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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 withher 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, hisfirst 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."









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