A History of Diagnosing Autism

Autistic people have always been a part of human society. Uta Frith’s analysis of the depositions of 29 witnesses in the case of Hugh Blair, son of a Scottish landowner, who in 1747 appeared in an Edinburgh court for a decision on his mental capacity argues that Blair was autistic. John Haslam published “Observations on Madness and Melancholy” in 1809 where he describes a boy with many of the classical traits of autism.

 

 eugen Bleuler sized

Autism comes from the Greek word autos meaning self and was used to describe people with conditions that limit their social interactions. Eugen Bleuler was the first to use the term in the early 1900s. A Swiss psychiatrist, Bleuler used autism to describe patients with a group of symptoms associated with a form of schizophrenia (a term he was also first to use).

 sukharev portrait sized

As early as 1926, the Kiev-based child psychiatrist Grunya Efimovna Sukhareva published a detailed description of autistic traits she had found in a number of children.

 

Asperger-Vienna-clinic

Hans Asperger working with a patient in 1930s Vienna

Hans Asperger working in Vienna in the mid 1930s is considered to have defined the autism spectrum. He considered autism to be very common with a range of patients from those who cannot function to one man he treated who went on to win the Nobel prize for Literature. Asperger published a definition of autistic psychopathy in 1944 that was nearly identical with that published by Sukharev. Traits included a lack of empathy, inability to form friendships, one-sided conversations, clumsy movements, and intense absorption in a special interest.

Much of the work going on in Europe was Interrupted by World War II with many leading researchers fleeing to the US.

 

Leo-Kanner sized

Leo Kanner – one of the 1st US child psychologists – hired Georg Frankl, Asperger’s chief diagnostician in 1937

Kanner’s approach was quite different from Asperger’s. To him autism was a rare childhood psychosis caused by cold, distant parents with no time for their kids or “refrigerator parents” as he called them. This came at a time when most childhood developmental issues were being blamed on poor parenting.

Psychologists at the time recommended that children be institutionalized to keep them away from their toxic parents. An opinion that held sway for most of the 20th Century. Kids were terribly mistreated, sometimes being placed in wards with adult psychotics and subjected to shock treatments, lobotomies and straight jackets.

Try putting yourself in those parents’ place… Imagine how they felt?

Kanner eventually had to admit that parents did not cause autism – but only after a decades long nightmare for parents and their affected children.

 

Various...Mandatory Credit: Photo by REX (788055l) Lorna Wing, psychiatrist and physician, specialist in autism, at home in Sussex Various

Credit: Photo by REX (788055l)

In the 1980s Asperger’s work was rediscovered by British psychiatrist Lorna Wing. While making a census of autistic kids in a London suburb, she found many kids that had several autistic traits, but did not meet all Kanner’s criteria. Wing didn’t know what to make of her data until she discovered a reference to Asperger’s work which, on investigation, described exactly what she was seeing.

Wing worked with the group developing the definition of autism in the Diagnostic and Statistical Manual of Mental Disorders, the bible of psychiatry, to broaden the diagnosis to include what we would now call the autism spectrum.

 

lovaas-obit-sized

Ole Ivar Lovaas, a psychologist at UCLA, was the first to show that at least some autistic children were teachable. Although he initially saw limited success with his techniques, which were based on applied behavior analysis, as he retargeted his processes to children under 5 years of age, and included home treatment and increased therapy time he began to see success and was able to integrate some of his subjects into regular classrooms and help them acquire needed social skills to function in the wider world.

Our attitudes over the years have led us to blame our modern society and the way we live to explain the rising prevalence of autism. People have tried to connect autism to vaccines, wifi, pesticides, or anti-depressants in the water supply. All of these have been thoroughly debunked.

This broader definition championed by Wing, combined with better diagnostic tools and intense public education, more accurately lie behind the rising rate of autism in today’s societies. Today we see autism as simply another way of being human.