07 May 2024

The History of Autism

The word autism was first used medically by Swiss psychiatrist Paul Eugen Bleuler in the early 20th Century. However, the meaning of the word has …

The word autism was first used medically by Swiss psychiatrist Paul Eugen Bleuler in the early 20th Century. However, the meaning of the word has changed over the years. In this guide, we’ll explain the history of Autism and Autism Diagnosis.

Autism in the Past

1910s Paul Eugen Bleuler

In the early 1900s, Swiss psychiatrist Paul Eugen Bleuler conducted research on schizophrenia, first describing the condition in a lecture in Berlin in 1908. He published his findings in 1911, where he defined traits associated with autism as a “detachment from reality, together with the relative and absolute predominance of the inner life”. He described autism as a symptom of childhood schizophrenia. We know now that autism is not the same as childhood schizophrenia. However, children with autism were commonly diagnosed with childhood psychosis or childhood schizophrenia at this time.

1920s Grunya Sukhareva

Born in the Russian Empire at the end of the 19th Century, Child psychiatrist Grunya Sukhareva’s characterisation of autism came two decades before the psychologists most widely credited for “discovering” autism as we know it today. Her findings and observations mirror the modern diagnostic criteria for autism.

Her studies in 1925 described autistic traits with a sympathetic and empathetic tone, focusing on the success of the children in her care at the sanatorium school in Kyiv, where she worked as a psychologist. She looked after six boys and five girls who would now be considered autistic. Her description of the children focuses on their interests and talents, such as;

  • A 12-year-old who taught himself to read aged 5. He preferred the company of adults to peers his age and was physically awkward.
  • A child who was a talented violinist but struggled to read social cues.
  • A child who was talented mathematically but couldn’t read or recognise faces.

Her definition of autism describes children with an “autistic attitude”. Some of the traits she described align with the modern diagnostic criteria we have today, such as;

  • The children found it hard to adapt and were never fully themselves with their peers, often preferring solitude.
  • They had a tendency towards automatism, preferring repetitive tasks.
  • The children had a certain flatness and superficiality of emotions, with a lack of facial expression.
  • The children pursued strong specific interests.
  • The children engaged in repetitive language and behaviours
  • They had certain sensory difficulties, like sensitivity to light and sound.

Sukhareva’s studies were overlooked by the medical community in the Western world despite being translated into German in 1926. Her findings were not translated into English until 1996.

 

1940s – Leo Kanner

Born in modern-day Ukraine in 1894, Leo Kanner immigrated to the United States in 1924, where he began his paediatric and psychiatric studies. In 1938, he began work on explaining how autism was not a precursor to schizophrenia as previously believed. He studied a group of eleven children to develop a diagnosis of “Kanner Syndrome” which became the basis of Autism Spectrum Disorder.

He published his findings in 1943, and his work shared striking similarities to Grunya Sukhareva’s studies. The children Kanner observed were “happiest when left alone” and carried out repetitive behaviours where actions “were carried out in the same way in which they had been performed originally”. Kanner also observed that the children were often delayed in their speech or used to speak in inflexible ways, with the repetition of certain words or phrases. He claimed that the behaviour of the children was a result of an anxious and obsessive desire for sameness.

  • Other Autistic traits highlighted in Kanner’s work included;
  • Difficulties in following social cues.
  • Sensory sensitivity like loud noises and tastes and textures from food.
  • Echolalia, and the tendency to repeat words, phrases and songs.

1940s – Hans Asperger

Hans Asperger was born in 1906 in Vienna Austria, and worked as a child psychologist during WWII. Historically, Aspergers was used as a diagnosis for people with Autism who did not have a learning disability.

In 1944, Hans Asperger observed children who struggled to form friendships, struggled to follow social cues, had special interests and had below-average motor skills. As the paper was published during World War II in Germany, it was not widely recognised until it was translated into English in the late 1980s.

Aspergers is no longer an official diagnostic term since 2013, partly due to the controversy surrounding Hans Asperger, it’s been debated whether Asperger willingly participated in the Nazi’s Child Euthanasia Program.

People who would have previously been diagnosed with Aspergers now are diagnosed with Autism Spectrum Disorder.

 

1980s & 90s – DSM and ICD definitions

By the 1980s and 90s, the diagnostic criteria for autism became much more standardised, with the introduction of diagnostic frameworks like the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases.

The diagnostic criteria in the 1980s described the key features of autism as;

  • Impairment in social interaction, lack of responsiveness to others, limited or absent use of nonverbal communication and difficulties with relationships
  • Delayed or deviant language development, echolalia and lack of spontaneous language.
  • Restricted and repetitive behaviours such as repetitive movements, insistence on sameness and narrow intense interests.
  • Present before the age of 30 months.

How was Autism treated in the past?

As our understanding of autism has improved in the last century, so has our treatment of individuals with the condition. Where the focus has changed from aiming to eliminate certain behaviours to supporting autistic people’s needs.

Little research into autism was carried out by doctors and psychologists before 1900. Sadly, many children who demonstrated non-typical social behaviours were often institutionalised, where individuals received residential care but were not given any support tailored to their needs or development.

In the 1960s and 70s, behaviourism became popular. It focused on encouraging target behaviours and eliminating “problematic” behaviours. While this approach focuses on fixing surface-level problems, it focuses more on compliance, and conformity can be harmful, leading to anxiety and trauma.

 

Autism today

Today, autism Spectrum Disorder or ASD is defined as a neurodevelopment disorder by the DSM. It’s recognised as a spectrum and can vary in presentation among individuals. A child must have deficits in three areas of social communication and interaction and at least two out of four types of restricted repetitive behaviours.

 

Social Communication Criteria

  • Trouble interacting with others in a typical way. Such as difficulty in conversations, sharing feelings or showing interest in what others are doing.
  • Trouble with using and understanding body language, gestures, and facial expressions to communicate.
  • Difficulty forming and keeping friendships and understanding how to act in different social situations.

Repetitive Behaviours

  • Stereotyped or repetitive behaviours such as hand flapping or repeating the same phrases and words.
  • Insistence on sameness and routine, needing things to stay the same and getting upset if their daily routine is disrupted.
  • Highly restricted interests that manifest as specialist subjects.
  • Sensory sensitivities such as sounds, lights, smells, and textures.

How is Autism Treated today?

Today, we understand that autism is caused by your brain developing differently – there is less focus on a cure as we understand that it is not an illness. Now, we focus on providing individuals with the support they need for a better quality of life.

Some of the approaches medical professionals might recommend to help manage living with autism include;

  • Developing daily living skills.
  • Developing communication skills.
  • Medication or therapy to treat other conditions, such as anxiety.
  • Speech and language therapy.
  • Support and friendship groups.

How can the Autism Service help?

Here at the Autism Service, we have 29 clinics across the UK offering the gold standard in Autism Assessments for both Adults and Children following national guidance from NICE. Our assessments are carried out by a multi-disciplinary team, using the best available tools to provide you with an accurate diagnosis recognised by the NHS and other organisations. Ready to start your diagnostic journey? Find a clinic today.

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