Since Kanner first described the unique features of early infantile autism (1943), it has received widespread recognition as a clinical syndrome. It remains a challenging problem because it is the earliest psychosis known to occur in childhood
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and because it has similarities to and differences from childhoodschizophrenia.
The original diagnosis of the sixty-three cases successfully traced in this study was based on the conjunction of extreme self-isolation in the first years of life and obsessive insistence on the preservation of sameness. All the children exhibited distortions of language; few had organic abnormalities of the central nervous system and where these did exist they were inadequate to explain the clinical phenomena. These children have been restudied at a mean age of fifteen years, after a mean period of nine years since previous study. Outcome was classified in three categories: 'Good' adjustment—three; 'fair'—fourteen; 'poor'—forty-six. A little less than a third can be said to be functioning at a 'fair-to-good' social level. Those children who were so isolated from human contact that they failed to develop or, having developed, lost the ability to communicate by speech did much more poorly than the others. Half of those with useful speech at age five improved, whereas only one of the thirty-one who could not communicate verbally by that age showed significant improvement.
The study fails to reveal any correlation between formal psychiatric treatment and the clinical outcome. Impressed by the prodigious efforts expended by both schools and parents for those children who have improved, the author believes that the extraordinary consideration extended to these patients was an important factor in the amelioration of their condition. There is, however, no justification for the assumption that psychiatric supervision is superfluous or that recovery will occur if verbal communication is present. The clinical course of these children justifies the segregation of early infantile autism as a clinical entity, probably to be included within the group of schizophrenias.
Severely autistic children exhibit a preoccupation with the sensory impressions stemming from the world about them, but seem unable to organize perceptions into functional patterns. The primary psychopathologic mechanism might be described as a disturbance in social perception.
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(1959). American Journal of Psychiatry. CXII, 1956. Psychoanal. Q., 28:118-119