Risk Factors (Genetics & Inherited Conditions)
Boys are four times more likely than girls to have autism. Siblings of a child with autism have a 3-7 percent chance of being autistic.
A number of other conditions are associated with autism, although the relationships among them are not clear. These conditions include neurofibromatosis, tuberous sclerosis, fragile X syndrome, phenylketonuria (PKU), Möbius syndrome, epilepsy, herpes encephalitis, and cytomegalovirus.
Children born to women who have problems during pregnancy or delivery, or who contract rubella during pregnancy, are also at risk. These conditions primarily affect the central nervous system.
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Etiology and Genetics (Genetics & Inherited Conditions)
Autism is a complex condition whose expression is determined by a host of genetic, developmental, and environmental factors. While the genetic determinants appear to play the predominant role, they are difficult to quantify since so many different genes are apparently involved.
The first genetic region shown to have an association with autism is a deoxyribonucleic acid (DNA) sequence on chromosome 5 that is between two genes that specify cell-adhesion molecules. These proteins are important components of nerve synapses, the junctions between nerve cells. In subsequent years, many additional genes or genetic regions have been implicated in autism occurring in some families. A 2009 report identifies no fewer than twenty-seven different genetic regions with rare copy number variations (duplications or deletions), located on twenty different chromosomes, that were found in children with autism but not in the control group. Specific genes that are thought to play a contributing role in some cases include Shank3 (at position 22q13.3), BZRAP1 (at position 17q23.2), MDGA2 (at position 14q21), MECP (at position Xq28), and PTEN (at position 10q23.31).
One classical estimate of the extent to which genetics plays a role in the development of a complex trait or disease is the measurement of concordance rates in monozygotic (identical) twins as compared with those for dizygotic...
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Symptoms (Genetics & Inherited Conditions)
Autism first appears in children aged three and younger. The severity of symptoms varies over a wide spectrum. Behaviors and abilities may differ from day to day; symptoms may decrease as the child grows older. Children with autism may exhibit a combination of abnormal behaviors.
Symptoms include avoiding social contact, loss of language, using words incorrectly, changing the meaning of a common word, gesturing frequently, avoiding eye contact, and having trouble with nonverbal communication. Other symptoms include lack of interest in normal activities for their age; spending a lot of time alone; not playing imaginatively; not starting pretend games; not imitating others; sensitivity to sound, smell, taste, sights, and touch; responding to stimulation in an abnormal way; and not reacting to smiles in the manner expected. Hyperactivity; passiveness; tantrums; single-mindedness; aggression; hurting themselves or self-mutilation; repetitive movements, such as rocking or flapping a hand; resisting change; forming odd attachments to objects; sniffing or licking toys; and not understanding other people’s feelings and needs are additional symptoms.
Some people with autism suffer from other disorders as well, including seizures, mental retardation, and genetic disorders, such as fragile X syndrome.
Some people with autism have unusual abilities. For example, they may memorize things or be able to play a musical instrument...
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Screening and Diagnosis (Genetics & Inherited Conditions)
Doctors who specialize in autism will observe a child’s behavior, social contacts, and communication abilities. They will assess mental and social development and ask parents about the child’s behavior. Some doctors ask parents to bring in videotapes of the child at home.
Tests may include neuropsychological tests, questionnaires and observation schedules, and intelligence quotient (IQ) tests. Medical tests can rule out other conditions that cause similar symptoms. Blood tests; urine tests; deoxyribonucleic acid (DNA) testing; and an electroencephalogram (EEG), a test that records the brain’s activity by measuring electrical currents through the brain, are among these medical tests.
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Treatment and Therapy (Genetics & Inherited Conditions)
There is no cure for autism. The severity of symptoms may decrease over the years, but the condition lasts for life. Children with autism and their families may benefit from early intervention. Children with autism respond well to a structured, predictable schedule. With help, many children with autism learn to cope with their disabilities. Most need assistance and support throughout their lives. Others are able to work and live independently when they grow up.
Interventions to help children with autism include special education programs; these programs are designed to meet the child’s special needs and improve the odds of learning. Children with autism may have trouble with assignments, concentration, and anxiety. Teachers who understand the condition can build on the child’s unique abilities. Programs should incorporate the child’s interests. Some children do better in a small-group setting; others do well in regular classrooms with special support. Vocational training can help prepare young adults for jobs.
Therapy services, such as speech, physical, and occupational therapies, may improve speech and activities. Children with autism need help developing social skills.
Professional support helps a family cope with caring for a child with autism. Counselors help parents learn how to manage behaviors. Caring for a child with autism can be exhausting and frustrating; arranging occasional respite care...
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Prevention and Outcomes (Genetics & Inherited Conditions)
Further Reading (Genetics & Inherited Conditions)
Boucher, Jill. The Autistic Spectrum: Characteristics, Causes, and Practical Issues. Los Angeles: Sage, 2009.
Dodd, Susan. Understanding Autism. New York: Elsevier, 2005.
EBSCO Publishing. Health Library: Autism. Ipswich, Mass.: Author, 2009. Available through http://www.ebscohost.com.
Moldin, Steven O., and John L. R. Rubenstein, eds. Understanding Autism: From Basic Neuroscience to Treatment. Boca Raton, Fla.: CRC/Taylor & Frances, 2006.
Rapin, I. “An Eight-Year-Old Boy with Autism.” Journal of the American Medical Association 285, no. 13 (April 4, 2001): 1749-1757.
Sykes, N. H., and J. A. Lamb. “Autism: The Quest for the Genes.” Expert Reviews in Molecular Medicine 9, no. 24 (2007): 1-15.
Thompson, Travis. Making Sense of Autism. Baltimore: Paul H. Brookes, 2007.
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Web Sites of Interest (Genetics & Inherited Conditions)
Autism Canada Foundation. http://www.autismcanada.org/home.htm
Autism Information Center, Centers for Disease Control and Prevention. http://www.cdc.gov/ncbddd/autism/index.htm
Autism Society of America. http://www.autism-society.org
Autism Society Canada. http://www.autismsocietycanada.ca
Genetics Home Reference. http://ghr.nlm.nih.gov
National Institute of Mental Health. http://www.nimh.nih.gov
National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov
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Causes and Symptoms (Magill’s Medical Guide, Sixth Edition)
Autism is a lifelong neurodevelopmental disorder that is almost always diagnosed in early childhood, though mild presentations may not be diagnosed until middle childhood. According to the handbook of mental health, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR (4th ed., 2000), autism is diagnosed if there is evidence of qualitative impairment in both social interaction and communication, together with a marked participation or interest in restricted and repetitive behaviors or activities. Autism also typically involves delays or abnormal functioning in imaginative and symbolic play in childhood. At least one of these symptoms must have been observed prior to age three for a diagnosis of autism to be made.
In the DSM-IV-TR, autistic disorder is grouped under the general classification of pervasive developmental disorder, together with Asperger’s syndrome, childhood disintegrative disorder, Rett’s disorder, and “pervasive developmental disorder (not otherwise specified).” These disorders have similar symptom profiles; however, children with these diagnoses tend to demonstrate a wide range of behavioral, psychological, and physical symptoms. For this reason, practitioners often refer to autistic spectrum disorder to capture the breadth of symptom profiles and varying severity levels that are characteristic of children with autism and related...
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Treatment and Therapy (Magill’s Medical Guide, Sixth Edition)
There is no cure for autism, nor is there one single treatment. Because children with autism can display such a wide range of symptoms, the range of available treatments is also wide. Physicians, psychologists, and other health professionals focus on alleviating the symptoms that are the most disruptive to a particular individual with autism. Available treatments include behavior modification, social skills training, speech/language therapy, occupational therapy, play therapy, music therapy, dietary interventions, and medication, among others. Often a combination of these types of treatments will be used to address the therapeutic needs of an autistic individual.
One of the most successful treatments for autism has been intensive behavior modification therapy. In his book The Autistic Child: Language Development Through Behavior Modification (1977), O. Ivar Lovaas describes a program of intensive one-on-one behavior modification therapy that can be highly effective in alleviating disturbing symptoms and in engendering positive social behaviors in autistic children. Lovaas’s technique is controversial because it involves both rewards for appropriate behaviors, such as making eye contact or maintaining conversation, as well as punishments for inappropriate behaviors, such as self-damaging acts, stereotypies, or pica. In a well-publicized legal case in the 1990’s, Massachusetts banned the use of punishment in...
(The entire section is 732 words.)
Perspective and Prospects (Magill’s Medical Guide, Sixth Edition)
Though it is likely to be an old syndrome, autism was first described in the 1940’s. Leo Kanner in the United States and Hans Asperger in Austria independently published papers describing children with severe social and communicative impairments. Both Kanner and Asperger used the term “autism” (meaning “alone”) to describe the syndromes they had identified. Kanner described children who had impoverished social relationships from early in life, employed deviant language, and were subject to behavioral stereotypies. Asperger’s description identified children with normal IQ’s and normal language development who suffered from social and some types of communicative impairments. As of the early twenty-first century, there is ongoing controversy as to whether autism and Asperger’s syndrome represent two ends of a single spectrum disorder or whether individuals with Asperger’s syndrome constitute a distinct clinical group.
In his original report, Kanner observed that the parent-child relationships in cases of children with autism appeared to be somewhat unusual. This suggestion fit with the tenor of the times, in which psychology and psychiatry were dominated by Freudian theories. Thus early explanations of autism, now discredited, suggested that children developed the syndrome as a result of cold, abusive, or confusing home environments (references were made to “refrigerator mothers”), and early...
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For Further Information: (Magill’s Medical Guide, Sixth Edition)
Autism Society of America. http://www.autism-society.org. A leading source of information and referral on autism, focusing on access and opportunity for persons within the autism spectrum, education, advocacy at state and federal levels, active public awareness, and the promotion of research.
First Signs. http://www.firstsigns.org. A nonprofit organization dedicated to educating parents and families, caregivers, and health professionals about autism and related disorders. Site includes resource links.
Frith, Uta. Autism: Explaining the Enigma. 2d ed. Malden, Mass.: Blackwell Science, 2006. This book, by one of the world’s leading researchers into autism, provides an overview of current knowledge and scientific research on the behavioral, cognitive, and brain characteristics of individuals with autism.
Greenspan, Stanley and Serena Wieder. Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate, and Think. Cambridge, Mass.: Da Capo Press, 2006. This book highlights the positive, potentially productive side of autism and outlines a program for engaging individuals with autism in social interactions.
Happe, Francesca. Autism: An Introduction to Psychological Theory. Hove, East Sussex, England: Psychology Press, 2002. This readable book gives a historical overview of autism and presents various theories that have been proposed to explain the...
(The entire section is 262 words.)
Introduction (Psychology and Mental Health)
The modern term “autism” was originated by Leo Kanner in the 1940’s. In “Autistic Disturbances of Affective Contact” (1943), he described a group of autistic children; he viewed them as much more similar to one another than to schizophrenics, with whom they generally had been associated. Until that time, the classical definition for autism (still seen in some dictionaries) was “a form of childhood schizophrenia characterized by acting out and withdrawal from reality.” Kanner believed that these children represented an entirely different clinical psychiatric disorder. He noted four main symptoms associated with the disorder: social withdrawal or “extreme autistic aloneness”; either muteness or failure to use spoken language “to convey meaning to others”; an “obsessive desire for maintenance of sameness”; and preoccupation with highly repetitive play habits, producing “severe limitation of spontaneous activity.” Kanner also noted that autism, unlike other types of childhood psychoses, began in or near infancy and had both cognitive and affective components.
Over the years, several attempts have been made to establish precise diagnostic criteria for autism. The criteria that are given in the current edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR(rev. 4th ed., 2000), are onset prior to thirty-six months of age; pervasive lack...
(The entire section is 923 words.)
Treatment (Psychology and Mental Health)
Autistic children can be very frustrating to both parents and siblings, disrupting their lives greatly. Often, having a child diagnosed with autism causes grief and guilt feelings in parents. According to Mary Van Bourgondien, Gary Mesibov, and Geraldine Dawson, this can be ameliorated by psychodynamic, biological, or behavioral techniques. These authors point out that all psychodynamic therapy views autism as an emotional problem, recommending extensive psychotherapy for the individual with autism and the rest of the family. In contrast, biological methodology applies psychoactive drugs and vitamins. Finally, behavioral therapy uses the axioms of experimental psychology, along with special education techniques that teach and reinforce appropriate behavior.
Psychodynamic approaches are based on the formation of interpersonal relationships between the child and others. One example is holding therapy, which involves the mother holding the child for long periods of time so that a supposedly damaged bond between the two can be mended. The intervention technique called Floortime, in which the therapist or parent joins the child in his or her activities and follows the child’s lead in play, is a more active method of establishing a bond with a child.
Biological methods of treatment attempt to influence how the brain receives and processes information. Sensory integration is favored by occupational therapists who take the...
(The entire section is 533 words.)
Changing Perceptions (Psychology and Mental Health)
As defined by Kanner in the 1940’s, autistic children were at first perceived to be victims of an affective disorder brought on by their emotionally cold, very intellectual, and compulsive parents (so-called refrigerator mothers). The personality traits of these parents, it was theorized, encouraged such children to withdraw from social contact with them and then with all other people.
In the years that have followed, additional data, as well as conceptual changes in medicine and psychology, have led to the belief that autism, which may actually be a constellation of disorders that exhibit similar symptoms, has a biological basis that may reside in subtle brain and hormone abnormalities. Increasingly since the beginning of the twenty-first century, scientists and practitioners have begun to refer to autism spectrum disorders (ASD) to capture the fact that children as well as adults with autism vary widely in terms of the severity of their symptoms, their strengths and weaknesses, and their responses to different treatments.
(The entire section is 160 words.)
Sources for Further Study (Psychology and Mental Health)
Baron-Cohen, Simon. Autism and Asperger Syndrome (The Facts). New York: Oxford University Press, 2008. This volume by one of the world’s experts on autism and related disorders provides a broad overview of the indicators and diagnosis of autism, its biological bases, and various treatments.
Frith, Uta. Autism: A Very Short Introduction. New York: Oxford University Press, 2008. This brief volume outlines the research on the brain bases of autism and integrates the results with modern theories of the disorder.
Grandin, Temple. Thinking in Pictures: My Life with Autism. London: Vintage Press, 2006. A firsthand account of what it is like to be a high-functioning person with autism. Grandin overcame early difficulties with communication and social relationships to become a successful animal scientist, professor, and expert on her own disorder, autism.
Greenspan, Stanley I., and Serena Wieder. Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate, and Think. Cambridge, Mass.: Da Capo Lifelong Books, 2006. This book first describes autism, highlighting the positive as well as the negative elements of autistic behavior, then describes the Floortime approach to intervention and therapy and reviews the research on its effectiveness.
Maurice, Catherine, Gina Green, and Stephen C. Luce, eds. Behavioral Intervention for Young Children...
(The entire section is 274 words.)
Autism (Encyclopedia of Genetic Disorders)
Autism is a potentially severe neurological condition affecting social functioning, communication skills, reasoning, and behavior. It is considered a "spectrum disorder," meaning that the symptoms and characteristics of autism can present themselves in a variety of combinations, ranging from extremely mild to quite severe.
Autism is a neurological disorder that affects a persons ability to communicate and form relationships. Individuals with autism have deficits in social interaction, communication, and understanding. Some individuals with autism have unusual repetitive behaviors such as head banging, rocking, and hand-flapping. Up to 75-80% of individuals with autism are mentally retarded. Only a small portion of this group (15-20%) have severe mental retardation. Additionally, over one-third of individuals with autism will develop seizures in early childhood or adolescence.
There is a wide degree of variability in the specific symptoms of autism. Because of this variability, autism is considered a spectrum disorder. There is no standard type or form of autism. Each individual is affected differently. This variability is reflected in some of the terms or names for autism. Asperger syndrome is a term...
(The entire section is 3550 words.)
Autism (Encyclopedia of Medicine)
Autism is a severe disorder of brain function marked by problems with social contact, intelligence and language, together with ritualistic or compulsive behavior and bizarre responses to the environment.
Autism is a lifelong disorder that interferes with the ability to understand what is seen, heard, and touched. This can cause profound problems in personal behavior and in the ability to relate to others. A person with autism must learn how to communicate normally and how to relate to people, objects and events. However, not all patients suffer the same degree of impairment. There is a full spectrum of symptoms, which can range from mild to severe.
Autism occurs in as many as one or two per 1,000 children. It is found four times more often in boys (usually the first-born) and occurs around the world in all races and social backgrounds. Autism usually is evident in the first three years of life, although in some children it's hard to tell when the problem develops. Sometimes the condition isn't diagnosed until the child enters school.
While a person with autism can have symptoms ranging from mild to severe, about 10% have an extraordinary ability in one area, such as in mathematics, memory, music, or art. Such children are known as "autistic savants" (formerly known as...
(The entire section is 2310 words.)
Autism (Encyclopedia of Neurological Disorders)
Autism is a behavior disorder, characterized by an impairment in social communication, social interaction, and social imagination. Those with autism often have a restricted range of interests and display repetitive behaviors and mannerisms, along with altered reactions to the everyday environment.
In 1943, the American physician Leo Kanner published his seminal paper, in which he described 11 children who were socially isolated, with "autistic disturbances of affective contact," impaired communication, and behavioral inflexibility. He coined the term "infantile autism" and discussed the causes in terms of biological processes, although at that time, most scientific attention was focused on analytical theories of the disorder. Kanner's paper did not initially receive much scientific credit, and children with autistic symptoms continued to be incorrectly diagnosed with childhood schizophrenia. His choice of the term "autism" may have created some confusion, because the word was first used to describe a mental state of fantastical, self-centered thought processes, similar to the symptoms of schizophrenia.
During the development of the disorder, the first year of life is usually marked with no clear discriminating features. Between two and three years of age, children show impairment in...
(The entire section is 1866 words.)
Autism (Encyclopedia of Mental Disorders)
The term "autism" refers to a cluster of conditions appearing early in childhood. All involve severe impairments in social interaction, communication, imaginative abilities, and rigid, repetitive behaviors. To be considered an autistic disorder, some of these impairments must be manifest before the age of three.
The reference book used by mental health professionals to diagnose mental disorders is the Diagnostic and Statistical Manual of Mental Disorders, also known as the DSM. The 2000 edition of this reference book (the Fourth Edition Text Revision known as DSM-IV-TR) places autism in a category called pervasive developmental disorders. All of these disorders are characterized by ongoing problems with mutual social interaction and communication, or the presence of strange, repetitive behaviors, interests, and activities. People diagnosed with these disorders are affected in many ways for their entire lives.
Each child diagnosed with an autistic disorder differs from every other, and so general descriptions of autistic behavior and characteristics do not apply equally to every child. Still, the common impairments in social interaction, communication and imagination, and...
(The entire section is 3374 words.)
Autism (Encyclopedia of Psychology)
A severe psychological disorder that first appears in early childhood and is characterized by impaired social interaction and language development, and other behavioral problems.
First described by Dr. Leo Kanner in 1943, autism is a severe psychological disorder that affects an estimated four children in 10,000. Autism manifests itself in early childhood. The autistic child is impaired socially, in language development, and exhibits other behavioral problems. This disorder is also known as infantile or childhood autism and Kanner's autism.
The occurrence of autism is four times higher in boys than girls. It is now believed that some of the "wild" or "feral" children found living outdoors on their own may have been autistic children abandoned by their parents. The most famous of these was Victor, the "wild boy of Aveyron," discovered in 1799 at the age of approximately 11. Although he remained almost totally unable to speak, Victor showed great improvements in socialization and cognitive ability after working for several years with Jean-Marc-Gaspard Itard, a physician and teacher of the deaf.
Contrary to earlier beliefs, autism is not thought to have psychological origins, such as inadequate parenting. Several possible causes of autism have been proposed, including...
(The entire section is 965 words.)
Autism (Encyclopedia of Children's Health)
Autism is a severely incapacitating developmental disorder of brain function characterized by three major types of symptoms: impaired social interaction, problems with verbal and nonverbal communication, and unusual or severely limited activities and interests.
Autism is a complex developmental disability with symptoms that typically appear during the first three years of childhood and continue throughout life. It is the most severe disorder within a group of developmental disorders called autism spectrum disorders (ASDs) or pervasive developmental disorders (PDDs) that cover a wide range of behaviors and symptoms, all related to a lesser or greater extent to impaired social and communication skills.
In its most severe form, autism may include extreme self-injurious, repetitive, highly unusual, and aggressive behaviors.
According to the Center for Disease Control and Prevention, PDDs were estimated to occur in two to six per 1,000 births in 2003 with autism being the most common PDD, affecting an estimated one in 250 births. As of 2004, as many as 1.5 million Americans are were believed to...
(The entire section is 2726 words.)
Autism (Encyclopedia of Alternative Medicine)
Autism is a chronic and often severe disorder of brain functioning that begins during childhood. It is marked by problems with social contact, intelligence, and language, coupled with ritualistic or compulsive behavior, sensory integration and processing problems, and strange environmental responses.
Autism is a lifelong disorder that interferes with the ability to understand what is seen, heard, and touched. This can cause profound problems in personal behavior
and in the ability to relate to others. A person with autism must learn how to communicate normally and how to relate to people, objects, and events. However, not all patients suffer the same degree of impairment. The severity of the condition varies between individuals, ranging from the person with extremely unusual and aggressive behavior to one with something resembling a mild personality...
(The entire section is 1896 words.)
Autism (International Dictionary of Psychoanalysis)
Autism has had two meanings. The first, historically associated with schizophrenia, refers to the investment of a person's psychic energy in his or her own delusions, which prevents the person from investing in the outside world. The second refers to an absence of development of communication with others beginning in earliest infancy.
The word was introduced into the psychiatric vocabulary by Eugen Bleuler in 1911 in his description of schizophrenia. However, a hint of it could be detected as early as 1907 in the correspondence between Freud and Jung: "Bleuler still misses a clear definition of autoerotism and its specifically psychological effects. He has, however, accepted the concept for his Dem[entia] pr[aecox] contribution to Aschaffenburg's Handbook. He doesn't want to say autoerotism (for reasons we all know), but prefers 'autism' or 'ipsism"' (Freud and Jung, p. 44-45).
Bleuler, who very early on took an interest in Freud's work, did not accept his libido theory, and this was the reason for the amputation that produced the word autism from autoerotism: to distance it from the libidinal significations of the latter term, while keeping the former's Greek root, auto, meaning "self." For Bleuler, the autism of schizophrenia is a shutting-in of the subject in an impenetrable, incommunicable world, closed in on itself, made up of unorganized delusional elements to which all the subject's disposable mental energy is attached.
In 1943, Leo Kanner adopted the term to describe "early infantile autism," a syndrome associated with problems of communication and social behavior, as well as serious developmental disturbances of mental functioning, most notably of imagination
Psychoanalytic research bearing upon infantile autism led to significant advances in the understanding of the beginnings of psychic life. From the genetic point of view, for example, infantile autism corresponds to a stage of psychical development to which the child regresses or remains fixated. In research with normal infants after her initial studies of autistic children, Margaret Mahler placed autism on a developmental axis that progresses from birth to "separation-individuation." Donald Winnicott attributed the genesis of autism to maternal care, particularly the ability to protect the infant from inconceivable anxieties: a feeling of disintegration, being unable to stop falling, lacking relation to its own body, and having no orientation. Bruno Bettelheim defined the "extreme situation" that set the baby on the path to becoming autistic as a feeling that it could not act in a manner favorable to itself, but that every action on its own part could only be unfavorable because of a "mutuality" between the child and its mother.
From the structural point of view, autism is governed by a structure that establishes mental functioning. The students of Jacques Lacan developed the concept in this direction by relating it sometimes to the concept of "foreclosure" (Piera Aulagnier and Maud Mannoni), sometimes to "jouissance" (ic Laurent), and sometimes to the "topology of the subject" (Rosine and Robert Lefort).
From a dynamic point of view, it was possible to explore infantile autism in terms of the transference and counter-transference. In 1975, Donald Meltzer proposed a model articulated around three concepts: "the dismantling of the ego," "the bidimensionality of the object relation," and "the adhesive identification." Dismantling is a splitting of the ego along the lines of articulation of the different sensorial modalities, so the autistic child never concentrates feelings on the same object, and stimuli received is never synthesized. The world, perceived in this way, is without depth or volume and is reduced to a juxtaposition of sensations. Bidimensionality is a mode of relation to a libidinal object, established in a world without depth. It is a relation of surface to surface, a binding with an object not experienced as having an interior. Adhesive identification is the result of bidimensionality: the self identifies itself with the object on the surface, owning to no more interior space than the object itself. This prevents mental communication necessary to the development of thought.
Later, Meltzer proposed a model based on the theory of "aesthetic conflict." He suggested that the fetus, at the end of pregnancy, is eager to exercise its senses but receives only the most filtered stimuli in utero. Birth would be experienced as liberation and as something marvelous because of the abundance of sensorial stimulation. The impact would be experienced as an intense aesthetic experience that would at the same time be a source of anxiety because of the vivid contrast between the infant's overabundant awareness of the qualities of the object's surface and complete misrecognition of the object's interior. Occasionally, the impact of the aesthetic object would be so intense as to force the infant to withdraw into infantile autism.
Frances Tustin has emphasized a fantasy of discontinuity, which the autistic infant experiences physically as the tearing away of a part of its own substance. So long as it lacks the experience that makes possible symbolization, an infant would seem to require the illusion of continuity between its body and the object upon which its drives are satisfied. The autistic infant imagines a catastrophic rupture in this continuity that takes the form of a fantasy of mouth-tongue-nipple-breast, experiencing a damaged breast and torn-off nipple that leaves the mouth a black hole inhabited by tormenting objects. To protect itself from the pain caused by this black hole, the autistic infant constructs the delusion of merging with the environment that abolishes any separation or space, any difference or alterity. To maintain these delusionary autistic objects, concrete objects are not manipulated for use value or symbolic value, but solely for the surface sensations that they offer, giving the illusion of continuity between body and environment. By means of his or her own secretions (tears, saliva, urine, feces) and autistic objects, the subject creates what Tustin called "autistic forms," which are cutaneous or mucous with nebulous, unstable contours. The autistic subject procures these as a salve to minimize pain and as protection from the exterior world. But these autistic forms cannot be shared with others or identified with objects in the external world. The autistic child uses sensitivity to stimuli to protect himself or herself from the external world; Frances Tustin calls this "perverse self-sensuality."
See also: Adhesive identification; Autistic capsule/nucleus; Autistic defenses; Bettleheim, Bruno; Black hole; Bleuler, Paul Eugen; Child analysis; Developmental disorders; Dismantling; Empty Fortress, The; Infantile psychosis; Infantile schizophrenia; Psychoses, chronic and delusional; Schizophrenia; Self-mutilation in children; Symbiosis/Symbiotic relation; Tustin, Frances.
Freud, Sigmund, and Jung, Carl G. (1974a [1906-13]). The Freud-Jung letters: the correspondence between Sigmund Freud and C. G. Jung (William McGuire, Ed.; Ralph Manheim and R. F. C. Hull, Trans.). Princeton: Princeton University Press Press.
Meltzer, Donald, and Williams, Meg Harris. (1988). The apprehension of beauty. Perth: Clunie Press.
Meltzer, Donald, et al. (1975). Explorations in autism. Perth: Clunie Press.
Tustin, Frances. (1977). Autism and childhood psychosis. London: Hogarth. (Originally published 1972)
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Gaddini, Renato. (1993). On autism. Psychoanalytical Inquiry, 13,134-143.
Gergely, G. (2000). Reapproaching Mahler: autism, symbiosis, splitting, libidinal object. Journal of the American Psychoanalytic Association, 48, 1197-1228.
Guntrip, Harry. (1973). Science, psychodynamic reality, and autistic thinking. Journal of the American Academy of Psychoanalysis, 1, 3-22.
Ogden, Thomas H. (1989). On the concept of an autistic-contiguous position. International Journal of Psychoanalysis, 70, 127-140.