Autism in Childhood - One

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.

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Hans Asperger (1906 - 1980)

In what follows, I will describe a particularly interesting and highly recognisable type of child. [1]

The children I will present all have in common a fundamental disturbance which manifests itself in their physical appearance, expressive functions and, indeed, their whole behaviour.

This disturbance results in severe and characteristic difficulties of social integration. In many cases the social problems are so profound that they overshadow everything else. In some cases, however, the problems are compensated by a high level of original thought and experience. This can often lead to exceptional achievements in later life.

With the type of personality disorder presented here we can demonstrate the truth of the claim that exceptional human beings must be given exceptional educational treatment, treatment which takes account of their special difficulties. Further, we can show that despite abnormality human beings can fulfil their social role within the community, especially if they find understanding, love and guidance.

There are many reasons for describing in detail this type of abnormally developing child. Not the least of them is that these children raise questions of central importance to psychology and education.

Name and Concept

I have chosen the label ‘autism’ [2] in an effort to define the basic disorder that generates the abnormal personality structure of the children we are concerned with here. The name derives from the concept of autism in schizophrenia.

Autism in this sense refers to a fundamental disturbance of contact that is manifest in an extreme form in schizophrenic patients. The name ‘autism’, coined by Bleuler, is undoubtedly one of the great linguistic and conceptual creations in medical nomenclature. [3]

Human beings normally live in constant interaction with their environment, and react to it continually. However, ‘autists’ have severely disturbed and considerably limited interaction.

The autist is only himself (cf. The Greek word αύτος) and is not an active member of a greater organism which he is influenced by and which he influences constantly.

Bleuler’s formulations of schizophrenic autism included the following: The schizophrenic patient loses contact with reality to varying degrees. He ceases to care about the real world. He shows a lack of initiative, aimlessness, neglect of reality, distractedness, but also impulsive and bizarre behaviour. Many of his actions, as well as his whole attitude to life, are insufficiently externally motivated.

Both intensity and extent of attention are disordered. There is lack of persistence, but occasionally certain goals are held on to tenaciously. One often finds ‘whimsical obstinacy’, that is, the patient wants something and at the same time the opposite. One finds obsessional acts, automatic acts, automatic commands etc. Schizophrenic patients often live in an imaginary world of wish fulfilment and ideas of persecution.

Bleuler here describes a particular type of thinking which he calls ‘autistic’ or ‘dereistic’ thinking. [4] This thinking is not goal-directed but is guided by desires and affects. Apart from schizophrenia, where it is at its most bizarre, autistic or dereistic thinking can also be found in people who are not psychotic, and indeed in everyday life, for example, in superstition or pseudo-science.

However, this type of thinking does not play a role in the children we are concerned with here. At most, there may be occasional hints at this particular type of thought disturbance. All but the last mentioned feature of Bleuer’s concept of autism can be found in the type of personality disorder to be described here.

While the schizophrenic patient seems to show progressive loss of contact, the children we are discussing lack contact from the start. Autism is the paramount feature in both cases. It totally colours affect, intellect, will and action.

Essential symptoms of schizophrenia and the symptoms of our children can thus be brought under a common denominator: the shutting-off of relations between self and the outside world.

However, unlike schizophrenic patients, our children do not show a disintegration of personality. They are therefore not psychotic instead the show a greater or lesser degree of psychopathy. The fundamental disorder that we have identified in our children affects all expressions of their personality and can explain their difficulties and deficits as well as their special achievements.

Once one has learnt to pay attention to the characteristic manifestations of autism, one realises that they are not at all rare in children, especially in their milder forms. A few prototypical cases will be described below.

Fritz V.

We start with a highly unusual boy who shows a very severe impairment in social integration. This boy was born in June 1933 and came for observation to the Heilpädagogische Abteilung (Remedial Department) of the University Paediatric Clinic in Vienna in the autumn of 1939. [5]

He was referred by his school as he was considered to be ‘ineducable’ by the end of his first day there. Fritz was the first child of his parents. He had a brother two years younger who was also somewhat difficult but not nearly as deviant as Fritz. Birth was normal. Motor milestones were rather delayed. He learnt to walk at fourteen months, and for a long time was extremely clumsy and unable to do things for himself. He learnt the practical routines of daily life very late and with great difficulty. [6]

This will be looked at in more detail later. In contrast, he learnt to talk very early and spoke his first words at ten months, well before he could walk. He quickly learnt to express himself in sentences and soon talked ‘like an adult’. [7] Nothing was reported about unusual childhood illnesses and there was no indication of any brain disease.

From the earliest age Fritz never did what he was told. He did just what he wanted to, or the opposite of what he was told. He was always restless and fidgety, and tended to grab everything within reach. Prohibitions did not deter him. Since he had a pronounced destructive urge, anything that got into his hands was soon torn or broken. [8]

He was never able to become integrated into a group of playing children. He never got on with other children and, in fact, was not interested in them. They only ‘wound him up’, He quickly became aggressive and lashed out with anything he could get hold of (once with a hammer), regardless of the danger to others. For this he was thrown out of kindergarten after only a few days.

Similarly, because of his totally uninhibited behaviour, his schooling failed on the first day. He had attacked other children, walked nonchalantly about in class and tried to demolish the coat-racks. He had no real love for anybody but occasionally had fits of affection. Then he would embrace various people, seemingly quite unmotivated. The effect, however, was not at all pleasant. This behaviour never felt like the expression of genuine affection, instead, it appeared to be as abrupt as a fit.

One could not help thinking that Fritz might never be able to love anyone and would never do something solely to please somebody else. He did not care if people were sad or upset about him. He appeared almost to enjoy people being angry with him while they tried to teach him, as if this were a pleasurable sensation which he tried to provoke by negativism and disobedience. [9]

Continue reading: Autism in Childhood - Part Two

1 The first seven pages of general and somewhat discursive introduction, which Asperger himself omitted from a slightly revised reprint of the paper in his textbook “Heilpädagogik” (1952), are omitted in this translation. The omitted section consists of a discussion of various then current typologies, whose aim it was to categorise personalities in normal as well as pathological forms. It finishes with the suggestion that it is possible to overcome their limitations by using general descriptions as well as individual ease studies.

2 The title of Asperger's landmark paper has propagated the term autistic psychopathy. This term could have been translated as autistic personality disorder or else autism to bring it into line with current terminology.

3 The Swiss psychiatrist Eugen Bleuler, who wrote an influential textbook of psychiatry, coined not only the term autism but also the term schizophrenia. Bleuler differentiated autism and autistic thinking. In English translations of his writings these are usually translated as dereism and dereistic thinking, referring to a lost of contact with reality.

4 For Bleuler autistic thinking meant thought associations driven by affects. He applied this concept not only to schizophrenic patients but also to normal people. “Autistic thinking turns the boy playing soldiers into a general, the girl playing with her doll into a happy mother... it enables the dreamer to express his wishes and fears!”

In 1919 Bleuler published ‘The Autism-Undisciplined Thinking in Medicine and How to Overcome it’, where he castigated then current medical practice. He gave examples of beliefs in medicine that are wishful rather than truthful, analogical rather than logical, fantasy rather than reality. It is clear from this bitter treatise that autistic thinking in Bleuler’s sense has nothing to do with autism as we know it. This is also recognised by Asperger, who in his later revision for his textbook (1952), omits any reference to dereistic thinking.

5 This famous clinic was founded in 1918 by Erwin Lazar and pioneered a combination of special education and paediatrics.

6 Practical routines include self-help skills such as washing, dressing and, generally, keeping clothes and body clean, and probably also some typical social skills, such as eating properly at table, and sitting still and paying mention at school. Toilet training is never mentioned while it looms large as a problem in Kanner’s cases.

7 Donald, Kanner's first case, also appears to have had rather early and unusual development of speech. By the age of two, he was said to be able to name large numbers of pictures and to recite poetry and prose. Asperger's descriptive phrase “talking like an adult” suggests oddness over and above precocity.

8 While conduct problems are highly prominent symptoms in Asperger’s cases, they are not in Kanner's sample although the problems mentioned there do include aggressive and destructive behaviour. This difference can perhaps be explained by the more child centred attitudes prevalent in the United States at the time, while in Europe the instilling of respect and discipline had remained a major aspect of education.

9 The social impairment described here closely resembles the picture of the ‘odd‘ rather than the ‘aloof’ or ‘passive` type, using Wing and Gould‘s (1979) terminology.