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Carol was referred to University Hospitals Nursery School by the local child guidance center at her parents' request.
Carol was three years, four months old, rather small and thin for her age, but well built and physically healthy. She looked very dainty with her dark hair, big brown eyes, and delicate complexion. Quite often, however, her features and her whole body became rigid, tense, and distorted, and she would stare in an intense, blank fashion which seemed to repel, rather than absorb, whatever she saw. Even in her more relaxed moments she could not smile or laugh. In observing Carol, it became evident that she was not able to relate to adults or children and that she could not comprehend the meaning of everyday events around her. She would sometimes stand apart with a withdrawn expression, or she would for longer periods monotonously pour water from one can into another, or shovel sand in the play yard; but she seemed to pay little attention to what she was doing, apparently absorbed in thought. Then her placid attitude would suddenly change: her body stiffened, her hands and arms began to wave excitedly, and she would rather rigidly dance around on her tiptoes, showing tremendous over-all excitement. At such times she talked excitedly to herself or to others, but one could not understand her in spite of her clear articulation. Here is an example of her speech recorded at that time:
Carol picks up two wooden blocks and hands them to the teacher. She talks in a loud voice, accompanied by much dancing and waving of hands. "You hold this, that, eat it—perfume. Feels good, it's an airplane. Things