Psychoanalysis may be able to help some children with autism or an autism
spectrum disorder make dramatic progress toward normalcy.
So reported psychoanalyst Susan Sherkow, M.D., an associate professor of
psychiatry at Albert Einstein College of Medicine, at the January meeting of
the American Psychoanalytic Association in New York City.
Susan Sherkow, M.D.: "If you start early enough with these kids,
you can achieve empathy rather quickly."
Credit: Joan Arehart-Treichel
Moreover, during the meeting, she provided details about one patient to
make her case. Later, during a phone interview, she said that she has also
used psychoanalysis with five more children who were "flat-out
autistic" or "on the spectrum," and that the outcomes in
these cases too were quite positive. The six children ranged in age from 2 to
9 when they started analysis, she
Autistic children tend to have difficulty communicating verbally, or even
if they can talk, it is often difficult to understand them, Sherkow explained
to Psychiatric News. Nor is it always possible to know whether what
they are saying is connected to what they are thinking or feeling. So a major
goal of her analysis with each of the six children (five boys and one girl),
she said, was to "pay very close attention to the child's
behavior" so that the behavior would give her clues to thoughts and
emotions. And once she had decided on how to interpret the child's behavior,
she would verbalize it in her or his presence. For example, if the child
appeared to be upset, she would say, "You're upset." Or if he or
she appeared to be angry, she would say, "You must be angry." And
if the child gave her a furtive glance after she made such a comment, she
would conclude that her interpretation of the behavior was probably correct.
So by using such techniques over a period of weeks, she came to understand
quite well what the child was thinking and feeling when he or she engaged in
various behaviors, she said.
Further, her verbally expressing her interpretations of the child's
behaviors in his or her presence served another purpose, she pointed out. The
child came to realize that thoughts and feelings were being understood. She
was forging a relationship with the child.
Another goal of the analysis was to help the child relinquish stereotypic
behaviors for imaginative play, Sherkow reported. "These kids are
typically lacking in imaginative play," she said. "Imaginative
play comes from having used language and from having identified emotions with
Also, the mother of each of the six children was present during her child's
analytic sessions, Sherkow noted. There were several reasons why the mother
was included, Sherkow said. One was to help the mother recognize what her
child was thinking and feeling. Another was to help her and her child
communicate verbally with one another. Yet a third goal was to demonstrate to
her that her child could be helped.
The six children whom Sherkow analyzed were in analysis anywhere from two
to four years, she said.
"All six significantly improved in outcome," Sherkow reported,"
but I will clarify that since 'outcome' is a very broad word.... By the
end of the first year of analysis they had developed empathy.... They can
socialize with other children and communicate their needs. They can say 'I'm
angry,' 'I'm sad,' 'I'm hungry,' or 'I'm tired.' They look like a child
without a diagnosis. I would say that they all arrived at that.... Some have
even gone on to mainstream schools...."
How much of these children's impressive outcomes were actually due to
Emanuel DiCicco-Bloom, M.D.: "We are learning that the brain has
an incredible amount of plasticity. So outgrowing a diagnosis of autism? Well,
it might be possible."
Credit: Joan Arehart-Treichel
Sherkow is the first to admit that she is not sure, especially since the
children were also receiving speech therapy and occupational therapy and, in
some cases, physical therapy. Further, she and the other therapists worked
closely together in each case "to make sure that everybody was on the
same page." Nonetheless, she has little doubt that the children's
remarkable results were due at least in part to analysis. For example, her
patient who had started analysis at age 9 had already had speech therapy, and
it had done nothing to help him with his grave speech difficulties. But now,
after analysis, "he is understandable," she reported. "You
can actually have conversations with
Sherkow's greatest achievement may have been in making the children
empathetic, Emanuel DiCicco-Bloom, M.D., a professor of neuroscience at the
Robert Wood Johnson Medical School and an autism scientist, declared at the
APsaA meeting. "It is heartwarming, something we don't hear about at our
autism meetings," he added.
But perhaps the more sweeping implication of these outcomes, DiCicco-Bloom
pointed out, is that they challenge the traditional belief that children with
a diagnosis of autism or of an autism spectrum disorder cannot get better."
We are learning that the brain has an incredible amount of
plasticity," he declared. "There is far more plasticity than many
of us would have imagined even 10 years ago."
Sherkow agreed: "One of the main things we are up against in our work
is that there has been a lot of press over the years that you can't lose the
diagnosis of autism.... Now we are beginning to see that that is just not
Other American analysts are also using analysis to help autistic children,
Sherkow noted. So are some European analysts, she added. So does she recommend
that children with autism or an autism spectrum disorder receive
psychoanalysis? "Absolutely!" she replied. And where might
American parents find an analyst to help an autistic child? "They should
go to a psychoanalytically trained child psychiatrist or child psychologist
who knows how to do this or who would learn how to do it because it is based
on how we do child analysis anyway." ▪