Beyond Heritability: Biological
Process in Social Context
Brown Medical School and The Miriam Hospital
As an undergraduate student in the early 1980s, I became interested in the disorder autism. I received an opportunity to become involved in research on this condition, much of which involved direct observation of children and adolescents who were living in a residential facility. Over the course of 3 years of direct contact with these youngsters, the profound mystery of their condition overwhelmed me. Essentially all of them had parents who did not show evidence of psychiatric disorder, and many of them had healthy siblings. There was no evidence of parental mistreatment or trauma, and in most cases no known etiological event. Yet all of them demonstrated profound difficulties in relating to others, and many clearly had severe cognitive and developmental delays.
Working directly with individuals with autism made me curious about the history of the disorder. I became aware that the modern conceptualization of this disorder could be traced back to a 1943 article by the child psychiatrist Leo Kanner. In that paper, Kanner (1943) presented his clinical observations of a number of children whose behavior could not be captured by the prevailing diagnostic categories. He noted that these children showed profound difficulties in relating to others, including their parents, as well as a number of other notable interruptions in the developmental process. Based on parental report and retrospection, it appeared that these children had demonstrated impairment in social relatedness from a very early age. even during infancy. Kanner also noted that some of the parents seemed