Autism – Initial definition and refrigerator mother hypothesis
Kanner's perspective on autism, as an infrequent and narrowly defined condition, influenced perceptions for years, contributing to precise diagnosis but potentially hindering a broader understanding of the spectrum.
Our understanding of autism has undergone significant evolution, shaped by both early observations and subsequent scientific advancements. Initially, the term "autism" was coined by Swiss psychiatrist Eugen Bleuler in 1908, describing symptoms observed in schizophrenia as a withdrawal into an inner world or self-absorption. Leo Kanner, born in Austria in 1894, later became a key figure in defining and shaping the early understanding of autism.
Leo Kanner – Psychogenic theories - 1941
Leo Kanner, who earned his MD degree in Berlin, moved to the United States, and embarked on a career in psychiatry. His influential work began in 1928 when he underwent psychiatric training and eventually joined John Hopkins University Hospital. Kanner's contributions included establishing a child psychiatric unit, transforming the doctor-patient relationship perspective. In 1935, he authored "Child Psychiatry," the first English-language textbook on the subject. During this time, he helped clinicians Anne Weiss and George Frankl to escape the Nazi regime in Germany. Frankl later joined Kanner at John Hopkins University.
In 1941, Kanner presented a paper titled "Autistic Disturbances with Affective Contact," which was eventually published in 1943. This seminal work outlined observations of 11 children with common signs, including social isolation, a desire for sameness, routine obsession, delayed echolalia, and splinter memory skills. Kanner's perspective on autism, as an infrequent and narrowly defined condition, influenced perceptions for years, contributing to precise diagnosis but potentially hindering a broader understanding of the spectrum.
Kanner proposed the concept of emotionally neglectful mothers (refrigerator mothers) in his observations of parents of children with autism. He suggested that cold and neglectful mothers might contribute to the development of autism in their children.
Bernard Rimland – Autism as a neurological condition - 1964
It wasn't until Bernard Rimland challenged this hypothesis in 1964, advocating for a more biological and neurological understanding of autism in his book "Infantile Autism: The Syndrome and Its Implications for a Neural Theory of Behavior," that a shift occurred in the scientific community's perspective. Rimland's work played a significant role in steering away from psychogenic theories and toward a more comprehensive understanding of autism as a neurological condition.
Behavioral Approaches – Foundations of ABA
Grounded in empirical research, ABA is a data driven method relying on collection and analysis of objective data to analyze the effectiveness of behavior interventions. It has evolved into one of the evidence-based approaches to working with autism.
As psychogenic theories were shifting with Bernard Rimland advocating for a more biological understanding, Dr. Ivar Lovaas played a pivotal role in developing Applied Behavior Analysis (ABA). Lovaas utilized behavior modification techniques to address language and communication challenges in young children with autism, employing principles of operant conditioning and reinforcement to encourage desired language behaviors.
Ivar Lovaas – Applied Behavior Analysis - 1965
In 1965, Lovaas published a groundbreaking study, "A Stereotypic Language in Young Children," focusing on behavior modification techniques for language deficits in children with autism. Emphasizing individualized treatment plans, he recognized the diversity of autism and stressed tailored interventions based on each child's specific needs. Lovaas highlighted the importance of early intervention, acknowledging that addressing language deficits during early development could positively impact overall communication abilities in children with autism.
His study employed a data-driven approach, prioritizing the collection and analysis of objective data to evaluate the effectiveness of behavioral interventions. This commitment to empirical research became foundational to the scientific approach characteristic of Applied Behavior Analysis (ABA), which Lovaas and his colleagues further developed in the 1980s.
While the 1965 study focused on language development, it set the stage for Lovaas's comprehensive approach to autism treatment. Continuing his research and developing the Lovaas Method in the 1980s, he contributed to establishing ABA as a prominent, evidence-based intervention for individuals with autism.
ABA involves breaking down complex behaviors into smaller components and using reinforcement strategies to encourage desired behaviors while discouraging undesirable ones. The Lovaas Method features intensive one-on-one behavioral therapy, often exceeding 40 hours per week, with a focus on structured learning, positive reinforcement, and individualized goals. Grounded in empirical research, Lovaas's work, including the 1987 study "Behavioral treatment and normal educational and intellectual functioning in young autistic children," played a crucial role in establishing ABA as a leading intervention for autism.
Study of autism in twins – Investigating genetic origins - 1977
The study's significance lies in shifting the perception of autism from an environmentally caused disorder to one of the most heritable psychiatric disorders.
A few years down the line, despite Bernard Rimland's efforts to challenge the refrigerator mother theory, the concept resurfaced in 1967, perpetuated by Bruno Bettelheim, a psychoanalyst who echoed and popularized the theory in his book titled "The Empty Fortress."
A significant turning point came with the first-ever study of twins and autism in the history of autism research, providing an alternative perspective to blaming parents. Previous studies had noted a lack of resemblance for non-twin siblings, challenging the consideration of genetic influence on autism. The rarity of autism diagnoses at the time (2-4 children out of 10,000) contributed to the low rates observed in siblings, even if heritability were high.
The groundbreaking study conducted by Susan Folstein and Michael Rutter focused on 21 pairs of British twins, examining the concordance rates for autism. They studied identical twins (monozygotic), where a fertilized egg splits and develops into two babies with the same genetic information, as well as non-identical twins (fraternal or dizygotic) where two eggs are fertilized by two sperm and produce two genetically unique children.
Among the 10 pairs of fraternal (dizygotic, DZ) twins, where at least one twin was diagnosed with autism using strict criteria, not a single co-twin was diagnosed with autism, indicating zero concordance for fraternal twin pairs.
The most striking result emerged from the 11 pairs of identical (monozygotic, MZ) twins, genetically identical as clones. Among these pairs, 4 (36%) were concordant for strictly diagnosed autism. The researchers used case histories from interviews with parents and observations of the 42 children, maintaining blindness to whether the children were members of identical or fraternal twin pairs.
The study's significance lies in shifting the perception of autism from an environmentally caused disorder to one of the most heritable psychiatric disorders. As molecular genetic research advanced in the 1980s, autism became a prominent target. However, Folstein and Rutter anticipated that genetic influence on autism might result from multiple genes of small effect size, explaining the challenges in identifying specific genetic culprits.
The 1977 paper not only contributed to understanding the heritability of autism but also made additional discoveries that continue to shape the research agenda for autism, particularly in refining the diagnosis of autism.
Autism Appears in DSM III - 1980
Following the increased recognition and understanding of autism, Autism made its way to the DSM-III (Diagnostic and Statistical Manual of Mental Disorders, Third Edition) as an independent diagnosis. This marked a significant step in acknowledging and categorizing autism spectrum disorders within the psychiatric diagnostic framework.