Many written documents in the field of philosophy, psychology, history, and medicine have reached to our day. People have had time to make long observations. Many diseases and disorders have been defined for almost 1000 years and various treatments have been tried. But no child with autism has been identified. Although there are historical personalities similar to the syndromes which are now called Asperger syndrome, the definition of autism has not been made until a century ago.
We know that Socrates did not like bathing, did not empathize with people, did not have emotional ties with his family, and was indifferent to the death penalty. But he was a master in using the language. Similarly, it was noted that Michelangelo and Mozart had repetitive movements and that they were not interested in anything other than their work.
However, the case of mild autism to severe autism, which we can see as one of the common disorders that we often encounter today, was first reported in the early 1900s.
First, autism was defined by Kanner in 1943 in medical writing as a chronic disorder with core symptoms such as restricted and repeating behavior patterns, impairments in socialization, problems in verbal and non-verbal communication. Following Kanner’s definition of autism, so far, biological, psychological and clinical research has changed the viewpoint of the disorder.
Earlier it was thought that autism was caused by the parents’ attitude, lack of love, or having fear of establishing and maintaining social relationships. For the last 20 years, the notion that autism is not related to the child’s upbringing or child’s past life and has a neurobiological etiology has gained importance.
In today’s world, many diagnostic systems are used in order to diagnose autism spectrum disorder. The common feature of these systems is that they emphasize that there should be a lack of three competencies to diagnose autism.
Autistic symptoms and treatment have been described long before the name of autism has been established. One of Martin Luther’s works has a 12-year-old boy who may be severely autistic. A wild child caught in 1798, Victor from Aveyron, showed various signs of autism. Jean Itard, a medical student, treated the child with a behavioral program that enabled him to establish social bonds and make speeches through imitation.
The first writings on the behavioral characteristics that recall autism date back to the 18th century. In the 1700s, Jan Itard in France and Jon Hâlsam in England started to talk about autism. These scientists have studied autism and named individuals with autism as different individuals without any diagnosis or sometimes named as crazy.
Despite some very clear definitions of autistic behavior by some early writers, no one has established a link between individual cases until the last half of the 19th century. First, in 1867, Maudsley described some children who had very strange behavior as crazy. Although initially shocking, Maudsley’s ideas on mental health were accepted.
In the first half of the 20th century, the term childhood psychosis came into use, and those working in the field of abnormal child development began to identify subgroups.
The term “autism” was first used in 1911 by Swiss psychiatrist Eugen Bleuler. He used this term as a result of the findings in some schizophrenia patients, which is not associated with autism today. The terms autism and autistic are derived from the word “autos” in Greek, meaning self and essence. Bleuler has used the term autistic for individuals who have completely isolated themselves from the outside world. Also, he used the word as the meaning of a person’s adorable admiration for himself/herself.
Autism was defined as a symbolic inner life of individuals and it was not readily accessible to other people in the environment. Experts related to autism in Britain used the word autism with this meaning throughout the 1920s and up until to the 1950s.
On the other hand, it was thought that autism was caused by gluten in the 1920s and some diets were started to be applied for individuals with autism. During the 1920s, autism was taught as caused by toxic dietary factors and thus can be treated with the changes in a child’s diet. Although the exact biochemical dietary factors and nutrition recommendations have changed since then, some autism researchers are still utilizing strict restrictive diets in the treatment of autism.
In 1922, Piaget took everything one step further with his theories. He claimed that pre-verbal stages of a child’s thought could be defined as autistic behaviors or symbolic. He claimed this argument because of drawing from Bleuler and Freud.
Piaget claimed that autistic thinking and symbolic thinking are characterized by the same features. These features were the absence of logic, the visual images being dominant over conceptual thinking, and the awareness of the possible connections between visual perceptions. He also linked the concept of autism directly to the child’s efforts on progressive reality.
In 1930, autism defined as infant dementia by Heller, stating that the severe regression was accompanied by stereotypes, unrest, and loss of speech. Moreover, in the 1930s, electroconvulsive (ECT) method was used to correct these behaviors on some of the autism sufferers. With this method, it has been tried to prevent individuals with autism from harming themselves.
Because of its association with severe psychiatric and psychological illnesses, electroconvulsive therapy (ECT) was one of the first treatment approaches for autism, in that time. However, even though there are arguments and debates about the usage of ECT, it is still used.
In the 1940s, autism was used for children with mood disorders and who had problems in communication. Also in those years, as Leo Kanner treats autism as a different developmental disorder, autism has been studied in depth as a developmental disorder as the first time.
Leo Kanner claimed that he had identified a unique psychological disorder in children characterized by extreme autism, obsessiveness, stereotypy, and echolalia. He referred to this as inborn autistic disturbances of affective contact.
The first articles on autism, Autistic Disturbances of Affective Contact, were published in 1943 by Leo Kanner, who was a children’s psychiatrist living in the United States of America, as a result of his first examinations on 11 children. He defined autism as the lack of communication, adherence to objects, the desire to repeat the same thing that occurred before 30 months.
In his report, he first used the term ‘early infantile autism’. Almost all of the features described in the first article of Kanner, especially insistence on sameness and autistic aloneness, are still seen as typical features of autistic spectrum disorders.
The classic definition of Kanner’s children in the younger age group was as follows; social distance, lack of speech or echolalia, a unique form of speech, intense resistance to any change by maintaining their own detail-oriented repetitive routines, a discrete ability in visual-spatial or memorization memory, but a general delay in learning.
Kanner emphasized the attractive, shy and intelligent-looking appearance of these children. This behavioral pattern, which he named as early childhood autism, was unique and thought to be different from all other childhood disorders.
In addition, In 1944, Hans Asperger, who lived in Vienna, Austria, used the term autism in order to identify the most prominent features of the disease in children with similar characteristics in a pediatric clinic. In these years, it was thought that there was a connection between schizophrenia and autism. His work described the milder form of autism, and now mild autism is called Asperger’s syndrome.
Asperger described the features he saw in older children and adolescents in a German article published in Vienna as follows; naive, non-conformity in social interaction, good language skills, but using this skill as a monologue for their particular interests, speaking with a monotonous tone and not using body language, intense occupation in their restricted areas of interest and mostly poor motor coordination, intelligence levels seen as mentally retarded, normal and superior intelligence, there were often special learning difficulties.
His work was introduced to the field when other researchers and experts, who were interested in autism, started questioning the diagnostic criteria that were used at the time. Asperger’s work made a huge difference in the way people have come in order to view and understand autism.
The reason why Kanner and Asperger’s articles are still very popular in today’s world is that they can identify children with very strong details. The children came to life on the pages of their articles. Although both Kanner and Asperger thought that their syndromes, they described, were special and unique, we now know that the syndromes they describe overlap each other, and many children have a mixture of both conditions.
Kanner claimed that children’s condition due to cold, indifferent, perfectionist mothers and fathers who treated their children as officials of a machine. He stated that almost all of the children’s parents he saw were graduated from university and they had an occupation. He thought these children were potentially normal and well-minded but emotionally damaged and he strongly believed that there was no physical pathology in the brain.
Kanner’s ideas have been widely accepted by professionals and even parents. The results were frightening. Parents were blamed by a feeling of guilt, blaming each other and getting a divorce. Some families paid large amounts of money for long-term psychoanalytic treatment for their children. Of all these, the children suffered a lot of harm because they did not receive training and assistance as they needed.
Freud’s theory and other psychoanalytic approaches developed in Europe in the early 20th century and they were very influential in America during and after World War II. In spite of the fact that Kanner thought that genetic factors play a role in autism, he was also influenced by psychoanalytic theories.
In the 1950s, Bettleheim put forward an opinion that autism was due to the cold and indifferent mother. Today, they are described as refrigerator mothers. Back then, refrigerator mothers were responsible for observing symptoms in children. It was assumed that deficits in children’s functioning were linked to poor attachment or absentee parenting. Many parents experienced great shame for having a child with autism, because of the fact that they were often blamed for their children’s disorders.
Due to refrigerator mothers and lack of parental care, back then, parentectomy was used as a common treatment approach for autism. Parentectomy means that entailed separation of children from their parents for an extended period of times.
However, this view is completely devoid of the scientific basis and has been lost in time. In spite of the fact that there were autism-like symptoms in children who were exposed to unrelated family or intensive TV, they were found not to be sufficient to diagnose autism.
In 1952, DSM-I (The Diagnostic and Statistical Manual of Mental Disorders 1st edition) was referred to as a type of childhood schizophrenia from autism. Fortunately, not everyone gave a premium to the theory of autism based on emotional reasons. Some of the experts in this area were talking about a great overlap with mental retardation. Some of them are interested in abnormalities in language development. Others thought that neuropathology should be investigated.
In the 1960s, some medicines and treatment methods have been tried. However, it was not fully understood which treatment helped correct the situation. The rewarding and punishment method was used to correct some behaviors. Also, the first scientific findings of autism emerged in the 1960s.
In the 1960s, new expansions began to open up new ideas. There were two main reasons why this was so. First, families who opposed the psychoanalytic approach came together and began to establish family associations. These institutions became widespread and played an important role in determining the needs of families and children in changing opinions about autism. The second reason was the introduction of more rigorous scientific studies.
For example, in 1964, Bernard Rimland published the first scientific foundations of autism as a biological origin. He has also established a non-governmental organization for autism which was the American Autism Association. In 1966, Andreas Rett published an article describing the Rett syndrome.
Articles about autism before 1960 were mostly based on clinical case studies. In 1966, Victor Lotter made a major contribution to scientific studies on autistic disorders. In England, he initiated the first epidemiological study of Kanner’s autism.
As the most important descriptive features (the most important ones) which they were used; distance from sociality, indifference to others, resistance to change of their repetitive routines. Michael Rutter began his autism studies in the 1960s. He and his colleagues described the clinical characteristics of children in detail, investigated the profiles of intelligence tests and followed adolescence and adulthood.
Following the study of Victor Lotter, various studies have described the prevalence of autism. Lorna Wing and her colleague Judith Gould conducted a study in London with children with various disorders. They have reached children who were showing any of the autistic features. They are not limited to those who only have typical Kanner autism. As a result, they have developed a broad spectrum of a hypothesis that includes autistic states, and Kanner syndrome was only a small part of it.
In the late 1960s, autism began to be accepted as lifelong. Its difference from mental retardation, schizophrenia, and other developmental disorders was revealed. It was accepted that there was a separate disorder from others by demonstrating the benefits of parental participation in active therapy programs. There was little evidence of the role of genetics in autism until the mid-1970s, but nowadays it is thought that autism is the most hereditary in all psychiatric conditions.
Treatment methods which were used in the 1960s and 1970s consisted of LSD, electric shock and behavioral changes that focused on pain and punishment. Shock therapy and aversive punishment mainstream treatment approach for autism. In addition, Guy Berard developed auditory integration training (AIT) for autism. Even today and even there is no scientific evidence, according to parent’s reports, this method is very effective and that’s why still recommended by experts.
AIT is based on the theory that aggressive behaviors in children with autism are caused by hypersensitivity to sound. The treatment involves exposing the child to a random variation of sounds. The belief is this therapy will make the individual used to different auditory inputs and therefore perceive them as normal.
With mental retardation (IQ below 70), the distribution of children with autistic spectrum disorder was determined to be 20 in 10,000. In the 1980s, Christopher Gillberg put forward the hypothesis that the autistic spectrum is only one of the disorders with which there is a lack of empathy.
In 1971, Eric Schopler developed the TEACCH, Treatment, and Education of Autistic and Related Communication Handicapped, program at the University of North Carolina. It is also known as structured instruction. The physical environment is configured, events are predictably arranged, visual plans that can be followed are prepared and structured workspaces are used. Dependencies to others are trying to minimize.
In1972, Michael Rutter who was a child psychiatric researcher from the United Kingdom conducted the first genetic study of autism. According to the study, he claimed that child with autism has a deficiency of fantasy rather than an excess. After that point, the meaning of the word autism was reformulated. It became a description of someone who fantasized excessively to one who did not fantasize at all.
After a period of silence of about 10 years, in 1977, Susan Folstein and Michael Rutter published the first paper on the genetic basis of autism, in which they conducted a study of twins. Research on twins found that autism was largely caused by genetics and biological differences in brain development.
After these newly developed researchers and results, in the late 1970s, pharmaceutical treatments for autism became the main treatment method.
In 1980, schizophrenia and autism have been accepted as two different disorder. Autism in DSM-III (The Diagnostic and Statistical Manual of Mental Disorders 3rd edition) was discussed under the umbrella of pervasive developmental disorder, and the term “infantile autism” was used for the first time for behaviors that occurred before 30 months.
Thanks to DSM-III, the condition which was autism was officially separated from childhood schizophrenia. Moreover, behavioral therapy has been introduced and started to apply.
The term “autistic disorder” was used in the DSM III – R, a revision of DSM III published in 1987, in which the term infantile autism was changed. There are 16 criteria for diagnostics. In 1988, the Childhood Autism Rating Scale (CARS) was developed by Eric Schopler and his colleagues.
Childhood Autism Rating Scale (CARS) was based on the observation of behaviors of the child with autism. Children’s relationships with other people around them, using their bodies, adaptation to changes, listening to others, and verbal communication are evaluated on a 15-point scale.
In addition, in 1988, “Rain Man” which was a movie was captured. Dustin Hoffman played a man with savant syndrome with autism who has a photographic memory and can calculate the huge and complex number in his head. This movie was important in order to gain an understanding of autism in public. The only drawbacks that the movie gave the people is that although every individual with autism spectrum disorder has completely different kinds of skills, the movie gave an idea that everyone on the spectrum shares the same skills.
In the 1990s, improvements in understanding the causes of autism and related neuropathology were recorded. Michael Rutter and his colleagues pointed out the importance of genetic factors in autism. In addition, psychological aspects of autistic disorders – including abnormalities in communication and language – were examined.
The first scientific diagnosis and classification studies were published in the early 1990s. In the 1990s, therapies were started to be implemented in cases where children could not establish eye contact. In 1991, Catherine Lord, Michael Rutter and Ann LeCouteur published the Autism Diagnostic Interview. In 1992, the American Psychiatric Association clarified the criteria for the diagnosis of autistic disorders in DSM-IV.
In DSM-IV; issues such as autistic disorder, Asperger disorder, disintegrative disorder, Rett disorder, Pervasive Developmental Disorder, and Not Otherwise Specified Developmental Disorder have been mentioned frequently and contributed to the formation of today’s definition of autism.
A similar classification was proposed by the World Health Organization in 1993 which was ICD10: International Classification of Diseases. ICD 10 is an international classification system for diseases and health problems. It is formed by a very detailed description of known diseases and disorders.
In 1994, the criteria for the diagnosis of autistic disorders in the DSM-IV guidelines were clarified. Also, Asperger’s syndrome is added to the DSM in 1994, expanding the autism spectrum to include milder forms in which individuals tend to be more highly functioning.
The first biomedical studies such as diagnosis and classification studies began in the 1990s. For example, in 1994, the National Alliance for Autism Research in the United States was established and the first biomedical research on autism was initiated in the United States. As a result of several studies conducted over a period of ten years, genomic regions which are thought to carry genes that may be associated with autism have been identified.
Uta Frith and her friends have shown that children have difficulties in understanding the minds of others. Simon-Baron Cohen and their colleagues in 1996 developed a short study that identified autism in 18-month-old children. The basis of this review relies on the ability to participate in common interest and symbolic play. They stated that they reached the age of fairy tales and myths, psychoanalysis and finally the practical realism of today.
As a result of the studies conducted by Lorna Wing and her friends in London, it was revealed that different symptoms of autism were not found together by chance. As a result of these studies, the three most important features in autism was revealed, which are communication, imagination, and lack of socialization.
Nowadays, the existence of a broad autistic spectrum including Kanner and Asperger syndrome is accepted. The whole was combined when three disorders of psychological functioning were present. These are social interaction, communication, and imagination. The activity pattern of the person in the presence of this triple disability is solid, narrow and repetitive. Research and clinical studies show that there is a social dysfunctioning on the basis of this triad.
In the last published version of DSM which is DSM-V, it is defined as social-communicative disabilities and repetitive behaviors. The definition accepted today is based on a neurobiological defect that is thought to be caused by the brain and nervous system having different congenital structures and functions.
In today’s world, the term “autism spectrum disorder” is used for autism. Some assessment tools have been developed to understand and determine the current situation. Applied behavior analysis and psychological therapies have been implemented. It is interesting to know that, now autism is one of the fastest-growing developmental disorders in the United States.
Autism is now referred to as autism spectrum disorder. This is because there are 5 different disorder that is all under the umbrella of autism spectrum disorder. All of them have different symptoms as well as different severities. However, Obviously, they are related enough to be categorized together. These five disorders were all brought under autism spectrum disorder in 2013.
After that point, Asperger’s syndrome is no longer considered a separate condition. It is added under the umbrella of autism spectrum disorder. Autism is defined by two categories. One is impaired social communication and interaction. Another one is restricted and repetitive pattern of behaviors.
What is needed now is research on the neurological basis of social instinct in autism and normal development. Autism may be observed alone or may be combined with other physical and psychological disorders. The level of intelligence within the range varies from low intelligence to superior intelligence.
The situation in the adult period is closely related to the skill level in childhood. Only those with normal and superior intelligence are likely to continue their future life independently. However, regardless of skill levels, training is required in order to improve the quality of life of those suffering from this condition which is autism spectrum disorder.
Although there are still unclear points for children with an autism spectrum disorder, it is much more understood than before. Now many children with autism can be educated easily with the help of the state, government and with their own means. Although the treatment of this disorder is not possible until now, we have enough knowledge about training methods, setting up the environment, increasing skills and reducing negative behaviors.
Autism is a disorder that usually manifests symptoms before the age of 3 and adversely affects the social communication, interaction and behavior of individuals. According to the latest research conducted in the United States, it has been determined that autism has started to be observed in 1 of 59 births and today it has become one of the most researched subjects.
With the emergence of parental organizations and the collapse of the social stigma of childhood autism, the implications for the effects, limits, and treatment of autism spectrum disorder have been greatly influenced.
The Global Network has helped individuals with an autism spectrum disorder in order to participate in online communities and work remotely, regardless of the non-verbal signs and emotional sharing they have had difficulty dealing with. The sociological and cultural aspects of autism spectrum disorder have improved. Some of them in the community seek a cure, others believe that autism is only another way of being.
Our hope is to find effective methods in the prevention and treatment of a severe form of autism spectrum disorder and to determine the exact causes. For those with high functioning autism, our hope is to develop their special abilities and ensure that they can live their lives in a satisfactory way.
In recent years, remarkable awareness studies on autism spectrum disorder have been carried out. These efforts aim at the prevention of autism, creating positive attitudes towards people with autism and providing the necessary services.