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This report is intended to be a historical review of one of the most puzzling disorders of childhood - autism or childhood psychosis. Discussions of autism began appearing in the psychiatric literature only three decades ago.1 Since that time there has been a noticeable shift from the global generalizations of psychoanalytic thinking to more specific information from current research.
This shift will be traced in areas of
a) diagnosis, b) theories of causation,
c) role of parents, d) treatment and
e) research and social action.
BACKGROUND
Children similar to those who might today be called autistic were reported far back in human history. These children, and even the term autism, have been shrouded with myth and mystique. Reports of wild children, and those supposedly reared by wolves and other animals, trace back to early Roman history. A French physician, J. Itard2, documented his efforts to develop teaching techniques for such a child in 1795. Reports of feral children have continued until very recently,3 and the plausibility of the children having been reared by wolves was accepted by so eminent a physician as Gesell.4 Bettelheim questioned the evidence for animal foster-parents.5 He presented convincing arguments that feral children could not have survived wilderness conditions for very long. Describing behavioral similarities he saw between the autistic children at his school and the feral children reported in the literature, he argued that the so-called feral children were actually autistic children who had been neglected by their mothers. In writing on the subject, Bettelheim claimed that his correction of this widely held error might contribute more to social science than to the discovery of any new theory. He concluded that he had succeeded in demonstrating that there are no feral children, but perhaps only feral mothers. In this conclusion he promoted a pervasive and harmful myth regarding the cause of autism to be discussed below.
DIAGNOSIS
The diagnostic term infantile autism was first formulated in 1943, when Kanner1 reported on a series of children he had examined at Johns Hopkins. His definition was so sufficiently clear that soon children with similar symptoms were being written about in the psychiatric literature of other clinics and countries. During this period other diagnostic terms referring to severely disturbed children appeared. These included,...