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Here we present a brief outline of the two principal clinicians, their original work and how this connects to current diagnostic criteria for autism today. As you read this outline you will realise how far we have moved on in common understandings about autism as understanding and acknowledgement of autism and its characteristics has developed markedly since the days of early recognition by Kanner and Asperger. Contemporary understanding recognises that the autism spectrum is wide and diverse with many factors within a person’s personality and profile of competences influencing how they present as an individual. Colleagues in the autism community commonly remark within the world of autism that once you’ve met one person with autism; you’ve met one person with autism. The message for professionals must therefore be – recognise difference and diversity and adopt a strengths based approach.
In America in 1943, Leo Kanner, a psychiatrist at Johns Hopkins Hospital in Baltimore, Maryland described in his paper Autistic Disturbances of Affective Contact cases of children with similar characteristics sent to his clinic. He grouped the symptoms and gave them them a common name of early infantile autism. In his original description, Kanner noted that in most cases the child’s behaviour was abnormal from early infancy. He suggested this was an “inborn”, genetic disorder.
In Europe meanwhile, a Viennese physician, Hans Asperger, described young boys of normal intelligence and language development, who also exhibited autistic-like behaviours and deficiencies in social and communication skills. His paper was published in 1944 in German, but was not translated into English until relatively recently . Symptoms described by Asperger include the DSM-IV’s three diagnostic criteria for autism.
Whilst Kanner reported that 3 of his 11 patients did not speak at all, and the remainder rarely used language, Asperger noted that his patients spoke ‘like adults’. Kanner also reported poor motor coordination but good fine motor skills whereas Asperger observed that both were affected. Kanner described impairment in social interaction and communication, and restricted, repetitive, and stereotyped patterns of behaviour, interests, and activities. Asperger’s cases were reported to have special interests, fixations and stereotyped play activities and movements, including ritualised behaviours. Intelligence, according to Asperger’s description, encompassed all levels from high intellectual ability to learning disability.
Asperger’s publication, however, received little attention outside German-speaking countries and since international access to his work was limited was undoubtedly eclipsed by Kanner’s description. In England, Lorna Wing was the first to use the term Asperger’s syndrome in 1981. Kanner and Asperger’s syndromes are currently seen as different parts of the same autism spectrum. Social challenges along with restrictive and repetitive behaviours and interests are required by the DSM-IV for diagnosing both autism and Asperger’s syndrome. The main differences between the two are thought to be in language and intellectual development: people with Asperger’s syndrome will normally not have had delayed language development in early childhood.