It is not a simple matter to diagnose an autistic disturbance in personal contact, especially since this disturbance can not be sharply distinguished from other disturbance in contact. In only 17 of 103 patients who were seen in five years' time in connection with presumptive autism, this diagnosis could be maintained after three months' observation. Once the diagnosis has been made, an elaborate examination is required since other pathology may occur coincidentally.
I dwelled at greater length on those autistic patients who also showed childhood psychotic syndrome (7 of the 17 patiens). The essential feature of this psychosis is that the child does not regard its mother as the first representative of outward reality: that is, that she continues to form part of its delusional omnipotente. Because of that neither separation nor individuation come into existence. The lack of softening or libidinisation of the first expressions of agression — a process that in the progress of a normal development comes into being through 'mothering' — plays a preponderant part in this disturbance of development. I have described the clinical manifestations of these patients, and have indicated in which way we have tryed to help the interrupted processes of development to recommence.