History of autism spectrum disorders

The word “autism” was first used by Swiss psychiatrist Eugene Bleuler in a 1912 issue of theAmerican Journal of Insanity. It comes from the Greek word for “self,” (autos). Bleuler used it todescribe the schizophrenic’s apparent difficulty in connecting with other people. Though the termwas used to describe individuals displaying the autistic tendency to isolate themselves frompersonal interaction, the condition itself was not specifically defined until the 1940s.

Leo Kanner was the first physician in the United States to be identified as a child psychiatrist andhis first textbook, Child Psychiatry (1935), was the first English language textbook to focus on thepsychiatric problems of children. His seminal 1943 paper Autistic Disturbances of AffectiveContact, together with the work of Hans Asperger, forms the basis of the modern study of autism.

In 1943 Dr. Leo Kanner of the Johns Hopkins Hospital meticulously studied a group of 11 childrenand introduced the label ‘early infantile autism’ into the English language. He suggested the term“autism” to describe the fact that the children seemed to lack interest in other people. Kanner’sfirst paper on the subject was published in a now defunct journal, The Nervous Child, and almostevery characteristic he originally described is still regarded as typical of Autism SpectrumDisorders.

At the same time a German scientist, Dr. Hans Asperger, made similar observations, describinga milder form of the developmental disorder that became known as ‘Asperger syndrome.’Interestingly, as a child, Hans Asperger appears to have exhibited features of the very conditionnamed after him. He was described as a remote and lonely child, who had difficulty makingfriends. He was talented in language; he was particularly interested in the Austrian poet FranzGrillparzer whose poetry he would frequently quote to his uninterested classmates. Asperger diedbefore his identification of this pattern of behavior became widely recognized because his work wasmostly in German and little-translated.

The first person to use the term “Asperger syndrome” in a paper was British researcher Lorna Wing. As a result of having an autistic daughter, she became involved in researchingdevelopmental disorders, particularly Autism Spectrum Disorders.
Her paper, Asperger syndrome: a clinical account, was published in 1981 and challenged thepreviously accepted model of autism presented by Leo Kanner in 1943. The paper popularized theresearch of Hans Asperger and introduced the term ‘Asperger syndrome.’ Unlike Kanner, hisfindings were ignored and disregarded in the English-speaking world in his lifetime. Finally fromthe early 1990s, his findings began to gain notice, and nowadays Asperger syndrome is arecognized worldwide condition.

Although the papers of Kanner and Asperger represented the first explanation of ASDs, not muchprogress toward understanding the disorder was made until the 1960s.
In fact, in the 1950s and early 1960s, the widespread belief was that autism was not a biologicaldisorder, but a psychological one, caused by a cold and detached style of mothering. Therefore,mothers of children with autism were, at the time, seen as the cause of their children’s difficulties.

This erroneous notion was based on the findings and ideas of Dr. Bruno Bettelheim, whospecialized in child development and was among the first to concentrate on autism. In retrospect,it seems incredible – and quite disturbing – that the medical establishment should have based itsunderstanding of autism on a sweeping comparison made by one man. His explanation for itsorigin was breathtakingly wrong.

Bettelheim, who had spent time in a Nazi concentration camp, believed he saw parallels betweenthe behavior of some camp prisoners and autistic children. This led him to posit that autism wasa psychological disturbance arising from detached and “frigid” mothering – something akin to howprisoners reacted to the cold authority of camp guards.
The shock is not so much that Bettelheim could be so wrong as that it took decades before anyonein the medical community listened to the few lone voices, such as Dr. Bernard Rimland, Dr. EricSchopler and the mothers themselves, who had been challenging the unfounded theory ofmother-blame since the early 1960s.

Dr. Rimland went on to present an authoritative review of existing evidence that proved autismto be a biological condition rather than a psychological one.
A groundbreaking study of autistic twins (1977) co-authored by Dr. Susan Folstein, professor ofpsychiatry at Tufts University, replaced the bad parenting theory with evidence that autism hascomplex genetic roots.

The study, published in the Journal of Child Psychology and Psychiatry, implicated regions ofchromosomes 7 and 13 as possibly being involved in autism.

In the 1990s, researchers focusing on the genetic component of autism began to find connectionsbetween the disorder and people with irregularities on chromosome 15.
In 1992, Dr. Stanley Greenspan’s book, Infancy and Early Childhood: the Practice of ClinicalAssessment, brought Floortime to the fore, though Greenspan and co-creator Dr. Serena Wiederbegan using it on children with autism spectrum disorders in the mid-1980s. Floortime, or playtherapy, as some refer to it, is a competing method to behaviorism and now the fastest growingintervention in the field, though ABA  still dominates.

In 1998 Dr. Andrew Wakefield comes to public attention when Lancet medical journal publisheshis study that suggested a possible link between rising rates of autism and the measles, mumps andrubella vaccine.
A report by the National Academy of Sciences’ Institute of Medicine concludes in 2004 that theevidence did not support the vaccine-autism theory.
By 2001, researchers had discovered several genomic regions possibly related to autism.

Both Asperger syndrome and autism are today listed in the Diagnostic and Statistical Manual ofMental Disorders DSM-IV-TR (fourth edition, text revision) as two of the five PervasiveDevelopmental Disorders (PDD), more often referred to today as Autism Spectrum Disorders(ASD). These disorders are all characterized by varying degrees of impairment in communicationskills, social interactions, and restricted, repetitive and stereotyped patterns of behavior.
The Pervasive Developmental Disorders, or Autism Spectrum Disorders, range from a severe form,called autistic disorder, to a milder form, Asperger syndrome.
If a child has symptoms of either of these disorders, but does not meet the specific criteria foreither, the diagnosis is called pervasive developmental disorder not otherwise specified(PDD-NOS). The intent of the DSM-IV is that the diagnostic criteria should not be used as achecklist but, rather, as guidelines for the diagnosis of pervasive developmental disorders. Thereare no clearly established guidelines for measuring the severity of a person’s symptoms. Therefore,the line between autism and PDD-NOS is often difficult to find.

Other rare, very severe disorders that are included in the Autism Spectrum Disorders are Rettsyndrome and childhood disintegrative disorder.
Autism is a handicap that is difficult to grasp. This is reflected by the fact that even a consensus ofthe name of the handicap has proven to be difficult and is subject to changing scientific views.

“Autism-related disorders” proves to be a confusing nomenclature. It suggests that it has nothingto do with autism. It is, in fact, a less pure form of autism in which it is possible that the disorderhas not penetrated all development areas and is less acute. Yet, this disorder is certainly part of thespectrum. The accompanying problems can be of a serious nature.

The disorders of Asperger and PDD-NOS rank among the group of autism-related disorders.

History of autism spectrum disorders
What You Should Know About Autism Spectrum Disorders
Autism Books