Overall, there was increasing dissatisfaction with the chaotic state of affairs that had prevailed with psychiatric diagnoses in earlier versions of the APA’s manual. 2019).ĭuring the 1970s, there were important developments in the area of psychiatric diagnosis in general and in autism in particular that contributed to the decision to include autism as an official diagnostic category. Additionally, as we discuss below, Kanner’s suggestion that autism was not associated with other medical conditions proved incorrect (Rutter and Thapar 2014 Yuen et al. Others interpreted Kanner’s findings as suggesting that autism might be the earliest form of that condition. Among the most important was that his use of the word autism immediately called to mind impaired self-centered thinking of the type noted by Bleuler as one of the characteristics of schizophrenia (Bleuler 1911). As we will discuss later, the relationship of problems in communication (more broadly defined than just problems in language) has been an important consideration over time, as has our understanding of the ‘insistence on sameness’ principle noted by Kanner in 1943.Īs much as we are grateful for his clinical insight, Kanner’s report also contained some potential false leads for early research. These include things like echolalia, pronoun reversal, and unusual prosody. He noted many of the features we still encounter in work with individuals with autism. In an important way, Asperger’s report started what has been a continued debate on the boundaries of autism, the “broader autism phenotype”, and issues of neurodiversity (Ingersoll and Wainer 2014 Silverman 2015). Unlike Kanner who emphasized the importance of autism as a developmental condition, Asperger described behaviors that more closely resembled a personality disorder and reported that fathers of his cases showed similar problems. While the independence of Kanner’s and Asperger’s observations are debated, with some historians suggesting that Kanner may have been aware of Asperger’s work prior to publishing his 1943 report (Silberman 2015), both men described different conceptualizations of autism that uniquely contributed to our understanding of the disorder today. 2012).Īlthough attracting considerably less attention at the time, Hans Asperger’s report (Asperger 1944) of boys who had marked social difficulties, unusual circumscribed interests, and good verbal skills was also monumental. Presumably, these feral children had either been abandoned or run away from their parents, the latter being a problem still noted by families of children with autism today (Anderson et al. Kanner’s report was, of course, groundbreaking, but it is also important to note that even earlier descriptions of children who likely had autism were made in the 1800s in a training school for the intellectually disabled (Donvan and Zucker 2016) and in the 1700s with some reports of feral children (Candland 1995). To Kanner, these movements appeared to be ways for the child to maintain sameness in his/her world. The latter term also included some of the unusual stereotyped movements he noted such as body rocking and hand flapping. He emphasized two essential features of the condition: (1) autism-or severe problems in social interaction and connectedness from the beginning of life, and (2) resistance to change/insistence on sameness. Kanner ( 1943) described 11 children, 8 boys and 3 girls, who presented with “inborn autistic disturbances of affective contact”.
Any discussion of the development of autism as a diagnostic concept inevitably starts with the work of Leo Kanner and his landmark observation in 1943 (Kanner 1943).