Thursday, September 24, 2009

Obituary: First doctor to rigorously study autism, ADD dies

From The New York Times:

Dr. Leon Eisenberg (pictured), who conducted some of the first rigorous studies of autism, attention deficit disorder and learning delays and became a prominent advocate for children struggling with disabilities, died on Sept. 15 at his home in Cambridge, Mass. He was 87.

The cause was prostate cancer, said his wife, Dr. Carola Eisenberg.

The field of child psychiatry was dominated by Freudian psychoanalysis when, in the late 1950s and 1960s, Dr. Eisenberg began conducting medical studies of children with developmental problems. Working at Johns Hopkins University with Dr. Leo Kanner, who first described autistic behavior, Dr. Eisenberg completed the first detailed, long-term study of children with autism, demonstrating among other things that language problems predicted its severity.

In a similar study among children who were developing normally, Dr. Eisenberg showed that reading difficulties early in school predicted behavior problems later on.

In the 1960s, he performed the first scientific drug trials in child psychiatry, testing stimulants like Dexedrine and Ritalin to soothe the behavior of children identified as “delinquent” or “hyperkinetic.” These studies, which became the basis for drug treatment of what is now called attention deficit disorder, ran counter to psychoanalytic theories on the most effective treatments.

“Leon took a very courageous stand and denounced the way psychiatry treated children, this whole system in which we had a few rich kids and their parents getting psychoanalysis five days a week and still not being cured,” said C. Keith Conners, a professor emeritus in the department of psychiatry and behavioral sciences at Duke University. “No one even knew what a cure looked like. He had this conviction that nothing was being done for the bulk of children who needed help, and that we had very little scientific data to guide us.”

Dr. James Harris, a professor of psychiatry and behavioral science at Johns Hopkins University, said that Dr. Eisenberg was “the pivotal person in 20th-century child psychiatry who moved the field from simple descriptions of childhood disorders to actually looking at the science behind both the diagnosis and treatment.”

Leon Eisenberg was born in Philadelphia on Aug. 8, 1922, the eldest child of immigrants from Russia. He earned his undergraduate degree and, in 1946, his medical degree from the University of Pennsylvania, before taking an internship at Mount Sinai Hospital in New York, where he developed an interest in psychiatry. He completed his psychiatric residency at Sheppard Pratt Hospital in Towson, Md.

After two years in the Army teaching psychology, in 1952 he began a residency at Johns Hopkins and his collaboration with Dr. Kanner. In 1967, he took over as chief of psychiatry at Massachusetts General Hospital, where he continued to publish and, among many other projects, helped formulate and carry out affirmative action policies at Harvard Medical School.

In 1980, he established the medical school’s department of social medicine, with the aim of applying the tools of social science to improving access to and practice of medicine worldwide.

In addition to his wife, a co-founder of Physicians for Human Rights, Dr. Eisenberg is survived by two children from a previous marriage, Kathy and Mark Eisenberg; two stepchildren, Alan and Larry Guttmacher; two sisters, Essie Ellis and Libby Wickler; and six grandchildren.

For two days last week, Harvard lowered its flags to half-staff in honor of Dr. Eisenberg.

In his later years, Dr. Eisenberg became increasingly alarmed at trends in the field he helped establish, criticizing what he saw as a cozy relationships between drug makers and doctors and the expanding popularity of the attention deficit diagnosis.

The diagnosis “has morphed from a relative uncommon condition 40 years ago to one whose current prevalence is 8 percent,” he wrote. “Correspondingly, the prescription of stimulant drugs has gone up enormously. The reasons are not self-evident.”