The History of Autism

 New England Journal of Medicine once featured a historical perspective by Jeffrey Baker 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. “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.”

Autism is not a new problem; it's actually been on the books for more than 70 years-and our thinking about the condition has changed dramatically during that time. 

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. 

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association (APA) and offers a common language and standard criteria for the classification of mental disorders. It is used for patient diagnosis and treatment, and is important for collecting and communicating accurate public health statistics. The Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV is the standard classification of mental disorders used by mental health professionals in the United States. The DSM is now in its fifth edition, DSM-5, published on May 18, 2013.

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:

1908: The word autism is used to describe a subset of schizophrenic patients who were especially withdrawn and self-absorbed.

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’s 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.

If you want to get a further glimpse of the history of autism, you can also refer to the book In a Different Key: The Story of Autism. In this book, the author portrays an extraordinary narrative history of autism: the riveting story of parents fighting for their children ’s civil rights; of doctors struggling to define autism; of ingenuity, self-advocacy, and profound social change.

(Source: https://www.autismspeaks.org/science/science-news/autism-70-%E2%80%93-kanner-dsm-5;

https://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders)

Social Issues

Issues with Autism

One of the hallmarks of autism is a lack of interest in or connection with other people. Although other senses, like hearing or touch, may also be impacted by autism, it is the “social sense” — our intuitive understanding of how to read, reach out to, and successfully interact with other human beings — that is most intensely affected.

An infant seems uninterested in making eye contact, never smiles, or can’t bear to be held. A toddler rocks in a corner, watching his own fingers flick before his face in seeming fascination, oblivious to a parent’s attempts to engage him. A child wanders the playground in circles before stopping to stare at the pattern of veins in a fallen leaf, uninterested in the other kids and unable to engage in the recess activities going on around him.

Sensory Issues

We know that individuals with ASDs struggle to navigate the social world with an impaired “social sense.” The way the world is experienced through other senses is also often off kilter. 

Some individuals with an ASD can be hypersensitive, that is over-sensitive, to stimuli  such as sound or touch. For example, a child with an ASD might hold his hands over his ears and crawl under a table in a noisy, crowded room, or panic at another person’s attempt to put their arm around him. 

Other individuals appear to be hyposensitive, that is under-sensitive, to sensory information coming at them from the environment. For instance, a child may act so unmoved by someone’s voice that she appears deaf even although her hearing is perfectly intact.

This issue surrounding pressure shows that more than the usual five senses — sight, hearing, smell, taste, and touch — are involved. Two additional senses which are often discussed are the proprioceptive sense (which involves knowing what your muscles and joints are doing and where you are in space) and the vestibular sense (which is related to the inner-ear and involves your awareness of movement, head position, and balance). “Some individuals,” writes one expert, “seek proprioceptive input by crawling under furniture or into small, cramped spaces, or seek vestibular input by spinning, swinging, or bouncing repetitively.” 

Sleep Issues

Many individuals with an ASD have difficulty achieving normal sleep patterns. Whether they have trouble getting to sleep, wake numerous times during the night, or awaken very early and stay awake the rest of the day, sufficient sleep is definitely lacking. REM sleep patterns have been shown to be disturbed, and some individuals on the spectrum may even be suffering from an actual sleep disorder.

This can be a problem for the person with an ASD, as they have plenty to handle already without adding sleep deprivation to the list. Clearly, their unusual sleep pattern may also be a problem for family members whose own rest is disrupted. This is particularly true of parents of young children. Coping with their child with an ASD may be nearly impossible if parents are not only stressed, but constantly suffering from broken sleep.

Behavioral issues

 This is one of the most challenging aspects of autism. A child diagnosed with an autistic spectrum disorder exhibits a range of symptoms which vary according to where they are placed on that spectrum. But whether they are at the 'mild' end or the 'severe' end the fact remains that anyone with this condition displays the same symptoms but at differing levels. 

Autistic children will display a variety of behavior which can be attributed to their confusion and difficulty in dealing with the world around them. They find social interaction daunting and cannot always communicate with other people or understand what the other person is saying (and thinking). They may become frustrated when trying to communicate with you or has a particular need which you are unable to decipher. They may be uncomfortable with being close to other people or being touched or hugged.

Mixing with other children is another source of discomfort. Autistic children do not pick up on social cues or understand the rules of social interaction which include taking turns in conversation or asking someone their opinion about something. They often have strong views about something and does not realize that someone else will have a different opinion. They often talk over someone else and at length about something which interests them without realizing that they are boring the other person. 

They may find different sensory inputs such as a particular noise, taste, smell or texture distressing or unpleasant to deal with. Their ability to process this information is heightened — they are often hypersensitive to this — which causes them to react in various ways. These include waving their hands around, banging their head against a surface, spinning around in a circle or screaming. They may even run away from the source of their distress. 

A child with autism prefers a strict routine in which they know exactly what is going to happen and when. They prefer to do the same things each day and cannot always deal with a change to their routine. They find the concept of ’free time’ such as the lunchtime interval at school an alien concept. 

They are poor at processing information in a linear fashion or understand that  actions occur in a sequential way, e.g. A then B followed by C and so on. The concept of time and how we use this to structure our days is another strange concept to an autistic child.

(Sources: https://iancommunity.org/cs/challenging_behavior/social_issues；

https://iancommunity.org/cs/challenging_behavior/sensory_issues；

https://iancommunity.org/cs/challenging_behavior/sleep_issues；

http://www.medic8.com/mental-health/autism/behavioural-issues.html）

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