Drexel University Online - March and May

The Man Who Understood Autism When Nobody Else Did – A Tribute to Leo Kanner

In 1956, my younger son was born. He was about five years old before we finally found a name for the problem he had. We had visited many professionals and asked them to diagnose his condition and tell us what we could do.

“There is no name,” most of them said, “and the only thing to do is to put him into a State Hospital.” We refused to do that.

But there was a man who was doing something in those years. We did not know about him at the time – nor who he was or what he was doing. But he had a profound effect on our lives and on the lives of every family with an autistic child. He was the first researcher who understood autism as a distinctive brain-related syndrome, and his work was the basis of all subsequent research and practice in helping individuals with autism develop and live independently. He was also the man who popularized the word “autism” to refer to this syndrome, and thereby distinguished it enough that people could focus on specific treatments for it. His name was Leo Kanner, MD

Kanner was born on June 13, 1894 in Klekotow, Austria. He grew up in a Jewish community, in which his primary education took place at a Cheder (traditional Jewish school), as well as an ecumenical secular school. He was an extraordinary student and began to write poetry when he was about 10 years of age. He received his MD degree in 1921 from the University of Berlin.

Because of the growing political instability in Germany, a friend persuaded Dr. Kanner to accept a position in the United States as Assistant Physician at the State Hospital in Yankton, South Dakota. He arrived in 1924. During the next few years, he studied the English language in order to publish some of his thoughts on psychiatrics.

In 1928, Dr. Kanner applied and was accepted for training as a psychiatrist. At the end of his three year fellowship he was given a position at Johns Hopkins University Hospital. He set up and oversaw a child psychiatric unit – this started the changes that brought a completely different perspective on the relationship between a doctor and a child patient.

In 1935, Kanner wrote his first book, Child Psychiatry. This was the first English language text book on child psychiatry. His book emphasized a need for a full description of the child within the context of family and environment – before suggesting diagnoses and interventions. This gave clinicians a method with which to understand the problems of an autistic child.

A child psychiatry service within the pediatric hospital was set up for Dr. Kanner. The examining room was equipped with a washstand and table for an office. The doctor then set out to work with young children who had behavioral problems.

Dr. Kanner found a group of 11 children between the ages of 2 and 8, and saw them periodically for the next twenty-eight years. At the beginning, Dr. Kanner set the interview with each child individually, and established a rapport between patient and Doctor. The two carried on a conversation where the child was at ease and could speak without criticism.

After choosing and working with his initial small group of 11, he brought together a larger group of 55 children from whom he could get a wider range of information. Later, he found other large groups of children from whom he would monitor behavior patterns and other information. He worked steadily as a researcher until his death at age 86 in 1981.

Over time, Dr. Kanner created a new methodology for working with these types of children. In treatment, he spoke directly to the child, using the child’s words to formulate any definitive diagnoses. Dr. Kanner used the child’s exact words in naming the symptoms.

He also made a great contribution in his writing. Dr. Kanner kept notes on each of the children. He referred to each by the case number in his notes. The final report that carried material regarding each child was entitled, Autistic Disturbances of Affective Contact. He ultimately wrote eight books and 300 articles about his work. Most of his books are still being used as textbooks or reference works today.

Dr. Kanner dealt, from the beginning, with a topic that remains very controversial today: the causation of infantile autism. Unlike many observers of his day, he seemed to believe in both environmental and organic factors. His explanation for this complex attribution was a note on the importance of “not reducing all mental disorders to a few basic conflicts.” He saw autism as the outcome of many different forces – biological, developmental and environmental.

Dr. Kanner was also a strong voice in favor of ending the terrible conditions at state mental hospitals. His interest in this started with the 11 children whom he studied in his first group. They came from families that were affluent, and in some cases very controlling. Some of the parents lost their confidence in him at one point; feeling that too little of their children’s behavior had changed; they placed these children into a state psychiatric hospital, where mentally disabled and retarded children were sent. But the parents soon discovered that the children got even worse in the state hospital and took them out. Dr. Kanner’s methods were the only methods known, at that time, which could help children from sliding into a less capable, less communicative state.

After Dr. Kanner observed what was happening to the individuals placed in state hospitals, he expressed a great deal of concern about the usual treatment that the mentally retarded children received. His voice was among those that helped bring an end to the poor treatment of the individuals in mental hospitals, and an eventual end to the hospitals themselves.

In all of these ways, Dr. Kanner’s contribution to child psychiatry was numerous. Most importantly, his ever-broadening work with children with autism formed the basis for a new field of research. He made an immeasurable contribution to the lives of people who were and are still being diagnosed as autistic. This includes my son, who was able to be diagnosed early in his life because Dr. Kanner showed the way. All of the achievements that my son made, I can show direct correlation to the good doctor.

 

My thanks to Mr. Robert Q. Kreider, President and CEO of the Devereux Foundation.

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