The Five Year Old Who Danced In Circles
Donald T. and The Discovery of Autism
“Dr. Leo Kanner shattered the previous misconceptions that children like Donald were feeble-minded, retarded, moronic, idiotic, or schizoid.”
Dr. Leo Kanner stumbled upon a perplexing case after receiving a 33-page letter from Donald T’s father. In the late 1930s, there was no established diagnosis for the child’s symptoms. But the Austrian-American psychiatrist and physician at the Johns Hopkins Medical School in Baltimore became troubled after reading the letter. The five-year-old boy did not fit into any of the known psychiatric frameworks of the era, and none of them adequately captured his peculiar behavior.
Kanner wrote the father.
The father’s description of the boy’s symptoms particularly struck Dr. Kanner as not only strange, but undocumented in medical case history: “Donald was happiest when alone… drawing into a shell and living within himself… oblivious to everything else around him. ” He was struck by the young boy’s other peculiar symptoms: “Donald exhibited other strange, alarming behaviors. He developed a mania for “spinning toys, liked to shake his head from side to side and spin himself around in circles.”
To Dr. Leo Kanner and everyone who observed Donald, he looked like a child that entered a solo dancing contest that might never end. But at the time, this was unfamiliar was because there was no such thing as Infantile Autism until Kanner gave it a name.
Thus, the long, sad and happy story of Autism began.
Disease of the Self
After Kanner arranged for Donald to be seen, his worst suspicions were confirmed. On top of the father’s description, Donald would explosively blurt out words unrelated to any conversation — he spoke a unique language, or perhaps there was a secondary conversation going on in his head, Kanner couldn’t be sure. Donald referred to himself in the third person, as if someone were speaking to him, and repeated words and phrases, mulling them repeatedly. Donald was a one-man variety show.
According to his landmark paper, Kanner thoughtfully captured the problem: Donald was “so self-satisfied that to get his attention almost requires one to break down a mental barrier between his inner consciousness and the outside world.” He observed that a child-like Donald is happiest if left alone, frequently retreating into his little world and oblivious to everything.
But at the time Kanner joined the faculty of the Henry Phipps Psychiatric Clinic for Invalid Children in Baltimore in 1930, Autism wasn’t an area of legitimate study. Kanner borrowed a term from a scientist named Eugene Bleuler who used it to describe the self-absorption of adults with schizophrenia: from ancient Greek “autos,” meaning self. Kanner gave “autism” a new resonance by affixing it to children. He recognized that certain kids suffered from a ‘disease of the self.” By giving it a handle, the strange behaviors became medical symptoms, and now it could be treated scientifically.
The year 1943 represents a kind of Declaration of Independence in the timeline of Autism. That was because Kanner described his observations of ten other children in a groundbreaking paper titled “Autistic Disturbances of Affective Contact.” It turned the world of clinical psychiatry upside down and shattered the previous misconceptions that children like Donald were feeble-minded, retarded, moronic, idiotic, or schizoid. Dr. Kanner’s unique insights opened everyone’s eyes to a new syndrome called “infantile autism.”
As time went on, experts discovered that children with Autism struggled to understand that others could have thoughts different from their own. This made social interactions challenging, like sharing imaginary adventures or empathizing with their emotions. They were marching to the beat of their own drum.
Over time, the understanding of Autism expanded beyond Kanner’s initial findings. Another clever scientist named Hans Asperger also described autistic children but with different traits. This led to confusion between Asperger syndrome and high-functioning autism. The definition continued to evolve, with ongoing debates and revisions, but it had already come a long way by then.
His Majesty the Baby
In 1914, Sigmund Freud came across a symptom he called “primary narcissism,” suggesting that infants were born with an irrational sense of self-absorption. Freud suggested that all babies were born this way: supremely independent, self-involved, and entirely without needs for others — and gave the syndrome a charming description —
“His Majesty the Baby.” The condition, manifested in children like Donald T, was not so charming.
By 1925, one decade after Freud’s involvement, Dr. C.F. Oberndorf founded a psychiatric service for New York’s Hebrew Sheltering Guardian Society in Pleasantville, New York. The role was to admit orphans whose parents had abandoned them or died. Then, he began to notice something peculiar.
Over ten years, the kind of orphans initially admitted had been slowly replaced by a different breed. He referred to them as “psychoneurotic” and “psychopathic” children. The challenges they presented to the staff were monumental: uncontrollable tantrums and extreme social isolation. They were far more challenging to treat than the “normal grief” of children who lost their parents.
The institution’s staff members redoubled their efforts “toward satisfying the child’s need for love and recognition.” The angrier the child, the more loving the staff became. They tried experimenting with art, play, and occupational therapies and even had the children sit in chairs while therapists lay on couches in hopes that the children would project their problems. These techniques all presumed that psychological harm had been done to the children’s emotional development.
The results of a study that correlated 50 children’s treatment with their post-graduation outcomes showed no consistent patterns and no promise of relief for children or the parents or the clinical staff. It seemed hopeless, and the children naturally fell into decline and abandonment.
Blaming Mom
After Freud’s time, advancements in diagnoses, if not in remedies, led scientists to confirm that Autism resulted from a complex combination of genetics, neurology, and biochemistry. Prominent psychiatrists like Bruno Bettelheim popularized the concept of the “refrigerator mother,” attributing cold and unavailable maternal behavior could lead to a child’s retreat into Autism. He emphasized the transformative power of early nurture, suggesting that the illness was related to something that went wrong in early childhood.
When Margaret Ribble’s book, “The Rights of Infants,” underscored the significance of mothering at the emergence of Autism, it was classified as a clinical syndrome. Whether mothers were stingy or generous, neglectful or smothering, the atmosphere into which new human beings were born determined lifelong outcomes.
Mothers and mothering became targets.
Flipping the coin on its head, David Levy’s work from 1927 to 1933 shed light on its contra theme, “maternal over-protection,” at the New York Institute for Child Guidance. He theorized that the damage done by “emotional hunger for maternal love” could be counterproductive if overprotective mothers were too present.
Mothers were now seen as potential heroines or villains. The war on mothers had begun. It preceded the war on poverty, nutrition, and gas stoves. Voila, the problem was that everything stayed the same. That is the way of experts. They apply outlier findings to their most illogical conclusions to the entire sample set, hoping for citations and admiration.
That was why Leo Kanner would devote his life to the cause of children with Autism. Perhaps it was because he was brought up differently.
“The Harriet Lane Home for Invalid Children and the Phipps Psychiatric Clinic were in the same building divided by a locked door. Within a year of Kanner’s arrival on November 1, 1930, the door was unlocked. He said, “the portal connected, rather than separated, the two departments.”
The Reservation
By first grade, Leib (Yiddish for ‘lion’) Kanner spoke Yiddish, Ruthenian [a local Slavic language], read and wrote Hebrew, and had a smattering of Aramaic.” Kanner’s mother hired a tutor to teach him German and Polish. He was raised in a traditional Orthodox Jewish household in Klekotów, Austria-Hungary, or present-day Ukraine, on June 13, 1894. Kanner despised his given name and chose to go by “Leo,” not surprisingly, from Latin for lion.
It was not the last time he would roar against authority.
After elementary school, he took classes taught in German in geography, history, mathematics, botany, zoology, Latin, Polish, and Ruthenian. He was proud of his fluency in German, extending even to minor 19th-century novelists. He began medical school in 1913, graduating with “Very Good or Good grades. Except for one subject, psychiatry, I was rated as ‘Satisfactory.’ ”
At that time, doctors from all over the world traveled to Berlin and Vienna for advanced study. Kanner was restless and ready for a change and found a position at the Yankton, S.D., State Hospital. Family members cautioned him against the move, fearful that in America, he would fall victim to Plains Indians or gangsters in the city streets.
Unconcerned, he and his wife and daughter boarded a ship for New York in 1924. At sea, he wrote: “The past was behind us, and every knot removed us farther from it. The future lay ahead, vague, unstructured, neutral, neither promising nor threatening. … everything was drenched in beauty.”
He made his first ward rounds at Yankton on February 18, 1924. His poor marks in psychiatry mattered not at all. “All that physicians needed was a diploma from a medical school; they became a psychiatrist by dint of their employment in a mental hospital, where they took care of the physical ills of the inhabitants.”
After a few years in Yankton, Kanner was offered a fellowship in psychiatry with Adolph Meyer at Johns Hopkins and the opportunity to advance psychiatric knowledge for pediatricians. He began work November 1, 1930, at the Harriet Lane Home for Invalid Children at Hopkins.
The Harriet Lane Home for Invalid Children at Hopkins and the Henry Phipps Psychiatric Clinic were physically in the same building but divided by a locked door. The door was unlocked within a year of Kanner’s arrival on November 1, 1930. Symbolically, he said, “the portal now connected, rather than separated, the two departments.
Conclusion
In time, the connections between psychiatry and pediatrics strengthened into a distinct new specialty — Kanner is considered the founder of child psychiatry — and would go on to write the first textbook. In doing so, he saved the emotional lives of millions of desperate children and their families and gave the world a window to see them as they are and not as we think they should be.
Three threads repeatedly surface in this work.
One was his genuine interest in others. Recalling his school days, he wrote: “I developed the hobby of collecting people.” At Yankton, Kanner was curious and sought to dig deeper into what his patients were thinking more than was revealed by a rote list of questions: “My interest in patients as people took precedence over any abstract generalization about psychiatry.” At Hopkins, it merged into his “capacity for entering the world of the child,” as one former student said.
A second theme was disenchantment with rigid ideology, extending to the brutal and cruel political ideologies that wrecked Europe in his lifetime.
The third shadow hovering throughout his autobiography is the recollection of people from his childhood who escaped or were slaughtered in the Holocaust. “My 70-year-old mother was dragged from her home and gassed somewhere in Bohemia,” he wrote. It inspired him to help 200 refugee physicians and academics escape Nazi-controlled territories and find a home and employment in the United States between 1938 and 1942. He was tireless as usual, wrote voluminous letters in support, and constantly lobbied unfriendly, foot-dragging American diplomats.
Among those Kanner helped bring to this country were two other researchers on children’s mental health, George Frankl and Anni Weiss, who came to Hopkins for a time after working with Hans Asperger in Vienna.
It left him with a lifelong obsession to improve all that he could for children.
Autism Fast Forward
Medical researchers have been studying Autism Spectrum Disorder (ASD) for over 100 years since Freud’s first comments without much success. Autism is a mental illness influenced by interpersonal dynamics in early life in which the self cannot focus externally. No one believed that it was normal for babies to remain permanently oblivious to the people (analysts called them “objects”) all around them or detached from the intimate emotional ties (“object relations”) that populated children’s mental worlds as well as their daily lives in families, schools, and communities.
As time passed, experts discovered that children with Autism had difficulty understanding that others could have different beliefs. This made it challenging for them to engage in everyday social interactions, like sharing imaginary adventures or empathizing with emotions. They were on their wavelength, marching to the beat of their own drum. It made them hard to diagnose and even harder to cure. The inputs were blocked, and the outputs were unhelpfully obtuse.
Then, in the 1970s, a husband and wife team from Stanford University’s Autism Center followed in Kanner’s footsteps and developed a breakthrough treatment for autistic children, giving it a catchy name, Pivotal Response Therapy, or PRT. Drs. Robert and Lynn Kern Koegel were driven by the profound suffering experienced by children with Autism, characterized by solitary confinement and the misery inflicted on both child and parents.
However, they were equally dissatisfied with the available treatments, which ranged from long-term in-patient care to rehabilitation centers, and the cost of available treatment was prohibitive. They sought to create a more naturalistic approach.
PRT earned the highest praise from the National Academy of Sciences, labeling the treatment as comprehensive for Autism Spectrum Disorder.
Their goal is to treat Autism within a real-life setting by targeting the primary pivotal skills with the broadest impact. Their book, Pivotal Response Treatment for Autism Spectrum Disorders (PRT), focused on the specific keys that could unlock a better future:
- Parents are encouraged to become active agents of intervention.
- Families should weave interventions into everyday routines that can prompt desired behavior by establishing clear antecedents (causes) and consequences (effects).
- Parents should facilitate symbolic play, ensuring children generalize skills to other settings.
- PRT typically involves a commitment of 25 or more hours per week.
Donald T
“If a man does not keep pace with his companions, perhaps it is because he hears a different drummer. Let him step to the music which he hears, however measured or far away.” — Henry David Thoreau, Walden
After a long and fulfilling life, Donald Grey Triplett died on June 15, 2023, just shy of his 90th birthday.
He lived independently in his childhood home in a safe community where everyone knew his name. As an adult, he had regular friends, a Cadillac to get around, and a daily hobby he loved — golf. And when he wasn’t teeing off, he traveled. Donald explored most of the states in the U.S. and traveled to dozens of countries.
Donald resembled a content retiree, far from the institutionalized fate that once seemed inevitable. Dr. Kanner and his parents deserve immense credit for bringing him home and tirelessly helping him connect with the world, learn the language, and become self-sufficient.
But credit must also be given to Donald himself. His innate intelligence and capacity for learning propelled him forward. By his teenage years, he attended a regular high school and later went on to college, where he achieved passing grades in French and mathematics.
The town he lived in, ironically named Forest, Mississippi (about two hours from Forest Gump’s hometown of Greenbow, Alabama) — played a significant role in Donald’s positive outcome.
The roughly 3,000 residents of Forest made a collective, albeit unconscious, decision to embrace and protect this extraordinary man who lived among them. Their acceptance and treatment of him as one of their own became evident when locals warned the media (BBC was writing a story about his life) of dire consequences if they were to upset Donald.
Donald was never ‘cured’ of Autism, but he gradually overcame it to expand the possibilities in his life. He still had obsessions, spoke mechanically, and struggled with extended conversations. However, he blossomed into a fully realized individual.
Donald’s story conveys an important message to parents, families, and society about children with disabilities. We have unique learning potential, just as Donald did, even if they achieve milestones at their own pace — Donald learned to drive only in his late twenties.
Then, as with everything else he tried, Donald never stopped.
