Autism in Childhood - Two

Autistic Psychopathy in Childhood, ex Die ‘Autistischen Psychopathen’ im Kindersalter. Asperger, H. (1944) Archiv für Psychiatrie und Nervenkrankheiten, 117, 76-136.Translated and annotated by Uta Frith. From “Autism and Asperger syndrome” Edited by Uta Frith. ISBN-10: 052138608X

©1991 Cambridge University Press.

Part Two

Fritz did not know the meaning of respect and was utterly indifferent to the authority of adults. He lacked distance and talked without shyness even to strangers. Although he acquired language very early, it was impossible to teach him the polite form of address (‘Sie’). He called everybody ‘Du’.

Another strange phenomenon in this boy was the occurrence of certain stereotypic movements and habits. [10]

Family history

The mother stemmed from the family of one of the greatest Austrian poets. Her side of the family were mostly intellectuals and all were, according to her, in the mad-genius mould. Several wrote poetry ‘quite beautifully’. A sister of the maternal grandfather, ‘a brilliant pedagogue’, lived as an eccentric recluse. The maternal grandfather and several of his relatives had been expelled from state schools and had to attend private school. Fritz strongly resembled this grandfather. He too was said to have been an exceptionally difficult child and now rather resembled the caricature of a scholar, preoccupied with his own thoughts and out of touch with the real world.

The mother herself was very similar to the boy. This similarity was particularly striking given that she was a woman, since, in general, one would expect a higher degree of intuitive social adaptation in women, more emotion than intellect. In the way she moved and spoke, indeed in her whole demeanour, she seemed strange and rather a loner.

Very characteristic, for instance, was the situation when mother and son walked to the hospital school together, but each by themselves. The mother slouched along, hands held behind his back and apparently oblivious to the world. Beside her the boy was rushing to and fro, doing mischief. They gave the appearance of having absolutely nothing to do with each other. [11]

One could not help thinking that the mother found it difficult to cope not only with her child but with the practical matters of life. She was certainly not up to running the household. Even living, as she did, in the upper echelons of society, she always looked unkempt, unwashed almost, and was always badly dressed. [12]

She was also, clearly, not coping with the physical care of her son. It has to be said, however, that this was a particularly difficult problem. The mother knew her son through and through and understood his difficulties very well. She tried to find similar traits in herself and in her relations and talked about this eloquently. She emphasised again and again that she was at the end of her tether, and this was indeed obvious as soon as one saw them both together.

It was clear that this state of affairs was due not only to the boy‘s own internally caused problems, but also to the mother’s own problems in relating to the outside world, showing as she did a limited intuitive social understanding. Take the following typical trait: whenever things became too much for her at home she would simply walk out on her family and travel to her beloved mountains. She would stay there for a week or more at a time, leaving the rest of the family to struggle for themselves.

The boy‘s father came from an ordinary farming family, with no reported peculiarities. He had made a successful career for himself, eventually becoming a high-ranking civil servant. He married late and was fifty-five years old when his first child was born. The father was a withdrawn and reticent man who did not give much away about himself. He clearly hated to talk about himself and his interests. He was extremely correct and pedantic and kept a more than usual distance.

Appearance and expressive characteristics

The boy was of a rather delicate build and very tall, 11 cm above the average height for his age. He was thin, fine-boned and his musculature was weakly developed. His skin was of yellowish-grey pallor. The veins were clearly visible on the temples and upper parts of the body. His posture was slouched, his shoulders slumped, with the shoulder blades protruding, Otherwise his appearance was unremarkable. The face showed line and aristocratic features, prematurely differentiated in a six-year-old, Any baby features had long since gone.

His eye gaze was strikingly odd. [13] It was generally directed into the void, but was occasionally interrupted by a momentary malignant glimmer. When somebody was talking to him he did not enter into the sort of eye contact which would normally be fundamental to conversation. He darted short ‘peripheral’ looks and glanced at both people and objects only fleetingly. It was as if he wasn't there.

The same impression could be gained of his voice, which was high and thin and sounded far away. The normal speech melody, the natural flow of speech, was missing, Most of the time, he spoke very slowly, dragging out certain words for an exceptionally long time. He also showed increased modulation so that his speech was often sing-song.

The content of his speech too was completely different from what one would expect of a normal child: only rarely was what he said in answer to a question. One usually had to ask a question many times before it registered, When he did answer, once in a while, the answer was as short as possible. Often, however, it was sheer luck if he reacted at all! Either he simply did not answer, or he turned away while beating a rhythm or indulging in some other stereotypic behaviour.

Occasionally, he repeated , the question or a single word from the question that had apparently made an impression on him; sometimes he sang, “I don't like to say that ...”

Behaviour on the ward

Posture, eye gaze, voice and speech made it obvious at first glance that the boy's relations to the outside world were extremely limited. This was instantly apparent also in his behaviour with other children. From the moment he set foot on the ward he stood out from the rest of the group, and this did not change.

He remained an outsider and never took much. Notice of the world around him. It was impossible to get him to join in group play, but neither could he play properly by himself. He just did not know what to do with the toys he was given. For instance, he put building blocks in his mouth and chewed them, or he threw them under the beds. The noise this created seemed to give him pleasure. [14]

While appropriate reactions to people, things and situations were largely absent, he gave full rein to his own internally generated impulses. These were unrelated to outside stimuli. Most conspicuous in this respect were his stereotypic movements; he would suddenly start to bear rhythmically on his thighs, bang loudly on the table, hit the wall, hit another person or jump around the room. He would do this without taking any notice of the amazement of those around him.

For the most part, these impulses occurred out of the blue, but sometimes they were provoked, for instance, when certain demands were made which acted as undesirable intrusions into his encapsulated personality. Even when one was able to get him to respond for a short time, it was not long before he became unhappy, and there would eventually be an outburst of shouts or odd stereotypic movements.

On other occasions, it was sheer restlessness which seemed to drive him to engage in stereotypic behaviour. Whenever the ward was in a noisy, happy or restless mood, for instance, when there was a competitive game going on, then one could be sure that he would soon break out of the group and start jumping or hitting.

In addition to these problems there were also various nasty and unacceptable habits. He ate the most impossible things, for example, whole pencils, wood and lead, or paper, in considerable quantities. Not surprisingly, he frequently had stomach problems. He was in the habit of licking the table and then playing around with his spit.

He also committed the mischievous acts which are characteristic of this type of child. [15] The same boy who sat there listlessly with an absent look on his face would suddenly jump up with his eyes lit up, and before one could do anything, he would have done something mischievous. Perhaps he would knock everything off the table or bash another child. Of course he would always choose the smaller, more helpless ones to hit, who became very afraid of him.

Perhaps he would turn on the lights or the water, or suddenly run away from his mother or another accompanying adult, to be caught only with difficulty, Then again, he may have thrown himself into a puddle so that he would he spattered with mud from head to foot.

These impulsive acts occurred without any warning and were therefore extremely difficult to manage or control. In each of these situations it was always the worst, most embarrassing, most dangerous thing that happened. The boy seemed to have a special sense for this, and yet he appeared to take hardly any notice of the world around him! No wonder the malicious behaviour of these children so often appears

altogether ‘calculated’. [16]

As one would expect, the conduct disorders were particularly gross when demands were made on him, for instance, when one tried to something to do or to teach him something. This was regardless of whether he was in a group with other children or on his own. It required great skill to make him join some physical exercise or work even for a short while.

Apart from his intransigence to any requests, he was not good at PE because he was motorically very clumsy. He was never physically relaxed. He never ‘swung’ in any rhythm. He had no mastery over his body. It was not surprising, therefore, that he constantly tried to run away from the PE group or from the work-table. It was particularly in these situations that he would start jumping, hitting, climbing on the beds or begin some stereotyped sing-song.

Similar difficulties were encountered when one worked with him on his own. An example was his behaviour during intelligence tests. It turned out that it was impossible to get a good idea of his true intellectual abilities using standard intelligence tests. The results were highly contradictory.

His failure to respond to particular test questions seemed to be a matter of chance and a result of his profound contact disturbance. Testing was extremely difficult to carry out. He constantly jumped up or smacked the experimenter on the hand. He would repeatedly drop himself from chair to floor and then enjoy being firmly placed back in his chair again.

Often, instead of answering a question, he said ‘Nothing at all, nobody at all’ grinning horridly. Occasionally he stereotypically repeated the question or a meaningless word or perhaps a word he made up.

Questions and requests had to be repeated constantly. It was a matter of luck to catch him at exactly the moment he was ready to respond, when he would occasionally perform considerably in advance of his age. Some examples are given below.

Continue reading: Autism in Childhood - Part Three

10 Examples later on show that Fritz’s stereotypic (repetitive) movements and habits include jumping, hitting and echoing speech. The critical feature of such activity is its fragmentary nature. Often it seems to be generated without external provocation.

11 It is interesting to compare Kanner and Eisenberg`s (1955) description of the autistic boy George and his mother: ‘As they come up the stairs, the child trails forlornly behind the mother, who does not bother to look back’. Here the authors seem to sympathise with the child while being somewhat censorious of the mother. Asperger instead points out the similarity of mother and sort in the way they ignore each other.

12 Kanner and Eisenberg’s (1955) account of George's mother is again strikingly similar: ‘His mother, a college graduate, looked bedraggled at the time of the first visit. She felt futile about herself, was overwhelmed by her family responsibilities and gave the impression of drabness and ineffectualness

13 Kanner (1943) does not dwell much on peculiarity of gaze in his first case descriptions, but a clear reference to the same phenomenon that Asperger describes appears in the case of Virginia: ‘She responded when called by getting up and coming nearer, without even looking up to the person who called her. She just stood listlessly, looking into space’.

14 In comparison, Donald (Kanner’s first case described in 1943) “had a disinclination to play with children and do things children his age usually take an interest in”. Further, “he kept throwing things on the floor, seeming to delight in the sounds they made.”

15 Kanner (1943) does not talk of mischievous behaviour. However, Donald showed behaviour that Asperger would almost certainly have labelled spiteful: “He still went on chewing on paper, putting food on his hair, throwing hooks into the toilet, putting a key down the water drain, climbing onto the table and bureau, having temper tantrums.”

16 One of the most controversial of Asperger’s ideas is his contention that the autistic children he describes display intentionally spiteful or malicious behaviour. This idea has to be seen together with his other observations of the children’s general indifference to other people’s feelings Examples that Asperger gives suggest that the child had only a physical effect in mind, not a psychological one, as, for instance, when Fritz provoked his teacher because he enjoyed seeing her display anger.