Autism Spectrum Disorders

Abstract

The word autism , from the Greek autos , was coined by the Swiss psychiatrist Eugen Bleuler in his 1911 description of patients with schizophrenia (Asperger 1944/1991). However, its application as we understand it today was first written in parallel descriptions by the Viennese-American child psychiatrist Leo Kanner (1943) in “Autistic Disturbances of Affective Contact” and by the Viennese pediatrician Hans Asperger (1944/1991) in “‘Autistic Psychopathy’ in Childhood.” Kanner (1943) wrote, “There is from the start an extreme autistic aloneness that, whenever possible, disregards, ignores, shuts out anything that comes to the child from the outside” (p. 242). Despite being separate publications, the similarities between the observations of Kanner and Asperger are striking and may be connected by Georg Frankl, the chief diagnostician in Asperger’s clinic, who went to Johns Hopkins Hospital to work with Kanner in 1938 (Silberman 2015). Unlike Kanner’s astute and compassionate descriptions of children, Asperger’s writing has fallen out of favor because of his disparaging characterizations of his patients and his participation in Nazi programs, including euthanasia of children with disabilities (Czech 2018). Initial theories of autism were largely psychological, and it took some time before autism was connected to biological risk factors. Kanner and Asperger described their patients as having similar personalities to their parents but did not always elaborate on this point in relation to genetic risk. Although he did not use the term refrigerator mother , some of Kanner’s writing described a maternal attitude focused on material needs rather than affect. The false and powerfully derogatory attribution of autism’s origins to a cold parenting style was advanced most vocally by Bruno Bettelheim. An art historian by training, Bettelheim gained a substantial psychodynamic following with his claim that emotional neglect caused autism. He advocated for a “parentectomy,” which led to many children being institutionalized. The theory prevailed until the 1960s and 1970s, when an understanding of the role of biology and genetics in autism began to emerge. In 1980, with the publication of DSM-III (American Psychiatric Association 1980), autism became a codified diagnosis. The diagnosis has been refined in subsequent DSM editions; DSM-5 (American Psychiatric Association 2013) removed the diagnostic labels of pervasive developmental disorder and Asperger’s disorder and describes the condition as autism spectrum disorder (ASD), with presentations varying along a continuum. The neurodiversity movement advocates that ASD is not a disorder but a natural variation of being (Donvan and Zucker 2016). In this chapter, we respect this perspective while recognizing the needs of impaired individuals with ASD who require assessment and services.

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