‘Discovery’ of Asperger’s Syndrome and Autism as a spectrum - 1981
Lorna Wing proposed the concept of the "autism spectrum." She emphasized that autism is a spectrum of disorders with a wide range of presentations, including different degrees of severity and a diverse set of characteristics. Her work has had a lasting impact on autism research, diagnosis, and support systems.
Dr. Lorna Wing (1928-2014) trained as a medical doctor specializing in psychiatry. She and her husband John Wing both specialized as psychiatrists. They had a daughter Susie in 1956. Susie was delayed in development and had a ‘detached, insular’ manner. Despite being specialists in psychiatry, it took them years to get a diagnosis of autism. Convinced of the need for more research in the space, Dr. Wing changed her focus to child psychiatry. Dr. Wing and her collaborator Dr. Judith Gold did pioneer work in the field of autism. They initiated Camberwell Case register to record all patients using psychiatric services in that area of London and relentlessly accumulated case data that formed the basis of the influential insight that autism formed a spectrum.
In 1981, she published a paper titled ‘Asperger syndrome: A clinical account’, popularizing the research of Hans Asperger. Asperger was an Austrian psychiatrist who, in 1940s, described a form of autism in a group of intelligent boys who were intensely interested in one or two subjects like dinosaurs or trains. They shared many of the usual problems associated with autism like the inability to make friends, repetitive behaviors, and distress at any change in routines.
Dr. Wing presented Asperger’s paper, along with her own research, as strong evidence for her larger argument that autism should be understood as a spectrum of disorders sharing common roots. At one end are some who, like Dr. Asperger’s patients, would go on to successful careers and untroubled lives, at the other end, may be patients like those studied by Dr. Kanner.
Who was Hans Asperger and how did his research not see the light of day till 1980s, while stigmatizing ideas of autism were around for about 40 years?
Hans Asperger – the other end – 1944
Hans Asperger (1906-1980), an Austrian pediatrician born in Vienna. He pursued medicine and received his medical degree in 1931 from the University of Vienna. He joined the University Children's Clinic in Vienna. His mentor and supervisor at the clinic for the most part was Franz Hamburger, a prominent Austrian pediatrician. Under Hamburger's guidance, Asperger had the opportunity to observe and work with a diverse range of pediatric cases.
Asperger's work on autism was influenced not only by his medical training but also by the clinical experiences and mentorship he received during his tenure at the University Children's Clinic. His colleagues had a unique way of treating children with special needs and they tried to adopt new ways of teaching and learning for those children. The collaboration between Asperger and Hamburger thus played a crucial role in shaping Asperger's understanding of child development and psychopathology, contributing to the pioneering observations that would later define his work on autism.
During his tenure at the Children's Clinic in Vienna, Asperger extensively studied over 200 children. These children displayed a range of symptoms, from prodigious abilities coupled with struggles in school to more severe disabilities that led to institutionalization. Despite the diversity, they all shared common features such as precocious talents, social awkwardness, and an intense focus on laws, rules, and schedules.
In 1944, Hans Asperger published a groundbreaking paper titled "Die 'Autistischen Psychopathen’ im Kindesalter" ("The 'Autistic Psychopaths' in Childhood"). This seminal work detailed his observations and conceptualization of a distinctive set of behaviors displayed by certain children, which are now recognized as falling within the autism spectrum.
Asperger adopted a holistic understanding, viewing autism as a variation in neurodevelopment rather than a disorder. Crucially, Asperger recognized that these symptoms existed on a continuum, affecting both children and adults. He also keenly noted that the symptoms were noticeable in children only when they were 2 years old or older. Additionally, his work acknowledged the lifelong implications of autism but also expressed optimism about individuals leading fulfilling lives with appropriate support.
When Asperger eventually shared his research with the world, he chose to highlight his higher-functioning patients. This decision was influenced by the era he lived in, marked by the Nazis' pursuit of purifying the land of the "feebleminded," leading to the euthanization of many institutionalized children. Consequently, Asperger unintentionally conveyed the impression that autism was a rare condition affecting young geniuses, rather than the more common syndrome he had identified. However, despite its significance, the paper did not gain widespread recognition initially, due to the language barrier and the second world war.
The mystery of Asperger – Kanner Connection
Psychiatrist George Frankl was working at the Vienna clinic much before Asperger joined there. Psychologist Anne Weiss was also a part of the staff at the clinic. Both published papers in 1934-35, which included descriptions of children who had same characteristics as autism. They were working closely with Asperger. Both were jews, and they escaped the Nazi regime in 1935-37. Asperger was named the head of the clinic in 1935.
Frankl and Weiss, who later married each other went to work with Leo Kanner in 1938. Kanner’s paper titled "Autistic Disturbances of Affective Contact" was published in August 1941. Asperger’s paper, which Lorna Wing translated in 1981, was first submitted as a postdoctoral thesis in 1942 and was published in 1944.
It is difficult to imagine Kanner was unaware of Asperger’s work, while definitive evidence is not available. One can only wonder what would have happened if they acknowledged each other’s work and collaborated.