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The author gives a good clinical description of what is undoubtedly a case of juvenile schizophrenia. The patient has been under observation between the ages of four and eight years. Evidence is given to prove that the psychotic process began at about the age of three years. Organic disease of the central nervous system has been ruled out. Disorders of thinking and perception, deviations in language and speech, alternations of stupor and excitement, negativism, impulsive behavior and primitive motor discharges were present in the forms characteristic of a malignant adult process. Progressive mental deterioration occurred.
Despert believes that it is most important to emphasize the point that 'severe behavior disorders, associated with regressive characteristics, are not uncommon in young children with acute emotional disturbances', but that, '… in the absence of affective dissociation the diagnosis of schizophrenia cannot be made'. Difficulty in the discovery of affective dissociation in children is due to the '… present lack of knowledge of early intellectual function and the relation of emotional factors to symbolic structure at various developmental levels'.
The evidence on which the author bases the presence of the pathognomonic sign in this case lies in what she calls 'dissociation between language-sign and language-function'. The child was able to retain and use many difficult words at an early age but their use was autistic and not for the purpose of communicating with other people. 'The significance of this affective dissociation, as reflected in the anomaly of language development, has not been emphasized enough and should be recognized and further investigated, since the use of early language in the child represents his first attempt to employ an adult means of communication with his environment.'