The Trance Children

The most tragic, and in some ways most mysterious, form of mental illness in children is infantile autism. Autistic* children live in a lonely and unbreakable trance. As babies, they seldom look into their mothers' eyes, they never reach out to be picked up and cuddled. By the age of about two, they have withdrawn completely from the world, ignoring the people around them in favor of the Teddy bears or dolls to which they become fanatically attached. The smallest departure in routine can send them into screaming paroxysms; some must wear tiny football helmets to prevent them from smashing their heads against a wall.

Unlike children afflicted with brain damage, the victims of autism often display tantalizing flashes of intelligence. Some can memorize long, complicated stories with flawless accuracy; many have perfect pitch. Psychiatrists differ widely in their views on the cause of autism, and real cures have been rare. In Washington last week, discussions at the annual meeting of the National Society for Autistic Children indicated that research and treatment are beginning to move along some new paths.

No Blame. Parents of autistic children have never had much reason for hope. Until Dr. Leo Kanner of Johns Hopkins University identified and defined the disease in 1943, most doctors concluded that autistic children were mentally retarded, and could recommend nothing more than packing them off to a vegetable-like existence in a custodial institution. Kanner, taking more careful note of their mental abilities, concluded that the disease was a psychosis. He felt that the condition was innate, but noted that many parents of autistic children were highly intellectual and emotionally cold--"refrigerator parents," as he called them. Other experts in autism, including Chicago Psychoanalyst Bruno Bettelheim, accept the theory that parental rejection is the basic cause of the children's problems.

The specialists who belong to the National Society--and the parents who founded the organization 3-c- years ago --strongly disagree. They point out that the symptoms of autism usually develop in a baby's first weeks, seemingly well before strong parental influence is possible. Moreover, studies indicate that the other offspring of parents with an autistic child are almost invariably normal. Some researchers hope that autism will turn out to be similar to cretinism and phenylketonuria (or P.K.U.)--products of some defective chemistry affecting the nervous system. Meanwhile, a growing number of experts would like to sidestep the question of parental blame and concentrate on teaching autistic children acceptable substitutes for their difficult and harmful behavior. Says Dr. Leon Eisenberg, chief of psychiatry at Boston's Massachusetts General Hospital: "Guilt is the most useless commodity available."

A careful use of discipline is the heart of several recent approaches. Adopting the principles of reinforcement therapy (TIME, July 11), psychologists at the U.C.L.A. Neuropsychiatric Institute put autistic children through a demanding series of exercises. The therapist waits for them to perform a small act as a normal child would, then quickly rewards them with praise and a few bits of cereal or an M & M candy. If they revert to autistic behavior, he promptly says "No," and may even strike them. After literally hundreds of repetitions, the rewardable behavior begins to replace autistic distraction, and the children can be stimulated by praise alone.

No Cure. Similar ideas are also being put to use in a few of the schools that attempt to treat autistics along with other problem children. Carl Fenichel of Brooklyn's League School for Seriously Disturbed Children told the National Society meeting that he has had some success by firmly distracting autistic children from their tantrums and insisting they practice simple mechanical tasks such as holding a pencil or using an egg beater. "Disorganized children need someone to organize their world for them," he says. "They fear their own loss of control and seek protection against their own impulsive drives; they need teachers who know how to limit as well as accept them."

None of these methods can "cure" autism, the researchers warn. The best that therapy can do now is abate the worst symptoms, allowing children to remain at home with their parents and attend special schools that serve the braindamaged, the retarded, and children with other mental conditions that are more amenable to treatment than autism. The parents of autistics, who make up most of the N.S.A.C.'s 700 members, are lobbying to force all states to provide this kind of care through the public schools. So widespread is the feeling that children with severe mental illness can never be helped, says N.S.A.C. Legislative Chairman Herman Preiser, that only six states make it mandatory to provide any education for them at all.

* From the Greek word for self.

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