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Case 10

John F. was first seen on February 13, 1940, at 2 years, 4 months of age.

The father said: “The main thing that worries me is the difficulty in feeding. That is the essential thing, and secondly his slowness in development. During the first days of life he did not take the breast satisfactorily. After fifteen days he was changet from breast to bottle but did not take the bottle satisfactorily. There is a long story of trying to get food down. We have tried everything under the sun. He has been immature all along. at 20 months he first started to walk. He sucks his thumb and grinds his teeth quite frequently and rolls from sid to side before sleeping. If we dom’t do what he want’s, he will scream and yell.”

John was born September 19, 1937; his birth weight was 7Ѕ pounds. There were frequent hospitalizations because of the feeding problem. No physical disorder was ever found, except that the anterior fontanelle did not close until he was 2Ѕ years of age. He suffered from repeated colds and otitis media, which necessitated bilateral myringotomy.

John was an only child until February, 1943. The father, a psychiatrist, is “a very calm, placid, emotionally stable person, who is the soothing element in the family.”The mother, a higt school graduate, worked as secretary in a pathology laboratory before marriage-  “a hypomanic type of person; sees everything as a pathological specimen rather than well; throughout the pregnancy she was very apprehensive, afraid she would not livethrough the labor.”The paternal grandmother is “obsessive about religion and washer her hands every few minutes.”The maternal grandfather was an accountant.

John was brought to the office by  both parents. He wandered aboput the room constantly and aimlessly. Except for spontaneous scribbling, he never brought two objects into relation to each other. He did not respond to the simplest commands, except that his parents with much difficulty elicited bye-bye, pat-a-cake, and peek-a-boo gestures, performed clumsily. His typical attitude toward objects was to throw them on the floor.

Three months later, his vocabulary showed remarkable improvement, though his articulation was defective. Mild obsessive trends were reported, such as pushing aside the first spoonful of every dish. His excursions about the office were slightly more purposeful.

At the end of his fourth year, he was able to form a very limited kind of affective contact, and even that only with a very limited number of people. Once such a relationship had been established, it had to continue in exactly the same channels. He was capable of forming elaborate and grammatically correct sentences, but he used the pronoun of the second person when referring to himself. He used language not as a means of communication but mainly as a repetition of things he had heard, without alteration of the personal pronoun. There was very marked obsessiveness. Daily routine must be adhered to rigidly; any slightest change of the pattern called forth outbursts of panic. There was endless repetition of sentences. He had an  excellent rote memory and colud recite many prayers, nursery rhymes, and songs “in different languages”; the mother did a great deal of stuffing in this respect and was very proud of these “achievements”: “He can tell victrola records by their color and if one side of the record is identified, he remembers what is on the other side.”

At 4Ѕ years, he began gradually to use pronouns adequately. Even though his direct interest was in objects only, he took great pains in attracting the attention of the examiner ( Dr. Hilde Bruch) and in gaining her praise.

However, he never addressed her directly spontaneously. He wanted to make sure of the sameness of the environment literally by keeping doors and windows closed. When his mother opened the door “to pierce through his obsession,”he became violent in closing it again and finally, when again interfered with, burst helplessly into tears, utterly frustrated.

He was extremely upset upon seeing anything broken or incomplete. He noticed two dolls to which he had paid no attention before. He saw that one of them had no hat and became very much agitated, wandering about the room to look for the hat. When the hat was retrieved from another room, he instantly lost all interest in the dolls.

At 5Ѕ years, he had good mastery of the use of pronouns. He had begun to feed himself satisfactorily. He saw a group photograph in the office and asked his father, “When are they coming out of the picture and coming in here:”

He was very serious about this. His father said somethig about the pictures they have at home on the wall. This disturbed John somewhat. he corrected his father: “We have them near the wall”( “on”apparently meaning to him “above”or “on top”).

When he saw a penny, he said, “Penny. That’s where you play tempins.”He had been given pennies when he knocked over tenpins while playing with his father at home.

He saw a dictionary and said to his father, “That’s where you left the money?”

Once his father had left some money in a dictionary and asked John to tell his mother about it.

His father whistled a tune and John and correctly identified it as “Mendelssohn’s violin concerto.”Thogh he could speak of things as big or pretty, he was utterly incapable of making comparisons (“Which is the bigger line? Prettier face?”etc.).

In December, 1942, and January, 1943, he had two series of predominantly right-sided convulsions, with conjugate deviation of the eyes to the right and transient paresis of the right arm. Neurologic examination showed no abnormalities. His eyegrounds were normal. an electoencephalogram indicated “focal disturbance in the left occipital region, “but “a part of the record colud not be read because of the continuous marked artefacts due to the child’s lack of cooperation.”









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