Grunya Sukhareva

Contribution to the study of autism

One of Sukhareva's primary areas of study throughout her career was autism in children. She is credited by scholars as making observations that closely mirror ASD as described by the DSM-5 and ICD-11.

Research conducted by Sukhareva during her time at the Sanatorium School gave her an advantage in making such groundbreaking, modern diagnostic assessments, likely due to the school's unique pedagogical approach. Students at the school were children with no other shelter or family, and thus were provided with a safe haven at the school in the aftermath of World War I. Students typically spent around 2–3 years at the school and were offered a range of training aimed at developing social and motor skills. While at this institution, Sukhareva worked very closely with the children under her care and made very distinct, meticulous observations regarding both their physical and behavioral characteristics. The detail of her findings played an integral role in her research being considered so significant by experts in the field of psychiatry today.

Sukhareva's first publication, wherein she became the first person in history to detail autistic traits in children, was released in Russian in 1925 and translated to German for publication in 1926. Sula Wolff translated it in 1996 for the English-speaking world. This seminal work consisted of clinical accounts of the syndrome in 6 young boys, wherein Sukhareva detailed behaviors that she identified as representative of "schizoid psychopathy". She expanded upon her discoveries in 1927 with the publication of her second work regarding manifestation of autism in young girls. Given the relatively little research that has been conducted in autistic women and girls, and the ICD-11 notes they remain under-diagnosed with ASD, Sukhareva is considered a pioneer in the field of psychiatry for her contributions in this regard as well. Sukhareva frequently cited her professor, and head of the psychoneurological department at Moscow, Mikhail Osipovich Gurevich, as her primary mentor in her publications. Scholars suggest the two worked closely together throughout her career.

While Sukhareva utilized the term "autistic" to describe these children and their proclivities, the term was only just surfacing in psychiatric literature at the time of her seminal publication. A decade prior to this publication, the term originated from Swiss psychiatric scholar Eugen Bleuler. Bleuler, frequently cited in Sukhareva's works, coined the term to encompass socially introverted or withdrawn behaviors that were typically linked to schizophrenia at the time. Along with other prominent Soviet psychiatrists of the era, Bleuler posited that ASD was a form of "mild schizophrenia". Sukhareva's work expanded upon the definition throughout her career while making great strides in differentiating between ASD and schizophrenia nearly 30 years prior to the establishment of separate classifications for these diagnoses with the publication of the DSM-III in 1980.

Sukhareva's observations on autistic tendencies were not the only aspect of her work that is considered to be well before its time by scholars. In fact, she is known to have hypothesized a neurological basis for the syndrome, suggesting that the anatomical brain regions known as the cerebellum, frontal lobe, and basal ganglia are all implicated in the development of ASD. These hypotheses have been confirmed by more recent neuroimaging studies.

She initially used the term "schizoid psychopathy" ("schizoid" meaning "eccentric" at the time), but later replaced it with "autistic (pathological avoidant) psychopathy" to describe the clinical picture of autism. The article was created almost two decades before the case reports of Hans Asperger and Leo Kanner, which were published while Sukhareva's pioneering work remained unnoticed. In as much as Sukhareva's autism research was translated and published in German-language journals within a year of its domestic publication in Russian, there existed no serious barrier to access of these materials by Asperger and Kanner. Kanner cited Sukhareva's 1932 publication Über den Verlauf der Schizophrenien im Kindesalter in papers published in 1949 and 1962. The precise reason for her extensive research remaining uncited in the work of Asperger, who also published in German, cannot be precisely determined, and is still a matter of discussion by experts. Her name was transliterated as "Ssucharewa" when her papers appeared in Germany.

Psychiatry

Sukhareva believed that for personality disorders to appear in children and teenagers, a significant social factor was required. Some of the factors she discussed for personality disorders were a poor family environment and societal structure. She was a pioneer in using the method of suggestion, and fought for children's rights, stating that difficult children should not be sent to prisons, but to medical institutions. She also studied PTSD from war injuries sustained by children.

Award

By order of the Moscow Department of Health, the Moscow Scientific and Practical Center for Mental Health of Children and Adolescents was named after Sukhareva, with the prefix G. E. Sukhareva appended to the front. The center is the leading specialized medical institution for the treatment of suicidal states in children and adolescents under 18 years of age.

Sukhareva's patients

In 1926 then 1927, Sukhareva described six boys and five girls as having what is now considered autism. These anonymous patients, some of the first to be identified as having the disorder, were described as follows:

• A 12-year-old who had taught himself to read at age five. He was physically awkward and preferred talking to adults instead of children. He was very interested in philosophy.
• A gifted violinist who struggled socially.
• A child with exceptional memory of numbers but with face blindness.
• A child who had imaginary friends that lived in a fireplace.