History of autism

The first clinical descriptions

In 1943, American child psychiatrist Leo Kanner published a landmark paper describing 11 children with distinctive patterns of behaviour. He observed difficulties with social connection, insistence on sameness, unusual responses to sensory stimuli, and intense, focused interests. He called this “infantile autism”, borrowing the word from Eugen Bleuler, who had used “autistic” to describe inward-focused thinking in schizophrenia. Kanner’s appropriation of the term created lasting confusion between autism and psychosis that took decades to resolve.

One year later, in 1944, Austrian paediatrician Hans Asperger independently described a group of children with overlapping but distinct characteristics. The children he observed had average to above-average intelligence, fluent speech, and intense interests, but marked difficulties with social reciprocity. He called this “autistic psychopathy” (psychopathy meaning personality pathology, not what the word implies today).

The two descriptions existed largely independently for decades, with Kanner’s work dominating English-language psychiatry and Asperger’s work remaining relatively unknown outside the German-speaking world.

The refrigerator mother myth

The 1950s to 1970s saw one of the most damaging periods in autism’s history. Psychoanalyst Bruno Bettelheim promoted the theory that autism was caused by emotionally cold, rejecting mothers, the so-called “refrigerator mothers”. He compared the experience of autistic children to that of concentration camp prisoners, a comparison he had no basis to make.

This theory was completely wrong. There is no evidence that parenting style causes autism. But the damage was profound and far-reaching. Mothers of autistic children were blamed for their child’s condition, subjected to psychoanalytic treatment, and in some cases had their children removed. The psychological harm to these families lasted generations.

The spectrum emerges

The 1980s brought a fundamental shift. Lorna Wing, a British psychiatrist whose daughter was autistic, translated and popularised Asperger’s work in English for the first time. She proposed that autism existed on a spectrum, with Kanner’s autism and Asperger’s syndrome representing different points along a continuum rather than separate conditions. Her concept of the “triad of impairments” (difficulties with social interaction, communication, and imagination) became the basis for understanding autism for the next three decades.

In 1994, the DSM-IV formally recognised Asperger’s Syndrome as a separate diagnosis from Autistic Disorder. This categorical distinction influenced clinical practice, service provision, and identity for nearly 20 years.

The DSM-5 unification

In 2013, the DSM-5 removed Asperger’s Syndrome as a separate diagnosis and created a single category: Autism Spectrum Disorder. The ICD-11 followed in 2019 with a similar approach.

This was one of the most significant and contested changes in recent psychiatric history. The rationale was sound: research consistently showed that the distinction between “Asperger’s” and “autism” was unreliable. Different clinicians would give different diagnoses to the same person. The boundary between the two was artificial.

However, the change had real consequences. Many people who identified strongly with the Asperger’s label felt their identity was being erased. Others, who had been denied support because Asperger’s was seen as “mild”, found that the unified spectrum model better reflected their actual support needs.

The Hans Asperger controversy

Recent historical research has revealed that Hans Asperger cooperated with the Nazi regime in Vienna during World War II. Evidence suggests he referred children with significant disabilities to the Am Spiegelgrund clinic, where many were killed as part of the Nazi child euthanasia programme.

This history requires acknowledgement. The clinical observations Asperger made were valuable, and his descriptions of autistic children were insightful. But separating the clinical contribution from the man is important, and for many in the autistic community, the Asperger’s label now carries associations that make it unwelcome. The move away from Asperger’s as a diagnostic term has, for some, been welcomed for this reason as well as for clinical ones.

Women, girls, and diagnostic invisibility

Like ADHD, the history of autism is marked by a profound gender gap. Early research focused almost exclusively on boys, creating diagnostic criteria and clinical expectations based on male presentations. Autistic girls and women, who often show different patterns of social behaviour, more effective masking, and different interest profiles, were systematically missed.

The consequences are still being felt. Many women are diagnosed with autism in their 30s, 40s, or later, having spent decades without understanding why they found the world so difficult. The current wave of late-diagnosed autistic women represents not a new phenomenon but the correction of a historical oversight.

The neurodiversity movement

From the late 1990s, autistic people began advocating for autism to be understood as a form of human neurological variation rather than a disease to be cured. The neurodiversity movement, championed by autistic advocates including Judy Singer, has fundamentally changed how many people understand autism.

This movement does not deny that autism can involve significant difficulties and that some autistic people need substantial support. Rather, it challenges the assumption that autistic people are broken versions of neurotypical people and advocates for accommodation, acceptance, and respect for different ways of being.

Further reading on neurobetter

• Autism - overview
• Late diagnosis
• Masking
• Understanding diagnosis
• The language of neurodiversity

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