Last year marked the 70th anniversary of autism as a disorder and the spectrum of treatment throughout its history is almost as diverse as autistic individuals themselves. In 1943, Leo Kanner was the first psychiatrist to coin the term autism in his reports, labeling it “Early Infantile Autism” based on the typical onset age of 6 months to three years. As has been the case throughout its 70 years, autism is still difficult to define.
Kanner’s 1943 report described “eleven highly intelligent children who displayed a profound preference for being alone.” Kanner also remarked on the autistic individuals’ need for “sameness” in their environment. Before Kanner’s work in the 1940s, these same children would have been labeled emotionally schizophrenic, disturbed, or psychotic.
Hans Asperger’s work in Austria during the 1940s discovered symptoms that were similar to Kanner’s “autism” but his subjects were differentiated by better developed language skills and a solid grasp of highly technical knowledge. Asperger’s work was not truly recognized until the 1970s but he always believed that his “disorder” was different from Kanner’s. History proved him correct and Asperger’s Syndrome as added to diagnostic manuals in 1994.
The psychiatrists of the 1950s and 1960s continued to view autism as a form of childhood schizophrenia. This time frame also brought Bruno Bettelheim who blamed autism on emotionally cold mothering, characterizing it as an emotional disorder. Bettelheim coined the phrase “refrigerator mothers” and likened the experience of autistic children to that of prisoners in Nazi concentration camps, with the mothers in the role of Nazi guards. It should be noted that Bettelheim spent nearly a year in one of these camps during WWII. Bettelheim enjoyed a very public status with the mainstream media and wrote several widely publicized books, which helped perpetuate his theory of refrigerator mothers.
Autism was at last understood as a biological disorder in the 1970s and was thought to have roots in a child’s brain development. With this focus on the brain, electric shock therapy began to be used on people with autism. This change in perception opened the door for the creation of new testing inventories in the 1980s, using much more objective criteria than the ones of decades past. Still, between 1950 and 1980, only a minority of autistic children went to school. Eighty percent of these children were instead sent to group homes and other therapeutic environments.
The 1980s brought major changes to the field of autism. The 1975 mandate for “school as a right” slowly began to change the education system until an “inclusion system” was pioneered in the mid-1980s. Before this, special education was conducted in different classrooms, often on different campuses and the two populations rarely mixed. There were also forays into more holistic approaches – diet, sensory integration therapy, holding therapy and auditory retraining.
Autism professionals cheered in the 1980s when the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-3) was released and autism was clearly separated from childhood schizophrenia. In 1984, the revised DSM-3 (DSM-IIIR) released a checklist of criteria mental health professionals could use for diagnosing autism; community and education resources improved dramatically. In 1988, the movie Rain Man catapulted autism into the public eye and brought home four Academy Awards, including Best Picture.
The autism spectrum disorder was expanded in the 1990s to include Asperger’s syndrome. Individuals with Asperger’s are characterized by having difficulty understanding social cues. Just last year, the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was released where the vast number of autism subcategories were rolled under a single diagnosis of autism spectrum disorder (ASD). ASD’s two defining categories are ‘repetitive/restricted behavior’ and “impaired social communication.” The DSM-5 lists a second diagnosis called Social (Pragmatic) Communication Disorder (SCD). This secondary term is focused on social relationships, verbal and non-verbal communication and fills that grey area many call “autistic-like behavior.” There are mixed feelings on the SCD diagnosis – some feel it will lower the availability of needed services for autistic individuals and their families, others believe the differentiation is overdue and that the lower ratio of children diagnosed with ASD will be “more consistent with reality.”
Throughout the last three decades, the treatment that has consistently provided the best results is ABA Therapy, or Applied Behavioral Analysis. This is a multi-faceted approach that provides skills to the parents and the teachers, in addition to the autistic individuals themselves. ABA focuses on an autistic individual’s behaviors, rather than attempting to understand why the behavior occurred. Instead, it focuses on re-training unwanted behaviors with various methods of reinforcement. This model, used in conjunction with Individual Education Plans (IEPs) has allowed autism professionals, teachers and parents to focus together on reasoning skills as well as social and motor skills, and verbal behaviors.
Many books have been written about autism in its 70 Year history, but the current treatment of the subject matter ranges from poignant to funny. There are lists to be found on reading platforms like Goodreads. One of the most highly recommended is The Rosie Project by Graeme Simsion, a fictional account of dating and romance from the point of view of a man with Asperger’s. The Rosie Project has been described as engaging and “well worth the read for anyone who knows someone with Asperger’s or autism spectrum disorder.”
By Jenny Hansen