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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. Hevomited 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 emergedfrom 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 our 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 notbe 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.









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