October 26, 2006

The Age of Autism: None So Blind

The Age of Autism: None so blind
UPI Senior Editor

WASHINGTON, Oct. 24 (UPI) -- How long have we known -- or should have known -- that medical treatment might help thousands of autistic kids? A half century, it now appears.

I recently came across a 1955 study titled "The Autistic Child in Adolescence," by Dr. Leon Eisenberg of The Johns Hopkins Hospital in Baltimore. Eisenberg was a colleague of Leo Kanner, the child psychiatrist who first identified autism as a distinct disorder in 11 children in 1943.

By 1955 there were 80 such cases in the Hopkins files; researchers managed to locate 63 of them. The results were not encouraging: Eisenberg wrote that only three "can be said to have achieved a good adjustment."

Here's where it gets interesting: One of those three was the very first patient diagnosed at Hopkins by Leo Kanner -- "Case 1: Donald T." As readers of this column know, I located Donald T. and, in 2004, went to his Mississippi hometown in search of more information.

Donald didn't respond to my requests for an interview; I have never met him. But I talked to his brother, a lawyer in the same town where the family has lived for generations.

The brother told an amazing story: At Kanner's suggestion, Donald was living with a nearby farm couple when, in early adolescence, he was stricken with a baffling illness. Even the Mayo Clinic couldn't diagnose it.

Donald's joints swelled up; he had high fevers; he couldn't eat. His father told a family doctor in a nearby town: "It looks like Don's getting ready to die." Sight unseen, the doctor offered a possible diagnosis: A rare case of juvenile rheumatoid arthritis (JRA).

His parents took Donald to the Campbell Clinic in Memphis, where he got a series of gold salts injections, the standard remedy of the day.

The treatment was a spectacular success, his brother said. And to my astonishment, he wasn't just talking about the arthritis symptoms, which cleared up except for one fused knuckle.

"When he was finally released, the nervous condition he was formerly afflicted with was gone," the brother said. "The proclivity toward excitability and extreme nervousness had all but cleared up." Donald was able to attend high school, graduate from college, work at a bank, live on his own.

A "good adjustment," indeed. Or, as his brother put it, "a miraculous response to the medicine."

When I came across Leon Eisenberg's 1955 paper recently on the Web site www.neurodiversity.com -- which hosts a superb collection of early autism research -- I was stunned to find that he mentioned the gold treatment. The description -- though not the emphasis -- exactly matched the brother's account, starting with Donald's placement with "a warm and unsophisticated farm couple without intellectual pretensions." It's worth quoting at length:

"Donald remained in this rural setting for 3 years; moderate improvement was noted, though while on vacation with his parents during this period, his mother reported that his chief interest on the trip was to record carefully the mileage between towns.

"The board arrangement had to be terminated when Donald, at 14, developed an undiagnosed illness manifested by fever, chills, and joint pains. He became bedridden and developed joint contractures. On the basis of a tentative diagnosis of Still's disease (a form of JRA), he was placed empirically on gold therapy with marked improvement.

"After 18 months he was once again ambulatory. He emerged with little residual deficit from a second episode of arthritis a year later. The clinical improvement in his behavior, first observed during his rural placement, was accelerated during and after his illness and convalescence at home. He was able to enter and graduate from high school. At present he is doing well in his studies at a Junior College, where he was elected a class officer."

Notice that while Eisenberg mentions gold therapy, he doesn't connect it to Donald's "accelerated" progress at the same time. Why not? Well, consider this: Two years later, in 1957, Eisenberg wrote an article titled "The Fathers of Autistic Children."

"They tend to be obsessive, detached and humorless individuals," he said, repeating the now-discredited orthodoxy of the day. "Such interest as they have in the children is in their capacity of performing automata. ... They are no less inadequate as husbands than they are as fathers. Work takes precedence over family life. Marriage seems mostly a convenient arrangement for meals and laundry."

And: "An unusually large number have college degrees, as do their wives."

Aha! Why are we not surprised that "a warm and unsophisticated farm couple without intellectual pretensions" gets credit for Donald's progress, while a "miraculous response" to medical treatment is missed?

Not for the last time, a family noticed something significant while the experts prattled on about their pet theories. When Leo Kanner looked back at those first cases in a 1972 paper, "Followup Study of Eleven Autistic Children Originally Reported in 1943," he never even mentioned gold salts. Kanner credited Donald's rare success -- remember, only three out of 63 had good outcomes -- to the farm environment that, not coincidentally, he had recommended.

He wrote that Donald, "because of the intuitive wisdom of a tenant farm couple, who knew how to make him utilize his futile preoccupations for practical purposes and at the same time helped him to maintain contact with his family, is a regularly employed bank teller; while living at home, he takes part in a variety of community activities and has the respect of his fellow townspeople."

What a touching agrarian idyll. What a bunch of hooey.

Until now, I thought Kanner and the rest of the medical establishment simply weren't aware of Donald's improvement following the gold salts treatment; otherwise, they would have followed up this very promising and obvious lead from the very first case.

Now I don't know what to think.

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