Running Head: Historical Perspective of ASD

The Examination of our Historical Perspective of Autism Spectrum Disorder

Leora Fisher
University of Calgary
August 13, 2013

Running Head: Historical Perspective of ASD

Introduction
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized
by impairments in reciprocal social interaction and communication skills, abnormal
language development and restricted repertoire of behaviour and interests (American
Psychiatric Association, 2000). From the early 1900s, ASD was referred to a range of
neuro-psychological conditions. However, the term autism, which has been in use for
approximately 100 years, comes from the Greek word autos, meaning self
(Fombonne, 2003). The term describes a condition in which a person is removed from
social interaction (Fombonne, 2003). Eugen Bleuler, a Swiss psychiatrist, was the first
person to use the term autism (Klinger, Dawson, & Renner, 2000). He started using the
term in 1911 to refer to one group on symptoms of schizophrenia (Rutter, 1968). Due to
this ASD and schizophrenia remained linked in many researchers minds until the early
1960s (Fombonne, 2003).
In the 1960s through the 1970s, studies into treatment for ASD focused on
psychiatric medication, electric shocks, and behavioural interventions (Fombonne, 2003).
Behavioural interventions frequently included pain and punishment. During the 1980s
and 1990s, the role of behavioural interventions and the use of highly controlled learning
environments developed as the leading treatment for individuals with ASD. Presently, the
basis treatment for individuals with ASD include behavioural and language intervention.
In the past ASD was believed to be a rare disorder, which affected less than 10 in
10 000 individuals (Klinger et al., 2000). Nevertheless, in the early 1900s research in the
area of autism greatly increased as a result of the efforts of the National Alliance for
Autism Research (NAAR) and Cure Autism Now (CAN). These groups persuaded

Running Head: Historical Perspective of ASD

research groups to address the causes and treatments relating to ASD.

Currently, the Centers for Disease Control and Prevention estimates that
approximately 1 in 88 children have been identified with an ASD. In addition to the
physical and emotional toll ASD children has on a family, data from the Autism Society
indicates that the estimated lifetime cost of an individual diagnosed with ASD is
approximately $3.2 million (Amaral, 2011). Behaviour intervention and therapy for
children can cost between $40, 000 to $50, 000 per year (Amaral, 2011). Caring for an
adult with ASD in a supported residential setting can cost $50,000 to $1000, 000 per year
(Amaral, 2011). Due to the increase rise of children being diagnosed with ASD and the
financial and societal costs associated with ASD there has been an impetus for continued
research into the treatment and causes of ASD.
Our understanding of ASD has undergone several changes in terms of our
comprehending of the causes and treatments for children diagnosed with ASD. Our
knowledge will continue to evolve as current and future research continues. This paper
will examine the historical view of ASD, and will examine how current research shapes
both interventions and treatment plans. Lastly, this paper will provide further insight into
our changing understandings as school psychologist of individuals diagnosed with ASD.

Evolution of Autism Spectrum Disorder

Autistic symptoms and treatment were described long before autism was
recognized and deemed as a developmental disorder. The Table Talk of Martin Luther
contains an account of a young boy who may have been severely autistic (Rutter, 1968).
Luther reportedly classified that the young boy was a soulless mass of flesh that was
possessed by the devil (Rutter, 1968). In 1748 the earliest well-documented case of

Running Head: Historical Perspective of ASD

autism is that of Hugh Blair of Borgue, which was a court case in which his brother
successfully petitioned to annul Blairs marriage to gain Blairs inheritance (Rutter,
1968).
The term autism first took its modern sense in 1939 when Hans Asperger of the
Vienna University adopted Bleulers terminology autistic psychopaths in a lecture
about child psychology (Eisenberg, 1957). In 1943 Leo Kanner, then a director and
psychiatrist of Child Psychiatric Clinic of the John Hopkins Hospital in the United States,
published a paper Autistic Disturbances of Affective Contact describing a rare and
unusual psychiatric condition of children which he later coined Infantile Autism
(Eisenberg, 1957). While working with eleven children with striking behavioural
similarities he believed that he had discovered a new class of childhood disorders, that
had not been detected before and that could be distinguished from the already existing
ones. According to Kanner one characteristic of all these children is their inability to
relate to people and situations from the beginning of life (Eisenberg, 1957). Kanner
reports parents as referring to their children as always having been self-sufficient, like
in a shell, acting as if people were not there (Eisenberg, 1957). As describes by Kanner,
these characteristics also included delays in the acquisition of speech together with
language abnormalities. Kanner also reported that many of these children had excellent
rote memory, but had an obsessive need for routine.
Leo Kanner was at the foreground of both research and treatment for children
with autism. He began to hypothesize as to the etiological roots of autism. Kanner placed
great emphasis on the emotional coldness and focused on maternal deprivation, which
led to misconceptions of autism as an infants response to refrigerator mothers (Rutter,

Running Head: Historical Perspective of ASD

1968). Kanner believed that some type of innate defect, combined with parental
deprivation was responsible for the onset of autism in children (Kanner, 1943). The
emotional coldness that he described was often attributed to the primary caregiver at the
time. The term refrigerator mother was coined around the early 1950s; during this time
mothers were often blamed for their childrens atypical behaviour (Rutter, 1968). The
term of refrigerator mother was still frequently used into the mid 1980s when advanced
research into the neurodevelopmental roots of autism dispelled that false representation.
A number of studies during the 1980s built on the theory, indicating that ASD is
primarily due to psychogenic reasons.
During this time many psychiatrist and psychologist believed that childhood
autism fell under the same umbrella as mental retardation, schizophrenia, and psychosis.
Therefore, many researchers wanted autism to be classified under a more general term
(Rutter, 1968). Nevertheless, there were an increasing number of researchers and medical
doctors that were advocating that autism needed a separate and distinct category to other
mental illnesses. At this time researchers started to hypotheses as to the causes of autism.
Some researcher and doctors believed that autism was due to organic brain disease or
brain damage occurring in-utero or during the birthing process (Rutter, 1968). While
other researchers believed that autism was the caused by either an overactive or
underactive reticular system (Rutter, 1968). Some studies indicated that autism behaviour
was the cause of a deficit in sensory perception (Rutter, 1968). Nevertheless, many
studies concluded that autism was a form of mental sub normality, and could be further
divided into organic and psychogenic varieties (Rutter, 1968).

Running Head: Historical Perspective of ASD

Barnard Rimland was another influential autism researcher during the 1960s. He
overturned conventional theories about the origin of autism and later forced researchers
and policymakers to consider alternative causes and treatment of autism. Rimland was
psychologist and a father to a son with autism. When Rimlands son was diagnosed with
autism, doctors blamed the disorder on emotional cold parenting and distant mothering.
In his book Infantile Autism: The Syndrome and Its Implications for a Neural Theory
Behavior, Rimland disproved the cold-mother theory by providing evidence that the
disorder is rooted in biology (Amaral, 2011). Rimland suggested that if some of the
comorbid conditions, such as epilepsy, were due to neural dysfunction, there was no
reason not to think that the core features of autism might be due to dysfunction of the
nervous system (Amaral, 2011). Rimland also developed the first checklist for
diagnosing autism and was among the first scientists to recognize that a brand of
systematic rewards and punishments could lead to significant improvements in children
with autism. This new understanding of autism served as the drive force for a new
generation of research in autism.
Diagnostic Criteria for Autism Spectrum Disorder
The criterion needed for a diagnosis of autism has changed over the years. Autism
was first included as a separate category in the Diagnostic and Statistical Manual of
Mental Disorders third edition (DSM-III) in 1980 when it was called infantile autism.
This was later changed to autistic disorder in 1987. Aspergers syndrome was added
into the DSM-IV in 1994. One of the most significant changes in the DSM-V is the
separate diagnostic label of Autistic Disorders, Aspergers Disorder, and Pervasive
Developmental Disorder Not Otherwise Specified (PDD-NOS), which is replaced by

Running Head: Historical Perspective of ASD

Autism Spectrum Disorder. Further emphasis on the severity of the disorder is given
through a classification system of three levels. The severity levels are based on the
amount of support needed, due to challenges with social communication and restricted
interests and repetitive behaviours. For example a child might be diagnosed with Autism
Spectrum Disorder with a level 1 (Requiring support), level 2 (Requiring substantial
support) or level 3 (Requiring substantial support). Finally, the removal of the formal
diagnoses of Aspergers Disorder and PDD-NOS is a major change in the DSM-V. People
who currently hold these diagnoses will likely receive a different diagnosis when reevaluated.
Numerous hypotheses have been suggested as a likely underlying cause of ASD.
Researchers have been evaluating five different possible information-processing
impairments in ASD: theory of mind, memory, attention, abstraction, and executive
functioning (Klinger et al., 2003). In addition, some researchers have examined
biological and etiological factors related to the development of autistic disorder. Such
findings have dispelled the myths that the development of ASD is linked to social factors
and child rearing. Today, the emphasis has shifted by determining the biological and
genetic markers with the objective of making early diagnosis and intervention the main
goal.
The Diagnostic Assessment of Autism Spectrum Disorder
Screening instruments are typically designed to be over-inclusive so that any
potential cases of ASD are identified, however they cannot be a substitute for a thorough
diagnostic assessment, which provides an objective validation of the profile of behaviour
and abilities identified by the screening instruments. Currently there are two diagnostic

Running Head: Historical Perspective of ASD

tests that have been designed for children with autism: the Autism Diagnostic Interview
Revised (ADI-R) and the Autism Diagnostic Observation Schedule Generic (ADOS-G)
(Lord, Rutter & Le Couteur, 1994). The ADI-R uses a semi-structured interview with
information provided by a parent or caregiver and provides a dimensional measure of the
severity of the signs of autism. The ADOG-G is a protocol for the observation of the
social and communication ability associated with autism, with a rating of the quality of
behaviours and abilities.
Obtaining a diagnosis of autism is often difficult even with our growing
understanding and knowledge of ASD. Although the symptoms of autism typically
become apparent by early childhood, they can often be mistaken by other causes.
Unfortunately, this puts children with ASD at a considerable disadvantage as ASD
interventions are more effective when implemented in early childhood (Jonsdottir,
Saemundsen, Sif Antonsdottir, Sigurdardottir, Olason, 2011). Research has shown that
when a child receives a misdiagnosis in the early school years, it is often a diagnosis of
Attention Deficit Disorder (ADHD) (Jonsdottir et al., 2011). Nevertheless, when scores
on a variety of cognitive and adaptive scales are administered to the child with either an
ADHD diagnosis or an ASD diagnosis it becomes apparent that in contrast, children with
an ASD diagnosis generally achieve significantly lower on subtests involving
socialization (Jonsdottir et al., 2011). School psychologists can bring a wealth of
knowledge and understanding to the table and support parents in attaining the appropriate
diagnosis and help in finding early intervention.
Historical Review of Treatment for Autism Spectrum Disorder
In the 1950s school psychologists traditionally had very little to do with

Running Head: Historical Perspective of ASD

designing interventions as most children with ASD were not schooled, but rather put into
special schools. Dr. Bettelheim, head of the University of Chicagos Orthogenic School
for Disturbed Children, agreed with Kanner and believed that the cause of autism was
related to mothers (Herbert, Sharp, & Gaudino, 2002). He used everything a child did and
distorted it to fit his theory. For example, when a young autistic child was obsessed with
the weather he said that the child was actually sensing that her mother did not want her.
Bettelheim broke the word weather down to we/eat/her showing that the child thought
that her mother wanted to eat her (Herbert et al., 2002). With this belief, Bettelheim
developed parentectomy and removed children from their parents. After Bettelheims
death it became apparent that he had fabricated many results and had no formal training
in psychoanalysis (Herbert et al., 2002).
During the 1960s scientists started to investigate the use of Lysergic Acid
Diethylamide (LSD-25), a serotonin-inhibiting drug, as a treatment for autism (Herbert et
al., 2002). The notion behind the drug was that autism was a type of personality trait and
therefore drugs are intended to alter the persons perceptive state (Herbert et al., 2002). A
study by Bender, Goldschimdt, and Siva (1962) tried using LSD as a treatment by giving
a daily maintenance dose. The children that were given the drug were observed to be
overall happier (Bender, et al., 1962). Even though, the study showed positive results it
was very controversial treatment method that was developed before much was known
about ASD.

In the mid 1970s electric shocks therapy was used as a punishment for
undesirable behaviour in children with ASD. When a child with ASD engaged in

Running Head: Historical Perspective of ASD

10

unwanted behaviour the child received a shock to decrease the frequency of that
behaviour. The electric shock was also used in an avoidance contingency where the child
had to obey an order to avoid a shock. Research showed that both contingencies helped
increase positive behaviour and decrease negative behaviour with minimal side effects
(Bender et al., 1962). One positive outcome included that the chid with ASD was able to
generalize the punishment to multiple behaviours (Bender, et al). After such studies it was
believed that the positive side effects outweighed the negative ones (Lichstein, 1976).
Due to the notion or idea that ASD may be caused by diet one treatment involves
eliminating gluten and casein from the childs diet as a curative treatment. This notion
first began in the 1930s, however research is still being conduct today. One popular
study showed that when gluten and casein was eliminated from the diet of 150 children
with ASD they saw significant improvement within five months (Elder, Shankar, Shuster,
Theriaque, Burns, Sherrill, 2006)). In a preliminary study by Elder, et al. parents noted an
improvement in behaviour and language, however the data was not significant (Elder et
al., 2006). Today, to increase the success of this type of treatment it is paired with other
behavioural treatments as well.
Applied behaviour analysis (ABA) therapy developed by Ivar Lovaas in the
1960s is currently viewed as the most effective therapy for children with ASD and has
the most research behind it (Elder et al., 2006). A study done by Lovaas treated 20
children with ASD using ABA therapy, 50% of the treated children reached average IQ
scores and were later placed in mainstream classes (Elder et al., 2006). However, studies
have shown that the earlier the intervention is administered the more effective ABA is on
the child. ABA is a very intense theory approach, which is done for most of the day

Running Head: Historical Perspective of ASD

11

through a therapist. ABA uses careful observation of behaviour followed by a positive

reinforcement. When the child does the desired or correct behaviour they receive
something they find rewarding such as a high five or candy. The theory behind this
intervention is to look at what triggers an undesirable behaviour. Then the therapist can
eliminate the trigger and use reinforcement when a desirable behaviour happened. ABA is
implemented in a one-on-one setting so that the program is catered to specific needs for
each child.
The Responsibility of School Psychologist for Children with Autism Spectrum
Disorder
Recent epidemiological studies have clearly demonstrated that the incidence of
ASD is increasing (Kohrt, 2004). Ninety-four percent of school psychologists who
responded to a recent electronic survey reported an increase in the number of students
with autism being referred for an assessment (Kohrt, 2004). Although enhanced
diagnostic practices and expanded classification systems account for a percentage of this
increase, it is now believed that yet to be identified factors may have emerged in the last
few decades that place infants and young children at greater risk for developing autism
(Ozonoff & Rogers, 2003, p. 17). Regardless of the reason or reasons of the increased
rate of ASD, there is no disagreement that current school psychologists are more likely to
assess students with autism than in the past. Given this new reality it is essential that
school psychology clearly define its roles, responsibilities, and limitations when it comes
to the identification of these disorders.
One of the major responsibilities of a school psychologist is the identification of
ASD. Not all cases of this disorder will be identified before a child enters school.

Running Head: Historical Perspective of ASD

12

Findings from an American population- based study aimed at identifying 7- year-old

children with ASD indicated that the mean age for an ASD diagnosis is 5.5 years of age
(Jonsdottir, Saemundsen, Sif Antonsdottir, Sigurdardottir, & Olason, 2011).
Nevertheless, it is not uncommon for students with milder forms of ASD to go
undiagnosed until after school entry. Hence, it is essential for school psychologists to
understand ASD and be observant for this disorder.
Early identification of ASD is imperative as ASD interventions are most effective
when implemented in early childhood. Early and specialized intervention can produce
significant gains for many children with an ASD diagnosis. A recent study has illustrated
that absence of early intervention resulted in a recovery rate of only 1-2% (Newsom &
Hovanitz, 2006). Therefore, it is vital for children with ASD to be identified early and
receive an intensive and specialized intervention program.
It is well-defined that school psychologists need to be more vigilant for signs of
ASD among the students they work with, and better prepared to identify this disorders.
School psychologists must to be ready and capable to engage in screening and referral for
diagnostic assessments. Although it is expected that not all school psychologists will have
had the training and experiences required to diagnose ASD, it is expected that all school
psychologists should know how to assist in the process of diagnosing ASD. This will
include the administration of psycho-educational assessments to determine learning
strengths and challenges, as well as to help determine special education eligibility and
develop IEP goals and objectives.
Conclusion
Our understanding of autism spectrum disorder has gone through many changes

Running Head: Historical Perspective of ASD

13

throughout the years and will continue to evolve as current and future research continues
to form our beliefs. The increasing incidence of ASDs, combined with the importance of
early identification creates the need for school psychologists to become better prepared to
identify these disorders. With appropriate intervention there is hope that the student with
autism spectrum disorder will be able to achieve a significant degree of independent
functioning. In summation, having a strong understanding of the history, theoretical
foundations and the need for early intervention for autism spectrum disorder allows the
school psychologist to provide accurate information to educators and parents.

Running Head: Historical Perspective of ASD

14

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