Abstract
This brief and very personal review of clinical experience with infantile autism shows that none of the files on this particular disturbance pattern can as yet be closed. As regards the etiology, I believe that the condition is most probably caused by a variety of factors, each of which can be involved to a greater or lesser extent in creating the disturbance. I have taken the term "autistic" to mean a supra-individual reaction type having to some degree its own intrinsic laws, a type which can be caused by various noxae. Whether there is a special function disturbance on which autistic behaviour is based has also still not been decided. Along with Rutter (1968) and in particular Ploog, I would assume that the function disturbance is most likely to be a specific disturbance of perception, of comprehension of the social milieu, but I would place it quite early on in the child's life before the development of language and in the area of the system of social signals. Such an individual with impaired ability to comprehend his fellow-humans adequately and to express himself to them starts out on life with a severe handicap. His psycho-social development will be retarded, and he will be slow to understand his fellow-beings and himself. His language will develop at a correspondingly slow rate and in a highly peculiar way, and he will face the entire world and the people in it not understanding and afraid, possibly indeed, frightened to death. As a result, the retardation in development caused by an existing lack of faculties is joined by a secondary turning away and turning back, which can finally lead without any additional psychotic process to stagnation of the psychic development in the autistic defect. The therapy, which in fact, as Bettelheim believes, is still only in the early stages of its development, should in accordance with this view be directed both at helping the inadequately developed and insufficiently talented individual to improve and at treating the abnormal attitude, the psychodynamic autistic withdrawal. Only by adopting such a two-pronged program of therapy and by going deeper into the theory behind it, improving at the same time our therapeutic methods, will we be able to treat the problems of autistic children squarely.