The First Documented Cases of Autism: A Historical Perspective

When I discuss autism with my patients and their families, I often encounter skepticism about its legitimacy as a diagnosis. Some view it as a modern phenomenon, blaming everything from electronic screens to environmental toxins. But autism's documented history tells a different story—one that began nearly a century ago.

The First Case: Moscow, 1924

Picture this: It's 1924 in Moscow. A 12-year-old boy visits Dr. Sukhareva, a Ukrainian psychiatrist at the Children's Hospital. His parents were apprehensive about their son's difficulties. Their description of his behaviors would sound remarkably familiar to any modern autism specialist:

• He preferred solitude or the company of adults over peers
• Despite remarkable intelligence and self-taught reading abilities, he struggled to make friends
• He showed rigid adherence to familiar tasks and resistance to change
• He experienced frequent emotional outbursts
• He demonstrated intense interest in fantasy and philosophy
• He exhibited physical clumsiness and motor skill challenges
• He suffered from anxiety attacks and frequent stomach aches

If this child walked into my office today in 2024, the diagnosis would be the same as Dr. Sukhareva's: Autism Spectrum.

Dr. Sukhareva's Groundbreaking Work

Dr. Sukhareva was truly ahead of her time. She chose the term "autistic tendencies" (derived from the Greek word "auto," meaning "self") to describe children who showed a "preference for their inner world" and difficulty integrating with peers. Between 1924 and 1926, she documented about a dozen cases of boys and girls with similar presentations.

What's particularly remarkable is that she hypothesized the involvement of the basal ganglia and cerebellum in autism long before modern brain imaging technology confirmed her suspicions. Due to the political tensions between World War I and World War II, her groundbreaking research didn't reach the United States until decades later, when Dr. Leo Kanner independently documented autism cases.

Autism Today: A Century of Understanding

In the century since these first documented cases, our understanding of autism has evolved significantly. We now recognize autism as a spectrum condition that affects individuals differently across their lifespan. Yet remarkably, the core features Dr. Sukhareva described remain consistent with what we observe today.

We've moved beyond viewing autism as simply a diagnosis to understanding it as a unique neurotype—one where:

• Creativity and imagination flow freely
• The mind's eye often sees beyond what others can perceive
• Logic and intuition merge with raw, genuine emotions
• The heart feels what words sometimes cannot express

Moving Forward

As a psychiatrist following Dr. Sukhareva's footsteps, my mission extends beyond diagnosis. We need to shift society's paradigm on autism, moving toward a perspective that recognizes and embraces neurodiversity. With rising diagnosis rates, we must also address the critical mental health challenges within the autism community.

The goal isn't just to understand autism—it's to create a culture of inclusion, acceptance, and support. Autism isn't a modern trend or a new phenomenon; it's a fundamental part of human neurodiversity that has always been present in our society, deserving of understanding and accommodation.

This history reminds us that while our understanding of autism continues to evolve, its core features have remained remarkably consistent over the past century. It's not a new condition—we're simply getting better at recognizing, understanding, and supporting those on the spectrum.

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_Sources: 

_{Sher DA, Gibson JL. Sukhareva's contribution to autism and schizophrenia. Eur Child Adolesc Psychiatry. 2023;32(3):475-490.}

_{Manouilenko I, Bejerot S. How History Forgot the Woman Who Defined Autism. Sci Am. 2021 Nov 8.}