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Ella was referred to the Child Guidance Clinic at the age of three years eight months by an Audiology Unit where she had been sent for suspected deafness. She was found to have normal hearing but the doctors referred her to the Child Guidance Clinic as she only spoke a few words, made inappropriate noises and seemed retarded. She also had many obsessional mannerisms and rituals and all this made the Psychiatrist and Psychologist at the clinic suggest autism as a diagnosis. They noted that autistic children are commonly thought to be deaf.
In view of the seriousness of Ella's symptoms, her development and considerable improvement before and during her treatment is interesting. The improvement in her means of communication may be noted especially in the material from a session prior to a holiday, given below, where Ella, by now well in touch with her feelings, seems to be describing in words and drawings, what she originally had to act out with her body and rituals.
When she first came to the clinic, Ella spoke only a few words and dominated the family with her obsessional rituals. She was fascinated by records spinning on the record player and had a complicated ritual connected with it. Things and people always had to be in exactly the right place, for example the family had to walk in line on the path in the park and crockery or cutlery on the table had to be in straight lines. She also had many fears; of the lavatory, the bath, the dentist, any vehicles that went backwards, etc. Several of the fears could be generalized as a fear against any change. She showed no affection to anyone.
It is useful to know a few details of Ella's early history. The pregnancy was difficult. There was a threatened miscarriage and Mother had already had several miscarriages since the birth of Ella's only sibling, Barry, four years older than Ella. Ella was four weeks premature. Mother felt labour was precipitated by her own step-mother's death two days before. The birth was very quick and