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Hans Asperger: Not the Good Doctor A Review of Edith Sheffer, Asperger’s Children: The Origins of Autism in Nazi Vienna

Asperger's childrenBNote: Thank you to Jonathan Rose for permission to reprint this book review. Find the original at History News Network.

By Jonathan Rose

Edith Sheffer, Asperger’s Children: The Origins of Autism in Nazi Vienna.  W. W. Norton, 317 pp., $27.95 hardcover.

​Outside of a few endnotes, this book never mentions Steve Silberman’s NeuroTribes.  That’s remarkable, because for all practical purposes, Asperger’s Children is a through point-by-point demolition of Silberman’s saintly portrait of Hans Asperger, based on honest research by a real historian.  Edith Sheffer is a Senior Fellow at the Institute of European Studies at Berkeley.  She has an autistic son, she has studied a vast array of diagnostic records and case histories in psychiatric archives, and she has produced what is by far the best early history of the autism pandemic.  And while she is unfailingly polite about it, she recognizes when people are talking nonsense about autism.  She says at the outset that her aim “is not to indict any particular individual” or neurodiversity as a concept.  But in effect Asperger’s Children is a devastating indictment.

​Sheffer recognizes that autism is something new: as her subtitle suggests, it originated less than a century ago.  She does not attempt to concoct a fanciful “history” of the disorder stretching back into the mists of prehistory.  Though she believes that soaring autism rates may be partly attributable to better diagnosis or changing definitions, she does not deny that there is also “an objective increase in symptoms.”  (For a robust historical demonstration that autism is a very real, recent, and devastating epidemic, see Dan Olmsted and Mark Blaxill,Denial: How Refusing to Face the Facts about Our Autism Epidemic Hurts Children, Families, and Our Future [2017].  I read a draft of this book and sent comments to the authors.) 

Asperger’s Children doesn’t address the causes of autism, but the scientific research clearly indicates that it is a combination of a genetic predisposition and an environmental insult.  In other words, we are poisoning a subset of our children, and we can stop poisoning them if we identify and remove the environmental triggers.  In that sense autism is in the same category as lead poisoning in Flint or fetal alcohol syndrome on Indian reservations.

​Late in life Asperger claimed that he had worked to protect handicapped children whom the Nazis wanted to exterminate, and Silberman accepted that unquestioningly.  But everything Sheffer and other researchers have found in the archives tells a very different and terrible story.  Asperger was in fact a Holocaust perpetrator who signed death warrants for dozens of mentally handicapped children.  Though he never actually joined the Nazi Party, he was a member of several Nazi-affiliated and ultra-right organizations, and he enthusiastically promoted Nazi eugenic policies.  

Sheffer’s story begins in the 1920s, when the Nazi Party was a tiny Bavarian fringe group. Vienna was then governed by Socialists who created an impressive system of social welfare, including free clinics and school medical examinations.  However, a key part of their program was eugenics, an idea embraced at the time by the Left as well as the radical Right.  Julius Tandler, Vienna’s chief of public welfare, talked openly of compulsory sterilization of “the inferior” and the “extermination” of “life unworthy of life”. That was exactly the vocabulary that Asperger and the Nazis would adopt.  Tandlerwas a Jewish socialist whose programs had dramatically improved the health of Vienna’s working classes, and perhaps that success blinded him to the dangers in what he was proposing.  His medical services established a regime of surveillance and control over patients which the Nazis later used to carry out their own version of eugenics.  

In 1930 Franz Hamburger was appointed head of the University of Vienna’s Children’s Hospital.  Well before the Nazis had seized power in Germany and Austria, Hamburger was an ultra-reactionary who pushed Jews and liberals off the faculty and replaced them with doctors appointed more for their far-right politics than professional competence.  He gave young Doctor Asperger his first job and swiftly promoted him: after all, someone had to replace all those blacklisted Jews, and in 1934 Asperger joined an organization dedicated to firing still more Jewish doctors. To the end of his life Asperger worshipped Hamburger, even after his mentor had been thoroughly discredited.  At the Children’s Hospital Asperger worked closely with Erwin Jekelius, an outright Nazi who later supervised the killing of mentally handicapped children.  (Everyone at the hospital agreed that Jekelius had a wonderful bedside manner.)

At a young age Asperger became head of the hospital’s clinic for Heilpädagogik, which translates as “Curative Education” or what we would now call “holistic psychiatry”.  He had published nothing in that field: Sheffer concludes that he was “somewhat of a nonentity”. But in this brilliant department, doctors and nurses were talking about a newpsychiatric condition – autism – and they were publishing pioneering case studies.  Staff physician Georg Frankl explained that autistic children “do not sense the [social] atmosphere, and so cannot adapt,” because they have a “poor understanding of the emotional content of the spoken word”.  Frankl argued that this condition was not pathological, “rather just a dysfunction”, though he acknowledged that more severely affected children were “autistically locked.”  Anni Weiss, a psychologist at the same clinic, described an autistic boy as awkward, bullied, and vulnerably naïve. He “cannot grasp what is happening around him with any fine shade of feeling….What others perform naturally in the social machinery—perceiving, understanding, and then acting—does not function in him as it ought to.”  And she noted that some of these children had narrow but unusual talents: “calendar experts, jugglers of figures, artists of mnemonics.” 

So if anyone “discovered” autism, it was Frankl and Weiss who produced very early and strikingly perceptive descriptions of the condition.  We can’t explain why a mediocrity like Asperger was promoted over them, except to note that they were both Jewish, and Asperger had astutely allied himself to a powerful patron.  Antisemitism forced Frankl and Weiss to emigrate to the United States, where they married.  Frankl’s escape was assisted by none other than Leo Kanner, who in 1943 published his famous article “Autistic Disturbances of Affective Contact.”  Steve Silberman constructed a far-fetched theory that Kanner had appropriated Asperger’s work without acknowledgement, but Sheffer shows that Kanner actually drew on Frankl and Weiss and generously cited them.  Asperger also owed a great debt to Frankl, Weiss, and others in his clinic, and he never acknowledged them.  Yet Sheffer notes that Asperger’s approach to autism, though highly derivative, was in one respect distinctive: his “diagnosis would be steeped in the principles of Nazi child psychiatry.” 

After the German takeover of Austria in March 1938, the remaining Jews in medicine and psychiatry were forced out, opening up still more career opportunities for men like Asperger – provided they conformed to the new regime.  That October Asperger delivered a notorious lecture in which he welcomed the Nazi revolution in medicine, “a massive reorganization of our mental life….The fundamental idea of the new Reich—the whole is greater than the parts, the Volk more important than the individual—must lead to profound changes in our entire attitude toward the most valuable asset of the nation, its health.” And he identified a key problem: “children who we name ‘autistic psychopaths’”, a term he had never used before.  Frankl and Weiss did not regard autistic children as either geniuses or psychopaths, but Asperger now sorted them into the saved and the damned.  On the one hand there were those we now call “high-functioning”, whose “astonishingly mature special interests” and “originality of thought” spurred them to “outstanding achievements”.  But low-functioning children were “nonsensical, eccentric, and useless.”  They were “always loners, and fall out of every children’s community.”  In fact “Nobody really likes these people.”

All this was entirely in accord with the eugenic policies of the Third Reich.  The Nazis never intended to eliminate all handicapped people.  They honored disabled war veterans, and the Hitler Youth had special sections for the blind, the deaf, and the physically handicapped.  If you could be educated and become a productive member of society, the National Socialist state offered treatment and support services.  But under the T4 program (directed from a Berlin office at Tiergartenstrasse 4) the severely disabled were marked down for elimination.  More than 200,000 were legally murdered, of which 5000 to 10,000 were children, including 789 at Spiegelgrund, a Vienna children’s hospital which also served as a death center.  This policy literally gave physicians discretionary power over life and death. After examining patients, they could in effect check off a box: Euthanize/Don’t Euthanize.  This was all part of the larger Nazi project of sorting humanity into superior and inferior breeds, nurturing the former and eradicating the latter.  

There lies the terrible danger in portraying autistic people as eccentric geniuses: most of them aren’t, and those who don’t fit the narrative must somehow be eliminated.  The Nazis killed them; today we merely ignore them.  NeuroTribes and the mass media usually foreground high autistic acheivers, effectively marginalizing the low-functioning.  Sheffer clearly rejects that kind of ableism: Asperger’s Children devotes equal attention to all of those children, regardless of their levels of ability.

Together with his colleagues, Asperger advanced the concept of Gemüt, meaning the psychological capacity to support and conform to the larger community.  Gemüt was central to Nazi ideology, and it seemed to be lacking in children with autism or other behavioral problems.  But in Asperger’s view, autistic Germans were still Germans, and if they were gifted with (say) exceptional mathematical abilities, they confirmed notions of racial superiority.  Though they had a handicap, with treatment and support they could be molded into productive citizens of the Reich. In his clinical work, Asperger readily awarded this positive diagnosis to sons (but not daughters) of the intellectual and creative classes.  He insisted that these boys were gifted with “rare maturity of taste in art”, a “special clear-sightedness…seen only in them…a special understanding of works of art which are difficult even for many adults.” Evidently they had a particular flair for “Romanesque sculpture or paintings by Rembrandt.” Sheffer skeptically notes that Asperger offered no evidence for the existence of these magical critical faculties, which girls somehow never seemed to possess.  Today this idealized portrait of autism, rooted in Nazi scientific racism, is transmitted to the American viewing public in the hit television series The Good Doctor, starring an autistic surgeon blessed with Aryan good looks and positively miraculous diagnostic powers.

But to return from fantasy to reality: what did Asperger say about those autistic children who were less brilliant or more difficult, or came from troubled working-class homes?  Along with delinquents, the underclass, Gypsies, and those with incurable neurological disorders, they were labelled social liabilities, and Asperger prescribed “the expulsion of the predominantly worthless and ineducable through early diagnosis.” Sheffer notes that Asperger never arrived at a clear and consistent definition of autism: “It meant, basically, not fitting in…[a] totally amorphous diagnosis.  Asperger used it for some children to suggest their humanity, but he used it for others to deny their humanity.” She adds that his 1944 postdoctoral thesis was for the most part “disparaging of autistic children.”  Except for the favored and treatable few, he dismissed them as “automata”, “grotesque and dilapidated”, and “unable to learn” (his emphasis).  

Those words would have ghastly consequences.  Sometimes Sheffer is too ready to make excuses for Asperger:

Where, if anywhere, can one draw lines of complicity for ordinary people in a criminal state?  In marginal and major ways, conscious and unconscious, people became entangled in systems of slaughter.  Asperger was neither a zealous supporter not an opponent of the regime.  He was an exemplar of this drift into complicity…. 

No, Asperger did not drift into exterminating children in the passive voice.  In August 1941 German Catholic bishops courageously denounced the euthanasia program, and it was officially ended. However, the killing continued covertly, carried out by (among others) Asperger and his colleagues.  The following December Asperger joined forces with Erwin Jekelius and Franz Hamburger to dispatch what Asperger called “difficult cases” to Spiegelgrund for “stationary observation” and “treatment”.  Sheffer fully recognizes that these were code words for euthanasia.  She calculates that Asperger played a role in sending at least 44 children to Spiegelgrund, of which 37 were killed.  Given that the medical records are incomplete, the actual toll was probably higher.  Asperger was a Catholic who went far out of his way to violate one of the fundamental principles of his own church.   

​Medical personnel received cash incentives for every handicapped child they reported and eliminated, though Jekelius accepted bribes for exempting favored patients.  Two commonly used methods were lethal injections or overdoses of barbiturates.Elfriede Grohmann entered Asperger’s clinic when she was thirteen. Youth services referred her because she was a habitual runaway, not surprising given that she was born to a single mother in an unstable home.  Clinic reports wrote her off as isolated, insensitive to social cues, “always peculiar”, and a “very abnormal being”. But Sheffer, reading Elfriede’s medical files closely, discovers a beautiful mind.  All day the girl wroteaffectionate letters to her loved ones: evidently she was highly communicative and connected.  Nevertheless, the clinic pronounced her ineducable and assigned her to Spiegelgrund.  Elfriede knew what happened to children in that institution.  In a letter to her mother she wrote that this was “perhaps the very last mail since I do not know if we will see each other again.  Because I can’t know if I won’t die in this trip.”

​In fact Elfriede may have survived.  Sheffer found no document confirming her death. Psychiatrists under the Nazi regime issued arbitrary and inconsistent diagnoses, and often changed their minds. But Spiegelgrund was hellish even for itssurvivors, who faced a daily regime of sadistic discipline, unheated dormitories, starvation rations, and handcarts carrying out the corpses of euthanized children.  The Children’s Hospital itself carried out the kind of horrific and often fatal “medical experiments” conducted at concentration camps: for instance, deliberately infecting infants with tuberculosis in order to test the effectiveness of a vaccine.

​Asperger should have been put on trial for crimes against the handicapped, but he never suffered any consequences for his actions.  After the war the upward trajectory of his career resumed.  He was not penalized by denazification programs, because technically he had not been a Party member. In the 1970s he claimed that he had refused to report children for euthanasia and had twice been threatened by with arrest by the Gestapo. Silberman accepted this story at face value, but it was clearly specious and self-serving.  Every relevant document we have from Nazi archives suggests that the Party considered him politically reliable, a man they could work with, and as long as they ruled Austria he prospered.  

​Asperger’s thesis was rediscovered and promoted by psychiatrist Lorna Wing, and it was she who (after his death in 1980) created the term and diagnostic category “Asperger’s Syndrome”.  Sheffer notes that we “typically research historical figures before designating eponymous diagnoses in order to avoid naming a condition after a person who has engaged in ignominiously actions,” but Asperger’s past wasn’t investigated beforehand.  She adds pointedly that “numerous conditions named after Nazi-era doctors who were implicated in programs of extermination now go by alternative names.”  If we rechristened it “Frankl-Weiss Syndrome” we would honor the true discoverers of autism, who described the condition more accurately and humanely than Asperger.  And of course some individuals on whom we have stuck the “Asperger’s” label may prefer not to be identified with a doctor who might have had them exterminated.​

​Ultimately, Sheffer wonders whether we shouldn’t do away with the autism label altogether.  Granted, diagnostic categories tend to pigeonhole individuals and oversimplify complex psychiatric conditions – sometimes with ghastly consequences, as in the case of Asperger and his colleagues.  But realistically, it is far too late in the game to erase “autism” from the dictionary.  And Scott Badesch, the head of the Autism Society, poses a sobering question: “If in the past they were called autistic and now they are not labeled anything, how will they get help?”  In fact, the Centers for Disease Control are now planning to narrow the definition of autism, and a study in the Journal of Autism and Developmental Disorders estimates that this change would reduce diagnoses for PDD-NOS by 75 percent – even while demand for special education is surging throughout the developed world.  There is good reason to fear that doctoring the numbers could make autistic children disappear from public consciousness, deny them the supports they need, and mask the true extent of the pandemic.  Kalman Hettleman, former Maryland Secretary of Human Resources, blithely suggests that as many as 80 percent of pupils in special education classes somehow don’t belong there, a view warmly endorsed by the Washington Post.

​Sheffer is entirely right to point out the dangers of unbridled medical surveillance and intervention, but neglect can be just as deadly as deliberate killing.  Autism frequently leads to seizures, drowning, fatal accidents, and suicide: taken together, they can reduce life expectancy by as much as half.  Unless we find some means of cure or prevention, in a few years autism-related deaths could easily exceed the toll for the T4 program.

​The story told in Asperger’s Children is not entirely new: the basic outlines were previously sketched out by Austrian investigator Herwig Czech and by John Donvan and Caren Zucker in their 2016 book A Different Key.  But Sheffer offers us far more background, context, and damning research.  Somehow the earlier exposes of Asperger had little impact on his public image, so one hopes that Sheffer will finally make us face the reality. Everyone in the autism community should read Asperger’s Children, though they may find parts of it terribly painful, especially the sections describing the horrors inflicted at Spiegelgrund.  If you are an autism parent, you will recognize your children in the institution’s inmates.  If you are autistic, you will recognize yourself.

​Edith Sheffer’s voice is always calm, objective, and professional, never hectoring.  She lets readers draw their own conclusions, but the relevance of Asperger’s Children isimpossible to miss.  This book casts a stark light on the dangers of medical dictatorship, where the rights of parents and children are disregarded, where doctors assume their own infallibility and purge dissenters from the profession, where the individual is sacrificed to “the greater good”, where “science” becomes a justification for mass murder. Asperger’s Children compels us to think about such disturbing ethical issues as Alfie Evans, the now-discredited Liverpool Care Pathway for terminal patients, the role of doctors and drug companies in creating the opioid epidemic, aborting Down’s Syndrome babies, and the young women who say they were damaged by Gardasil (should they be allowed a #MeToo moment?).  

​Given that Asperger’s theories were rooted in Nazi scientific racism, and given that those theories have been a source of inspiration for Silberman and many neurodiversity activists, may we conclude that they too are scientific racists?  Scientific racism is the delusion, backed by pseudoscience, that some groups, defined by their common genetic inheritance, have innately superior (or inferior) intellectual powers.  Silberman has claimed that “genes associated with autism are also associated with higher levels of cognitive ability.” He also endorsed Temple Grandin’s theory that “people with autism, dyslexia, and other cognitive differences could make contributions to society that so-called normal people are incapable of making” (his paraphrase). This statement is half nonsense.  Yes, autistic people can make contributions, but nonautistic people can and do make the same kind of contributions: there are no limits to the powers of a fully functioning human brain.  Yes, Temple Grandin can “think visually”, but so can artists, photographers, graphic designers, architects, film directors, and interior decorators.  Grandin has also resorted to eugenics, speculating that autistic genes may be the source of all human creativity, going back to the cavedwellers.  Those who are lucky enough to inherit these genes may be “more creative, or possibly even geniuses.  If science eliminated these genes, maybe the whole world would be taken over by accountants.”  And Judy Singer, who invented the term “neurodiversity”, explained that the typical brain represents “only one type of brain wiring, and, when it comes to working with hi-tech, quite possibly an inferior one”. (There she promoted the stereotype that all autistic individuals are computer whizzes: most of them aren’t.)

​The latest neurodiversity hypothesis has been advanced by Barry Wright and Penny Spikins at the University of York.  They argue that autism appeared in the last Ice Age: in order to survive harsh climactic conditions, cavedwellers evolved higher levels of cognition and intelligence, reflected in their cave paintings.  Spikins says that artistic ability “is found very commonly in people with autism and rarely occurs in people without it,” and autism is most common among Northern Europeans (so much for Italian Renaissance painting).  What’s deeply troubling here is that, if you substitute the word “Aryan” for “autistic”, you have something that reads like a Nazi racial screed.  The Nazis insisted that “Nordics” had evolved into supermen because they were steeled by the rigors of the frozen north.  According to this theory, Africans had it much easier in sunnier climes, and therefore developed no art.  Doctor Asperger undoubtedly would have approved.

​All this demonstrates that scientific racism is highly seductive, and must be resisted regardless of the form it takes.  Edith Sheffer illustrates unforgettably how this ideology precipitated the Handicapped Holocaust.  Sheffer and Silberman both appreciate that autistic adults can often exceed expectations and achieve remarkable things, but she is much more sensitive to the burdens that autism imposes on the autistic.  Silberman, who is neither an autism parent nor autistic, tends to treat the condition as a kind of neurological trust fund.  He is right to criticize some misguided psychiatric interventions, notably Bruno Bettelheim’s theory that autism was caused by “refrigerator mothers”, but he fails to recognize that the most destructive autism doctor of all was Hans Asperger.

​In his 1944 thesis Asperger claimed his clinic had observed more than 200 cases of autism over a decade, though he only described four in any detail.  Assuming the 200-plus figure was correct and did not include any cases outside of Austria, that would work out to an overall rate of 1 in 30,000, still extremely rare.  Today the autism rate is 1 in 59 for eight-year-olds in the United States, 1 in 34 in New Jersey, and 1 in 21 among Belfast schoolchildren.  Silberman, neurodiversity activists, and public health officials have consistently assured us that these soaring numbers reflect no real increase, only “better diagnosis”, and that the actual autism rate is more or less constant.  That is, they ask us to believe that the rate was about 1 in 21 everywhere and at all times, in all corners of the world and throughout human history.  There were untold millions of autistic people out therefor thousands of years, but until very recently no one noticed them.  At that rate autistic individuals would have met face to face every day, but somehow they consistently failed torecognize each other. When the T4 program killed the mentally handicapped, medical authorities assured relatives that they had died of natural causes, but some families figured out what was happening and vocally protested, despite the grave risks of standing up to Nazi power.  Of course there’s an important difference between the two cases: we don’t have to worry about the Gestapo knocking down our doors.  So when are we going to react?

Jonathan Rose is William R. Kenan Professor of History at Drew University.  His most recent book is Readers’ Liberation (Oxford University Press).

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British Autism Mother

@ Jonathan Rose (and others?)
I thought Asperger’s Syndrome was renamed HFA (High Functioning Autism) by DSM 4 or 5 several(?) years ago - except for those people already diagnosed who could retain the term AS. My own adult child was told by a consultant psychiatrist of the change at that time.
Please note that I cast no aspersions on Edith Sheffer’s sincerity. My scanning of her book left me convinced of the care she had clearly taken to search out corroborative sources of information. How I wish I’d studied German at school.
May I refer anyone reading my two comments, for once, to consult Wikipedia to read about “the law of unintended consequences” which was observed and recorded by an American not that many years ago.

Jonathan Rose

British Autism Mother: I'm sure Edith Sheffer was entirely sincere she she suggested that Asperger's Syndrome might be renamed, but I think we have to call it something. Otherwise the distinction between the high-functioning and low-functioning will be erased, and then everyone will assume that all autistic children are high-functioning. While her book never directly tackles the vaccine issue, I think it's an acute embarrassment to pharma and its allies, who very much want everyone to think that autism is a "gift".

British Autism Mother

My copy of this book is waiting for me on my return from holiday. I thought I would be getting a bit of a break from autism but, hey ho!
I have a reservation about the potential re-naming of Asperger’s Syndrome to what??? You see, over twenty years ago the term used was “acquired autism” for those children who lost various abilities. Now there are very few references to “acquired autism”, the term of choice appears to be “regressive autism”. So what? I hear you say. This means that all the google references to the old term have been lost. Now isn’t that mightily convenient for the vaccine manufacturers?
Just call me suspicious but I see a golden opportunity for the vaccine manufacturers to piggyback the discrediting of Hans Asperger onto the loss of embarrassing references and statistics.

John Stone

Jonathan

Yes, but after 3 decades they have not found anything which could even support that. Did they ever find the genes which caused smokers to get lung cancer? Back in the middle of the last decade I remember an article by leading British geneticist Prof Steve Jones in the Daily Telegraph admitting that genetics had mostly proved a dead end from the point of view of medical science and should receive limited funding (which didn’t stop him using dirty tactics against Andy Wakefield). So, I think it is right to view it more as a red herring and not something which is simply misused.

Jonathan Rose

Exactly, John. Certainly some people have a genetic predisposition to cancer, but that only means that they are more sensitive to carcinogens: if they weren't exposed to those carcinogens, they wouldn't have cancer. Likewise, I would support genetic research into autism if it were used to identify children who are predisposed to autism and grant them medical exemptions from vaccination, but obviously that is not the goal of such research: the objective is to divert attention from autism's environmental causes.

John Stone

Alessandro

Yes, I suspect it is only in the realm of why one person gets ill and another doesn’t - many random elements of environmental exposure. Gene studies which find vague statistical tendencies and make a song and dance about them also talk only of susceptibility and not determination, and they are a racket to deflect money and attention from the hostile elements in the environment, and provide employment for drone scientists. I don’t think one can say absolutely that infants might not have genetic vulnerabilities but it is no more relevant than the etiology of other pathologies where genetics at least take a back seat. I am sure Jonathan would not disagree with that?

As I understand it in inception the gene project was started by the tobacco industry trying to deflect attention from smoking as a cause of lung cancer while trying to turn the sufferers into defective people.

susan welch

Alessandro, I do feel you are being a little oversensitive.

Jonathan is reviewing a book which implicates both environmental and genetic cause for autism. Are you suggesting AoA should leave out any part of a book review that may upset readers? If so, this would make it not much better than the media, where only 'acceptable' points are raised. The reason so many people love this site is because diverse views are allowed to be aired.

If you are saying that genetics (as a contributory cause) should not be brought up on this site, then I cannot agree. As 2 of my 3 grandsons are autistic, then I have to accept that genetics play a part. None of my sibling's grandchildren have problems. It isn't pleasant, but facts do have to be faced. If we deny what is clearly true, then what hope for future research?

Alessandro

"Asperger’s Children doesn’t address the causes of autism, but the scientific research clearly indicates that it is a combination of a genetic predisposition and an environmental insult."

AoA should not allow statements like that to appear in its articles at least not without challenge because they are entirely misleading.

It is important for people to understand that is the same as saying that autism is a result of an environmental insult and breathing. If the kids were not breathing they would not have become autistic.

The only significant aspect is the environmental insult. All disease happens because humans are genetic just as all humans who are going to continue to live continue to breathe.

Most disease is a combination of genes and external causes. Internally caused disease is solely genetic like haemophilia. For those diseases there is no external cause. The body itself does not work properly.

For all diseases we describe as externally caused the genetic element is in every case irrelevant in the sense that once there is an external cause, the genetic aspect is not the "cause". Some people may be more susceptible to a particular disease because of their genes but just being susceptible alone does not result in the disease.

If the external cause is removed for treatable diseases the disease is "cured".

So medicine distinguishes internally from externally caused disease. It is unnecessary and pointless to add "genetic" as we are all genetic. If we were not we would not get diseases.

cia parker

Science is Pure,

I agree. I was resentful at the time articles started to come out about the dearth of girls in mathematics and many sciences. I wasn't good at math, had no interest at all in it, and just a few physics-like words give me a headache. No one could have made me like them. I loved history, geography, world cultures, poetry, literature, and the history of art, and was very good at them. Isn't that enough? Let who will study math and physics, but don't act as though we were infinitely malleable and that it was a crying shame that most girls just didn't like math and physical science. It's insulting. I was very unhappy to see how the public schools have thrown out nearly all of history and geography, nearly all of poetry and world literature, to replace them with an appalling number of required courses in math and science. Which my daughter can't do at all, of course. Just because the US was lagging behind Taiwan and Hong Kong in the math and science stakes. Hmm, maybe the Chinese have a greater aptitude for them? Bravi! While we have been busily damaging our children's brains and intellectual function for decades now.

cia parker

Pete,
I absolutely DO think that no one should get the pertussis vaccine, ever, and that is what has caused most of the problems associated with the DPT/DTaP. I think we need to keep careful figures on those who get only the DT series, how many have severe reactions, and how many unvaccinated people get tetanus and how many die of it. Right now, we really don't know what would happen if very few people got even the DT series. Hilary Butler said in one of her books that the DT seemed to be less reactive than the T alone, and it would be very bad if diphtheria were to make a comeback, so I think the DT for most children presents very low risk.

John Stone

Science is pure

Yes, I wrote about a lot of this when we first reported it back in 2009:

http://www.ageofautism.com/2009/01/simon-baroncohen-thinking-differently-about-autism.html

The opening is a bit a confusing because it was at the moment when the IACC had voted to research the environmental causes of vaccines, a decision reversed at a secret meeting a few days later.

Science is pure.  People are corrupt.

There is zero prospect for a prenatal test for autism despite the claims by the likes of the BBC, so that is an unnecessary distraction.

With regard to girls and the study of mathematics, physical sciences and engineering, there have been extensive attempts to promote the subjects to schoolgirls so as to prevent any intimidation they might feel in entering a male dominated world, but with little success since few girls are inclined to show any interest in the subjects.

Indeed, when I was an undergraduate approaching girls I found the words: 'I study physics' to be the ultimate conversation killer.

Science is pure.  People are corrupt.

There is zero prospect for a prenatal test for autism despite the claims by the likes of the BBC, so that is an unnecessary distraction.

With regard to girls and the study of mathematics, physical sciences and engineering, there have been extensive attempts to promote the subjects to schoolgirls so as to prevent any intimidation they might feel in entering a male dominated world, but with little success since few girls are inclined to show any interest in the subjects.

Indeed, when I was an undergraduate approaching girls I found the words: 'I study physics' to be the ultimate conversation killer.

Gary Ogden

Jonathan: I cannot fathom how anyone could claim girls cannot do math. They have not been around children. Among my students (10-12 age-group), those gifted in math were just as likely to be girls as boys, and this really opened doors for them (especially the girls). The brightest student I ever had was also the brightest in math I ever had the pleasure to teach. She ate it for lunch!

cia parker

I think the term autism spectrum, including Asperger's at the high-functioning end, is appropriate. My mother, brother, and I all have/had Asperger's: my mother reacted to the diphtheria vaccine when she was four and my brother and I reacted to the DPT at three months old. When I started kindergarten at nearly five, I could say very little, and only my parents could understand the little I could say. I was put in the slower of the two kindergarten classes, but they quickly saw that I could already read, having been self-taught (hyperlexic), and my parents were greatly surprised. And I read voraciously, with good understanding. My mother had also been very slow to begin talking, and once a woman asked her if the cat had got her tongue, and, from behind her mother's skirts, she expressed her displeasure non-verbally.

Some say that difficulty with acquiring and using language means autism and not Asperger's, that Asperger's means children start to speak at the normal age and use language adequately, except for the little professor syndrome. Although that's not quite true either: my Asperger's nephew (who would go on for an hour at a time telling you figures regarding the sizes and distances of all the planets, with no participation on your part) came to Thanksgiving when he was seven, and I told him that I was a vegetarian on ethical grounds and did not eat turkey. He replied that the Indians had eaten turkey. I said yes, that's true, but they needed to eat turkey and other wild animals to get enough protein, and we didn't need to. And he repeated: The Indians used to eat turkey. And I showed him a pamphlet from Farm Animal Rescue with a turkey then at a sanctuary, and said: Look at this turkey who was going to be killed and eaten. And he said The Indians used to eat turkey. I was astounded: my brother had never told us that he was on the autism spectrum, and I had never seen anything like that before. He went on to win many prizes in mathematics competitions at the state level: brilliant mathematically.

I don't think we yet know everything we need to in order to categorize these conditions appropriately.

Grace Green

Will,
I think it's a shame to exclude any group, and I'm sure "Asperger's" is not a mental illness, as it includes the inability to understand, causing difficulty communicating. This can also result in inability to obtain necessary services, as I myself have experienced, whereas severely disabled autistic people are more likely to have someone advocating and providing for them. It's very easy to dismiss all sorts of brain conditions as "mental illness", with devastating consequences for the sufferer. I do however think that the name of this condition is extremely unfortunate, as is also "autism", which I recently read a doctor said was just what they call it to medically untrained people so that they would understand. Chemical brain injury can obviously occur at a whole spectrum of levels, and also be affected by the previous level of IQ.

David Weiner

Go Trump,

That is a good point. The world learned to fear obvious and unstable demagogues like Hitler, but people are perfectly comfortable with the soft-spoken, seemingly reasonable demagogues that we have for politicians and bureaucrats today. Style over substance is the name of the political game.

John Stone

Jonathan

Gayle’s mathematical skills are completely boggling!

go Trump

At least with Hitler and the Nazis, they figured out what they doing after a few years and the rest of the world put a stop to it.

The medical Nazis of the United States have been loading children onto “Autism railroad cars” for nearly 30 years now, with the complete cooperation & help of our “long bought out American news media” who will “do anything or say anything” for the price of a few advertisements.

Without the internet & active Autism groups that never give up, we might still be in the dark of what is really happening to our children.

will

Why would the medical community name a mental disease after a Nazi? The new DSM does not include Asperger's syndrome which is concerning, Autism is a developmental disability and Asperger's is a mental illness with similar symptoms. I do not like it when mild disabilities confused with moderate or severe disabilities it allows people to receive services not needed while the more needy have denials and delays in needed services from the social welfare and developmental disabilities offices.
Disabled people were an ignored victim of the holocaust. The AshkaNazis will complain for decades and not seek compensation, punishment, or recognition for other groups like the Disabled or Roma (Gypsies). these disabled victims included those with autism. Other dictators and extremist groups targeted disabled people for massacres. DAESH committed an atrocity against disabled persons yet Fox news only talks about Christians.

Jonathan Rose

Thank you, John, for quoting more nonsense from Simon Baron-Cohen -- who is every bit as funny as his cousin Sacha Baron-Cohen. I'm surprised (or maybe I shouldn't be surprised) that no one has pointed out that Simon is grossly sexist, effectively arguing that girls can't do math. The article that AoA published below mine is by my best friend Gayle DeLong (also my wife), who is the computer jockette in our family. She performed some highly sophisticated number crunching to show a correlation between using the HPV vaccine and reduced female fertility. I can't even balance my checkbook.

By the way, Edith Sheffer doesn't explain why early cases of autism showed up in Austria, but she does note that in the 1920s the socialist municipal government of Vienna instituted a universal-coverage public health program which no doubt included vaccination. Then in the 1930s children started showing up in psychiatric clinics with symptoms of autism.

Morag

Dachau Concentration Camp -Wikipedia -Local folk called it "The Halls of correction"
Outlines a fast-track brief description of our current and approaching landscape? with similar "Caps" and "Cap Badges" using more contemporary and creative terminology to describe the same and similar vulnerable /elderly now being described as a" burden of care" Different style of haircut and shoes todat but still the same colour and pattern on the wallpaper eugenics /euthanaesia now being described as "best interest " decision making . with The Frankfurt School being the opposite side of the same coinage as the fascist National Socialist German Workers Party.Ideoligy from 1919 onwards?
NHS Quango? Focus Group? See History of [NICE] The National Institute for Clinical Excellence .
First Piece of Guidance -A Rapid assessment of Flu Product Zanamivir .
NICE renamed in 2013 as The National Instute for Health and Care Excellence .
But wait a wee minute if an Instutite is a place ? and an Association is a group of professional people making cost/benefit judgements on "Lebenswertes leben " tick box-model with the swipe of a personal opionated pen, judgements over who is judged worthy of health support and or treatment and who is NOT!
"NACE" As National Association of Clinical Excellence or even "NAHCE" National Association for Health and Care Excellence . They may have had a "Big Aversion"with looks like ,sounds like ,with the association abbreviation sounding too similar with other political specrtums and ie NAZI perhaps?
Pink Floyd -Another Brick in The Wall -You Tube
See -The Chief attempts to prove that Tasers are safe / Scot Squad-youtube

Mary S. Holland

Excellent piece. Thank you, Jonathan!
Mary Holland

nhokkanen

After reading Jonathan Rose’s trenchant, comprehensive review of Asperger’s Children, I wanted to learn more about Edith Sheffer. Google page 1 showed a link to The New York Times; feeling able to suffer fools, I gave the oddly titled piece a read without first checking the byline. Sadly its unoriginal generalities, peculiar focus on side issues and overall lack of intellectual rigor made me embarrassed for The Gray Lady.

Everything fell into place when I saw the byline: Seth Mnookin. Such tristis defectum.

Gary Ogden

Jonathan: Thank you for this fine review, and for your fascinating history of reading, "Readers' Liberation." I'm on my second time through. I always read a book worth reading thrice before I truly grasp it. We readers are powerful! We have, to some extent, directed the course of history.

Gary Ogden

Shelley Tforzas: Thanks for the tip about Operation Paperclip. The next book I purchase.

Shelley Tzorfas

Mercury/Thimerosal was added to vaccines in 1929 and suddenly there was a group of children harmed including showing signs of banging their heads and rocking back N Forth. Some of these children died. Dr Leo Kanner wrote about them in the early 1940's and claimed erroneously that they had a Psychiatric disorder rather than Brain Encephalitis. The Nazi's were famous for harming people with their medical Program and vaccines. They were looking for ways to kill the Jewish people in a less messy and economically feasible manner than utilizing the gas chambers which took up a lot of space.
After the war the US IMPORTED these Nazi Scientists to continue the great vaccination Program. The US changed the bio, background and passports so that the Nazi Scientists could help to head up Merck and other vaccine corporations, under Operation Paperclip.
As a result of using lethal chemicals-Aluminum, Thimerosal, cancer-promoting Formaldehyde, Tumorigenic aborted human fetal cell DNA and other Toxins, children are at risk of chronic diseases rather than short term illnesses like Chickenpox. Today 1 in 34 children have Autism in NJ with 1 in 22 boys and that is based on 8 yr. olds from 4 years ago. It is only higher in NJ because NJ is Required to report it. A child banging his head, no speech or eye contact, throwing things out of the classroom window would NOT have gone Undiagnosed 30 years ago- It is Preposterous to think it is better diagnosis.

Shelley Tzorfas

Mercury/Thimerosal was added to vaccines given to children in 1929. Of the original group of kids that reacted poorly to the chemicals the term Autism was used to describe those children found rocking back n forth, banging, no eye contact, and in some cases, their untimely death. Autism was given the credit for those behaviors-Not Brain Encephalitis or chemical poisoning as it should have been. The Nazi's are known for creating Vaccines and chemical torture. One of their interests was to find a cheaper, less messy way to kill thousands. They looked for ways to Inject people instead of using gas chambers or wasting a bullet. Under "Operation Paperclip" the United States changed the identification and background as well as passports to the Scientific Leaders of the Nazi Regime to bring them here to continue the Great Vaccination Program.
Back then, "​Medical personnel received cash incentives for every handicapped child they reported and eliminated, though Jekelius accepted bribes for exempting favored patients. Two commonly used methods were lethal injections or overdoses of barbiturates." Today, Medical Personnel Receive Cash Incentives for every child who gets Brain Encephalitis aka Autism. Some doctors Exempt kids but those who do are now having the medical/pharmaceutical complex attempt to obstruct their licenses. At this time they are going after knowledgeable attorneys who fight the system against poisoning as in Alan Phillips in N Carolina, attempting to get his private client files.

In the Nazi Era, Jewish judges were quietly gone after and killed in different towns without the news reporting on the story. Thus people were Uninformed. Once the judges were gone-eliminated, the Germans passed laws that hurt those people. You might only food shop on Tuesdays, your kids cannot go to school, you must wear an armband, you must lose your home and piano leading eventually to losing their lives.

Those Vaccine scientists went into Merck, J&J and others. Many vaccines have been created with that mind set. Our government has given the pharmaceutical industry and lobby Zero Liability and today children receive 74 vaccines; aluminum, Fetal Tissue cell DNA from abortions, Mercury/thimerosal, pig cow dog monkey rats cells, ether, peanut oils leading to anaphylaxis, MSG and other toxic chemicals. One of the results beyond those babies that die from SIDS-Sudden Infant Death Syndrome, or SUDS Sudden Unexplained Death Syndrome for the who suddenly die after age 2, SADS-Sudden AdultDeath Syndrome (College kids for example) is AUTISM which is now 1 in 34 kids in NJ and 1 in every 22 boys, Not because of bette diagnosis but because Nj is the only state Required to report it. There is no way that a child rocking back and forth, throwing objects out a classroom window, screaming with no speech or eye contact would have gone Undiagnosed 30 some ODD years ago-Preposterous! The numbers of children with Seizures, cancers,Tourettes, ADHD, Auto-immune diseases, paralysis, and GERD is Off the Rails. It is like World War 3 where we have "Continued the great (Nazi) Vaccine Program while the news once again says nothing. In Ca a private vaccine Co. just purchased the LATIMES and other newspapers. What could go wrong?

David Weiner

Jonathan,

Thanks for this excellent and thorough review.

"His medical services established a regime of surveillance and control over patients which the Nazis later used to carry out their own version of eugenics."

History repeats itself. Socialism often seems to confer benefits over the short term, but ultimately whatever benefits it may provide always come with strings attached and an exorbitant price.

Bill

"Psychiatrists under the Nazi regime issued arbitrary and inconsistent diagnoses, and often changed their minds." <--from the article above....
And today, little if anything has changed. Psychiatry is a pseudoscience, a drug racket, and a means of social control. It's 21st Century Phrenology, with potent neuro-toxins. Psychiatry has done, and continues to do, FAR MORE HARM than good. The DSM-5 is in fact a catalog of billing codes. And the DSM-5 does NOT list "Aspergers", having folded it into "ASD", "autism-spectrum disorder".
The more I think about it, the less I can support the bogus "spectrum" paradigm. People are people, and we all vary widely, in many diverse ways. But we're all human. This idea that humans can be classed on some sort of imaginary "line", with a "left", "right", and "middle", is patently ridiculous. (The "right/left" delusion is equally destructive in politics, but that's another issue....)
We all need to understand, that in REALITY, there is NO "spectrum". This "spectrum" we imagine is exactly that, - a figment of our imagination. We're not as far away from Nazi ideology as we'd like to believe. And, we also need to remember, that not EVERYbody who has been "diagnosed" does indeed *have* whatever "condition" has been "diagnosed".
Years ago, I worked on a case of a troubled and troubling young man who was "diagnosed" with "Asperger's", and whose mother seemed more like his puppet-master. "Mom" also breast-fed her son until he was in his teens, and regularly had sexual relations with him. The mental, emotional, verbal, and psychological abuse "Mom" heaped on her son was horrific. She got him "diagnosed" with "Asperger’s” largely so she could get his ~$1,000/month Social Security disability check. That's only the "tip of the iceberg" of what was a very difficult case, but it reminds us that things, and people, are not always what they seem, or present themselves to be.
And, from my own personal experience, I want to repeat that psychiatry is a pseudoscience, a drug racket, and a means of social control. It's 21st century Phrenology, with potent neuro-toxins. The fact that yes, there are *some* good, kind, caring, and compassionate individual psychs does NOT negate the TRUTH of my claims about a hideously and hopelessly corrupted "medical specialty".
Thank-you, AoA, KEEP UP the GOOD WORK, and have a GREAT WEEKEND, everybody!....
(c)2018, Tom Clancy, Jr., *NON-fiction

John Stone

Jonathan

Regarding autism prevalence (and notably the Belfast figure) this is my letter published last month in BMJ on-line:

Re: Autism spectrum disorder: advances in diagnosis and evaluation

https://www.bmj.com/content/361/bmj.k1674/rr

I have read this review with interest but disquiet [1]. There is perhaps little point in talking about a global prevalence of autism, which Zwaigenbaum and Penner place according to literature at between 1 and 1.5% if autism is rising dynamically in many parts of the world including the United Kingdom - as I have been recently detailing in the columns of BMJ on-line [2]. For instance, recent data from Northern Ireland showed an overall prevalence in schools there of 2.9%, having risen from 1.2% nine years ago, but there are also big disparities between economic classes and town and country, while in Belfast the rate was 4.7% [3,4]. Unfortunately, as Zwaigenbaum and Penner point out diagnosis is characteristically delayed so the true rates are likely much higher.

The rate that be can be established for England from education figures may be at the top end of official estimates at 1.5% but is rising steeply year on year - the rate of Pervasive Development Disorder (the widest possible category of Autistic Spectrum Disorders) for those born between 1984 and 1988 in the United Kingdom was recorded in official data as being 0.2% in 1999. The present figure from Scottish schools data is around 2.2%. However, dramatic reports appear from around the country [2], notably a report from S.W. London where five London boroughs geared to already diagnosing 750 cases a year were confronting almost double that number a year ago . Extrapolated across the capital that might be 10,000 cases a year, which would possibly be in the 10% region [5]. I have argued that still without any officially accepted explanation for this phenomenon - and certainly Zwaigenbaum and Penner provide none - we are on the brink of population catastrophe. They state:

"Lifetime societal costs related to services and lost productivity by patients and their parents average $1.4m (£1.0m; €1.1m) to $2.4m in the United States and £0.9-£1.5m per child in the United Kingdom, depending on comorbid intellectual disability. When the prevalence of ASD is factored in, the annual estimated societal costs of ASD are $236bn in the US and $47.5bn in the UK."

However, most autism parents know from experience that these are very modest or even delusorily low estimates. Even in 2001 Järbrink and Knapp estimated an average lifetime cost per case in the UK as £2.4m (perhaps £3.8m in today's money) though they thought the overall prevalence was 5 in 10,000, which it perhaps still was in the adult population [6].

We come back in the end to the reality that when it comes to what could be driving these changes to our society the authors neither acknowledge the problem, or have any explanation of it. I fear they may be fiddling as Rome burns.

[1] Zwaigenbaum L, Penner M, 'Autism spectrum disorder: advances in diagnosis and evaluation', BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1674 (Published 21 May 2018)
[2] Responses to Viner RM, 'NHS must prioritise health of children and young people', https://www.bmj.com/content/360/bmj.k1116/rapid-responses
[3] John Stone, 'Re: NHS must prioritise health of children and young people - 1 in 21 children in Belfast now have an autism diagnosis' 13 May 2018, https://www.bmj.com/content/360/bmj.k1116/rr-6
[4] Information Analysis Directorate 'The Prevalence of Autism (including Asperger Syndrome) in School Age Children in Northern Ireland 2018', published 10 May 2018, https://www.health-ni.gov.uk/sites/default/files/publications/health/asd...
[5] John Stone, 'Re: NHS must prioritise health of children and young people - what about autism?' , 19 March 2018, https://www.bmj.com/content/360/bmj.k1116/rr
[6] Järbrink K, Knapp M, 'The economic impact of autism in Britain', Autism. 2001 Mar;5(1):7-22.

John Stone

http://news.bbc.co.uk/1/hi/health/7736196.stm

Autism test 'could hit maths skills'
Simon Baron-Cohen

VIEWPOINT
Professor Simon Baron-Cohen
Director, Autism Research Centre, Cambridge University


The prospect of a prenatal test for autism, allowing couples to choose whether to have a baby with the condition, is coming closer. And with it also comes the possibility of a prenatal drug treatment being developed.

But in this week's Scrubbing Up, leading autism expert Professor Simon Baron-Cohen warns caution is needed to ensure associated talents, like numerical abilities, are not lost if the test or a "cure" become available.

"Males, maths and autism. On the face of it, these three things don't appear to be linked. And yet they are.

Males are much more likely to apply to university to study maths, for example.

In 2007, three quarters of applicants to read maths at Cambridge were male, as were 90% of applicants for the computer sciences degree.

Cambridge is not unique in this way. So why are males so attracted to studying maths?

And why, in over 100 years of the existence of the Fields Medal, maths' Nobel Prize, have none of the winners have ever been a woman?

Similarly, people with autism are much more likely to be male. Among those with classic autism, which includes a developmental delay in language and a risk of learning difficulties, males outnumber females by four to one.

And among those with Asperger Syndrome, males outnumber females by nine to one.

People with the condition talk at a normal age and have at least an average IQ, but share the social and communication difficulties of those with classic autism, as well as the narrow - even obsessive - interests and love of repetition.

'Male brains'

It seems as you move to the extremes of mathematical excellence, autism becomes more common.

The search to understand why led scientists to genetics. Fathers and grandfathers of children with autism are more likely to work in the field of engineering, a field that needs good attention to detail and a good understanding of systems, just like mathematics.

Boy with autism

Autistic traits have been linked to levels of the male hormone
Siblings of mathematicians also have a higher risk of autism, suggesting the link between maths and autism is genetically mediated. And parents of children with autism show male-typical brain function in tests.

But genetics may not be the only explanation.

Research published this year showed a link between higher levels of the male hormone testosterone in the amniotic fluid surrounding a foetus and autistic traits when the child was eight.

And animal studies have shown foetal testosterone levels influence brain development, masculinising it.

'Wise to think ahead'


Research is not yet at the stage where autism can be detected prenatally using a biological test, but this may not be far off.
Such a test will need to prove itself clinically in terms of whether it is highly specific (in detecting just autism).

But assuming such a test is developed, we would be wise to think ahead as to how such a test would be used.

If it was used to 'prevent' autism, with doctors advising mothers to consider termination of the pregnancy if their baby tested 'positive', what else would be lost in reducing the number of children born with autism?


SCRUBBING UP
Surgeon scrubbing up

The BBC News website is launching the "Scrubbing Up" weekly column, where leading clinicians and experts give their perspectives on issues in health
Each week, you will be able to have your say
Would we also reduce the number of future great mathematicians, for example?

Or if this test led to some kind of prenatal treatment, such as the use of drugs to block the effect of testosterone which is already medically possible, would this be desirable?

If reducing the testosterone in a foetus helped that baby's future social development, we would all be delighted.

But what if such a treatment reduced that baby's future ability to attend to details, and to understand systematic information like maths?

Caution is needed before scientists embrace prenatal testing so that we do not inadvertently repeat the history of eugenics or inadvertently 'cure' not just autism but the associated talents that are not in need of treatment."

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