Fifty years ago, most children who would today be diagnosed with autism were labeled with “childhood schizophrenia.” In the mid-1970s, autism did not exist as its own diagnosis in the major psychiatric manuals used in the United States. Instead, clinicians working from the DSM-II (published in 1968) had only one option for children showing the signs we now associate with autism: “schizophrenia, childhood type.”
Childhood Schizophrenia Was the Official Label
The DSM-II, which guided American psychiatrists throughout the 1970s, contained no mention of autism at all. Children who showed severe social withdrawal, language delays, repetitive behaviors, and resistance to change were diagnosed with “childhood schizophrenic reaction.” This was the only available category for what Leo Kanner had described in 1943 as “early infantile autism,” a term he coined after observing children with a striking combination of social aloneness and insistence on sameness.
Internationally, the picture was slightly different. The World Health Organization’s ICD-8, published in 1967, did mention “infantile autism” by name, but it listed the condition under the schizophrenia grouping. So whether a clinician used the American or international system, autism was treated as a form of childhood psychosis rather than a distinct developmental condition.
How Clinicians Recognized It
Even without a formal autism diagnosis, clinicians in the 1970s were looking for recognizable patterns. A British working group had established nine key features of “schizophrenic syndrome in childhood” that overlap heavily with what we now call autism. These included gross impairment in emotional relationships with people, apparent unawareness of personal identity, preoccupation with particular objects, sustained resistance to environmental change, abnormal perceptual experiences, and speech that had been lost or never developed. Some children also showed unusual movement patterns and pockets of normal or exceptional skill against a background of serious intellectual disability.
By the late 1960s, the influential researcher Michael Rutter had argued these nine points could be simplified to three core features: profound abnormalities in language development, ritualistic and compulsive behaviors, and a distinctive disturbance in relationships with other people. This framework brought the clinical picture much closer to how autism is understood today.
Autism and Schizophrenia Were Tangled Together
The boundary between autism and childhood schizophrenia was genuinely blurry in the 1970s. Some psychiatrists used the terms interchangeably, while others drew careful distinctions. Kanner himself went back and forth. He initially saw autism as something entirely separate from schizophrenia because it appeared to be present from birth. Later, he described autism as “intimately related to the basic nature of childhood schizophrenia as to be indistinguishable from it,” differing mainly in that autistic children tended to have earlier onset, a less severe overall picture, and the specific traits of aloneness and desire for sameness.
One key dividing line was psychosis. Some leading psychiatrists argued that without evidence of a break from reality (hallucinations, delusions, or severe emotional disconnection), the schizophrenia label should not apply, no matter how severe the behavioral disturbance. This distinction would eventually help separate the two conditions, but in the mid-1970s, many autistic children were still being grouped into a psychosis category that didn’t quite fit.
The “Refrigerator Mother” Theory Was Fading but Not Gone
In the 1970s, the question of what caused autism was shifting. For decades, a dominant theory held that autism resulted from cold, emotionally distant parenting, particularly from mothers. This “refrigerator mother” theory, popularized by Bruno Bettelheim, placed blame squarely on families. Kanner himself contributed to this idea early on, though in 1969 he publicly reversed course, giving a speech in which he “acquitted” parents and insisted autism was innate.
That reversal didn’t reach every clinic. Even after Kanner’s 1969 statement, parents of autistic children continued to encounter traces of psychoanalytic blame in psychiatric offices across the country. Bernard Rimland, a psychologist and father of an autistic child, became a leading voice pushing the field toward biological explanations, particularly neurological development. By the late 1970s, his view was gaining ground, but the transition was slow and uneven.
Very Few Children Were Diagnosed
Under these older labels, autism was considered exceptionally rare. Data from the British Cohort Study of 1970 identified only five children with autism (and one suspected case) out of more than 13,000 children, a prevalence of roughly 4.5 per 10,000. Researchers have since suggested this was likely an undercount, given how narrow the diagnostic criteria were and how many children were simply categorized as intellectually disabled or schizophrenic without further distinction. For comparison, current estimates place autism prevalence at roughly 1 in 36 children in the United States.
Schools Had No Autism Category
In 1975, Congress passed the Education for All Handicapped Children Act, a landmark law guaranteeing a free, appropriate public education to children with disabilities. Before this law, U.S. schools educated only one in five children with disabilities, and many states had laws that explicitly excluded certain students. The act was a major step forward, but it did not include autism as a disability category. Children on the spectrum were typically served under labels like “emotionally disturbed” or “intellectually disabled,” if they were served at all. Autism was not added as its own educational category until the law was reauthorized as the Individuals with Disabilities Education Act (IDEA) in 1990.
When Autism Finally Got Its Own Diagnosis
The turning point came in 1980, when the DSM-III was published. For the first time, “infantile autism” appeared as a standalone diagnosis, separate from schizophrenia. The criteria required a pervasive lack of responsiveness to other people, gross deficits in language development (including, if speech was present, peculiar patterns like echolalia or pronoun reversal), and bizarre responses to the environment such as resistance to change or unusual attachments to objects. All of these had to be present before 30 months of age.
This was a narrow definition that excluded many people we would now consider autistic, particularly those with average or above-average intelligence and fluent speech. That group had to wait longer for recognition. Hans Asperger had described such children in a 1944 paper published in German, but his work remained virtually unknown to the English-speaking scientific community for decades. In 1981, the British psychiatrist Lorna Wing introduced the term “Asperger syndrome” to describe children with social isolation and lack of reciprocity, normal or advanced language skills but subtle communication differences, narrow and intense interests, and motor clumsiness. Asperger’s original paper was not translated into English until 1991, and the diagnosis was not added to the DSM until 1994.
So fifty years ago, the child who today receives an autism diagnosis might have been called childhood schizophrenic, emotionally disturbed, or simply “retarded,” depending on the setting. Many were never diagnosed with anything at all. The shift from a psychosis framework to a developmental one reshaped not just the terminology but the entire understanding of what autism is and who it affects.