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Poldi came to me at the age of ten—a well-proportioned boy, large and very strong for his age, with no evidence of glandular disturbance or other physical abnormality—but his face was frequently distorted by tic-like, twitching movements: blinking, wrinkling of the nose and jerking of the mouth. In moments of excitement these movements increased to the point of grimacing, and in addition he would hop from one foot to the other, at the same time opening and closing his hands convulsively and bringing his arms together, first in front and then in back. Since this condition could be induced by the least excitement, Poldi was in almost constant motor agitation.
Added to this extraordinary condition were other symptoms which had caused his parents to seek medical assistance repeatedly. Poldi was tormented by constant anxiety which made it impossible for him to be alone, even for a short time. Moreover, he was unable to keep himself occupied, either when he was by himself or with anyone else. He masturbated excessively in an exhibitionistic manner and for this reason had already been excluded from kindergarten and school.
He was especially clumsy with his hands, and his vocabulary and manner of expressing himself by no means corresponded to his age level. Arithmetic was particularly difficult for him; he could add and subtract only with the help of his fingers, and even then he made mistakes; simple multiplication tables which he could memorize came more easily to him, but it was impossible for him to solve any written problem.
Poldi was subjected to a thorough physical and neurological examination. No organic basis for his illness was found, but its possibility was not excluded. The report of the Children's Hospital after a six-weeks period of observation when Poldi was six years old did not exclude the possibility of a cerebral