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Leo Kanner's 1943 paper on autism

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Gerald D. Fischbach
7 December 2007

Leo Kanner was the first scientist to clearly define autism.

Donald T. was not like other 5-year-old boys.

Leo Kanner knew that the moment he read the 33-page letter from Donaldʼs father that described the boy in obsessive detail as “happiest when he was alone... drawing into a shell and living within himself... oblivious to everything around him.” Donald had a mania for spinning toys, liked to shake his head from side to side and spin himself around in circles, and he had temper tantrums when his routine was disrupted.

When Kanner met Donald, his suspicions were confirmed. In addition to the symptoms the letter described, Kanner noted Donaldʼs explosive, seemingly irrelevant use of words. Donald referred to himself in the third person, repeated words and phrases spoken to him, and communicated his own desires by attributing them to others.

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.”

In recent years, experts have called attention to the inability of children with autism to understand that others have beliefs that are different than their own. These deficits prevent normal social intercourse, including the ability of the children to engage in joint fantasy or to empathize with the feelings of others.

Kanner borrowed the term ‘autismʼ from Eugene Bleuler, who had coined it to describe the inward, self-absorbed aspects of schizophrenia in adults. But Kanner did not consider infantile autism an early form or prodrome of schizophrenia. The clinical signs were not identical and, unlike schizophrenia, Kannerʼs patients seemed to have autism from birth.

Humane approach

Kanner was born in Austria and educated in Berlin. He came to the U.S. in 1924. In 1930, he moved to Johns Hopkins University, where he founded the first child psychiatry clinic in the country. Based largely on his clinical experience, he then wrote a textbook that defined the field of child psychiatry. His humanism is evident in his lifelong fight against the abuse of children with autism and intellectual disability, and his enduring concern for their families. He also made extraordinary efforts to help physicians and scientists escape from Nazi-controlled territories.

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.

Controversies over clinical definitions may only be resolved with the discovery of biomarkers ― biochemical, anatomical or physiological measures ― that are specific to one or more aspects of autism. Biomarkers are essential for an understanding of brain mechanisms underlying the various autisms, and for the development of useful therapeutics.

Innate disorder

Kanner appreciated the need for biomarkers from the beginning. He noted a tendency toward autistic behaviors in some families and described autism as an ‘innateʼ disorder. He foresaw the need for research into the genetics of autism at about the same time that DNA was first identified as the bearer of genetic information. Today, genetics offers the best hope for discovery of relevant biomarkers.

It took courage to offer a hypothesis of innate determinants in 1943. The prevailing view of the day, based on Freudian psychology, had been that autism was due to poor parenting, with much of the blame placed on ‘frigidʼ mothers accused of rejecting their children.

Studies of identical twins have since made it clear that genetics is a powerful force in autismʼs etiology. But it is also clear that autism is not inherited in a simple Mendelian fashion. Many genes, perhaps as many as 50, may be involved, each one adding to the risk of clinically manifest autism. As these genes are uncovered, clinical descriptions will be further revised, and some may disappear entirely.

We may not speak any longer of autism or schizophrenia or bipolar disorder. Rather, traits that share the same underlying brain mechanisms, and that may fall into similar therapeutic categories, may be emphasized. The relation between autism and other disorders will be debated on a different level.

The search for genetic factors that enhance the risk of autism is now in high gear. Evidence for changes in DNA sequence, structural rearrangements of DNA including sub-microscopic, de novo copy number variants, and epigenetic modifications of DNA, have all been reported in recent years. Success in this effort will lead to a clearer idea about mechanisms that disrupt normal brain development and underlie the onset of autism. Identification of such risk factors and how they might interact with environmental influences will be only the first step in this effort. Progress will speed up once the entire cast of characters is identified.

Other measures, including quantitative functional anatomy, revealed through powerful, new imaging techniques, and quantitative estimates of proteins and gene expression will contribute to the search for biomarkers.

The need for research into the biological bases of autism and of other neuropsychiatric disorders is urgent. In the midst of the current excitement, Kannerʼs paper is worth rereading. Not only is it is the source of much of what we do today, but it can provide new clues for those prepared to receive them. Future attempts to resolve the neural bases of autism will rely heavily on this seminal work.

References

Reproduced without permission of the author, for educational purposes only, according to the Fair Use doctrine.

  1. Kanner L. Autistic disturbances of affective contact. Nervous Child 2, 217-250 (1943) PDF

Comments

Name: isaiah
3 April 2009 - 12:40PM

i have autism and i think it is kind of cool that leo is the one who discovered it

Name: Sampson
8 April 2014 - 12:33AM

May be a bit late to respond, but then as a full blooded Aspergian. I as dx'd (diagnosed) as an adult in my 30's. I got booted out of high school, for sticking to my principles in spite of them getting me suspended for a week at a time (defying the authority of the school my !%#). I earned my GED č (č=with, š=without) honors. I earned my bachelors with cum laude honors.
The times I have been held back in life have been when I have to hype myself the way the nipical (neurotypical or nt) do. I am good at doing things, not at convincing others that I am good at it with my words, mind you those who see me in action have no doubt of my abilities. If your reading a child on the spectrum, don't worry about them being different, help them to be better for it.

Name: Sue
31 March 2010 - 3:05PM

Hi Isaiah
I just read Leo Kanner's paper. I am interested in autism because I just started working for a company that writes genetic research software. I am very interested in your thoughts on this, since you left a comment, I thought I would too.

Sue

Name: Monica
31 March 2010 - 3:05PM

Hi Isaiah
I am Jeremias' mother, he is 6 years old and has autism. I must say I am impressed to see that you have autism. I would like to know a bit about you, if you don't mind, your routine, your achievements, etc.

Name: Taline
31 March 2010 - 3:06PM

HI Isaiah
I would love to read your comments, as a person with autism. How old are you, do you have anyhting written about your experiences?

Name: RA Jensen
31 March 2010 - 3:07PM

Kanner published another paper in 1965 'Infantile Autism and the Schizophrenias' in Behavioral Science http://neurodiversity.com/library_kanner_1965.html

This paper may have relevance to the 'autism epidemic' which has seen prevelance rates rise 10 ten fold since 1994. DSM-III (1980) incorporated Kanner's definition 'A pervasive lack of responsiveness to other people - autism'.

In 1994, Kanner's definition was completly removed from all diagnostic schemes and was replaced by the vague and ambigous 'qualitative impairment in social reciprocity'.

Many theories have attempted to explain the ten fold rise in incidence, but Kanners explanation for 'diagnostic substitution' in 1965 is the best explanation for a rise in the incidence autism that occured within a decade of his 1943 article.

Name: Judy
31 March 2010 - 3:08PM

Hi Isaisah,
My son has autism and ever since I have been very interested in this condition. I found this site searching for extra information for my expository essay as a final project for school. How old are you?

Name: Sarah
29 April 2010 - 10:15AM

I've been reading alot lately in Kanner's original description of autism, and can clearly see now, why there's is the rise in cases of autism. Kanner descibed his 11 cases as mostly average to above average intelligence, had idiosyncratic language, and seemed to be an innate disorder. Now however, his original discription, the man who originally made these connections, is being over run by today's professionals. Kanner did not say that these individuals were nonverbal, that these individuals were intellectualy challenged, or that they even appeared to have regressed. That however is the way, people describe classic autism today. Would seem to me that the one who discovered the disorder would hold the true description of "the classic end of the spectrum." Just my opinion though.

Name: Autistic
20 September 2011 - 5:34AM

Kanner's autism and Asperger's autism, as described by Kanner and Asperger, are both autism, classic, one and the same.

Name: Loana
23 April 2012 - 1:29PM

Asperger's syndrome is not as severe as autism, as it lacks cognitive development impairments and language delays. Just started the topick in my lectures, and I'm sooo excited about it ^.^

Name: amit kanta lahiri india
7 August 2012 - 9:40AM

we are greatful to leokanner, because we learn many from his research.

f/o an autistic person

Name: Sampson
8 April 2014 - 12:43AM

Thoughts on Kanner and Asperger : Hans Asperger studied children that were similar to him as a child (outside accounts tell of him quoting his favorite poet at length to his classmates without noticing their clear disinterest . Kanner describes "Donald's father it's a highly detail oriented man who would become so lost within his own thoughts that he would notice nothing else around him.
Hmm sounds a lot like aspergers or a proto aspi to me

Name: Mary Ann
12 April 2014 - 9:32AM

All these comments and the preceding data had me in tears of joy. What hope they all inspire! I have long helped schizophrenic and autistic gifted people. A young friend of twelve who is mildly autistic and his parents leave me awestruck as they help him through our Catholic Mass. Our whole section becomes involved.

Name: Kimmie
4 May 2014 - 1:53AM

Unbelievable lies! First off, Leo Kanner was describing children from the 30's, all children from well educated, professional parents! Did these parents expose their children to vaccines? (except for Robert... in Leo's story). Why didn't Leo Kanner tell us why all his subjects parents were from affluent homes and in the medical profession? Although I totally agree with how Autistic children behave and respect his finding's... (read: Pathology; Disturbances Of Affected Contact, by Leo Kanner) you will better understand what I'm saying if you read all ten of his subjects and their educated parents! Autism wasn't around before vaccines!

Name: J
16 May 2014 - 11:33AM

Still searching for the vaccine link, that is sad.

Name: Victor
18 May 2014 - 6:08PM

Kimmie

Sorry to disappoint. The structural anatomical defects of autism are present before birth. Forget the celebrities and their stupid mumblings i.e. McCarthy and her disciples, and concentrate on the genetics. Doing a Ph.D will help you from blowing your stack that is full of smoke and hot air and devoid of scientific facts. And while you are about it forget Kanner - he is ANCIENT HISTORY - after all would you rely on what Christopher Columbus wrote down in his daily journal when he sailed around the world, or would you use GPS? Autism is a molecular genetic disorder possibly affected by environmental factors. Forget your irrational vaccine theory, only loonies even consider vaccines as causative i.e. movie stars and their followers. Oh I forgot the other nut cases, the conspiracy theorists. If you know more about interpretation of mathematical statistical analysis then you should be the HOD at McMaster, Harvard or Oxford. All the staff have PH.D in mathematics, not grade 10 algebra like McCarthy has. Her brain is hardly turning over and she is quoted by all and sundry as if she were a messiah. The average North American is utterly stupid when it comes to science

Name: Victor
18 May 2014 - 6:53PM

One of many articles on proving no connection between MMR and autism.

Thimerosal in the MMR vaccine, equivalent to one grain of sugar can damage the brain? Then why don't we see hundreds of thousands of Autism cases in people living near coal fired power stations that were spewing toxic mercury compounds into the air for decades and still are in Africa, South America, Russia, China and India. With all the toxic lead and mercury belched out into the atmosphere every second person and their dog should have autism spectrum disorder in these 3rd world countries. These people were exposed to a hundred times more mercury than there is in a MMR vaccine. And if one were to get Autism from a weakened virus vaccine what on earth would one get from a full blown case of measles pertussis or rubella? A completely destroyed or wiped out brain? Last time I looked the survivors of measles-pertussis-mumps and rubella are all ahm-well-sorta NORMAL!
The only abnormal people in this whole autism-MMR-mercury fiasco are the deluded hangers on to a belief system that has failed them. Only eccentrics and believers in naturopathy and homeopathy think like this ie they cannot think, they rationalize and get confused between fact and fiction. But then 95% of North Americans are scientifically illiterate so what do you expect. That’s what you get for not paying attention in grade 10 science class - a dumbo who is condemned to forever making false and inaccurate assumptions and belongs to the gullible masses that follow WWF Hollywood and Reality TV. The walking, brain dead, oxygen thieves who have climbed out from under rocks and emerged from forests with BigFoot in hot pursuit. One really also has to blame TV shows where many Americans get their mis-education e.g. that moron Oprah Winfrey. Look at the other monster she created Dr Mehmet OZ , the wizard of alternative, crackpot, medicine. I meant jackpot because he sure has hit the jackpot. So even a professor of cardiac surgery can slide down the slippery slope from the real world into the world of delusions.

Victor

Here is an extract that summarizes the no-link hypothesis

Measles-mumps-rubella vaccine and the development of autism
Elizabeth Miller, BSc, MBBSa, Corresponding author contact information, E-mail the corresponding author (FRCPath, FFPHM)
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Show more - http://dx.doi.org/10.1016/S1045-1870(03)00034-7

Abstract
The measles-mumps-rubella (MMR) vaccine has been postulated to cause a form of autism characterized by regression and bowel symptoms, and onset occurring shortly after vaccination. It is also claimed that, as a result, there has been a dramatic increase in autism prevalence. These hypotheses have now been tested in a number of epidemiologic studies that are reviewed in this article. None has found any evidence of the existence of a phenotypically distinct form of autism in children who received the MMR vaccine or of a clustering of onset symptoms in children who are autistic after receiving the MMR vaccine. There is no proof that the overall risk of autism is higher in children who were vaccinated with MMR or of an increase in autism prevalence associated with the use of the MMR vaccine. No epidemiologic evidence suggests an association between MMR vaccination and autism. Moreover, epidemiologic evidence against such an association is compelling.

Corresponding author contact information
Address reprints to Elizabeth Miller, BSc, MBBS, FRCPath, FFPHM, Immunisation Division, Public Health Laboratory Service, 61 Colindale Ave, London NW9 5EQ, United Kingdom
Copyright © 2003 Elsevier Inc. All rights reserved.

Name: Victor
18 May 2014 - 7:01PM

And Finally

Vaccines, Thimerosal, MMR, Mercury Not Associated With Autism
Comment Now Follow Comments

What it says on the tin: A new meta-analysis analyzing data from studies involving 1.3 million children is entitled “Vaccines are not associated with autism.”

If that’s not clear enough, author Luke Taylor and colleagues, who looked at five studies covering 1.26 million children and another five case-control studies of 9920 children, also give the (pre-press) bullet-point version of their findings, published in the journal Vaccine:

There was no relationship between vaccination and autism (OR: 0.99; 95% CI: 0.92 to 1.06).
There was no relationship between vaccination and ASD (autism spectrum disorder) (OR: 0.91; 95% CI: 0.68 to 1.20).
There was no relationship between [autism/ASD] and MMR (OR: 0.84; 95% CI: 0.70 to 1.01).
There was no relationship between [autism/ASD] and thimerosal (OR: 1.00; 95% CI: 0.77 to 1.31).
There was no relationship between [autism/ASD] and mercury (Hg) (OR: 1.00; 95% CI: 0.93 to 1.07).
Findings of this meta-analysis suggest that vaccinations are not associated with the development of autism or autism spectrum disorder.
It’s not that we didn’t know that already. But a meta-analysis takes the existing research and grinds the numbers and gives the bigger picture of what the aggregate of the findings tells us. Indeed, looking at the odds ratios the authors report–in which 1 means no effect of vaccine or other variable on odds and less than 1 means reduced odds–the data suggest reduced autism risk among children who received the MMR vaccine.

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