The History of Autism Spectrum Disorder

Autism Spectrum Disorder, or ASD, is a developmental disorder, impairing an individual’s ability to interact with others and behave appropriately. Autism Spectrum Disorder is a spectrum. Dr. Rebecca Landa, a researcher at Johns Hopkins University, said in an interview, “If you meet one person with autism, you meet one person with autism.” Each person with the disorder has a distinct set of strengths and challenges they must face when learning, thinking, and problem-solving. Some autistic individuals may have extreme sensitivity to light or sound, some may avoid eye contact, others have difficulty with emotion comprehension, some may be nonverbal, or maybe do repetitive motions with objects. According to an article on psychiatry.org, “Autism differs from person to person in severity and combinations of symptoms. There is a great range of abilities and characteristics of children with autism spectrum disorder – no two children appear or behave the same way.” As time has passed, ASD diagnostic criteria has become more definite due to a stronger understanding of the disorder. 

The term “autism” was first coined by German psychiatrist Eugen Blueler in 1911 to describe a severe case of schizophrenia. The University of Zurich professor believed that individuals with schizophrenia had autistic thinking, characterized by infantile wishes to avoid unsatisfying realities and replace them with hallucinations. Psychologists and psychiatrists continued to use this term until the 1950s when it was entirely reframed as a new descriptive category when modelling development. 

Sigmund Freud is known to all as the father of modern psychology and believed that most psychological issues stemmed from early childhood trauma. Many medical experts in the 1940s to 1970s became knowledgeable in psychoanalytic theory, an idea developed by Freud which emphasizes the unconscious mind and trauma. Since autism was believed to be a type of mental illness, many researchers assumed that it was brought about in a child through early trauma created by the most dominant figure in a child’s life: their mother. Leo Kanner, an Austrian-American psychiatrist, and Hans Asperger, a pediatrician, began to explore what were known as autistic behaviors. Due to the assumption of early trauma as having a role in causation, the two researchers primarily worked with children of upper-class parents who may have been cold towards their children. This was known as the “refrigerator mother” theory, which was later debunked by Bernard Rimland, the founder of the Autism Research Institute in California, who presented that autism is a biological condition. 

Kanner was the first person to really define autism as a disorder by acknowledging its abnormal behavior patterns. Kanner studied 11 children – Donald, Frederick, Richard, Paul, Barbara, Virginia, Herbert, Alfred, Charles, John, and Elaine – from ages 2 to 8 who had experienced difficulties in social interactions, adapting to changes in routines, sensitivity to stimuli, and high intellectual potential. In a 1943 paper published in the journal Nervous Child, Kanner characterized these behaviors as “early infantile autism” since it appeared during the first three years of life. He concluded that autism was a neurodevelopmental disorder and that children with the condition had an innate inability to relate to others but also noted that the parental coldness could contribute to the autistic behaviors. He is attributed with coining the term, refrigerator mother, to describe the mothering of autistic children as if from a refrigerator that didn’t defrost. 

One year after Kanner’s experiment, Hans Asperger wrote an article for his postdoctoral thesis describing similar characteristics to Kanner’s experimental group in another group of children. Both researchers emphasized that the disorder they were analyzing differed from schizophrenia, another condition similar to autism as stated above. Unfortunately, Asperger’s work continued to be unknown to the global scientific community for about half a century until it appeared in 1991 in Uta Frith’s textbook, “Autism and Asperger Syndrome”. Once recognized, the name ‘Asperger’s Syndrome’ gained increased recognition, however the idea made way that Kanner’s autism description and Asperger’s syndrome were two different disorders, which were distinguished by the evidence that children with aspergers had normal cognitive skills as well as normal development during the first 2-3 years of life. Kanner argued that one other major difference was that the autistic child’s behaviors are governed by a powerful desire to maintain sameness. Regardless of these differences, the American Psychiatric Association broadened the diagnostic boundaries of Autism under the DSM-IV to include Autistic Disorder, Asperger Syndrome, and Pervasive Developmental Disorder Not Otherwise Specified. 

Though Asperger and Kanner both recognized a neurological, biological basis of autism, other researchers still clung to the “refrigerator mother” theory which proved false. In 1967, psychologist Bruno Bettelheim, declared that refrigerator mothers caused autism in that they didn’t love their children enough. Decades later, Fred Volkmar, the editor-in-chief of the Journal of Autism responded, “They didn’t consider the role of biology or genetics, which we now understand is the main cause.” This has also been proven by countless studies using twins which have found that autism is largely caused by genetic differences in brain development. In 1977, Susan Folstein and Michael Rutter studied 21 pairs of British twins. For ten pairs of fraternal twins in which at least one twin was diagnosed with autism, there was not one co-twin also diagnosed with autism. However, for the 11 pairs of identical twins, 4 were concordant for strictly diagnosed autism. Because of this twin study conducted by Folstein and Rutter, autism went from being thought of as an environmentally-caused disorder to one of the most inheritable psychiatric disorders. 

Additionally, Lorna Wing and Joudith Gould made significant impacts in autism research in 1979. The two female researchers studied 173 children in South London who had features of autism, as described by Leo Kanner. In 2009, Wing told Adam Feinstein that in their study, there was a huge proportion of participants who were sort of positioned in the middle when it comes to the severity of symptoms and IQ. The two female researchers concluded that there was a broader autism phenotype and they eventually introduced the concept of the triad of impairments in autism: deficits in social relations, communication, and imagination. This concept of the broader autism phenotype has gained more recent popularity with additional published studies. The broader autism phenotype is a collection of autistic traits that are more common in families in which a member has autism spectrum disorder than in the general population and can account in part for the genetic basis of the disorder but also how the disorder encompasses a broad spectrum of symptoms.

The condition autism was originally described as a form of childhood schizophrenia and the result of cold parenting, eventually being recognized as a spectrum condition with wide-ranging degrees of impairment. Today, parents, peers, and researchers have all gained a greater understanding of autism spectrum disorder and why individuals on the spectrum act the way they do. Not only has research in the field prevailed, but advocacy for people with the disorder has strengthened. Autism Speaks has worked for the past 17 years to promote a greater understanding and acceptance of ASD to create a world where all individuals on the spectrum can reach their full potential. The organization is devoted to advancing research into causes and treatments for autism spectrum disorder. Luv Michael is another organization, founded in 2015, focusing on the significant employment of autistic adults as recent studies have shown that 90% of autistic individuals are underemployed or unemployed. 

References

Cohmer, Sean. “‘Autistic Disturbances of Affective Contact’ (1943), by Leo Kanner | The Embryo Project Encyclopedia.” The Embryo Project Encyclopedia, 23 May 2014, embryo.asu.edu/pages/autistic-disturbances-affective-contact-1943-leo-kanner

Evans, Bonnie. “How Autism Became Autism.” History of the Human Sciences, vol. 26, no. 3, 2013, pp. 3–31. Crossref, https://doi.org/10.1177/0952695113484320.

Harris, James. “Leo Kanner and Autism: A 75-Year Perspective.” International Review of Psychiatry, vol. 30, no. 1, 2018, pp. 3–17. Crossref, https://doi.org/10.1080/09540261.2018.1455646.

Luiselli, James, et al. “Wing, Lorna.” Encyclopedia of Autism Spectrum Disorders, 2013, pp. 3382–83. Crossref, https://doi.org/10.1007/978-1-4419-1698-3_1877.

Mandal, Ananya, MD. “Autism History.” News-Medical.Net, 26 Feb. 2019, www.news-medical.net/health/Autism-History.aspx.

National Autistic Society. “The History of Autism.” National Autistic Society, www.autism.org.uk/advice-and-guidance/what-is-autism/the-history-of-autism. Accessed 16 May 2022

Pov. “History of Autism Blame | Refrigerator Mothers | POV | PBS.” POV | American Documentary Inc., 18 Jan. 2002, archive.pov.org/refrigeratormothers/fridge.

Ronald, Angelica. “1977 Paper on the First Autism Twin Study.” Spectrum | Autism Research News, 30 Aug. 2015, www.spectrumnews.org/opinion/viewpoint/1977-paper-on-the-first-autism-twin-study.

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