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The eleven children (eight boys and thrre girls) whose histories have been briefly presented offer, as is to be expected, individual differences in the degree of their disturbance, the manifestation of specific features, the family constellation, and the step-by-step development in the course of years. but even a quick review of the material makes the emergence of a number of essential common characteristics appear inevitable. These characteristics form a unique “syndrome,”not heretofore reported, which seems to be rare enough, yet is probably more frequent than is indicated by the paucity of observed cases. It is quite possible that some such children have been viewed as feebleminded or schizophrenic. In fact, several children of our group were introduced to us as idiots or imbeciles. One still resides in a state school for the feebleminded, and two had been previously considered as schizophrenic.
The outstanding, “pathognomonic,” fundamental disorder is the children’s inability to relate themselves in the ordinary way to people and situations from the begining of life. Their parents referred to them as having always been “self-sufficient”; “like in a shell”; “happiest when left alone”;“acting as if people weren’t there”; “perfectly oblivious to everything about him”; “giving the impression of silent wisdom”; “failing to develop the usual amount of social awareness”;“acting almost as hypnotized.”T his is not, as in schizophrenic children or adults, a departure from an initially present relationship; it is not a “withdrawal”from formerly existing participation. There is from the start an extreme autistic aloneness that, whenever possible, disregards, ignores, shuts out anything that comes to the child from the outside. Direct physical contact or such motion or noise as threatens to disrupt the aloneness is either treated “as if it weren’t there”or, if this is no longer sufficient, resented painfully as distressing interference.
According to Gesell, the average child at 4 months of age makes an anticipatory motor adjustment by facial tension and shrugging attitude of the shoulders when lifted from a table or placed on a table. Gesell commented:
It is possible that a less definite evidence of such adjustment may be found as low down as the neonatal period. Althought a habit must be conditioned by experience, the opportunity for experience is almost universal and the response is sufficiently objective to merit further observation and record.
This universal experience is supplied by the frequency with an infant is picked up by his mother and other persons. It is therefore highly significant that almost all mothers of our patients recalled their astonishment at the children’s failure to assume at any time an anticipatory posture preparatory to being picked up. One father recalled that his daughter ( Barbara) did not for years change her physiognomy or position in the least when the parents, upon coming home after a few hour’s absence, approached her crib talking to her and making ready to pick her up.
The average infant learns during the first few months to adjust his body to the posture of the person who holds him. Our children were not able to do so for two or three years. We had an opportunity to observe 38-month old Herbert in such a situation. His mother informed him in appropriate terms that she was going to lift him up, extending her arms in his direction. There was no response.She proceeded to take him up, and he allowed her to do so, remaining completely passive as if he were a sack of flour. It was the mother who had to do all the adjusting. Herbert was at that time capable of sitting, standing, and walking.
Eight of the eleven children acquired the ability to speak either at the usual age or after some delay. Three (Richard, Herbert, Virginia) have so far remained “mute.”In none of the eight “speaking” children has language over a period of years served to convey meaning to others. They were, with the exception of John F., capable of clear articulation and phonation. Naming of objects presented no difficulty; even long and unusual words were learned and retained with remarkable facility. Almost all the parents reported, usually with much pride, that the children had learned at an early age to repeat an inordinate number of nursery rhymes, prayers, lists of animals, the roster of presidents, the alphabet forward and backward, even foreign-language (French) lullabies. Aside from the recital of sentences contained in the ready-made poems or other remembered pieces, it took a long time before they began to put words together. Other than that, “language”consisted mainly of “naming,”of nouns identifying objects, adjectives indicating colors, and numbers indicating nothing specific.
Their excellent rote memory, coupled with the inability to use language in any other way, often led the parents to stuff them more and more verses, zoologic and botanic names, titles and composers of Victrola record pieces, and the like. Thus, from the start, language-which the children did not use for the purpose of communication-was deflected in a considerable measure to a self-sufficient, semantically and conversationally valueless or grossly distorted memory exercise. To a child 2 or 3 years old, all these words, numbers, and poems (“questions and answers of the Presbyterian Catechism”; “Mendelssohn’s violin concerto”; the “Twenty-third Psalm”; a French lullaby; an encyclopedia index page) could hardly have more meaning than sets of nonsense syllables to adults. It is difficult to know for certain whether the stuffing as such has contributed essentially to the course of the psychopathologic condition. But it is also difficult to imagine that it did not cut deeply into the development of language as a tool for receiving and imparting meaningful messages.
As far as the communicative functions of speech are concerned, there is no fundamental difference between the eight speaking and the three mute children, Richard was once overheard by his boarding mother to say distinctly, “good night.”Justified skepticism about this observation was later dispelled when this “mute”child was seen in the shaping his mouth in silent repetition of words when asked to say certain things. “Mute” Virginia-so her cottage mates insisted-was heard repeatedly to say, Chocolate," Marshmallow," Mama, “Baby.”
When sentences are finally formed, they are for a long time mostly parrot-like repetitions of heard word combinations. They are sometimes echoed immediately, but they are just as often “stored”by the child and uttered at a later date. One may, if one wishes, speak of delayed echolalia. Affirmation is indicated by literal repetition of a question. “Yes”is a concept that it takes the children many years to acquire. They are incapable of using it as a general symbol of assent. Donald learned to say “Yes”when his father told him that he would put him on his shoulders if he said “Yes.”This word then came to “mean”only the desire to be put on his father’s shoulders. It took many months before he could detach the word “Yes”from this specific situation, and it took much longer before he was able to use it as a general term of affirmation.
The same type of literalness exists also with regard to prepositions. Alfred, when asked, “What is this picture about?”replied:”People are moving about.”
John F. corrected his father’s statement about pictures on the wall; the pictures were “near the wall.” Donald T., requested to put something down, promptly put it on the floor. Apparently the meaning of a word becomes inflexible and cannot be used with any but the originally acquired connotation.
There is no difficulty with plurals and tenses. But the absence of spontaneous sentence formation and the echolalia type reproduction has, in every one of the eight speaking children, given rise to a peculiar grammatical phenomenon. Personal pronouns are repeated just as heard, with no change to suit the altered situation. The child, once told by his mother, “Now I will give you your milk,”expresses the desire for milk in exactly the same words. Consequently, he comes to speak of himself always as “you,”and of the person addressed as “I.”Not only the words, but even the intonation is retained. If the mother’s original remark has been made in form of a question, it is reproduced with the grammatical form and the inflection of a question, it is reproduced with the grammatical form and the inflection of a question. The repetition “Are you ready for your dessert?” means that the child is readly for his dessert. There is a set, not-to-be-changed phrase for every specific occasion. The pronominal fixation remains until about the sixth year of life, when the child gradually learns to speak of himself in the first person, and of the individual addressed in the second person. In the transitional period, he sometimes still reverts to the earlier form or at times refers to himself in the third person.
The fact that children echo things heard does not signify that they “attend” when spoken to. It often takes numerous reiterations of a question or command before there is even so much as an echoed response. Not less than seven of the children were therefore considered as deaf or hard of hearing. There is an all-pwerful need for being left undisturbed. Everything that is brought to the child from the outside, everything that changes his external or even internal environment, represents a dreaded intrusion.
Food is the earliest intrusion that is brought to the child from the outside. David Levy observed that affect-hungry children, when placed in foster homes where they are well treated, at first demand excessive quantities of food. Hilde Bruch, in her studies of obese children, found that overeating often resulted when affectionate offerings from the parents were lacking or considered unsatisfactory. Our patients, reversely, anxious to keep the outside world away, indicated this by the refusal of food. Donald, Paul (“vomited a great deal during the first year”), Barbara (“had to be tube-fed until 1 year of age”), Herbert, Alfred, and John presented severe feeding difficulty from the beginning of life. Most of them, after an unsuccessful struggle, constantly interfered with, finally gave up the struggle and all of a sudden began eating satisfactorily.
Another intrusion comes from loud noises and moving objects, which are therefore reacted to with horror. Tricycles, swings, elevators, vacuum cleaners, running water, gas burners, mechanical toys, egg beaters, even the wind could on occasions bring about a major panic. one the children was even afraid to go near the closet in which the vaccum cleaner was kept. Injections and examinations with stethoscope or otoscope created a grave emotional crisis. Yet it is not the noise or motion itself that is dreaded. the disturbance comes from the noise or motion that intrudes itself, or threatens to intrude itself, upon the child’s aloneness. The child himself can happily make as great a noise as any that he dreads and move objects about to his heart’s desire.
The eleven children (eight boys and thrre girls) whose histories have been briefly presented offer, as is to be expected, individual differences in the degree of their disturbance, the manifestation of specific features, the family constellation, and the step-by-step development in the course of years. but even a quick review of the material makes the emergence of a number of essential common characteristics appear inevitable. These characteristics form a unique “syndrome,”not heretofore reported, which seems to be rare enough, yet is probably more frequent than is indicated by the paucity of observed cases. It is quite possible that some such children have been viewed as feebleminded or schizophrenic. In fact, several children of our group were introduced to us as idiots or imbeciles. One still resides in a state school for the feebleminded, and two had been previously considered as schizophrenic.
The outstanding, “pathognomonic,” fundamental disorder is the children’s inability to relate themselves in the ordinary way to people and situations from the begining of life. Their parents referred to them as having always been “self-sufficient”; “like in a shell”; “happiest when left alone”;“acting as if people weren’t there”; “perfectly oblivious to everything about him”; “giving the impression of silent wisdom”; “failing to develop the usual amount of social awareness”;“acting almost as hypnotized.”T his is not, as in schizophrenic children or adults, a departure from an initially present relationship; it is not a “withdrawal”from formerly existing participation. There is from the start an extreme autistic aloneness that, whenever possible, disregards, ignores, shuts out anything that comes to the child from the outside. Direct physical contact or such motion or noise as threatens to disrupt the aloneness is either treated “as if it weren’t there”or, if this is no longer sufficient, resented painfully as distressing interference.
According to Gesell, the average child at 4 months of age makes an anticipatory motor adjustment by facial tension and shrugging attitude of the shoulders when lifted from a table or placed on a table. Gesell commented:
It is possible that a less definite evidence of such adjustment may be found as low down as the neonatal period. Althought a habit must be conditioned by experience, the opportunity for experience is almost universal and the response is sufficiently objective to merit further observation and record.
This universal experience is supplied by the frequency with an infant is picked up by his mother and other persons. It is therefore highly significant that almost all mothers of our patients recalled their astonishment at the children’s failure to assume at any time an anticipatory posture preparatory to being picked up. One father recalled that his daughter ( Barbara) did not for years change her physiognomy or position in the least when the parents, upon coming home after a few hour’s absence, approached her crib talking to her and making ready to pick her up.
The average infant learns during the first few months to adjust his body to the posture of the person who holds him. Our children were not able to do so for two or three years. We had an opportunity to observe 38-month old Herbert in such a situation. His mother informed him in appropriate terms that she was going to lift him up, extending her arms in his direction. There was no response.She proceeded to take him up, and he allowed her to do so, remaining completely passive as if he were a sack of flour. It was the mother who had to do all the adjusting. Herbert was at that time capable of sitting, standing, and walking.
Eight of the eleven children acquired the ability to speak either at the usual age or after some delay. Three (Richard, Herbert, Virginia) have so far remained “mute.”In none of the eight “speaking” children has language over a period of years served to convey meaning to others. They were, with the exception of John F., capable of clear articulation and phonation. Naming of objects presented no difficulty; even long and unusual words were learned and retained with remarkable facility. Almost all the parents reported, usually with much pride, that the children had learned at an early age to repeat an inordinate number of nursery rhymes, prayers, lists of animals, the roster of presidents, the alphabet forward and backward, even foreign-language (French) lullabies. Aside from the recital of sentences contained in the ready-made poems or other remembered pieces, it took a long time before they began to put words together. Other than that, “language”consisted mainly of “naming,”of nouns identifying objects, adjectives indicating colors, and numbers indicating nothing specific.
Their excellent rote memory, coupled with the inability to use language in any other way, often led the parents to stuff them more and more verses, zoologic and botanic names, titles and composers of Victrola record pieces, and the like. Thus, from the start, language-which the children did not use for the purpose of communication-was deflected in a considerable measure to a self-sufficient, semantically and conversationally valueless or grossly distorted memory exercise. To a child 2 or 3 years old, all these words, numbers, and poems (“questions and answers of the Presbyterian Catechism”; “Mendelssohn’s violin concerto”; the “Twenty-third Psalm”; a French lullaby; an encyclopedia index page) could hardly have more meaning than sets of nonsense syllables to adults. It is difficult to know for certain whether the stuffing as such has contributed essentially to the course of the psychopathologic condition. But it is also difficult to imagine that it did not cut deeply into the development of language as a tool for receiving and imparting meaningful messages.
As far as the communicative functions of speech are concerned, there is no fundamental difference between the eight speaking and the three mute children, Richard was once overheard by his boarding mother to say distinctly, “good night.”Justified skepticism about this observation was later dispelled when this “mute”child was seen in the shaping his mouth in silent repetition of words when asked to say certain things. “Mute” Virginia-so her cottage mates insisted-was heard repeatedly to say, Chocolate," Marshmallow," Mama, “Baby.”
When sentences are finally formed, they are for a long time mostly parrot-like repetitions of heard word combinations. They are sometimes echoed immediately, but they are just as often “stored”by the child and uttered at a later date. One may, if one wishes, speak of delayed echolalia. Affirmation is indicated by literal repetition of a question. “Yes”is a concept that it takes the children many years to acquire. They are incapable of using it as a general symbol of assent. Donald learned to say “Yes”when his father told him that he would put him on his shoulders if he said “Yes.”This word then came to “mean”only the desire to be put on his father’s shoulders. It took many months before he could detach the word “Yes”from this specific situation, and it took much longer before he was able to use it as a general term of affirmation.
The same type of literalness exists also with regard to prepositions. Alfred, when asked, “What is this picture about?”replied:”People are moving about.”
John F. corrected his father’s statement about pictures on the wall; the pictures were “near the wall.” Donald T., requested to put something down, promptly put it on the floor. Apparently the meaning of a word becomes inflexible and cannot be used with any but the originally acquired connotation.
There is no difficulty with plurals and tenses. But the absence of spontaneous sentence formation and the echolalia type reproduction has, in every one of the eight speaking children, given rise to a peculiar grammatical phenomenon. Personal pronouns are repeated just as heard, with no change to suit the altered situation. The child, once told by his mother, “Now I will give you your milk,”expresses the desire for milk in exactly the same words. Consequently, he comes to speak of himself always as “you,”and of the person addressed as “I.”Not only the words, but even the intonation is retained. If the mother’s original remark has been made in form of a question, it is reproduced with the grammatical form and the inflection of a question, it is reproduced with the grammatical form and the inflection of a question. The repetition “Are you ready for your dessert?” means that the child is readly for his dessert. There is a set, not-to-be-changed phrase for every specific occasion. The pronominal fixation remains until about the sixth year of life, when the child gradually learns to speak of himself in the first person, and of the individual addressed in the second person. In the transitional period, he sometimes still reverts to the earlier form or at times refers to himself in the third person.
The fact that children echo things heard does not signify that they “attend” when spoken to. It often takes numerous reiterations of a question or command before there is even so much as an echoed response. Not less than seven of the children were therefore considered as deaf or hard of hearing. There is an all-pwerful need for being left undisturbed. Everything that is brought to the child from the outside, everything that changes his external or even internal environment, represents a dreaded intrusion.
Food is the earliest intrusion that is brought to the child from the outside. David Levy observed that affect-hungry children, when placed in foster homes where they are well treated, at first demand excessive quantities of food. Hilde Bruch, in her studies of obese children, found that overeating often resulted when affectionate offerings from the parents were lacking or considered unsatisfactory. Our patients, reversely, anxious to keep the outside world away, indicated this by the refusal of food. Donald, Paul (“vomited a great deal during the first year”), Barbara (“had to be tube-fed until 1 year of age”), Herbert, Alfred, and John presented severe feeding difficulty from the beginning of life. Most of them, after an unsuccessful struggle, constantly interfered with, finally gave up the struggle and all of a sudden began eating satisfactorily.
Another intrusion comes from loud noises and moving objects, which are therefore reacted to with horror. Tricycles, swings, elevators, vacuum cleaners, running water, gas burners, mechanical toys, egg beaters, even the wind could on occasions bring about a major panic. one the children was even afraid to go near the closet in which the vaccum cleaner was kept. Injections and examinations with stethoscope or otoscope created a grave emotional crisis. Yet it is not the noise or motion itself that is dreaded. the disturbance comes from the noise or motion that intrudes itself, or threatens to intrude itself, upon the child’s aloneness. The child himself can happily make as great a noise as any that he dreads and move objects about to his heart’s desire.