Autism Spectrum Disorders

History of Autism

As a diagnostic term, autism was first coined in a 1948 medical case report of 11 children exhibiting what the author, the psychoanalyst Leo Kanner, characterized as “an extreme autistic aloneness.” Each of these children tended to shut out any social contact, treated people as objects, and exhibited “obsessive desires for the maintenance of sameness” in activities such as play and other childhood activities. Further analysis of these and other children described with “early infantile autism” by Kanner and his contemporary, Hans Asperger, also indicated delayed and deviant language/communicative behaviors that were often devoid of emotional resonance and characterized by echolalia, extreme literalness, and pronominal reversal (e.g., “you” in reference to self and “I” in reference to others). Some of these children also exhibited striking rote memory ability or other splinter skills (e.g., musical ability or calculating proficiency) that were far above levels expected given their other limitations. Kanner and others (B. A. Ruttenberg and B. Bettelheim) suggested that autism was at least partly psychogenetically based. Throughout the 1950s and 1960s, a psychoanalytic theory of autism was advocated, and even as late as the 1970s, autism was considered by some (e.g., the World Health Organization) to be a psychotic disorder. Ruttenberg hypothesized that autism was a disorder of emotional development that affected psychosexual stages, and Bettelheim, among others, hypothesized that parents of children with autism were often cold, obsessive, and unresponsive so the children never developed the ability to relate to others. The term refrigerator mother was used in relation to parents of autistic children in a seminal 1967 book on autism, The Empty Fortress. Since the mid-1960s, theory and research has demonstrated a greater causal role played by biological factors. In Bernard Rimland's 1965 book, Infantile Autism, the psychogenic model of autism was rejected and support was provided for a more biological model of causation. This model was supported and extended by a plethora of excellent research studies that discredited the previously accepted psychoanalytic theories of autism. These studies ended the psychogenic theories that placed significant blame on parenting. Presently, biological theories of autism include neurological, physiological, and genetic studies and explanations, and the research community conceptualizes autism as a neurodevelopmental condition. Jeffrey Baker suggests that over the past 30 years, four tenets have been empirically developed with regard to autism. First, research has proven conclusively that the causes of autism are primarily biological and no more attributable to parental behaviors than is cerebral palsy or Down syndrome. Second, autism is recognized as a spectrum of disorders hallmarked by impaired social interaction but joined with intellectual and language skills ranging from severely impaired to mildly impaired or higher functioning. Third, if autism is based on biological factors, its treatment must be primarily rehabilitative rather than curative. This has resulted in a wide range of interventions ranging from psychodynamic and biological to various forms of behavioral and educational approaches incorporating different conceptualizations of human [Page 45]learning (behavioral/operant vs. social/constructivist). Fourth, it has been determined, as with other developmental disorders, that early referral and intervention will result in the greatest positive outcome.

...