Asperger’s 1944 Paper in English / Part Three – Fritz cont.,

Hans Asperger, ‘Autistic psychopathy’ in childhood, 1944. 

Translated and annotated by Uta Frith

Comments on the “thinking” behind the behavior of “children like this” is not to condone it; I’m offering insight from my own experiences, as to what may be the source of “mysterious” “impossible to understand” behaviors described.

The case of Fritz; continued

Let us consider this issue again from a different point of view. It is not the content of words that makes a child comply with requests, by processing them intellectually. It is, above all, the affect of the care-giver which speaks through the words. Therefore, when making requests, it does not really matter what the care-giver says or how well-founded the request is. The point is not to demonstrate the necessity of compliance and consequence of non-compliance — only bad teachers do this. (And yet, this is the basis of American “black box” reward and punishment pedagogy) What matters is the way in which the request is made, that is, how powerful the affects are which underlie the words. These affects can be understood even by the infant, the foreigner or the animal, none of whom is able to comprehend the literal meaning.

In our particular case (Fritz), as indeed, in all such cases, the affective side was disturbed to a large extent, as should have become apparent from the description so far. The boy’s emotions were indeed hard to comprehend. (Which does not mean that he is not comprehensible) It was almost impossible to know what would make him laugh or jump up and down with happiness, and what would make him angry and aggressive. It was impossible to know what feelings were the basis of his stereotypic activities or what it was that could suddenly make him affectionate. So much of what he did was abrupt and seemed to have no basis in the situation itself. Since the affectivity of the boy was so deviant and it was hard to understand his feelings, it is not surprising that his reactions to the feelings of his care-givers were also inappropriate.

In fact, it is typical of children such as Fritz V. that they do not comply with requests or orders that are affectively charged with anger, kindness, persuasion or flattery. (The “authenticity” problem) Instead, they respond with negativistic, naughty and aggressive behaviour. While demonstrations of love, affection and flattery are pleasing to normal children and often induce in them the desired behaviour, such approaches only succeeded in irritating Fritz, as well as all other similar children. While anger and threats usually succeed in bending obstinacy in normal children and often make them compliant after all, the opposite is true of autistic children. (Threats don’t “work” – they “hurt”) For them, the affect of the care-giver may provide a sensation which they relish and thus seek to provoke.

“I am so horrible because you are cross so nicely”, said one such boy to his teacher. (Chiding manipulation on the part of the teacher – I see through you.)

 It is difficult to know what the appropriate pedagogic approach should be. As with all genuine teaching, it should not be based primarily on logical deduction but rather on pedagogic intuition. Nevertheless, it is possible to state a few principles which are based on our experience with such children. The first is that all educational transactions have to be done with the affect ‘turned off’. The teacher must never become angry nor should he aim to become loved. It will never do to appear quiet and calm on the outside while one is boiling inside. Yet this is only too likely, given the negativism and seemingly calculated naughtiness of autistic children! (Calculation is a common misconception – “we” are born with our own set of rules that we are compelled to follow, just as any animal manifests its “instructions for being” in its behavior: INSTINCT. Social humans also act according to instinct – but it’s different than ours. Unfortunately, neurotypicals believe that they are the one and only correct model of Homo sapiens) The teacher must at all costs be calm and collected and must remain in control. He should give his instructions in a cool and objective manner, without being intrusive. A lesson with such a child may look easy and appear to run along in a calm, self-evident manner. It may even seem that the child is simply allowed to get away with everything, any teaching being merely incidental. Nothing could be further from the truth. In reality, the guidance of these children requires a high degree of effort and concentration. (The person has to “be present” You can’t phone it in…) The teacher needs a particular inner strength and confidence which is not at all easy to maintain!

There is a great danger of getting involved in endless arguments with these children, be it in order to prove that they are wrong or to bring them towards some insight. This is especially true for the parents, who frequently find themselves trapped in endless discussions. On the other hand, it often works simply to cut short negativistic talk: for example, Fritz is tired of doing sums and sings, ‘I don’t want to do sums any more, I don’t want to do sums any more’, the teacher replies, ‘No, you don’t need to do sums’, and continuing in the same calm tone of voice, ‘How much is . . .?’ (Acknowledge the child’s feelings.)

Primitive (simple is good) as they are, such methods are, in our experience, often successful.

There is an important point to be made here. Paradoxical as it may seem, the children are negativistic and highly suggestible at the same time. Indeed, there is a kind of automatic or reflex obedience. This behaviour is known to occur in schizophrenics. It could well be that these two disorders of the will are closely related! With our children we have repeatedly found that if one makes requests in an automaton-like and stereotyped way, for instance, speaking softly in the same sing-song that they use themselves, one senses that they have to obey, seemingly unable to resist the command. (The child responds to acknowledgment of shared intent. Egalitarianism)

Another pedagogic trick is to announce any educational measures not as personal requests, but as objective impersonal law. But more of this later.

I have already mentioned that behind the cool and objective interaction with Fritz and all similar children there needs to be genuine care and kindness if one wants to achieve anything at all. These children often show a surprising sensitivity to the personality of the teacher. However difficult they are even under optimal conditions, they can be guided and taught, but only by those who give them true understanding and genuine affection, people who show kindness towards them and, yes, humour. The teacher’s underlying emotional attitude influences, involuntarily and unconsciously, the mood and behaviour of the child. Of course, the management and guidance of such children essentially requires a proper knowledge of their peculiarities as well as genuine pedagogic talent and experience. Mere teaching efficiency is not enough. (All children want to be acknowledged – that requires “being there”)

It was clear from the start that Fritz, with his considerable problems, could not be taught in a class. For one thing, any degree of restlessness around him would have irritated him and made concentration impossible. For another, he himself would have disrupted the class and destroyed work done by the others. Consider only his negativism and his uninhibited, impulsive behaviour. This is why we gave him a personal tutor on the ward, with the consent of the educational authority. Even then, teaching was not easy, as should be clear from the above remarks. Even mathematics lessons were problematic when, given his special talent in this area, one might have expected an easier time. Of course, if a problem turned up which happened to interest him at that moment (see previous examples), then he ‘tuned in’ and surprised us all by his quick and excellent grasp. However, ordinary mathematics — sums — made for much tedious effort.

As we will see with the other cases even with the brightest children of this type, the automatisation of learning, that is, the setting up of routine thought processes, proceeds only with the utmost difficulty. (What is routine for socials – linear / hierarchical thinking – is not routine for visual thinkers)

Writing was an especially difficult subject, as we expected, because his motor clumsiness, in addition to his general problems, hampered him a good deal. In his tense fist the pencil could not run smoothly. A whole page would suddenly become covered with big swirls, the exercise book would be drilled full of holes, if not torn up. In the end it was possible to teach him to write only by making him trace letters and words which were written in red pencil. This was to guide him to make the right movements. However, his handwriting has so far been atrocious. Orthography too was difficult to automatise. He used to write the whole sentence in one go, without separating the words. He was able to spell correctly when forced to be careful. However, he made the silliest mistakes when left to his own devices. Learning to read, in particular sounding out words, proceeded with moderate difficulties. It was almost impossible to teach him the simple skills needed in everyday life. While observing such a lesson, one could not help feeling that he was not listening at all, only making mischief. It was, therefore, the more surprising, as became apparent occasionally, for example through reports from the mother, that he had managed to learn quite a lot. It was typical of Fritz, as of all similar children, that he seemed to see a lot using only ‘peripheral vision’, or to take in things ‘from the edge of attention’. Yet these children are able to analyse and retain what they catch in such glimpses. (Intuitive – visual – sensory learning again) Their active and passive attention is very disturbed; they have difficulty in retrieving their knowledge, which is revealed often only by chance. Nevertheless, their thoughts can be unusually rich. They are good at logical thinking, and the ability to abstract is particularly good. It does often seem that even in perfectly normal people an increased distance to the outside world is a prerequisite for excellence in abstract thinking.

Despite the difficulties we had in teaching this boy we managed to get him to pass successfully a state school examination at the end of the school year. The exceptional examination situation was powerful enough to make him more or less behave himself, and he showed good concentration. Naturally, he astounded the examiners in mathematics. Now Fritz attends the third form of a primary school as an external pupil, without having lost a school year so far. Whether and when he will be able to visit a secondary school we do not know.

Differential diagnosis

Considering the highly abnormal behaviour of Fritz, one has to ask whether there is in fact some more severe disturbance and not merely a personality disorder. There are two possibilities: childhood schizophrenia and a post-encephalitic state.

There is much that is reminiscent of schizophrenia in Fritz: the extremely limited contact, the automaton-like behaviour, the stereotypies. Against this diagnosis, however, speaks the fact that there is no sign of progressive deterioration, no characteristic acute onset of alarming florid symptoms (severe anxiety and hallucinations), nor are there any delusions. Although Fritz shows a very deviant personality, his personality remains the same and can largely be seen as deriving from father and mother, and their families. In fact, his personality shows steady development, and on the whole this is resulting in improved adaptation to the environment. Lastly, the complex overall clinical impression, which cannot be pinned down further, is completely different from that of a schizophrenic. There, one has the uncanny feeling of a destruction of personality which remains incomprehensible and incalculable, even if it is perhaps possible to some extent to stave off disintegration through pedagogic means. Here, however, there are numerous genuine relationships, a degree of reciprocal understanding and a genuine chance for remedial education.

One has also to consider the possibility of a post-encephalitic personality disorder. As we shall see below, there are a number of similarities between autistic children and brain-damaged children who either had a birth injury or encephalitis. Suffice it to say here that there was no reason for thinking this applied in the case of Fritz. There were certainly none of the symptoms that are always present in post-encephalitic cases (though these are sometimes easily overlooked). There was not the slightest evidence of neurological or vegetative symptoms such as strabismus, facial rigidity, subtle spastic paresis, increased salivation or other endocrine signs.

Yes, there is more…. 

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