Prologue

THE DISORDER KNOWN AS AUTISM HAS HAD A HISTORY fraught with controversy over its every aspect, including nomenclature, diagnosis and classification, etiology, and treatment. Despite considerable research and growing understanding, the disagreements and controversies over this still mysterious disorder remain. Contrary to conventional wisdom, autism is not a rare disorder. Recent epidemiological studies place the prevalence rate as high as one per 1000; if the full autism spectrum is included, this figure may be more than two per 1000. This would make disorders of the autism spectrum more common than Down syndrome or all combined forms of childhood cancer (Bristol et al., 1996; Rapin and Katzman, 1998).

One source of much confusion surrounding autism has to do with terminology. The word autism has been, and still is, used to refer both to the syndrome discussed here and to a psychological symptom or hypothesized primitive mental state (Bleuler, E. 1950; Mahler, 1952, 1955; Ogden, 1994; Tustin, 1993, 1995). Unfortunately, there is no term in widespread use that clearly differentiates the syndrome of autism from other uses of the word that are unrelated to it (Rutter, 1968). Despite an attempt by Kanner in his initial and subsequent writings to distinguish his use of the term early infantile autism from that used by Bleuler and other psychoanalytic writers, the autism of “Kanner's syndrome” rapidly became confused with these other concepts. Misapplication of concepts resulting from important early investigations into maternal deprivation, such as those in the works of A. Freud, Burlingham, and Spitz on institutionalized infants (A. Freud and Burlingham, 1944; Spitz, 1945, 1946) provided one such source of influence. The work of such authors as B. Rank (1949, 1955), Despert (1938, 1942, 1951), and most significantly Bettelheim (1959, 1967) incorporated these ideas and were major influences on the viewpoint of autism that predominated until sometime in the late 1960s to e