Died: January 20, 1940 to December 1944
Cause of death: Lethal injection, gassing, starvation, shooting, and others.
Aktion T4 was the Nazi involuntary euthanasia program that targeted Germans with disabilities--at first children, and eventually adults. It was part of the eugenics movement; Nazi ideology held that those who could not work were useless eaters and life unworthy of life. It was stressed that these people were a burden on their communities and would make Germany weak because they were so expensive to care for.
Parents were encouraged to send their disabled children to institutions, where they "could be better cared for". These children, and later on adult patients of mental institutions, were sent to euthanasia clinics where they were killed, usually by lethal injection. Parents were sent a notice that their child had died of natural causes like measles or pneumonia.
A total of 70,273 people were killed in Aktion T4. Most were disabled or mentally ill; a few were political dissidents. Some of these people would have been autistic.
Germany had a population of approximately 70 million at the time, so the death rate from Aktion T4 was about 1:1000. In modern times, autism is known to affect about 1:100 people, and 16% of these have an IQ below 50. About 80% do not work. Since only 1:1000 Germans died in Aktion T4, it is possible to conclude that many autistic people either escaped death or were incarcerated in normal concentration camps as being "work-shy".
Many of the less disabled autistics would have survived because they were never diagnosed with anything and were able to work. Others would have survived because they were female and their families helped them compensate for their deficits, since women were not necessarily expected to work outside the home. Hans Asperger first defined Asperger syndrome in the shadow of the Nazi regime, and part of his argument was that his autistic boys were talented and could be useful members of society; Asperger's original patients survived the Holocaust.
Both "feeble-mindedness" and inability to work would have made German autistic people more vulnerable to extermination by the Nazis, though some of the unemployed would have been labeled "work-shy" and incarcerated in the normal concentration camps.
The autistic people most likely to die in Aktion T4 would have been children with obvious autism, or whose autism was associated with epilepsy. Any institutionalized Jewish Germans, whether child or adult, would have been automatically selected for euthanasia. About one-third of autistics have epilepsy; about one-sixth have a moderate to profound intellectual disability. Both of those conditions raised the risk that a person would be selected. However, we don't know what the true autism rate was in 1940s Germany, since at that point autism was not well-known. Most such autistics would have been simply labeled "feeble-minded", "epileptic", or in some cases "schizophrenic".
It is possible to estimate roughly how many of the T4 victims were autistic. About 20% of people have a disability; about 1% of people have autism. Autism tends to be more severe, on average, than other disabilities; but a conservative estimate would be that about 5% of disabled people have autism. If 5% of the Aktion T4 victims were autistic, then the total number of autistic T4 victims would have been around 3,500.
Disabled German children were among the very first victims of the Holocaust. I have been trying to find profiles, to find out what these children were like, but it is a difficult search. Most of the Aktion T4 victims who are remembered today were not disabled, but were political dissidents. The stories of the disabled children who died seem to have, for the most part, faded into history. But they still deserve to be remembered.
Aktion T4, more than any other Nazi extermination program, drew widespread outrage from Germans. Though Nazi officials tried to hide the reality of the extermination program, parents began to find out and clergy began to speak against it. In response, the program was officially terminated in August of 1941, though the killing continued until the end of the war.
Montana ASA, Autism Facts
IQ in children with autism
Chartbook on Disability in the US
Holocaust Encyclopedia, Euthanasia Program
Berlin unveils memorial for disabled Holocaust victims