Fundación Atención Temprana (Early Care Foundation)
Between 20 and 25% of the children attended in the CDIATs (Child Development and Early Care Centers) of the Foundation’s Early Care Program, fall within the autism spectrum. They have been referred to us for “delayed speech or language development”, “delayed language and attention development”, “socialization problems” or “general developmental disorder”. These appellations, resulting from the assessments of the Aragonese Institute of Social Services, describe a set of discrete signs in children between 2 and 4 years of age.
The parents say: “He doesn’t respond when we call him, he doesn’t turn around”, “it’s like he is doing his own thing”, “she doesn’t speak or takes us by the arm to take us to what she wants, or stays, looking, in front of the refrigerator until you ask her…”, “he makes a grunt when he wants something, like a moan”. When asked during the admissions interview if the child babbled in the cradle, most of them answer yes, there was baby talk, the lalangue (1) was present but did not become words. In some cases, they tell us: “he said ‘mama’, ‘dada’, ‘woof’, … but that was all, now he only says ‘this’ or ‘here’”. Parents usually cannot pinpoint the moment things changed, as if words had progressively been retained. Nevertheless, coincidences appear in the telling of the developmental milestones, as if everything had been normal during the first year and a half and then … Things changed with the first steps, the weaning of the breast or the pacifier, the change to baby food. Every child is different and in some cases we cannot obtain any information other than the objective fact that he “doesn’t talk like other children his age” or “she doesn’t wave goodbye”.
Another important sign is the motor development, which is sometimes delayed. Children who have not crawled and begin to walk after 18 months. Nevertheless, there is also the child that “walks alone and doesn’t look back, runs rather than walks”. There is no fixed or “normal” development, human beings evolve through the different stages with great variability.
Parents are told of delays in the acquisition of speech or language, in psychomotricity or in social development. Delays entail the implementation of compensatory measures and a referral to stimulation treatments (Psychomotricity, Speech therapy and Psychotherapy). Speech and language development cannot be evaluated because the children “do not seem to pay attention to the examiner”.
Each one of these children uses his treatment to a particular end. I must say I prefer the verb play rather than the verb work. Because playing is a very serious matter to them, as it includes pleasure but also jouissance and because playing is something they desire. I willingly cede the term “work” to teachers. I do not need to say “let’s play” to the subjects who enter a session, because I don’t direct their attention to a concrete object or activity, I just invite them to come in with a greeting and they then choose what to say or do. The discourse of the master prescribes “working” to establish an equivalence with “making the most of time”, which is what we are supposed to do in therapies, but following Freud, we shall say that “children repeat in their play everything that has made a great impression on them in actual life, that they thereby abreact the strength of the impression and so to speak make themselves masters of the situation.” (2)
Do autistic children pay? It is difficult to infer pleasure from their continuous construction of a new internal and external reality, with the imaginary elements at their disposition. Under transference, the analyst can become a part in that construction, providing the countenance for an incomplete, more manageable Other, who does not anticipate his desire. This drains the excess of the real for at least the duration of the session, providing a relief to the child.
Usually, several professionals see the children in weekly individual sessions and the cases are constructed at the team meetings in which everybody participates, including the administrative personnel who receives the families at the door. This permits the existence of a third place of reference and the questioning of everyone’s particular knowledge.
The accompaniment of the parents, the conversations regarding their knowledge of their children, of the things that worry them as well as those which surprise them, is daily. We cannot do our work if we do not rely on the family, which is why we share with the parents what we learn about their children and invite them to share with us what they discover.
Alex, two years old, ran but did not speak. His parents had difficulty in going with him for a walk in the park, for example, because he would set off on his own without looking back. His mother had to be present during our first meetings and Alex would give the little cars to her, he would press against her body and her hands were a prolongation of his own. He would only communicate by pointing or tugging her arm. He would nonetheless say a few words, such as “mom”, “bread”, “dad”. He would not look at me, but he did not seem to be afraid of me, only to perceive me as an intruder. He soon chose two sorts of games: making the cars roll and putting the dolls to bed. When he had had enough, he would open the door and run out without waiting for his mother, who had to go after him. I would talk to both him and his mother while he played next to her during the sessions, which were brief. A woman who blamed herself for working all day long, would return home to focus on his needs and attached meaning to her son’s signs-“the only thing I do is to be with him”. She was only disconcerted by his escapes: “What do I do?”. Alex would never go far enough to get lost but neither could he grasp the risk of an accident. In a few sessions, Alex was able to stay in the session by himself and he deployed a vaster language that was now necessary to him. This was almost three years ago, he does not escape anymore and he usually responds when spoken to, his parents are so happy they want to leave the program. Alex now induces people to follow him through other means, he is a boy with his own ideas, that he wants to impose. For example, he called a crocodile-xylophone that he was taking for a walk a “popotamus”. I did not understand at first and said “The crocodile?”, “No, it’s a popotamus” he rectified, with the patience of one teaching a mistaken other, awkward but not ill-intentioned.
The perspective of development leads to observation, as with J. Piaget. But the analyst is chiefly a listener submitting body and desire to the patient wait for an encounter with each child. That is, someone who will not obstruct whatever may occur.
Initial signs in a spectrum as vast as ASD are not determining nor necessarily indicative of a deficiency. We see children who invent words or objects that help them build a body that once was disorganized. Others speak of worlds they have ordered in great detail, be they of animal species, planetary systems or basket-ball teams, and they can then learn by themselves. We let ourselves be taught by these children that we accompany in their itinerary of discovery, to attain a form of socialization and bonding that includes them among others.
When they are three years old, most children attend ordinary schools, and some of them receive special education. We coordinate with the Guidance Teams to advise them on methodology and on assisting the children in this important moment that requires the assumption of new rules, schedules and demands, and we continue to do so with the tutors of the children.
The children included in this great ADA spectrum will need specific support beyond the remit of the EC program, when they become six years old. At this time we offer the families the possibility to continue the treatments through the Child Care Services, attending individual therapy, parenting groups and leisure or artistic activities that open new opportunities for growth and socialization.
- Lalangue, term coined by J. Lacan (Seminar 20). Lalangue is the word before its grammatical and lexicographical ordering, it is therefore separate from language, which serves jouissance.
- Freud, S. Beyond the pleasure principle
From the authorized translation of the second german edition by CJ.M. Hubback.
Translated by Soledad Székely
Translation by Soledad Székely