Zeldovich, L. (2018, April 9). The evolution of 'autism' as a diagnosis, explained. Spectrum. https://www.spectrumnews.org/news/evolution-autism-diagnosis-explained/.

The evolution of 'autism' as a diagnosis, explained

The history of autism. Masters in Special Education Degree Program Guide |. (2021, March 19). https://www.masters-in-special-education.com/history-of-autism/.

The history of autism 

Evans B. (2013). How autism became autism: The radical transformation of a central concept of child development in Britain. History of the human sciences, 26(3), 3–31. https://doi.org/10.1177/0952695113484320

How autism became autism: The radical transformation of a central concept of child development in Britain.

Autism as a concept was first introduced by German psychiatrist Eugen Bleuler, and he used it to describe a symptom of severe cases of schizophrenia. He believed autistic thinking involved infantile desires to avoid bad realities, replacing them with fantasies. This definition would carry through into the second DSM. 


1911: The Coining of The Term "Autism" 

In the 1940s, autism was likened to an emotional disturbance. The DSM-2 (1952) had it marked as a psychiatric condition like a childhood schizophrenia. Rather than a developmental disorder, autism was considered a psychiatric disturbance distinguished by social and emotional problems. Around 1943, child psychiatrist Leo Kanner described autism as lack of affective contact, fascination with objects, desire for sameness and non-communicative language before 30 months of age”. 

ASD in the 1940s-50s: Psychiatric Disturbance

In the 1950s-1960s, Autism was blamed on bad and detached mothers, dubbed “refrigerator mothers”. This sprouted from the theories of Leo Kanner, where he described autistic children as being reared in emotional refrigerators due to lack of parental warmth. However, he studied this in a small population of white, educated families that displayed this detachment, making his assumption incorrectly over-generalized. Regardless, Kanner’s “refrigerator mother” theory prevailed for a long time, pushed into the limelight by popular professor Bruno Bettelheim’s public endorsement. 

ASD in the 1950s-1960s: Refrigerator Mothers

Kanner’s “refrigerator mother” hypothesis was disproven in the late 60s to early 70s due to apparent biological roots, thus shifting the DSM-3 in 1980 to categorize it as a developmental disorder that was not related to schizophrenia. The DSM-3 further defined three essential features for a diagnosis of autism: lack of interest in people, impairments in communication and bizarre responses to environmental stimuli, and all developing within the first 30 months of life. This was further revised in 1987, adding a mild diagnosis of pervasive developmental disorder-not otherwise specified (PDD-NOS) and dropping the requirement of onset before 30 months. 

ASD in the 1970s-80s: Biological Roots

The publishing of the DSM-4 in 1994 and revised in 2000 finally saw autism categorized as a spectrum. In this manual, there were 5 sub-categories of related disorders in addition to autism: 
- Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS)
- Asperger’s Disorder
- Childhood Disintegrative Disorder (CDD)
- Rett-syndrome

ASD in the 1990s-2000s

The diagnosis of Autism has changed a lot over time to what it is now. It’s had quite a long and convoluted history as our understanding has changed.

- 1911: The Coining of the Term "Autism"
- ASD in the 1940s-50s
- ASD in the 1950s-60s
- ASD in the 1970s-80s
- ASD in the 1990s-2000s

University of Rochester

Grinnell College

As our understanding of Autism Spectrum Disorder has evolved, our definition and explanations have evolved as well, modifying diagnostic criteria and labels. Most likely, it will continue to adapt and evolve as we learn more about it, as our current understanding is incomplete. 

ASD Definitions Through Time

Autism Spectrum Disorder and Developmental Disabilities, Campbell et al.

Autism Spectrum Disorder Library

ASD Diagnostic History

Prior to DSM-5, there were multiple separate diagnoses under the broad range of the Autism Spectrum, but now they are simply denoted as ASD. The single diagnosis of ASD replaced the subcategories that existed prior. To be diagnosed, the individual must have persistent difficulties in social skills and communication and restricted and repetitive behaviors that have been around since childhood. 
Screening is recommended at 18 and 24 months old during regular clinician visits, though more screenings could be recommended if the child is at higher risk. 

- Diagnostic Screening Tools
- Diagnoses Prior to DSM-5


Diagnosing ASD in Children (DSM-5)

In recent years, the approach to diagnosing conditions on the autism spectrum has shifted. Instead of several distinct diagnoses (such as Autistic Disorder and Asperger's Syndrome), a single diagnosis of 'Autism Spectrum Disorder' is now used, with specifiers for severity. Critically evaluate this change. In your response, discuss at least one potential benefit and one potential drawback of this diagnostic consolidation.

Evaluating Diagnostic Consolidation for Autism

Based on the evolution of diagnostic criteria for developmental disorders, analyze the following scenario and explain the relationship between the historical diagnosis and the current diagnostic framework.

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