Herbert B. was referred on February 5, 1941. at 3 yeras, 2 months of age. 
He was thought to be seriously retarded in intellectual development. There were no physical abnormalities except for undescended testicles. His electroencephalogram was normal. 
Herbert was born November 16, 1937, two weeks before term by elective cesarean section; his birth weight was 6 ¼ pounds. He vomited all food from birth througt the third month. Then vomiting ceased almost abruptly and, except for occasional regurgitation, feeding proceeded satisfactorily. 
According to his mother, he was “always slow and quiet.”for a time he was believed to be deaf because “he did not register any change of expression when spoken to or when in the presence of other people; also, he made no attempt to speak or to form words.”He held up his head at 4 months and sat at 8 months, but did not try to walk until 2 years old, when suddenly “he began to walkwithout any preliminary crawling or assistance by chairs.”He persistently refused to take fluid in any but an all-glass container. Once, while at a hospital, he went three days without fluid because it was offered in tin cups. He was “tremendously frightened by running water, gas burners, and many other things,”He became upset by any change of an accustomed pattern: “if he notices change, he is very fussy and cries.”But he himself liked to pull blinds up and down, to tear cardboard boxes into small pieces and play with them for hours, and to close open the wings of doors. 
Herbert’s parents separated shortly after his birth. The father, a psychiatrist, is described as “a man of unusual intelligence, sensitive, restless, introspective, taking himself very seriously, not interested in people, mostly living within himself, at times alcoholic.”The mother, a physician, speaks of herself as “energetic and outgoing, fond of people and children but having little insight into their problems, finding it a great deal easier to accept people rather than try to understand them.”Herbert in the youngest of three children. The second is a normal, healthy boy. The oldest, Dorothy, born in June, 1934, after thirty-six hours of hard labor, seemed alert and responsive as an infant and said many words at 18 months, but toward the end of the second year she “did not show much progression in her play relationships or in contacts with other people.”She wanted to be left alone, danced about in circles, made queer noises with her mouth, and ignored persons completely except for her mother, to whom she clung “in panic and general agitation.”(Her father hated her ostensibly.) “Her speech was very meager and expression of ideas completely lacking. She had difficulties with her pronouns and would repeat ‘you’and ‘I’ instead of using them for the proper persons.”She was firs declared to be feebleminded, then schizophrenic, but after the parents separated (the children remaining with their mother), she “bolssomed out.”She now attends scholl, where she makes good progress; she talks well, has an IQ of 108, and-tough sensitive and moderately apprehensive-is interested in people and gets along reasonably well with them. 
Herbert, when examined on his first visit, showed a remarkably intelligent physiognomy and good motor coordination. Within certain limits, he displayed astounding purposefulness in the pursuit of sef-selected goals. 
Among a group of blocks, he instantly recognized those were glued to a board and those that were detachable. He could build a tower of blocks as skillfully and as high as any child of his age or even older. He could not be diverted form his self-chosen occupations. He was annoyed by any interference, shoving intruders away (without ever looking at them), or screaming when the shoving had no effect. 
He was again seen at 4 years, 7 months, and again at 5 years, 2 months of age.He still did not speak. both times he entered the office without paying the slightest attention to the people present. He went after the Seguin form board and instantly busied himself putting the figures into their proper spaces and taking them out again adroitly and quickly. when interfered with he whined impatiently. When one figure was stealthily removed, he immediately noticed its absence, became disturbed, but promptly forgot all about it when it was put back. At times, after he had finally quieted down following the upset caused by the removal of the form board, he jumped up and down on the couch with an ecstatic expression on his face. He did not respond to being called or to any other words addressed to him. he sometimes uttered inarticulate sounds in a monotonous singsong manner. At on time he gently stroked his mother’s leg and touched it with his lips. He very frequently brought blocks and other objects to his lips. There was an almost photographic of his behavior during the visits, with the main exception that at 4 years he showed apprehensino and shrank back when a match was lighted, while at 5 years he reacted by jumping up and down ecstatically. 

Case 8  

Alfred L. was brought by his mother in November, 1935, at 3½ years of age with this complaint: 
He has gradually shown a marked tendency toward developing one special interest which will completely dominate his day’s activities. He talks of little else while the interest exists, he frets when he is not able to indulge in it (by seeing it, coming in contact with it, drawing pictures of it), and it is difficult to get his attention because of his preoccupation.... there has also been the problem of an overattachment to the world of objects and failure to develop the usual amount of social awareness. 
Alfred was born in May, 1932, there weeks before term. For the first two months, “The feeding formula caused considereble concern but then he gained rapidly and became an unusually large and vigorous baby.”He sat up at 5 months and walked at 14. 
Language developed slowly; he seemed to have no interst in it. He seldom tells experience. He still confuses pronouns. Henever asks questions in the form of questions (with the appropriate inflection), Since he talked, there has been a tendency to repeat over and over word or statement.He almost never says a sentence without repeating it. Yesterday, when looking at a picture, he said many times, “Some cows standing in the water.”we counted fify repetitions, then he stopped after several more and then began over and over. 
He dad a good deal Of “worrying”: 
He frets when the bread is put in the oven to be made into toast, and is afraid it will get burned and be hurt. He is upset when the su sets. He is upset because the moon does not always appear in the sky at night. He prefers to play alone; he will get down from a piece of apparatus as soon as another child approaches. He likes to work out some project with large boxes (make a trolley, for instance) and does not want anyone to get on it or interfere. 
When infantile thumb sucking was prevented by mechanical devices, he gave it up and instead put various objects into his mouth. On several occasions pebbles were found in his stools. Shortly before his second birthday, he swallowed cotton from an Easter rabbit, aspirating some of the cotton, so that tracheotomy became necessary. a few months later, he swallowed some kerosene “with no ill effects.” 
Alfred was an only child. His father, 30 years old at time of his birth, “does not get along well with people, is suspicious, easily hurt, easily roused to anger, has to be dragged out to visit friends, spends his spare time reading, gardening, and fishing.”He is chemist and a law school graduate. The mother, of the same age, is a “clinical psychologist,”very obsessive and excitable. The paternal granparents died early; the father was adopted by a minister. the maternal grandfather, a psychologist, was severely obsessive, had numerous tics, was given to “repeated hand washing, protracted thinking along one line, fear of being alone, cardiac feras,”The grandmother, “an excitable, explosive person, has done public speaking, published several books, is an incessant solitarie player, greatly worried over money matters,”A maternal uncle frequently ran away from home and school, joined the marines, and later “made a splendid adjustment in commercial life.” 
The mother left her husband two months after Alfred’s birth. The child has lived with his mother and maternal grandparents. “In the home is a nursery school and kindregarten (run by the mother), which creates some confusino for the child.”Alfred did not see his father until he was 3 years, 4 months old, when the mother decided that “he should know his father”and “took steps to have the father come to the home to see the child,” 
Alfred, upon entering the office, paid no attention to the examiner. He immediately spotted a train in the toy cabinet, took it out, and connected and disconnected the cars in a slow, monotonous manner. He kept saying many times, “More train-more train-more train.”He repeatedly “counted”the car windows: “One, two windows-one, two windows-one, two windows-four window, eight window, eigth windows,”He could not in any way be distracted from the trains. A Binet test was attempted in a room in which there were no trains. It was possible with much difficulty to pierce form time to time through his preoccupations. He finally complied in most instances in a manner that clearly indicated that he wanted to get through with the particular intrusion; this was repeated with each individual item of the task. In the end he achieved an IQ of 140. 
The mother did not bring him back after this visit because of “his continued distress when confronted with a member of the medical profession.”In august, 1938, she sent upon request a written report of his development. From this reprt, the following passages are quoted: 
He is called a lone wolf. He prefers to play alone and avoids groups of children at play. He does not pay much attention to adults except when demanding stories. He avoids competition. He reads simple stories to himself. He is very fearful of being hurt, talks a great deal about the use of the electric chair. He is thrown into a panic when anyone accidentally covers his face. 
Alfred was again referred in June, 1941. His parents had decided to live together. Prior to that the boy had been in eleven different schools. He had been kept in bed often vecause of colds, bronchitis, chickenpox, streptococcus intection, impetigo, and a vaguely described condition which the mother-the assurances of various pediatricians tothe contrary notwithstanding-insisted was “rheumatic fever.”While in the hospital, he is said to have behaved “like a manic patient.”The mother liked to call herself a psychiatrist and to make “psychiatric”diagnoses of the child. From the mother’s report, which combined obsessive enumeration of detailed instsnces with “explanations”trying to prove Alfred’s “normalcy,”the following information was gathered. 
He had begun to play with children younger than himself, “using them as puppets-that’s all.”He had been stuffed with music, dramatics, and recitals, and had an excellent rote memory. He still was “terrbly engrossed”in his play, didn’t want people around, just couldn’t relax: 
He had many fears, almost always connected with mechanical noise (meat grinders, vaccun cleaners, streetcars, trains, etc.). Usually he winds up with an obsessed interest in the things he was afraid of. Now he is afraid of the shrillness of the dog’s barking. 
Alfred was extremely tense during the entire interview, and very serious-minded, to such an extent that had it not been for hs juvenile voice, he might have given the impression of a worried and preoccupied little old man. At the same time, he was very retless and showed considerable pressure of talk, which had nothing personal in it but consisted of obsessive questions about windows, shades, dark rooms, especially the X-ray room. He never smiled. No change of topic could get him away from the topic of light and darkness. but in between he answered the examiner’s questions, which often had to be repeated several times, and to which he sometimes responded as the result of a bargain-”You answer my question, and I’ll answer Yors.”He was painstakingly specific in his definitions. A ballon “is made out of lined rubber and has air in it and some have gas and sometimes they go up in the air and sometimes they can hold up and when they got a hole in it they’ll bust up; if people squeeze they’ll bust. isn’t right?”A tiger “is a thing, animal, striped, like a cat, can scratch, eats people up, wild, lives in the jungle sometimes and in the forests, mostly in the jungle. Isn’t right?”This question “Isn’t it right?’was definitely meant to be answered; there was a serious desire to be assured that the definition was sufficiently complete. 
He was often confused about the meaning of words. When shown a picture and asked, “what is this picture about?”he replied, “People are moving about.” 
He once stopped and asked, very much perplexed, why there was “The Johns Hopkins Hospital”printed on the history sheets: “Why do they have to say it?”This, to him, was a real problem of major importance, calling for a great deal of thought and discussion. Since the histories were taken at the hospital, why should it be necessary to have the name on every sheet, though the person writing on it knew where was writing? The examiner, whom he remembered very well from his visit six years previously, was to him nothing more nor less than a person who expected to answer his obsessive questions about darkness and light. 

Cases 9 and 10.