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Discussion
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Case
3
Richard M. was referred
to the Johns Hopkins Hospital on February 5, 1941, at 3 years, 3 months
of age, with the complaint of deafness because he did not talk and did
not respond to questions. Following his admission, the interne made this
observation:
The child seems quite intelligent,
playing with the toys in his bed and being adequately curious about instruments
used in the examination. He sems quite self-sufficient in his play. It
is difficult to tell definitely whether he hears, but it seems that he
does. He will obey commands, such as "Sit up"or "Lie down,"even when he
does not see the speaker. He does not pay attention to conversation going
on around him, and although he does make noises, he says no recognizable
words.
His mother brought with
her copious notes that indicated obsessive preoccupation with details and
a tendency to read all sorts of peculiar interpretations into the chil's
performances. She watched (and recorded) every gesture and every "look."trying
to find their specific significance and finally deciding on a particular,
sometimes very farfetched explanation. She thus accumulated an account
that, though very elaborate and richly illustrated, on the whole revealed
more of her own version of what had happened in each instance than it told
of what had actually occurred.
Richard's father is a professor
of forestry in a southern university. He is very mich immersed in his work,
almost entirely to the exclusion of social contacts. The mother is a college
graduate. The maternal grandfather is a physician, and the rest of the
family, in both branches, consists of intelligent professional people.
Richard's brother, thirty-one months his junior, is described as a normal,
well-developed child.
Richard was born on November
17, 1937. Pregnancy and birth were normal. He sat up at 8 months and walked
at 1 year. His mother began to "train"him at the age of 3 weeks,
giving him a suppository every morning "so his bowels would move by the
clock."The mother, in comparing her two children, recalled that while her
younger child showed an active anticipatory reaction to being picked up,
Richard had not shown any physiognomic or postural sign of preparedness
and had failed to adjust his body to being held by her or the nurse. Nutrition
and physical growth proceeded satisfactorily. Following smallpox vaccination
at 12 months, he had an attack of diarrhea and fever, from which he recovered
in somewhat less than a week.
In September, 1940, the
mother, in commenting on Richar's failure to talk, remarked in her notes:
I can't be sure just when
he stopped the imitation of word sounds. It seems taht he gone backward
mentally gradually for the last two years. we have thought it was because
he did not disclose what was in his head, that it was there all right.
Now that he is making so many sounds, it is disconcerting because it is
now evident that he can't talk. Before, I thought he could if he only would.
He gave the impression of silent wisdom to me.... One puzzling and discouraging
thing is the great difficulty on has in getting his attention.
He had himself led willingly
to the psychitrist's office and engaged at once in active play with the
toys, paying no attention to the persons in the room.Occasionally, he looked
up at the walls, smiled and uttered short staccato forceful sounds_ "Ee!
Ee! Ee!"He complied with a spoken and gestural command of his mother to
take off his slippers. When the command was changed to another, thi time
without gestures, he repeated the original request and again took off his
slippers (which had been put on again). He performed well with the unrotated
form board but not with the rotated form board.
Richard was again seen at
the age of 4 years, 4 months. He had grown considerably and gained weight.
When started for the examination room, he screamed and made a great fuss,
but once he yielded he went along willingly. He immediately proceeded to
turn the lights no and of. He showed no interest in the examiner or any
other person but was attracted to a small box that he threw as if it were
a ball.
At 4 years, 11 months, his
first move in entering the office (or any other room) was to turn the lights
on and off. He climbed on a chair, and from the chair to the desk in order
to reach the switch of the wall lamp. He did not communicate his wishes
but went into a rage until his mother guessed and procured what he wanted.
He had no contact with people, whom hw definitely regarded as an interference
when they talked to him or otherwise tried to gain his attention.
The mother felt that she
was no longer capable of handling him, and he was placed in a foster home
near Annapolis with a woman who had shown
a remarkable talent for
dealing with difficult children. Recently, this woman heard him say clearly
his first intelligible words. They were, "Good night."
Case
4
Paul G. was referred in
March, 1941, at the age of 5 years, for psychometric assessment of what
was thought to be a severe intellectual defect. He had attended a private
nursery school, where his incoherent speech, inability to conform, and
reaction with temper outbursts to any interference created the impression
of feeblemindedness.
Paul, an only child, had
come to this country form englend with his mother at nearly 2 years og
age. The father, a mining engineer, belived to be in Australia now, had
left his wife shortly before that time after several years of an unhappy
marriage, The mother, supposedly a college graduate, a restless, unstable,
excitable woman. gave a vague and blatantly conflicting history of the
family background and the child's development. She spent much time emphasizing
and illustrating her efforts to make Paul clever by teaching him to memorize
poems and songs. At 3 years, he knew the words of not less than thirty-seven
songs and various and sundry nursery rhymes.
He was born normally. He
vomited a great deal during his first year, and feeding formulas were changed
frequently with little success. He ceasedvomiting when he was started on
solid food. He cut his teeth, held up his head, sat up. walked, and established
bowel and bladder control at the usual age. He had measles, chickenpox,
and pertussis without complications. His tonsils were removed when he was
3 years old. On physical examination, phimosis was found to be the only
deviation from otherwise good health.
The following features emerged
from observation on his visits to the clinic, during five weeks' residence
in a boarting home, and during a few days stay in the hospital.
Paul was a slender, well-built,
attractive child, whose face looked intelligent and animated. He had good
manual dexterity. He rarely responded to any form of address, even to the
calling of his name. At one time he picked up a block from the floor on
request. Once he copied a circle immediately after it had been drawn before
him. Sometimes an energetic "Don't!"caused him to interrupt his activity
of the moment. but usually, when spoken to, he went on with whatever he
was doing as if nothing had been said, Yet one never had the feeling that
he was willigly disobedient or contrary. He was obviously so remote thet
the remarks did not reach him. He was always vivaciously occupied with
something and seemed to be highly satisfied, unless someone made a persistent
attempt to interfere with his sel-chosen actions.Then he first tried impatiently
to get out of the way and, when this met with no success, screamed and
kicked in a full-fledged tantrum.
There was a marked contrast
between his relations to people and to objects. Upon entering the room,
he instantly went after objects and used them correctly. He was not destructive
and treated the objects with care and even affection. He picked up a pencil
and scribbled on paper that he found the table. He opened a box, took out
a toy telephone, singing again and again: "He wants the telephone,"and
went around the room with the mouthpiece and receiver in proper position.
He hold of a pair of scissors and patiently and skillfully cut a sheet
of paper into small bits, singing the phrase "Cutting paper,"many times.
He helped himself to a toy engine, ran around the room holding it up high
and singing over and over again, "The engine is flying."While these utterances,
made always with the same inflection, were clearly connected with his actions,
he ejaculated others that could not be linked up with immediate situations.These
are a few examples: "The people in the hotel"; "Didi you hurtyour leg?"
"Candy is all gone, candy is empty"; "You'll fall off the bicycle and bump
your head."However, some of those exclamations could be definitely traced
to precious experiences. He was in the habit of saying almost every day,
"Don't throw the dog off the balcony,"His mother recalled that she had
said those words to him about a toy dog while they were still in England.
At the sight of a saucepan he would invariably exclaim, "Peter-eater."The
mother remembered that this particular association had begun when he was
2 years old and she happened to drop a saucepan while reciting to him the
nursery rhyme about "Peter, Peter, pumpkin eater."Reproductions of bodily
injury constituted a major portion of his utterances.
None of these remarks was
meant to have communicative value. There was, on his side, no affective
tie to people. He behaved as if people as such did not matter or even exist.
It made no difference whether one spoke to him in a friendly or a harsh
way. He never looked up at people's faces. When he had any dealings with
persosn at all, he treated them, or rather parts of them, as if thev were
objects. He would use a hand to lead him. He would, in playing, butt his
head against his mother as at other times he did against a pillow. He allowed
his boarding mother's hands to dress him, paying not the slightest attention
to her. When with other children, he ignored them and went after their
toys.
His enunciation was clear
and he had a good vocabulary. His sentence construction was satisfactory,
with one significant exception. He never used the pronoun of the first
person, nor did he refer to himself as Paul. All statements pertaining
to himself were made in the second person, as literal repetitions of things
that had been said to him before. He would express his desire for candy
by saying, "You want candy."He would pull his hand away from a hot radiator
and say, "You get hurt,"Occasionally there were paraot-like repetitions
of things said to him.
Formal testing could not
be carried out, but he certainly could not be regarded as feebleminded
in the ordinary sense. After hearing his boarding mother say grace three
times, he repeated it without a flaw and has retained it since then. He
could count and name colors. He learned quickly to identify his favorite
victrola records form a larde stack and knew how to mount and play them.
His boarding mother reported
a number of observations that indicated compulsive behavior. He often masturbated
with complete abandon. He ran around in circles emitting phrases in an
ecstatic-like fashion. He took a small blanket and kept shaking it, delightedly
shouting, "Ee! Ee!"He could continue in this manner for a long time and
showed great irritation when he was interfered with. All these and many
other things were not only repetitions but recurred day after day with
almost photographic sameness.
Cases
5 and 6. |