In 1943 an article by Dr. Leo Kanner created a disability. If it had been possible to patent it, he would have made a fortune; Kannerian© autism™.
The article was titled Autistic Disturbances of Affective Contact. and appeared in a shortlived journal called Nervous Child. Since 1938, he said, he had seen in his work as a child psychiatrist eleven children who seemed to form a special group. The children were physically normal, or nearly so. They had difficulties relating to other people and situations, they had delayed language or language difficulties, and they had an obsessive desire for the maintenance of sameness. Furthermore,
Even though most of these children were at one time or another looked upon as feebleminded, they are all unquestionably endowed with good cognitive potentialities. They all have strikingly intelligent physiognomies. ... The astounding vocabulary of the speaking children, the excellent memory for events of several years before, the phenomenal rote memory for poems and names, and the precise recollection of patterns and sequences, bespeak good intelligence in the sense in which this word is commonly used.
Kanner later gave the condition the name 'early childhood autism'. It was a powerful, persuasive, and well-written article, and it was the first of several thousand articles, books, and films on the topic in the fifty years since. What, though, did Kanner do?
The commonsense view is that he discovered autism. He identified a condition, described it, defined it, and differentiated it from other diseases in the same way that a naturalist might discover a new species. He noted a set of characteristics that generally occurred together, decided that the connection was not simply accidental, and made an implicit prediction that they would also be found together in other cases. Since then the discovery of tens of thousands of similar cases has, it would seem, borne out his thesis.
But if it was that easy, why hadn't someone else done it first? Other discoveries aren't really comparable. Newton wasn't the first person to observe that apples fell. He explained gravity, he didn't identify it. Koch discovered that tuberculosis was caused by the tuberculosis bacillus - he didn't have to convince people that tuberculosis existed. The question to ask is not 'How did Kanner discover autism? but 'What were the questions Kanner was asking for which 'autism' was the answer?'
The first question was 'How can the children of intelligent people be retarded?' This was a time when hereditarian theory was still riding high. Intelligent people should have intelligent children.
There is one other very interesting common denominator in the backgrounds of these children. They all come of highly intelligent families. Four fathers are psychiatrists, one is a brilliant lawyer, one a chemist and a law school graduate employed in the government Patent Office, one a plant pathologist, one a professor of forestry, one an advertising copy writer who has a degree in law and has studied in three universities, one is a mining engineer , and one a successful business man. Nine of the eleven mothers are college graduates ... All but three of the families are represented either in Who’s Who in America or American Men of Science or both.
The second question, of course, was 'What do I tell these parents is wrong with their children?'
Kanner’s article makes interesting reading. It is one of the last achievements of the heroic age of psychiatry, and it could not have survived in the current climate of academicism. A brief comparison with the other twenty papers reprinted in Donellan’s Classic Readings in Autism shows that Kanner’s is significantly longer and more discursive - thirty-nine pages, against an average of seventeen. It is anecdotal - a good read, even for the non-professional. A further feature of Kanner’s article now seems almost unbelievable. The other papers include an average of 53 citations. Kanner’s has none at all, and has no bibliography. No refereed journal would dream of accepting it today.
Since Kanner’s paper the needs of psychologists have changed, and the criteria for autism have been extended; to put it more precisely, autism has been redefined. For several decades after Kanner, a diagnosis of autism exempted a child from intelligence testing. By definition, the autistic child had intelligence that was concealed by its affective impairments. If the child was retarded, it wasn't autistic. In a culture that was increasingly believing that IQ explained almost everything this represented a continuing anomaly. The protection given by the old definition was removed in the sixties. Two papers were published, one stating that children with autism were not untestable, and the second of which correlated outcome and IQ score; both findings fitted in with the rising domination of the testing system, and both were accepted without question. Children with autism were given IQ tests, the scores were accepted as meaningful, and the accepted meaning was that most children with autism were severely intellectually impaired. To no one’s surprise, those children with autism who had always been seen as high-functioning - children who could speak and who had better hand skills - confirmed their supremacy by doing better on the IQ tests than autistic children who didn't speak and who could barely feed themselves. There are, of course, other explanations for correlations between IQ scores and outcomes, explanations which have nothing to do with intelligence, but if you believe that retardation is an explanation rather than a puzzle you don't have any reason to look for other explanations.
The generally accepted position on autism is summarized in a 1987 Australian article.
It was formerly believed that autistic children were normally intelligent children whose potential was not realized because of the severity of the emotional disturbance. Most autistic children are in fact retarded; at least half of them severely or profoundly so... IQ is a good predictor of adjustment in the majority of cases....
Children who are untestable on intelligence or adaptive behavior tests have a poor prognosis...
Only a minority of children acquire functional language and even then this is usually immature, deviant, inflexible, concrete, and lacking in communicative competence...
Behavioral methods ... permit the learning of basic self-help skills, eye contact, and some co-operative behavior...
They are educable for the most part consistent with their level of intellectual ability, though there are always reports of a small number of unusual cases who surprise their caretakers by making major gains.
I'd only seen one child before 1986 who'd been diagnosed as autistic, a breathtakingly cute hyperactive seven-year-old with appalling behavior. His mother was a friend, and she'd asked me if I could help him to communicate (he was totally mute). I'd worked with Jonathon for several years, and by the time DEAL opened he was able to type short sentences (although his willingness to do so was very variable indeed). Initially I'd held his hand while he typed (partly to stop him running away) but he had gradually moved beyond that, although he still generally needed a hand on his shoulder to maintain focus. Having only seen one of him, however, I didn't know whether his problems were typical of children diagnosed as autistic. The word got around, though, and after DEAL opened we were approached by a number of parents asking if we would see their autistic children and try and find some way for them to communicate.