Transatlantic Diagnostics: A Tale of Divergences in the History of Autism

Jonathyne Briggs

A comparative analysis of how France and the United States have scientifically investigated autism over the course of the later twentieth century has much to teach us about how practices of scientific inquiry and inference affect care practices. Specifically, it shows how narrowing the scope of scientific inquiry and focusing on monocausal explanations can lead to negative care outcomes. It also demonstrates the impact of parental advocacy groups in shifting scientific and health care paradigms, often in conflict with state actors.

In the 1950s – shortly after autism had been medically identified – the U.S. and France collaborated for the purposes of investigation and treatment, with researchers and therapists sharing ideas and sometimes even patients. The most famous example of this was Sammy Y, a young man who was treated by both Serge Lebovici in France and Bruno Bettelheim at the University of Chicago.^[1] With the diagnostics of autism developing out of Leo Kanner’s work at Johns Hopkins University, the United States became an important center of research on autism.^[2] Additionally, European intellectual migration to the U.S. during the Second World War and the creation of the World Health Organization following the war fostered connections between Europe and the United States in the realm of psychology.^[3] With psychoanalysis as a dominant force in psychology in this period, the European connection provided a conduit for transatlantic exchange.^[4]

However, by the 1970s a divergence between the two countries had developed. Whereas researchers in France continued to emphasize psychoanalysis as the proper frame to understand autism, those in the United States developed behavioral and educational approaches that sought to mitigate the social impact of autism for young people. According to the psychoanalytic paradigm postulated by theorists like Bruno Bettelheim, autism was an emotional response to caustic parenting. As such, it ought to be treated not just through psychoanalytic methods but also through removal of children from their homes to ameliorate the negative impact of parental harms. ^[5] However, in the United States, scientists like Dr. Bernard Rimland had challenged psychoanalysis’s dominance. Rimland highlighted the biological origins of autism and promoted behavioralist and educational models of care.

This divergence is significant because it impacted the care options available to parents, specifically in France. Although U.S. and French researchers had collaborated for decades, French parents could not access the pathbreaking research conducted by American scientists due to language barriers or lack of awareness of foreign research. Those parents who were curious about American research often lacked the connections to access it until advocacy groups brought American experts to France to explain their approaches directly to parents and to contrast their efficacy with psychoanalysis.

One such example took place on March 21, 1981, in the town of Vichy. The Union nationale des associations de parents et amis de personnes handicapées mentales (UNAPEI) held a conference that brought together researchers from the United States and French parents of children with developmental disabilities to introduce new methods of intervention for autistic children. As a parent-led advocacy group, UNAPEI wanted to present a wide array of options for parents to help their children integrate into French society by moving away from illness models that still defined a lot of thinking about autism. The UNAPEI conference sharpened the contrast between the two national approaches by highlighting the pluralism of American research, which indicated an openness that many parents felt was lacking in France.

One participant at the Vichy conference, Edward Ritvo, an American psychiatrist from the UCLA School of Medicine, theorized a genetic origin for autism and questioned the appropriateness of psychoanalysis as an intervention. Ritvo observed that two major interpretations concerning the origins of autism developed during the 1960s: a biological and a psychosomatic one. The latter received the lion’s share of attention from transnational researchers. He argued that some behaviors of autism, including repetitive motor movements and impaired verbal communications – what would now be labeled as stimming – were not deliberate or subconscious responses as psychoanalysts had interpreted them.^[6] Rather, Ritvo argued that autism was a product of genetic conditions and therefore was not a psychological disorder but rather a form of disability. Ritvo also lamented the continued influence of Bettelheim in France.^[7] In particular, Bettelheim’s assertions that autism resulted from “refrigerator mothers” who wished their children didn’t exist disparaged the efforts of mothers who took great pains to get care for their children. Much of the conference was dedicated to challenging the dominance of psychoanalysis in French thinking, using then-current American examples as a viable, scientific alternative for parents. UNAPEI held the conference annually thereafter, attracting an increasing number of parents and advocates during the 1980s who were interested in American ideas.

Outside of the Vichy conference, many French parents communicated directly with American researchers to understand how their techniques might be adapted for use in France. At the University of North Carolina, Eric Schopler developed the TEACCH method based on his awareness of communication difficulties for people with autism. Through a series of pictures that were designed to provide templates for non-verbal communication, people with autism could convey their feelings and desires and create narratives through interactions with storyboards. Because it used a visually oriented vocabulary, TEACCH was easily translated into other languages and remains a common intervention throughout the world. French parents reached out to Schopler and his collaborator Gary Merzibov in the late 1970s to develop a French version of TEACCH that could be used in treatment facilities and implemented within the home. Parents who had not found success with psychoanalysis and who wanted to participate in their children’s therapy embraced the method eagerly. Schopler and Merzibov eventually traveled to France to teach them their method, so that they could subsequently teach other French parents.^[8]

In some cases, the United States was a refuge for French people with autism, especially those who lacked a diagnosis or therapy options. One parent, Neil Offen, shared his experience of navigating the growing French divergence concerning autism treatment. His son Paul had been born in Paris in 1980. The family soon after relocated to Provence, where services were less available to track Paul’s development. After Paul’s pediatrician had characterized him as nervous, Offen sought specialized services for his son and found them lacking. Professionals also recommended Paul for special education due to speech delays and his lack of social engagement with other children. Despite a lack of diagnosis, Offen speculated that his son might be autistic, leading him to a psychologist who wanted to assess the emotional trauma in the family as part of his analysis. When he reached the age of four, Offen took his son to the United States to receive a diagnosis of autism. He then connected with the TEACCH center at UNC. On his return to France shortly after, Offen attended the UNAPEI’s annual conference. During this time, Gloria Laxer, a French special educator, suggested that for Paul’s sake he should return to the United States, which he did.^[9] French experts commonly took the position that the U.S. would provide a better life for autistic people due to the plurality of approaches and the willingness to continue to explore new ideas about autism rather than continuing to rely on psychoanalysis.

The variance of research in the U.S. continued into the twenty-first century Researchers have explored genetics, special education, behavioral therapy, and pharmaceutical interventions as possible interventions for some people on the spectrum, rooted in the understanding of autism as a form of disability. Recently however, the US Department of Health and Human Services has sought to define autism solely as a biological response to vaccination, a long-discredited position. They are moving away from the multivalent model that attracted French parents and permitted a wide range of research. American leadership in the field of autism research and advocacy is likely to come under pressure from this new position, marking an end of era.

However, given the political and economic power of the US, this divergence could potentially pull other countries seeking funding and research support along a similar path. The narrowing of the conversation in the United States to a singular cause contrasts with more recent efforts in France to expand discussions about autism. In France, there is a growing awareness of limitations of diagnoses that obscure the actual number of autistic people and support for diverse approaches through research funding, special education, and public health policy, portending a new dynamic in the transatlantic conversation.

Featured image courtesy Tara Winstead.

Jonathyne Briggs

Jonathyne Briggs is a Professor of History and Interim of the College of Arts and Science and the School of the Arts at Indiana University Northwest. He is the author of Perpetual Children: The Politics of Autism in France since 1950 (2025) and Sounds French: Globalization, Community, and Pop Music, 1958-1980 (2015), both with Oxford University Press.

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