When people say, “There are so many more autistic children today,” they are often comparing today’s visibility to a very different world of our past, when children with disabilities and learning differences were hidden from society.
Before laws such as the Education for All Handicapped Children Act (which later became Individuals with Disabilities Education Act), many disabled children had no guaranteed right to attend public school. School districts could and did exclude children with significant disabilities or learning differences. Some families kept children at home. Others sent them to segregated special schools. Children with more complex disabilities were often placed in institutions.
Children with autism, especially those with high support needs, were frequently diagnosed differently than they would be today. Some were labeled as intellectually disabled, emotionally disturbed, psychotic, schizophrenic, brain damaged, or simply “uneducable.” Many never received an autism diagnosis at all.
The visibility issue is important. Before the disability rights movement, disabled children were often physically separated from the rest of society. If a child lived in an institution, attended a segregated school, or remained at home because public schools would not accommodate them, the average person simply did not encounter them.
As a result, many people remember having “no autistic kids” or “no disabled kids” in their schools, when in reality those children existed but were being educated elsewhere, or not at all.
The disability rights laws of the 1970s and 1990s changed that dramatically. Section 504 of the Rehabilitation Act prohibited disability discrimination in federally funded programs. (All public schools are federally funded.) IDEA established the right to a free appropriate public education. Later, the Olmstead v. L.C. reinforced the principle that people with disabilities should receive services in the most integrated setting possible rather than being unnecessarily institutionalized.
So, when people compare schools from the 1960s or 1970s to schools today, they are often forgetting that a significant number of disabled children simply were not present in regular classrooms. They were also not visible in society, but they still existed. Their absence was not evidence that those disabilities were rare.
That said, researchers generally believe that increased identification is not the entire story behind the rise in autism diagnoses. Broader diagnostic criteria, greater awareness among parents and professionals, diagnostic substitution (children who once would have received other labels now receiving an autism diagnosis), and improved access to evaluation and services account for much of the increase. There is ongoing research into whether environmental and other factors may also contribute, but there is no single proven explanation for all of the increase.
Society used to hide people with disabilities. Today, disabled and autistic children are far more visible because they have legal rights to attend neighborhood schools, participate in community life, and be seen as members of society rather than people who should be separated from it. That change alone can make it feel as though there are many more disabled people, when in part there are simply many more people being allowed to be visible.
For much of the late 19th and much of the 20th century, many disabilities were viewed through a combination of charity, shame, fear, and eugenics. Terms such as “feebleminded,” “moron,” “imbecile,” “idiot,” “mentally defective,” “retarded,” “subnormal,” and “emotionally disturbed” were used in medical, educational, and government records. Today these terms are recognized as offensive, but at the time they were often considered clinical language.
Children with what we would now recognize as autism, intellectual disability, cerebral palsy, Down syndrome, epilepsy, developmental delays, or multiple disabilities were frequently institutionalized during this time in history.
In the mid-20th century, it was not unusual for physicians to advise parents that a disabled or non-responsive child would “ruin the family,” prevent siblings from developing normally, destroy a marriage, or place unbearable burdens on the mother. Many parents were told it was best to place the child in an institution and “forget about them.” During this time in history, parents were told it was the courageous and moral thing to do.
In some cases, parents were encouraged not to form an attachment at all. After birth, doctors often did not let parents see a visibly disabled baby. Mothers might be told not to take the baby home, not to visit once a baby was institutionalized, or that seeing the child would make placement more difficult. This happened to many families of children with Down syndrome and Spina Bifida in particular from the 1940s through the 1970s. Some parents later described living with decades of grief because they had trusted medical advice that is now recognized as deeply flawed.
Many parents later said they were not truly offered a choice. They were presented with institutionalization as the responsible, loving, or medically correct decision. Some never saw the child again. Others spent years wondering whether they had done the right thing.
Looking back, many disability advocates regard this as one of the most significant failures of 20th-century medicine and social policy: professionals often assumed that separation was best, when what many families actually needed was support and information that simply did not exist yet.
The institutions themselves varied tremendously. A few were relatively humane by the standards of their time, but many became overcrowded warehouses where children received little education, stimulation, therapy, or family contact. Investigations in the 1960s and 1970s exposed neglect, abuse, and appalling living conditions in some facilities, helping fuel the disability rights and deinstitutionalization movements.
Disabled children who were not institutionalized remained largely invisible. Families often faced enormous stigma. Some were advised to keep disabled children at home and out of sight. Others encountered schools that refused admission to children with disabilities, both physical and intellectual.
In many communities, having a disabled child was viewed as a source of shame for the family. Disability was sometimes seen as evidence of poor parenting, bad family genetics, a moral failing, or even divine punishment.
Parents, particularly mothers, were often blamed for their child’s condition and subjected to judgment, pity, or social isolation. Families frequently faced pressure to hide their disabled children from public view, not only because society was uncomfortable with disability, but because many believed it reflected negatively on the family itself. During periods when disability was widely viewed as hereditary, some families feared that having a disabled child would damage the reputation of the entire family. In some communities, there were concerns that siblings might face social stigma, have difficulty finding marriage partners, or be viewed as carrying undesirable family traits. As a result, some families felt intense pressure to institutionalize disabled children or keep them out of public view in an effort to protect both the family’s social standing and the future prospects of their other children.
As a result, countless disabled children grew up separated from their peers, excluded from community life, and largely unseen by the general public. Their absence did not mean they did not exist. It meant society often chose not to see them.
Neighbors could be openly cruel. Disabled children were often stared at, mocked, bullied, excluded from activities, and treated as objects of pity, fear, or ridicule. Adults frequently failed to intervene, and in many communities such treatment was viewed as normal rather than unacceptable. What is perhaps most striking today is not that such behavior occurred, but how often it was tolerated. Adults rarely stepped in, even kind neighbors frequently looked the other way, and communities often accepted exclusion and ridicule as a normal response to disability.
One thing historians often point out is that many people today sincerely believe there were “fewer disabled children” decades ago because they rarely saw them. In reality, many disabled children were:
- Institutionalized.
- Educated in segregated settings.
- Kept home by their families and out of the sight of others.
- Excluded from public schools.
- Misdiagnosed under different labels.
- Hidden by social stigma.
As a result, they were largely absent from everyday public life. This is especially true historically for children we would now diagnose with autism.
One of the reasons disability rights activists fought so hard for laws such as IDEA, Section 504, and community integration is that they had lived through an era when disabled people were routinely removed from public life. The goal was not merely access to schools and buildings; it was the radical idea that disabled people belonged in their families, neighborhoods, schools, workplaces, and communities, and that being visible was a civil right, not a privilege.
When people today say, “There weren’t autistic kids when I was growing up,” many disability historians would respond: the children were there, society simply made them much harder to see and used different labels.
Yes. Before autism became a widely recognized diagnosis, many children who would likely receive an autism diagnosis today were given a variety of other labels, depending on the era, the doctor’s training, the child’s specific traits, and whether intellectual disability was also present.
Some of the more common labels included:
- Childhood schizophrenia – One of the most common historical misdiagnoses. Before autism was better understood, children with social withdrawal, unusual behaviors, repetitive movements, or communication differences were often diagnosed with schizophrenia.
- Childhood psychosis or infantile psychosis – Used especially in the 1940s–1970s for children who appeared disconnected from others or had severe communication difficulties.
- Emotionally disturbed or seriously emotionally disturbed (SED) – Often used in schools rather than medical settings.
- Behaviorally disturbed – Another educational label frequently applied when the cause of the behavior was not understood.
- Developmentally delayed – Sometimes used when a child’s developmental differences were recognized but not specifically identified as autism.
- Mentally retarded (the clinical term used at the time for intellectual disability) – Many autistic children, particularly those with speech delays or higher support needs, received this diagnosis instead of autism.
- Brain damaged or minimally brain damaged – Surprisingly common in the 1950s and 1960s when doctors suspected a neurological cause but lacked better terminology.
- Minimal brain dysfunction (MBD) – A diagnosis that was used for a wide variety of developmental and behavioral differences.
- Childhood onset psychosis – Similar to childhood schizophrenia.
- Withdrawn child – Not a formal diagnosis, but often used in medical records and evaluations.
- Atypical child – Another broad term sometimes found in educational or psychological records.
- Communication disorder or language disorder – For children whose most obvious challenge was speech and language.
- Learning disabled – Some autistic children of average or above-average intelligence ended up under this category once it became available.
- Socially maladjusted – A school label sometimes used when a child’s social differences were misunderstood.
- Eccentric, odd, peculiar, antisocial, or unsociable – Not diagnostic terms, but descriptions often found in reports and records.
In even earlier decades, particularly before the 1960s, some children would simply have been described as:
- “slow”
- “backward”
- “feebleminded”
- “subnormal”
- “defective”
- “uneducable”
- “trainable” or “educable” (categories used for children with intellectual disabilities)
The educational terms “trainable mentally retarded (TMR)” and “educable mentally retarded (EMR)” were especially common in schools from the 1950s through the 1970s, and continued to be used well into the 1990s in many school districts. Many autistic children were placed into those categories because autism itself was not recognized or well understood.
Another important point is that boys and girls who displayed autistic traits were often viewed very differently because of the social expectations placed upon them. For much of the twentieth century, boys were expected to grow into confident, independent breadwinners who could support a family. Traits such as social withdrawal, emotional sensitivity, shyness, unusual interests, difficulty fitting in with peers, or struggles with communication were often viewed as serious concerns because they appeared inconsistent with prevailing ideas of masculinity and adult success.
Girls who displayed similar traits were frequently overlooked rather than identified. A quiet, shy, socially withdrawn, anxious, or highly imaginative girl might be dismissed as timid, sensitive, eccentric, immature, or simply “a daydreamer.” Because girls were often expected to become wives, mothers, and homemakers rather than primary wage earners, their social and developmental differences sometimes attracted less professional attention. As a result, many girls who would likely be recognized as autistic today were never evaluated or diagnosed.
As women’s educational, professional, and economic opportunities expanded during the latter half of the twentieth century, expectations for girls and women changed as well. Researchers gradually began recognizing that autism could present differently in girls than in boys, leading to increased identification of autistic women and girls who might previously have been overlooked. This shift helped reveal a population that had often gone unrecognized.
This is one reason historians and researchers are cautious when comparing autism rates across generations. A child born in 1955 who would clearly receive an autism diagnosis today might instead have been labeled emotionally disturbed, schizophrenic, brain damaged, mentally retarded, developmentally delayed, or simply “odd”, or may have been institutionalized in infancy without any autism diagnosis appearing in the records at all.
Although the term “autism” existed as far back as 1911, it was only used then to describe a symptom of schizophrenia. The term autism as a distinct diagnosis did not exist until 1943, when Leo Kanner described what he called “early infantile autism” in just eleven children receiving this diagnosis. It was considered extremely rare and very severe. Children with “early infantile autism” were often institutionalized in the 1940s well into the 1970s.
His definition was extremely narrow and focused on children with significant social and communication differences. For decades, many people who would likely be diagnosed as autistic today were instead labeled as emotionally disturbed, schizophrenic, intellectually disabled, developmentally delayed, or simply “odd.”
When people compare autism rates in the 1950s to today, they’re often comparing today’s broad spectrum definition to Kanner’s very narrow 1943 definition. That’s not an apples-to-apples comparison. Many people who are recognized as autistic today would never have met Kanner’s original criteria, or would have been given an entirely different diagnosis. That alone makes historical comparisons much more complicated.
Beginning in the 1980s, the diagnostic criteria gradually expanded as researchers gained a better understanding of autism. By the 1990s and early 2000s, it had become clear that autism was not a single condition but a broad spectrum encompassing people with a wide range of abilities, challenges, support needs, and levels of intelligence.
Today’s understanding of Autism Spectrum Disorder reflects decades of growing knowledge and recognizes that autistic people can range from those requiring substantial lifelong support to those who live independently, pursue higher education, and excel in their chosen fields.
We now understand that autism is a neurodevelopmental condition that affects how a person experiences, processes, and interacts with the world. It is characterized by differences in social communication and interaction, along with patterns of restricted interests, repetitive behaviors, sensory differences, or a strong preference for routines. Autism is considered a spectrum, meaning that people with autism can have very different strengths, challenges, personalities, and support needs.
One of the most important changes in our understanding of autism is the recognition that there is no single “autistic profile.” Some autistic individuals require substantial lifelong support with daily living, communication, and decision-making.
Others live independently, attend college, build successful careers, and raise families. Intelligence among autistic people spans the full human range, from those who also have intellectual disabilities to those who possess average, above-average, or exceptionally high intelligence. Many autistic individuals demonstrate remarkable strengths in specific areas such as mathematics, science, technology, music, art, language, memory, or pattern recognition.
Modern understanding recognizes that autism is not defined by intelligence, character, or a person’s value. Rather, it describes a different way of experiencing and interacting with the world. As with the rest of humanity, people with autism are individuals first, each with their own unique combination of abilities, challenges, interests, and support needs.
This broader understanding of autism also helps explain why so many more autistic people seem to exist today. In previous generations, many autistic individuals were misdiagnosed, institutionalized, hidden from public view, denied access to public education, or simply labeled with other terms.
Today, because people with autism are more likely to be recognized, educated in their communities, and included in society, they are far more visible than they were in the past. The increase in visibility does not necessarily mean autistic people did not exist before; in many cases, it means society has become better at recognizing them and allowing them to participate openly in community life.
That captures both how far we’ve come since Kanner’s very narrow 1943 description of autism and the modern understanding that autism encompasses people with vastly different abilities, challenges, and support needs.
People often assume there are more autistic people today because they see more autistic people today. But visibility and prevalence are not the same thing.
Few people claim there were no blind children in the 1950s, yet many blind children attended specialized schools and were rarely seen in neighborhood classrooms. The same was true for many deaf children. They existed in similar numbers, but they were educated separately and largely remained out of public view.
Many autistic people and others with developmental, intellectual, or physical differences were likewise hidden from public life. Some were institutionalized. Some attended segregated schools, while others were kept at home or trained for menial tasks. Others were given entirely different diagnoses. They were always part of our communities, but society often chose not to see them.
Today, people who were once excluded from public life are more visible because they are more likely to attend neighborhood schools, live in their communities, pursue higher education, hold jobs, and participate in society.
By the 1990s and early 2000s, it had become clear that autism was not a single condition but a broad spectrum encompassing people with a wide range of abilities, challenges, support needs, and levels of intelligence. It also became clear that autism was not related to schizophrenia or any other mental illness.
Today’s understanding of Autism Spectrum Disorder (ASD) reflects decades of growing knowledge and recognizes that autistic people can range from those requiring substantial lifelong support to those who live independently, pursue higher education, and excel in their chosen fields.
Historic Timeline of the Term “Autism”
- 1911: Autism was not a separate diagnosis, but a characteristic of schizophrenia.
- 1943: The term “early infantile autism” was used as a separate diagnosis to describe 11 children with significant social and learning differences. It was considered to be rare and severe, often requiring institutionalization.
- 1943–1970s: Autism was often confused with childhood schizophrenia, psychosis, intellectual disability, or emotional disturbance.
- 1980 (DSM-III): Autism was officially recognized as a separate diagnosis from schizophrenia. This was a major turning point.
- 1987 (DSM-III-R): The criteria were broadened considerably, allowing many more people to qualify for a diagnosis.
- 1994 (DSM-IV): Multiple related diagnoses were added, including Asperger Syndrome, PDD-NOS (Pervasive Developmental Disorder Not Otherwise Specified), and others. This greatly expanded who could be identified.
- 2013 (DSM-5): The separate diagnoses were combined into Autism Spectrum Disorder (ASD), formally recognizing autism as a spectrum with varying strengths, challenges, and support needs.
Note from the author: Many out-of-date words are used in this article. Please note that they are only used in terms of providing historical context. The same is true when “people first” labels are avoided in some portions of this article, again for historical clarity.
