Remembering baby psychiatrist Michael Rutter | Spectrum
Debunking Myths: Michael Rutter spent his career debunking myths about autism, but as a rigorous clinician and researcher, he also worked to refute his own prior work.
Courtesy King’s College London
Sir Michael Rutter, the child psychiatrist who turned outdated ideas about the origins of autism, died on October 23 at the age of 88. In July, Rutter had retired 55 years from the Institute of Psychiatry, Psychology and Neuroscience at King’s College London in the UK, where he had worked.
During this time, Rutter co-authored a groundbreaking study on autistic twins from 1977 that found that genetic factors play an important role in the condition. His work helped dispel the myths that autism was a form of childhood schizophrenia or that it could be traced back to particular parenting styles. In the second half of his career, Rutter also focused on the challenges autistic people face as they age – a long-overlooked area of autism research.
Many of the people Rutter was diagnosed with autism as children are now between 60 and 70 years old, and they still remember how different his approach was compared to that of his contemporaries, says longtime associate Patricia Howlin, professor emeritus for clinical child psychology at King’s College London.
“These are autistic adults who acknowledge how much they owe him, especially from a time when there was very little support and very little understanding for neither the autistic children themselves nor their families,” Howlin says. “This is not just a loss for the academic world.”
Rutter’s commitment to the autistic community went beyond the usual clinical boundaries, says Emily Simonoff, professor and director of child and adolescent psychiatry at King’s College London.
“Mike counseled and supervised autistic children for many years whose adult needs were not well met by adult mental health services.”
Within the academic community, Rutter’s influence extended across the world. Clinical psychiatry trainees consider his 1981 textbook Child and Adolescent Psychiatry to be “the Bible,” says Meng-Chuan Lai, associate professor of psychiatry at the University of Toronto, Canada. “I was trained as a clinician in Taiwan, so his influence is global. It is not limited to the English-speaking world. “
Not only did the textbook lay the foundation for the field, but it challenged readers to question conventional wisdom, says Lai – an approach that extended to his clinical training.
“Mike encouraged the trainees to read extensively, think critically, and organize their ideas into manageable scientific questions,” says Simonoff. “His claim to scientific quality was always at the highest level, and he advised trainees and colleagues against being satisfied with less in their own work.”
Clinical focus:
Rutter’s work focused primarily on the clinic, where he wanted to help parents and teachers promote the development of autistic children. In the early 1970s, when many clinicians were primarily interested in the difficulties such children may encounter, Rutter emphasized the extraordinary memory, motor, musical, and math skills that some possess, Howlin says.
“One of his special legacies was realizing the benefits of autism instead of just focusing on the things kids couldn’t do,” she says.
Playtime: Rutter helped develop the Autism Diagnostic Observation Schedule, a clinical tool that involves playing with young children.
Corbin O’Grady Studio / Science Photo Library
This tendency to reject conventions shaped Rutter’s career. He brought methodological rigor to his practice and emphasized the importance of reliable measurements – something that had previously been lacking in psychology and psychiatry, says Eric Fombonne, professor of psychiatry at Oregon Health and Science University in Portland, who has been with Rutter since the 1980s . “He established our field as a scientifically oriented discipline. It wasn’t before him and now it is. “
Rutter is not resting on his laurels, but has always tried to expose his own work, says Fombonne.
“He was very interested in getting the best measurements possible,” says Fombonne. “He always paid close attention to the quality and informative value of our measurements.”
To that end, Rutter helped develop two gold standard diagnostic tools for autism – the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview – in collaboration with Catherine Lord, distinguished professor of psychiatry and education at the University of California, Los Angeles .
“He was really proud of his collaboration,” says Lord. “Almost everything he did was collaboration.”
When they were working together on ADOS, a clinical tool used to play with young children, the somewhat formal Rutter was a little out of touch, Lord says. Still, he had good ideas on how to collect the best possible data. “He really insisted on getting people to be reliable and tried to make the information as meaningful as possible,” she says.
Reach and severity:
In the late 20th century, when many psychiatry researchers were isolated in their disciplines, Rutter made several forays beyond autism. He examined genetic influences on development and participated in educational policy. In his studies of the Isle of Wight, he conducted epidemiological studies on a range of psychiatric illnesses and behavioral problems.
“This is a remarkably rich tapestry that very few people own,” says Tony Charman, professor of clinical child psychology at King’s College London. “For many of us, when we’re working on autism and [attention deficit hyperactivity disorder], we see ourselves as a very versatile scientist. “
One of Rutter’s best-known contributions outside of autism was his work with Romanian orphans who were deprived of care as infants in the 1980s and 1990s. He followed their development and showed that a faster introduction led to improved development results.
Charman peer-reviewed one of Rutter’s manuscripts on the orphans and declined to use the term “quasi-autistic” to describe some of their clinical features.
Rutter was always ready to change his mind when presented with new evidence, says Charman. “Some people who are very important can be iconoclastic.” At the same time, however, “if he disagreed with the comments of reviewers or editors, he would defend his view fairly vigorously.”
After a “robust” debate, says Charman, the term made it into final publication.
Quote this article: https://doi.org/10.53053/XHYO5289
