Eur Child Adolesc Psychiatry (2004) 13:201–208 DOI 10.1007/s00787-004-0363-5 ORIGINAL CONTRIBUTION Sula Wolff The history of autism ■ Accepted: 19 August 2003 Abstract Autism remains a fas- some ideas once held with convic- cinating condition, perhaps the tion, were later proved to be un- most prolifically researched of all founded; and socio-political shifts child psychiatric disorders. Its his- as well as research findings have tory yields many lessons: early ac- radically altered our understanding counts of possible autism are, with of the syndrome as well as the care one exception, unclear; the greatest and treatment offered to people contributions to our understanding with autism. have come from individual clini- ■ Sula Wolff, FRCP,FRCPsych (౧) cians and researchers; the concept Key words autism – Asperger 38 Blacket Place and definition of the disorder have syndrome – history Edinburgh EH9 1RL, UK changed greatly over the years; distortions in autism, the increasing evidence of links Introduction between autism and other developmental disorders, as well as the association of autism with specific medical Since its discovery 60 years ago, autism has been puz- conditions. While it was at first thought that autism zling, fascinating and massively researched. It has gen- might be an early form of childhood schizophrenia, by erated two international Journals: The Journal of Autism 1979 this idea had been abandoned. The Journal hence- and Developmental Disorders, which started life in 1971 forth was to be concerned with a wider range of devel- as The Journal of Autism and Childhood Schizophrenia, opmental issues to clarify the similarities and diffe- with Leo Kanner and Stella Chess as its foundation edi- rences between the various distortions of the tors; and Autism: the International Journal of Research developmental process [69]. and Practice which first appeared in 1997.A further two The main aim of the editors of Autism: the Interna- journals dedicated to autism are Focus on Autism and tional Journal of Research and Practice (published in as- other Developmental Disabilities,first published in 1985, sociation with the UK National Autistic Society) was to offering practical articles on care, treatment and educa- strengthen the interface between research and practice, tion for a multidisciplinary readership and The Interna- in the belief that new treatments are often inadequately tional Autism Research Review started in 1987. In 2001 evaluated and that researchers need more regularly to the University of Birmingham in collaboration with the clarify the implications of their findings for practice West Midlands Autistic Society and the Autism Services [40]. Accreditation Programme initiated the journal Good Autism Practice. All this in addition to many publica- tions by parent organizations! Early accounts of children with possible autism Announcing the change of title and scope of the Jour- nal of Autism and Developmental Disorders in 1979, its Surprisingly, in view of its striking clinical features, few ECAP 363 then editors, Eric Schopler, Michael Rutter and Stella early accounts of psychiatric disorders of children fulfil Chess, stressed Kanner’s emphasis on developmental the classical criteria for Kanner’s syndrome. There are 202 European Child & Adolescent Psychiatry (2004) Vol. 13, No. 4 © Steinkopff Verlag 2004 descriptions of conditions allied to autism, and of intel- recording here in some detail a 13-year old boy who may ligent and gifted children and adults who would now be have had Asperger syndrome, he did not describe any diagnosed as having Asperger syndrome. But there is child with classical autism [54]. only one report of autism without associated brain dam- Early accounts of the history of child psychiatry also age, mental retardation, possible developmental lan- fail to mention childhood autism [12, 51, 25]. guage disorder or severe early social deprivation. There has been much speculation about the possible This is Uta Frith’s analysis of the depositions of 29 disabilities of“wolf children”,that is children discovered witnesses in the legal case of Hugh Blair, son of a Scot- in the wild, who had supposedly been reared by wolves tish landowner, who in 1747 at the age of 39 appeared in or other wild animals [59].When found,they were mute, an Edinburgh court for a decision on his mental capac- tended to walk on all fours, were insensitive to cold, and ity to contract a marriage [31, 20]. His younger brother ate only raw foods. Numerous cases were described over successfully petitioned for annulment of the marriage to time,especially in India.Ireland in 1875 thought most of gain his brother’s inheritance. In a beguiling book, enti- them were idiots, who had been abandoned by their im- tled “Autism in History”, written with the social histo- poverished parents and that the idea that cruel animals rian Rab Houston, Frith convincingly argues for a diag- would spare the innocents was an “agreeable myth”[37]. nosis of autism, despite the lack of a developmental But Malson in 1972 dismissed this notion because,he ar- history.All we know is that Hugh Blair had not been ex- gued, how could such backward children survive on posed to early privations or serious illnesses. The their own in the wild [53]? He preferred Tredgold’s idea deficits in his social relationships included tactlessness of “isolation dementia” [72]. and abnormal gaze,although in adult life he was friendly The most celebrated enfant sauvage was Victor, “the and affectionate. There was severe retardation and ab- wild boy of Aveyron”, found naked and covered with normality of language, including echolalia (“he was in scars, in the woods in 1798 aged about 11 or 12. An ear- the habit of repeating simple phrases”) and, while able lier sighting and failed capture when he was 6 is de- to write out the Lord’s prayer faultlessly,when examined scribed by Jean Itard [53].Victor’s fame rests on the ded- on the catechism at school, he would always reply with icated, ingenious and affectionate attempts over a 5 year both question and answer. His obsessive and repetitive period of this young French physician to educate and behaviour included odd motor mannerisms, collecting humanise him [53, 42, 47]. feathers and sticks, always sitting in the same seat in At first, Victor’s gaze was shifting and expressionless; church and insisting that domestic objects retained he was insensitive to loud or pleasing noise and indif- their same place.At the time he was described as lacking ferent to smells,but sniffed at every object; he made only common sense and having a “silent madness”. guttural sounds; did not imitate; attended only to ob- Until then, John Haslam had been credited with antic- jects he wanted; could not climb a chair to reach what he ipating Kanner by 140 years [73].In his “Observations on wanted; and he rocked to and fro.He seemed profoundly Madness and Melancholy” published in 1809, in a chap- melancholy but had outbursts of laughter and re- ter entitled “Cases of insane children”,Haslam described sponded with joy to the sun,a bright moon,the snow.He a boy of nearly 7 who had had infantile convulsions, se- was gluttonous, although at first eating only acorns, vere measles as well as a small pox inoculation. He was potatoes and raw chestnuts. Itard devised a carefully slow to walk and very late to talk.In hospital he was rest- graded behavioural programme whose goals were first, less and inattentive, but curious about his environment, to help Victor form social attachments, then to awaken and he lied to cover up misdeeds.He had a poor grasp of his nervous sensibilities,to extend the range of his ideas, distance, attempting to reach the ceiling. When seen and finally to induce speech via imitation. Victor had a again at 13 his language had progressed but he spoke of good memory and a great sense of order. Within 9 himself in the third person and pulled his mother’s arm months he was able to match letters of the alphabet. At to gain her attention. No echolalia or abnormal gaze are this time he had one convulsion. Five years later, he had recorded.He recognised Dr Haslam and was friendly.He learnt to distinguish emotions expressed by different was solitary (watching other boys at play,but never join- tones of voice; he had become genuinely affectionate ing in) and had a number of obsessive preoccupations and loved helping people; he enjoyed his lessons; used (he loved going to church,without understanding its pur- objects imaginatively; could bring objects whose names pose; he never used a closet, only a bowl as when he was were written down and could ask for things in primitive in hospital; he talked only about toy soldiers and loved writing, but his spoken language never progressed be- martial music) [26].Vaillant,rightly,suggested the possi- yond meaningless monosyllables. bility of a post-encephalitic syndrome [73]. Itard thereafter devoted his life to the education of Henry Maudsley in his 1879 edition of The Pathology mute children, both deaf mute and children with hear- of Mind,includes a chapter on “The insanity of early life” ing, and he devised teaching methods still relevant to- which was greatly respected by Kanner.Although Maud- day in the education of children with autism and with sley mentioned affective insanity and moral insanity, other language and intellectual disabilities. S. Wolff 203 History of autism John and Lorna Wing held “there can be no doubt verely retarded children, whose clinical picture is ob- that Victor was autistic” [78, 81]. This view is shared by scured by prolonged institutionalisation. One mute boy Uta Frith [20] and others. Itard worked for over 20 years once uttered a complete and pertinent sentence under with 40 language disabled children whom he distin- stress, a feature of autism described by Kanner [41].