Autism, Viewpoint on the Brain Disorder

1 - Conrad
This book is written in memory of my son Conrad, who
was a classic example of Kanner autism. He had no
developmental delays in motor milestones, but
displayed the social obliviousness characteristic of
autism and the echolalic or "irrelevant and
metaphorical" speech described by Kanner (1946).
He was well past the age of six before learning to use
the pronoun "I" rather than "you" to refer to himself,
and this was through the sustained efforts of special
education including instruction in deaf sign language.
Throughout his life however Conrad continued to
make mistakes in pronoun usage and never gained
full competence in language use.

Conrad was born in a "face presentation" rather than
with the crown of the head passing first through the
birth canal. He was limp and pale at birth, and
several minutes passed before he uttered a few weak
cries. Conrad's older brother, Ralf, cried before I
could be told his sex, because even after forceps
delivery of his head extraction of his shoulders
required special interventions. Ralf was born pink
except for his feet, which were completely blue; so
Ralf too suffered some oxygen insufficiency during
birth. Ralf was a week overdue and weighed 8
pounds 11 ounces at birth. Conrad was born a week
early and weighed 8 pound 14 ounces.

Large heads run in our family, and all four of my sons
have large heads. A note for the doctor on the next
shift "N.B. contracted pelvic outlet" was made in the
margin of my medical record during my labor with
Ralf. The year was 1962, before medical insurance
covered childbirth. My husband was a graduate
student and we did not have the means to afford a
private delivery. No one could have been in better
health than I was, and I was assured by everyone that
I would get the best of care at the old Boston Lying-in
clinic. It has been my eternal regret that I did not
somehow find the money needed go to a specialist for
delivery of my first two children.

Conrad's older brother, Ralf, clearly suffered a
traumatic birth. He had a cephalhematoma that
covered the right half of his head and remained
prominent for most of his first year of life. Figure 6 is
a picture of an infant with a cephalhematoma, from
the article by Towbin (1970). If this is not a drawing of
Ralf shortly after birth, it looks just like Ralf and the
bump on the head he was born with. I contacted the
author of the article, Abraham Towbin, who told me
the drawing was made in the newborn nursery at the
Boston Lying-In Hospital around the time of Ralf's
birth in September 1962.

Pediatricians tried to reassure me that lots of babies
are born with bumps on their heads. My response
was, "Then why don't I see lots of other babies with
bumps on their heads?" Many strangers would gasp
and ask how my baby got such a bump on his head,
and whether he fell off the bed or down the stairs. In
his article, Towbin discussed the seriousness of
cephalhematoma and provided by way of contrast a
picture of an infant with caput succedaneum, a more
common and less serious bruise to the head caused
during birth.

Towbin also emphasized that birth can be one of life's
most traumatic experiences. That human birth is
hazardous deserves attention, whether the outcome
is autism, cerebral palsy, or non-significant. But birth
trauma may appear to be non-significant and
well-weathered by a "genetically sound" infant, but it
is more likely responsible for anomalies of
development that in the end are not insignificant.
There is an association between perinatal problems
and later-developing schizophrenia, and problems like
childhood conduct disorder and life-long anti-social
personality disorder should also be investigated as
possible sequelae of perinatal difficulties.

The sooner trauma at birth is acknowledged and
measures taken to prevent it, the sooner litigation will
end. Problems like umbilical cord prolapse should
also be more rigorously investigated. An infant born
with the cord around his neck has not been
sufficiently oxygenated during labor and delivery.
Blood flow through the umbilical cord should keep it
taut so that it is not free to wrap around the neck.
Why and how prolapse occurs, as well as other
common hazards of labor and birth, should be
investigated as vigorously as loci of autism genes on
chromosomes. We live in a culture that urges family
planning, but then the safety of each carefully
planned pregnancy must be vigorously pursued.