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The organs are anastomosed as pictured:. Pancreatic ductal adenocarcinoma red , ampullary carcinoma blue , and distal common bile duct carcinoma green all arise within close proximity to one another and can therefore overlap in terms of the anatomic space they occupy. Furthermore, pancreatic ductal adenocarcinoma can secondarily involve the ampulla or common bile duct, and ampullary carcinoma and distal common bile duct carcinoma can similarly invade structures from which they did not originate.
Careful consideration of the size, epicenter, presentation, and histology of each lesion should allow for accurate diagnosis. Gonzalez RS et al. Modern Pathology ; Your Email Leave this field blank. Identify and ink pancreatic neck resection margin blue and uncinate resection margin black.
Identify the common bile duct margin if present. Shave a cross section and save in cassette for gross day. Alternatively, do after fixation. Open the duodenum carefully along the anti-mesenteric border, away from the Ampulla of Vater. Describe and measure any duodenal lesions and measure their closest approach to resection margin.
Open stomach or gallbladder if present. Fix in formalin. How to evaluate the opened specimen Pancreatic ductal adenocarcinoma red , ampullary carcinoma blue , and distal common bile duct carcinoma green all arise within close proximity to one another and can therefore overlap in terms of the anatomic space they occupy.
Gross Orient the specimen. If not done during triage, submit all margins: Pancreatic neck margin: ink, shave, serially section Pancreatic uncinate margin: ink, shave, serially section Bile duct margin: shave cross section place face down in cassette Duodenal margins: longitudinal proximal and distal sections Stomach margin: longitudinal proximal section if present Serially section the pancreas perpendicular to pancreatic and bile ducts.
Determine whether tumor impinges upon the distal common bile duct. Describe tumor including: size relation to anatomic structures color, consistency distance from margins any obstruction of ducts Describe the remaining pancreas looking for necrosis, cysts, stones.
Describe duodenum, stomach, gallbladder. Several are usually attached to the pancreas or in the fat immediately adjacent to the pancreas.
Pancreas (Whipple) | Gross Pathology Manual.Yahoo Sports
Home • UCLA Department of Psychology.Auto text: “Insert Ovary and Tube Tumor” or “Insert Ovaries and Tubes Prophylactic”
Check out our current listings here! Page views in 4, Cite this page: Bychkov A. Accessed February 3rd, Surgical procedures. Step by step procedure. Sections to obtain. Thyroid without nodules diffuse inflammatory lesions, i. Gross appearance of main thyroid lesions.
Gross description template. Anterior surface has a fragment of attached skeletal muscle. The right upper pole is oriented with a white surgical suture. The central portion is densely white, firm and focally calcified. Open the duodenum carefully along the anti-mesenteric border, away from the Ampulla of Vater.
Describe and measure any duodenal lesions and measure their closest approach to resection margin. Open stomach or gallbladder if present. Fix in formalin.
How to evaluate the opened specimen Pancreatic ductal adenocarcinoma red , ampullary carcinoma blue , and distal common bile duct carcinoma green all arise within close proximity to one another and can therefore overlap in terms of the anatomic space they occupy. Gross Orient the specimen. If not done during triage, submit all margins: Pancreatic neck margin: ink, shave, serially section Pancreatic uncinate margin: ink, shave, serially section Bile duct margin: shave cross section place face down in cassette Duodenal margins: longitudinal proximal and distal sections Stomach margin: longitudinal proximal section if present Serially section the pancreas perpendicular to pancreatic and bile ducts.
The medical student Jean Itard treated him with a behavioral program designed to help him form social attachments and to induce speech via imitation. In , British doctor John Down used the term "developmental retardation" to describe conditions including what would be considered autism today.
Also in , German doctor Adolf Kussmaul defined the condition "aphasia voluntaria" - when people choose not to speak. Italian psychiatrist Sante de Sanctis defined a condition called "dementia praecocissima" in , [6] a form of "dementia" that started very early in people's lives. It included:. Austrian educator Theodor Heller defined a condition called "dementia infatilis" in The DSM currently considers it part of autism spectrum disorder.
The New Latin word autismus English translation autism was coined by Blueuler in As to why he created the term, and giving the first explanation of its meaning , Bleuler wrote:. But I think it is good to avoid the latter expression, as it is misunderstood by anyone not familiar with Freud's writings.
The patient who wants to shut himself off from reality must not only let his surroundings affect him as little as possible, he must also not want to actively influence it. For two reasons; he would be distracted from his inner being and forced to pay attention to the outside world in order to be able to influence it; but he would also create new sensory stimuli and other connections with reality through the action itself.
In the earlier mentioned edition of the "Handbook of Psychiatry" edited by Gustav Aschaffenburg , Bleuler explains what his new term "autism" means:. This detachment from reality together with the relative and absolute preponderance of inner life is what we call autism The name autism says essentially on the positive side what P.
But we cannot readily accept the latter expression, because it covers the symptom far too generally. Our relatively severe institutional patients are, for the most part, very good at such institutional events that are irrelevant to their complexes.
You can get detailed anamneses [patient accounts of their medical history] from them, which are confirmed, etc. In short, they show every day that they have not lost their grasp of reality, but that this ability is only inhibited and lost in certain contexts The behavior of many shows at first nothing remarkable; only after a longer period of observation does one see how much they are always looking for their own way and how little they let their surroundings get to them.
Even severely ill chronic patients often have a very good connection with their surroundings in normal everyday life; they chat, take part in games, often seek out stimuli - but they choose; they have their complexes to themselves; they never say a word about it and don't want to be touched from the outside Wishes and fears form the content of autistic thinking; Wishes alone in the not very frequent cases where the contradiction with reality is not felt; Fears when the obstacles opposed to the desires are felt.
Even where no actual delusions arise, autism is demonstrable in the patient's inability to deal with reality, in their inappropriate reaction to external influences irritability and in their lack of resistance to any ideas and ideas shoots. Just as autistic feeling is turned away from reality, so autistic thinking has its own special laws: autism, of course, uses the usual logical connections as far as it suits it; but is by no means tied to it.
It is directed by affective needs. Alongside this, he thinks in symbols, in analogies, in incomplete concepts, in accidental connections. If the same patient turns to reality, he may be able to think sharply and logically again. So we have to distinguish between realistic and autistic thinking, side by side in the same patient.
In realistic thinking the patient orients himself quite well in the time and space of reality; he directs his actions accordingly, insofar as they appear normal to us. Delusions, gross violations of logic and decency and similar pathological symptoms arise from autistic thinking. The two forms are often quite well separated, so that the patient can now think completely autistic and now completely normally; in other cases they mix to the point of complete interpenetration He repeated this entry with slight modification , and added more material in his book Dementia praecox, oder, Gruppe der Schizophrenien [12] Dementia praecox, or, the group of schizophrenias.
He included:. Soon they are obtrusive, cannot bring themselves to keep saying the same thing, are completely deaf to all objections; soon they behave dismissively, briefly, rudely Autism in itself cannot be used for diagnosis, since it occurs notably in hysterical dream states, but only in a certain way, e.
In the non-schizophrenic cases the symptom looks different, but it is difficult to describe the differences. The epileptic and organic simply withdraw into themselves when they adopt behavior resembling autism, while the schizophrenic find themselves in opposition and at odds with reality. Also, in the non-schizophrenics, the barrier to the outside world is much less complete; under certain circumstances they may not actively concern themselves with reality, but they immediately come to terms with it if they are e.
Only in the sexual area is it possible to fulfill one's wishes to some extent with autism; for the patient, the imaginary lover is more than a real one, which is why normal intercourse is relatively rarely sought, and that is why the sexual life of even those who are not quite advanced moves almost entirely in the field of onanistic gratification In a similar way, certain inclinations, ways of life, and "passions" are accused of producing the disease.
One is said to have become ill because he took up the exciting profession of an actor, the other because he lived so irregularly and has always changed careers, the third because he is passionate about travel.
If you look closely, you will not find the slightest reason for such a suspicion. Schizophrenics pay less attention to reality, for better or worse, because of their autism they become more independent in thinking and acting; they are much more inclined to carry out an idea than others who are prevented from doing so by good and bad considerations, herd spirit, suggestibility towards the way of thinking of the majority, and generally greater adaptability to the situation as it is.
All new movements attract the latent schizophrenics first and are promoted and endangered by them at the same time. An etiological significance of dissatisfaction with life cannot be dismissed under all circumstances.
It is probable that such psychic stimuli can make the disease manifest. Usually, however, it is also the case there that people are never satisfied with their profession and their position because they are ill If the forms of our logic only repeat associations given by experience or draw analogies to them, it is self-evident that the acquired logical associations are damaged before the innate affective ones in a general mental disorder.
If there is a schizophrenic disposition in the psyche, it should be borne in mind that individuals whose ability to reproduce reality and whose connections are poorly developed must be predisposed to autism But where the patients have completely developed into their autism, the outside world only has a reality value insofar as it disturbs their thoughts; if an affect then accompanies external events, it can only be that of "rejection.
A direct consequence of the schizophrenic split in the psyche is autism; the healthy person has the tendency in logical operations to draw on all the pertinent material without regard to its affective value. In the schizophrenic loosening of logic, on the other hand, there is an exclusion of all associations that resist an emotional complex. The need, which no human being lacks, to seek a substitute for insufficient reality in the imagination can be satisfied without resistance in this way.
However much the products of the imagination may contradict reality, they do not come into conflict with it in the patient's brain; they are brought into contact with her only to the extent that they can be reconciled with the patient's affective needs.
In the severe cases, all of reality with its never-ending sensory stimulation is shut off; it only exists in banal contexts, when eating, when dressing Autism has always attracted attention, particularly among the French. There are examples: one side of it is emphasized under the names of autophilia , egocentrism , hypertrophy of the ego , augmentation du sens de la personalite [increased sense of self], while the negative side is called "perte du sens de la realite" [loss of sense of reality] or described as "perte de la fonction du reel" [loss of the function of reality].
Autism is also the exaggeration of a physiological phenomenon. There is a normal autistic thinking, which does not need to take reality into account and is determined in its direction by affects. The child plays with a piece of wood, which sometimes means a baby, sometimes a house. But even without a substratum, most people imagine a fairy tale in which their wishes or fears are fulfilled in the case of hysterics, this fantasy can be exaggerated to pathological levels; cf. Pick, , a.
A large part of the fantasy literature, the fairy tales and sagas arise from this way of thinking For these patients, autism has the same meaning as the monastery walls for the monks, the desert for some saints, the study room for some types of scholars. The difference between sick and healthy is only a quantitative one here Quite apart from the anatomical findings, which do not correspond to the severe symptoms, some things are not unfavorable to the assumption of a psychic genesis of the disease.
Aggravations and improvements are often psychological. In the antecedents of the schizophrenic there is usually an introverted disposition, from which autism and, indirectly, most other symptoms could be explained The strict and completely unrelenting implementation of the house rules in this respect had the result that within a few days they all gave up their resistance, and with the majority also that they became more accessible altogether. If it can cure a patient of his suicidal instinct if he is allowed to do so, it can also have the same effect if the patient sees the absolute impossibility of following the instinct.
Many loathsome bad habits can be got rid of by not tolerating them. The general tasks of the treatment are education and establishing contact with reality, that is, fighting the Autism Bleuler believed that the idiosyncratic behaviours of schizophrenics displaying autistic behaviour were due to them engaging with personal fantasy rather than with the world as it is.
It is not entirely clear what features of the "schizophrenics" Bleuler referred to belonged to what we consider "schizophrenia" today, and what proportion were caused by what we consider "autism". It was characterised by reticence, seclusiveness, shyness and a preference for living in fantasy worlds, among other things. In , Swiss psychiatrist Carl Jung used the term " introverted " in a lecture at Clark University. In , the Mental Deficiency Act was passed in England and Wales, ensuring institutional care for all children identified as "mental defectives.
The term " schizoid " began to be used just before It was used to describe people who had symptoms similar to "schizophrenia", but were not as pronounced. This expanded version was published as the book Physique and Character [22] in English in , and used the term "schizoid". At this time Bleuler also believed that everyone had a schizoid element, writing "Every man then has one syntonic [in harmony with one's environment] and one schizoid component, and through closer observation one can determine its force and direction Also in , Austrian-Swiss psychiatrist Moritz Tramer published the paper Einseitig Talentierte und Begabte Schwachsinnige Single-sided talented and gifted mental defectives.
In , Sante de Sanctis published another paper about "dementia praecocissima". It had some overlap with Heller's syndrome. Sukhareva was born in Kyiv to a Jewish family. In , she founded a school for children with psychological problems at the Psychoneurological Department for Children in Moscow, [30] and worked there for some time. Her description of the condition included the following as translated by Sula Wolff in : [35].
This last feature often marks the personality out as odd. All affected children keep themselves apart from their peers, find it hard to adapt to and are never fully themselves among other children. Cases 1, 2 and 3 became objects of general ridicule for the other children after their admission to our school. Cases 4 and 5 carried no weight among their peers and were nick-named "talking machine", although their level of overall functioning was far above that of the other children.
Case 6 himself avoids the company of children because he finds it painful. All these children manifest a tendency towards solitude and avoidance of other people from early childhood onwards; they keep themselves apart, avoid communal games and prefer fantastic stories and fairy tales. There is a certain flatness and superficiality of emotions cases 2, 3, 5.
The latter is often combined with what Kretschmer has aptly called the Psychasthetic aspect of mood. This mixture of insensitive and oversensitive elements was seen in all our cases.
Case 1 had affective sluggishness as well as exaggerated sensitivity; case 2 demonstrated increased irritability resulting in explosive emotional outbursts, combined with affective sluggishness, in line with Bleuler's description of spasms and paralysis of emotions. Case 5 had a generally calm mood state and was at the same time passionately tender towards some of the people close to him. Case 4 was a gloomy, irritable misanthrope but also a tenderly loving son.
We did not observe any definite negativism. Apparently unmotivated obstinacy was seen in two cases 5 and 6. Definite motor impairments were found in all our cases: clumsiness, awkwardness, abruptness of movements, many superfluous movements and synkinesias cases 1, 2, 3 and 4. Lack of facial expressiveness and of expressive movements manneristic cases 1, 4 and 5 ; decreased postural tone cases 2, 4 and 6 ; oddities and lack of modulation of speech cases 1, 2 and In most of our cases environmental causes could be excluded on the basis of a detailed case history: pathogenic factors such as brain pathology, intoxication, or a poor child rearing environment were absent.
Furthermore, the symptoms had been persistently present since early childhood Our observations force us to conclude that there is a group of personality disorders whose clinical picture shares certain features with schizophrenia, but which yet differs profoundly from schizophrenia in terms of its pathogenesis.
The explanation that best fits the clinical phenomena is that schizoid personality disorder arises on the basis of an inborn deficiency of those systems which are also affected in schizophrenia but that in the latter condition other, additional, influences are at play. Sukhareva followed this paper with one the next year that focused on girls with the condition. She found that there were four main sex-related differences. While Sukhareva's writings would be read and referenced by American child psychology researchers like Louise Despert, [37] Charles Bradley , [38] and Leo Kanner [39] in the s and 40s, her work was subsequently largely unknown in the Anglosphere and Western Europe.
In , young Austrian psychiatrist Hans Asperger joined the Vienna University's Children's Clinic 's department of curative education. He learnt from those already working there, including the Austrians psychiatrist George Frankl, psychologist Anni Weiss, and nurse Viktorine Zak. In December , Grunya Sukhareva published about autism in German again, with Uber den Verlauf der Schizophrenien im Kindesalter On the course of schizophrenia in childhood , [41] noting:.
Even the psychiatric untrained educator these children seem striking and odd. What is striking about them is the unexpected and unpredictably absurd of their actions, theirs affectless impulsiveness, their unmotivated obstinacy The premorbid features of these children in cases where such features are at all possible, i.
From early childhood on, such children showed a lack of adaptability to life in the collective, a certain autism and unreliability. In 8 cases increased sensitivity was reported, in 5 cases emotional coldness; in the remaining cases the emotional habitus was predominantly indifferent and torpid. Reports of inadequacies in motor skills are strikingly frequent: tardiness, poor mobility, clumsiness "eats very slowly", "has no interest in physical exercises", "learned to help himself very late", etc.
In terms of intellectual development, we had marked retardation in 5 cases, early development in 3 cases, and normal range in the remaining cases. It divided people with childhood schizophrenia into two groups, those with normal intelligence, and those with lesser intelligence. It identified a group of children with particular language difficulties that some have subsequently considered autistic.
Additionally in , Moritz Tramer published the paper Elktiver Mutismus bei Kindern [49] Elective Mutism in Children , coining the term " elective mutism ". In April , Anni Weiss published the paper Qualitative intelligence testing as a means of diagnosis in the examination of psychopathic children , [50] which includes a case study about an autistic boy.
During this period, the term "autism" came to be used quite widely during this period, with a variety of related meanings. Austrian psychiatrist Hans Asperger was the head of the Vienna University's Children's Clinic 's department of curative education. He had published the first American textbook on the topic in One of the psychiatrists working for Asperger was George Frankl. Frankl was working at the Clinic long before Asperger, and had taught Asperger much about child psychiatry.
So he left Vienna in and migrated to the United States in November that year. In , Swiss psychiatrist Jakob Lutz of the University of Zurich published a short book reviewing the available material on childhood schizophrenia, including the work of Sukhareva, Potter, Grebelskaja-Albatz and others. One part of it identified a group of five children that might today be considered autistic.
The paper was published in March It has been suggested that this paper was a major influence on Kanner. Hans Asperger used the term autistic psychopath in a 3 October lecture [61] to describe a pattern he had seen in his patients and elsewhere. It instructed its predominantly Viennese listeners and readers that people who are a bit strange may also be very intelligent, and that knowing this will become important "when the ' Law for the Prevention of Hereditary Diseased Offspring ' comes into force in our country.
Equivalent to this lack of instinct is not only the clumsiness in pure motor skills; but also the poor practical understanding, the success of practice that is so difficult to achieve, the "difficult mechanization.
After what has been said, it is not surprising that these children are always loners, falling out of any children's community: they themselves do not strive for any community, since they have no personal relationships with anyone they never have a friend either , and the community also rejects them, since they are always a foreign body; but because of their peculiarities, especially because of their clumsiness, they are always an object of unanimous ridicule in the community, for which they know how to take revenge often enough.
But one thing is very often not only not disturbed in these severely constricted personalities, as in this boy, but is actually well developed above average, namely the intelligence in the narrower sense, the ability to think logically, to formulate one's thoughts well in language they often find particularly original, almost linguistically creative expressions ; very often astonishingly mature special interests are present, often really scientific e. At other times, the autistic originality only comes across as absurd, cranky and useless.
Leo Kanner visited the autistic child Donald Triplett on 27 October In and , Dutch psychiatrist Alfons Chorus of Nijmegen 's Pedological Institute published a pair of papers describing children that were "autists" and "schizoid", which today would be considered autistic.
After having studied outspoken disorders cases 3 and 4 , we became aware that similar behavior in children is by no means rare. We saw children who were preoccupied with drawings of sexual content, others who were preoccupied with drawing of animals. They enjoyed their activities and interests, although from time to time they became aware that they were helpless to prevent them.
The chief difficulties arose from the fact that their behavior led to a conflict with the surroundings. Casually, these preoccupations might be referred to as obsessions and compulsions. The children, however, felt that they had an interesting and fascinating occupation and regretted merely the lack of understanding of adults.
We propose the term "impulsions" for these preoccupations and activities. They do not represent merely a passing or fleeting impulse which suddenly breaks through the defenses and fears on the surface; they are preoccupations and actions which are in the foreground of the person's experience for weeks, months or even years. Impulsions are not obsessions in the strict sense. They have something in common with the obsessive character trends. American psychiatrist Charles Bradley of the Emma Pendleton Bradley Home , [65] published the book Schizophrenia in Childhood [38] in , which described what is today considered autism.
It includes case studies of eleven children and their families who have particular things in common. He doesn't use the term "autism" as the name of the children's condition. He summarises:. The combination of extreme autism, obsessiveness, stereotypy, and echolalia brings the total picture into relationship with some of the basic schizophrenic phenomena But in spite of the remarkable similarities, the condition differs in many respects from all other known instances of childhood schizophrenia All of the children's activities and utterances are governed rigidly and consistently by the powerful desire for aloneness and sameness Between the ages of 6 and 8 years, the children begin to play in a group, still never with the other members of the play group, but at least on the periphery alongside the group.
Reading skill is acquired quickly, but the children read monotonously, and a story or moving picture is experienced in unrelated portions rather than in its coherent totality It is not easy to evaluate the fact that all of our patients have come of highly intelligent parents One other fact stands out prominently. In the whole group, there are few really warmhearted fathers and mothers.
For the most part, the parents, grandparents, and collaterals are persons strongly preoccupied with abstractions of a scientific, literary, or artistic nature, and limited in genuine interest in people. Almost all the characteristics described in this paper, notably "autistic aloneness" and "insistence on sameness", are still regarded as typical of autistic spectrum disorder.
We must, then, assume that these children have come into the world with innate inability to form the usual, biologically provided affective contact with people, just as other children come into the world with innate physical or intellectual hand[i]caps.
The term " Kanner's syndrome " was later coined to describe the children's condition, in particular to distinguish them from differing symptoms of Asperger's children. This syndrome has also sometimes been known as " classic autism ". George Frankl published the paper "Language and Affective Contact" [69] in the same journal edition as Kanner's paper. It describes different kinds of speech problems children have. In particular, he identifies a group of speech-troubled children defined by having a "lack of contact with persons", which can considered to be an autistic group.
Frankl's precise role in the development of the concept of autism is not clear. This work offered by far the most detailed description of autism as yet published. The difficulties which the young child has in learning the simple skills of practical life and in social adjustment come from the same disorder which causes the learning and behavioural difficulties of the school child, which causes the professional difficulties and the special achievements of the adolescent, and which speaks to the adult's marital and social conflicts Unfortunately, not in all cases, not even in most cases, does the positive, future-oriented traits of the autistic personality prevail.
We have already talked about the fact that there are autistic characters of very different personality levels: from an originality bordering on genius to unrealistic, insular, inefficient oddballs to the most severely contact-disordered, automaton-like imbeciles With the cleverest of them, the teachers sometimes overlook the poorer performance in the mechanizable learning requirements because of their other achievements, because of their clever answers.
Most of the time, however, the teacher is in despair over the agonizing trouble that arises for both parts from this disruption in the way they work We want to show that the basic disorder of autistic psychopaths is a narrowing of their relationships with the environment, that the personality of these children can be understood from this point of view, that it is "thoroughly organized" from that point of view Very differentiated likes and dislikes in the area of the sense of taste are almost regularly found - the frequent occurrence in the same direction is more proof for us of the unity of our type Many of these children have an aversion to certain tactile sensations, which goes to abnormal degrees Either [autistic children] don't notice the things around them at all, for example they don't care about toys at all, or they have an absurdly strong attachment to certain individual things, never take their eyes off a whip, a block of wood, a mere rudimentary doll, can't eat, can't go to sleep if the "fetish" isn't with them, make the most difficult scenes trying to snatch the thing they've held so passionately from them That one has to keep oneself clean and in addition meet the numerous requirements of personal hygiene can only be taught to them with great difficulty, often not at all completely - even the adults, who then have mostly chosen intellectual professions, can walk around unwashed and unkept The autistic psychopath is an extreme variant of male intelligence, male character.
Typical differences between boys' and girls' intelligence can already be found within the normal range of variation: girls are generally the better learners, they are good at concrete, descriptive, practical, clean, eager work; on the other hand, logic, the ability for abstraction, the precise thinking and formulating, that independent research is much more in the possibilities of the boys While, as already mentioned, we have not met any girl in whom the image of the autistic psychopath has been fully developed, we have met several mothers of autistic children who were themselves markedly autistic in their behaviour The steadfastness and the power that lies in the "spontaneous" activity of the autistic, the narrowing down to individual areas of life, to an isolated special interest - this proves to be a positive value that enables these people to achieve special achievements in their areas.
Especially with the autistic we see - with far greater clarity than with the "Normals" - that they seem predestined for a certain profession from their earliest youth, that this profession grows out of their special talents as a result of fate.
In regards to his work's academic antecedents, Asperger frequently acknowledges Bleuler, and also:. Jaensch and above all with the " introverted thinking type " by Jung. It has been suggested that Asperger was also likely aware of Sukhareva's work. The particular patterns Asperger identified later became known as " Asperger syndrome ", [3] particularly those that differed from the children described by Kanner.
Despite many important English-publishing autism researchers being fluent in German, and his work being covered in some English language works, Asperger's concept of autism would be almost unknown by non-German-speaking psychological professionals until the s. It would take yet longer for substantial numbers of non-German-speaking people it describes to hear about it. In September , Kanner published the paper Early Infantile Autism , [73] giving his newly identified condition a new name.
The paper has much in common with Kanner's paper. It included only two case studies, but had a much more detailed introduction. During the past six years, I have become increasingly interested in a number of children, twenty by now, whose behavior differs uniquely and markedly from anything reported so far. Among the individual patients there are great variations in the degree of the disturbance, in the manifestation of specific features, and in the step-by-step development in the course of time.
Yet in spite of this seeming divergence they all present essential common characteristics to such an extent that they cannot but be considered as fundamentally alike from the point of view of psychopathology. Many of these children were brought to us primarily with the assumption that they were severely feeble-minded or with the question of auditory impairment. Psychometric test performances yielded indeed very low quotients, and often enough absent or inadequate responses to sounds of any kind gave good reason for the suspicion of deafness.
But careful examination showed very soon that the children's cognitive potentialities were only masked by the basic affective disorder; in fact, a few of the children had started out by amazing their parents with phenomenal feats of rote repetition. In all instances it could be established that hearing as such was not defective. The common denominator in all these patients is their disability to relate themselves in the ordinary way to people and situations from the beginning of life.
Their parents referred to them as always having been "self-sufficient," "like in a shell," "happiest when left alone," "acting as if people weren't there," "giving the impression of silent wisdom. An excellent rote memory, retaining many poems, songs, lists of presidents, and the like, made the parents at first think of the children proudly as child prodigies The child's behavior is governed by an anxiously obsessive desire for the maintenance of sameness that nobody but the child himself may disrupt on rare occasions.
Changes of routine, of furniture arrangement, of a pattern, of the order in which everyday acts are carried out can drive him to despair Every one of the twenty children has a good relation to objects; he is interested in them; he can play with them happily for hours. The children's relation to people is altogether different. Every one of the children upon entering the office immediately went after blocks, toys, or other objects without paying the least attention to the persons present.
Kanner's two papers became very influential in the English-speaking world, the Americas and elsewhere. One of its first tasks was to create a global standard list of all health conditions, which was approved by an international conference at the end of April. It included "primary childhood behaviour disorders" , which was used to categorise all children with what was considered disordered behaviour.
There was also the condition of "specific learning defects" One of its "disorders of character, behaviour, and intelligence" was the "pathological personality" of "schizoid personality" Various categories of schizophrenia were additionally represented, though not specifically "childhood" schizophrenia.
Kanner published a third autism paper in , entitled Problems of nosology and psychodynamics of early infantile autism. The paper also says much about the personality type of the parents of autistic children, including:. One is struck again and again by what I should like to call a mechanization of human relationships.
They are, on the whole, polite and dignified people who are impressed by seriousness and disdainful of anything that smacks of frivolity. He also notes that the parents were typically "reared sternly in emotional refrigerators," and that "the parents did not seem to know what to do with the children when they had them.
They lacked the warmth which the babies needed. The "League for Emotionally Disturbed Children" was founded in New York in by 20 parents of emotionally disturbed children, [76] including doctor and researcher Jacques May. The group established the "League School" [77] in Brooklyn in Enrolment was limited to children diagnosed with "childhood schizophrenia". The school helped establish a new method of teaching, lead by teacher Carl Fenichel and assisted by psychiatrists Alfred Freedman and Zelda Klapper.
In the early s, the refrigerator mother theory emerged as an accepted explanation for Kanner's early infantile autism. The hypothesis was based on the idea that autistic behaviors stem from the emotional frigidity, lack of warmth, and cold, distant, rejecting demeanor of a child's mother.
The DSM was created to give each of America's mental disorders a clear definition. Two of the conditions it defined included reference to Bleuler's understanding of "autism" - the symptom of keeping-to-oneself.
Each was named primarily using another of Bleuler's terms, and defined with a paragraph. Here will be classified those schizophrenic reactions occurring before puberty. The clinical picture may differ from schizophrenic reactions occurring in other age periods because of the immaturity and plasticity of the patient at the time of onset of the reaction.
Psychotic reactions in children, manifesting primarily autism, will be classified here. Special symptomatology may be added to the diagnosis as manifestations. The term "schizophrenia" was defined elsewhere in the manual. The disorders are marked by strong tendency to retreat from reality, by emotional disharmony, unpredictable disturbances in stream of thought, regressive behavior, and in some, by a tendency to "deterioration.
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