asid valproik

which mothers with epilepsy sometimes take,

yang ada kalanya diambil si ibu yang alami sawan

we know can increase that risk of autism.

yang kami tahu akan meningkatkan risiko autisme.

In addition, there can be some infectious agents

Selain daripada itu, ada agen yang berjangkit

that can also cause autism.

yang boleh menyebabkan autisme.

And one of the things I'm going to spend

Salah satu perkara yang saya

a lot of time focusing on

akan tumpukan

are the genes that can cause autism.

adalah gen yang menyebabkan autisme.

I'm focusing on this not because genes

Saya fokus pada gen

are the only cause of autism,

bukan kerana ia satu-satunya penyebab autisme,

but it's a cause of autism

tapi ia penyebab autisme

that we can readily define

yang lebih mudah untuk dedifinisikan

and be able to better understand the biology

dan biologinya lebih mudah difahami

and understand better how the brain works

serta lebih mudah untuk memahami cara otak berfungsi

so that we can come up with strategies

supaya kami boleh fikirkan strategi

to be able to intervene.

untuk menghalangnya.

One of the genetic factors that we don't understand,

Salah satu faktor genetik yang kami tak fahami

however, is the difference that we see

adalah perbezaan yang boleh dilihat

in terms of males and females.

antara lelaki dan perempuan.

Males are affected four to one compared to females

Nisbah lelaki adalah empat berbanding setiap seorang perempuan

with autism,

yang alami autisme

and we really don't understand what that cause is.

dan kami tak tahu puncanya.

One of the ways that we can understand

Salah satu perkara yang kami faham

that genetics is a factor

berkenaan gen sebagai faktor

is by looking at something called

adalah perihal sesuatu yang dipanggil

the concordance rate.

kadar kesejajaran.

In other words, if one sibling has autism,

Dalam erti kata lain, jika seseorang mempunyai autisme

what's the probability

apakah kebarangkalian

that another sibling in that family will have autism?

adik-beradik dalam keluarga yang sama mengalami autisme?

And we can look in particular

Kita boleh lihat secara lebih dekat

at three types of siblings:

tiga jenis adik-beradik:

identical twins,

kembar seiras,

twins that actually share 100 percent

kembar yang berkongsi 100 peratus

of their genetic information

maklumat genetik

and shared the same intrauterine environment,

dan berkongsi persekitaran intrauterin yang sama,

versus fraternal twins,

dengan kembar tak seiras,

twins that actually share 50 percent

kembar yang berkongsi 50 peratus

of their genetic information,

maklumat genetik

versus regular siblings,

berbanding adik-beradik biasa,

brother-sister, sister-sister,

abang-adik, kakak-adik,

also sharing 50 percent of their genetic information,

yang juga berkongsi 50 peratus maklumat genetik

yet not sharing the same intrauterine environment.

namun tak berkongsi persekitaran intrauterin yang sama.

And when you look at those concordance ratios,

Apabila kita lihat ratio kesejajarannya,

one of the striking things that you will see

salah satu perkara menarik yang boleh dilihat

is that in identical twins,

adalah pasangan kembar seiras

that concordance rate is 77 percent.

mempunyai kadar kesejajaran sebanyak 77 peratus.

Remarkably, though,

Namun yang ajaibnya,

it's not 100 percent.

ia bukan 100 peratus.

It is not that genes account for all of the risk for autism,

Maksudnya, gen bukanlah punca mutlak autisme

but yet they account for a lot of that risk,

namun is penyumbang terbesar risiko autisme

because when you look at fraternal twins,

kerana apabila kita lihat kembar tak seiras,

that concordance rate is only 31 percent.

kadar kesejajarannya hanyalah 31 peratus.

On the other hand, there is a difference

Walau bagaimanapun, ada beza

between those fraternal twins and the siblings,

antara kembar tak seiras dan adik beradik biasa

suggesting that there are common exposures

yang menunjukkan pendedahan sama

for those fraternal twins

untuk kembar tak seiras

that may not be shared as commonly

mungkin tidak dikongsi

with siblings alone.

dengan adik beradik biasa.

So this provides some of the data

Jadi ini memberikan data

that autism is genetic.

yang punca autisme mungkin genetik.

Well, how genetic is it?

Berapa banyak faktor genetik itu?

When we compare it to other conditions

Apabila kami bandingkan dengan kondisi lain

that we're familiar with,

yang kami tahu

things like cancer, heart disease, diabetes,

seperti kanser, sakit jantung, diabetes.

in fact, genetics plays a much larger role in autism

Hakikatnya, genetik mainkan peranan lebih besar dalam autisme

than it does in any of these other conditions.

berbanding kondisi-kondisi lain.

But with this, that doesn't tell us what the genes are.

Namun, ia tak beritahu kami gen yang menjadi puncanya.

It doesn't even tell us in any one child,

Ia juga tak beritahu kami dalam seorang kanak-kanak

is it one gene

adakah hanya satu gen

or potentially a combination of genes?

atau kemungkinan yang ia kombinasi beberapa gen?

And so in fact, in some individuals with autism,

Jadi, bagi sebahagian individu yang alami autisme

it is genetic!

ia adalah genetik!

That is, that it is one single,

Itulah satu-satunya

powerful, deterministic gene

gen kuat yang menghasilkan

that causes the autism.

dan menjadi punca autisme.

However, in other individuals,

Namun, bagi individu lain

it's genetic, that is,

ia genetik, maksudnya,

that it's actually a combination of genes

ia kombinasi genetik

in part with the developmental process

bersama proses perkembangan

that ultimately determines that risk for autism.

yang akhirnya menentukan risiko autisme.

We don't know in any one person, necessarily,

Kami tak dapat pastikan dalam diri seseorang

which of those two answers it is

antara kedua jawapan itu

until we start digging deeper.

hingga kami kaji sedalam-dalamnya.

So the question becomes,

Jadi persoalannya sekarang,

how can we start to identify

bagaimana nak mula kenal pasti

what exactly those genes are.

gen tersebut?

And let me pose something

Biar saya tanya sesuatu

that might not be intuitive.

yang mungkin tak begitu intuitif.

In certain individuals,

Bagi sesetengah individu,

they can have autism

mereka alami autisme

for a reason that is genetic

mungkin disebabkan genetik

but yet not because of autism running in the family.

namun bukan sebab ada autisme di kalangan ahli keluarga.

And the reason is because in certain individuals,

Ini kerana bagi sesetengah individu itu

they can actually have genetic changes or mutations

mungkin berlaku perubahan genetik atau mutasi

that are not passed down from the mother

yang tidak diturunkan daripada ibu

or from the father,

atau daripada ayah,

but actually start brand new in them,

tapi sesuatu yang baru berlaku dalam diri mereka sendiri.

mutations that are present

Mutasi mungkin berlaku

in the egg or the sperm

semasa di tahap telur atau sperma

at the time of conception

pada waktu kehamilan

but have not been passed down

tetapi tidak diturunkan

generation through generation within the family.

dari satu generasi ke satu generasi dalam keluarga.

And we can actually use that strategy

Kami dapat guna strategi itu

to now understand and to identify

untuk memahami dan kenal pasti

those genes causing autism in those individuals.

gen yang menyebabkan autisme dalam individu tersebut.

So in fact, at the Simons Foundation,

Jadi di Yayasan Simons

we took 2,600 individuals

kami ambil 2,600 individu

that had no family history of autism,

yang tiada sejarah autisme dalam keluarga

and we took that child and their mother and father

dan kami ambil anak serta ibu bapanya

and used them to try and understand

dan gunakan mereka untuk cuba memahami

what were those genes

gen-gen

causing autism in those cases?

yang menjadi punca autisme dalam kes mereka.

To do that, we actually had to comprehensively

Untuk berbuat begitu, kami melihat secara komprehensif

be able to look at all that genetic information

semua maklumat genetik

and determine what those differences were

dan pastikan perbezaannya

between the mother, the father and the child.

antara ibu, bapa dan kanak-kanak tersebut.

In doing so, I apologize,

Dalam berbuat begitu, saya ingin minta maaf.

I'm going to use an outdated analogy

Saya akan guna analogi lapuk

of encyclopedias rather than Wikipedia,

iaitu ensiklopedia dan bukan Wikipedia,

but I'm going to do so to try and help make the point

tapi saya buat begitu untuk cuba buktikan sesuatu.

that as we did this inventory,

Sambil melakukan inventori ini,

we needed to be able to look at

kami perlu melihat

massive amounts of information.

maklumat yang amat banyak.

Our genetic information is organized

Maklumat genetik kita di susun

into a set of 46 volumes,

dalam set 46 jilid

and when we did that, we had to be able to account

dan apabila kami berbuat begitu kami perlu kira

for each of those 46 volumes,

setiap satu daripada 46 jilid,

because in some cases with autism,

kerana dalam sesetengah kes autisme,

there's actually a single volume that's missing.

sebenarnya ada satu jilid yang hilang.

We had to get more granular than that, though,

Kami terpaksa kaji dengan lebih teliti lagi

and so we had to start opening those books,

jadi kami mula buka buku-buku itu

and in some cases, the genetic change

dan dalam sesetengah kes perubahan genetik itu

was more subtle.

amat halus sekali.

It might have been a single paragraph that was missing,

Kemungkinan ada satu perenggan yang hilang,

or yet, even more subtle than that,

ataupun, lebih halus lagi

a single letter,

satu huruf

one out of three billion letters

daripada tiga bilion huruf

that was changed, that was altered,

yang ditukar, yang diubah,

yet had profound effects

namun menyebabkan kesan mendalam

in terms of how the brain functions

dari segi cara otak berfungsi

and affects behavior.

dan kesannya pada tingkah laku.

In doing this within these families,

Dengan kajian yang melibatkan keluarga-keluarga ini,

we were able to account for approximately

kami dapat kesan lebih kurang

25 percent of the individuals

25 peratus individu

and determine that there was a single

dan menentukan yang adanya satu

powerful genetic factor

faktor genetik yang kuat

that caused autism within those families.

yang menyebabkan autisme dalam keluarga itu.

On the other hand, there's 75 percent

Walaupun begitu, ada 75 peratus

that we still haven't figured out.

yang kami masih tak dapat pastikan.

As we did this, though,

Semasa melakukan kajian ini,

it was really quite humbling,

ia pengalaman yang buat kami rasa rendah diri,

because we realized that there was not simply

kerana kami sedar yang tak ada

one gene for autism.

satu gen untuk autisme.

In fact, the current estimates are

Hakikatnya, buat masa ini dianggarkan

that there are 200 to 400 different genes

ada 200 ke 400 gen berbeza

that can cause autism.

yang boleh menyebabkan autisme.

And that explains, in part,

Itu dapat menjelaskan,

why we see such a broad spectrum

kenapa kita lihat spektrum yang luas

in terms of its effects.

berkenaan kesan-kesannya.

Although there are that many genes,

Walaupun terdapat banyak gen,

there is some method to the madness.

ada cara untuk mengenal pastinya.

It's not simply random

Ia bukan sesuatu yang rawak.

200, 400 different genes,

200, 400 gen berbeza,

but in fact they fit together.

tapi sebenarnya, ia berkelompok.

They fit together in a pathway.

Ia berkelompok di satu laluan.

They fit together in a network

Ia berkelompok dalam satu rangkaian.

that's starting to make sense now

Itu yang boleh difahami sekarang

in terms of how the brain functions.

dalam erti kata fungsi otak.

We're starting to have a bottom-up approach

Kami mulakan pendekatan bawah ke atas

where we're identifying those genes,

di mana kami mengenal pasti gen-gen,

those proteins, those molecules,

protein dan molekul tersebut

understanding how they interact together

serta memahami cara ia berinteraksi

to make that neuron work,

untuk menggerakkan neuron.

understanding how those neurons interact together

Kami cuba faham cara neuron tersebut berinteraksi

to make circuits work,

untuk menggerakkan litar

and understand how those circuits work

dan memahami cara litar berfungsi

to now control behavior,

untuk mengawal tingkah laku

and understand that both in individuals with autism

dan memahami individu autisme

as well as individuals who have normal cognition.

serta mereka yang mempunyai kognisi normal.

But early diagnosis is a key for us.

Namun diagnosis awal amat penting bagi kami.

Being able to make that diagnosis

Jika kami dapat buat diagnosis

of someone who's susceptible

ke atas seseorang yang berkemungkinan alaminya

at a time in a window

pada tingkap masa

where we have the ability to transform,

di mana kami mampu buat perubahan

to be able to impact

dan beri impak

that growing, developing brain is critical.

kepada otak yang sedang berkembang itu sesuatu yang kritikal.

And so folks like Ami Klin have developed methods

Ami Klin contohnya, wujudkan cara

to be able to take infants, small babies,

untuk uji bayi kecil

and be able to use biomarkers,

dan guna penanda bio,

in this case eye contact and eye tracking,

dalam kes ini hubungan mata dan mengesan pergerakan mata,

to identify an infant at risk.

untuk mengenal pasti bayi yang berisiko.

This particular infant, you can see,

Bayi ini, seperti yang anda boleh lihat,

making very good eye contact with this woman

memandang mata wanita ini dengan baik sekali

as she's singing "Itsy, Bitsy Spider,"

sambil dia menyanyi, "Itsy, Bitsy Spider"

in fact is not going to develop autism.

menunjukkan dia takkan alami autisme.

This baby we know is going to be in the clear.

Bayi ini, kami tahu, tiada masalah tersebut.

On the other hand, this other baby

Bayi yang ini pula

is going to go on to develop autism.

akan alami autisme.

In this particular child, you can see,

Bayi ini, seperti yang anda boleh lihat,

it's not making good eye contact.

tidak memandang mata.

Instead of the eyes focusing in

Dia tidak fokus pada mata

and having that social connection,

dan tiada hubungan sosial.

looking at the mouth, looking at the nose,

Dia memandang mulut, hidung,

looking off in another direction,

melihat arah lain,

but not again socially connecting,

tapi tiada hubungan sosial.

and being able to do this on a very large scale,

Melakukan saringan ini pada skala lebih besar,

screen infants, screen children for autism,

menyaring bayi, menyaring kanak-kanak untuk autisme

through something very robust, very reliable,

melalui sesuatu yang teguh, boleh dipercayai

is going to be very helpful to us in terms of being

amat menolong kami dalam erti kata

able to intervene at an early stage

menghalangnya pada tahap awal

when we can have the greatest impact.

waktu impak terhebat boleh berlaku.

How are we going to intervene?

Bagaimana kami nak menghalangnya?

It's probably going to be a combination of factors.

Ia mungkin kombinasi beberapa faktor.

In part, in some individuals,

Bagi sesetengah individu,

we're going to try and use medications.

kami akan cuba beri ubat.

And so in fact, identifying the genes for autism

Jadi, dalam mengenal pasti gen untuk autisme

is important for us

penting untuk kami

to identify drug targets,

mengenal pasti sasaran ubat,

to identify things that we might be able to impact

untuk mengenal pasti perkara yang akan beri impak

and can be certain that that's really

dan kami boleh pastikan yang ia benar-benar

what we need to do in autism.

apa yang kami perlukan untuk autisme.

But that's not going to be the only answer.

Namun bukan itu saja jawapannya.

Beyond just drugs, we're going to use educational strategies.

Selain daripada ubat, kami akan guna strategi pendidikan.

Individuals with autism,

Bagi individu autisme,

some of them are wired a little bit differently.

ada yang litar otak mereka sedikit berbeza.

They learn in a different way.

Mereka belajar dengan cara berbeza.

They absorb their surroundings in a different way,

Mereka faham persekitaran mereka dengan cara berbeza

and we need to be able to educate them

dan kita perlu ajar mereka

in a way that serves them best.

dengan cara yang paling sesuai dengan mereka.

Beyond that, there are a lot of individuals

Selain daripada itu, terdapat ramai individu

in this room who have great ideas

di dalam blik ini yang mempunyai idea hebat

in terms of new technologies we can use,

dalam hal teknologi baru yang kita boleh gunakan,

everything from devices we can use to train the brain

daripada peralatan yang kita boleh guna untuk latih otak

to be able to make it more efficient

jadikannya lebih efisien

and to compensate for areas in which

dan mengimbangi kekurangan dalam hal

it has a little bit of trouble,

yang mereka hadapi masalah,

to even things like Google Glass.

hinggalah ke sesuatu seperti Google Glass.

You could imagine, for instance, Gabriel,

Anda boleh bayangkan, contohnya, Gabriel,

with his social awkwardness,

dengan rasa kekoknya untuk bersosial

might be able to wear Google Glass

mungkin boleh pakai Google Glass

with an earpiece in his ear,

dengan peranti di telinga

and have a coach be able to help him,

dan jurulatih yang boleh membantunya

be able to help think about conversations,

tolong dia fikir tentang perbualan,

conversation-starters,

topik untuk mulakan perbualan,

being able to even perhaps one day

dan membantu mungkin satu hari nanti

invite a girl out on a date.

ajak gadis ke luar berjanji temu.

All of these new technologies

Kesemua teknologi baru ini

just offer tremendous opportunities

menawarkan peluang baik

for us to be able to impact

untuk kita beri impak

the individuals with autism,

kepada individu autisme,

but yet we have a long way to go.

tapi perjalanan kita masih jauh.

As much as we know,

Walaupun banyak kita tahu,

there is so much more that we don't know,

masih banyak lagi yang kita tak tahu.

and so I invite all of you

Jadi saya ajak kamu semua

to be able to help us think about

tolong kami fikirkan

how to do this better,

cara untuk lakukannya dengan lebih baik.

to use as a community our collective wisdom

Gunakan kebijaksanaan bersama dalam komuniti

to be able to make a difference,

untuk melakukan perbezaan

and in particular,

dan secara khususnya

for the individuals in families with autism,

untuk individu dalam keluarga autisme,

I invite you to join the interactive autism network,

saya ajak anda sertai rangkaian autisme interaktif

to be part of the solution to this,

sebagai sebahagian daripada solusi autisme

because it's going to take really a lot of us

kerana ia memerlukan kita semua

to think about what's important,

untuk fikirkan perkara penting.

what's going to be a meaningful difference.

Apa yang akan bawa perbezaan bermakna?

As we think about something

Sambil kita fikirkan sesuatu

that's potentially a solution,

yang ada potensi jadi solusi,

how well does it work?

bagaimana dengan keberkesanannya?

Is it something that's really going to make a difference

Adakah ia sesuatu yang akan bawa perbezaan

in your lives, as an individual,

dalam hidup anda, sebagai individu,

as a family with autism?

sebagai keluarga yang ada autisme?

We're going to need individuals of all ages,

Kita perlukan semua orang dari semua peringkat umur

from the young to the old,

dari yang muda hingga ke tua

and with all different shapes and sizes

dengan fizikal yang berbeza

of the autism spectrum disorder

dalam gangguan spektrum autisme

to make sure that we can have an impact.

untuk pastikan yang kita boleh beri kesan.

So I invite all of you to join the mission

Saya mengajak anda semua untuk sertai misi

and to help to be able to make the lives

dan menolong

of individuals with autism

individu autisme

so much better and so much richer.

hidup lebih baik dan bermakna.

Thank you.

Terima kasih.

(Tepukan)

(Applause)