Psychiatrist Leo Kanner is usually lauded as a hero for his pioneering work on autism in the 1940s – findings that didn’t just define the condition, but also ushered in a more humane approach towards it. But one of his ideas would cause most modern doctors to shudder. In a theory now thoroughly discredited, Dr Kanner placed the ‘blame’ for autism at the feet of detached, emotionally distant parents who kept their children in a metaphorical ‘refrigerator which doesn’t defrost’. Given the era, ‘refrigerator mothers’, as he called them, received the lion’s share of censure – a title that stuck for decades.
Autism spectrum disorder is not caused by parenting, scientists now know, but believed to be the result of a complex interaction of genetic and environmental factors. Yet the basic thrust of Kanner’s argument – that autism is an illness that can be prevented – remains a live issue. And it reared its head again recently, after a study published by the University of Manchester and University of Western Australia found that interventions in the first year of a child’s life can seriously reduce the likelihood they will go on to receive a diagnosis of autism.
Researchers assessed 104 infants, aged nine to 14 months, all of whom displayed early signs of autism, such as avoiding eye contact and failing to respond to their name. Half of the group were randomly assigned routine care, whilst the other half were given a special course of therapy, in which parents were videoed playing with their children. Professionals then watched the footage with parents, to help them understand how their child might be communicating with them in atypical ways – and how best to respond.
The children were assessed again by independent clinicians when they turned three. One-fifth of the control group were diagnosed with autism, versus only seven per cent of the group who received the special therapy. The study was small and should come loaded with caveats. But Tony Attwood, professor of clinical psychology at Australia’s Griffith University, and a well-respected expert on autism, thinks it is ‘common sense’ that an autistic child’s psychology can be influenced by the ways their parents communicate with them.
"One of the key components of autism is social disengagement," he explains. "If parents are aware of this and accommodate it, this is going to set up neural connections that [will] reduce the impact of autism. One example: sometimes an autistic child is overwhelmed by lots of hugs and affection, which is too much social and tactile experience. But if parents then moderate it to a level the child can accommodate and enjoy, you get a much better chance of connection."
It is not a case of ‘preventing’ or ‘curing’ autism, Prof Attwood is careful to point out, but parents doing what they can to not ‘amplify’ it. Still, read between lines, and you could easily infer that autism could and should be prevented where possible – a suggestion sure to prove controversial. The National Autistic Society insists that "autism does not need a ‘cure’ and should be seen as a difference, not a disadvantage". Modern campaigners argue that it should be embraced as part of the infinitely neurodiverse human experience.
This is the broad argument of We’re Not Broken: Changing the Autism Conversation, a memoir by Eric Garcia, an American journalist who lives with autism. "We don’t need to be cured or fixed," she says. "A lot of the autistic people I interviewed were wonderful, brilliant, intelligent, kind, and industrious but they still had trouble succeeding. And a lot of times it’s because of the lack of systems in place that allow them to succeed."
Indeed, parents of autistic kids say they can’t help feeling a little hurt by the findings of the study. Lucy*, a mother-of-two, says she "always knew there was something slightly amiss" with her daughter, who was diagnosed aged nine, but "studies like this one... can make parents feel our kid’s autism is somehow our fault."
Prof Attwood has sympathy, but says, "if you talk to autistic people, one of their challenges in life is socialising. The desire for having a friend and relationship is as great in autism as in the general population."
"What inhibits that is social issues," he adds. And anything that identifies and resolves those early, can only help autistic people to flourish and thrive.
*Name has been changed
The Daily Telegraph