Autism Progress: Everything isn’t Going to Hell in a Hand Basket

In the midst of the economic crisis facing the nation and the very discouraging employment news, one often gets the impression that things are inevitably and generally getting progressively worse. But sometimes, specific things actually do change for the better. I recently re-read several early articles by distinguished autism experts of their day, that should help us realize that our families’ lives have changed for the better, despite the discouraging news.
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In the 1950s, the so-called “Whirling Test” was proposed to diagnose autism by Lauretta Bender, a highly-regarded pioneering child psychiatrist. “The test was performed as follows: The child stands with his arms extended, parallel to each other, and with his eyes closed. In order that he may be distracted, he is asked to count. The head is now passively rotated to one side as far as possible without discomfort. Reaction is noted and the head is rotated to the other side. The positive response, or whirling, consists of the child's turning his entire body as long as the examiner turns his head. The ne
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gative response consists of a slight rotation of the trunk but the entire body does not turn.” In an article based on collecting actual data comparing children with and without autism, Kramer, (pictured here) Rabkin and Spitzer in 1958 concluded, “The ‘whirling’ response or test has been described as highly specific for childhood schizophrenia (which was what autism was called at the time)…The whirling test cannot be used as a diagnostic sign of mental disease because of the large number of children with mental disease that do not whirl… It appears that in our present state of knowledge, the whirling test isnot a useful test in child psychiatry.” Parenthetically, Kramer et.al. found that many typically developing children DID “whirl” when tested.

Lauretta Bender, a leader in child psychiatry of the era thought there was no difference between intellectual disability and autism. Of Kanner’s work she wrote, “it would appear that the non-speaking autistic child under the age of five years, of Kanner's classification, cannot be differentiated from other mentally retarded or defective children as far as their ability to function intellectually or socially, or as far as their future outcome is concerned. It is not clear what he means by saying that there is
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evidence that autistic children have greater intellectual potentialities, unless he is referring to the family background of his colleagues, professors and intellectual sophisticates who have selected his services.” Bender worked in a state institution and was apparently led to make snarky remarks about Leo Kanner’s patients at Johns Hopkins. Fortunately, the work of Lovaas and many others have demonstrated that autism is not the same as intellectual disabilities and many children with autism with little or no language can learn to communicate.

Louise Despert, a widely regarded expert in child psychiatry wrote, “The first International Congress on Child Psychiatry took place in Paris in July 1937. Only a few articles on the subject of childhood schizophrenia had been published….In contrast, nearly 3
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5 years later, we are confronted with undue popularization….almost vulgarization, reflects gains in knowledge about the disorder and the ensuing dissemination of such knowledge. Regretfully, however, they reflect the spreading confusion about the syndrome formulated in the not too distant past.” Note that when Dr. Despert said “the not too distant past,” she was referring to 28 years after publication of Leo Kanner’s original article characterizing autism.

A year later Leo Kanner, Alejandro Rodriguez, and Barbara Ashenden wrote, “In a long-range follow-up study of eleven autistic children, i
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t could be ascertained that two of them, not differing essentially from the others in their basic initial symptoms, had in their childhood attained a modus vivendi which allowed them to function gainfully in society…. There was nothing in the detailed observations of the patients' childhood development and behavior, nor is there anything in the documented experiences with psychotic children generally, that would offer reasonably sure indicators of prognostic value.”

We certainly have come a long way from the Whirling Test to diagnose autism, and the notion that interest in autism is prematurely vulgar, and autism and intellectual disability are indistinguishable, and somewhat surprisingly, the notion that there were no predictors of the outcome of children with autism, which are now widely recognized. It has been four decades since Louise Despert’s and Leo Kanner’s papers were written (and five since Bender’s) and the progress in the field has been quite stunning. Thank goodness our government has committed resources we have been able to make remarkable progress because dedicated people, parents and professionals, have committed themselves to applying the tools of science to understanding and intervening in autism.

 References

Bender, L. (1959) Autism in children with mental deficiency. American J Mental Deficiency, 64: 81-6.

Despert, JL (1971) Reflections on Infantile Autism. Journal ofAutism and Childhood Schizophrenia, 1, pgs 363-7

Kramer, Rabkin and Spitzer (1958) Whirling as a clinical test in childhood schizophrenia. Journal of Pediatrics 52:295-303