A brief history
of autism

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There have been a number of separate descriptions of autism around the world dating as far back as 1910, when the Swiss psychiatrist, Eugen Bleuler described a schizophrenic patient who had withdrawn into his own world. The term Bleuler used was, autism, and came from the Greek word ‘autós’ - meaning self. Bleuler was describing autism as

‘a morbid self-admiration and withdrawal within self’.

Two of the most well-known and influential, early researchers in the field were Leo Kanner and Hans Asperger. Kanner was an Austrian-American psychiatrist, who, in 1943, described autism in children. He talked about them having

“extreme autistic aloneness”, “delayed echolalia” and an anxiously obsessive desire for the maintenance of sameness”.

He also noted that these particular children often had high intelligence and an extraordinary memory. Kanner viewed autism as a

‘profound emotional disturbance, not affecting cognition’.

Under this influence, the Diagnostic and Statistical Manual of Mental Disorders (DSM) second edition (1952), defined autism as a psychiatric condition although it was listed as a form of childhood schizophrenia, which Kanner did not believe was the case.

Around the same time, in Vienna in 1944, a physician named Hans Asperger, published his own definition of “autistic psychopathy” based on his studies of four boys. (Incidentally, it is said that his definition was similar to that of a Russian neurologist named Grunya Sukhareva, in 1926.)

Asperger’s account had many similarities to Kanner’s, but emphasised children with certain abilities, such as grammatical language which was average or above average. However, Asperger's work was not widely recognised until after his death - one of the possible reasons for this may have been that his work was published in German.

In the meantime, Kanner’s work had become dominant in the English speaking world and autism continued to remain within the realms of psychiatry. Throughout the 1970s, two more greatly influential researchers, Lorna Wing and Judith Gould were, together, further defining and researching the prevalence of autism, as it had been thus far defined by Kanner.

They were aware that some of their patients did not fit into the existing categories of that time, which were autism and schizophrenia. Their patients did not have any obvious intellectual disabilities or delusions, but still needed help due to depression, profound difficulties with obsessive thinking and social interaction.

After coming across Hans Asperger’s research and roughly translating it into English, Wing was impressed by his detailed, sympathetic descriptions of his patients and the similarities between his descriptions and those in her own studies. At that time, the word autism was heavily stigmatised, being associated with ‘muteness and total social withdrawal’. In 1981, Wing introduced the English-speaking world to the little-known work of Hans Asperger, and in doing so, challenged the accepted, yet narrow boundaries of the Kanner model of autism.

In 1991, Uta Frith produced her authoritative translation of Asperger’s work, and Wing presented an extremely influential article, proposing the term Asperger Syndrome. So influential in fact, that Asperger Syndrome was included in both the International Classification of Diseases, tenth edition (ICD-10) in 1993 and the DSM-4 in 1994.

Wing and Gould broadened the definition of autism to one of a spectrum disorder; and one which did not always entail intellectual disability. Importantly, they showed that autism could exist in all ages and abilities, and their research also challenged the view that autism was rare (since proved to be correct).

They introduced something called the ‘triad of impairments’ which at that time, included social interaction, communication and imagination. These, together with a repetitive stereotyped pattern of activities, first defined autism as a syndrome (a group of symptoms which together are characteristic of a specific disorder).

The use of the term ‘spectrum’ to describe autism continued throughout the 1990s. After the Human Genome Project was completed in 2003, many other studies continued to search for a gene that could be associated with each of the five autism conditions of that time. Hundreds of genes were found - too many to assign to just five conditions - so a more ‘all-inclusive’ diagnosis was developed, ranging from the so-called ‘mild’ end of a spectrum to the ‘severe’ end.  

In 2013, after several years of concern over a lack of consistency around how each type of autism was being diagnosed in different areas, and by different clinicians, the DSM-5 removed the term Asperger Syndrome. Instead, it introduced the diagnosis of autism spectrum disorder (ASD) which is also called autism spectrum condition (ASC) in some countries. This included the stricter criteria with which we are more familiar today. 

Rather than using the DSM-5, some countries preferred to use the ICD-10 for the assessment of autism. Although they weren’t fundamentally so different from each other, the most recent ICD-11 has moved autism diagnosis a little further into to the 21st century. It now gives autism spectrum disorder its very own dedicated section and gives clinicians a little more leeway to assess the person’s traits and see if they match up to the diagnostic criteria.  

Importantly, it introduces the much-needed distinction between autism with, and without intellectual disability, and is considered less culturally specific, allowing for more flexibility in different countries and cultures. For example, there is less emphasis on what games children might play, but rather how they follow or impose rules in those games. And finally, it also now acknowledges that adults and women may mask their autism traits.   

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Eureka!

Two other notable contributors to autism in the domain of psychiatry were Sula Wolff and Grunya Sukhareva. Sukhareva, a Soviet child psychiatrist, is considered to have written one of the earliest known detailed definitions of autism in 1925. Translated into German a year later, it shared many similar observations with both Kanner and Asperger. Sukhareve used the term ‘schizoid psychopathy, but she later replaced this with ‘autistic (pathological avoidant) psychopathy’.

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Like Asperger, Sukhareve’s work went largely unnoticed until Sula Wolff, a German born, British paediatric psychiatrist translated it from German to English in 1996. Wolff herself had spent many years studying children with average or higher ability, alongside difficulties with social interaction, and noticed that they did not fit into the existing ‘triad of impairments’. Sometimes they displayed ‘exceptional gifts’.

Wolff was very much aware that, although these children were considered to be more ‘independent’, they struggled at school and therefore needed recognition and support. Her definitions very much aligned with those of Asperger Syndrome in those children who were considered ‘high functioning’ at the time.