History of autism

In European folklore . Scholars have suggested that stories of changelings in European folklore may have originated as a folk explanation for autism. The tales involve young children being taken by fairies or other beings, and replaced by changelings. These children were "unresponsive, resistant to affection, did not express emotion, cried a lot or did not speak." Autism may not be initially apparent when a child is very young but become more clear over time, which contributed to the myth that a child had been replaced. The connection between changeling tales and autism was first proposed in 2005 by Australian social scientist Julie Leask. She was prompted into the line of inquiry after hearing a modern mother claim her true child had been "stolen". Autistic people before "autism" Authors have identified cases, from long before the term "autism" was created, of people who perhaps today would have been diagnosed as autistic. The Table Talk of Martin Luther, compiled by his note taker, Mathesius, contains the story of a 12-year-old boy who may have been autistic with high support needs. The earliest well-documented case of autism is that of Hugh Blair of Borgue, as detailed in a 1747 court case in which his brother successfully petitioned to annul Blair's marriage to gain Blair's inheritance. Henry Cavendish was a prolific natural philosopher, first published in 1766. During his life, Cavendish was considered eccentric and his behaviour was described as "peculiarly shy" by contemporaries. When researching Cavendish as a subject for a 2001 article in the journal Neurology, neurologist Oliver Sacks determined that evidence for an ASD diagnosis was "almost overwhelming". The Wild Boy of Aveyron, a feral child found in 1798, showed several signs of autism. He was non-verbal during his teenage years, and his case was widely popular among society for its time. Such cases brought awareness to autism and related disabilities, and more research was conducted on the natural dimensions of human behaviour. The medical student Jean Itard treated him with a behavioural program designed to help him form social attachments and to induce speech via imitation. Early descriptions of autistic symptoms Around 1810, French psychiatrist Jean-Étienne Dominique Esquirol defined the condition of monomania. He published about it in 1827. It was centred on the contemporary concept of the fixed idea (idée fixe), a single subject of obsession in an otherwise healthy mind. Autistic people often have strong fixations on certain topics or objects. Echolalia is the practice of repeating other people's words without explicit awareness. The French doctor Jean Marc Gaspard Itard coined the term in 1825. French psychiatrist Jean-Pierre Falret first defined the term stereotypy in 1864. He used it to refer to the repeated expression of an idea by certain mental patients. The term later became used to include repeated physical acts as well, and later still became mainly used for this. These acts when performed by autistic people are now usually considered stimming (and sometimes secondary stereotypic movement disorder). Austrian psychiatrist Richard von Krafft-Ebing pioneered understanding of obsessional thought in an 1867 work. In 1877, British doctor John Down used the term developmental retardation to describe conditions including what would be considered autism today. Also in 1877, German doctor Adolf Kussmaul defined the condition aphasia voluntaria - when people choose not to speak. Some people considered to have aphasia voluntaria may have been autistic and non-verbal. In 1887, John Down gave a lecture which describes idiots savants, people whose mental abilities were generally poor, but who had strong abilities in a particular area. He notes that "In none of the cases of 'idiot savant' have I been able to trace any history of a like faculty in the parents or in the brothers and sisters..." The term obsessive neurosis was first used by Austrian psychiatrist Sigmund Freud in 1894. This concept became adopted in English speaking countries, eventually becoming obsessive-compulsive disorder. French doctor Édouard Brissaud defined the condition of auto-echolalia (repeating one's own words without explicit awareness) in 1899. This later became known as palilalia. French psychiatrist Pierre Janet published the book Les Obsessions et la Psychasthénie (The obsessions and psychasthenia) in 1903. It included the newly defined condition of psychasthenia, which became a prototype of Carl Jung's later introverted personality type, and was believed by Grunya Sukhareva to be a component of schizoid psychopathy in childhood. German sociologist Georg Simmel wrote about urban sensory overload in his 1903 essay "The Metropolis and Mental Life". The concepts of interoception and proprioception were introduced in 1906 by British neurophysiologist Charles Sherrington. Interoception describes the sensory system that receives internal information from the body. (Autistic people's minds are sometimes less good at receiving this information than non-autistic people, particularly when children or experiencing sensory overload. Sometimes interoceptive signals in autistic people are louder than are typical in non-autistic people.) Proprioception describes the system that senses the position and location of muscles, tendons and joints. (Autistic people's minds can be less good at receiving this information than non-autistic people). Dementia praecox and related conditions The term dementia praecox (premature dementia) was first used by German psychiatrist Heinrich Schüle in 1880, and also by 1891 by Arnold Pick, a Czech professor of psychiatry. Scottish psychiatrist Thomas Clouston in his 1883 book Clinical Lectures on Mental Diseases, described a new condition he called psychoneurosis. His description covered what is today considered the schizophrenia and autism spectrums - what others had considered "dementia praecox". The term "dementia praecox" was greatly popularised in 1899 through the sixth edition of German Psychiatrist Emil Kraepelin's book Psychiatrie. Ein Lehrbuch für Studirende und Aerzte (Psychiatry. A text-book for students and physicians). This condition was defined very broadly by today's standards. The primary disturbance in dementia praecox was seen to be a disruption in cognitive or mental functioning in attention, memory, and goal-directed behaviour. Autistic people often have these attributes and some people diagnosed with this condition would be considered autistic today. Italian psychiatrist Sante De Sanctis briefly mentioned a condition in a 1906 paper he called dementia praecocissima (very premature dementia), which was a form of dementia praecox that started very early in people's lives. He wrote about it in more detail in a 1908 paper. It was a very broadly defined condition he considered "very similar to the hebephrenic or catatonic symptom complex of puberty and adolescence." Austrian educator Theodor Heller defined a condition called dementia infantilis (infantile dementia) in 1908. This condition would go on to be called Heller's syndrome and childhood disintegrative disorder. The DSM currently considers it part of autism spectrum disorder. It is a rare genetic condition. == Autism as a symptom of schizophrenia (1908–1924) ==

Eugen Bleuler created the concept of autism, using it to describe a type of behaviour. Eugen Bleuler was a Swiss psychiatrist who was the director of the Burghölzli mental hospital, which was associated with the University of Zurich. In April 1908 he gave a lecture explaining that dementia praecox was very different to other forms of dementia. He proposed that it be given the unique name schizophrenia - a split mind. The term would be increasingly adopted over the next fifty years. What is now known as "schizophrenia" is different from what Bleuler described. He included what is today considered as autism, schizoid personality disorder and various schizophrenia spectrum and other psychotic disorders in his definition. The Neo-Latin word autismus (English translation autism) was coined by Bleuler in July 1910. (On the theory of schizophrenic negativism). He derived autismus from the , and used it to mean morbid self-admiration, referring to "autistic withdrawal of the patient to his fantasies, against which any influence from outside becomes an intolerable disturbance". He believed they drew on an early childhood mental state that was unable to form theory of mind. Hoch also said they had "a poorly balanced sexual instinct [and] strikingly fruitless love affairs". This personality was identified because a high proportion of patients with dementia praecox had shut-in behaviour before more serious symptoms appeared. detailed character types that would later be considered schizoid by Grunya Sukhareva. Kraepelin writes of an as-of-yet poorly understood group of patients who may be intellectually well-endowed, yet are "absent-minded, forgetful, and show fluctuations in their intellectual capacity." in English in 1925, and used the terms schizoid and schizothmes (the latter being like schizoid, but more neurotypical). He included the schizothmic artistic temperament as one of two varieties of genius, and defined the socially withdrawn schizothymia as a personality type. In 1924, Bleuler said schizoid people were:At this time Bleuler also believed that everyone had a schizoid element, writing "Every man then has one syntonic [in harmony with one's environment] and one schizoid component, and through closer observation one can determine its force and direction". Carl Jung: Introversion coined the term introverted. In September 1909, Swiss psychiatrist Carl Jung used the term introverted in a lecture at Clark University. A transcript of this lecture was then published with two others in a journal in 1910, the first time the term appeared in print. In the lecture he mentions that love that is "introverted", "is turned inward into the subject and there produces increased imaginative activity". was published as Personality Types in English in 1923. It described the "introverted" in detail for the first time. (Various new editions were published until 1949). A more concise definition of the introverted type was given by Jung in February 1936, in his paper "Psychologische Typologie" (Psychological Typology). It included:Hans Asperger would later see similarities between Jung's introversion and his concept of autism. The group was founded by American teacher Elizabeth Farrell to bring together teachers of disabled children. The group later became known as the Council for Exceptional Children. Moritz Tramer In 1924, Austrian-Swiss psychiatrist Moritz Tramer published the paper "Einseitig Talentierte und Begabte Schwachsinnige" (Singularly talented and gifted mental defectives). It described idiot savants. Leo Kanner would later claim Tramer's autism work as an antecedent of his own. == Pioneering research (1925–1945) ==

Grunya Sukhareva was the first to comprehensively define what is now considered autism. Soviet child psychiatrist Grunya Sukhareva (Груня Сухарева) was the first person to comprehensively define what is now considered autism. She was born in Kyiv to a Jewish family, and between 1917 and 1921 worked in a psychiatric hospital in Kyiv. In 1921, she founded a school for children with psychological problems at the Psychoneurological Department for Children in Moscow, In 1925 she published a pioneering paper containing six case studies and a detailed description of schizoid personality disorder in children, titled "Шизоидные псиxопатии в детском возрасте" (Schizoid Psychopathies in Childhood). This was revised slightly and published in German in 1926, as "Die schizoiden Psychopathien im Kindesalter" (The Schizoid Psychopathies in Childhood). Her definition aligned well with that for ASD in the DSM-5. She summarised the condition as being made up of five factors: • A peculiar type of thought, with a tendency towards the abstract and schematic. This often combined with a tendency to reason and engage in absurd pondering. The latter often makes them seen as being eccentric. • Autistic attitude. All children in this group remained aloof from their environment, adapt to their environment with difficulty and never fully integrate into it. Cases 1, 2 and 3 immediately become the object of general ridicule among the other children upon admission to school. Cases 4 and 5 had no authority among their classmates and are nicknamed "talking machines", although their general level put them significantly above the rest of the children. Case 6 even avoided the company of children, which traumatized him. The tendency to loneliness and the fear of people can be observed in all of these children from early childhood onwards; they stay apart from the others, avoid playing together, they prefer fantastic stories and fairy tales. • In the area of the thymopsyche, a certain flatness and superficiality of feelings (cases 2, 3, 5). This is often combined with what Kretschmer described as an aesthetic personality. • Special features: • tendency to automatism (cases 1, 2, 3, 4 and 6), which is expressed by sticking to work that has been started. Their rigid psyche has difficulty adapting to the new. • impulsive absurd actions (cases 1, 2, 3), • a silly demeanour, the tendency to rhyme, and to create stereotypical new words (cases 1, 2, 3, 5). • tendency to obsessive states (cases 1, 2, 3, 4) and • increased suggestibility (cases 1, 3 and 6). • A pronounced motor insufficiency could be observed: clumsiness, angularity of movements, many superfluous movements, synkinesis (cases 1, 2, 3 and 4). Inadequacy of facial expressions and expressive movements (cases 1, 4 and 5), slack posture (cases 2, 4, 6), linguistic peculiarities, and insufficiently modulated speech (cases 1, 2, 3). She found that there were five main gender-related differences. Separate to this, she notes that one of her patients "strives to mask her embarrassment with laughter, grimaces, and superfluous movements." (New Zealand translator Charlotte Simmonds translated this paper into English in 2020.) In 1930, Sukhareva published the paper K probleme struktury i dinamiki detskikh konstitutsionnykh psikhopatiĭ (shizoidnye formy) (Toward the problem of the structure and dynamics of children's constitutional psychopathies (Schizoid forms)). It was translated into English by William New and Hristo Kyuchukov in 2022. In this paper she notes the presence of psychomotor disorders, disorder of affect and emotional responses and issues with associative work and thinking. In one she notes that even from early childhood, these children showed a "lack of adaptability to life in the collective, a certain autism and unreliability". In 1939, Sukhareva published the three book collection Клинические лекции по психиатрии детского возраста, (Clinical lectures on child psychiatry). The second volume included her findings about schizoid/schizophrenic children. New editions were published in 1959 and 1965. Charles Bradley, and Leo Kanner in the 1930s and 40s, her work was subsequently largely unknown in the Anglosphere and Western Europe. Sukhareva would not become well known in the West until much later. In September 1996, British child psychiatrist Sula Wolff published her translation of Grunya Sukhareva's 1925 paper, followed closely by California and Washington in 1909. Several other states followed. Forced sterilization rates of disabled people across the United States were relatively low, with the exception of California, until the 1927 U.S. Supreme Court decision in Buck v. Bell, which upheld under the U.S. Constitution the forced sterilization of patients at a Virginia home for intellectually disabled people. The number of sterilizations performed per year increased until another Supreme Court case, Skinner v. Oklahoma in 1942. Aktion T4 The German expression "life unworthy of life" first appeared in print in the 1920 book, Die Freigabe der Vernichtung Lebensunwerten Lebens (Allowing the Destruction of Life Unworthy of Life). Its authors, the Germans jurist Karl Binding and psychiatrist Alfred Hoche, believed some living people who were brain damaged, intellectually disabled and psychiatrically ill were "mentally dead", "human ballast" and "empty shells of human beings". They believed that killing such people was useful. Similarly eugenic thinking was at that time popular in Europe and North America. Emil Kraepelin and Eugen Bleuler both thought people with severely disabling genetic conditions should not reproduce. The National Socialist German Workers' Party adopted eugenic thought, and gained power in Germany in March 1933. In July 1933, they passed the "Law for the Prevention of Hereditarily Diseased Offspring". It prescribed compulsory sterilisation for people with disabling conditions thought to be hereditary, such as "imbecility". The law was administered by the Interior Ministry under Wilhelm Frick through special Hereditary Health Courts (), which examined the inmates of asylums, special schools and other facilities to select those to be sterilised. It is estimated that 360,000 people were sterilised under this law between 1933 and 1939. In August 1939, German nurses were asked to identify young children with intellectual disabilities. From September these children began to be secretly sentenced to death. This sentencing was soon extended to older children, adults and to people with many other disabilities. This death policy was later known as Aktion T4. Initially the victims were shot by the Einsatzgruppen and others. In January 1940, they began to be sent to six killing centres (Tötungsanstalt) where they were killed by lethal injection, and later gas chambers. Gas vans were also used. Aktion T4 was led by the Germans Philipp Bouhler (bureaucrat) and Karl Brandt (doctor). In August 1941, German public outcry against these semi-secret killings lead to the official end of the program. However, its aims continued to be quietly pursued until the end of the Third Reich in 1945. Asperger would later say his autism thinking was influenced by its explanation of schizothyms. In 1935, Asperger went on to become the head of the department. In April 1935, Anni Weiss published the paper "Qualitative intelligence testing as a means of diagnosis in the examination of psychopathic children", which includes a case study about an autistic boy. (Command and Obey), which identified a group of children with particular language difficulties that some have subsequently considered autistic. As a Jew, Frankl was in danger from the growing Nazi sentiment in his country. So he left Vienna in 1937 and migrated to the United States in November that year. He went to work with his friend Leo Kanner at Johns Hopkins Hospital. Austria became part of the German Reich in March 1938, however not all of its laws were immediately enacted. Asperger used the terms autistic psychopath and autism in a 3 October 1938 lecture to describe a pattern he had seen in his patients and elsewhere. The lecture was published later that year as Das Psychisch Abnormale Kind (The Mentally Abnormal Child). The lecture included two case studies, and analysis. It instructed its predominantly Viennese listeners and readers that people who are a bit strange may also be very intelligent, and that knowing this will become important "when the 'Law for the Prevention of Hereditary Diseased Offspring' comes into force in our country". This paper "Die "Autistischen Psychopathen" im Kindesalter" (The "Autistic Psychopaths" in Childhood) included four cases studies and related analysis over 61 pages. (He later published a slightly revised version in his 1952 textbook Heilpädagogik (curative education)). Asperger identified a typical behaviour pattern seen among autistic children, and with extensive detail outlined his observations. He concludes that "...the individual personalities [of autistic people] stand out from one another not only through the degree of the contact disorder, through the level of intellectual and character strengths, but also through numerous individual traits, special ways of reacting, and special interests." Asperger also details his lack of finding autistic traits in young girls. Mirroring his findings in 1938, he tells readers in the Reich and beyond that "We are convinced then, that autistic people have their place in the organism of the social community. They fulfil their role well, perhaps better than anyone else could, and we are talking of people who as children had the greatest difficulties and caused untold worries to their care-givers." In regards to his work's academic antecedents, Asperger frequently acknowledges Bleuler, and also said:Asperger was aware of Suchareva's work, which is confirmed by the papers Asperger wrote. However, in his paper on "Autistic Psychopaths", he deliberately omitted the source. Although Suchareva was Jewish, citing her as a source was not prohibited in Germany at the time. Despite many important English-publishing autism researchers being fluent in German, and his work being covered in some English-language works, Asperger's concept of autism would be almost unknown by non-German-speaking psychological professionals for a long time. More detailed coverage in English-language works such as Gerhard Bosch's book of 1970, Lorna Wing's paper of 1981, and Uta Frith's translation of Asperger's thesis in 1991 were important steps in this occurring. Leo Kanner introduced the concept of autism to many people in the United States and other countries.Leo Kanner was born in 1894 to a Jewish family in what is Ukraine today, and what was then the Austro-Hungarian Empire. He went on to study and work in Berlin. He then immigrated to the United States in 1924. In 1930, the first child psychiatry clinic in the United States was established at Johns Hopkins Hospital, and Kanner was appointed to run it. In May 1933, American psychiatrist Howard Potter, (assistant director of the New York State Psychiatric Institute and Hospital), published a paper titled "Schizophrenia in Children". Potter defined six diagnostic criteria for childhood schizophrenia, which Kanner would later say was important when thinking about autism: • A generalized retraction of interests from the environment. • Dereistic thinking, feeling and acting. • Disturbances of thought, manifested through blocking, symbolization, condensation, perseveration, incoherence and diminution, sometimes to the extent of mutism. • Defect in emotional rapport. • Diminution, rigidity and distortion of affect. • Alterations of behaviour with either an increase of motility, leading to incessant activity, or a diminution of motility, reacting to complete immobility or bizarre behaviour with a tendency to perseveration or stereotypy. In 1934, Soviet psychiatrist Evgenia Grebelskaya-Albatz (Евгения Гребельская-Альбац) of Moscow published the paper "Zur Klinik der Schizophrenie des frühen Kindesalters" (On the clinic of early childhood schizophrenia). It divided people with childhood "schizophrenia" into two groups, those with intelligence within the normal range, and those with below average intelligence. Kanner would later say that she was one of the three people to identify autism before he did. titled Child Psychiatry. (While many sources say he published the first English-language book of that kind, Kanner himself credits this to William Ireland). In 1937, Swiss psychiatrist Jakob Lutz of University of Zurich published a short book reviewing the available material on childhood schizophrenia, including the work of Sukhareva, Potter, Grebelskaja-Albatz and others. Lutz visited Kanner's department at Johns Hopkins in early 1938. Kanner later acknowledged Lutz's influence on his work. The paper referenced two researchers, Sukhareva and Grebelskaya-Albatz. It has been suggested that this paper was a major influence on Kanner. Its 34 pages included case studies of eleven children and their families who have particular things in common. He did not use the term autism as the name of the children's condition. In the paper he notices a pattern of children with childhood schizophrenia have a "combination of extreme autism, obsessiveness, stereotypy, and echolalia..." that differ greatly from other people with schizophrenia. He also notes that these children often present with "the powerful desire for aloneness and sameness..." and "between the ages of 6 and 8 do not play with other children but instead along side them." He adds that "reading skill is acquired quickly, but the children read monotonously, and a story or moving picture is experienced in unrelated portions rather than in its coherent totality..." It is also possibly the first time that the phrase "special interest" is used in print in its modern autism-related context. As for the cause of the condition, it states:The term ''Kanner's syndrome'' was later coined to describe the children's condition, in particular to distinguish them from the differing symptoms of Asperger's children. This syndrome has also sometimes been known as classic autism. Kanner and Asperger's colleague George Frankl published the paper "Language and Affective Contact" in the same journal edition as Kanner's 1943 paper. It describes different kinds of speech problems children have. In particular, he identifies a group of speech-troubled children defined by having a "lack of contact with persons", which can be considered to be an autistic group. Frankl's precise role in the development of the concept of autism is not clear. In September 1944, Kanner published the paper "Early Infantile Autism", giving his newly identified condition a new name. The paper has much in common with Kanner's 1943 paper. It included only two case studies, but had a much more detailed introduction. Kanner wrote two more papers on autism in the 1940s. German child psychiatrist August Homberger released the book Vorlesungen über Psychopathologie des Kindesalters (Lectures on childhood psychopathology) in 1926, which included a chapter called "Die Schizophrenie" (The schizophrenia). Charles Bradley would later quote from it extensively. In it he proposed that autism comes from the patient's loss of contact with reality, and was the core component of "schizophrenia". He thought autism was of two types, "rich" (full of fantasy/psychosis) and "poor" (with few thoughts and feelings). Contrary to Bleuer, he thought that the vast majority of autistic cases were of the "poor" type. Austrian-British psychoanalyst Melanie Kline published a case study about a child that would today be considered autistic in 1930. Other European psychoanalysts would publish similar case studies during the following decade. German psychiatrist R. Niedenthal published the paper "Uber Schizophrenie im Kindesalter" (On schizophrenia in childhood) in 1932. It was devoted to defining the symptoms of childhood schizophrenia. studied 29 tuberous sclerosis (TSC) patients who were in mental institutions in 1932. They described behaviour that today would be recognised as autistic. In 1934, Moritz Tramer published the paper "Elektiver Mutismus bei Kindern" (Elective Mutism in Children), coining the term elective mutism. During this period, the term autism came to be used quite widely, with a variety of related meanings. In 1936, Swiss psychologist Jean Piaget first published about centration - the ability to focus on only one salient aspect of a situation. In December 1937, British psychiatrist Mildred Creak of Maudsley Hospital presented a paper titled "Psychoses in Children". One part of it identified a group of five children that might today be considered autistic. The paper was published in March 1938. In 1939 and 1940, Dutch psychiatrist Alfons Chorus of Nijmegen's Pedological Institute published a pair of papers describing children that were called autists and schizoid, which today would be considered autistic. In late 1938 or early 1939, the Institute created a category for its child students called "autists", representing those who were particularly self-centred. This paper describes in detail children with what would earlier be considered monomania, and later be considered "special interests":American psychiatrist Charles Bradley of the Emma Pendleton Bradley Home, published the book Schizophrenia in Childhood American Academy of Speech Correction The American Academy of Speech Correction (AASC) was founded in 1925, bringing together people working to correct serious communication problems some people had. This included some autistic people. Speech correctionists later became known as "speech therapists" and "speech pathologists", amongst other terms. The AASC changed its name to the American Speech–Language–Hearing Association (ASHA) in 1978. In 2022, the US Centers for Disease Control and Prevention (CDC) noted that "The most common developmental therapy for people with ASD is Speech and Language Therapy." Similar bodies later formed in other parts of the world, including the UK's College of Speech Therapists (now Royal College of Speech and Language Therapists) in 1945, the Australian College of Speech Therapists (now Speech Pathology Australia) in 1949 and Speech-Language & Audiology Canada (SAC). Fragile X syndrome In July 1943, the British neurologist James Martin and British geneticist Julia Bell described a pedigree of X-linked intellectual disability. This would later be called Fragile X syndrome, and is now considered one of the genetic causes of autism. == Increasing awareness (1946–1967) ==

Starting in the early 1950s, awareness of "autism" as a distinct condition began to spread to psychiatrists and the wider culture in the United States, before spreading to Europe and other places. Parents of autistic children began to group together around the condition, and advocate for their children and themselves. ICD-6 On 7 April 1948, the newly formed United Nations established the World Health Organization (WHO). One of its first tasks was to create a global standard list of all health conditions, which was approved by an international conference at the end of April. The WHO adopted and greatly expanded an earlier list of fatal conditions, the ILCD-5. The first International Classification of Diseases (ICD-6) soon became widely used in Europe and elsewhere. It included "primary childhood behaviour disorders" (324), which was used to categorise all children with what was considered disordered behaviour. There was also the condition of "specific learning defects" (326.0). One of its "disorders of character, behaviour, and intelligence" was the "pathological personality" of "schizoid personality" (320.0). Various categories of schizophrenia (300) were additionally represented, though not specifically "childhood" schizophrenia. (The DSM-II would later explicitly state that its concept of childhood schizophrenia had no ICD equivalent). The ICD would not substantially change its representation of autism-related conditions until the ICD-9 in 1978. Refrigerator mother theory The refrigerator mother theory emerged in 1948 as an accepted explanation for autism. A Time magazine article from late April that year entitled "Medicine: Frosted Children" was based on a recent talk by Leo Kanner, which circulated his view that autistic behaviours may stem from the emotional frigidity, lack of warmth, and cold, distant, rejecting demeanour of a child's mother. The paper behind this talk was published in 1949. Kanner himself eventually rejected the theory. British psychiatrist John Bowlby's 1951 paper and monograph on maternal deprivation, reinforced the concept. In France, it was championed by psychoanalyst and psychiatrist Françoise Dolto. (Psychoanalysts in France have maintained the currency of the theory in that country into the mid-2020s.) Austrian-British psychologist Anna Freud and German-British psychologist Sophie Dann published a paper in 1951 that found that the extreme conditions of deprivation of affection of the Nazi concentration camps did not induce autistic pathology in children. This was later used as an argument against the refrigerator mother theory. The League for Emotionally Disturbed Children The League for Emotionally Disturbed Children was founded in New York in 1950 by 20 parents of emotionally disturbed children, including doctor and researcher Jacques May. The group established the League School in Brooklyn in 1953. Enrolment was limited to children diagnosed with "childhood schizophrenia". The school helped establish a new method of teaching, led by teacher Carl Fenichel and assisted by psychiatrists Alfred Freedman and Zelda Klapper. Leo Kanner noted in 1956 that the organisation had sponsored research that was "attempting to uncover metabolic and electrophysiologic abnormalities" in autistic children. In 1966, Fenichel established the League School of Boston. DSM-I The first edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) was released in 1952. The DSM was created to give each of America's mental disorders a clear definition. Two of the conditions it defined included reference to Bleuler's understanding of "autism" - the symptom of keeping-to-oneself. Each was named primarily using another of Bleuler's terms, and defined with a paragraph. One was "Schizophrenic reaction, childhood type" (000-x28), used in cases of "psychotic reactions", including those manifesting primarily autism. This diagnosis was used in cases where there were intellectual disturbances, repetitive behaviour, or a retreat from reality. The other was "Schizoid personality" (000-x42), which was characterized by avoidance of close relations with others, inability to express ordinary aggressive feelings, and autistic thinking. Kanner and Eisenberg's 1956-57 work In February 1956, American psychiatrist Leon Eisenberg published the paper "The Autistic Child in Adolescence", which compared the childhood and adolescence of 63 autistic people. He found that almost one third had achieved at least a moderate social adjustment over the period, predominantly those who had possessed "meaningful language" by the age of 5. He also found that "the fundamental feature [of autism] is a disturbance in social perception." In July that year, Kanner and fellow Johns Hopkins researcher Eisenberg published the paper "Early infantile autism, 1943-1955". Providing Kanner's most concise definition of the condition yet published, the paper says:Supporting the refrigerator mother hypothesis, the paper notes: "The emotional frigidity in the typical autistic family suggests a dynamic experiential factor in the genesis of the disorder in the child." Kanner published a number of other papers about autism in the 1950s and 60s. Mildred Creak's nine point definition Until 1961, autistic children in the UK were often institutionalised from a young age. Poor disease control in these institutions often led to a quick death. At this time, the British government sought to discover exactly how many psychotic children there were in the UK. They commissioned Mildred Creak of Great Ormond Street Hospital to lead a group to define the symptoms of childhood psychosis/schizophrenia, and the group completed their work the same year. They came up with a nine-point definition that soon became widely used in that country, and in time would form the definition of the condition used in most of the world through the ICD. The nine points were more detailed than Sukhareva's similar definition. They lacked the earlier definition's mention of OCD and clumsiness, and added the inclusion of anxiety. A major difference came in Creak's ninth point: "A background of serious retardation in which islets of normal, near normal, or exceptional intellectual function or skill may appear." Later that year Elgar, Lorna Wing and others established the UK's Society for Autistic Children. (It became known as the National Autistic Society in 1982.) The Society proposed the "puzzle piece" as a symbol for autism in 1963, because it reflected their view of autism as a "puzzling condition". In 1965, the group set up The Society School for Autistic Children, which was later named after Sybil Elgar. As of 2023, the society operates seven schools across England. Representative organisation Scottish Autism began in 1968, and continues independently today. (Autism Northern Ireland would follow in 1991.) In the United States Austrian-American psychologist Bruno Bettelheim at the University of Chicago published an article in 1959 in Scientific American, "Joey the Mechanical Boy", about a 9-year-old with autism. This increased public awareness of the condition in the United States. Hungarian-American psychiatrist Thomas Szasz's book The Myth of Mental Illness was published in 1961. This advanced the idea that while "mental illness" did not exist, some people had "problems in living", caused by their situations in life. 1961 also saw the publishing of French psychologist Michel Foucault's history Madness and Civilization. Both fuelled the anti-psychiatry movement. Rosemary Kennedy, sister of US President John F Kennedy, was autistic. Her sister Eunice Kennedy Shriver made the public aware of this through an article in the New York Post in September 1962. Rosemary's treatment with brain surgery severely impacted her. The US Community Mental Health Act (CMHA) of 1963 prompted the closure of most of the country's residential institutions for the mentally unwell. The intent was that as many people as possible would be enabled to live freely in homes without full time professional supervision, but could draw on support from community mental health centres. The introduction of Medicaid in 1965 increased the rate of institutional closure. In 1963, the Council for Exceptional Children established the Association for Children with Learning Disabilities (now the Division on Autism and Developmental Disabilities). In 1966, the Association established the journal Education and Training of the Mentally Retarded. (In 2010, the publication became known as Education and Training in Autism and Developmental Disabilities.) refuted the refrigerator mother theory and co-founded the Autism Society of America. In 1964, Bernard Rimland published the book Infantile Autism: The Syndrome and Its Implications for a Neural Theory of Behavior, which refuted the refrigerator theory. Instead, Rimland suggested, autism was a result of biochemical defects "triggered by environmental assaults". It included a foreword by Leo Kanner. The book challenged the medical establishment's perceptions of autism. Rimland's message resonated with parents, who wanted to share their stories with him and ask for advice. In May that year, Life magazine published an article on the work led by Norwegian-American behaviourist psychologist Ivar Lovaas at UCLA's Young Autism Project. "Screams, Slaps and Love" showed how the adults working with autistic children hit them as part of their training. Both this TV episode and magazine article led to further awareness of the condition in the United States. Later in 1965, this newfound awareness coalesced as Rimland, Lovaas, nurse Ruth C. Sullivan and others founded the National Society for Autistic Children (NSAC). Leo Kanner and Carl Fenichel soon joined its Professional Advisory Board. September 1966 saw the first episodes of Star Trek broadcast on American television. A prominent character in the program, Spock, has been seen by some as being autism-coded. Bettelheim countered Rimland's assertions about the causes of autism in his 1967 book Empty Fortress: Infantile Autism and the Birth of the Self. It greatly popularised the refrigerator theory. Bettelheim subsequently appeared multiple times on The Dick Cavett Show in the 70s to discuss theories of autism and psychoanalysis. (Refrigerator theory has since been refuted in the scientific literature, including a 2015 systematic review which showed absolutely no association between caregiver interaction and language outcomes in ASD patients.) Another notable book of 1967 was The Siege: The First Eight Years of an Autistic Child by American teacher Clara Claiborne Park. It told the story of Clara's daughter and Clara's efforts to help her. (An updated version was released in 1982). Bernard Rimland left his central role at the NSAC in 1967, founding the Autism Research Institute. However, he remained attached to the NSAC. Newly defined commonly comorbid conditions What is today considered to be auditory processing disorder (APD) was first scientifically described by American otorhinolaryngology surgeon Samuel Joseph Kopetzky in 1948. His work was followed in 1954 by important papers by British otorhinolaryngology surgeon PF King and American psychologist Helmer Rudolph Myklebust. Some believe that APD is "one of the primary characteristic features of ASD", or that it is often comorbid. The term "dyspraxia" was coined by Spanish-French psychiatrist Julian de Ajuriaguerra and French psychologist Mira Stambak in 1964. It describes someone's difficulties with physical coordination and movement. This is said to affect up to 88% of people with autism. American psychiatrist Peter Sifneos identified that some people without brain lesions experienced emotional agnosia in 1967, they not being able to recognise the emotions expressed by others. Hyperlexia is when a child can read at an early age. This can be a symptom of autism, particularly when their reading ability is much better than their speaking ability. The term was coined by husband-and-wife American psychologists Norman E. Silberberg and Margaret C. Silberberg, and first published in September 1967. Other scientific and treatment contributions Netherlander child psychiatrist Dirk van Krevelen published the paper "Een geval van 'early infantil autism'" (A case of early infantile autism) in 1952. It was the first European paper about "early infantile autism". In it, van Krevelen notes that while the condition is well known by United States child psychiatrists, it is virtually unknown in Europe. as part of a book. (An early form of it had been given as a lecture in November 1940). It included Fairbairn's belief that the schizoid type was defined by "(1) an attitude of omnipotence, (2) an attitude of isolation and detachment and, (3) a preoccupation with inner reality", with last being by far the most important. Fairbairn believed that people became schizoid because they had been unable to get the parental love they sought when they were small children. He also saw an equivalency between being "schizoid" and being "introverted". In 1955, Niels Bank-Mikkelsen, Director of the Danish Service for Mental Retardation, proposed the normalisation principle, defining it as "The possibility for the mentally retarded to lead an existence as close to normal as possible." In 1959, this was adopted into Danish law. published the paper "A method for the experimental analysis of the behavior of autistic children". This was possibly the first paper to show how behaviorism could be used to teach autistic students. Also in January, Dirk van Krevelen and Christine Kuipers published a paper in English regarding the work of Asperger, "The psychopathology of autistic psychopathy". Also in 1962, German psychiatrist Gerhard Bosch published the book Der Frühkindliche Autismus: Eine Klinische und Phänomenologisch-Anthropologische Untersuchung am Leitfaden der Sprache (Early Childhood Autism: A Clinical and Phenomenological-Anthropological Study Using Language as a Guide). Among other things, it briefly compared the work of Asperger and Kanner and suggested both men had described variants of the same condition. Bruno Bettleheim cited it substantially in his later work. American psychologist Herman Witkin and his colleagues first published about his concept of field dependence in 1962. It related to the difference between people in either focusing on fine detail or the "big picture" (also known as "bottom up" and "top down" thinking). Autistic people were later found to more commonly focus on the former, compared to non-autistic people. American social worker, teacher and dramatist Viola Spolin released the book Improvisation for the Theater in 1963, based on her decades of experience teaching people how to more effectively communicate with each other. The book contained a series of exercises for teaching people how to understand other people's thoughts about their shared situation, and how to react to them effectively. This kicked off the theatre games set of practices, which form an important part of drama therapy. (A second edition was published in 1983, and a third in 1999.) British psychiatrist John K Wing edited the first edition of Early Childhood Autism; Clinical, Educational and Social Aspects in 1966, which included chapters from both Ivar Lovaas and Lorna Wing. Later editions would contain different chapters. American psychologist Robert Zaslow developed the "Z-process" in the 1960s, first publicly presenting about it in 1967. This line of thinking became known as attachment therapy. Establishment of new organizations In addition to new scientific and cultural developments, the 1960s also saw the establishment of new autism support groups in developed countries, predominantly by parents of autistic children: • The first French national autism organisation, the ASITP (Association au service des inadaptés présentant des troubles de la personnalité), was founded in Paris in 1963. (Since 1990, it has been known as (FFSA)). • Kfar Tikva was established in Israel as a village for people with "cognitive, developmental and emotional disabilities" in 1964. This includes autistic people. (The similar Kishorit community opened in 1997.) the Autistic Children's Association of New South Wales (now Aspect, 1966), Victorian Autistic Children's and Adult's Association (now Amaze, 1967), Autistic Children's Association of Queensland (now Autism Queensland, 1967), and what is now the Autism Association of Western Australia (1967). These organisations continue today. (Later, Autism Tasmania (1992) and Autism NT (2002) would be founded.) Autism began to be mentioned in Australian magazines and TV programs in the late 1960s. • In Brazil, the Comunidade Terapêutica Leo Kanner (Leo Kanner Therapeutic Community) was founded in Porto Alegre in 1965. • 40 parents of autistic children met in Tokyo in December 1966. In February 1967, they and others formed the Association of Autistic Children's Parents. A national body was established in 1968. In time, this would become (日本自閉症協会). == Evidence grows (1968–1977) ==

In this period scientists found increasing evidence that autism was a distinct condition, The edition also saw hyperkinetic reaction of childhood added to the typology. This condition later became known as attention deficit hyperactivity disorder (ADHD). Its symptoms were first described by German doctor Melchior Adam Weikard in 1775. The concept of child hyperactivity or hyperkinetic behaviour became established in the United States in the 1930s. Around 50-70% of people with ASD also have ADHD. Applied behaviour analysis and related techniques was a pioneer of what would become known as applied behaviour analysis. While serving as an assistant professor of psychology at Indiana University from 1957 to 1962, Charles Ferster employed errorless learning to instruct young autistic children how to speak. This was an early example of what would later be known as applied behaviour analysis. From the late 1950s, Ferster and others used the new science of behaviorism to teach autistic people and those with other mental conditions. This led a group of researchers at the University of Kansas to start the Journal of Applied Behavior Analysis in the northern spring of 1968, establishing the concept of applied behavior analysis (ABA). A concise definition of the concept, still used today, was given in the first issue of the journal. ABA soon came to be used extensively with autistic children in the United States and elsewhere. In the US, ABA became the only autism-specific teaching method insurance companies would typically pay for, thus most autism-specialist teachers there became ABA trained and qualified. (Two major American professional associations would later be founded for ABA practitioners.) The Behavior Research Institute was founded by Matthew Israel in the United States in 1971. It would later become known as the Judge Rotenberg Educational Centre. Six residents have died of preventable causes at the centre since it opened. Various bodies have accused the centre of repeatedly torturing autistic people in the name of ABA. Matthew Israel invented the graduated electronic decelerator to provide electric shocks as punishment for residents. This includes shocks nine times as powerful as a cattle prod. The MidWestern Association for Behavior Analysis was founded in the United States in 1974. It later became the Association for Behavior Analysis International (ABAI). A 2018 study by Henny Kupferstein showed a significant link between early childhood exposure to ABA and Post-Traumatic Stress Disorder (PTSD), "Nearly half (46 percent) of the ABA-exposed respondents met the diagnostic threshold for PTSD..." Asperger's 1968 paper In April 1968, Asperger wrote about the similarities and differences of his and Kanner's concepts of autism in the paper "Zur Differentialdiagnose des kindlichen Autismus" (On the differential diagnosis of childhood autism), noting: Highlighting his broad use of the term autism, he also remarked: Leo Kanner republished a copy of his 1934 paper in the same journal edition. Kanner's work in the 1970s The Journal of Autism and Childhood Schizophrenia was established in January 1971, with Leo Kanner as the editor. This was the first scientific journal devoted to autism. Kanner wrote a paper called "Childhood psychosis: A historical overview" Another paper in the first edition however compares Kanner's syndrome (early infantile autism) with Asperger's syndrome (autistic psychosis). Kanner released the fourth and final edition of his textbook Child Psychiatry in 1972. in 1973, and wrote three of its chapters. It reviewed 30 years of research into early infantile autism and childhood schizophrenia. In it he bemoaned the diagnosing of intellectually disabled children with a few autistic features as singularly having autism. The "First International Leo Kanner Colloquium on Child Development, Deviations, and Treatment" was held in October 1973. The papers tabled were published as the popular academic book Psychopathology and child development: research and treatment in April 1976. Many of the papers were about autism. It was edited by German-American psychologist Eric Schopler and American psychiatrist Robert J. Reichler. Eric Schopler would become the second editor of the Journal of Autism and Childhood Schizophrenia in 1974, staying in that role until 1997. Kanner wrote additional papers about autism in the 1970s. Ayres proposed that what is now called sensory processing disorder is linked to emotional regulation, learning, behaviour, and participation in daily life. This condition is recognised by some major occupational therapy bodies. The STAR Institute suggests that at least three-quarters of autistic children have significant symptoms of the disorder. Ayres's 1972 book Sensory Integration and Learning Disorders launched her program of sensory integration therapy (SIT). just as Bleuler had separated schizophrenia from dementia. British psychiatrist Michael Rutter's extensive research in the 1960s provided statistically robust evidence that the syndrome of "early infantile autism" existed. Punding is the compulsive performance of repetitive tasks due to unusual dopamine regulation; which can include collecting or sorting objects or information. The term was first published by Swedish forensic psychiatrist in November 1968. 1970 saw the release of the English translation of Gerhard Bosch's 1962 book as Infantile autism: a clinical and phenomenological-anthropological investigation taking language as the guide. It was translated by Derek and Inge Jordan, and included an introduction from Bruno Bettelheim. The English-language edition included a large appendix about Asperger and Kanner not included in the German one. It used the term ''Asperger's syndrome'' to describe the symptoms of Asperger's patients. American psychiatrist Stella Chess conducted studies on the potential link between rubella and autism. In 1971, she found that children with congenital rubella syndrome developed autism at rates 200 times higher than the general population at the time. She followed this up with a 1977 study. South African-British psychiatrist Israel Kolvin provided much evidence that "early infantile autism" was a very different condition to later onset schizophrenia through two studies published in 1971. It refers to people having difficulties in understanding the emotions experienced by themselves or others. This is common in autistic people, but is not always the case. By the early 2000s it was found that about half of autistic people have at least some alexithymia traits. In 1975, American-British psychologist Donald Meltzer released his book Explorations in Autism: a psychoanalytic study, documenting the treatment of childhood autism following the thinking of Melanie Klein. Hungarian-American psychologist Mihaly Csikszentmihalyi's 1975 book Beyond Boredom and Anxiety: Experiencing Flow in Work and Games defined the newly coined concept of flow. Some believe this concept explains certain autistic traits. His more popular book on the subject Flow: The Psychology of Optimal Experience became a bestseller in 1990, greatly increasing knowledge of the concept. Asperger gave a lecture in Fribourg in 1977, of which a translation in English titled "Problems of Infantile Autism" was published in 1979. July 1977 saw Israeli psychologist publish the first paper on global precedence (being able to "see the forest for the trees"). This built on earlier work on field dependence. It was later found that autistic children tend to have relatively weak global precedence, and that this correlated with a relatively weak ability to identify emotion and age in both humans and dogs. American psychiatrist Susan Folstein and British psychiatrist Micheal Rutter published a significant twin study establishing the genetic basis of autism in September 1977. Also in September that year, American linguist Ann Peters defined the "analytic" and "gestalt" language learning strategies. From 1982, American speech-language pathologist Barry Prizant argued that autistic people use the gestalt style more commonly than non-autistic people, and that this explained certain aspects of their unusual language use. This line of thinking was later developed by fellow American speech-language pathologist Marge Blanc. Other treatment programmes, advocacy and books The University of North Carolina's TEACCH Autism Program was founded by Eric Schopler in 1971, building on work started by Schopler and a colleague in 1964. It recognizes autism as a lifelong condition and does not aim to cure but to respond to autism as a culture. It uses behaviourism in a small group setting. Its methods have been adopted by many practitioners. British researcher Lorna Wing of the Institute of Psychiatry, London published the book Autistic children - a guide for parents in 1971. Louise Despert endorsed the book, and provided its forewords. In 1972, German-American Wolf Wolfensberger released his book Normalisation. It advocated that society should provide opportunities to people with disabilities so that they can do what people without those disabilities can do. The popular book A child called Noah: a family journey was written about the autistic boy Noah Greenfield by his father the American playwright Josh Greenfeld, and was published in 1972. Josh Greenfield was to write two other books about Noah, and Noah's brother would write an additional one. In 1975, Canadian speech pathologist Ayala Hanen Manolson founded The Hanen Centre. Here she developed a new program for groups of parents whose children had significant language delays, known as the "Hanen Approach." Previously, speech pathology was largely delivered by professional pathologists - this approach trained parents to provide the same guidance to children. Over decades, this approach further developed into programs such as More Than Words and Talkability. Also in 1975, the first sensory room was constructed by the Netherlanders Ad Verheul (occupational therapist) and Jan Hulsegge (music therapist). These rooms are used to calm people with sensory processing conditions, including people with autism. In November 1975, two British organisations, the Union of the Physically Impaired Against Segregation and the Disability Alliance, held a discussion about the "fundamental principles of disability." The published summary of that discussion advanced a new definition of disability. "In our view, it is society which disables physically impaired people. Disability is something imposed on top of our impairments, by the way we are unnecessarily isolated and excluded from full participation in society." This sentiment later became the basis of the social model of disability, and was important in disability self-advocacy. The home-based autism treatment program Son-Rise, was developed by American couple Barry Kaufman and Samahria Kaufman in the early 1970s. Barry published a book on the method in 1976, (Son-Rise), claiming that it cured his son of autism. An American TV movie based on the book, Son-Rise: A Miracle of Love, was released in 1979. It was influential in Brazil, and was repeatedly aired there during the 1980s. In 1990, the BBC in the UK aired a documentary about one boy's treatment using the Son-Rise program, titled I Want My Little Boy Back, as part of the series Q.E.D.: Challenging Children. An updated and expanded Son-Rise book, Son-Rise: The Miracle Continues was released in 1994. In the United States In 1970, NSAC launched an ongoing national autism awareness campaign. In 1972, it started the first National Autistic Children's week, which later evolved into Autism Awareness Month. The Rehabilitation Act of 1973 stated, "No otherwise qualified handicapped individual in the United States, shall solely by reason of his handicap, be subject to discrimination under any program or activity receiving federal financial assistance." Division 33 of the American Psychological Association was established in 1973, bringing together American psychologists interested in "Mental Retardation and Developmental Disabilities", including autism. As of 2023, the group covers "Intellectual and Developmental Disabilities/Autism Spectrum Disorder" (IDD/ASD). The Education for All Handicapped Children Act (EHA) was passed in November 1975, after a series of related Supreme Court decisions. In 1970, US schools educated only one in five children with disabilities. Many states had laws excluding emotionally disturbed and intellectual disabled children from public education. The EHA guaranteed each disabled child a free and appropriate public education. • In Germany, what is now (Autism Germany) was founded in 1970. • In Sweden, what is now (Autism Sweden) was founded in 1973. Its original name, up until 1990, was Föreningen för psykotiska barn (The Association for Psychotic Children), the term barndomspsykos (childhood psychosis) being a slightly broader definition in Swedish at the time, however primarily including autism. From 1990 the name was Riksföreningen Autism (The National Autism Association), and from 2010 Autism- och Aspergerförbundet (The Autism and Asperger Association). • In Canada's most populous province, the Ontario Society for Autistic Children was founded by parents in 1973. (After a number of name changes, it became Autism Ontario in 2006.) • The Israeli Society for Children and Adults with Autism (ALUT) was founded in 1974. As of 2023 it has over 2,500 employees, providing services to over 15,000 families. • In January 1975, Autismus Deutsche Schweiz (Autism German Switzerland) began in German-speaking Switzerland. (This was followed with an allied body in French-speaking Switzerland in 1985, and one in Italian-speaking Switzerland in 1989. The three groups now form a confederation called Autism Switzerland.) • Autism Society Canada was established in 1976. • Autism support group APAFAC was founded in Catalonia in 1976. It was joined by Aspanaes in Galacia in 1979, and similar bodies in other parts of Spain after that. == Formal recognition (1978–1993) ==

Autism became recognized as a developmental disorder distinct from schizophrenia for the first time by a major psychiatric body, the WHO, in 1978. This and the APA's adoption of a similar definition in 1980, was a major milestone in enabling research into autism. Public awareness of autism greatly increased with the release of the movie Rain Man. Asperger's work became known to a wider audience, thanks in part to new publications by Lorna Wing. Stronger self-advocacy by autistic people laid the foundations of the neurodiversity movement. ICD-9 The international medical condition classification system, the ICD, greatly changed the way it categorised autism-related conditions in 1978, with the release of the ICD-9. "Infantile autism" (299.0) was now recognised as a condition, with separate sub-categories for it having a "current or active state" or "residual state". Its definition of this condition was based on the criteria devised by Mildred Creak for "childhood schizophrenia" in the early 1960s. DSM-III and DSM-III-R DSM-III Under advisement from the NSAC, "Elective mutism" was now categorised as in independent condition. "Withdrawing reaction of childhood (or adolescence)" became "schizoid disorder of childhood or adolescence". The DSM-III notes that people with this condition have qualifying symptoms "Not due to Pervasive Developmental Disorder; Conduct Disorder, Undersocialized, Nonaggressive; or any psychotic disorder, such as Schizophrenia." "Schizoid personality" in adults was split into "schizoid personality disorder", "avoidant personality disorder" and "schizotypal personality disorder". The DSM's third PDD category became "pervasive developmental disorder not otherwise specified" (PDDNOS, later PDD-NOS). Lorna Wing on the autism spectrum and Asperger's syndrome Considering the wide difference of autistic traits in different people, British psychiatrist Lorna Wing and British psychologist Judith Gould coined the term autism spectrum in their March 1979 paper "Severe impairments of social interaction and associated abnormalities in children: epidemiology and classification." While it did not use the term, the paper also established the autistic triad of impairment definition of the condition: "severe impairments of social interaction, language abnormalities, and repetitive stereotyped behaviors." greatly increased awareness of the existence of Asperger's autism work. Start of the neurodiversity movement American schizophrenic Judi Chamberlin's 1978 book On Our Own: Patient Controlled Alternatives to the Mental Health System was a notable voice against the damage caused by "forced treatment" of brain conditions. The book was an important driver of the psychiatric survivors movement. (Chamberlin's American lawyer husband Ted Chabasinski had been institutionalised for his autism when a child, and was himself an important part of that movement). The United Nations declared 1981 the International Year of Disabled Persons. This gave increased focus on people with disabilities in many countries. The physically disabled British musician Ian Dury released the song Spasticus Autisticus in protest to elements of the year. In 1983, building on developments over the previous twenty years, the disabled British academic Mike Oliver coined the term "social model of disability", which posits that "disability" is caused by a lack of acceptance by society of people's non-typical natures. This was contrasted with the "medical model of disability", which posits that disability is that non-typical nature itself. American autistic Jim Sinclair is credited as the first person to communicate the "anti-cure" or "autism rights" perspective in the late 1980s. In 1992, Sinclair co-founded the Autism Network International (ANI) with fellow autistics Kathy Grant (American) and Donna Williams (Australian). ANI is an organization that publishes newsletters "written by and for autistic people". This grew into the autism rights movement. Neurodiversity is the idea that people can think differently to the norm without those differences being a medical problem. Its first use was in the late 1990s on the mailing list "Independent Living". Australian sociologist Judy Singer and American autism self-advocate Jane Meyerding were early noted users of the term in 1998. It was used by the group known as the "Institute for the Study of the Neurologically Typical" (INST). The term first appeared in print in the September 1998 article Neurodiversity by autistic American neurodiversity activist Kassiane Asasumasu. She includes all forms of brain non-normality in her definition. Many in the autistic community use it to refer just to autism, or just autism and ADHD. Mirror neurons led the team that discovered mirror neurons. Researchers Giacomo Rizzolatti, Giuseppe Di Pellegrino, Luciano Fadiga, Leonardo Fogassi, and Vittorio Gallese at the University of Parma published a paper announcing the existence of mirror neurons in 1992. They found that when a monkey watches another monkey doing something, specialised neurons in the first monkey's brain fire in a way that mirrors the firing of the neurons in the acting monkey. The same scientists later found the same thing in human brains. It has been proposed that differences in the mirror neuron system could in part explain differences between autistic and neurotypical people. A well-cited study in 2006 by American psychiatrist Mirella Dapretto and others found such a connection. Later research, however, did not support this connection. Scientific developments The term "infodumping" was first used in 1978. The popular academic book Language of autistic children was published in 1978, and was written by American psychiatrist Don W. Churchill. The term "sensorimotor gating" was first used in print in July 1978 to describe a brain's ability to subconsciously filter out low-relevancy sensory information, in a paper by a team led by American psychiatrist David Braff. This term later developed into "sensory gating". Autistic differences in sensory gating lead to more common cases of sensory overload than for neurotypical people. (This in turn often leads to stimming, meltdowns and burnout). It can also lead to sensory underload, (which also can lead to stimming). The opioid excess theory of autism was proposed by Estonian-American neuroscientist Jaak Panksepp in a 1979 paper. The possibility of a related relationship between autism and the consumption of gluten and casein was first articulated by Norwegian medical researcher Kalle Reichelt in 1991. This work led to the use of a gluten-free, casein-free diet (GFCF) to treat autism symptoms. The concept of hysteroid dysphoria was defined in print by American psychiatrists Michael Liebowitz and Donald F. Klein in December 1979. It described people who often have a strong negative reaction to perceived rejection by someone else. Klein later renamed the condition rejection sensitivity disorder. In 1981, Jakob Lutz published the paper "Hans Asperger und Leo Kanner zum Gedenken" (Hans Asperger and Leo Kanner in memoriam). The Minspeak image-based language was first implemented on a computer in 1981. It was developed by American linguist Bruce R Baker. It has gone on to become popular on augmentative and alternative communication devices. French ear, nose and throat specialist Guy Bérard announced auditory integration training (AIT) to the world through a 1982 book. Annabel Stehli's 1991 book The Sound of a Miracle told the story of her autistic daughter's treatment by with this training. Bérard's book was translated into English in 1993. By 1994, over 10,000 US children and adults had received AIT. Later larger and better controlled studies failed to bear out the promise of AIT, and its use is now discouraged by significant bodies. In 1983, Swiss-American neurologist Isabelle Rapin and psycholinguist Doris A Allen coined the term semantic pragmatic disorder to describe the communicative behaviour of children who presented traits such as pathological talkativeness, deficient access to vocabulary and discourse comprehension, atypical choice of terms and inappropriate conversational skills. They referred to a group of children who presented with mild autistic features and specific semantic pragmatic language problems. (In the late 1990s, the term "pragmatic language impairment" (PLI) was proposed to cover this situation.) A controversial claim suggested that watching extensive amounts of television may cause autism. This hypothesis was largely based on research suggesting that the increasing rates of autism in the 1970s and 1980s were linked to the growth of cable television at the time. The popular academic book Educating and understanding autistic children was edited by Americans Robert L. Koegel (psychiatrist), Arnold Rincover (psychologist) and Andrew L. Egel (educationalist), and released in 1983. The 1985 book Biology of the Autistic Syndromes proposed that autism was a syndrome with multiple biological etiologies. It was written by American neurologist Mary Coleman and Swedish psychiatrist Christopher Gillberg. (New editions were published in 1992 and 2003). In September 1985, Felix F. de la Cruz outlined extensively the physical, psychological, and cytogenetic characteristics of people with Fragile X syndrome in addition to their prospects for therapy. The term "theory of mind" was first applied to autism by the psychologists Simon Baron-Cohen (British), Alan M Leslie (Scottish) and Uta Frith (German-British) in October 1985, in a well cited paper. Multiplex developmental disorder was conceptualised by American researchers Donald J. Cohen (psychiatrist), Rhea Paul (speech pathologist) and Fred Volkmar (psychiatrist) in March 1986. They proposed that it be recognised as a variety of autism in the DSM, however this did not occur. The Handbook of autism and pervasive developmental disorders is a popular academic book about autism that was first released in 1987. The first edition was edited by Americans Donald J. Cohen, Anne M. Donnellan (educational psychologist) and Rhea Paul. New editions were published in 1997, 2005 and 2014. Additional editors have included Fred Volkmar (American psychiatrist), Ami Klin (multi-national psychologist), Sally J. Rogers (American psychologist) and Kevin A. Pelphrey (American neuroscientist). Uta Frith's 1989 well-cited book Autism: Explaining the Enigma posited the weak central coherence theory of autism. It proposes that autistic people typically think about things in the smallest possible parts. It argues that autistic people perceive details better than non-autistic people, but "cannot see the wood for the trees." (A second edition was published in 2003). Mind-blindness is a term first published in early 1990 by Simon Baron-Cohen. It refers to the idea that "autistic people are impaired in their ability to attribute mental states (such as beliefs, knowledge states, etc.) to themselves and other people". This is otherwise known as an impaired theory of mind (ToM). Baron-Cohen believed that a lack of ability to read eyes was a particularly important deficit, and developed a training program to develop this. It is now thought that all autistic people have some ToM ability. Baron-Cohen's book Mindblindness: An Essay on Autism and Theory of Mind was released in 1995. Asperger's early papers were first published in English in 1991, as part of the book Autism and Asperger Syndrome. They were translated by the book's editor, Uta Frith. This further increased awareness of Asperger's work, and of the concept of "Asperger syndrome". American animal behaviourist Temple Grandin invented the squeeze machine to therapeutically apply deep-touch pressure to herself in 1965. She was inspired by squeeze chutes used with livestock. and his colleagues introduced the concept of the "broader autistic phenotype" (BAP) to refer to family members of people diagnosed with autism who had some autistic traits, but not enough to themselves be considered autistic. New diagnostic tools The ICD and DSM newly recognising the condition of autism spurred the development of a number of new diagnostic tools. The Childhood Autism Rating Scale (CARS) was released in March 1980 by Americans Eric Schopler, Robert Jay Reichler, and Kenneth Daly. The Autism Diagnostic Observation Schedule (ADOS) was developed in 1989 by Catherine Lord, Michael Rutter, Susan Goode, Jacquelyn Heemsbergen, Heather Jordan, Lynn Mawhood and Eric Schopler. This was revised to become the ADOS-G in 2000, by a team including Andrew Pickles. The schedule became commercially available in 2001. (A further revised version, ADOS-2, was released in 2012). The Autism Diagnostic Interview (ADI) was also developed in 1989, by Ann Le Couteur, Michael Rutter, Catherine Lord, Patricia Rios, Sarah Robertson, Mary Holdgrafer and John McLennan. An updated version, the ADI-R, was commercially released in 2003. The Checklist for Autism in Toddlers (CHAT), a tool for diagnosing autism in children aged 18–24 months, was first published in December 1992 by Simon Baron-Cohen, Jane Allen and Christopher Gillberg. Simon Baron-Cohen and others also developed another test for autism in 18-month-olds, which was published in February 1996. Applied behaviour analysis The Early Start Denver Model of autism treatment for young children was developed in 1981 by American psychologists Sally J Rogers and Geraldine Dawson. It was initially called the "play school model", because its main actions happened during children's play. It is considered a variety of ABA. Positive behaviour support (PBS, PBIS, SWPBS or SWPBIS) emerged from the University of Oregon in the mid-1980s. It is a type of ABA that is typically used in schools. Tim Lewis is a noted practitioner of the concept, and is often credited as a co-founder. The Association for Positive Behaviour Support was founded in 2003. Pivotal response treatment (PRT) was pioneered by Americans Robert Koegel, Mary O'Dell and Lynn Kern Koegel in 1987. It is a "naturalistic" form of ABA used with young children. PRT aims to teach a few "pivotal skills", that will help the student learn many other skills. Initiating communication with others is deemed one such pivotal skill. Lovaas controversially reported that half his pre-school patients that received intensive therapy now had an IQ level equal to their non-autistic peers, and had "recovered" from their autism. It is sometimes called the "Lovaas method/model/program" and sometimes the "UCLA model/intervention". It has become the primary form of Early Intensive Behavior Intervention (EIBI), and now is often referred to by that name as well. One methodology it developed was discrete trial training, which has become a well-used ABA technique. was first released by American educationalists John O Cooper, Timothy E Heron, and William Lee Heward at Ohio State University in 1987. New editions were published in 2007 and 2019. Non-ABA treatment and support The "developmental, individual-difference, relationship-based model" (DIR) of autism diagnosis and treatment was developed by American psychiatrist Stanley Greenspan in 1979. This was later further developed into the Floortime program. Various deep touch pressure techniques were in common use with autistic people by American occupational therapists by 1980. In a February 1981 publication, Lorna Wing noted that although she believed there was currently no treatment for autism, "handicaps can be diminished by appropriate management and education" and that "techniques of behaviour modification used with autistic children can possibly be helpful if applied with sensitivity". of the University of Pittsburgh in 1981. The first paper explaining it was published in 1984. The program has autistic and non-autistic pre-schoolers share a classroom, with the latter assisting the former. It is considered a more-cognitive rather than a more-behaviourist form of teaching. It is also considered one of the best researched forms of training for autistic pre-schoolers. by Andy Bondy and Lori Frost. It is a communication teaching method for people with limited speech. In the late 1980s, the field of Developmental Education developed at the Sturt campus of SACAE in Adelaide, Australia. It brought together the concept of "normalisation" from the social model of disability with ideas from ABA. Developmental Education aims to teach life skills to disabled people who need them. The Autism CRC believes practitioners may be of help to autistic children and their families. The first consumer noise-cancelling headphones were released by Japanese electronics company Sony in 1992. This kind of headphones can help autistic people avoid sensory overload. Leadership of the TEACCH Autism Program passed from Eric Schopler to American psychologist Gary Mesibov in 1992. (Mesibov subsequently also succeeded Schopler as editor of the Journal of Autism and Developmental Disorders from 1997 to 2007.) Social skill teaching method, Social Stories, began its development in 1989 by American teacher Carol Gray. She published her first paper on it in April 1993, also publishing the first book about it that year. A survey of Ontario autism support workers in 2011 found that 58% had support programs influenced by her. The first International Conference on Autism was held in Toronto, Canada, in July 1993. It was organised by the Autism Society of America and Autism Society Canada. 2300 delegates from 47 countries attended. The "China Compulsory Education Law" (中华人民共和国义务教育法) was enacted in 1986. Like the American EHA, it required public schools to accept students with disabilities. In the United States The US congress endorsed Autism Awareness Month in 1984. The Americans with Disabilities Act of 1990 made it illegal to discriminate against people based on their disability, in a number of important categories. It also required covered employers to provide reasonable accommodations to employees with disabilities, and imposed accessibility requirements on public accommodations. In Finland Autism found its way into the Finnish disease classification in 1987. (It was only in 1996 that it was finally removed from the category of psychosis in the Finnish version of the ICD-10.) Newly established organizations • The (NVA) (Dutch Association for Autism) was founded in 1978 by parents of children with autism. • The Sensory Processing Disorder Foundation was founded in America in 1979 by occupational therapist Lucy Jane Miller. It is now known as the STAR Institute. • Domus Instituto de Autismo was established in Mexico in May 1980 by parents of children with autism. • Autism-Europe began in 1983, co-ordinating autism organisations across Europe. • In Brazil, (AMA, Association of Friends of the Autistic) was founded in 1983. Within a year of this, they were running a school. They soon became their country's main autism association. • The Autism Society of Taiwan (中華民國自閉症總會) was founded in January 1985. • Eleven mothers of autistic children in the Philippines held a gathering in 1987. In March 1989, they and others founded the Autistic Children and Adults of the Philippines (ACAP) Foundation. The group became the country's predominant autism organisation. It is now known as Autism Society Philippines. • 1987 saw America's National Association for Autistic Children became the Autism Society of America. • Representative organisation Autism South Africa (A;SA) was founded in 1989 by concerned parents and professionals. • In Saudi Arabia, the Saudi Autistic Society (الجمعية السعودية الخيرية للتوح) was founded in January 1990. • In India, Action for Autism (AFA) began in 1991 as a parent support group. It soon became India's foremost autism organisation. • In Turkey, a support group for parents of children with autism began in 1991. It reformed as the Turkish Autistic Support and Education Foundation (TODEV) in 1997. It is Turkey's pre-eminent autism group. Popular books and other media • One chapter of British neurologist Oliver Sacks' 1985 book The Man Who Mistook His Wife for a Hat featured an autistic savant. appearance on an episode of QED about savants. He would later gain fame in other countries. • American movie Rain Man was released in 1988. Its titular character was an autistic man with savant abilities. Bernard Rimland was consulted on how the character was portrayed. The movie did much to define public understanding of the condition. A second edition was published in 2000. The similar ''Asperger's syndrome and your child: a parents' guide'' was released in 2002. == Asperger syndrome recognised (1994–2012) ==

The 1990s saw the continued popularization of autism both in popular culture and in the scientific community. The newly ICD and DSM endorsed condition "Asperger syndrome" saw a particularly strong increase in attention and autistic self-identification. ICD and DSM changes The 1990s saw the release of both the ICD-10 and the DSM-IV, as well as the revised version DSM-IV-TR. Notably, Asperger syndrome came to be recognized as condition distinct from, but related to, autistic disorder/childhood autism. ICD-10 The ICD-10 was first published in 1992, for use beginning in 1994. It made a number of changes to its categorisation of autism-related conditions. It newly included "Asperger syndrome" (F84.5) - its first recognition by a major mental health body. It also included "childhood autism" (F84.0), and a category for "atypical autism" (F84.1, similar to the DSM's PDD-NOS). The ICD-10 categorised all of these as "pervasive developmental disorders", as the DSM had done since 1980. The ICD childhood shyness conditions were incorporated into the new section "disorders of social functioning with onset specific to childhood and adolescence", with a category for elective mutism (F94.0) and various categories not specifically aligning with common autism symptoms. "Schizoid personality disorder" would remain, though its subcategories would not. (The ICD-9 would continue to be used for coding by some organisations in the United States until 2015.) DSM-IV: autistic disorder, Asperger disorder and other conditions In 1994, reflecting the better understood diversity of autistic experience, the DSM-IV included a number of newly defined PDD conditions. "Autistic disorder" was redefined, and supplemented with the new conditions Asperger's disorder, Rett disorder and childhood disintegrative disorder (CDD). PDD-NOS remained. The definition of Asperger syndrome required those with it to have speech and language difficulties. This edition also saw the defining of developmental coordination disorder (DCD), a condition featuring "a marked impairment in the development of motor coordination." The DSM acknowledged that these symptoms were common in people with PDDs, and excluded such people from being diagnosed with DCD. In October 1994, the International Consensus Meeting on Children and Clumsiness adopted the concept of DCD, choosing to use it in place of earlier descriptions of child clumsiness. This led to the adoption of the concept by occupational therapists and physiotherapists as covering all abnormal child clumsiness. Schizoid personality disorder and avoidant personality disorder also remained in the manual. "Elective mutism" became "selective mutism". American psychiatrist Fred Volkmar was the lead author of the autism section in the DSM-IV. (From 2007, Volkmar would later be the fourth editor of the Journal of Autism and Developmental Disorders). DSM-IV TR The DSM-IV TR (2000) contained an almost complete rewrite of the definition of Asperger's disorder. Notably, it now no longer included speech and language difficulties. The organisation has subsequently developed a wide range of resources for teaching social skills to autistic people. Winner's works were a substantial influence on Ontario autism support workers in 2011. It emphasises cognitive psychology more than typical, behaviourism focused, varieties of ABA. American teacher Brenda Smith Myles at the University of Kansas began writing well-received books to help people with Asperger syndrome in the late 1990s. These books were also a substantial influence on Ontario autism support workers in 2011. These benefit some autistic people through deep-touch pressure. Weighted blankets were largely unknown to the public until they received significant publicity in 2017–18. The rainbow jigsaw ribbon symbol was first used to represent autism in 1999, it being developed by the Autism Society of America. It incorporated the puzzle piece motif first used by the UK's Society for Autistic Children in 1963. The ABA "Board Certified Behavior Analyst" (BCBA) certification was first issued in the northern Spring of 2000 in the United States, by the newly formed Behavior Analyst Certification Board. The qualification soon became recognised internationally. The International Board of Credentialing and Continuing Education Standards was founded in the United States in 2001. It provides training and certification to organisations that engage with autistic people. The well-cited book Educating Children with Autism was published in 2001 by the US National Research Council. Its editors were the American psychologists Catherine Lord and James P. McGee. Relationship Development Intervention (RDI) was developed by American husband-and-wife psychologists Steven Gutstein and Rachelle Sheely in the 1990s. It aims to increase a young child's desire and ability to be social. It became better known after the publishing of books on the topic in 2002. Fred Frankel and Robert Myatt developed the Children's Friendship Training (CFT) model over two decades at UCLA, publishing a book on it in 2002. The notable book Social Skills Training was published by American psychologist Jed Baker in August 2003 (another edition was published in 2023). He followed this with the similarly notable No More Meltdowns in April 2008. These and his other works were substantially influential on Ontario autism support workers in 2011. The model covers children's social communication (SC), emotional regulation (ER), and transactional support (TS). It is recommended for use with autistic children by the ASHA. a technique for teaching parents of young autistic children how to better communicate with them, was first released through a paper in November 2004. It was written by three British researchers, speech therapist Catherine Aldred, psychiatrist Jonathan Green, and speech therapist Catherine Adams. Aspies for Freedom celebrated the first Autistic Pride Day on 18 June 2005. This event was also the first use of a rainbow infinity symbol to represent autism. The Raising Children Network launched raisingchildren.net.au in May 2006, with the endorsement and financial support of the Australian government. This website provides extensive information for raising autistic children. Simon Baron-Cohen and others released an animated series for autistic pre-schoolers called The Transporters in 2006. Its creators claimed that autistic children could learn to read facial emotions as well as non-autistic children after repeated viewing, addressing their social-emotional agnosia and alexithymia. The series was nominated for a BAFTA. The British-voiced version of the series is available for free under a Creative Commons licence. The episodes have been translated into a number of languages, and complimentary training material has also been developed. The United Nations Convention on the Rights of Persons with Disabilities (UN CRPD) came into force in signatory nations in May 2008. Autism Spectrum News began as a quarterly print publication in the United States in September 2008. It was founded by father-and-son Americans Ira Minot (social worker) and David Minot (musician). It became online-only in 2021. The ASEAN Autism Network was created in January 2010, linking together autism organisations in South East Asia. It held the ASEAN Autism Games athletic competition in 2016 and 2018. The UK's Autism Act 2009 came into force in January 2010, which required the government to create a fully-funded "autism strategy" for "meeting the needs of adults in England with autistic spectrum conditions." Subsequent multi-year strategies were created, so far covering until 2026. The Program for the Education and Enrichment of Relational Skills (PEERS) was developed by Americans Elizabeth Laugeson and Fred Frankel in 2010, drawing on Frankel's earlier CFT work. PEERS programs are used to teach social skills to autistic and other people in many countries of the world. In April 2011, American indexer Paula C. Durbin-Westby established Autism Acceptance Day (later Autism Acceptance Month), intending to displace the Autism Awareness Month held in that country at that time. Some have said that the observance was the first time that the colour gold was used to represent autism. Autism Eye magazine for parents and professional helpers of autistic children began publishing in 2011, by British married magazine editors (and parents of an autistic child) Gillian Loughran and Mark Hayes. Autism Parenting Magazine was founded by British database administrator Mark Blakey in 2012. In December 2012, Brazil passed the Berenice Piana Law, which created the National Policy for the Protection of the Rights of Persons with Autism Spectrum Disorder. This officially classified autism as a disability under Brazilian law, and increased the condition's profile in the country. Pathological demand avoidance British child psychologist Elizabeth Newson first saw the pattern of pathological demand avoidance (PDA) in children in 1980. She published a number of papers about it in the 1990s. In 1997, the PDA Contact Group was established in the UK by parents of children with PDA. This later became the PDA Society. She believed that autistic people with pronounced PDA symptoms tend to behave quite differently to those that do not, and that people with PDA symptoms often do not have common autistic symptoms. New diagnostic tools The "Reading the Mind in the Eyes Test" was first published in 1997 by Simon Baron-Cohen and others. A very well-cited revised version was released in February 2001, which also involved British experimental psychologist Sally Wheelwright. The Modified Checklist for Autism in Toddlers (M-CHAT) was developed in 1999 by American psychologists Diana Robins, Deborah Fein and Marianne Barton. Revised versions, the M-CHAT-R (2009) and M-CHAT-R/F were later released. In February 2001, the autism-spectrum quotient (AQ), a measure of autism within an individual, was released by a Simon Baron-Cohen-led team from the University of Cambridge. The Gilliam Asperger's disorder scale was first published by American special education researcher James Gilliam in 2001. This later became known as the "Gilliam Autism Rating Scale", with the release of revisions GARS-2 (2008) and GARS-3 (2013). The "Diagnostic Interview for Social and Communication Disorders" (DISCO) was released in March 2002 by Lorna Wing and others. It was a further development of the child-specific "Handicaps Behaviour and Skills" (HBS) schedule Wing had developed in the 1970s. As of 2023, it is still in use in the UK. (The subsequent SRS-2 was released in 2011.) The empathy quotient measure was released in April 2004 by Simon Baron-Cohen and Sally Wheelwright. The paper it was published in also introduced the terms "affective empathy" (feeling what someone else is feeling) and "cognitive empathy" (understanding what someone else is feeling). In February 2008, American psychiatrist Riva Ariella Ritvo and others released the Ritvo Autism and Asperger Diagnostic Scale (RAADS). A revised version, RAADS-R, was released in 2011. Also in 2008, American psychologist Marilyn Monteiro released the "Monteiro Interview Guidelines for Diagnosing Asperger's Syndrome" (MIDGAS). Compared to other measures, it has a greater focus on sensory issues and on accounts from people who know the person being tested. The MIDGAS-2 (where "AS" stands for "the Autism Spectrum") was released in 2018, and was co-authored by fellow American psychologist Sheri Stegall. The "Autism Spectrum Rating Scales" (ASRS) were first published by American psychologists Sam Goldstein and Jack Naglieri in 2009. In the United States The atypical antipsychotic drug risperidone was approved in the United States for treating autism-associated aggressive and self-injurious behaviors in October 2006. The similar but less problematic drug aripiprazole was approved in 2009. The United States passed its Combating Autism Act in December 2006, providing US$1 billion for autism services and research in that country, over five years. The US state of South Carolina enacted Ryan's Law in July 2008. This requires health insurers to provide up to $50,000 of behavioural therapy each year for autistic people aged 16 and younger. Autism Speaks American advocacy organisation Autism Speaks was founded in 2005 by businessman Bob Wright and his wife Suzanne Wright, grandparents of a child with autism. It adopted a puzzle piece as part of its logo. The puzzle piece was originally blue, but was modified for the organization's 15th anniversary in 2020 to include a more complex and polished colour palette to promote more diversity and inclusion across the spectrum. In 2009 it released the video "I am Autism", which portrayed the condition very negatively. People with a neutral or positive perception of their own autism complained, and the video was soon taken out of circulation. Autism Speaks has since strongly refuted the sentiments in the video. In 2023, the organisation claimed it had so far provided more than 18 million people with free autism information and resources. Simons Foundation Autism Research Initiative The Simons Foundation established the Simons Foundation Autism Research Initiative (SFARI) in 2006. As of 2023, the foundation has a research budget of over US$100 million per year. The SFARI website launched a "News & Opinion" section in 2008. This grew, and was given its own identity as Spectrum in 2015. This has become an important autism research news website. Recognition in China China's Eleventh Five Year Development Programme for the Disabled (中国残疾人事业"十一五"发展纲要) was released in 2006. It officially recognised autism as a neurological disability. Autistic Self Advocacy Network (ASAN) The Autistic Self Advocacy Network (ASAN) was co-founded in November 2006 by Americans Ari Ne'eman and Scott Michael Robertson. It has positioned itself as America's foremost body of autistic people representing the interests of autistic people. In early 2017, American writer Julia Bascom became the second president of ASAN. Affiliated bodies were later formed in Australia/New Zealand, Canada and Portugal. The Academic Autistic Spectrum Partnership In Research and Education (AASPIRE) was also founded in the United States in 2006. It focuses on improving the lives of autistic adults. It has come to work closely with ASAN. ASAN's activities have included organising the first Disability Day of Mourning on 1 March 2012, which commemorates disabled people who were killed by their parents. The organisation also assisted in the production of the 2020 Pixar short film Loop by Erica Milsom, which features a non-verbal autistic teenage girl. World Autism Awareness Day World Autism Awareness Day was first held by the United Nations in April 2007. Lighting buildings with blue light at night is a common means of awareness raising on this day. Autism Speaks quickly embraced it. This had led some neurodiversity-embracing autistic people to shun using the colour blue to represent autism. In France In 2005, the French government began the first of its multi-year . These plans aimed to improve the lives of people with autism and their families. They led to the establishment of across the country. The last of these plans concluded in 2022. Each year, the French government assigns a "Great National Cause" for the country to focus on. This includes much free publicity on state television and radio. Autism was the cause for 2012. Other scientific developments The concept of hyperfocus was used in the mid-1990s, and began appearing in academic literature more commonly in the early 2000s. Social dominance orientation was defined by the American psychologists Felicia Pratto, Jim Sidanius and Lisa M. Stallworth, and Austrian-American psychologist Bertram F. Malle, in October 1994. It was later suggested that autistic people may tend to differ from non-autistic people on this scale. "Executive Functions and Developmental Psychopathology" is a well-cited paper published in January 1996. In it, the Americans Bruce F Pennington (psychiatrist) and Sally Ozonoff (psychologist) explored the effects of various conditions (including autism) on executive function. In February 1997, the Britons Patrick Bolton (psychiatrist) and Paul Griffiths (neuroradiologist) published about 18 patients with tuberous sclerosis, half of whom had some form of autism. They found a strong association between having tubers in the temporal lobes and autism. American occupational therapist Winnie Dunn published a model of human sensory processing in April 1997. In it, she described how people having varying thresholds for sensing stimuli (high or low) and had varying behaviour responses to them (active or passive). Autistic people are more likely to be high on both these two factors than neurotypical people. When this is the case, they are categorised as being "sensory seeking". Autistic people can also be unusually "sensory avoidant" (and these are often the same people that are unusually "sensory seeking".) Autistic reaction to stimuli (and lack of stimuli) can lead to stimming. The first edition of the scientific journal Autism was published in July 1997 by Sage Publishing and the British National Autistic Society. The children's infection-caused condition PANDAS was first published about in August 1998 by American neuroscientist Susan Swedo and others. PANDAS (and other conditions in the group known as PANS), can cause autistic symptoms. It has sudden onset in childhood in response to an infection. It can usually be cured by treating the infection. The "process model" of emotion regulation was defined by American psychologist James Gross in September 1998. The 2000 Simpsonwood CDC conference in the United States examined evidence of the effect of thimerosol in vaccines on neurological development. There are certain specialised parts of the brain that non-autistic people use to process face information. American psychologist Karen Pierce and others found that autistic people do not use these parts of the brain for this task. They also found that the fusiform face area in individuals with autism has a reduced volume. They published a paper on these and related findings in October 2001. (Pierce later found that autistic children did use the fusiform area when processing the faces of their parents and other children, but not strange adults). The empathising–systemising theory of autism was released by Simon Baron-Cohen in June 2002. He and others would go on to develop it in subsequent years. The term allistic was coined by British autistic software engineer Andrew Main in January 2003. It means "not autistic". Spoon theory was first published about by American lupus advocate Christine Miserandino in 2003. The well-cited paper "Model of autism: increased ratio of excitation/inhibition in key neural systems" by the Americans John Rubenstein (neurobiologist and psychiatrist) and Michael Merzenich (neuroscientist) was published in October 2003. It proposed that autism could be modelled as a "brain excitation/inhibition imbalance" matter involving glutamate and GABA. Russian-British doctor Natasha Campbell-McBride introduced the GAPS diet for helping people with autism and other conditions through the popular book Gut and Psychology Syndrome in 2004. Claims of the diet's usefulness for children with autism are not supported by scientific studies. Harriet Hall has described the GAPS diet as "a mishmash of half-truths, pseudoscience, imagination, and untested claims", and Quackwatch includes the GAPS Diet in its Index of questionable treatments. The theory of monotropism was developed by three autistic activists, the British linguist and teacher Dinah Murray, British-Australian psychologist and social worker Wenn Lawson and British mathematician Mike Lesser. They started their formulation in the 1990s, and first published the theory in May 2005. It proposes that autism's symptoms are caused by a person being highly focused on a small number of things, giving relatively little focus to things in general. British psychiatrist Chris Frith and his wife Uta Frith published a well-cited short description of theory of mind in September 2005. In January 2006, British neuroscientist Francesca Happé and Uta Frith published a well-cited paper furthering Frith's weak central coherence theory. In October 2006, N. Carolyn Schanen (of the University of Delaware), found two chromosomes with a strong epigenetic association with autism. The journal Research in Autism Spectrum Disorders was first published in January 2007 by Elsevier. The well-cited paper "Strong Association of De Novo Copy Number Mutations with Autism" was published in April 2007 by 32 people including American geneticists Jonathan Sebat and Daniel Geschwind. It found that de novo germline mutation was a more significant causative factor for ASD than was previously recognised. The journal Autism Research was founded in February 2008 as the US-based journal of the International Society of Autism Research (INSAR), partnering with publishers Wiley-Blackwell. The imprinted brain hypothesis of autism was first presented by Canadian biologist Bernard Crespi and British sociologist Christopher Badcock in June 2008. "Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample" is a well-cited paper published in August 2008. Its six authors included the Britons Emily Simonoff (psychiatrist) and Andrew Pickles (biostatistician). It found that seventy percent of its autistic sample had at least one other recognised psychiatric condition, and that 41% had two or more. The most common comorbid diagnoses were social anxiety disorder (29%), ADHD (28%), and oppositional defiant disorder (28%). proposed that autistic traits, including increased abilities for spatial intelligence, concentration and memory, could have been naturally selected to enable self-sufficient foraging in a more (although not completely) solitary environment, referred to as the "Solitary Forager Hypothesis". A well-cited study published in April 2012 estimated the global prevalence of autism and other PDDs. It found that 62 in every 10,000 people likely had ASD. The lead author was the French-Canadian psychiatrist and epidemiologist Éric Fombonne. The concept of the double empathy problem was first described as such in October 2012 by British psychologist Damian Milton. The idea proposes that the interaction issues between autistic and non-autistic people are at least in part because these two types of people think differently from each other, understand other people in their own group, but have difficulty understanding people that think differently. This contrasts with the idea that the interaction issues are due to autistic people having lesser social understanding abilities than non-autistic people. The Australian government established its national autism research organisation Autism CRC in March 2013. The April 2013 paper "Prenatal valproate exposure and risk of autism spectrum disorders and childhood autism" showed that taking the psychiatric drug valproate greatly increased the chance of a woman giving birth to a child with autism. Its lead author was Danish neurologist Jakob Christensen. The maternal effects of valproate were the subject of public debate in the UK in the 2010s and 2020s. Organizations This period saw the establishment of various new autism-related organizations: • Stars and Rain was the first non-governmental organization established for autism in China. It was founded in March 1993 by Tian Huiping (田慧萍), a mother of a child with autism. The institution runs training programs for both parents and children, and overall has a focus on ABA. • The nationwide (Autism Spain) was established in Spain in January 1994 by the coming together of autonomous community based organisations. • The Korean Autism Society (한국자폐학회) was founded in South Korea in 1994. It has focused on professionals who treat those with the condition. • The US National Alliance for Autism Research was founded in 1994 by Americans Karen London and her psychiatrist husband Eric London in 1994. It merged with Autism Speaks in early 2006. (Its founders were later establishers of the Autism Science Foundation.) • (Indonesian Autism Foundation) was founded by five doctors and eight parents of autistic people in 1997. • Ambitious About Autism is a UK group founded in 1997 to provide education to autistic children. It has since established five schools, and provides other services. • The Behavior Analyst Certification Board was founded in May 1998 in the United States to provide accreditation for ABA practitioners. It quickly became an established international authority. • On November 21, 1998, the World Autism Organisation (WAO) began. It was set up by Autism-Europe to prompt the UN to do more about autism, and to increase autism support in countries with few services of that kind. • The United States' Interagency Autism Coordinating Committee was set up in 2000. It coordinates US government autism actions. • The Autism Resource Centre (Singapore) was established in 2000. • Autism Awareness Campaign UK was founded in 2000. It held a UK "Autism Awareness Year" in 2002, which in February included the first annual Autism Sunday religious observance. • US group Talk About Curing Autism (TACA) was founded in 2000 by parents of autistic children. (In 2019, it was renamed "The Autism Community in Action"). • In 2001, the autistic daughter of Israeli Major General Gabi Ophir inspired him and others to establish Special in Uniform, an organisation that supports a squad of teens with disabilities or autism in the Israel Defense Forces. • (PAS, Persons on the Autism Spectrum) was founded in the Netherlands in 2001. It represents autistic people with normal or higher IQs. • The International Society for Autism Research (INSAR) was formed in 2001 in the United States. • Autistic-specialist employment services company Specialisterne was founded by Danish IT worker Thorkil Sonne in 2003. It has gone on to operate in various parts of Europe, North America and Australia. • The National Autism Association was founded in the United States in 2003 for parents of autistic people. • Aspies For Freedom (AFF) was established in 2004 as a global online organisation by Welsh husband-and-wife Gareth Nelson and Amy Nelson. • The autism community website Wrong Planet was started in 2004 by American high school students Dan Grover and Alex Plank. • The British autism research charity Autistica was founded in 2004 by German-British software entrepreneur Dame Stephanie Shirley. • (한국자폐인사랑협회는) was founded in South Korea in January 2006. It has focused on representing autistic people and their parents. • Israeli people-with-autism representative organisation began in early 2006. • The UK's Autism Education Trust was established by the National Autistic Society and the UK's Department for Children, Schools and Families in 2007. It is tasked with ensuring that all British children with autism are educated appropriately, through better education of their teachers. • The Association of Professional Behavior Analysts was founded in the United States in 2007, to serve "the unique needs of professional practitioners." It has since expanded its operations into other countries. • The Autism Science Foundation was founded in the United States in April 2009, by Americans (and mothers of autistic children) Alison Singer (businessperson) and Karen London. Other popular support books and software • The Autistic Spectrum: A Guide for Parents and Professionals was released by Lorna Wing in 1996. It did much to popularise the concept of an "autistic spectrum". • A popular book of 1998 was sensory processing guide The Out-of-Sync Child by American music and movement teacher Carol Stock Kranowitz. New editions were published in 2005 and 2022. • The Introvert Advantage: How to Thrive in an Extrovert World was a popular book released by American psychologist Marti Olsen Laney in February 2002. • August 2002 saw the publishing of Freaks, Geeks, and Asperger Syndrome: A User Guide to Adolescence by 13-year-old British adolescent with Asperger syndrome, Luke Jackson. The book was praised by Sula Wolff. In 2005, a fictional movie based on the family, Magnificent 7, was aired on the BBC. It included a character based on Luke's mother, fellow autistic subject author Jacqui Jackson. • Another book first published in August 2002 was ''A Parent's Guide to Asperger Syndrome and High-Functioning Autism by American psychologist Sally Ozonoff. A second edition, A Parent's Guide to High-Functioning Autism Spectrum Disorder: How to Meet the Challenges and Help Your Child Thrive'', was published in 2014 by Ozonoff and fellow American psychologists, Geraldine Dawson and James C. McPartland. Over 125,000 copies of the books have been printed. • Raising a Sensory Smart Child was first released in March 2005 by two Americans, the occupational therapist Lindsey Biel and the writer Nancy Peske. New editions were released in 2009 and 2018. • Ten Things Every Child with Autism Wishes You Knew was first published by American speech therapist Ellen Notbohm in 2005. New editions were published in 2012 and 2019. Over 250,000 copies have been sold. • ABA book The Verbal Behavior Approach: How to Teach Children With Autism and Related Disorders was released in May 2007 by two Americans, nurse Mary Barbera and writer Tracy Rasmussen. • Released in September 2007 was the book ''Louder Than Words: A Mother's Journey in Healing Autism'' by American mother Jenny McCarthy. • Smart but Scattered: The Revolutionary "Executive Skills" Approach to Helping Kids Reach Their Potential was released in January 2009. Written by American psychologists Peg Dawson and Richard Guare, it has over 375,000 copies in print. • Disconnected Kids was released by American neurologist Robert Melillo in January 2009. • Aspergirls: Empowering Females with Asperger Syndrome was published by American writer Rudy Simone in 2010. She went on to write a number of other books on autistic subjects. • Emotional control guidebook Zones of Regulation was published by American occupational therapist Leah Kuypers in 2011, to help autistic people and others who needed it. It has since sold over 100,000 copies. Various other products helping people understand and use the Zones concept have since been created. • ''Understanding Your Child's Sensory Signals: A Practical Daily Use Handbook for Parents and Teachers'' was released in September 2011 by American occupational therapist Angie Voss. Two further editions have subsequently been published. • The software program The Social Express was first released in November 2011, by American parents of autistic children Marc Zimmerman and Tina Zimmerman. • Bestselling book ''Quiet: The Power of Introverts in a World That Can't Stop Talking'' was published by American writer Susan Cain in January 2012. • The Survival Guide for Kids with Autism Spectrum Disorders (And Their Parents) was released in March 2012 by Americans Elizabeth Verdick (a writer) and Elizabeth Reeve (a psychiatrist). A new edition was released in 2021. • Denver Early Start Model book, An Early Start for Your Child with Autism: Using Everyday Activities to Help Kids Connect, Communicate, and Learn was released by Americans Sally J. Rogers, Geraldine Dawson and Laurie A. Vismara in May 2012. It has sold over 100,000 copies. • ''The Asperkids' (Secret) Book of Social Rules: The Handbook of Not-So-Obvious Guidelines for Teens and Tweens'' was published by American social worker Jennifer Cook in September 2012. It sold many copies, and won the Autism Society of America's Temple Grandin Outstanding Literary Work of the Year. Cook later write a number of other books about autism. Other books and media Other popular books and other media were published during this period, most notably the following: • Personal memoir Nobody Nowhere: The Extraordinary Autobiography of an Autistic Girl by Australian Donna Williams was published in 1992, and was on the New York Times Bestsellers list in 1993. • The Hollywood action movie Mercury Rising (1998) featured an autistic boy. • ''Pretending to Be Normal: Living with Asperger's Syndrome was an autobiography published by American researcher Liane Holliday Willey in 1999. She also coined the term aspie''. She released an updated edition in 2014. (The book was praised by Sula Wolff). • The British fiction book The Curious Incident of the Dog in the Night-Time was published in May 2003 by Mark Haddon. It features a protagonist that the publishers have said has Asperger's syndrome, but was not specifically written that way. In 2012, it was made into a successful West End play, which then went to Broadway in 2014. • The Flemish fiction book Nothing Was All He Said about a teenage boy with Asperger's syndrome was released by Belgian author Nic Balthazar in 2003. He would later direct the story as the movie Ben X, which was released in September 2007. (The movie was later remade in Sweden in 2013 as IRL). • Mozart and the Whale, an American romantic comedy-drama film about two people with Asperger's syndrome, was first released in September 2005. It was based on a true story. • The documentary feature Normal People Scare Me: A Film About Autism was produced by American actor Joey Travolta in 2006. • The popular photo-book All Cats have Asperger Syndrome was released in October 2006 by Australian teacher Kathy Hoopmann. A second edition (retitled All Cats have Autism) was released in 2020. She also wrote other books about autism and related conditions. • Bestselling memoir The Reason I Jump was published in 2007. It is attributed to Naoki Higashida, a Japanese 13-year-old boy with autism. It was released in English in 2013, and has been translated into over 30 languages. • Another popular book of 2007 was ''Look Me in the Eye: My Life with Asperger's'' by American John Elder Robison, first released in September that year. Robison would later become a board member of Autism Speaks. • Children of the Stars (来自星星的孩子) is a 2007 documentary about lives of autistic children in China. • The documentary movie '' (Her Name is Sabine'') was screened at the Cannes Film Festival in May 2007. It was made by Sabine's sister, the French actress Sandrine Bonnaire. It won the Globe de Cristal for Best Documentary in 2008. • The character Sheldon Cooper first appeared on American television in September 2007, in the popular sitcom The Big Bang Theory. While he is not explicitly autistic, according to the actor who plays him as an adult, the character "could not display more traits" of Asperger's syndrome. (The character would later be the protagonist of the series Young Sheldon.) • Popular autobiography Born On A Blue Day: Inside the Extraordinary Mind of an Autistic Savant was released by its British author Daniel Tammet in October 2007. • The American dramatist Michael Golamco's short play Please Stand By is centred on an autistic woman, and was first staged in 2008. In 2017 it became the movie Please Stand By. • The 2008 Swiss film '''' was about a teenage boy with autism. • The soap opera Aapki Antara first went on air in India in June 2009. The title character of the series is an autistic girl. • The American film Adam was about a young man with Asperger's syndrome. It was released in July 2009. • The 2011 documentary Le Mur (The Wall) challenged the extensive use of psychoanalysis in treating autism in France. It was made by French director . Notable autism history books • ''Histoire de l'autisme : de l'enfant sauvage aux troubles envahissants du développement'' was released in October 2010 by British autism researcher Adam Feinstein, having been commissioned by Autistica founder Dame Stephanie Shirley. • Understanding Autism: Parents, Doctors, and the History of a Disorder was released in November 2011 by American science historian Chloe Silverman. == Neurodiversity and autism as a spectrum (since 2013) ==

In 2013, the DSM-5 eliminated Asperger's disorder as a separate diagnosis, instead considering autism to be a spectrum disorder referred to as autism spectrum disorder (ASD). Both in the research community and among autistic people, there is ongoing debate about whether autism should be considered a disorder, or whether it should be thought of as merely a different way of being. DSM-5 In May 2013, the DSM-5 was released. It combined "autistic disorder", "Asperger's disorder", "CDD" and "PDD-NOS" into the broader concept of "autism spectrum disorder" (ASD), and discontinued the four earlier conditions. It also grouped the symptoms of ASD into two groups - impaired social communication and/or interaction, and restricted and/or repetitive behaviors. The new definition was narrower than the collective definitions of its DSM-IV predecessors had been, reducing the number of neurodivergent people covered by it. One study found 10-40% of people covered by the immediately previous definitions were not covered by that in the DSM-5. The DSM-5 assigned three "severity levels" for ASD, with people in level 1 "requiring support", level 2 "requiring substantial support" and level 3 "requiring very substantial support". Some autism activists believe the autistic spectrum should not be measured in this way, as it does not take into account the greatly varying attributes the people in the different DSM severity levels have, or that support needs can be context-dependent. DSM publishers, the American Psychiatric Association, said that "The revised diagnosis represents a new, more accurate, and medically and scientifically useful way of diagnosing individuals with autism-related disorders." It also noted that the conditions that the new ASD condition replaced "were not consistently applied across different clinics and treatment centers". A new condition of social (pragmatic) communication disorder (SCD) was added. This does not apply to people who fulfil all of the ASD criteria, but to those who only have the social communication difficulties found in the ASD definition. (It drew on the earlier concepts of "semantic pragmatic disorder" and "pragmatic language impairment.") Another new condition was avoidant/restrictive food intake disorder (ARFID). A 2023 study found that 21% of autistic people had ARFID features. "Schizoid personality disorder", "avoidant personality disorder" and "selective mutism" remained. Another major change in this edition of the DSM was allowing individuals to be diagnosed with both ASD and ADHD. Previously, under the DSM's rules people could only be diagnosed as having one of their antecedent conditions. There is evidence to suggest that a majority of people with ASD also have ADHD. Similarly, people diagnosed with ASD could now also be diagnosed with other commonly co-morbid psychiatric syndromes such as social anxiety disorder, oppositional defiant disorder and developmental coordination disorder. ICD-11 January 2022 saw the first official use of the ICD-11 (it having been released in 2019). This version of the ICD combined all PDD conditions as "autistic spectrum disorder" (following the DSM's practice). However, unlike the DSM-5, the ICD-11 included a number of ASD subdivisions. Apart from an "other" and an "unspecified" category, these subdivisions were differentiated by two factors: "disorder of intellectual development" and impairment of "functional language." As with the DSM-5, it now also allowed for dual-diagnosis of ASD with similar conditions. Science Though it had been conceptualised and had become popular with autistic people much earlier, the concept of autistic masking (autistic people hiding their autistic natures through suppressing or replacing behaviours) became a focus of academic research in the 2010s. Such masking often requires an exceptional mental effort, leading to cognitive overload. This is a main cause of burnout in autistic people. It is also linked with other adverse mental health outcomes. A diagnostic test called the "Aspie Quiz" was released by Swedish researcher Leif Ekblad in July 2013. A December 2013 published study found that the brains of children with Asperger syndrome produced (on average) 42% more information when at rest, compared to non-ASD children. It was conducted by Spanish-Canadian biochemist and biophysicist Jose Luis Perez-Velazquez, and Spanish-American neuroscientist Roberto Fernández Galán. The Review Journal of Autism and Developmental Disorders was established in the United States by Springer in March 2014. Autism Speaks, Hospital for Sick Children (Toronto) and Google Genomics began the AUT10K project in 2014. It created one of the world's largest collections of autism related genetic material, and had open access to researchers, called AGRE. The project later evolved into the similar MSSNG project. MSSNG aims to "provide the best resources to enable the identification of many subtypes of autism". The MSSNG project was quickly met with criticism from autistic self-advocates. "Synaptic, transcriptional and chromatin genes disrupted in autism" was a well-cited paper published in October 2014. The study investigated thousands of people with autism, and identified the gene mutations involved. The paper's lead authors were the Americans Joseph Buxbaum (neuroscientist) and Mark Daly (geneticist). Brazilian researcher Alysson Muotri and others founded the company Tismoo in 2015, which aims to develop genetic treatments for autism and other conditions. The journal Advances in Autism was launched by British publisher Emerald Publishing in July 2015. The term aphantasia (an inability to picture something in one's mind), was first published by British neurologist Adam Zeman, British neuropsychologist Michaela Dewar, and Italian-British neuroscientist Sergio Della Sala in December 2015. (The phenomenon was first described by British polymath Francis Galton in 1880.) A 2021 study led by British psychologist Carla Dance found that people with aphantasia had higher levels of autistic symptoms than controls. A later Australasian study did not find such a correlation, and noted that many autistic people are visual thinkers. The open access journal Autism & Developmental Language Impairments was launched by American publisher Sage Journals in January 2016. The as-yet untested hypothesis of "RCCX Theory" was first self-published in February 2016 by American psychiatrist and internal medicine physician Sharon Meglathery. It posits that genetic variations in the RCCX cluster lead to a cluster of comorbid autism, Ehlers-Danlos syndrome, postural orthostatic tachycardia syndrome (POTS) and other conditions. The theory gained greater prominence in September 2024. An October 2016 paper by three researchers from the University of York examined Asperger syndrome as "an alternative prosocial adaptive strategy" which may have developed as a result of the emergence of "collaborative morality" in the context of small-scale hunter-gathering, i.e. where "a positive social reputation for making a contribution to group wellbeing and survival" becomes more important than complex social understanding. French neuroscientist Mohamed Jaber found that the brain's motor fronto-striatal and cerebellar systems were major sites of autistic brain difference, and published about it in an April 2017 paper. The term "restraint collapse" was first published by Canadian counselling psychotherapist and teacher Andrea Loewen Nair in April 2017. It describes the collapse of behavioural restraint that can occur when people move from spending time in a rigid social environment (like a school) to a more casual one (like a home). This can manifest as a meltdown. Autistic people who make great efforts to conform to a social situation often experience restraint collapse when leaving that situation. A study by American psychologist Henny Kupferstein published in January 2018 found that autistics who had been given ABA therapy were 86% more likely to have PTSD than those who had not. The well-cited study "Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014" was released in April 2018 by 26 US-based authors led by epidemiologist Jon Baio. It found that one in 59 US children aged 8 years had ASD (nearly 2%). It also found that 56% of autistic children had an intellectual disability (with an IQ of 85 or less), and 44% had IQ scores in the average to above average range. The term AuDHD, describing people with both autism and ADHD, began to be used in scientific papers from around 2018. A National Guideline for the Assessment and Diagnosis of Autism Spectrum Disorders in Australia was released by Autism CRC in August 2018. The journal Autism in Adulthood was launched by American publisher Mary Ann Liebert, Inc. in March 2019. The Camouflaging Autistic Traits Questionnaire (CAT-Q) was released by British psychologist Laura Hull, Simon Baron-Cohen and others in March 2019. It measured autistic masking. Another March 2019 published study found that microbiota transfer therapy was an effective treatment for autistic symptoms. The lead author was Korean-American environmental engineer Dae-Wook Kang. The well cited paper "Identification, Evaluation, and Management of Children With Autism Spectrum Disorder" was published in January 2020. It was a wholistic primer on child autism for doctors. The lead author was American paediatrician Susan L. Hyman. An ABA tool, the graduated electric decelarator, became the third device ever banned by the United States' Food and Drug Administration (FDA) in March 2020. Its main user, the Judge Rotenberg Center, filed a lawsuit against the FDA, and in July 2021, the DC Circuit Court overturned the ban, meaning that the centre can still use the device. The concept of autistic burnout became much more common on Twitter in 2017–18, and subsequently attracted more academic research. The establishing paper on the subject was published by American systems scientist Dora Raymaker et al. in June 2020. The report Interventions for children on the autism spectrum: A synthesis of research evidence was released by the Autism CRC in November 2020. It compared dozens of different interventions. A January 2022 published study by Catherine Lord and others introduced the concept of profound autism. It refers to autistic people that have no or minimal verbal language, and/or an IQ less than 50. The "profound" refers to the perpetual access to a carer that adults with the condition require, noting that "profound autism is thus defined not by autistic features but by intellectual or language disability." American psychiatrist Lynn Kern Koegel became the sixth editor of the Journal of Autism and Developmental Disorders in 2022. She and her husband had earlier developed pivotal response treatment. The concept of the pebbling social behaviour became defined by 2022. The Autistic Burnout construct screening test for burnout in autistic people was released in May 2023. It was developed by American psychologist Jared Richards and twelve others. The term "AuADHD" referring to someone with both autism and ADHD originated around the year 2020, with it becoming used in academic literature in 2024. An August 2024 published study found that male mouse foetuses with low aromatase activity were more likely to develop autism symptoms post-birth, and this likelihood could be increased by maternal BPA exposure. It also found a connection between maternal BPA exposure and male child autism in humans. The study was led by Singaporean-Australian biochemist Wah Chin Boon and Australian epidemiologist Anne-Louise Ponsonby. Autism CRC released the ''National Framework for assessing children's functional strengths and support needs in Australia'' in December 2024. In July 2025, a team led by Russian-American computer scientist Olga Troyanskaya published that they had found four biologically distinct autism subtypes with differing comorbidities and symptoms. The four subtypes were: • Moderate challenges (low impact of the seven autism symptom factors measured) • Broadly affected (high impact of all factors, frequent co-occurring conditions (particularly OCD, seizures/epilepsy and tics), very high rate of intellectual disability) • Social and/or behavioural (low impact of developmental delay, and frequent co-occurring OCD, tics, ADHD, anxiety, seizures/epilepsy and major depression, high rate of intellectual disability) • Mixed ASD with developmental delay (low impact of mood symptoms and disruptive behaviour, frequent co-occurring seizures/epilepsy, very high rate of intellectual disability) In September 2025, US President Donald Trump, the US Department of Health and Human Services and the US Food and Drug Administration announced that paracetamol (acetaminophen) use should be avoided by pregnant mothers due to it being a cause of autism, and that it is also better for an unborn baby than their mother running a high fever. Many other health authorities believed the autism-inducing effects to be less than warned. Simultaneously, it was announced that leucovorin was to be begin the US government approval process for treating cerebral folate deficiency, which was said to be a cause of autistic symptoms in some people. In October 2025, a team led by the psychiatry researchers Xinhe Zhang (Chinese-British) and Varun Warrier (Indian-British) published that they had found two biologically distinct autism subtypes. One is a typically early-diagnosed condition that includes significant childhood communication difficulties. The other is typically later-diagnosed, involving significant adolescent social difficulties, and has significant overlap with ADHD, depression, and PTSD. Support The Iran Autism Association was founded in 2013 by treatment professionals along with autistics and their families. Also in 2013, the French single mother "Rachel" had her three children taken from her by the government. They claimed that the children were mistreated, as evidenced by their unusual behaviour. Rachel claimed that their behaviour was due to autism and other conditions, but the government health authorities disagreed. It was subsequently determined that two of the three children had autism (with the other having ADHD), and that the mother herself had Asperger's syndrome. The matter gained great publicity in France, being known as the "". The United States government passed the Autism CARES Act of 2014, authorising the spending of US$1.3 billion between 2015 and 2019. This extended the work of the Combating Autism Act. The Act was reauthorised in 2019. The "Autism Navigator" website for parents and clinicians of children that have or are suspected of having autism, was launched in April 2015 by Florida State University. It is highly regarded by the American Academy of Pediatrics. manual was published in 2015 by British speech and language therapist Catherine Adams. SCIP was based on research she and others had conducted since 2005. The program teaches social communication skills to children. It involves social understanding and social interpretation, pragmatics and language processing. Emotion-recognition teaching game "EmotiPlay" was first developed in 2015 by Israeli educational software company . In October 2015, representative body Autism Canada was created through the merger of Autism Society Canada and Autism Canada Foundation. The Hidden Disabilities Sunflower program was established in 2016 by London's Gatwick Airport, in consultation with two autism support groups and other disability advocates. It soon spread across the UK, and later to other developed countries. In March 2017, the Russian peak parents-of-autistic-children representative body Autism Regions (Аутизм Регионы) was founded. Neurodiversity employment services organisation Untapped Group was co-founded by Australian accountant Andrew Eddy in 2017. It operates in the United States and Australia, and notably organises the prominent Autism at Work conferences. The ABA Coding Coalition greatly changed US prescription practice to fund more ABA treatment of autistic people on 1 January 2019. It did this by convincing the American Medical Association to class ABA as a proven effective treatment in the government mandated Current Procedural Terminology coding system, while previously it was classed as only having some evidence of efficacy. This meant that US health insurance companies now had to fund prescribed ABA for their clients, when previously they could contest it. It is concerned with autistic people who have an IQ of 85 or less. The Blue Envelope Program helps US police understand how autistic people behave, and vice versa. It began operating in January 2020. Australia's National Disability Insurance Scheme went into full operation in 2020. It provides many autistic people in that country with substantial amounts of money to help them live fuller lives. In April 2021, America's Autism Awareness Month became Autism Acceptance Month. Global online support organisation the "Stimpunks Foundation" was established in the United States in December 2021, by IT workers Ryan Boren and Inna Boren. The National Guideline for Supporting the Learning, Participation, and Wellbeing of Autistic Children and Their Families in Australia was released by Autism CRC in February 2023. The first autistic Barbie doll was released in January 2026. It was developed with the assistance of ASAN. People • British singer Susan Boyle mentioned in a December 2013 interview that she had been diagnosed with Asperger's syndrome. • Swedish activist Greta Thunberg's mother told a national newspaper of her daughter's Asperger's diagnosis in May 2015. Greta would become globally prominent as an activist in 2018. • British actor Anthony Hopkins mentioned in a January 2017 interview that he had been diagnosed with Asperger's syndrome. • American actor David Howard Thornton, known for playing Art the Clown in the Terrifier franchise, spoke in a 2023 interview about discovering he is autistic as an adult. Popular books for helping autistic people and their parents • ''Quiet influence: the introvert's guide to making a difference'' by American counsellor Jennifer B. Kahnweiler, was released in 2013. • Speech therapist Barry Prizant (one of the SCERTS authors), released a popular book in August 2015 - Uniquely Human: A Different Way of Seeing Autism. The book explains autism from a neurodiversity perspective. A new edition was published in 2022, with the help of writer Tom Fields-Meyer. • The ABA Visual Language: Applied Behavior Analysis by Japanese ABA practitioner Makoto Shibutani, was published in May 2017. • ABA book Positive Parenting for Autism: Powerful Strategies to Help Your Child Overcome Challenges and Thrive was released by American speech therapist Victoria Boone in December 2018. • Autobiography Autism in Heels: The Untold Story of a Female Life on the Spectrum was released by American writer Jennifer Cook O'Toole in December 2018. • A book to help children, Can You See Me?, was released by the Americans Libby Scott (autistic child) and Rebecca Westcott (special school teacher) in August 2019. Three sequels have followed. • A book to help non-autistic people communicate with autistic ones, Connecting With The Autism Spectrum, was released by Dutch-Canadian autistic artist Casey Vormer in October 2020. • ''Divergent Mind: Thriving in a World That Wasn't Designed for You'' was released by American journalist Jenara Nerenberg in February 2021. It explores how ADHD, autism, synaesthesia, high sensitivity, and sensory processing disorder manifest in women. • ABA book Turn Autism Around: An Action Guide for Parents of Young Children with Early Signs of Autism was released in March 2022 by American nurse Mary Barbera. • Unmasking Autism: Discovering the New Faces of Neurodiversity was a popular book written by American psychologist Devon Price, and published in April 2022. • ''What I Mean When I Say I'm Autistic: Unpuzzling a Life on the Autism Spectrum'' was an autobiography released by American writer Annie Kotowicz in October 2022. • Autobiography Strong Female Character was released by autistic Scottish comedian Fern Brady in January 2024. Notable autism history books • Autism: A Social and Medical History was published by Dutch autism researcher Mitzi Waltz in 2013. (A second edition was published in 2023.) • The Encyclopedia of Autism Spectrum Disorders was first published in 2013. Its chief editor was American psychiatrist Fred Volkmar. (A second edition was published in 2021). • Bestseller NeuroTribes: The Legacy of Autism and the Future of Neurodiversity was published by American writer Steve Silberman in August 2015. It did much to spread the concept of neurodiversity, and explain the history of autism. • In a Different Key: The Story of Autism by American journalists John Donvan and Caren Zucker was released in January 2016. The book was a finalist for a 2017 Pulitzer Prize. It was adapted into a documentary movie released in 2021. • The Metamorphosis of Autism: A History of Child Development in Britain was released by British health historian Bonnie Evans in 2017. • ''Asperger's Children: The Origins of Autism in Nazi Vienna'' was released by American historian Edith Sheffer in May 2018. • Our autistic lives: personal accounts from autistic adults aged 20 to 70+ was compiled by British autism writer Alex Ratcliffe, and was released in January 2020. Autism in popular culture == See also ==