Autism or Sukhareva's syndrome?

Sukhareva's contribution to the field of autism

In 1924, a 12-year-old boy was referred to Sukhareva for diagnostic assessment (5, 6, 8). She noted that the boy had a distinctive behaviour compared to his peers. He preferred spending time with adults rather than children of his own age. Sukhareva described the boy as highly intelligent, and reported that she was able to have 'philosophical discussions' with him. He had learnt to read as a four-year-old and spent his days reading rather than playing with children his own age. He had set rituals, verbal difficulties, clumsy motor skills, was anxious and had eating difficulties.

In the course of the next year, Sukhareva examined five more boys whose clinical characterisations were almost identical. In 1925, she published a study of all six patients in a Russian medical journal, where she gave a detailed description of symptoms and findings (7). In order to make the work more accessible to scholars in the West, the Russian article was translated and printed in a German medical journal in 1926 (9). The clinical characterisation presented by Sukhareva in this article later turned out to be virtually identical to that described by Leo Kanner almost 20 years later (1, 5).

Nevertheless, Sukhareva's work was never cited in the years that followed, either in Europe or in the United States. It is also puzzling that neither Leo Kanner nor Hans Asperger appear to have made any contact with Sukhareva. Astonishingly, she was also never mentioned by either of them. They are likely to have been aware of Sukhareva's paper, at the very least the German version of it from 1926, which was published in a well-respected journal. The big question is why they never cited her (10).

In 1996, the British child psychiatrist Sula Wolff (1924–2009) published an article that gave an English translation of Sukhareva's works (6). Here, Wolff was the first to suggest that it was Sukhareva who came up with the very first description of autism, and that the accolade should be all hers. Wolff was an acclaimed child psychiatrist who had been working to classify children with autism and emphasise the genetic component of the disorder. She provided a more detailed clinical characterisation in her book Loners. The Life Path of Unusual Children (11). Wolff also asked how it was possible that Hans Asperger appeared not to know Sukhareva's work (6). There has been speculation about whether this was due to Sukhareva being Jewish, but Kanner also did not cite Sukhareva's contribution to this field (8).

The clinical characterisation that Sukhareva presented in her article from 1925 is virtually identical to the diagnostic criteria set out in DSM-5

In the years that followed, the matter received little attention. Numerous articles about autism were produced, but Kanner and Asperger continued to be credited as the first to describe the clinical aspects of the disorder. Not a single paper mentioned Sukhareva in the context of providing the original description of autism. It was not until 2015 that Posar and Visconti (12) highlighted who they felt should be credited for the first description of autism. These authors pointed out that the clinical characterisation that Sukhareva presented in her article from 1925 is virtually identical to the diagnostic criteria set out in DSM-5.

Sukhareva was even more ahead of her time when, in 1927, she published a study of five girls who had similar problems: 'Die Besonderheiten der schizoiden Psychopathien bei den Mädchen' (13). In 2020, Simmonds published an article co-authored by Sukhareva posthumously, in which she highlighted how Sukhareva even at that early stage had shed light on the different presentation of autism in girls, a point that is still being made today (14).

In the years that have passed since Posar and Visconti's article, the international literature on autism has, in our opinion, yet to give Grunya Efimovna Sukhareva her rightful recognition. She remains unknown to many authors and scholars, despite being a visionary and productive pioneer in the fields of paediatric and neuro psychiatry. Whatever the reason, we must acknowledge that this is yet another example in medical history of a failure to credit a person who deserves recognition.