A Brief History of ASD

Paul Eugen Bleuler (Switzerland, 1911) first used “autism” medically to describe “detachment from reality, together with the relative and absolute predominance of the inner life”, framing autism as a symptom of childhood schizophrenia. Today, we know that autism is not the same as childhood schizophrenia. However, at the time, children with autism were commonly diagnosed with childhood psychosis or childhood schizophrenia.

Grunya Sukhareva (Russia, 1925) independently described children with many traits that match modern autism spectrum disorders. Despite being translated into German in 1926 and into English in 1996, Sukhareva’s studies were largely overlooked by the medical community in the West.

Today, the father of the medical description of Autism is recognized to be Dr. Chaskel Leib (Leo) Kanner. He was born in Austria in 1894, and at the onset of World War I, Kanner served in the medical corps of the Austro-Hungarian army. The experience sparked his interest in medicine, and later, he completed his education at the University of Berlin in 1921. Kanner moved to the United States in 1924 with his family, and then in 1928, he moved to work in the Henry Phipps Clinic at Johns Hopkins University, where he established the nation’s first academic department of child psychiatry in 1930.

He noted that individuals experiencing social withdrawal, insistence on sameness, language differences, echolalia (repetition of words just spoken by another person), and sensory issues were distinct from those who suffered from schizophrenia.

If you want to learn more about Leo Kanner, please consider reading the review penned by Angela Hamidi, Nadiya A Persaud, Latha Ganti, and Leila Keeler.

Today, our understanding is that autism is caused by your brain developing differently. There is less focus on a cure, as we understand that it is not an illness. Modern treatment programs focus on providing autistic individuals with the support they need for a better quality of life and social inclusion.

What are Common Autism Symptoms?

By the 1980s and 90s, the diagnostic criteria for autism were refined and standardized, with the adoption of diagnostic frameworks like the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases by the World Health Organization (ISD).

The definition adopted by the WHO ISD reads:

“A type of pervasive developmental disorder that is defined by:

(a) the presence of abnormal or impaired development that is manifest before the age of three years, and (b) the characteristic type of abnormal functioning in all the three areas of psychopathology: reciprocal social interaction, communication, and restricted, stereotyped, repetitive behavior.

In addition to these specific diagnostic features, a range of other nonspecific problems are common, such as phobias, sleeping and eating disturbances, temper tantrums, and (self-directed) aggression.”

An expanded entry can be found here.

The definition adopted by the “Diagnostic and Statistical Manual of Mental Disorders” (Fifth Edition, Page 50) reads:

"Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive):

1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.

2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language, or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.

3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.”

An archived version is available on the Internet Archive platform here.

Who Is Qualified to Diagnose Autism in Children and Adults?

If you are an adult, please speak with your GP, who can refer you to an autism assessment team. ASD is recognized as a spectrum and can vary in presentation among individuals. Since Autism encompasses challenges in social communication and interaction and restricted repetitive behaviors, the assessment is carried out by a multi-disciplinary team. You will likely be directed to work with clinical psychologists, psychiatrists, and other autism specialists. The assessment team will have to work through your developmental history, current behavior, and collateral information.

If you have a child that you need tested for ASD, please work with your GP, preferred pediatrician, child and adolescent psychiatrists, clinical psychologists, and speech and language therapists who are commonly involved in childhood autism assessments. Your pediatrician is likely to refer you to a specialist in child development or neurodevelopmental services for a formal assessment. Assessment teams collect developmental history from caregivers, observe the child, and consult teachers and other informants. This helps them form a diagnosis using standardized tools plus clinical judgment.

Validation studies show that screening questionnaires help identify individuals who may want to receive full assessments, while multidisciplinary diagnostic evaluation remains the gold standard for accurate detection and differential diagnosis.

Online Autism Test—Does It Work?

Validated screening questionnaires such as the Autism Spectrum Quotient (AQ) are offered online as an initial step. These tests are not substitutes for the assessment from qualified medical professionals. There are a few online test tools that can be your first step in testing yourself or your child for ASD. We will reference a few helpful starting points:

“Autism Speaks” offers several online tools for ages 12 to 60 months and for ages 16+ years that you can find at www.autismspeaks.org/autism-screening. These are available only in English. Fortunately, the University of Cambridge Autism Research Centre offers an autism spectrum questionnaire in 45 languages. Their test is customized for adults, so keep that in mind. More versions of the test can be accessed through “Embrace Autism” if you are interested.

Private clinics offer full diagnostic assessments if you prefer or face long public wait times, and you need a faster decision for work/benefits/education purposes. We will list a few notable private clinics in Canada, the US, the UK, and Ireland:

• If you are in Canada and need a private assessment service, then you may want to contact "Monarch House" and the “Red Path Centre”.
• If you are in the US, you may consider contacting “The Owl Centre” and the “ABA Centers of America”.
• If you are based in the United Kingdom, you could reach out to the “National Autistic Society” and “Psicon”.
• If you are based in Ireland, you may want to reach out to the “Autism Assessment Centre” and the “AsIAm” charity.

Recommendations

The American Academy of Pediatrics (AAP) recommends that all children be screened for autism at ages 18 and 24 months, along with regular developmental surveillance. Toddlers and children should be referred for a diagnostic evaluation when screening or developmental surveillance indicates an increased risk for developmental disorders, including autism. Autism spectrum disorder (ASD) is a common neurodevelopmental disorder with reported prevalence in the United States of 1 in 59 children (approximately 1.7%), says a clinical report from January 1st, 2020, in the “Pediatrics” journal, Volume 145, Issue 1. If you suspect that you may have symptoms, please check with your GP and maybe do the online test while waiting for an appointment.

Treating Autistic Individuals

As mentioned above, ASD is recognized as a spectrum and can manifest differently among individuals. A family history of autism spectrum disorder, communication disorders, or specific learning disorder appears to increase the risk for social (pragmatic) communication disorder. Medical professionals commonly recommend the following approaches to treat autistic individuals:

• Help with developing daily living skills.
• Assistance with developing communication skills.
• Medication or therapy to treat other conditions, such as anxiety.
• Conduct speech and language therapy.
• Encourage participation in support and friendship groups.

We hope this article was useful in helping you understand how testing for Autism works and how to find help. Please, remember to check our blog for more useful articles!