Hans Asperger, Leo Kanner, and the History of Autism

By Nelson Tang

Just like other developmental and intellectual disabilities, autism is oftentimes misunderstood or has stigmas and stereotypes attached to it. Some of the common misunderstandings include confusing autism and Down Syndrome as the same thing when in actuality, they are separate and different things. One of the main differences between the two disorders is that autism is on a spectrum, while Down Syndrome is genetics related. In other words, autism is much more diverse and varying when it comes to the symptoms, traits, and abilities, whereas with Down Syndrome there are more identifiable characteristics and similarities when diagnosing individuals who may share similar physical or intellectual features.

To begin, one has to understand what autism is as it all begins with learning and understanding the facts. What is autism? What causes autism? How common is it? When was autism first discovered and how was it diagnosed? What are the symptoms and characteristics of autism? How does it affect an individual and can they function independently? How much of the knowledge and understanding in the field changed since its discovery.? Who are Hans Asperger and Leo Kanner? What are their contributions to autism? In this essay, these questions will be explored and answered to foster a better understanding. 

Autism refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech, and nonverbal communication. It is also referred to as autism spectrum disorder or ASD for short. It is estimated that 1 in every 36 children and 1 in every 45 adults are affected by this in the United States according to the Centers for Disease and Control. As mentioned, this disorder is on the spectrum meaning that cases vary from person to person where it’s unlikely for two individuals with autism to be the same as each other. There is no one type of autism, but many” as said by Stephen Shore. For example, “some autistic people can speak, while others are nonverbal or minimally verbal and communicate in other ways. Some have intellectual disabilities, while some do not. Some require significant support in their daily lives, while others need less support and, in some cases, live entirely independently” [2]. In other words, autism is distinct in the sense that it is not the same experience and differs for individuals affected by it.

What are the causes of autism? Research indicates that there are a number of factors that cause autism stemming from a combination of genetics and environmental influences.  It may include things such as social determinants such as education, social surroundings, economic standing or any other non medical factors that can impact health outcomes. It is a common misconception and myth that vaccines can cause autism, but after extensive research; this has been proven to simply just be misinformation and false. Changes in certain genes or your genome increase the risk that a child will develop autism. If a parent carries one or more of these gene changes, they may get passed to a child, even if the parent does not have autism. For some people, a high risk for ASD can be associated with a genetic disorder, such as Rett Syndrome or Fragile X syndrome. For the majority of autism, multiple changes in other regions of your DNA  increase the risk of autism spectrum disorder. The majority of these DNA changes do not cause autism by themselves but work in conjunction with many other genes and environmental factors to cause autism” [2]. Moreover, these conditions increase the risk of autism occuring and through genetic testing, it can help in finding out the cause of the disorder in an individual. Furthermore, “most appear to affect crucial aspects of early brain development. Many autism risk genes influence other networks of genes, increasing or decreasing their expression. Some appear to affect how brain nerve cells, or neurons, communicate with each other. Others appear to affect how entire regions of the brain communicate with each other.  Research continues to explore these differences with an eye to developing interventions and supports that can improve quality of life” [2]. Autism can be diagnosed at any age and is described as a “developmental disorder” because symptoms generally appear in the first 2 years of life [1].

What are the signs or indicators of a person potentially having autism? There are two core symptoms when it comes to autism, which are challenges or difficulties when it comes to social communication and interactions skills and restricted or repetitive behaviors. The difficulties in social communications and interaction skills can be divided up into several areas, which include social interactions, communication, and developing, maintaining, and understanding relationships. Social interactions include and are not limited to sharing emotions or interests, understanding the thoughts or emotions of others, or engaging in conversations. Communication includes making eye contact, adjusting one’s tone, or understanding the body language, gestures, and behavior of others. In terms of developing, understanding, and maintaining relationships, it includes expressing one's feelings or seeking emotional solace and comfort from others, making connections and forming friendships, understanding boundaries, or personal space, or being overwhelmed in social situations. In terms of behaviors, one must display at least two types to be diagnosed with autism. Such behaviors include ritualistic or the need for a routine and an extreme distress if change occurs in the plans whether it be small or large. This reinforces the notion of the insistence of sameness or a routine. Repetitive movement or speech patterns, intense fixation on interests and things, and under or over-sensitivity to sensory stimulation can be other defining characteristics. There are numerous other signs and symptoms of autism, but the ones listed above are among the general or common ones. To restate again, autism manifests differently and varies greatly from individual to individual as no two are exactly the same. 

When was autism first discovered and how was it diagnosed? To begin, the first formal diagnosis was done in 1911 by a Swiss psychiatrist named Paul Eugen Bleuler who coined the term claiming it to be the “childhood version of schizophrenia” [8]. As more documentation was recorded involving different cases around the world, a better understanding began to take shape. Following, Blueler’s diagnosis, Grunya Sukhareva, who was a child psychiatrist in Kyiv, Russia, wrote about six children with autistic traits in a scientific German psychiatry and neurology journal in 1926 [8]. Not long after, Louise Despert, who was a  psychologist in New York, details 29 cases of childhood schizophrenia, some of whom have traits that resemble today's classification of autism [8]. However, there were difficulties in operationalizing diagnostic criteria and differentiating Asperger Syndrome from autism ultimately led to its merging into the unifying category of Autistic Spectrum Disorders [3]. Since then, what is understood about autism has evolved as more advancements and breakthroughs have been made throughout the years. 

Who is Hans Asperger and his relationship to the subject matter and what are his contributions to autism? Aspergers syndrome or high functioning autism is what Hans Asperger is most known for [4]. Contrary to the public image that Asperger crafted for himself as an opponent against the Nazi regime during World War II, the truth is far more disturbing. He was just another cog in the machine for the Nazi with his actions leading to the death of many children. He may have not joined the Nazi party, but was a member of several Nazi or Nazi- affiliated organizations. Am Spiegelgrund was the children's clinic at the large psychiatric hospital Am Steinhof in Vienna where Nazis' racial hygiene, eugenic murder programme took place. Asperger regularly referred disabled children to this clinic where they were at risk of being terminated [7]. He would also tend to use biological or constitutional reasoning and explanation rather than the use of pyschoanalysis where it was a trauma that impacted development in a child. Under the Nazi regime, eugenics and racial purity were some of the core ideologies. Psychiatrists and child psychiatrists played a major role in promoting and implementing the ideology, while doctors recorded everything down from illnesses to cognitive defects in order to foster “social hygiene” for a healthy population. [7]. Despite such controversies, Asperger made breakthroughs as he got further into his research. He believed that autism could be present in both highly intelligent individuals and those who suffer from what is now called intellectual disability [4]. He made this conclusion through observing hundreds of patients throughout his career taking note of “special abilities and disabilities.”

Who is Leo Kanner and what are his contributions to the field? Kanner is most known for helping to popularize autism in English. Shortly after Asperger, Kanner would write about the disorder and come to have some differing opinions and ideas regarding the subject matter such as the term “refrigerators mothers”as a cause [3.]. Leo Kanner was born in Austria and studied in Berlin before coming to the United States in 1924. He would go on to open the first child psychiatry clinic in the country at John Hopkins University and write a book on child psychiatry. His work showed great concern for those with autism and intellectual disabilities and their families standing up against the abuses the children went through. Other contributions included helping physicians and scientists escape from the Nazis [6]. One can see that Kanner had a much more humane approach towards individuals with autism. His findings created confusion for a time as he wrote shortly after Aspergner and it became difficult to distinguish between Asperger syndrome and high functioning autism. On the other hand, Asperger described children that he also called autistic. He noted that they seemed to have high non-verbal intelligence quotients and who used a large vocabulary appropriately [6.]  Thus, this shows how one can confuse the two for the same thing. 

In conducting the research, Kanner looked for biomarkers as he saw its importance from the beginning in identifying things. He noted that there was a specific tendency toward autistic behaviors in some families as he would describe autism as an ‘innateʼ disorder.   Furthermore, he concluded that the need for research into the genetics of autism was required moving forward [6]. Further research shows “it is also clear that autism is not inherited in a simple Mendelian fashion. Many genes, perhaps as many as 50, may be involved, each one adding to the risk of clinically manifest autism. As these genes are uncovered, clinical descriptions will be further revised, and some may disappear entirely” [6]. Since then, Kanner’s paper has been oftentimes misunderstood or misinterpreted as he blamed mothers and families for the conditions of autism manifesting in the children. He is seen as blaming mothers causing this by rejecting their children. However, this is not the truth. “Kanner addressed the question this observation raises: Are parents in some way to blame for their child's condition? On the contrary, he wrote: "The children's loneliness from the very beginning of life" suggests that parents' behavior is not a causative factor. He went on to state that scientists must assume "that these children have come into the world with the innate inability to form the usual, biologically provided affective contact with people” [5].  In other words, he was not actually laying the blame on the parents, but rather he was trying to distance themselves from the eugenic views that were dominant at the time. Kanner would also come in defense of mothers later in his career. “His subsequent research on children with autism showed there was no evidence for parental "mistreatment, overt rejection, or abandonment" as a factor in a child's having autism. In addition, Kanner had long fought against psychoanalytic theories that blame mothers” [5].   

Both Hans Asperger and Leo Kanner have contributed to autism research in their own ways both coming from Austria, but with different life journeys. Despite being the more controversial and questionable of the two, Asperger laid down the groundwork and ideas that would influence Kanner and others to conduct their own research and findings and make their own contributions to the field. Later in his life, Asperger would conclude that individuals with autism display special abilities and were not limited by their disabilities. Unlike Asperger, Kanner would apply a more humane approach insteading of supporting or applying eugenical ideology to his work. It is clear that without the work done by these two men, there would still be a lot that is unknown about this disorder.

Although many discoveries and breakthroughs have been made regarding autism, there are still things that are left unanswered and undiscovered. There needs to be more funding in order for more research and development. With more funding, there can be a better understanding of autism and the spectrum as there is much that we still don’t know about. There also needs to be greater advocacy, awareness, and inclusion for people with autism. They are oftentimes misunderstood and left out of the conversation being mistreated or isolated. Time and time again, they have proven to be able to function in society and independently being highly gifted and intelligent individuals. Education about autism and other developmental disabilities need to be taught and discussed at the early school level. It should be implemented at every school to foster a better understanding and for people to know how to interact with people with the disorder. In doing so, a better future is forged. 

References

[1.] “Autism Spectrum Disorder.” National Institute of Mental Health, U.S. Department of Health and Human Services, www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd. 

[2.] “Autism Symptoms.” Autism Speaks, www.autismspeaks.org/autism-symptoms

[3.] Barahona-Corrêa, J B, and Carlos N Filipe. “A Concise History of Asperger Syndrome: The Short Reign of a Troublesome Diagnosis.” Frontiers in Psychology, U.S. National Library of Medicine, 25 Jan. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4725185/. 

[4.] “Hans Asperger, 1906-1980.” The Autism History Project, blogs.uoregon.edu/autismhistoryproject/people/hans-asperger/

[5.] Harris, James. “Correcting the Record: Leo Kanner and Autism.” Medical News, MedpageToday, 27 Apr. 2016, www.medpagetoday.com/neurology/autism/57565.

[6.] “Leo Kanner’s 1943 Paper on Autism.” The Transmitter: Neuroscience News and Perspectives, 3 Mar. 2023, www.thetransmitter.org/spectrum/leo-kanners-1943-paper-on-autism/.

[7] Slagstad, Ketil. “Asperger, the Nazis and the Children – the History of the Birth of a Diagnosis.” Tidsskrift for Den Norske Legeforening, 16 May 2019, tidsskriftet.no/en/2019/05/essay/asperger-nazis-and-children-history-birth-diagnosis. 

[8.] Vincent Iannelli, MD. “The History and Timeline of Autism.” Verywell Health, www.verywellhealth.com/autism-timeline-2633213.