This week’s New England Journal of Medicine features a historical perspective on autism, marking the 70th anniversary of psychiatrist Leo Kanner’s 1943 description of the disorder.
“This year's revision of the diagnostic criteria for autism is among the most contentious of any," writes author and Duke University pediatrician and medical historian Jeffrey Baker. “[Yet] it reflects one of the central themes in the history of autism: a debate over where to set its boundaries. “
Dr. Kanner didn’t so much define autism as portray it, Dr. Baker notes. The 1943 paper described 11 children who shared high intelligence, a profound preference for being alone and an “obsessive insistence on the preservation of sameness.”
Through the 1960s, psychiatrists continued to view autism as a form of “childhood schizophrenia.” Also popular through the 1960s was the now-debunked idea that autism resulted from emotionally distant mothering (the “refrigerator mom” theory of autism).
The 1970s brought understanding that autism stemmed from biological differences in brain development. Objective criteria for diagnosing autism followed in the 1980s. So did a clear separation from childhood schizophrenia.
“Until the present, subsequent DSM editions have generally moved in the direction of greater diagnostic flexibility and expansion,” Dr. Baker writes. In 1994, for example, the DSM-IV added Asperger syndrome to the autism spectrum.
While the expanding definition provided greater access to services, it created difficulties in determining what kinds of therapy (and how much) are needed, Dr. Baker notes. “The DSM-5 criteria will not solve these problems,” he writes. “But they do represent a move toward a more rigorous definition of autism.”
“Rather than argue over the true definition of autism,” he concludes, “it may be more helpful to ask what definition is appropriate for the task at hand.”
History of Autism at a Glance:
1943 Leo Kanner publishes “Autistic Disturbance of Affective Contact”
describing 11 socially isolated children who share an obsessive desire
for sameness.
1950s-1960s Autism widely regarded as a form of “childhood
schizophrenia.” Psychoanalysts blame emotionally cold mothering.
1970s Autism understood as a biological disorder of brain development.
1980 DSM-III distinguishes autism from childhood schizophrenia.
1987 DSM-IIIR lays out a checklist of criteria for diagnosing autism.
1994-2000 DSM-IV and DSM-IV-TR expand definition of autism
and include Asperger syndrome.
2013 DSM-5 folds all subcategories into one umbrella diagnosis
of autism spectrum disorder (ASD). It is defined by two categories:
impaired social communication and/or interaction and restricted
and/or repetitive behaviors.
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