A psychoanalytic approach to language delay: When autistic isn't necessarily autism

This paper describes family work with four children from different ethnic backgrounds presenting with autistic features in the context of delayed or deviant language development and, in one case, elective mutism. It begins by describing how psychoanalytic approaches to language development have tended to see the process as underpinned by symbol formation as a compensation for loss of the object. This is contrasted with an approach which, following Bion, emphasizes language development as an aspect of a broad process concerned with enabling emotional experience to become thought. I also emphasize the significance of the survival and development of the self in achieving separation. In the case studies, the paper highlights the degree of trauma in the parents' backgrounds, which had impeded them from containing their children's developmental anxieties. The parents' telling their stories was both valuable to them and enabled them to become more emotionally available to their children. In all cases the work promoted language development and autistic features disappeared or waned considerably after relatively brief intervention. The conclusions discuss the relevance of these findings to the autistic child population, and the value of child psychotherapy to differential diagnosis within the autistic spectrum.