THIEME

Historical Notes 1

Revisiting the history of autism before Kanner

and Asperger: a tribute to Grunya Sukhareva
Revisitando a história do autismo antes de Kanner e
Asperger: um tributo a Grunya Sukhareva
Cristina Maria Pozzi1 Rudimar dos Santos Riesgo2 Francisco Baptista Assumpção Junior3

1 Universidade do Vale do Itajaí, Escola de Ciências da Saúde, Address for correspondence Cristina Maria Pozzi
Departamento de Pediatria, Itajaí SC, Brazil. (email: [email protected]).
2 Universidade Federal do Rio Grande do Sul, Faculdade Medicina,
Departamento de Pediatria, Porto Alegre RS, Brazil.
3 Universidade de São Paulo, Instituto de Psicologia, Departamento de
Psicologia Clínica, São Paulo SP, Brazil.

Arq. Neuro-Psiquiatr. 2024;82(8):s00441788269.

Abstract Almost two decades before Kanner’s and Asperger’s works, the original paper by child
psychiatrist Grunya Efimovna Sukhareva had already been written. It was published in
1926 by Sukhareva in a German scientific journal of psychiatry and neurology, with a
Keywords detailed description of children who presented clinical conditions whose character-
► Autistic Disorder istics and evolution closely resemble autism, according to current criteria. In the
► Psychiatry present historical note, we intend to present Sukhareva’s pioneering work and retrieve
► Asperger Syndrome the meaning of her original contribution.

Resumo Quase duas décadas antes dos trabalhos de Kanner e Asperger, o artigo original da
psiquiatra infantil Grunya Efimovna Sukhareva já havia sido escrito. Foi publicado por
Palavras-chave Sukhareva em 1926, em uma revista científica alemã de psiquiatria e neurologia, com
► Transtorno Autístico uma descrição detalhada de crianças que apresentavam quadro clínico cujas caracte-
► Psiquiatria rísticas e evolução em muito se assemelham ao autismo, segundo os critérios atuais.
► Síndrome de Nesta nota histórica, pretende-se apresentar o trabalho pioneiro de Sukhareva e
Asperger resgatar o significado da sua contribuição original.

THE UNTOLD HISTORY years later, took the name Asperger syndrome.2 However,
there is an author who is little explored in this story, whose
Whenever the historical review of autism is presented, it role has not been given due importance: Grunya Efimovna
begins with Kanner and Asperger. According to the official Sukhareva (1891–1981), a Jewish psychiatrist and researcher
story, in 1943, Kanner, an American child psychiatrist of born in Kiev.3–5
Austro-Hungarian origin, described a clinical picture in 11 In 1921, Sukhareva founded a therapeutic school for
children that was later considered classic early infantile children with psychiatric problems in Moscow. She was
autism.1 In 1944, Hans Asperger, an Austrian pediatrician, head of the Department of Psychiatry of the Kharkov Psy-
described “autistic psychopathy” in four boys, which, many choneurological Institute in 1933 and, between 1938 and

received DOI https://doi.org/ © 2024. The Author(s).

March 11, 2024 10.1055/s-0044-1788269. This is an open access article published by Thieme under the terms of the
accepted ISSN 0004-282X. Creative Commons Attribution 4.0 International License, permitting copying
May 6, 2024 and reproduction so long as the original work is given appropriate credit
Editor-in-Chief: Hélio A. G. Teive. (https://creativecommons.org/licenses/by/4.0/).
Associate Editor: Ylmar Correa Thieme Revinter Publicações Ltda., Rua do Matoso 170, Rio de
Neto. Janeiro, RJ, CEP 20270-135, Brazil
2 A tribute to Grunya Sukhareva Pozzi et al.

1969, she was head of the Psychosis Pediatric Clinic at the • Other characteristics: tendency towards automatism,
Institute of Psychiatry of the Union of Soviet Socialist manifesting itself as adherence to initiated tasks and
Republics.3 psychical inflexibility with difficulty in adapting to new
In 1926, Sukhareva published part one of a detailed situations; impulsive and strange behavior; tendency to
description of autistic traits in 6 boys, in the Monatsschrift stereotyped neologisms; tendency to obsessive-compul-
für Psychiatrie und Neurologie, a German scientific journal sive behavior and increased suggestibility; motor alter-
of psychiatry and neurology.6 In 1996, Sula Wolff7 translat- ations: clumsiness, awkwardness, sudden and
ed this article into English, originally published in Russian superfluous movements, synkinesis. Lack of facial expres-
in 1925 and in German the following year, entitled “Die siveness and expressive movements; decreased postural
Schizoiden Psychopathien im Kindesalter”. Sukhareva ini- tone; lack of speech modulation.
tially used the term schizoid (eccentric) psychopathy and
Recovering contribution
later replaced it with autistic psychopathy (pathological
avoidance) to report the clinical picture of what is now The precision and detail in the description of these cases is
described as autism. Her original paper was available surprising, since Sukhareva evidenced the presence of sen-
almost two decades before the studies by Kanner1 and sory abnormalities, which only recently regained their prop-
Asperger.2 However, Sukhareva’s pioneering work is rarely er relevance in the description of autism spectrum disorder
even cited. (ASD) in DSM-5.9
In 1927 she published “Die Besonderheiten der Schiz- Manouilenko and Bejerot3 presented a comparative anal-
oiden Psychopathien bei den Mädchen” in the same journal ysis between the clinical description highlighted by Sukhar-
as a follow-up to the first article, presenting 5 cases of girls eva in her original article and the similarity with the
and a discussion of the differences between the sexes in the description of ASD in DSM-5. They also discussed her ano-
presentation of schizoid psychopathy, potentially being con- nymity and trajectory and asked if Kanner and Asperger
sidered part of the autistic spectrum now. This study was really knew about her early work. Interestingly, these three
translated and published in 2020 by Charlotte Simmonds.8 pioneers who began to describe the clinical picture of autism
In the report of her first six patients, Sukhareva6,7 were all German-speaking and born in Ukraine and Austria,
presents the entire family history of parents, grandparents but died as citizens of the United States, Austria, and the
and uncles, the detailed neurological and psychological Soviet Union. Being Jewish, a citizen of the Soviet Union, and
clinical examination as well as the evolution observed during publishing in German and Russian, as well as being a woman,
their stay in the therapeutic school. Her final impressions may not have been a successful formula for achieving inter-
involved a clinical opinion, course, and diagnosis that resem- national acclaim at that time.
bled classical features of autism. At the end of the descrip- Sukhareva and Asperger studied Kretschmer’s early work
tions, Sukhareva pointed out that despite the individual on schizoid personality in adults and cited different editions
differences in the clinical picture of the cases, of what she of the book Körperbau und Character.3 Sula Wolff, who
initially called schizoid personality disorder, it was possible introduced the English translation of Sukhareva’s original
to define common characteristics to all children. These article in 1996,7 speculated that Hans Asperger should have
included: known about Sukhareva’s article, but this cannot be con-
firmed in contemporary times.
• A strange kind of thinking: a tendency toward abstraction It is understandable that the ASD is more heterogeneous
and schematization. This trait of thought was often com- and complex than the original description given by Sukhar-
bined with a tendency towards rationalization and absurd eva, but to deny the originality and accuracy of her descrip-
rumination, and the latter feature often marked the tions, almost 100 years after her publications, would be a
personality as strange. historical error, which we hope to repair.
• An autistic attitude: all affected children kept aloof from
their peers, had difficulty adapting, and were never fully Authors’ Contributions
themselves among other children. They also manifested a Conceptualization or design of the work, data acquisition,
tendency to loneliness and withdrawal from other people analysis or interpretation, writing or reviewing the man-
since early childhood. They kept themselves isolated, uscript. All authors approved the final version of the
avoided community games, and preferred fantastical sto- manuscript and agree to be responsible for all aspects of
ries and fairy tales. the work.
• Emotional life: there was a certain flatness and superfici-
ality of emotions. This mixture of insensitive and super- Conflict of Interest
sensitive elements was observed in all cases, from The authors have no conflict of interest to declare.
affective slowness and exaggerated sensitivity, to in-
creased irritability, resulting in emotional outbursts,
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