The Evolution of Autism – Part I: Introduction to the Diagnosis

“In October 1938, a 5-year-old boy was brought to my clinic from Forest, Mississippi. I was struck by the uniqueness of the peculiarities which Donald exhibited. He could, since the age of 2 ½ years, tell the names of all presidents and vice-presidents, recite the letters of the alphabet forwards and backwards, and flawlessly, with good enunciation, rattle off the Twenty-Third Psalm. Yet he was unable to carry on an ordinary conversation. He was out of contact with people, while he could handle objects skillfully. His memory was phenomenal. The few times when he addressed someone-largely to satisfy his wants-he referred to himself as “You” and to the person addressed as “I”. He did not respond to any intelligence tests but manipulated intricate formboards adroitly.” – Kanner, 1973

Donald would become one out of eleven children to be observed at the Child Study Home for exhibiting a condition that differed severely from any other diagnosis known at that time. All eleven children displayed a combination of extreme aloneness from the beginning of life and an anxiously obsessive desire for the preservation of sameness; having been described by their parents as “living in a world of their own”. They were little routine addicts, living in a world in which nobody other than themselves were allowed to make changes so far as their daily lives were concerned.

Leo Kanner, a member of the board of directors for the Child Study Home, recorded these observations in a paper titled Artistic Disturbances of Affective Contact. While we can tell that these children were on the spectrum, back then they were believed to have childhood schizophrenia. During this time, schizophrenia was seen mainly as an act of will by which one freely surrenders themselves to a fantasy – a withdrawal from reality. Kanner didn’t believe this applied to the children he was observing because he felt as though withdrawal implied a removal of oneself from previous participation. Since these children are displaying these symptoms as infants (hence no previous participation), he believed “the children have come into the world with an innate inability to form the usual, biologically provided affective contact with people, just as other children come into the world with innate physical and intellectual handicaps… for here we seem to have examples of inborn autistic disturbances of affective contact.” The term autistic was coined by Eugen Bleuler in connection with his work on schizophrenia in 1911. The Greek word “autos” meant self and the word “autism” was used by Bleuer to mean morbid self-admiration and withdrawal within self.

While observing these children from 1938 to 1943, Kanner also observed their parents. Throughout this article, his assumptions about parental causation become evident as he provided very negative descriptions of the parents. He described mothers’ obsessive preoccupation with details and interpretations of their child’s performances; fathers overworking and barely knowing their children, and even attributed the diagnosis’ symptom of memorizing and reciting facts as an illustration of the parents’ obsessiveness.

In 1949, Kanner wrote Problems of Nosology and Psychodynamics of Early Infantile Autism as a follow-up to his original piece. By this time, he had seen more than fifty children with the same ailments. He expanded the characteristic features of autism to include a “profound withdrawal from contact with people, an obsessive desire for the preservation of sameness, a skillful and even affectionate relation to objects, the retention of an intelligent and pensive facial expression, and either mutism or the kind of language which does not seem intended to serve the purpose of interpersonal communication”.  He describes, in more detail, how early infantile autism differs from schizophrenia due to age of onset (with schizophrenia appearing much later in life, in comparison to autism being seen within the first two years of life).

Additionally, he elaborated on his observations on the parents. He described mothers as being mechanic, fathers as being bigamists (stating that their second marriage is their job and that their job had priority) and that the parents were unable to derive enjoyment from the children as they are. He further stated that after delving into the “personalities, attitudes and behavior of the parents, that most of the patients were exposed from the beginning to parental coldness, obsessiveness, and mechanical type of attention to material needs only. They were the objects of observation and experiment conducted with an eye fractional performance rather than with genuine warmth and enjoyment. They were kept neatly in refrigerators which did not defrost. Their withdrawal seems to be an act of turning away from such a situation to seek comfort in solitude”.

The above passage led to decades of blame and guilt being placed directly onto mothers. One doctor in particular really pushed this theory thus introducing the world to the concept of the ‘Refrigerator Mom’. To be continued in part II.

Sources:

• Leo Kanner, 1963. (Credit: JHU Sheridan Libraries/Gado/Getty Images)
• Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, 217-250.
• Kanner, L. Problems of Nosology and Psychodynamic of Early Infantile Autism. American Journal of Orthopsychiarty, Vol 19(3), Jul 1949, 416-426.
• Kanner, L. The Birth of Early Infantile Autism. Journal of Autism and Childhood Schizophrenia, 1973, 3, 2, 93-95.