Sunday, November 14, 2010

Toward an Historical Understanding of Autism

After researching a bit for my last post on a statement by Dan Olmsted that autism didn't exist before 1931, my curiosity was piqued regarding DeSanctis' and Heller's descriptions of progressive dementia in children, which they termed dementia praecocissima and dementia infantilis, respectively. They came up with these terms in 1906 (DeSanctis) and 1908 (Heller), well before the development of Merthiolate (a.k.a. thimerosal or thiomersal) by Eli Lilly around 1927 and its later use in vaccines in 1931.

Why the interest in these disorders?

The descriptions that I initially read sounded awfully familiar. Children developed normally, then, around the ages of 3-10 years, they displayed a loss of speech, development of echolalia, stereotypies, tics and so forth. A lot of parents who claim that vaccines "stole their child" from them by causing autism describe a situation where their child developed normally, received a vaccine and then lost vocabulary, withdrew (the "light went out of their eyes") and ultimately became autistic. The similarities drove me to find out more about the syndromes described by DeSanctis and Heller.

In my perusing, I came across a 1942 paper by Dr. Alexander Kennedy and Dr. Denis Hill titled Dementia Infantilis with Cortical Dysrhythmia. Kennedy and Hill start out with a discussion on dementia in children. They describe cases observed by Heller as generally having an

onset at the age of about four, early interference with speech, stereotypies and stupor alternating with periods of motor restlessness. All terminated in a profound dementia. Heller specifically mentions the absence of convulsions and of gross abnormalities in the nervous system.

DeSanctis' cases exhibited symptoms similar to those observed by Heller, but the

essential difference was that [DeSanctis'] group had a slightly later onset and that some of the cases had convulsions.

Kennedy and Hill go on to describe a case where a boy was developing normally until about age 6 years. He was described as:

Began school at five and a half and was regarded by teacher as a particularly bright child. At six could print legibly, read simple phrases, add small sums of money and do simple mental arithmetic (e.g. 14+3, 9+4). He could do one-line compositions spontaneously, knew the primary colours and numerous shades and spent much time in drawing. He mixed well with other children, though a little timid, and was regarded as physically and mentally normal for his age.

Not long after his sixth birthday, he had a bout of pertussis (whooping cough). He had difficulty retaining new material and lost some previously learned vocabulary (e.g., some colors), yet was able to sing songs learned a year before. The boy developed echolalia, and he developed challenging behaviors similar to those found among autistics.

Also interesting was the description of his parents:

The parents are both of above average intelligence and show no gross neurotic traits. In the electroencephalogram, however, both gave abnormal records of the kind described by Lennox, Gibbs and Gibbs (1940) as frequently occurring in the relatives of epileptics. The patient is an only child. The father's brother stammers and has violent attacks of temper. The maternal grandmother was ' peculiar' and her brother was an epileptic defective. The maternal great-grandfather was an epileptic dement and was certified at the age of thirty.

This bore some similarities to the parents of Kanner's 11 case children, as I described before.

Reading Kennedy and Hill's description, I really wanted to read the original cases from Heller and DeSanctis, among others, like Weygandt and Constantini, who also observed similar cases, but I was unable to find copies on the web. If anyone has a copy they could send me, I would appreciate it.

At any rate, the disorders observed by Heller and DeSanctis later came to be called Childhood Disintegrative Disorder (CDD), which is classed among other autism spectrum disorders in the DSM-IV-TR. Applied Behavior Analysis for Children with Autism Spectrum Disorders, edited by Johnny L. Matson, also recognizes CDD/Heller Syndrome as part of the autism spectrum.

These descriptions so strikingly resemble the descriptions given by parents who have fallen in with the anti-vaccine propagandists. Developing normally until about 2 or 3, get a vaccine, then regress into autism. The marked difference, however, is that the children observed at the beginning of the 20th century hadn't received vaccines and certainly had not been exposed to thimerosal. It is not a big stretch, then, to think that what these parents are observing is CDD, not vaccine injury. The fact that a vaccine is given before the regression, considering the schedule, it is virtually guaranteed that there will be coincidences like this. Though the temptation to assign the cause to vaccines, given the findings of Heller, DeSanctis and other early researchers coupled with more recent research into thimerosal and vaccines, a non-vaccine cause seems far more likely.

To those who would blame vaccines, it is time to learn more about the history of what we know and move on to more promising areas of inquiry.

[Edited to Add (2/22/16): Smithsonian magazine published a very interesting article, "The Early History of Autism in America," which details the work of Samuel Gridley Howe. Howe undertook an effort to conduct a census of so-called "idiots" in 1846-1848, describing several cases whose features sound quite similar to autism.]

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