J Autism Dev Disord
DOI 10.1007/s10803-016-2746-0
LETTER TO THE EDITOR
History and First Descriptions of Autism: Asperger Versus
Kanner Revisited
Nick Chown1 Liz Hughes2
Springer Science+Business Media New York 2016
Abstract When reading Michael Fitzgeralds chapter en-
titled Autism: Aspergers SyndromeHistory and First
Descriptions in Aspergers Disorder edited by Rausch,
Johnson and Casanova, a while ago, one of us was struck
by his contention that Kanner was guilty of plagiarism as
well as non-attribution of Aspergers 1938 paper Das
psychisch abnorme kind (Fitzgerald in Aspergers disor-
der. Informa Healthcare, New York, 2008) published in a
Vienna weekly. Steve Silberman has discovered evidence
that Kanner rescued Aspergers chief diagnostician from
the Nazis in 1944 so must have been aware of Aspergers
work and conclusions. Fitzgerald was on the right track but
it appears that Kanner may have plagiarised Aspergers
ideas rather than his 1938 paper.
Keywords Academic ethics
Asperger
Autism
Kanner
All students of autism know about the apparent coinci-
dence that Hans Asperger and Leo Kanner reported on their
discovery of autism in consecutive years (Asperger 1944;
Kanner 1943) and that this is generally regarded as a co-
incidence. When reading Michael Fitzgeralds chapter en-
titled Autism: Aspergers SyndromeHistory and First
Descriptions in Aspergers Disorder edited by Rausch,
Johnson and Casanova, a while ago, one of us was struck
by his contention that Kanner was guilty of plagiarism as
well as non-attribution of Aspergers 1938 paper Das
& Nick Chown
npchown@gmail.com
1
C/de Tarragona, 81, Palau-solita i Plegamans,
08184 Barcelona, Spain
2
26 Waingap View, Whitworth, Lancashire OL12 8QD,
England, UK
psychisch abnorme kind (Fitzgerald 2008) published in a
Vienna weekly. In his recent Samuel Johnson Prize win-
ning book Neurotribes based on detailed research into the
history of autism research, Steve Silberman (2015) takes
this issue beyond one of possible plagiarism and non-at-
tribution. He has discovered evidence that Kanner rescued
Aspergers chief diagnostician (Georg Frankl), and a psy-
chologist (Anni Weiss) who had also worked for Asperger,
from the Nazis in 1944 so must have been aware of
Aspergers work and conclusions. It is clear to us that
Fitzgerald was correct about the publication of the two
accounts of autism not being coincidence. However, the
issue here appears to be possible plagiarism of ideas about
autism rather than of any particular publication.
In a previous letter to the editor of this journal on the
subject of the initial publications on autism by Asperger
and Kanner, one of us concluded that maybe we should
just leave it that two great individuals made ground-
breaking contributions in our field so that, in the end, it
does not really matter who was first (Chown 2012). That
conclusion appeared reasonable at the time of writing, but,
whilst acknowledging Kanners contributions, we must
now consider whether Silbermans findings suggest that it
does matter who was first. Much of Aspergers account of
autism has stood the test of time, whereas some key
aspects of Kanners account have not. Of course, we have
Kanner to thank for rescuing Aspergers colleagues and the
knowledge of autism they brought with them. And if
Kanner had not rescued them it is possible that the initial
identification, and subsequent development of our under-
standing of autism, would have been delayed. However,
had Kanner made their knowledge available (maybe, in
tandem with his own ideas about autism) a many decades
wait before Aspergers understanding of autism became
public knowledge might have been avoided. The delay in
123

making Aspergers knowledge available, and the hege-
mony of Kanners ideas, appear to us to have had an
adverse impact on the trajectory of the diagnostic aspects
of autism, and led to some rather unfortunate developments
in the field.
Whilst, up to now, it has been received opinion that the
two clinicians worked separately, and were unaware of
each others work, Silberman discovered that Kanners
assistant Georg Frankl had previously worked for Asper-
ger. He found a biographical file relating to Frankl in the
archive of the Johns Hopkins hospital, where Kanner had
his clinic, confirming that Frankl had worked at the Lazar
Clinic in Vienna, where Asperger worked, for 11 years. In
a letter written in 1939 to his mentor, Kanner commended
Frankls good background in paediatrics and close con-
nection for 11 years to the Lazar Clinic. It seems that
Kanner was aware of the work of Asperger, as he had
supervised Frankl (and Weiss) during those years, and it
therefore appears that Asperger identified autism before
Kanner. An examination of the historical record shows that
Kanners, in some cases inaccurate, original account of
autism was far more influential than Aspergers (and the
only game in town for many years).
Aspergers original paper was not translated into Eng-
lish until 1981. It took time for his interpretation of autism
to come to the attention of researchers of autism and
diagnosticians, and even longer for his views to influence
autism research and diagnostic criteria. In this respect,
Kanners views had a head start of more than 40 years
over Aspergers account of autism. Unsurprisingly, the
year before Aspergers paper was translated for English
speakers, Schopler et al. (1980, p. 91) wrote that the main
sets of guidelines for diagnosing autism were Kanners
(1943) original definition of autism together with various
attempts to translate the Kanner definition into an empir-
ical rating scale. In 1987 the Kanner-influenced perva-
sive lack of responsiveness to other people was replaced
by the Asperger-influenced qualitative impairment in
reciprocal social interaction (ibid., p. 389) in the Diag-
nostic and Statistical Manual of Mental Disorders (Re-
vised) (DSM III-R) of the American Psychiatric
Association. Almost 10 years after the paper by Schopler
and his colleagues, a report by Le Couteur et al. (1989) into
their development of an autism diagnostic interview made
no mention of Asperger. In the same year that Schopler
et al. reported on their development of a diagnostic tool for
autism, Gillberg and Gillberg reviewed studies relating to
Asperger syndrome (AS) (1989, p. 631) writing in their
introduction that Asperger syndrome has so far been the
subject of very little systematic empirical inquiry. In 1994,
almost exactly 50 years since Aspergers original paper
was published, criteria based on Aspergers work were
included in the DSM and the World Health Organisations
123
J Autism Dev Disord
International Classification of Diseases (ICD) for the first
time (the DSM was by then in its fourth edition, and the
ICD in its tenth edition). Although Aspergers Disorder
was removed from the DSM-5, Aspergers legacy remains
in the criteria adopted for the new diagnosis of Autism
Spectrum Disorder and, indeed, in the very title of this
diagnosis with its reference to a spectrum of autism.
It was Kanners insistence on infantile autism which was
a major part of the disservice done by Kanner to autistic
people, and their families and other carers, because it
implied that it was something of relevance only to children,
thus denying recognition or support to autistic adults for
several decades. Another important issue was Kanners
very narrow definition of his syndrome; extreme autistic
aloneness, present from birth, and an anxiously obses-
sive desire for the maintenance of sameness, which
effectively excluded very many of the children who
Asperger would have recognised as being on the autistic
continuum. Asperger regarded the range of manifestations
of autistic traits as being on a continuum, and that these
traits were not uncommon in the population whereas
Kanner regarded them as rare.
Whereas Asperger saw threads of genius and disability
inextricably intertwined (ibid, p. 188) through many
family trees, over many generations, Kanner regarded it as
a new and startling phenomenon, requiring urgent inves-
tigation and explanation. The explanation of this phe-
nomenon, to Kanner, lay in women who demonstrated little
emotional contact with their offspring, and were therefore
regarded as responsible for the emotional stunting of the
child. Kanner wrote that in the parents of the group of
children he had seen there are very few really warm-
hearted fathers and mothers (Kanner 1943, p. 250).
Although he added the qualification that The childrens
aloneness from the beginning of life makes it difficult to
attribute the whole picture exclusively to the type of the
early parental relations with our patients (ibid., p. 250, it is
clear from his own words that he considered early parental
relations to be a major contributing factor. It took many
years for the so-called refrigerator mother theory of aut-
ismnow more closely associated with Bruno Bettel-
heimto be discredited and abandoned. Due to
Bettelheims popularity and influence, Kanners parenting
theory became far more entrenched than we think it would
otherwise have done.
Whilst acknowledging the role Kanner played in setting
the autism ball rolling in the English-speaking world, we
think it may have rolled in a somewhat different direction
had Aspergers views been in the ascendancy.1 We believe
1
It cannot be denied that Kanner played the vital role in establishing
autism in the diagnostic canon, and that a number of his clinical
descriptions of classic autism in children remain valid today
J Autism Dev Disord
that if Aspergers work and beliefs had been in circulation,
instead of Kanners, or even alongside, and in fair com-
petition with Kanners theories, it is probable that the lives
of very many people with autism would have been
improved. Asperger acknowledged the family pattern of
autism, and that this could actually be a positive thing, due
to the understanding of autistic children by their parents,
who might not have been too dissimilar. He understood that
this was a lifelong state of being, that one was born with,
and that intelligent support could bring out the best in these
children, but never cure them, as they would always be
autistic. If Aspergers work had been made public a lot
earlier, it might have been more difficult for theories such
as that of the refrigerator mother to gain credence and
delay the development and proliferation of good theory.
However, as Freudian thinking was in vogue at the time
Kanner wrote his seminal article (Feinstein 2010), the
views of Asperger, being somewhat out of step with the
clinical zeitgeist, might have struggled to make headway.
But they were not given a chance.
Perhaps, most importantly, it would have been recog-
nised much earlier that autism was not just a condition of
childhood, or one that affected lower-functioning children
only, but could be seen in people of all ages, and at all
levels of intellectual ability. We strongly suspect that
support for adults, and higher-functioning individuals, with
autism would have been made available earlier had the
opportunity to publicise Aspergers account of autism
provided by the rescue of his two Lazar Centre colleagues
not been missed, whether deliberately or otherwise.
Fitzgerald was on the right track in suggesting that pla-
giarism and non-attribution may have been at play as there
are clear indications that Kanner may have plagiarised
Aspergers ideas (rather than his 1938 paper). However,
Footnote 1 continued
(Feinstein 2010). But, given Silbermans findings, it is difficult to
avoid the conclusion that Kanner played the role of establishing
autism with the benefit of Aspergers work.
there can be no doubt that Kanner knew about Aspergers
work, and cannot fail to have been influenced by it,
although he signally failed to acknowledge Aspergers
contribution for many years.
Author Contributions LH identified the topic and contributed to
the drafting of the letter. NC drafted the letter. Both authors read and
approved the final manuscript.
References
Asperger, H. (1944). Die Autistischen Psychopathen im Kinde-
salter. European Archives of Psychiatry and Clinical Neuro-
science, 117(1), 76136.
Chown, N. (2012). History and First descriptions of Autism: A
response to Michael Fitzgerald, Journal of Autism and Devel-
opmental Disorders, 42(10), 22632265.
Feinstein, A. (2010). A history of autism: Conversations with the
pioneers. New York: Wiley.
Fitzgerald, M. (2008). Autism: Aspergers syndromehistory and
first descriptions. In J. L. Rausch, M. E. Johnson, & M.
F. Casanova (Eds.), Aspergers disorder. New York: Informa
Healthcare.
Gillberg, I. C., & Gillberg, C. (1989). Asperger syndromesome
epidemiological considerations: A research note. Journal of
Child Psychology and Psychiatry, 30(4), 631638.
Kanner, L. (1943). Autistic disturbances of affective contact. Nervous
Child, 2, 217250.
Le Couteur, A., Rutter, M., Lord, C., Rios, P., Robertson, S.,
Holdgrafer, M., & McLennan, J. (1989). Autism diagnostic
interview: A standardized investigator-based instrument. Journal
of Autism and Developmental Disorders, 19(3), 363387.
Schopler, E., Reichler, R. J., DeVellis, R. F., & Daly, K. (1980).
Toward objective classification of childhood autism: Childhood
Autism Rating Scale (CARS). Journal of Autism and Develop-
mental Disorders, 10(1), 91103.
Silberman, S. (2015). NeuroTribes: The legacy of autism and how to
think smarter about people who think differently. Crows Nest:
Allen & Unwin.
123