Abstract
Theodor Heller first described a severe regression of adaptive function in normally developing children, something he termed dementia infantilis, over one 100 years ago. Dementia infantilis is most closely related to the modern diagnosis, childhood disintegrative disorder. We translate Heller’s paper, Über Dementia Infantilis, and discuss similarities in presentation between Heller’s cases, and a group of children with childhood disintegrative disorder. In particular we discuss a prodromal period of affective dysregulation described by Heller, and also evident in our sample, but not previously described in any detail since the publication of Über Dementia Infantilis.
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Notes
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In the translation, we have included both our own footnotes and Heller’s. Heller’s are distinguished by bold text.
Literally, “…that we cannot talk of a steadfast connection/relationship of dementia praecox to the formative years”. Formative years refers to adolescence.
The term Heller uses translates as idiocy, derived from the Greek idioteia, uncouthness or lack of education. Throughout we have replaced the term with ‘intellectual disability’.
2. Band, S. 266 f.
Über Idiotie, S. 44 f.
Über die Dementia praecox. Wiener mediz. Presse, 1905. Sep.-Ausdruck, S. 29.
This term is also temporarily accepted by Weygandt. (Idiotie und Dementia praecox, Bd. 1 dieser Zeitschrift S. 331 f.).
As the current work deals with a psychiatric and not an educational topic I decided to publish it after some hesitation. As far as I know the literature, no previous work on mental regression in early childhood has been published. Therefore I believe that I shouldn’t hesitate any longer with the publication of my case presentation as it might cause medical observers to discuss a topic of importance for the study of dementia in adolescents. My main goal is to inspire further discussion.
Hirschl, Die juvenile Form der progressiven Paralyse. Wiener med. Wochenschrift, 1901, Nr.21, Sep.-Abdr., S. 3f. Zappert, Handbuch der Kinderheilkunde (Pfaundler-Schlossmann), S. 661.
This case is also remarkable in that it is the youngest onset of progressive paralysis described so far (5th year of life). Mitteilungen der Gesellschaft für innere Medizin und Kinderheilkunde in Wien, IV. Jahrgang, Nr. 8, S.124 f.
Psychische Störungen des Kindesalters. Tübingen 1887, S. 181 f.
Dornblüth, Ein geheilter Fall von akuter Demenz. Allg. Zeitschrift f. Psych., Bd. 12. Ziehen (Die Geisteskrankheiten des Kindesalters, 2. Heft, S. 44 f.) uses the term stupidness instead of Dementia acuta. Following him the term Dementia acuta is wrong because only inhibitions are present rather than a real dementia.
Ziehen, a. a. O. Kraepelin, a. a. O., S. 34.
An area of higher vulnerability.
Lecture, given at the 77th Vers. Deutscher Naturf. und Ärzte, Merano, 1906: Bericht, 2. Bd., 2. Hälfte, S. 245.
Heller appears to be making a distinction of degree, excluding cases of regression superimposed on innate severe disabilities from the dementia infantilis designation.
“Dudeln”—to yodel, hum, tootle.
The term is more accurately translated as ‘complete’ rather than ‘severe’.
Heller uses the term “apathischer Blödsinn”, meaning apathetic idiocy. In a section of Heller’s paper, which was excluded, he discusses the difference between “Etethische” (excitable) and “Apathische” (apathetic) idiocy, distinguished on the basis of engagement and activity level.
Regarding the etiology of the disease the father gave the following information: After the boy put a stick into his nose he became very upset after pulling it out again. This information is relevant in so far as putting the stick into his nose already implies the boy’s abnormal mental state.
Night terrors.
Potassium and sodium bromine were used as anticonvulsants.
“Wasserbehandlung”, a form of water therapy used in the eighteenth and nineteenth century.
Jahrbücher für Psychiatrie und Neurologie, 1902, Sep.-Abdr., S.6.
“Die geringen sprachlichen Äußerungen sind verstümmelt und verdreht”.
Report of the congress in Merano, a.a.O. A more detailed report about this boy can be found in Weygandt’s essay “Über Idiotie und Dementia Praecox”, a.a.O.
Literally translated as “fierce resistance to all measures of/by the environment/surrounding.”
“Kreisspiele”, e.g., pattycake.
Heller writes “Fixierprüfung”, literally fixation test, but does not specify what type.
“Zerstörungssucht”, literally “addiction to destruction”.
The sentence is “Keine Spontaneität.” without context. The translators take it to mean “no spontaneity in his actions”.
Pagodenhafte—“oscillating”, “like a pendulum”, here translated metaphorically as “windmilling”.
We have excluded here several paragraphs in which Heller discussed the distinction between “erethischen und apatischen Idioten” (see footnote 19) which were only tangentially related to the discussion of dementia infantilis.
References
Heller, T. (1908). Über Dementia infantilis: Verblödungsprozeß im Kindesalter. Zeitschrift für die Erforschung und Behandlung des Jugendlichen Schwachsinns, 2, 17–28.
Kurita, H., Koyama, T., Setoya, Y., Shimizu, K., & Osada, H. (2004). Validity of childhood disintegrative disorder apart from autistic disorder with speech loss. European Child and Adolescent Psychiatry, 13(4), 221–226.
Lotz, D. (2000). Theodor Heller (1869–1938). In M. Buchka, R. Grimm und F. Klein (Hrsg.): Lebensbilder bedeutender Heilpädagoginnen und Heilpädagogen im 20. Jahrhundert (pp 111–128). München und Basel.
Malhotra, S., & Gupta, N. (2002). Childhood disintegrative disorder: Re-examination of the current concept. European Child and Adolescent Psychiatry, 11(3), 108–114.
Acknowledgments
The authors acknowledge the help of Thilo Neubacher in the translation and also the support of the Rumsey Cartier Foundation.
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Westphal, A., Schelinski, S., Volkmar, F. et al. Revisiting Regression in Autism: Heller’s Dementia Infantilis . J Autism Dev Disord 43, 265–271 (2013). https://doi.org/10.1007/s10803-012-1559-z
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DOI: https://doi.org/10.1007/s10803-012-1559-z