Kanner and Asperger

Kanner described Donald and ten other children in a 1943 paper entitled, Autistic Disturbances of Affective Contact1. In this initial description of ‘infantile autismʼ, which went on to become a classic in the field of clinical psychiatry, Kanner described a distinct syndrome instead of previous depictions of such children as feeble-minded, retarded, moronic, idiotic or schizoid. In the words of his contemporary Erwin Schrödinger, Kanner “thought what nobody has yet thought, about that which everybody sees.”

The spectrum of clinical conditions labeled autism soon expanded beyond Kannerʼs first description. In 1944, one year after Kannerʼs paper, Hans Asperger described children that he also called ‘autistic’, but who seemed to have high non-verbal intelligence quotients and who used a large vocabulary appropriately. Confusion remains about the distinction between Asperger syndrome and high-functioning autism.

It is remarkable that although Kanner and Asperger were born in Austria and educated in Germany, and both were astute clinicians focused on the same problems, they did not refer to each other. This may, initially, have been due to isolation during the war years, but it does not explain 35 years of silence.

Clinical definitions of autism continue to evolve. The current Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV) includes autism in a broad category of pervasive developmental disorders. This spectrum blurs at the edges with disruptive behavior, communication disorders and intellectual disability at one end, and with behaviors now thought to be normal at the other. Repeated revision and expansion of the diagnostic categories has probably contributed to the gradual increase in the reported prevalence of autism spectrum disorders that has been evident since the mid-1980s.