Hans Asperger, ‘Autistic psychopathy’ in childhood, 1944; continued
The case of “Fritz” Note: We need to remember that there was no diagnosis of “Asperger Disorder or Syndrome” at this time! I would assume that Fritz would be / was diagnosed with “Autistic Psychopathy” The current “Asperger diagnosis”, which technically doesn’t even exist anymore (but we’re all still here!), would not seem to be appropriate to the severity of Fritz’s condition, especially his violent behavior. Ironic… Bold phrases or sentences “ring a bell”. Red are my reactions as a “visual intuitive thinker”
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 Heilpadagogische Abteilung (Remedial Department) of the University Paediatric Clinic in Vienna in the autumn of 1939. He was referred by his school as he was considered to be ‘uneducable’ 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. 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’. 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.
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.
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. (egalitarian) 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.
Family history (Gee Whiz! No “clues” to Fritz’s behavior here! LOL)
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 her 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. 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. 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 fine and aristocratic features, prematurely differentiated in a six-year-old. Any baby features had long since gone.
His eye gaze was strikingly odd. 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. (Learns by listening – again not “observable behavior) 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. (That “blank feeling”) 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 (Much of the following “mystified” response on Asperger’s part seems to be due to “Intuition / visual thinking” Going on in Fritz – Since it is an Internal process, intuition does not provide clues for the observer as does verbal thinking.)
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.
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 beat 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 thegroup 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. 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 be 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’.
As one would expect, the conduct disorders were particularly gross when demands were made on him, for instance, when one tried to give him 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.
construction test (a figure made out of sticks, and consisting of two squares and four triangles, is exposed for a few seconds and has to be copied from memory). Even though he had only half-glanced at this figure, he correctly constructed it within a few seconds, or rather, he threw the little sticks so that it was perfectly possible to recognise the correct figure, but he could not be persuaded to arrange them properly.
rhythm imitation (various rhythms are beaten out to be copied). In spite of many attempts he could not be persuaded to do this task
memory for digits He very readily repeated six digits. One was left with a strong impression that he could go further, except that he just did not feel like it. According to the Binet test, the repetition of six digits is expected at the age of ten, while the boy was only six years old.
memory for sentences This test too could not be properly evaluated. He deliberately repeated wrongly many of the sentences. However, it was clear that he could achieve at least age-appropriate performance.
similarities Some questions were not answered at all, others got a nonsensical answer. For instance, for the item tree and bush, he just said, ‘There is a difference’. For fly and butterfly, he said, ‘Because he has a different name’, ‘Because the butterfly is snowed, snowed with snow’; asked about the colour, he said, ‘Because he is red and blue, and the fly is brown and black’. For the item wood and glass, he answered, ‘Because theglass is more glassy and the wood is more woody’. For cow and calf, he replied, ‘lammerlammerlammer . . . ‘. To the question ‘Which is the bigger one?’ he said, ‘The cow I would like to have the pen now’. (Possibly bored out of his mind?)
Enough examples from the intelligence test. We did not obtain an accurate picture of the boy’s intellectual abilities. This, of course, was hardly to be expected. First, he rarely reacted to stimuli appropriately but followed his own internally generated impulses. Secondly, he could not engage in the lively reciprocity of normal social interaction. In order to judge his abilities it was therefore necessary to look at his spontaneous productions.
As the parents had already pointed out, he often surprised us with remarks that betrayed an excellent apprehension of a situation and an accurate judgement of people. This was the more amazing as he apparently never took any notice of his environment. (But clearly he did, but covertly: Again – typical of an intuitive visual learner) Above all, from very early on he had shown an interest in numbers and calculations. He had learnt to count to over 100 and was able to calculate within that number-space with great fluency. This was without anybody ever having tried to teach him — apart from answering occasional questions he asked. His extraordinary calculating ability had been reported by the parents and was verified by us.
Incidentally, we found, in general, that the parents had an excellent understanding of their child’s intellectual abilities. Such knowledge as the boy possessed was not accessible by questioning at will. Rather, it showed itself accidentally, especially during his time on the ward, where he was given individual tuition. Even before any systematic teaching had begun, he had mastered calculations with numbers over ten. Of course, quite a number of bright children are able to do this before starting school at six. However, his ability to use fractions was unusual, and was revealed quite incidentally during his first year of instruction.
The mother reported that at the very beginning of schooling he set himself the problem — what is bigger ‘At or ‘/,« — and then solved it with ease. When somebody asked for fun, just to test the limits of his ability, ‘What is */, of izo?’, he instantly gave the right answer, ’80’. Similarly, he surprised everybody with his grasp of the concept of negative numbers, which he had apparently gained wholly by himself; it came out with his remark that 3 minus 5 equals ‘z under zero’. At the end of the first school year, he was also fluent in solving problems of the type, ‘If 2 workers do a job in a certain amount of time, how much time do 6 workers need?’
We see here something that we have come across in almost all autistic individuals, a special interest which enables them to achieve quite extraordinary levels of performance in a certain area. This, then, throws some light on the question of their intelligence. However, even now the answer remains problematic since the findings can be contradictory and different testers can come to different intelligence estimates. Clearly, it is possible to consider such individuals both as child prodigies and as imbeciles with ample justification.
Now, a word about the boy’s relations to people. At first glance, it seemed as if these did not exist or existed only in a negative sense, in mischief and aggression. This, however, was not quite true. Again, accidentally, on rare occasions, he showed that he knew intuitively, and indeed unfailingly, which person really meant well by him, and would even reciprocate at times. (Yes, Asperger “radar” for sincerity, authenticity and fairness works!) For instance, he would declare that he loved his teacher on the ward, and now and then he hugged a nurse in a rare wave of affection.
Implications of remedial education
It is obvious that in the present case there were particularly difficult educational problems. Let us consider first the essential prerequisites which make a normal child learn and integrate into school life, in terms not just of the subject matter taught, but also of the appropriate social behavior. Learning the appropriate behaviour does not depend primarily on intellectual understanding. Well before the child can understand the spoken words of his teacher, even in early infancy, he learns to comply.
He complies with and responds to the glance of the mother, the tone of her voice, the look of her face, and to her gestures rather than the words themselves. In short, he learns to respond to the infinitely rich display of human expressive phenomena. While the young child cannot understand this consciously, he none the less behaves accordingly. The child stands in uninterrupted reciprocity with his care-giver, constantly building up his own responses and modifying them according to the positive or negative outcome of his encounters. Clearly, an undisturbed relationship with his environment is an essential requirement. In Fritz’s case, however, it is precisely this wonderful regulating mechanism which is severely disturbed.
It is a sign of this disturbance that Fritz’s expressions themselves are abnormal. How odd is his use of eye contact! Normally, a great deal of the outside world is received by the eye and communicated by the eye to others. How odd is his voice, how odd his manner of speaking and his way of moving! It is no surprise, therefore, that this boy also lacks understanding of other people’s expressions and cannot react to them appropriately. (Again! The oddness is a product of an intuitive visual thinker responding poorly to a “verbal-social” environment that is simply alien.)
I’m pooped… continued in post 3.