The History of Autism

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The history of Autism

Leo Kanner first described his classic autistic syndrome more than 50 years ago. Since then, the findings of research and clinical trials have assisted us in learning more about autism. More people are being diagnosed as autistic, but we still have a long way to go before we can create a world that works for autistic people.

Timeline

Kanner Syndrome 1943

  • ‘Early infantile autism’ refers to the specific pattern of ‘abnormal behaviour’ first described by Leo Kanner. Kanner did not estimate the number of people who might have this condition, but he believed it was uncommon (Kanner, 1943).
  • Victor Lotter published the first results of an epidemiological study of children with Kanner’s behaviour pattern in the former county of Middlesex over 20 years later, yielding an overall prevalence rate of 4.5 per 10,000 children (Lotter, 1966).

The triad of impairments 1979

  • In 1979, Lorna Wing and Judith Gould studied the prevalence of autism, as defined by Leo Kanner, in children with special needs in the former London Borough of Camberwell
  • They discovered a prevalence of nearly 5 per 10,000 in those with IQs below 70 for this syndrome, which is similar to Lotter’s rate. Wing and Gould discovered a larger group of children (about 15 per 10,000) who had difficulties with social interaction, communication, and imagination (what they called the “triad” of impairments), as well as a repetitive stereotyped pattern of activities.
  • Although these children did not fit into Kanner’s full picture of early childhood autism (or typical autism), they were identified as being on the autism spectrum. In the Camberwell study, the total prevalence rate for all autistic children with special needs was around 20 out of every 10,000 children (Wing and Gould, 1979). Gillberg et al. (1986) discovered very similar rates in children with learning disabilities in Gothenburg, Sweden.
  • Other studies in various countries have looked into autism and the number of autistic children (but not the whole spectrum). These figures range from 3.3 to 60.0 per 10,000 people. This could be due to differences in definitions or methods of case-finding (Wing and Potter, 2002).

Asperger syndrome 1993-1995

Introduction to Asperger syndrome

  • In 1944, Hans Asperger (new evidence about his problematic history has recently been revealed, sparking a heated debate) published an account of children with many similarities to Kanner autism but with abilities, including grammatical language, in the average or superior range in Vienna. There is still debate about the exact relationship between Asperger and Kanner syndromes, but it is undeniable that they share a triad of impairments in social interaction, communication, and imagination, as well as a narrow, repetitive pattern of activities (Wing, 1981; 1991).

1993

  • Stephan Ehlers and Christopher Gillberg published the findings of a further study conducted in Gothenburg. This study looked at kids in mainstream classrooms. The study’s goal was to discover the prevalence of Asperger syndrome and other autism profiles in children with an IQ of 70 or higher.
  • Based on the number of children identified, they calculated a rate of 36 per 10,000 for those with Asperger syndrome and another 35 per 10,000 for those with social difficulties. Some of these children may have fit the Asperger description if more information had been available, but they were undoubtedly on the autism spectrum. Teachers of these children had previously identified social and/or educational differences but had been unable to identify a cause for these differences.

1995

  • For over 30 years, Sula Wolff, in Edinburgh, studied children of average or high ability who had difficulty with social interaction but did not fit into the triad of impairments. These children represent the autism spectrum’s most ‘subtle’ end. As adults, the majority become self-sufficient, many marry, and some exhibit exceptional abilities.
  • Why include them on the autism spectrum? As Sula Wolff points out, these children frequently struggle in school and require recognition, understanding, and acceptance from their parents and teachers. The approach that works best for them is the same as that recommended for children with Asperger syndrome and high-functioning autism (as it was then called).
  • Sula Wolff cites Ehlers and Gillberg’s research. She believes that the 71 per 10,000 figure includes the children she describes.

Autism spectrum 2005-2006

2005

  • According to the Office of National Statistics, the prevalence of autism in children and young people in the United Kingdom is 0.9%, or 90 for every 10,000. (Green et al, 2005). These were not divided into autism, Asperger syndrome, or other autism spectrum profiles.

2006

  • Gillian Baird and colleagues published the results of a prevalence study that surveyed children aged 9 to 10 in the South Thames region.
  • All children who had an autism diagnosis or who had social and communication difficulties were chosen for screening.
  • Children who were thought to be at risk of going undetected because they had a statement of special educational needs were also chosen.
  • Diagnoses were made using ICD-10 criteria. The findings revealed a prevalence rate of 38.9 in 10,000 for “childhood autism” and 77.2 in 10,000 for other conditions on the autism spectrum, for a total figure of 116 in 10,000. (Baird et al, 2006).
  • In this study, only a few children were found to have Asperger syndrome. Because of the selection criteria, the authors acknowledged that some children in mainstream schools who did not have a statement of special educational needs would have been missed. The authors emphasise that the prevalence estimate discovered should be regarded as a bare minimum (Baird et al. 2006).
  • The ICD-10 diagnostic criteria for Asperger syndrome depict that a person diagnosed with Asperger syndrome using Gillberg’s criteria would most likely be diagnosed with childhood autism or atypical autism using the ICD-10 criteria.

Autistic adults 2007

  • The Adult Psychiatric Morbidity Survey is the primary source of data for tracking trends in mental health in England. It included autism for the first time in 2007 and discovered that 1% of the population studied was autistic (Brugha, T. et al , 2009).
  • The Department of Health then funded a project to expand on the APMS study and examine the numbers of autistic adults who were not included in the original study more closely. People in residential care settings and those with complex needs were included. This research was led by Professor Terry Brugha of the University of Leicester. Brugha was also the APMS 2007 autism research leader. The study discovered that approximately 1.1% of people in England are autistic after combining its findings with the original APMS (The NHS Information Centre, Community and Mental Health Team, Brugha, T. et al, 2012).

Recent studies from other countries 2008-2012

  • In 2008, the Autism and Developmental Disabilities Monitoring Network in the United States examined eight-year-old children in 14 states and discovered a prevalence rate of autism within those states of 1 in 88, with approximately five times as many boys as girls diagnosed (Autism and Developmental Disabilities Monitoring Network Surveillance Year 2008 Principal Investigators, 2012).
  • The National Center for Health Statistics in the United States released results from telephone surveys of parents of children aged 6 to 17 conducted in 2011-12. According to the report, one in every fifty people has autism (Blumberg, S .J. et al, 2013).
  • A study of 0-17 year olds in Stockholm between 2001 and 2007 discovered a prevalence rate of 11.5 per 1,000, which is very similar to the rate found in other prevalence studies in Western Europe (Idring et al, 2012).
  • A much higher prevalence rate of 2.64% was discovered in a South Korean study, where researchers discovered that two-thirds of people on the autism spectrum were in the mainstream school population and had never been diagnosed. 2011; Kim et al.
  • Over the last few years, researchers comparing studies from around the world have come up with a more conservative estimate of 62 in 10,000. They conclude that both the increase in estimates over time and the variability between countries and regions are likely a result of broader diagnostic criteria, increased service availability, and increased public and professional awareness of autism (Elsabbagh M. et al, 2012).

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