N 1943, under the title Autistic Disturbances of Afective Contact, I pub-I lished 11 cases of infantile psychosis noticed as early as in the first two years of life. Since then, I have seen more than 50 such children, and knowledge of many others has come to me from psychiatrists and pediatricians in this country and abroad. To satisfy the need for some terminological identification of the condition, I have come to refer to it as "early infantile autism."Briefly, the characteristic features consist of a profound withdrawal from contact with people, an obsessive desire for the preservation of sameness, a skillful and even affectionate relation to objects, the retention of an intelligent and pensive physiognomy, and either mutism or the kind of language which does not seem intended to serve the purpose of interpersonal communication. An analysis of this language has revealed a peculiar reversal of pronouns, neologisms, metaphors, and apparently irrelevant utterances which become meaningful to the extent to which they can be traced to the patient's experiences and their emotional implications.The syndrome of early infantile autism is by now reasonably well established and commonly accepted as a psychopathologic pattern. The symptom combination in most instances warrants an unequivocal diagnostic formulation. Once I became impressed by the syndrome, my first interests went in the direction of observation and description.In the early days of scientific psychiatry, the singling out of a pathologic behavior syndrome was deemed fully sufficient. A certain type of symptom mosaic was lifted out of the diagnostic diffuseness and given a distinctive name, which was viewed as the designation of a disease entity. This happened, for instance, to Hecker's hebephrenia and Kahlbaum's catatonia.Nowadays, the study of a psychotic pattern imposes two major obligations. Kraepelin introduced one of these by emphasizing similarities and dissimilarities of clinical pictures. He was able to find a common denominator for hebephrenia, catatonia, and other apparently heterogeneous phenomena. Now that early infantile autism has a well-defined symptomatology and the syndrome as such can be recognized with relative ease, it is ready to apply for a place in the existing psychiatric nosology. In accepting this application, I am less interested in terminological allocation than in the inhood." * Presented at the 1948 Annual Meeting in a session on "Psychopathological Conditions in Child- 416This document is copyrighted by the American Psychological Association or one of its allied publishers.This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

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The June 1943 issue of the now extinct journal The Nervous Child carried a paper entitled "Autistic disturbances of affective contact"; the first 24 pages told about 11 children who had in common a pattern of behavior not previously considered in its startling uniqueness: this was followed by 9 pages of discussion and comment An introductory paragraph concluded with the sentence: "Since none of the children of this group has as yet attained age beyond 11 years, this must be considered a preliminary report, to be enlarged upon as the patients grow older and further observation of their development is made."Twenty-eight years have elapsed since then. The periodical in which the article was printed has been out of circulation for a long time.The patients were between 2 and 8 years old when first seen at the Children's Psychiatric Clinic of the Johns Hopkins Hospital. What has become of them? What is their present status? Case 1 (Donald T)In 1942, his parents placed him on a tenant farm about 10 miles from their home. When I visited there in May 1945,1 was amazed at the wisdom of the couple who took care of him. They managed to give him goals for his stereotypies. They made him use his preoccupation with measurements by having him dig a well and report on its depth. When he kept collecting dead birds and bugs, they gave him a spot for a "graveyard" and had him put up markers; on each he wrote a first name, the type of animal as a middle name, and the farmer's last name, e.g.: "John Snail Lewis. Born, date unknown. Died, (date on which he found the animal)." When he kept counting rows of corn over and over, they had him count the rows while plowing them. On my visit, he plowed six long rows; it was remarkable how well be handled the horse and plow and turned the horse around. It was obvious that they were gently firm. He attended a country school where his peculiarities were accepted and where he made good scholastic progress.The rest of the story is contained in a letter from the mother, dated April 6,1970: "Don is now 36 years old, a bachelor living at home with us. He had an acute attack of rheumatoid arthritis in 1955. Fortunately, this lasted only a few weeks. Physically, since that time, he has been in perfect health Since receiving his A.B. degree in 1958, he has worked in the local bank as a teller. He is satisfied to remain a teller, having no real desire for promotion. He meets the public there real well. His chief hobby is golf, playing four or five times a week at the local country club. While he is no pro, he has six trophies won in loval competition Other interests are Kiwanis Club (served as president one term), Jaycees, Investment Club, Secretary of Presbyterian Sunday School. He is dependable, accurate, shows originality in editing the Jaycee program information, is even-tempered but has a mind of his own He owns his second car, likes his independence. His room includes his own TV, record player, and many books. In College his major was French and he showed a particular aptitude for languages. Don is ...