1836 -1917

	Labelling Autism Leo Kanner published his first paper identifying autistic children in 1943. A year later in 1944 Hans Asperger wrote entirely independently about autism. Whilst Kanner explained that he had witnessed children with this disorder since 1938, this begs the question as to whether autism was recognised before this time, even if the terminology had not yet been given.
It has been presumed that before the discovery of the pattern of symptoms now known as autism, that people did exist with the syndrome, and were lumped together either with the mentally retarded or the insane. However, although one might expect to have inherited sufficiently-detailed descriptions of such people that would provide a pattern suggesting autism among them, there have not been many descriptions that suggest autism. One such description is of a boy found in the 19th century and named Victor. At the time, some assumed he had grown up without human contact in the forest. The story was recorded in the book The Wild Boy of Aveyron.
	It was only with the publication of the two independent papers by Kanner and Asperger within a year of each other, that autism really began to be recognised as a complex disorder different from other forms of mental disorders such as schizophrenia. Both papers contained detailed case descriptions and offered the first theoretical attempts to explain the disorder. Both authorities believed that there was present from birth a fundamental disturbance which gave rise to highly characteristic problems.
	Interestingly both Kanner and Asperger used the term 'autistic' in order to characterize the nature of the underlying disturbance. However they were not the first to use this label the term 'autism' had already been introduced by the eminent psychiatrist Eugen Bleuler in 1911.
It is the usage of the term that differs. It originally referred to a basic disturbance in schizophrenia (another term coined by Bleuler), namely the narrowing of relationships to people and to the outside world, a narrowing so extreme that it seemed to exclude everything except the person's own self. This narrowing could be described as a withdrawal from the fabric of social life into the self. Some writers describe Bleuler's understanding of the term as escape from reality but generally it is understood as terms of withdrawing into the self, or in modern terms, into one's on world. Hence the words 'autistic' and 'autism', from the Greek word autos meaning 'self'. Today the term 'autistic' is rarely used in any context other than as a description of the disorder first identified by Kanner. Both Kanner, working in Baltimore, and Asperger, working in Vienna, saw cases of strange children who have in common some fascinating features. Above all the children seemed to be unable to entertain normal affective relationships with people. In contrast to Bleuler's schizophrenia the disturbance appeared to have been there from the beginning. While Kanner's paper has become the most quoted in the whole literature on Autism, Asperger's paper, written in German, and published during the Second World War, was largely ignored. The belief has grown that Asperger described quite a different type of child, not to be confused with the one Kanner described. This has led to a long debate that still has not been entirely resolved. Some believed Kanner and Asperger to be writing about the same condition with Asperger focussing on those children who were autistic but were high functioning. Others claim a difference between autism where children have severe language impairment, as opposed to Asperger's syndrome where children have normal language development but difficulty with motor skills. Some say as they grow adults with aspergers syndrome are aware of their difficulties and can become increasingly depressed. Other determining factors are said to be the age of diagnosis. Since children with classic autism according to Kanner's explanation have severe language difficulties they can be diagnosed very early before school. With aspergers normal language development makes it difficult to see the extent of the child's problems which are only identified later. Nowadays, the label 'Asperger's syndrome' tends to be reserved for the rare intelligent and highly verbal, near-normal autistic child. This is unlikely to be what Asperger intended. Nowadays it is understood whether one opts for two different disorders or one, that autism exists along a continuum with different levels of functioning. Autism is also defined as involving a triad of impairments: Social impairment; Verbal and non-verbal language impairment; Repetitive/stereotyped activities The fundamental work relating to the triad of impairments was carried out by was done by Lorna Wing and Judith Gould in 1979. They carried out an epidemiological survey of all children living in an area of South London called Camberwell. From the total population of children under 15 (35,000) all children known to the social, educational and health services (914) were screened. Children were selected from the group if they had severe learning difficulties, and/or if they showed one of the following: Social impairment; Verbal and non-verbal language impairment; Repetitive/stereotyped activities The screening resulted in a group of 132 children whom attended special schools, and who ranged from 2 to 18 years. The children were observed and given medical and psychological tests and their carers interviewed using a schedule devised by the researchers. The group was divided on the basis of social behaviour into 58 children with appropriate social interaction and 74 socially impaired subjects. The groups did not differ in age but more males were seen in the socially impaired group. Further analysis led the researchers to conclude: 'All the children with social impairments had repetitive stereotyped behaviour and almost all had absence or abnormalities of language and symbolic activities. Thus the study showed a marked tendency for these problems to occur together'. However, theories and treatments for autistic difficulties develop all the time. New theories are given daily as to the cause of autism; educational programmes are developing all the time. Some even claim to cure the condition. What we do know is that although Kanner coined the phrase 'infantile autism', it is not a condition that is outgrown, it is a lifetime disability. Yet, the interest in this condition, both helped and hindered by films such as 'Rain Man' had meant that the outlook for children with this diagnosis is a lot more promising. In the timeline below are some of the major dates relating to the understanding of the condition. It is neither exhaustive or yet complete. Autism Timeline 1911 – The Swiss psychiatrist Eugene Bleuler first uses the term autistic in describing some of his patients. Autistic and Autism comes form the Greek word 'autos' meaning 'self.' 1943 – Leo Kanner publishes a paper where describes a new disorder, autism, citing cases of eleven children. He identifies two key traits of the disorder, the most important being a sense of emotional isolation. He states that these children entered the world in a state like other children with mental and physical disabilities. 1938-9 – Bruno Bettelheim is interned in concentration camps by the Nazis, first in Dachau then in Buchenwald. This experience came to play a crucial role in his theories of Autism. 1944 – Hans Asperger publishes a paper describing four children with many of the same symptoms as described by Kanner. He also calls it Autism. 1949 – Kanner writes a new paper in which he identifies a 'maternal lack of genuine warmth' in autism cases. He states that autistic children 'were kept neatly in refrigerators which did not defrost. Their withdrawal seems to be an act of turning away from such a situation to seek comfort in solitude.' This is the birth of the idea of 'refrigerator mothers and undemonstrative fathers' which became the precedent for understanding Autism. 1951 – British psychoanalyst John Bowlby publishes Maternal Care and Mental Health, which sends the message that 'children of inadequate mothers are emotional disasters.' 1950's – Bruno Bettelheim, an Austrian born psychologist who is head of the Orthogenic School for emotionally disturbed children at the University of Chicago, publishes articles on autism. He writes for a wider audience than Kanner, focusing on how lack of parental love and acceptance caused Autism. His has a bigger presence in the media and popular culture than that of Kanner, which helps to disseminate the 'Refrigerator Mother' theory throughout the American mindset. 1940's – 1960's – General themes of 'Blaming the Parent' persisted in Psychiatry This general idea is based on the Freudian notion that emotional disturbances stem from early childhood experiences, not from organic factors. J. Louise Despert and Leon Eisenberg blame 'emotionally detached' parents who have pushed their children too far in rote memorization skills of obscure knowledge for causing Autism. Due to the fact that children look normal, autism is thought of as an emotional problem caused by the parents. Savant talents indicate that these are bright children, but that inept parenting has caused behavioral abnormalities. 1960 – A Time Magazine profile on Kanner quotes him as describing mothers of autistic children as 'just happening to defrost enough to produce a child.' 1964 – Dr. Bernard Rimland publishes a book called Infantile Autism: the Syndrome and its I mplications for a Neural Theory of Behavior that describes the clinical features of Autism in detail and also provides the first evidence that Autism is a biological disorder. His theories are not as well popularized as Bethlehem's, so therefore he has less of an impact on the public understanding of Autism and the 'Refrigerator Mother.' 1967 – Bettelheim publishes The Empty Fortress: Infantile Autism and the Birth of the Self in which he likens the relationship of autistic children and their parents to prisoners in concentration camps and SS guards. 'The difference between the plight of prisoners in a concentration camp and the conditions which lead to autism and schizophrenia in children is, of course, that the child has never had a previous chance to develop much of a personality.' Refrigerator mothers are worse than SS guards. 1969 – The Autism Society of America is founded by parents of autistic children who work as volunteers to develop an organization that will serve to find, amalgamate and advertise information about Autism. Parents feel guilty. One mother, Annabel Stehli, says, 'I was willing to take on the blame and the responsibility for having caused it, if that meant I could cure it.' 1973 – Nobel Prize winner Nikolaas Tinbergen, in his acceptance speech states that autism 'can often be traced back to something in the early environment…most often something in the behavior of the parents, in particular the mothers.' He goes on to say that mothers are not to blame directly and they should be taught how to be maternal. 'They may be as much in need of help as the autists themselves.' 1977 – A twin study by Drs. Susan Folstein and Michael Rutter reveals a genetic basis for autism for the first time. 1980 – Autism is added to the DSM. 1990 – Bruno Bettelheim commits suicide. 1994 – Karen and Eric London found the National Alliance for Autism Research with the help of other parents with autistic children. It is the first national nonprofit organization to fund and perform research on autism. Late 1990's – Many reports providing evidence that localizes Autism to specific chromosomes are published. 1997 – Richard Pollack publishes a biography about Bettelheim called The Creation of Dr. B. He reveals that Bettelheim hyped the 'Refrigerator Mother' theory without sufficient evidence. 2002 – The movie Refrigerator Mothers airs on PBS. Web Links: Austism Timeline Autism FAQ National Autistic Society Asperger's Syndrome

Autism