EARLY I N F A N T I L E AUTISM LEO KANNER,
M.D
BALTIMORE, MD.
URING the past six years, I have become increasingly interested
D in a number of children, twenty by now, whose behavior differs uniquely and markedly from anything reported so far. Among the individual patients there are great variations in the degree of the disturbance, in the manifestation of specific features, and in the stepby-step development in the course of time. Yet in spite of this seeming divergence they all present essential common characteristics to such an extent that they cannot but be considered as fundamentally alike from the point of view of psychopathology. Many of these children were brought to us primarily with the assumption that they were severely feeble-minded or with the question of auditory impairment. Psychometric test performances yielded indeed very low quotients, and often enough absent or inadequate responses to sounds of any kind g a v e good reason for the suspicion of deafness. But careful examination showed very soon that the children's cognitive potentialities were only masked by the basic affeetive disorder; in fact, a few of the children had started out by amazing their parents with phenomenal feats of rote repetition. In all instances it could be established that hearing as such was not defective. The common denominator in all ,-these patients is their disability to relate themselves in the ordinary way to peopie and situations from the beginning of life. Their parents referred to them as always having been "self-sufficient," " l i k e in a shell," "happiest when left alone," " a c t i n g as if people weren't there," "giving the impression of silent wisdom." The ease histories indicate invariably the presence from the start of extreme autistic aloneness which, wherever possible, disregards, ignores, Shuts out anything that comes to the child from the outside. Almost every mother recalled her astonishment at the child's failure to assume at any time the usual anticipatory posture preparatory to being picked' up. According to Gesell this kind of adjustment occurs universally at 4 months of age. Two case histories may serve to illustrate the principal features: CASE 1 . - - P a u l 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 a t t e n d e d a nursery school where his ~ncoherent speech, inability to conform, and temper outbursts created the impression of feeble-mindedness. Paul, an only child, when nearly 2 years of age, had come to this country from England with his mother. The father, a mining engineer, had left his wife a f t e r several years of an unhappy marriage. The mother, a restless, unstable, excitable woman, gave a vague and b l a t a n t l y conflicting history of the family background 211