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NeuroTribes: The Legacy of Autism and the Future of Neurodiversity

2016; Lippincott Williams & Wilkins; Volume: 38; Issue: 2 Linguagem: Inglês

10.1097/dbp.0000000000000378

1536-7312

Jennifer Cross,

Autism Spectrum Disorder Research

For anyone who treats children with autism, this book is a must read: both enlightening and educational. Renowned neurologist Oliver Sacks described it as a “sweeping and penetrating history… presented with a rare sympathy and sensitivity.” It has been on the New York Times bestseller list and won the 2015 Samuel Johnson prize for nonfiction. Although it is not a medical text and is written by a journalist rather than a health care provider, it recounts a fascinating history, tracing the roots of autism and challenging many of the preconceived notions regarding the role of both Leo Kanner and Hans Asperger in identifying this disorder. The author, Steven Silberman, came upon the topic by chance after being sent to interview tech entrepreneurs behind many of the successful startup companies in Silicon Valley. Mr. Silberman was surprised to find that more than a few of them had children with autism, described by some as an “epidemic of Autism in Silicon Valley.” Intrigued, he set out to learn more about this phenomenon and what follows is an extraordinary story in which he presents compelling evidence that the “autism epidemic” may be in fact a myth. He begins in 1920s Vienna, with the story of a young pediatrician, Hans Asperger, who worked at the Lazar Clinic for “uneducable” children. There, Dr. Asperger encountered many children with social, communication, and behavioral challenges, whom he described as having “Autistic psychopathy.” He described these children as a diverse group with variable strengths and weaknesses and a broad phenotype. However, because of the rise of Hitler in Europe and the Nazis' aggressive eugenics campaign, the school closed, was subsequently bombed, and the papers and case reports were lost for decades. Dr Leo Kanner was safe in the United States, having emigrated from Germany in 1923. By the late 1930s, he had become a well-respected child psychiatrist at the Harriet Lane Clinic at John's Hopkins Hospital. It was there that he published his landmark paper “Autistic Disturbances of Affective Contact” in 1943, describing just 11 patients he had encountered over the previous decade. Dr. Kanner believed he was describing a rare disorder beginning in infancy, with a strict and narrow definition—despite the fact that two of Asperger's Jewish et al., who had been rescued from the Nazis by Kanner himself, worked at the Harriet Lane Clinic. Because of his stature in the field of psychiatry, Kanner's ideas would go on to define the diagnostic criteria of infantile autism for the next several decades. Had the original description been more inclusive in its reach and incorporated the ideas from Vienna, the author argues that autism would never have been considered a rare disorder. It then took the tireless efforts of parents, such as Bernard Rimland, a Navy psychologist in California, and Lorna Wing, a physician in England, to raise public awareness, and bring together parent advocacy groups in the United States and UK to acknowledge the broader concept of autism. It is Dr. Wing who is credited with recognizing the significance of Hans Asperger's work and bringing it into the mainstream medical establishment during the 1980s. Mr. Silberman then chronicles the development of the broadening criteria of autism, including the introduction of Asperger's Disorder in DSM 4 and its deletion in DSM 5. In addition to a compelling history, Mr. Silberman includes many personal stories from parents of autistic children who share their families' experiences. He also uses the words of several autistic adults, including Temple Grandin, to great effect, giving the reader insights into their views of the world and what it is like to live with this condition. This book brings a new perspective to our understanding of the “autism epidemic” and is a valuable resource for both clinicians and parents. It also includes, throughout the text, many useful references, including parenting books, websites, and several self-advocacy groups for autistic young adults.