Approaching the autistic child

How does one approach the autistic child? How does an analyst approach the child, and how does the child approach the analyst? Children generally appear occupied by their interests, their repeated actions; they seem caught up in their own world and thus disconnected from what is happening around them. Some children speak, and some do not; some become absorbed by certain objects or actions, others by the sight of a certain image. There is no single type of child, nor is there one type of autistic child. Rather, everyone is different in their uniqueness.

The interests of children, their passions, used to be referred to as obsessions. What role should they play in a child’s life and treatment? Are they obstacles to be corrected or eliminated? Ron Suskind’s testimony on the way in which he has achieved closeness to his son Owen through Disney cartoons, through respecting his son’s object of interest, his passion, illustrates how one can use a child’s inventions as a way point of connection.

Jean-Calude Maleval worked with different types of autism, ranging from the appoggiatura on the body, the creation of an object, the dynamic edge, to its effacement. His work certainly falls in line with the belief that there is diversity in autism, and this diversity is currently referred to as the autism spectrum. Maleval’s work also supports the idea that while autism is a unique functioning that remains stable throughout life, there can still be changes in the analytical treatment of autistic children through incorporating their inventions into treatment.

What does clinical diversity teach us about the autistic child’s interests and treatment?

1. Coming into contact

When Marcos, a nine-year-old boy, found himself for the first time with an analyst seated at his desk, he did not come in contact with him. The child reacted violently toward the slightest attempt at closeness. He would arrive at the office with a collection of small objects, which included a damaged-looking CD.

The analyst tried several interventions with the other objects, but did not have success. Finally, he captured the boy’s attention by putting the CD in the computer. From then on, the boy wanted to watch the movie in each session, but he was only interested in the credits at the beginning and the end. The rest of the movie went by quickly. The analyst introduced another object into the treatment, his cell phone, and filmed the parts of the movie that interested the boy. Then, he offered to show the boy what he filmed. Marcos would go back and forth between the computer and the cell phone, and started to become interested in the analyst’s actions. He watched where the analyst sat and walked; he watched him and occasionally emitted sounds. Later, Marcos became interested in certain scenes in Disney movies: in one of them, Lilo and Stich were talking; in another, Pinocchio was walking while singing. During these scenes, the boy moved closer to the analyst, laughed, moved his body, took the analyst’s face and stared into his eyes.

People often talk about breaking the tie of the autistic child, when in reality, they are talking about a “subtle tie” that the child maintains in accordance with his subjective potential. To the extent that the analyst meets the child at his point of interest, he can open a path toward new objects and circuits. The child shifts his fixation from being solely on the beginning and ending of the cartoon to other sequences, but without changing the point of interest. The analyst becomes a true stunt person, in which Marcos fixes his gaze and, upon doing so, expands his sphere to an “autism of two.”

2. Inside a Cartoon

During the first meeting with a ten-year-old girl, her unique intonation caused to me enter into her world of cartoons in which everything, from movements to words, had to be repeated in a precisely identical way. She would tell me what to do and say. “Repeat!” she ordered, and then she would tell me the phrase I was to repeat. She spoke in phrases from the cartoons, which allowed her to communicate in her environment. Through copying the cartoons, I found myself becoming part of them. I was not familiar with any of those cartoons, which were different depending on the television channel and hour of the day. But through them, the girl told me again and again about an accident she had when she was younger that had a strong impact on her. She also re-enacted television game shows in our sessions. She would ask me a question, give me three possible answers, and I then had to pick an answer. After I gave my answer, she would exclaim, “Correct!” with great happiness. It did not matter much to her whether the answers I randomly chose were right or wrong; the reenactment itself was what mattered. Along with the cartoons, the girl started including games into our sessions that required the same repetition and order. These changes adopted the same function of the prior behavior. Moreover, as I said goodbye, I found myself saying “Correct!” in response to something she said, and with the same intonation she used. She would then respond with a smile, followed by a hug.

Being a part of her cartoons, even without getting to know more than the fragment of her being that she chose to show through repetition, taught me many things. The girl quickly put me in a position of true stunt person in the transference. I had to imitate her movements so as to erase all differences between us; in other words, invert echolalia and echopraxia. The cartoons came to life through this encounter with the patient, and I found myself dealing with a script that she dictated to me and that neither resonated with, nor had meaning for me. Having respect for her invention, her world of cartoons and phrases extracted from them, allowed me, as the analyst, to interact with the girl as a true stunt person without it seeming intrusive and thus causing her distress.

3. Respecting the Invention

A seven-year-old boy diagnosed with Asperger’s had a particular interest in boats. He was well versed in them, and spent most of his time drawing, building them with legos, and talking about them. In Ushuia, boats are a central part of life. His family’s move brought the boy to Buenos Aires, a place far away from boats, and instead filled with trains and subways. Surprisingly, in the same way that he was occupied by boats during his first analysis, trains took the place of his previous passion in his analysis with me. He knew all train routs; he drew them on a paper, and also showed where they connected as he created the map. The boy was especially attentive to the schedules, the station announcements, and the details of the different forms of transportation. He could describe to me, in extraordinary detail, the cranks and distinct parts that connect one car to another, and especially the mechanical movements of the hitches when the cars move or are disconnected. In each session, the boy had me share in his knowledge of trains. I listened intently to his descriptions, even though sometimes it was hard for me to follow his explanations of how the mechanisms worked. One time, his parents bought him some history books so that he would occupy his time with other things. He brought his books to the session, and without hesitation, he showed me a map in one of them that he had found of the first subway in Buenos Aires. The boy’s life, his routines, and his learning were consumed by trains, and not much else concerned him. Content with his analysis, he wanted to move across from the office.

This boy taught me that the so-called obsessions and specific interests of an autistic child are not an obstacle keeping the child from building a life with others, such as in school, with his family, or through the transference bond. By concerning himself with a mode of operation, the boy himself managed to change his interests by taking from the elements in his environment. He could have not done it. It is not necessary to live in Africa in order to have a fear of tigers. But the fact that he did it shows his ability to change his interests while maintaining the same type of relationship with that which he is passionate about.

4. Analytic Treatment

In an initial analysis, one tries to enter into contact with the autistic child without being interpreted as an invader; one attempts to situate him/herself next to the child, familiarize him/herself with the child’s “passions,” the child’s world, learn what his/her interests are, and what resources he/she has. It is not necessary to force the child to give up certain behaviors or interests in exchange for what would be considered normal, nor is it necessary to teach him/her how to behave; education belongs to another institutional setting. It is not necessary, either, to take the object of interest away from the autistic child so that he/she becomes interested in new objects. The autistic object, the autistic stunt person, and the specific interests or islands of competence are the inventions that allow the child to stay in his/her world of safety, just as Maleval explained. The work on transference tries to supplant the autistic encapsulation and replace it with a playful space that includes metonymy of objects, the repetition of the sequences assembled by the child, and the words he/she uses that form his/her private language. As Eric Laurent states, this treatment is about achieving displacements in contiguity, knowing that the inclusion of what is new is accompanied by the cession of pleasure that affects the body and diminishes the outbursts of violence and self-mutilation. In his/her work, the analyst can play the role of the real stunt person, the addressee or a witness, starting from the subtle tie that engages the autistic child.

Lateral perceptions and the cadence of the musical quality described by Donna Williams; the thinking in images, in words, and the perception of Temple Grandin in patterns; the repeated gathering of numbers and letters in Daniel Tammet’s reality – these all illustrate how in autism, imaginary, symbolic and real registries play a role, along with a topology of their own space. Added to all this is the autistic child’s specific interest, which takes the central role. All are different.

That which is different often causes feelings of worry, and this is not only true in autism; difference generates fear of the unknown, and it can also drive segregation. By respecting the invention of each child, his/her specific interests, and making use of them, one can approach the autistic child in a way that helps the child find his/her own path in life. From this perspective, and knowing that each child is unique, affinity therapy and psychoanalysis have much to contribute to the field of autism.

Translated by Chloe Bergsma-Safar