https://www.marsreview.org/issue2/the-story-of-autism-how-we-got-here-how-we-heal-by-tao-lin-~dacten-sidlyn

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A NEW DISORDER

In the 1940s, Leo Kanner in the U.S. and Hans Asperger in Austria identified a new disorder in young children, different from “childhood schizophrenia” and “feeblemindedness.” These kids were very “autistic,” an adjective previously used in schizophrenia, meaning self-focused and -isolating, but unlike the insane they appeared to be affected since birth and didn’t have hallucinations, and unlike the mentally retarded they ranged in IQ and had “strikingly intelligent physiognomies.”

They seemed unwilling to interact with people. During social interaction, they looked preoccupied and inaccessible. Their facial expressions were blank or tense and troubled, and they used little to no gestures. They had “odd” eye gazes, not looking at eyes or faces. It was hard to get and sustain their attention. Many were suspected to have hearing problems, but did not. Some were mute, while others spoke rarely and curtly, in monotones or singsongs, and others were antisocially talkative, asking series of questions, repeating nonsequitur phrases.

Some kids took on a pleased, focused expression when left alone, even smiling to themselves, though some never smiled.

They played alone, with themselves and objects, which they treated affectionately. They enjoyed repetitive behaviors—collecting things, spinning things, drumming with their hands, masturbating, running in circles. One boy liked to shake a blanket while “delightedly shouting, ‘Ee! Ee!’” wrote Kanner in “Autistic Disturbances of Affective Contact” (1943). A mother quoted in the paper said about her son, “I could leave him alone and he’d entertain himself very happily, walking around, singing.”

They were fussy and unpredictable, sometimes displaying a little affection or joy, sometimes becoming distraught for unknown reasons. When their activities or routines were interrupted—when their expectations were thwarted—they became very upset, crying or tantruming, going into “long tirades,” unable to adapt to change. They had what Kanner called “an anxiously obsessive desire for the maintenance of sameness.”

Autism was rare—Asperger, in Vienna, saw around 200 cases over 10 years, while Kanner, at Johns Hopkins in Baltimore, described 11 cases—and ranged in severity. Kanner wrote of one boy who was a month short of five years old: “He did not communicate his wishes but went into a rage until his mother guessed and procured what he wanted.” The boy, who “had no contact with people,” was placed in a foster home. A few kids became functional in school and at home as they aged, but they still struggled and remained peculiar and awkward.

While normal kids behave unselfconsciously, autistic children “observe themselves constantly,” wrote Asperger in “‘Autistic Psychopathy’ in Childhood” (1944). They observed others too. They seemed lost in their own worlds, but they knew what was happening around them in the social world, having used their peripheral vision, observed Asperger, whose paper also focused on the positives of autism, including “independence of thought, experience, and speech.”

Instead of learning from others, autistic individuals gained knowledge out of their own experiences and theories and methods. This made some of their behavior “particularly original and delightful,” wrote Asperger. They had “a special creative attitude towards language,” which they tended to process literally, making them not “get” most jokes and be difficult to converse with, but also allowing them to perceive and describe reality accurately. One boy’s father said something about a picture they had “at home on the wall”; the non-literal use of “on” troubled the boy, who corrected his dad: “We have them near the wall.”

Autists without intellectual disability could achieve “professional success” in the sciences and arts, but their “emotional life remains a closed book” and they would likely have lifelong relationship difficulties, wrote Asperger, who concluded: