Case 7

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 ј 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 onhis 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.