2.0 History

2.1 Is autism new?

Whilst autism is a term coined in the 20th century, it is not a new phenomenon. Lorna Wing suggests that ancient legends of 'fairy changeling' children, in which fairies were believed to steal away a human baby and leave a fairy child in its place, are actually early references to autism. The two examples that follow illustrate that autism has, almost certainly been present though-out history.

2.2 Brother Juniper

Although Saint Francis of Assisi died in 1226 the first English translation of the Fioretti di Santo Francesco d'Assisi, (Little Flowers of St Francis) only appeared in 1864. This most spirited and racy of Italian classics introduces the reader to selected miracles of Saint Francis and his earliest disciples.

One of his chosen disciples was Brother Juniper, a man who many later researchers have suggested displayed many of the classic attributes of a person with autism. Here are a few examples of his actions, which indicate that he was a person with autism.

Brother Juniper and the pigs foot

When visiting a sick brother the man asked Brother Juniper 'thou wouldst give me great consolation if thou couldst get me a pig's foot to eat' whereupon Brother Juniper went into the forest, where many swine were feeding, and having caught one, he cut off one of its feet and ran off with it, leaving the swine with its foot cut off; and coming back to the convent, he carefully washed the foot, and diligently prepared and cooked it.

This literal interpretation of a request is common in people with autism.

Brother Juniper and the see-saw

On entering Rome, his fame attracted the attention of a large crowd. Brother Juniper, obviously puzzled, and probably frightened by this turn of events, caught sight of two children playing on a see-saw and joined them in their play. As the now assembled crowd waited for him to stop, Brother Juniper took no notice but instead gave his whole attention to his see-sawing.

This apparent stereotypical behavior seemed a response to an unusual and frightening sequence of events - again behavior traits common in people with autism.

How Brother Juniper fell into an ecstasy

In chapter XII of the Little Flowers of St Francis the following was reported:
'Brother Juniper was one day hearing Mass with great devotion, he fell into an ecstasy, and so continued for a long space of time. And when he came to himself, he said with great fervor of spirit to the other friars: 'Oh, my brethren, who is there in this world so noble that he would disdain to carry a basket of mud all the world over, in the hope of obtaining a house full of gold?'

Of course, with the passage of so much time it's impossible to know exactly what caused the ecstasy but perhaps this was the result of an epileptic seizure? Another condition known to be associated with autism.

2.3 The Wild Boy of Aveyron

It wasn't until the 19th century that anyone seriously started to study a person displaying the triad of impairment that characterizes a person with autism (although it was too early for them to recognise it as such).

In January 1801, a French Doctor, Jean-Marc-Garpard Itard, was given charge of a boy of about 12 years old who had been found living wild in the woods. The child, subsequently named Victor was mute and thought to have been isolated from human contact from an early age. Victor displayed the following characteristics that suggest very strongly that he was autistic:

• He never learned to speak;
• He had a 'decided taste for order';
• He pulled people towards objects that he wanted to use;
• He would not play with toys in any constructive manner;
• Itard also noted that whilst he could instruct Victor into how to behave in a social context, when that context was repeated in a different location he would revert to his previous behavior.

Through his work with Victor, Jean-Marc Gaspard Itard became known as the father of special education. He was the first to delve into the task of teaching a child who was 'different'. For many years after Itard, more educators and psychologists became interested in making people like Victor become a functional part of society.

In fact, his ideas were passed on via his student Edouard Seguin to Maria Montessori and still to this day influence methods of special education.

2.4 Modern thinking

We now turn to the 20th century, where a more rational and structured approach was adopted.

2.4.1 Leo Kanner

Up until the 1940s, there had been much work looking at individual people and describing their conditions. It was only in the first part of the 20th century that researchers began to look at groups of children and compare their behavioral traits and to look at any similarities.

Leo Kanner, a psychiatrist at Johns Hopkins University in the US, recognised that a number of children sent to his clinic displayed similar characteristics which he named 'early infantile autism' - the word autism deriving from the Greek for 'self'.

Although he described in detail the characteristics of 11 children he saw between September 1931 and February 1943, there were certain features that were universal and he selected those as crucial for diagnosis. These were:

• A profound lack of affective (emotional) contact with other people;
• Intense insistence on sameness in their routines;
• Muteness or abnormality of speech;
• Fascination with manipulating objects;
• High levels of visio-spatial skills or rote memory but major learning difficulties in other areas;
• An attractive, alert, intelligent appearance.

Kanner's pioneering work was slow to catch on but is now the focus of much international research.

2.4.2 Hans Asperger

A Viennese physician, Hans Asperger, working at the same time as Leo Kanner, published a paper which described a pattern of behaviors in several young boys who had normal intelligence and language development, but who also exhibited autistic-like behaviors and marked deficiencies in social and communication skills.

Asperger noted the similarities to Kanner's Syndrome but also observed some major differences:

• Whilst Kanner reported that 3 of his 11 patients did not speak at all, and the remainder rarely used language to communicate, Asperger noted that his case study patients spoke 'like little adults';
• There were also disagreements regarding gross coordination and fine motor skills. Kanner reported that whilst the former was poor the latter was very good whilst Asperger observed that both were affected;
• Kanner believed that learning by rote would be the best method of advancing an autistic person whilst Asperger suggested that his patients were 'abstract thinkers' and therefore performed best spontaneously.

2.4.3 Modern thinking and approaches

It was not until the extensive research work of Lorna Wing and Judith Gould in the late 1970s in Camberwell (UK) that it became apparent that both the diagnoses of Kanner and Asperger were accurate. By examining a large sample of children on one area of London, Wing and Gould were able to show that Kanner's Syndrome and Asperger's Syndrome were both part of a wide range of disorders affecting social interaction and communication. This led to the notion of 'autistic spectrum disorders' and to the idea of a 'triad of impairments' - it is to this that we now turn.