Autism- A History

Greetings Earthlings! 🙂

Today, in continuation from my post exploring autism through the ages, I’d like to give you a brief intro into how we came to know of  autism.

So how about a bedtime story then Earthlings? 🙂

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A long time ago in the land of Austria, two researchers were born that would go on to make medical history- Leo Kanner and Hans Asperger. Whilst these men interestingly did not collaborate, together their respective research laid the groundwork for our current understanding of ASD’s.

So how did it all begin?

Whilst some of the earliest documented cases of autism dates back to the 1700’s, the new Latin term autismus (“isolated self”) was first coined by Swiss psychiatrist Eugen Bleuler (who also coined the term schizophrenia) in 1910. Derived from the Greek word “autĂłs” (meaning ‘self’), Bleuler used the term to describe a sub group of people with schizophrenia that were removed from social interaction.

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The term autism first began to take it’s modern form in 1938 when Hans Asperger adopted the term ‘autistic psychopaths’ in a German lecture on child psychology. During this period, Asperger was investigating the ASD which would later bear his name, examining a group of four boys of normal intelligence who struggled with social integration and empathy. Asperger dubbed these boys “little professors” due to their ability to lecture at length on their favourite subjects!

Fun Fact: Asperger himself is widely thought to have displayed many of the symptoms of his discovery himself!

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In 1944 Asperger published an article in German titled ‘Autistic psychopathy’ in childhood, a publication which largely went unnoticed within the English speaking medical community until the 1980s when child psychiatrist Lorna Wing brought his work into the limelight.

This obscurity was also due in part to the work of his contemporary Leo Kanner at the prestigious John Hopkins University in the USA, who pipped Asperger to the post with his paper Autistic Disturbance of Affective Contact in 1943.

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In this work, Kanner described a group of 11 (8 boys, 3 girls) socially isolated children with a “need for sameness” and a “resistance to (unexpected) change.” Kanner claimed to have discovered a new medical condition which he named “infantile autism”, garnering much attention and praise within the medical community.

But was it coincidence that these men happened to work in tandem on such similar projects 4000 miles apart?

In his lifetime, Kanner claimed that he had never heard of Asperger’s work, however, it would appear that this was not the truth.

Author Steve Silberman has since discovered that Kanner likely heard of Asperger’s work through George Frankl- a work colleague from Vienna, and former chief diagnostician at Asperger’s clinic in 1938. Driven by an ambition to make his mark on medical history, it would appear that Kanner sought to recreate Asperger’s work in America, repacked it and claimed it as his own!!

Image result for fainting gifPoor Asperger- but at least his name lives on in Asperger’s syndrome! 🙂

 

So what did these early researchers believe to be the root of autism?

Difficult as it may be to imagine, Kanner firmly believed in something called the “refrigerator mother hypothesis“- a since (rightly) discarded theory which claimed that autism is caused by a lack of maternal warmth or love!!!

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I know!!!!!

Madness!

In addition to this, Kanner’s reuse of Bleuler’s term autism resulted in decades of confused terminology where autism and schizophrenia were one and the same.

Thankfully, the research caught up to give us a clearer insight into the physiological roots of autism (although it took about 20 years for the experts to catch on! 😛 ), leading to the establishment of autism (and later Aspergers syndrome in 1994) as a separate diagnosis in it’s own right in 1980.

And that is the history of autism dear Earthlings, I hope you enjoyed your bedtime story! 😉

Enjoy the weekend everyone! 😀

Aoife

Discussion:Women & Autism

Greetings Earthlings! 🙂

Today, I’m going to discuss a very important issue within the autistic community- gender bias and the misdiagnosis of women with autism.

If I asked you to close your eyes and picture a person with autism, the majority of you will have pictured a man (most likely Dustin Hoffman! 😛 ).

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The current ratio for male to female diagnosis of autism is estimated at 4:1 as the condition is thought to be rarer in women; however, many experts now believe that this figure may be as low as 2:1.

So why the discrepancy?

Did you know: Women with autism present differently to males on the spectrum?!

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Yep- as neurotypical men are from Mars and women from Venus, so too are autistic men and women from entirely different planets (maybe Krypton and Daxam for the DC nerds out there 😉 )!

So how do women with autism differ from men?

For starters, several neurobiological studies have shown distinct anatomical differences between the male and female autistic brain (which I will explore in a separate post at a later stage 🙂 ). Girls with autism are thought to have more active imaginations than boys and participate more in pretend play, often creating elaborate fantasy worlds (I had a particular penchant for this. My sister and I created an elaborate world for our teddies each night, so elaborate that our star couple had their own imaginary portable mansion when we went on holidays!! 😀 ). Reports also indicate that women have lower levels of restrictive and repetitive behaviours than men.

Evidence has also shown that women are better at recognizing emotions than males, almost as well as their neurotypical peers in fact, and demonstrate signs of better attentiveness in social situations.

As a gender, women are more socially inclined than men, and so female autists feel a greater need to make an effort socially.It is expected that women should be more social than men when it comes to communication, and as a result, we are often held to greater social standards. I can’t count how many times a teacher/my mother pulled me aside to advise or chastise me for my social ineptitude! 😛 It was thought that I struggled, not because something was wrong, but that I simply didn’t try hard enough socially. Had I been a boy this would not have been the case.

One of the biggest differences between men and women with autism is the tendency among women towards social mimicry. Girls are particularly adept in masking their symptoms through observation of their peers, obscuring them from the view of parents, teachers and medical professionals.

I’m particularly guilty of doing this. For example, when someone asks ‘How are you?’, I honestly don’t know how to respond! Should I just say fine? Should I reciprocate the sentiment? Should I detail the many ways my life sucks at present?! Three of the simplest words in the English language and I struggle to respond! I eventually developed a mental phrase card in my head for common questions like these so that I would have a standard answer when called for, and 90% of the time you pass for a functioning human being! Other times you get caught off guard and situations like this happen 😛 :

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My life is full of these little social coping mechanisms, which I’ll expand on separately at a later stage 🙂

Finally, as previously discussed, when it comes to specialist interests, female autists tend to have interests resembling those of their neurotypical peers (horses, Harry Potter, soap operas, Justin Bieber etc.), which can additionally hide them from view. Psychologists have also noted a ‘mothering’ tendency among peers of autistic girls, taking autists under their wing and adopting them into a social group. This further creates an illusion of social functioning for teachers, allowing these women to further slip beneath the radar.

As a result of all these differences, women are diagnosed much later than men, (men on average are diagnosed in childhood (~7 years); women as teenagers or adults)  if at all.

But why it it only now that these gender differences are emerging?

Gender bias in autism can trace it’s lineage to the original observations of both Leo Kanner (described autism) and Hans Asperger (described Asperger’s syndrome) in the 1940’s. In Kanner’s work, ‘Autistic Disturbance of Affective Contact’ (1943), Kanner observed a group of 8 boys, but only 3 girls with autism. Hans Asperger on the other hand, exclusively observed groups of boys, believing that AS was uniquely male! As a result, AS was not described in women until the 1990’s!!

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I know!

Consequently, the diagnostic criteria for autism has been largely based on the male model of the condition, and as such, many women like me have slipped under the diagnostic radar.

Due to our inherent talent for social mimicry, women with autism unknowingly find themselves hidden from view. The warning signs that are obvious in males are not always visible, and as a result thousands of women go un-diagnosed, or worse still are misdiagnosed.

Mental health issues such as OCD, eating disorders, ADD, bipolar disorder, anxiety and depression are frequently linked with ASD’s and are particularly prevalent among women.
Experts believe that women with autism tend to internalize their autistic symptoms, leading them to exhibit greater depressive symptoms and experience higher levels of anxiety than male autists.

Women are frequently mis-diagnosed with mental health issues, whilst the underlying root ASD goes unnoticed.

The internet is filled with stories of these women who spent years in mental anguish without receiving the one diagnosis they needed. I recently came across an article where it took “10 years, 14 psychiatrists, 17 medications and 9 diagnoses” before a 21 year old girl got her autism diagnosis! You can read the article here: (https://spectrumnews.org/features/deep-dive/the-lost-girls/).

Researchers and clinicians have in recent years begun to adapt the diagnostic criteria to better serve autistic women, but there is much work still that needs to be done.

Rain Man‘ has dominated for too long- we need now to focus on “Rain Woman”.

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Aoife

 

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