Object relations approaches to autism

Introduction: Kanner’s autism, Asperger’s syndrome and the autistic spectrum

In 1943, Leo Kanner described a case series of children with severe impairments in communication as well as in emotional and social relatedness. They were often without language, did not play symbolically, and screamed if their rituals were interfered with. Kanner saw their most important characteristic as “extreme autistic aloneness.” On follow-up, most of the cohort were in institutions; a few made an unexpectedly satisfactory adjustment, though it was unclear why. Wing and Gould (1979) summarized the essential features of childhood autism as the “Triad of impairments”—impairments in social interaction, in social communication, and in social understanding and imagination, with rituals taking the place of pretend play—and this triad remains central to the description and diagnosis of the condition.

A year later, the Viennese paediatrician Asperger (1944) independently outlined the syndrome that is named after him. His children shared with Kanner’s a greater or lesser incapacity for ordinary reciprocal relationships, particularly for eye contact and empathy. Importantly, unlike children with Kanner’s autism, they had no language delay, though their language use might be atypical. Intense, idiosyncratic interests (“obsessions”) seemed to correspond to the rituals present in Kanner’s syndrome. Asperger stressed his children’s many good capacities, and described them as suffering from a fundamental disorder of the personality rather than from psychosis (Simpson 2004). In 1981, Wing put forward the idea of an “autistic spectrum” comprising both Asperger’s syndrome and autism†. Since 1971 (Kolvin 1971; Rutter and Bartak 1971), psychiatrists have contrasted pervasive developmental disorders including autism, which have their onset in early childhood, with so-called late-onset psychoses such as manic depression and schizophrenia.

The original estimate for the incidence of Kanner’s autism was 4 cases