Revisiting the history of autism before Kanner and Asperger: a tribute to Grunya Sukhareva.

Almost two decades before Kanner's and Asperger's works, the original paper by child psychiatrist Grunya Efimovna Sukhareva had already been written. It was published in 1926 by Sukhareva in a German scientific journal of psychiatry and neurology, with a detailed description of children who presented clinical conditions whose characteristics and evolution closely resemble autism, according to current criteria. In the present historical note, we intend to present Sukhareva's pioneering work and retrieve the meaning of her original contribution.

Quase duas décadas antes dos trabalhos de Kanner e Asperger, o artigo original da psiquiatra infantil Grunya Efimovna Sukhareva já havia sido escrito. Foi publicado por Sukhareva em 1926, em uma revista científica alemã de psiquiatria e neurologia, com uma descrição detalhada de crianças que apresentavam quadro clínico cujas características e evolução em muito se assemelham ao autismo, segundo os critérios atuais. Nesta nota histórica, pretende-se apresentar o trabalho pioneiro de Sukhareva e resgatar o significado da sua contribuição original.

'Early childhood autism, Asperger type', by H. Asperger (1982).

After his 1944 thesis, Asperger continued to write about autism, but none of these texts have been translated. At a time when autism spectrum disorder faces many challenges (e.g. the nature and measurement of autism), this text tells us more about the particular population that Asperger worked with. He describes sensitive, intelligent, creative and rational children, a far cry from the Wing triad. Moreover, 'Asperger's Syndrome' was introduced after he had died, was included in the DSM-IV in 1994 and was omitted from the DSM-5 in 2013. The question posed by this last text, written before his death, is whether Asperger's descriptions of autistic children are really part of the autism spectrum disorder or whether they are outside the pathological field.

Non-complicit: Revisiting Hans Asperger's Career in Nazi-era Vienna.

Recent allegations that pediatrician Hans Asperger legitimized Nazi policies, including forced sterilization and child euthanasia, are refuted with newly translated and chronologically-ordered information that takes into account Hitler's deceptive 'halt' to the T4 euthanasia program in 1941. It is highly unlikely that Asperger was aware of the T4 program when he referred Herta Schreiber to Am Spiegelgrund or when he mentioned that institution 4 months later on the medical chart of another (unrelated) girl, Elisabeth Schreiber. Asperger campaigned vigorously from 1938 to 1943 to have his specialization, Curative Education, take priority in the diagnosis and treatment of disabled children over other fields that promoted Nazi racial hygiene policies. He neither disparaged his patients nor was he sexist. By 1938, he had identified the essentials of Asperger syndrome and described an unnamed boy whom he later profiled (as Ernst K.) in 1944. Rather than doing 'thin' research, Asperger made discoveries that were prescient, and some of his activities conformed to definitions of "individual resistance."

[Deconstructing Kanner]. / Deconstruyendo a Kanner.

Kanner, in 1943, and Asperger, in 1944, published papers that have been considered the first descriptions of autism. Kanner is acknowledged as having been the first to recognise this condition, while Asperger is attributed with the identification of a milder form of autism which has been denominated Asperger's syndrome. Kanner's paper played an important role in the development of the conceptualisation of autism due to its being published in the United States, where it became popular in the field of child psychiatry. In contrast, Asperger's work, written in German during the period dominated by Nazism, was practically ignored until almost four decades later. A review of the historical data, mostly collected by Silberman, reveals that Kanner had first-hand knowledge of the work on autism that Asperger had begun ten years earlier. Moreover, on re-reading and analysing the pioneering publications it becomes clear that the contributions made by Asperger are still fully valid today, to the point of having intuited a complex polygenic aetiology and that it would fit in perfectly with autism spectrum disorder in the DSM-5.

TITLE: Deconstruyendo a Kanner.Kanner, en 1943, y Asperger, en 1944, publicaron sendos articulos que se han considerado las primeras descripciones del autismo. A Kanner se le atribuye el merito de haber sido el primero en reconocer dicha entidad y a Asperger se le asigna la identificacion de una forma de autismo, mas leve, que se ha denominado sindrome de Asperger. La publicacion de Kanner tuvo una relevancia importante en el desarrollo de la conceptualizacion del autismo por el hecho de haberse editado en Estados Unidos, donde alcanzo una gran difusion en el campo de la psiquiatria infantil. Por el contrario, el trabajo de Asperger, escrito en aleman durante la epoca del nazismo, fue practicamente ignorado hasta pasadas casi cuatro decadas. La recopilacion de datos historicos, en gran parte recogidos por Silberman, revela que Kanner conocia de primera mano el trabajo sobre el autismo que Asperger habia iniciado diez años antes. Por otro lado, una relectura y analisis de las publicaciones pioneras pone en evidencia que las aportaciones de Asperger son plenamente vigentes, hasta el punto de haber intuido una etiologia poligenica compleja y de encajar plenamente con el trastorno del espectro autista del DSM-5.

Deconstruyendo a Kanner / Deconstructing Kanner

Kanner, en 1943, y Asperger, en 1944, publicaron sendos artículos que se han considerado las primeras descripciones del autismo. A Kanner se le atribuye el mérito de haber sido el primero en reconocer dicha entidad y a Asperger se le asigna la identificación de una forma de autismo, más leve, que se ha denominado síndrome de Asperger. La publicación de Kanner tuvo una relevancia importante en el desarrollo de la conceptualización del autismo por el hecho de haberse editado en Estados Unidos, donde alcanzó una gran difusión en el campo de la psiquiatría infantil. Por el contrario, el trabajo de Asperger, escrito en alemán durante la época del nazismo, fue prácticamente ignorado hasta pasadas casi cuatro décadas. La recopilación de datos históricos, en gran parte recogidos por Silberman, revela que Kanner conocía de primera mano el trabajo sobre el autismo que Asperger había iniciado diez años antes. Por otro lado, una relectura y análisis de las publicaciones pioneras pone en evidencia que las aportaciones de Asperger son plenamente vigentes, hasta el punto de haber intuido una etiología poligénica compleja y de encajar plenamente con el trastorno del espectro autista del DSM-5 (AU)

Kanner, in 1943, and Asperger, in 1944, published papers that have been considered the first descriptions of autism. Kanner is acknowledged as having been the first to recognise this condition, while Asperger is attributed with the identification of a milder form of autism which has been denominated Asperger’s syndrome. Kanner’s paper played an important role in the development of the conceptualisation of autism due to its being published in the United States, where it became popular in the field of child psychiatry. In contrast, Asperger’s work, written in German during the period dominated by Nazism, was practically ignored until almost four decades later. A review of the historical data, mostly collected by Silberman, reveals that Kanner had first-hand knowledge of the work on autism that Asperger had begun ten years earlier. Moreover, on re-reading and analysing the pioneering publications it becomes clear that the contributions made by Asperger are still fully valid today, to the point of having intuited a complex polygenic aetiology and that it would fit in perfectly with autism spectrum disorder in the DSM-5 (AU)

History and First Descriptions of Autism: Asperger Versus Kanner Revisited.

When reading Michael Fitzgerald's chapter entitled 'Autism: Asperger's Syndrome-History and First Descriptions' in 'Asperger's Disorder' edited by Rausch, Johnson and Casanova, a while ago, one of us was struck by his contention that Kanner was guilty of plagiarism as well as non-attribution of Asperger's 1938 paper 'Das psychisch abnorme kind' (Fitzgerald in Asperger's disorder. Informa Healthcare, New York, 2008) published in a Vienna weekly. Steve Silberman has discovered evidence that Kanner rescued Asperger's chief diagnostician from the Nazis in 1944 so must have been aware of Asperger's work and conclusions. Fitzgerald was on the right track but it appears that Kanner may have plagiarised Asperger's ideas rather than his 1938 paper.

Sukhareva--Prior to Asperger and Kanner.

As early as 1926, the Kiev-based child psychiatrist Grunya Efimovna Sukhareva (Груня Ефимовна Сухарева) (1891-1981) published a detailed description of autistic traits in a number of children in a scientific German psychiatry and neurology journal. She initially used the term "schizoid (eccentric) psychopathy" but later replaced it with "autistic (pathological avoidant) psychopathy" to describe the clinical picture of autism. Her original article was available almost two decades before the case reports of Asperger and Kanner; nevertheless, Sukhareva's pioneer work has been greatly overlooked. Here we present her description of autistic psychopathy in relation to the DSM-5 criteria of today.

The Dangers of Posthumous Diagnoses and the Unintended Consequences of Facile Associations: Jeffrey Dahmer and Autism Spectrum Disorders.

Posthumous diagnoses are not uncommonly given to notorious public and historical figures by applying retrospectively, and typically in the absence of the individual being diagnosed, contemporary diagnostic criteria. Although this may be relatively easy and free of consequences when it concerns clear-cut medical conditions, it may have unintended repercussions in the case of psychiatric disorders by creating myths and perpetuating stigma. The case of serial killer Jeffrey Dahmer is a typical example where a somewhat facile and almost syllogistic application of perhaps over-inclusive criteria may have contributed to the legend of solitary murderers as possibly suffering from an autism spectrum condition. Although there may be an understandable human need to explain abominable and heinous behaviors, the lack of the possibility to verify a diagnostic theory and the ill-advised attempt to make a diagnosis fit may de facto be the basis of prejudice and profiling that do not correspond to clinical reality. Although there is no doubt that the brain is the organ of behavior, the authors caution against a budding neo-Lombrosian approach to crime and criminality and against the all too common use of widely differing terms in the study of deviance, such as crime, delinquency, and aggression, the operational use of which, often used interchangeably even in association studies, often erroneously leads to further confusion.

Did Mozart suffer from Asperger syndrome?

The most reliable biographies of Mozart highlight elements that are compatible with current diagnostic criteria for Asperger syndrome including qualitative impairment in social interaction and stereotyped and repetitive motor mannerisms. Furthermore, numerous features are documented including difficulty in communicating his emotional state and in inferring the mental state of his interlocutors, motor clumsiness, specific skills and genius, left-handedness, special sense of humour, physical developmental abnormalities, bizarre thinking, overvalued ideas and delusions.

From Kanner to DSM-5: autism as an evolving diagnostic concept.

Seven decades have elapsed since Leo Kanner described the syndrome he termed early infantile autism. Over this time, and particularly over the past two decades, noteworthy changes have occurred in how the condition is conceptualized. Here we provide an overview of these changes, beginning with a brief discussion of the significance of classification in general before discussing Kanner's original paper and subsequent changes. We touch on relevant issues, such as comorbidity, dimensional aspects of diagnosis and screening, and the complex issue of diagnosis relative to eligibility for services. Approaches to diagnosis have tended to swing from emphasizing overarching groups (lumping) to focusing on potentially distinct subgroups (splitting). Autism raises particular problems given the broad range of syndrome expression over age and developmental level. The most recent revision of the American Psychiatric Association's diagnostic taxonomy marks a significant departure from its predecessor and has been the focus of much debate. It remains unclear which of the currently existing categorical approaches will ultimately be most widely applied. We hope to convey a sense of areas in which consensus has been achieved and areas of continued controversy.

'History and first descriptions' of autism: a response to Michael Fitzgerald.

Letter to the editor in response to Michael Fitzgerald's controversial allegation that one of the two pioneers of autism--Leo Kanner--may have been influenced by an earlier paper by the other autism pioneer--Hans Asperger--without acknowledging the debt, and that Kanner may even have been guilty of plagiarising Asperger. In correspondence, Professor Fitzgerald has suggested that I "consider doing my take on the matter". This is it.

Wittgenstein, medicine and neuropsychiatry.

A historical review is presented of the link between Ludwig Wittgenstein, considered the most important philosopher of the 20th century, and medicine, particularly neurology and psychiatry. Wittgenstein worked as a porter at Guy's Hospital in London, and then as a technician at the Royal Victoria Infirmary in Newcastle. He wrote about his important insights into language, and neuroscience. It has been suggested that he had Asperger syndrome and a possible movement disorder (mannerisms).

Wittgenstein, medicine and neuropsychiatry / Wittgenstein, medicina e a neuro-psiquiatria

A historical review is presented of the link between Ludwig Wittgenstein, considered the most important philosopher of the 20th century, and medicine, particularly neurology and psychiatry. Wittgenstein worked as a porter at Guy's Hospital in London, and then as a technician at the Royal Victoria Infirmary in Newcastle. He wrote about his important insights into language, and neuroscience. It has been suggested that he had Asperger syndrome and a possible movement disorder (mannerisms).

Uma revisão histórica sobre a ligação entre Ludwig Wittgenstein, considerado um dos mais importantes filósofos do século XX, e a medicina, a neurologia e a psiquiatria é apresentada. Ludwig Wittgenstein trabalhou como porteiro no hospital Guy, em Londres e depois como técnico na Royal Victoria Infirmary em Newcastle, no Reino Unido. Ele escreveu importantes insights sobre linguagem e tem sido sugerido que ele tinha a síndrome de Asperger, e possivelmente um distúrbio do movimento (maneirismo).

Qualitative or quantitative differences between Asperger's disorder and autism? Historical considerations.

The histories of autism and Asperger's Disorder (AD), based on original contributions by Kanner and Asperger, are reviewed in relation to DSM-IV diagnostic criteria. Their original articles appear to have influenced the distinction between AD and autism made in the DSM-IV. Based on up-to-date empirical research, however, it appears that AD and autism are not qualitatively distinct disorders, but are different quantitative manifestations of the same disorder. The differences between AD and autism may be a function of individual variability in these areas, not the manifestation of qualitatively distinct disorders. The DSM-IV criteria for AD and autism need to be considered with their historical developments, and based on empirical evidence, the DSM-IV diagnostic criteria may be subject to critical review.