Is autism a 20th century "disease"?

UPI Launches New Series: The Age of Autism

[By Dan Olmsted.]
http://www.upi.com/view.cfm?StoryID=20050126-113404-1472r

UPI - They were born within four months of each other, Fritz V. in June of 1933 and Donald T. that September. Fritz was born in Austria, Donald in Mississippi, but they had a surprising amount in common.

Unfortunately.

When Donald was taken by his beleaguered parents to Johns Hopkins University in 1938, he acted like no 5-year-old that famed child psychiatrist Leo Kanner had ever seen.

“He learned my name,” Kanner recounted decades later, “but he would never see me if he met me because he would never look up enough and had enough eye contact to recognize faces. … Also, while he spoke, it was not for communication, and if in order to satisfy his needs some communication was needed, he would not be able to distinguish between I and you, rather echoing religiously some of the things that he was interested in.

“For instance, if he wanted his milk, he remembered constantly that his mother always asked him, ‘Donnie, do you want your milk?’ And his way of asking for milk was ‘Donnie, do you want your milk?’ Well, this was only a part of some of his peculiar behavior.”

Yet strangely, by age 2 1/2 he could name the presidents and vice presidents of the Unites States backwards and forwards and recite the 25 questions of the Presbyterian catechism.

Fritz made an equally vivid impression on Hans Asperger, the pediatrician who first saw him in 1939 at age 6 in Vienna. Asperger described him as “a highly unusual boy who shows a very severe impairment in social integration. … His gaze was strikingly odd. It was generally directed into the void.”

In school, “He quickly became aggressive and lashed out with anything he could get hold of (once with a hammer). … Because of his totally uninhibited behavior, his schooling failed on the first day. … Another strange phenomenon in this boy was the occurrence of certain stereotypic movements and habits.”

As with Donald, “The content of his speech was completely different from what one would expect of a normal child,” Asperger said of Fritz. “Only rarely was what he said in answer to a question.”

Yet weirdly, he started speaking at 10 months and soon “talked like an adult.”

Donald T. and Fritz V. — last names were never given — have endured in medical literature because they are firsts. Donald was the first to confront Kanner with the behaviors that he later named “autism.” Fritz was the first case study of what came to be known as Asperger’s Disorder. Both conditions are now classed in the official U.S. guide to mental problems as Pervasive Developmental Disorders, and are also called Autism Spectrum Disorders. (Autism derives from the Greek word for self, “autos,” as in autobiography.) Most experts think the disorders are related, with autism the severe manifestation; Asperger’s is sometimes referred to as “autism lite” or “a dash of autism” and is differentiated by a lack of delay in language development.

Kanner’s study of Donald and 10 other children was titled “Autistic Disturbances of Affective Contact” and was published in the journal “Nervous Child” in 1943. Asperger called his study of Fritz and three other children “ ‘Autistic Psychopathy’ in Childhood”; it was published in “Archiv fur Psychiatrie und Nervenkrankheiten” in 1944.

Kanner described autism’s defining features as “extreme aloneness and a desire for the preservation of sameness.”

“The children seemed to live in a static world in which they could not seem to tolerate any kind of change introduced by anybody but themselves,” Kanner said in a 1972 speech, “and even that didn’t occur very often.”

“The autist is only himself,” Asperger wrote, “and is not an active member of a greater organism which he is influenced by and which he influences constantly.”

Kanner and Asperger did not collaborate on their studies. Nor did either predict the deluge that would follow: In the United States, a reasonable estimate is that 30 or 40 children out of every 10,000 are diagnosed with autism, and another 30 or 40 are diagnosed with other Pervasive Developmental Disorders, including Asperger’s. [NOTE: THESE STATS REFER TO RECENT ESTIMATES, NOT ESTIMATES FROM KANNER’S TIME]

This leads to a simple but significant question: Was it coincidence that the first few cases of these strikingly similar disorders were identified at the same time, by the same term, in children born the same decade, by doctors thousands of miles apart? Or is it a clue to when and where autism started — and why? The question reflects a huge, and hugely important, debate. If autistic children always existed in the same percentages but just weren’t formally classified until the 1940s, that would suggest better diagnosis, not a troubling increase in the number of autistic children.

But if autism had a clear beginning in the fairly recent past (a past so recent that Fritz and Donald could both be alive today at age 71), then the issue is very different. That would suggest something new caused those first autism and Asperger’s cases in the early 1930s; something caused them to increase; and something is still causing them today.

This ongoing series will look for answers by tracking the natural history of autism around the world — a road less traveled than one might think. For example, Asperger’s study was not translated into English until 1994 — a half-century later — and still is not easily available; actually reading Asperger’s account of Fritz V. makes you realize the severity of his disorder and its similarity to classical autism.

“The reader of Asperger’s first paper cannot fail to be impressed by the close similarities to Kanner’s case descriptions and the relatively few differences,” wrote British psychiatrist Lorna Wing in the 1994 anthology “Autism and Asperger Syndrome,” which includes the first English translation. The translator, Uta Frith, noted, “By a remarkable coincidence, Asperger and Kanner independently described exactly the same type of disturbed child to whom nobody had paid much attention before and both used the label autistic.”

Both said that autistic children were impossible to miss.

“Once one has properly diagnosed an autistic individual one can spot such children instantly,” said Asperger. “It is a unique syndrome,” said Kanner, “and almost photographically not identical, but similar.”

Yet Kanner was clear that he never saw an autistic child until he met Donald T. in 1938 — 17 years after he got his medical degree in Berlin on his way to becoming one of the world’s leading psychiatrists, to whom the toughest cases were often referred “all the way to the great Hopkins,” as he jokingly put it.

In fact, his landmark 1943 paper begins, “Since 1938, there have come to our attention a number of children whose condition differs so markedly and uniquely from anything reported so far, that each case merits — and, I hope, will eventually receive — a detailed consideration of its fascinating peculiarities.”

Markedly, uniquely different: The great psychiatrist at the great Hopkins believed he was seeing something new.

Next, we’ll look at the oldest of Kanner’s patients, the one whose birth might mark the start of the age of autism. Her name was Virginia S.

(This series intends to be interactive with readers and will take heed of comment, criticism and suggestions. e-mail: [email protected])

Is autism a 20th century "disease"?

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