00100	DEAR JOHN
00200	MANY THANKS FOR YOUR LETTER AND THE REPRINTS. THE DIAGNOSTIC CHAOS
00300	OF CHILD PSYCHIATRY APPEARS TO BE CLEARING A LITTLE. THE `AUTISMS'
00400	ARE OBVIOUSLY A HETEROGENEOUS GROUP WHICH CAN BE DISTINHUISHED
00500	FROM SCHIZOPHRENIA (THE ONSET, HISTORY, FAMILY HISTORY, SYMPTOMS,
00600	SEX-DISTRIBUTION, COURSE AND PROGNOSIS DIFFER) AND GROSS NEUROLOGICAL
00700	DISORDERS (ABNORMAL EEGS, PROGRESSIVE DETERIORATION, SEIZURES,
00800	CHOREIFORM MOVEMENTS, MUSCULAR INCOORDINATION, SOFT SIGNS).
00900	EVEN THE TERM `AUTISM' IS A MISNOMER SINCE THE CHILDREN ARE NOT
01000	WITHDRAWN NOR ARE THEY SOCIALLY OBLIVIOUS AS SIMON CLAIMS. IN FACT
01100	IN EXPERIMENTAL SITUATIONS `AUTISTIC' CHILDREN PAY MORE ATTENTION
01200	TO SOCIAL STIMULI THAN NORMAL CHILDREN. (SEE HERMELIN,B.A. AND
01300	O'CONNOR,N. PSYCHOLOGICAL EXPERIMENTS WITH AUTISTIC CHILDREN,
01400	PERGAMON PRESS,1970). THE `AUTISTIC' CHILD WITHDRAWS ONLY FROM
01500	PEOPLE WHO TALK TO HIM THEREBY FLOODING HIM WITH NOISES HE
01600	CANT UNDERSTAND AND REQUIRING HIM TO REPLY IN KIND WHICH HE CANT DO AT ALL.
01700	
01800	    AMONG THE `AUTISMS' THERE SEEM TO BE SEVERAL DISTINCT GROUPS, SPEAKING
01900	VERSUS NONSPEAKING AND EARLY (ONSET IN THE FIRST YEAR) VERSUS  LATE (ONSET
02000	IN THE SECOND OR THIRD YEAR BUT NOT IN THE FOURTH).
02100	IN OUR NONSPEAKING GROUP THE GREATEST DIFFICULTY LIES IN DISTINGUISHING
02200	DYSPHASIC FROM DYSSYMBOLIC CHILDREN. IN DYSPHASIA THE SYMBOL SYSTEM
02300	AFFECTED IS LIMITED TO LANGUAGE. A DYSPHASIC CHILD WILL IMITATE, USE
02400	GESTURES, DRAW AND EVEN LEARN TO READ IF HIS RECEPTIVE PROCESSES ARE
02500	NOT TOO DAMAGED. A DYSSYMBOLIC CHILD CANNOT, AT THE START, GRASP OR
02600	USE ANY SYMBOLIC SYSTEM. ENCLOSED IS A REPRINT PUTTING FORTH THE 
02700	LANGUAGE DIFFICULTY ARGUMENT BUT I WOULD GO EVEN FURTHER IN POINTING
02800	TO A GENERAL SYMBOLIC DIFFICULTY. HENCE I AM SKEPTICAL ABOUT INDICTING
02900	THE INFERIOR COLLICULUS. IT IS TOO LOW DOWN IN THE CNS AND HANDLES
03000	VISUAL AND AUDITORY REFLEXES RATHER THAN SYMBOLIC REPRESENTATIONS.
03100	IN OUR DAY I WELL REMEMBER YOUR STORY ABOUT THE HYPOTHALAMUS BEING
03200	AS LARGE AS THIS ROOM AND FUNCTIONING LIKE THE HOLY GHOST WHOM NO
03300	ONE EVER SEES.
03400	
03500	   I STILL WORRY ABOUT THE LACK OF AUTOPSIES AND THATS WHY IM NOT
03600	AN ETIOLOGIST IN THE FIELD. RECENTLY IT LOOKED LIKE WE WOULD HAVE
03700	SOME POSTMORTEM FINDINGS ON A GENUINE CASE OF KANNER'S SYNDROME FROM
03800	TEXAS BUT THEN THE HOSPITAL LOST THE BODY! BRAIN BIOPSIES ARE BEING
03900	TRIED BUT NO ONE KNOWS WHAT TISSUE TO REMOVE AND THERE ARE SOME
04000	ETHICAL PROBLEMS INVOLVED.
04100	
04200	   I AGREE THAT NONE OF YOUR CASES SOUND LIKE  ONE OF THE `AUTISMS'.
04300	D.M. CERTAINLY SEEMS TO HAVE GROSS BRAIN DAMAGE (SEIZURES, HYPEREXTENSION).
04400	IF YOU FOUND A CASE , I DONT KNOW EXACTLY WHAT TESTS TO RECCOMEND.
04500	THE TEST WE USE IS SIMPLY TO RECORD THE CHILDI'S INTERACTION AT THE 
04600	DISPLAY. AS YOU CAN SEE FROM THE ENCLOSED THERE IS A CLEAR DIFFERENCE
04700	THE NORMAL CHILD PRESSES A KEY , WAITS FOR THE SOUND TO BE PLAYED AND
04800	THEN HITS THE NEXT KEY. HE TRIES A VARIETY OF KEYS AND ONCE IN A 
04900	WHILE YOU CAN SEE AN ACTUAL WORD. A DYSSYMBOLIC CHILD HITS THE SAME
05000	KEY OVER AND OVER, DOES NOT WAIT FOR THE SOUND, SHOWS LONG INTERVALS
05100	BETWEEN HITTING KEYS AND TYPES NO WORDS. AS A REMEDIALIST I WOULD OF 
05200	Z.
05300	COURSE LIKE TO SEE THE DYSSYMBOLIC PATTERN CHANGE OVER TIME TO 
05400	THE MORE NORMAL PATTERN. OVER THE PAST YEAR WE HAVE FAILED WITH
05500	TWO CASES OF EXPRESSIVE DYSPHASIA  AND WE ARE CURRENTLY FAILING
05600	WITH A CLASSICAL KANNER CASE WHOSE E2 SCORE IS 26. (YOU CANT WIN
05700	THEM ALL BUT YOU CAN LOSE THEM ALL).
05800	   CLINICAL OBSERVATION OF THE ADULT 'AUTISMS' MIGHT BE ENOUGH.
05900	FOR EXAMPLE, ARE THEY ECHOLALIC, DO THEY HAVE TELEGRAPHIC SPEECH,
06000	DO THEY USE THE PRONOUN `I', DO THEY USE PREPOSITIONS, DO THEY
06100	UNDERSTAND COMPLEX COMMANDS (GO IN THE NEXT ROOM AND BRING ME YOUR
06200	SWEATER'), ARE THEY DYSPHASIC?
06300	  MAX AND I SEND YOU AND MIRIAM OUR BEST. WE HOPE YOUR EAR UNPLUGS
06400	UNLESS YOU FIND IT QUIETER NOT HEARING ALL THE NONSENSE THAT GOES ON.
06500	WE ARE ALL SICK AT THE MOMENT. I'M TAKING A DRUG TO LOWER MY
06600	CHOLESTEROL. ITS SIDE EFFECTS ARE MERELY WAVES OF NAUSEA, NUMBNESS
06700	OF THE HANDS AND AN OCCASIONAL FEELING OF SIMPLY FALLING APART. THIS
06800	WILL PROBABLY BE MY MAIN CONTRIBUTION TO MEDICINE.