Case 2

Frederick W. was referred on May 27, 1942, at the age of 6 years, with the physician’s complaint that his “adaptive behavior in a social satting is characterized by attacking as well as withdrawing behavior.” His mother stated:

The child has always beenself-sufficient. I could leave him alone and he’d entertain himself very happily, walking around, singing. I have never known him to cry in demanding attention. He was never interested in hide-and-seek, but he’d roll a ball back and forth, watch his father shave, hold the razor box and put the razor back in, put the lid on the soap box. He never was very good with cooperative play. He doesn’t care to play with the ordinary things that other children play  with, anything with wheels on.

He is afraid of mechanicalthings; he runs from them. He used to be afraid of my  egg beater, is perfectly pertrified of my vacuum cleaner. Elevators are simply a terrifying experience to him. He is afraid of spinning tops.

Until the last year, he mostly ignored other people. When we had guests, he just wouldn’t pay any attention. He looked curiously at small children and then would go off all alone. He acted as if people weren’t there at all, even with his grandparents. About a year ago, he began showing more interest in observing them, would even go up to them. But usually people are an interference, He’ll push people away from him. If people come too close to him, he’ll push them away. He doesn’t want me to touch him or put my arm around him, but he’ll come and touch me.

To a certain extent, he likes to stick to the same thing. On one of the bookshelves we had three pieces in a certain arrangement. Whenever this was changed he always rearranged it in the old pattern. He won’t try new things, apparently. After watching for a log time, he does it all of a sudden. He wants to be  sure he does it right.

He has said at least two words [“Daddy” and “Dora,” the mother’s first name] before he was 2 years old. From then on between 2 and 3 years, he would say words that seemed to come as a surprise to himself. He’d say them once and never repeat them. One of first words he said was ”overalls,” [The parents never expected him to answer any of their questions, were once surprised when he did give an answer-”Yes”.] At About 2Ѕ years, he began to sing. He sang about twenty or thirty songs, including a little French lullaby. In his fourth year, I tried to make him ask for things before he’d get them. He was stronger-willed than I was and held out longer, and he would not get it but he never in about it. Now he can count up to into the hundreds and can read numbers, but he is not interested in numbers as they apply to objects. He has great difficulty in learning the proper use of personal pronouns. When receiving a gift, he would say of himself: “You say ‘Thank you.’”

He bowls, and when he seesthe pins go down, he’ll jump up and down in great glee.

Frederick was born May 23, 1936, in breech presentation. The mother had “some kidney trouble” and an elective cesarean section was performed about two weeks before term. He was well after birth; feeding presented no problem. The mother recalled that he was never observed to assume an anticipatory posture when she prepared to pick him up. He sat at 7 months, walked at about 18 months. He had occasional colds but no other illness. Attempts to have him attend nursery school were unsuccessful: “he would either be retiring and hide in a corner or would push himself into the middle of a group and be very aggressive.”

The boy is an only child.The father, aged 44, a university graduate and a plant pathologist, has traveled a great deal in connection with his work. He is a patient, even-tempered man, mildly obsessive; as a child he did not talk “until late” and was delicate, supposedly “from lack of vitamin in diet allowed in Africa.” The mother, aged 40, a college graduate, successively a secretary to physicians, a purchasing agent, director of secretarial studies in a girls’ school, and at one time a teacher of history, is described as healthy and even-tempered.

The paternal grandfatherorganized medical missions in Africa, studied tropical medicine in England, became an authority on manganese mining in Brazil, was at the same time dean of a medical school and director of an art museum in an American city, and is listed in Who’s Who under two different names. He disappeared in 1911, his whereabouts remaining obscure for twenty-five years. It was then learned that he had gone to Europe and married a novelist, without obtaining a divorce from his first wife. The family considers him “a very strong character of the genius type, who wanted to do as much good as he could.”

The paternal grandmother is described as “a dyed-in-the-wool missionary if ever there was one, quite dominating and hard to get along with, at present pioneering in the South at a college for mountaineers.” The father is the second of five children. The oldest is a well known newspaper man and author of a best-seller. A married sister, “high-strung and quite precocious,” is a singer. Next comes a brother who writes for adventure magazines. The youngest, a painter, writer and radio commentator, “did not talk until he was about 6 years old,” and the first words he is reported to have spoken were, “When a lion can’t talk he can whistle.”

The mother said of her ownrelatives, “Mine are very ordinary people.” Her family is settled in a Wisconsin town, where her father is a banker; her mother is “mildly interested” in church work, and her three sisters, all younger than herself, are average middle-class matrons.

Frederick was admitted tothe harriet Lane Home on May 27, 1942. He appeared to be well nourished. The circumference of his head was 21 inches, of his chest 22 inches, of his abdomen 21 inches, His occiput and frontal region was markedly prominent. There was a supernumerary nipple in the left axilla. Reflexes were sluggish but present. All other findings, including laboratory examinations and X-ray of his skull, were normal, except for large and ragged tonsils.

He was led into the psychiatrist’s office by a nurse, who left the room immediately afterward. His facial expression was tense, somewhat apprehensive, and gave the impression of intelligence. He wandered aimlessly about for a few moments, showing no sign of awareness of the adults present. He then sat down on the couch, ejaculating unintelligible sounds, and then abruptly lay down, wearing throughout a dreamy-like smile. When he responded to questions or commands at all, he did so by repeating them echolalia fashion. The most striking feature in his behavior was the difference in his reactions to objects and to people. Objects absorbed him easily and he showed good attention and perseverance in playing with them. He seemed to regard people as unwelcome intruders to whom he paid as little attention as they would permit. When forced to respond, he did so briefly and returned to his absorption in things. When a hand was held out before him so that he could not possibly ignore it, he played with it briefly as if were a detached object. He blew out a match with an expression of satisfaction with the achievement, but did not look up to the person who had lit the match. When a fourth person entered the room, he retreated for a minute or two behind the bookcase, saying. “I don’t want you,” and waving him away, then resumed his play, paying no further attention to him or anyone else.

Test results (Grace Arthur performance scale) were difficult to evaluate because of his lack of cooperation. He did best with the Seguin form board (shortest time, 58 seconds). In the mare and foal completion test he seemed to be guided by form entirely, to the extent that it made no difference whether the pieces were right side up or not. He completed the triangle but not the rectangle. With all the form boards he showed good perseverance and concentration, working at them spontaneously and interestedly. Between tests, he wandered about the room examining various objects or fishing in the wastebasket without regard for the persons present. He made frequent sucking noises and occasionally kissed the dorsal surface of his hand. He became fascinated with the circle from the form board, rolling it on the desk and attempting, with occasional success, to catch it just before it rolled off.

Frederick was enrolled atthe Devereux Schools on September 26, 1942.