What is a Brief History of Autism

Autism as profound
Developmental disorder

We deliberately refrain from presenting the varied and heated discussion on the causes of autism here. Because none of the approaches convincingly explains all the phenomena of the disorder. For the present work we assume the diagnosed autistic disorder as given. It can be assumed with certainty that a genetic component is a necessary but not sufficient trigger. Furthermore, it was possible to prove by means of imaging procedures that people with an autism spectrum disorder process many perceptions in different parts of the brain than usual. F. Poustka 2004 gives an overview of the area of ​​autistic disorders.

1.1 On the history of the autistic developmental disorder

The term “autistic” was first introduced by Bleuler (1911) to describe one-sided thinking in schizophrenic patients. However, this does not document the first appearance of autistic behaviors, as earlier medical records (for a review see Frith, 1992) show.

Then, independently of one another, Kanner (1943) and Asperger (1944) described children with similar behaviors. Kanner (1943) describes the clinical picture as "early childhood autism" and assigns the behavioral disorder to childhood psychoses. He clearly differentiates autism from childhood schizophrenia because of its early onset.

In his opinion, the cardinal symptoms of “early childhood autism” are to be seen in the extreme self-centeredness or the inability to anticipate contact with those affected and the need to compulsively maintain the environment with the resulting fear of change.

Furthermore, secondary symptoms such as the conspicuous handling of objects and, in speaking children with autism, language disorders (e.g. echolalia, pronoun inversion and the lack of use of language as a means of communication) occur. On the basis of the intelligence and memory performance of the children examined, Kanner differentiates “early childhood autism” from an intellectual disability.

After extensive discussion in the professional world about diagnostic criteria and nomenclature of the behaviors described (for an overview see Lösche, 1992), Rutter (1978) published a much-noticed definition that picks up on Kanner's cardinal symptoms and the term "childhood psychosis" (Kanner, 1943) by the "Developmental disorder" (Rutter, 1978) replaced.

In contrast to Kanner, Asperger (1944) speaks of "autistic psychopaths". He describes behavioral problems similar to those of Kanner, which he only finds in boys and, because of the intellectual abilities shown, describes them as an “extreme variant of the male character” (Asperger, 1944, p. 129). Overall, the impression arises that Asperger's rather describes the speaking and more intelligent group of people with autism, while Kanner also included those with intellectual disabilities (Bormann - Kischel, 1984, quoted from Riehemann, 1992, p. 5).

Despite the intensive examination of the topic, no uniform term for the symptom picture autism has been able to establish itself to this day. Kehrer (1989) was one of the first German-speaking scientists to differentiate autism into autistic traits, autistic behaviors and autism syndrome. This subdivision was used by the diagnostic outpatient department of the Institute for Autism Research in Münster, which he directed, for their diagnoses.

Even the two most frequently used classification manuals of mental disorders differ in their designation on the one hand as "autistic disorder" (coded with 299.00) in the DSM-IV (Saß, Wittchen & Zausig, 1996) and on the other hand as "early childhood autism" (coded with F 84.0 ) in the “International Classification of Mental Disorders” (ICD-10) (Dillinger, Mombour & Schmidt, 2005). In addition, the latter differentiates between “atypical autism” (F 84.1) and “Asperger's syndrome” (F 84.5), while the former still differentiates between “Asperger's disorder” (299.80) and under the same number the “unspecified profound developmental disorder (including Atypical autism) ”(299.80).

The term autism spectrum disorder is currently being used increasingly in order to do justice to the broadly diversified appearance, which also does not always allow a clear demarcation of the various sub-forms.

1.2 Classification and symptoms

Both the DSM-IV and the ICD-10 classify autism as a pervasive developmental disorder. In the meantime, the following definition has become established in autism research: Autism is a disorder that is characterized by "a clearly abnormal and impaired development in the area of ​​social interaction and communication as well as a clearly restricted repertoire of activities and interests" (DSM- IV, Saß, Wittchen & Zausig, 1996, p. 103).

Abnormal means that the observed behavior is neither appropriate to his (delayed) level of development nor to his chronological age. The DSM-IV is basically based on the behavior described by Kanner in 1943 as the cardinal symptoms of early childhood autism. However, medical diagnosis in Germany is often based on the ICD-10, which corresponds to the DSM-IV in terms of diagnostic criteria. In both cases, it is a collection of behaviors that characterize autism as a disorder and whose diagnosis must be made using lists of symptoms.

In the multiaxial assessment of the DSM-IV, the profound developmental disorders are coded on axis I “Clinical disorders, other clinically relevant problems” and are considered the main diagnosis in the event of multiple diagnoses. Along with personality disorders, mental disabilities are coded on axis II.

The ICD-10 lists three main areas in which manifestations of Autism Spectrum Disorders must occur: a total of at least six, of which at least two from (1) and one each from (2) and (3). The onset of the disorder is before the age of three. In doing so, abnormalities in social interaction, in the function of language as a means of communication and / or in the area of ​​behavior, interests and activities are shown.

In detail, these are:

1. Qualitative impairment of social interaction

  • pronounced impairment in the use of diverse non-verbal behaviors such as eye contact, facial expression, posture and gestures to control social interaction
  • Inability to develop developmental relationships with their peers
  • Lack of spontaneous sharing of joy, interests, or success with others
  • Lack of socio-emotional reciprocity

2. Qualitative impairment of communication

  • Delayed onset or no development of spoken language at all and no attempt to compensate for this
  • Clearly impaired ability to start or continue a conversation in people with sufficient language skills
  • stereotypical or repetitive use of language or idiosyncratic language
  • Lack of various developmental role-playing or social imitation games

3. Significantly limited repertoire of activities and interests

  • extensive preoccupation with one or more stereotypical and limited interests, the content and intensity of which are abnormal
  • noticeably rigid adherence to certain non-functional habits or rituals
  • stereotypical and repetitive motor mannerisms
  • constant preoccupation with parts of objects

This list of characteristics summarizes the research results on the symptoms of autism spectrum disorders. A more detailed description of the research can be found in Kehrer (1989), Innerhofer & Klicpera (1988) or Büttner (1995).

Some authors, such as the Federal Association “Autismus” (1996), see, in an extension of the DSM-IV, perceptual processing disorders as a further characteristic feature for people with autism (cf. also Cordes & Dzikowski, 1991; Innerhofe & Klicpera, 1988 ; Kehrer, 1989; Ritvo & Freeman, 1978; Rollett & Kastner - Koller, 1994). The federal association reproduces the treatment of perceptual processing disorders that is strongly represented in therapeutic practice today for autism spectrum disorders.

Other possible abnormalities can occur in eating and sleeping behavior, in mood or affect, or in the form of external or auto-aggressive behavior, hyperactivity, short attention span or impulsiveness. The speech and speech abnormalities that describe the disorder, for example in the criteria of productive prosody such as pitch, speaking rhythm, speed or intonation (see Grimm & Engelkamp, ​​1981), occur in only about 60 percent of those affected. At least 40 percent do not speak at all.

Fearful behavior is often reported, sometimes even with harmless things. The life reports of people with autism confirm that fear is a determining element of everyday life (Grandin, 1992, 1994; Zöller, 1992).

Multiple disabilities of autism and intellectual disability (over 70 percent) occur more than average (Gillberg, 1988), as already described by Kanner (1943). The skills profile in standardized intelligence tests is not uniform. In other words: You cannot assume that the measured skills are roughly at the same level, as is usually the case, but that individual areas with clear performance peaks or deficits deviate from the individual overall profile.

In addition to these deficits, above-average partial performances or abilities of people with autism are described again and again (for an overview see Kehrer, 1989, 1992). Above-average numeracy, writing and reading skills also occur, sometimes without people with autism understanding the content of what they are reading or writing. In addition, outstanding memory performance in a wide variety of areas is mentioned again and again (for example calendar memory, number memory, geographical and visual memory).

Characteristic of autism spectrum disorders is the very inhomogeneous and varied disorder picture as well as its fluctuating and individual degree of severity.

1.3. Differential diagnostics

The two classification systems of mental disorders use largely identical descriptions of autistic disorders.

"Asperger's Syndrome (F84.5)" (ICD-10, 2005) is characterized by the same qualitative disorders as "Early Childhood Autism (F84.0)" (ICD-10, 2005). In contrast to this, those affected do not show any cognitive or linguistic developmental delay. That this differentiation is, on the one hand, different disorders or, on the other hand, “possibly different manifestations in the spectrum of a basic mental illness” (Jørgensen, 1998, p. 82) or Asperger's disorder “just ... a lighter form of the Kanner syndrome ”(Hebborn - Brass, 1993, p. 23), shows the contradicting professional discussion (see also Kehrer, 1989).

In cases in which the required diagnostic criteria of the disorder are not met in all three areas or do not occur until after the age of three, but otherwise a very similar picture emerges, "atypical autism (F 84.1)" is classified according to the ICD- 10 (2005) diagnosed.

In addition, for a number of years now, it has been necessary to distinguish it from the “Rett disorder” (299.80 in DSM-IV, 1996; F 84.2 in ICD-10, 1993). The Rett disorder, which has so far only been found in girls, was often incorrectly diagnosed with autism at the beginning due to a similar symptom profile. In addition to the different course and the stagnation of head growth in the Rett disorder, a distinction is made in particular via the motor skills. In contrast to the autism spectrum disorder, girls with Rett disorder lose conscious, targeted movement control after initially normal development (see also Rutter, 1988).

The demarcation to the “disintegrative disorder” in childhood is again based on normal development up to the second year of life, especially in the socio-communicative area with subsequent developmental regression.

Stereotypical behavior, also in the linguistic area, can be interpreted as "delusion". Due to the lack of hallucinations and the early onset of autism, however, a “schizophrenia diagnosis” must be avoided (DSM-IV, 1996). A demarcation from obsessive-compulsive disorder is usually made via the I-synthonic ascription or the performance of the rituals experienced as meaningful.

In "aphasia", the loss of language can lead to social withdrawal behavior, which, however, does not correspond to the qualitative impairment in autism, since non-verbal communication is also hardly noticeable (Weber, 1988).

Various studies have shown that although some of the affected people with autism have a more or less severe "intellectual disability", there are two different forms of disability, since the autistic disorder is the same regardless of the intellectual impairment. In addition, people with intellectual disabilities, in contrast to people with autism, are still interested in social contacts and able to communicate even if they are severely developed (cf. Kusch & Petermann, 2001). The latter also applies to the delimitation of “language disorders” and “elective mutism”.

In general, in addition to the autistic impairment, further impairments can occur comorbidly, such as compulsions, hyperactivity, ADHD and / or affective disorders such as anxiety and depression.

1.4 epidemiology

The prevalence rate for early childhood autism is, depending on the study, 16.8 out of 10,000 people and 8.4 out of 10,000 people for Asperger's (Poustka, 2004 p. 18). The disorder is four to five times more likely to occur in boys than in girls. Parental personality structures or upbringing as predisposing factors as well as a class-specific occurrence of the autistic disorder are no longer discussed today.

According to current scientific knowledge, a cure is not to be expected. However, an improvement in symptoms is possible with appropriate support and communication of compensation strategies.