“In
1943 Leo Kanner published a paper that would form the basis of present day
understanding of Autistic Spectrum Disorder. He considered five features to be
diagnostic. These were: a profound lack of affective contact with other people;
an anxiously obsessive desire for the preservation of sameness in the child's
routines and environment; a fascination for objects, which are handled with
skill in fine motor movements; mutism or a kind of language that does not seem
intended for inter-personal communication; good cognitive potential shown in
feats of memory or skills on performance tests, especially the Séguin form
board . He also emphasized onset from birth or before 30 months.”
A case extract from Kanner’s original paper
Donald
T. was first seen in October, 1938, at the age of 5 years, 1 month.
"Eating,......has always been a problem with him. He has never shown a
normal appetite. Seeing children eating candy and ice cream has never been a
temptation to him."
At
the age of 1 year "he could hum and sing many tunes accurately."
Before he was 2 years old, he had "an unusual memory for faces and names,
knew the names of a great number of houses" in his home town. "He was
encouraged by the family in learning and reciting short poems, and even learned
the Twenty-third Psalm and twenty-five questions and answers of the
Presbyterian Catechism." The parents observed that "he was not
learning to ask questions or to answer questions unless they pertained to
rhymes or things of this nature, and often then he would ask no question except
in single words." His enunciation was clear.
He
knew the pictures of the presidents "and knew most of the pictures of his
ancestors and kinfolks on both sides of the house." He quickly learned the
whole alphabet" backward as well as forward" and to count to 100.
It
was observed at an early time that he was happiest when left alone, almost
never cried to go with his mother, did not seem to notice his father's
home-comings, and was indifferent to visiting relatives.
He
does not observe the fact that anyone comes or goes, and never seems glad to
see father or mother or any playmate. He seems almost to draw into his shell
and live within himself.
He
seldom comes to anyone when called but has to be picked up and carried or led
wherever he ought to go. In his second year, he "developed a mania for
spinning blocks and pans and other round objects." At the same time, he
had a dislike for self-propelling vehicles, such as Taylor-tots, tricycles, and
swings.
He
was always constantly happy and busy entertaining himself, but resented being
urged to play with certain things. When interfered with, he had temper
tantrums, during which he was destructive. He appears to be always thinking and
thinking, and to get his attention almost requires one to break down a mental
barrier between his inner consciousness and the outside world.
The
father, whom Donald resembles physically, is a successful, meticulous,
hard-working lawyer who has had two "breakdowns" under strain of
work. He always took every ailment seriously, taking to his bed and following
doctors' orders punctiliously even for the slightest cold. "When he walks
down the street, he is so absorbed in thinking that he sees nothing and nobody
and cannot remember anything about the walk." The mother, a college
graduate, is a calm, capable woman, to whom her husband feels vastly superior.
When
he desired to get down after his nap, he said, "Boo [his word for his
mother], say' Don, do you want to get down?' "His mother would comply, and
Don would say: "Now say 'All right.' "The mother did, and Don got
down.
At
mealtime, repeating something that had obviously been said to him often, he
said to his mother, "Say 'Eat it or I won't give you tomatoes, but if you
don't eat it I will give you tomatoes,' " or "Say 'If you drink to
there, I'll laugh and I'll smile.' "And his mother had to conform or else
he squealed, cried, and strained every muscle in his neck in tension. This
happened all day long about one thing or another
When
he wanted his mother to pull his shoe off, he said: "Pull off your
shoe." When he wanted a bath, he said: "Do you want a bath?"
The
word "yes" for a long time meant that he wanted his father to put him
up on his shoulder. This had a definite origin. His father, trying to teach him
to say "yes" and "no," once asked him, "Do you want me
to put you on my shoulder?" *Don expressed his agreement by repeating the
question literally, echolalia-like. His father said, "If you want me to,
say 'Yes'; if you don't want me to, say 'No.' "Don said "yes"
when asked. But thereafter "yes" came to mean that he desired to be
put up on his father's shoulder. He paid no attention to persons around him.
He
gave no heed to the presence of other children but went about his favorite
pastimes, walking off from the children if they were so bold as to join him. If
a child took a toy from him, he passively permitted it.
He
was inexhaustible in bringing up variations: "How many days in a week,
years in a century, hours in a day, hours in half a day, weeks in a century,
centuries in half a millennium," etc., etc.; "How many pints in a
gallon, how many gallons to fill four gallons?" Sometimes he asked,
"How many hours in a minute, how many days in an hour?" etc.
When
asked to subtract 4 from 10, he answered: "I'll draw a hexagon."
The
paper is quite a gem and students of child psychiatry are well advised to read
it. Leo Kanner continually questioned
the given wisdom of the day; couple that with his keen observation power and
curiosity and a natural irreverence to authority, it was only natural that he
should have created history by being the first to describe Autism.
Leo Kanner--- A Discussion
The
following is an abstract taken from the DISCUSSION SECTION of Kanner's original
paper. It may be useful to have another look at what Kanner observed all those
years ago. Fortunately for us, he had no other motive except for his keen
medical curiosity and observational power:
......The
outstanding, "pathognomonic," fundamental disorder is the children's
inability to relate themselves in the ordinary way to people and situations
from the beginning of life. Their parents referred to them as having always
been:
self-sufficient
like
in a shell
happiest
when left alone
acting
as if people weren't there
perfectly
oblivious to everything about him
giving
the impression of silent wisdom
failing
to develop the usual amount of social awareness
acting
almost as if hypnotized
It
is therefore highly significant that almost all mothers of our patients
recalled their astonishment at the children's failure to assume at any time an
anticipatory posture preparatory to being picked up.
Eight
of the eleven children acquired the ability to speak either at the usual age/or
after some delay. Three (Richard, Herbert,
Virginia) have so far remained
"mute." In none of the eight "speaking" children has
language over a period of years served to convey meaning to others.
Almost
all the parents reported, usually with much pride, that the children had
learned at an early age to repeat an inordinate number of nursery rhymes,
prayers, lists of animals, the roster of presidents, the alphabet forward and
backward, even foreign-language (French) lullabies.
Thus,
from the start, language—which the children did not use for the purpose of communication—was
deflected in a considerable measure to a self-sufficient, semantically and
conversationally valueless or grossly distorted memory exercise.
It
is difficult to know for certain whether the stuffing as such has contributed
essentially to the course of the psychopathological condition. But it is also
difficult to imagine that it did not cut deeply into the development of
language as a tool for receiving and imparting meaningful messages.
"Yes"
is a concept that it takes the children many years to acquire. They are
incapable of using it as a general symbol of assent.
The
same type of literalness exists also with regard to prepositions. Apparently
the meaning of a word becomes inflexible and cannot be used with any but the
originally acquired connotation.
Personal
pronouns are repeated just as heard, with no change to suit the altered
situation.
The
repetition "Are you ready for your dessert?" means that the child is
ready for his dessert.
The
pronominal fixation remains until about the sixth year of life, when the child
gradually learns to speak of himself in the first person, and of the individual
addressed in the second person. In the transitional period, he sometimes still
reverts to the earlier form or at times refers to himself in the third person.
Our
patients, reversely, anxious to keep the outside world away, indicated this by
the refusal of food. One child had to be tube-fed until 1 year of age. Most of
them, after an unsuccessful struggle, constantly interfered with, finally gave
up the struggle and of a sudden began eating satisfactorily.
Another
intrusion comes from loud noises and moving objects, which are therefore
reacted to with horror. Yet it is not the noise or motion itself that is
dreaded. The disturbance comes from the noise or motion that intrudes itself,
or threatens to intrude itself, upon the child's aloneness.
The
child himself can happily make as great a noise as any that he dreads and move
objects about to his heart's desire.
There
is a marked limitation in the variety of his spontaneous activities. The
child's behavior is governed by an anxiously obsessive desire for the
maintenance of sameness that nobody but the child himself may disrupt on rare
occasions.
Changes
of routine, of furniture arrangement, of a pattern, of the order in which
everyday acts are carried out, can drive him to despair.
Once
blocks, beads, sticks have been put together in a certain way, they are always
regrouped in exactly the same way, even though there was no definite design.
After the lapse of several days, a multitude of blocks could be rearranged in
precisely the same unorganized pattern, with the same color of each block
turned up, with each picture or letter on the upper surface of each block
facing in the same direction as before.
This
insistence on sameness led several of the children to become greatly disturbed
upon the sight of-anything broken or incomplete.
A
great part of the day was spent in demanding not only the sameness of the
wording of a request but also the sameness of the sequence of events.
It
was impossible to return from a walk without having covered the same ground as
had been covered before.
Objects
that do not change their appearance and position, that retain their sameness
and never threaten to interfere with the child's aloneness, are readily
accepted by the autistic child.
Two
patients began in the second year of life to spin everything that could be
possibly spun.
The
children sensed and exercised the same power over their own bodies by rolling
and other rhythmic movements.
Every
one of the children, upon entering the doctor’s office, immediately went after
blocks, toys, or other objects, without paying the least attention to the
persons present.
The
father or mother or both may have been away for an hour or a month; at their
homecoming, there is no indication that the child has been even aware of their
absence.
After
many outbursts of frustration, he gradually and reluctantly learns to
compromise when he finds no way out, obeys certain orders, complies in matters
of daily routine, but always strictly insists on the observance of his rituals.
There
is a far better relationship with pictures of people than with people
themselves. Pictures, after all, cannot interfere.
The
astounding vocabulary of the speaking children, the excellent memory for events
of several years before, the phenomenal rote memory for poems and names, and
the precise recollection of complex patterns and sequences, bespeak good
intelligence in the sense in which this word commonly used.
They all come of highly intelligent families. All but
three of the families are represented either in Who's Who in
America or in American Men of
Science, or in both.
