Controversy Regarding Asperger’s Syndrome

A year after Leo Kanner published his findings on autism, Austrian physician Hans Asperger described “a particularly interesting and highly recognizable type of child” in his 1944 article ‘Autistic Psychopathy’ in Childhood. Like Kanner, he presented case studies describing the following four children’s clinical characteristics and commonalities.

Fritz V.

‘A highly unusual boy who showed severe impairment in social integration’, referred by his school because he was considered unteachable. Asperger described how Fritz’s had a normal birth but he showed delay in reaching motor milestones and explained how Fritz developed language at the early age of 10 months but was unable to walk until the age of 14 months [compared to most babies who take their first steps between 9 and 12 months]. He further discussed Fritz’s inability to integrate himself into a group of playing children, and the strange occurrence of certain stereotypic movements and habits (such as suddenly beating rhythmically on his thighs, banging loudly on the table, jumping around the room and hitting walls) – hinting at Fritz’s seemingly ‘destructive urge.’ He also noted Fritz’s interest in numbers and his mastery of calculations without having any formal teaching.

Harro L.

Harro was in his third year at school but was repeating the second year due to his failing in all subjects. He was referred by his teacher for being unmanageable, but who believed he could do well in school ‘if he only wanted to.’ Asperger explained the teacher’s belief regarding Harro’s intellect was based on his surprising mature, clever remarks, and his repeated statements of “this was far too stupid for me” when confronted about his inattention during instruction. Additionally, Harro would leave his desk during lessons and crawl on the floor on all fours and had a ‘savage tendency to fight’. Asperger sourced Harro’s tendency to fight as a reaction to teasing he received from other children, pointing out Harro’s lack of a sense of humor, especially when the joke was on him. Asperger noted his early independence in certain activities, including taking the 25 km train ride to school alone at 8 years old; and his rigid facial expressions.

Ernst K.

A seven-and-a-half-year-old boy who was referred by his school because of severe conduct and learning problems. Ernst had delayed speech, and had not spoken his first words until the age of  1½ years. Ernst also had a stammering problem for quite some time; but by the time Asperger saw him, his speech was exceptionally good and he spoke ‘like an adult.’  Ernst’s mother described Ernst as being unable to cope with the ordinary demands of everyday life, illustrating this by the necessity of her having to dress him and his learning how to feed himself recently. He was never able to get along with other children, both due to being teased and his behaviors of tickling, pinching or stabbing other children with his pen. He liked to tell fantastical stories and had a strong tendency to argue with everyone, including with his teacher regarding how to hold his pen. Asperger noted instances of  ‘peculiar signs of autistic intelligence’.

Hellmuth L.

To Asperger, it became evident that Hellmuth’s autism was due to a birth injury – having had asphyxia at birth, needing to be resuscitated at length, and multiple convulsions within a few days after his birth. Due to this, his development was delayed; as Hellmuth was not able to walk or talk until the end of his second year. However, he learned to speak relatively quickly and as a toddler was described as talking ‘like a grown-up.’ He often used unusual words, almost speaking in verse and sounding poetic; which his mother attributed to his interest in poetry. Additionally, he was an excellent speller. He had a big build and was labeled as often seeming to be in another world (illustrated by Asperger’s claim of Hellmuth being seen standing ‘in the midst of a group of playing children like a frozen giant’). Asperger also mentions that Hellmuth had very particular rituals, such as being especially concerned with his clothes, his frequent hand washing and his observations of his body and its functions.

Most interesting is that in all four case studies, Asperger noted a level of clumsiness within each child’s movements, a lack of eye contact and a deficit in the use of language  – observations missing from Kanner’s descriptions of autism. He also made notice of ‘autistic intelligence,’ referring to austitic children’s ability to see things and events from a new point of view, which often showed surpising maturity. To elaborate on this, he refers back to Harro and Fritz’s examples of a mixture of personally remembered experiences and factual knowledge found within their answers to basic questions [such example includes Harro’s answer to the difference between stairs and ladders, “Stairs are made out of stone. One doesn’t call them rungs, they are called steps, because they are much bigger, and on the ladder they are thinner and smaller and round. It is much more comfortable on the stairs than on a ladder.”]. The article concluded with a note about the ‘social value’ of individuals with autism and a call for respectful, appropriate education for autistic children and all ‘complicated individuals.’ Additionally, Asperger attributed the autistic personality as an extreme variant of male intelligence.

Asperger’s work did not get the acclaim it deserved until autism researcher, Lorna Wing, publicized it, utilizing his descriptions and findings to form a new diagnosis. In his honor, for being the first to document these variations of autistic symptoms, Wing named the disorder after Asperger.

Recently there’s been controversy regarding the naming of the disorder.

In the last few years, Asperger’s involvement in the racial hygiene measure by the Third Reich during the Holocaust, has come into the spotlight. In historian Edith Sheffer’s book, Asperger’s Children: The Origins of Autism in Nazi Vienna, Sheffer details that while Asperger was not a member of the Nazi party, he played a critical in role in identifying children with disabilities and sending dozens to Am Spiegelgrund – a children’s clinic where 789 patients were killed, in order to establish a ‘pure’ society by eliminating those deemed a ‘burden’.

Before this knowledge became popular, Asperger was known for defending kids with disabilities and supposedly emphasized their special talents in technical subjects in order to rescue them from the child euthanasia program. Asperger cultivated this image during the postwar period, telling people he’d risked his life in order to rescue children for career advancement. But according to historical documents, Asperger sent profoundly disabled children, who were under his care, to their deaths at the clinic.

With this new information, his descriptions of the four children, who were the subjects of his case studies, speaks volumes about his career as it becomes known that he frequently visited the clinic, in order to evaluate the children there. His 1944 article is based on these observations, suggesting that he chose (and saved) these children because of their intellectual ability (ie. Fritz’s inclination to numbers, Harro’s unusal degree of introspection, Ernst’s precise ways of doing things, and Hellmuth’s excellence in spelling).

The recent findings have prompted much debate in the autism community, regarding whether the name of the disorder should be changed. Some researchers believe those with the syndrome should not in any way feel tainted by the troubling history behind it, while parents do not want their children to be associated with a condition named after someone who sent children to their deaths. Others believe this topic to be moot, as the DSM-IV combined Asperger’s with Autism in the diagnosis of ‘Autism Spectrum Disorder’.

WHAT DO YOU THINK?

Sources:

• Asperger, Hans. “‘Autistic Psychopathy’ in Childhood”. Autism and Asperger Syndrome, edited by Uta Frith (Cambridge: Cambridge University Press, 1991), 37-92. Originally published as “Die ‘Autistischen Psychopathen’ im Kindesalter,” Archiv fur Psychiatrie and Nervenkrankenheitein 117 (1944):76-136.
• Herman, Ellen.  ‘Hans Asperger, “‘Autistic Psychopathy’ in Childhood,” 1944′. The Autism History Project. 2019
• Reese, Hope. The disturbing history of Dr. Asperger and the movement to reframe the syndrome. Vox. 2018
• Silberman, Steve. Was Dr. Asperger a Nazi? The Question Still Haunts Autism. npr. 2016.
• Yeginsu, Ceylan. Hans Asperger Aided Nazi Child Euthanasia, Study Says. The New York Times. 2018.