Howard W. Potter, “Schizophrenia in Children,” American Journal of Psychiatry 89 (May 1933):1253-70.
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Howard Potter made these observations about childhood schizophrenia during his tenure as Assistant Director, New York State Psychiatric Institute and Hospital, New York City. His case descriptions of six boys—five Jewish or “Hebrew” and one Italian—include a number of autism’s telltale signs. Especially notable to Potter were social indifference and “consistent lack of emotional rapport.” These would become the hallmarks of autism a decade later, after Leo Kanner published “Autistic Disturbances of Affective Contact” in 1943.
The six cases reported in this communication represent typical schizophrenia in children. All of them were or are patients under observation and treatment in the Psychiatric Institute. Their actual ages on admission were 4, 6, 10, 11, 11, and 12 years respectively….
Case I (No. 598). —A Jewish boy…. About four months prior to admission, when he was three and a half years of age, he began to be irritable, cross, very destructive and over active in a purposeless way. He soon became very unmindful of those about him, paid no attention to their questions or commands, became more quiet, spent most of his time in bed whispering to himself and playing with his fingers. A few days later he began to talk aloud again, but his talk was meaningless to his parents and his answers to questions totally irrelevant. He insisted on remaining in bed, and his face wore a fixed, blank expression…. His affect was an admixture of abstraction, indifference, self-absorption and to a certain degree, apprehension….
Case II (No. 620). —A Jewish boy, six and a half years of age on admission…. At kindergarten he spent most of his time wandering aimlessly about the room, quietly giggling or chuckling to himself. His interest could never be held long enough to get him to finish a task…. During the summer vacation just prior to his admission it was noticed that he especially avoided other children in the street. He took no interest in his toys. He would spend much of his time picking up bits of paper and arranging them in rows…. On many occasions he has been observed to attitudinize with his arms partially raised in the air or held at an angle away from the side of the body. At other times he is observed making stereotyped writing motions in the air…. He never makes any attempt to integrate himself with the group of children on the ward…. He will read in a monotonous undertone in an automatic fashion when asked by his teacher. He sings softly to himself and laughs to himself frequently in school class. He is indifferent to his family’s visits…. His affective tone is one of indifference, disinterest and preoccupation….
Case III (No. 290). —An Italian boy…. About one year prior to admission, when he was nearly nine years of age, it was noticed that he seemed slowed up, chronically tired, slouched at the table at meal times and became less social…. [H]e began to grimace and laugh aloud for no apparent cause…. During the 15 months’ period of observation at the institute, he has been, on the whole, asocial and seclusive. He is usually found in a corner in a comfortable chair reading a book quite unmindful of what is going on about him. The only activity that brings him back to reality for the time being is a game of baseball…. His affect is characterized throughout by indifference, apathy, abstraction, inadequate emotional responsiveness, and a characteristic lack of emotional rapport….
Case IV (No. 570). —A Jewish boy, 11 years and 2 weeks old…. He has an introverted, social, emotionally blunted father, who is syphilitic and a somewhat over concerned, neurotic, social, self-pitying, well-educated mother who blames the father for the patient’s condition because of the paternal syphilis…. At the age of three and a half, he suddenly stopped talking, held himself rigid for periods of several minutes, made faces and showed wide spread choreiform muscular twitchings together with incontinence of urine and feces….. He soon developed into an avid reader and delved into archaeology and astrology. He never succeeded, nor even attempted, to establish social or play contacts with other children…. [H]is affect is largely one of indifference and apathy with marked disinterest in his environment and to the visits of his family….
Case V (No. 25). —A Jewish boy, 11 years and 2 months old on admission…. He rarely, if ever, displayed the usual amount of affection for his parents. His whole life was marked by generalized indifference. He rarely, if ever, asked for a new toy and if one was presented to him, he accepted it with stolid indifference. Since early childhood he would have periods of marked sullenness and obstinacy. At times he would scream for hours because a wish was thwarted. On occasions he would stand outside the house by the door, refusing to come in…. [I]n the fourth grade, he habitually failed because, the teacher thinks, he lost all interest in school work and seemed absorbed in his own thoughts. He never played with his school mates or showed any interest in them. He would come home immediately after school and spend his time sitting about the house reading a book or simply idling about. About two years prior to admission, when about nine years of age, his sullenness and irritability increased. His talk became so incoherent at times that it was not possible to understand him. He would have outbursts of anger, laughter and grimacing…. During the first 12 months of his stay in the institute, he spent the major part of the time gazing fixedly out of the window with a perplexed frown on his face, and at times would be found under a bed or crouched in a corner behind a piece of furniture…. [H]is affect was characterized by a combination of disinterest, detachment and perplexity…..
Case VI (No. 188). —A Hebrew boy…. When the patient was eight years of age, his sister one year his junior, with whom he was quite companionable, died. Shortly after this he appeared unduly quiet and given to worry…. [T]hereafter he never again mingled with or played with other children, spending most of his time in the house and seeming subdued and at times abstracted…. On admission to the Psychiatric Institute he seemed completely self-absorbed and reacted continuously to auditory and visual hallucinations…. He showed no interest in the other children, spent most of his time gazing out the window, and seemed suspicious and a bit fearful of everyone approaching him. Sometimes he would stand before a mirror, grimacing. His replies to most questions were a stereotyped “I don’t know.” At times he would talk spontaneously though incoherently…..
Conclusion
From this study it appears that a typical schizophrenic reaction may put in its appearance long before the initiation of pubescence…. The outstanding symptomatology is found in the field of behavior and a consistent lack of emotional rapport. The drive for integration with the environment, so characteristic of normal children and so essential for their personality development is outstandingly absent….
It is the thought of the writer that a careful psychiatric study, from a psychodynamic approach, of the patients in institutions for mental defectives, might demonstrate that schizophrenia in childhood is not as rare as is now generally believed.