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Understanding Autism As An Incomplete Attachment

Autism is like being trapped in an enclosed maze.  Within this maze it is dark and scary.  You can see out, but no one can see in.  You are in a perpetual state of terror with no access to others or a way out.  You feel the walls closing in and can do nothing about it.  You are screaming inside, but nobody can hear your screams. You are frantic.  You keep running in circles to no avail.  Alas you run out of steam.  It is futile, hopeless and depressing.  It is no use.  No one can see you.  You have become a lost child forever.  You have become forgotten.  Lost in a never-never land.  It is a never-ending hell on earth.  The only thing you can do is wait and hope that you will be discovered.

Mystery and controversy surround the etiology and clinical work with children diagnosed with an Autism Spectrum Disorder.  Although the etiology by many is considered to be unknown, the majority of professionals working in the field of autism and parents of children with autism consider autism to be a neurological disorder.  From this perspective, the clinical work with this population focuses primarily on techniques such as Applied Behavioral Analysis, modeling and social skills development.  The work done thus far with this population should be commended and not discounted.  We are now ready to augment the present state-of-the-art work with this population by introducing Attachment Relational Therapy.  This therapy is similar to Floortime in that it emphasizes the relationship between the child and the caregiver or therapist.  The major difference is that Attachment Relational Therapy introduces a treatment process (plan) that at its core is based on understanding the etiology of autism.  Once the etiology is understood, then the parent or therapist can understand how to engage with the child.

From this alternative perspective it is my belief that children on the spectrum have not had the advantage of a completed attachment.  I call this perspective Incomplete Attachment.  Thus it is my belief that what one sees when observing children on the spectrum is a child who is waiting for the attachment process to be completed.  The child is doing the best he can to cope with this predicament.  All the behaviors such as flapping arms, nonverbal communication, echolalia, lack of responsiveness to others or the inability to communicate one's needs, can all make sense when taken from this perspective.

It is my belief that Autism Spectrum Disorders can also inform our understanding of psychological development in general and specifically Theory of Mind.  Autism Specturm Disorders can be viewed as a window into the understanding of how all typical individuals develop psychologically.  It is my hope that this article will lead to a beneficial dialogue within the autism community and beyond.

What does an incomplete attachment look like?  One only needs to look at any child, adolescent or adult on the autism spectrum continuum to answer this question.  The behaviors one sees with such individuals seem to be confusing and do not make sense.  No two individuals with autism seem similar or manifest the same behaviors.  If one thinks about autism from the perspective of an incomplete attachment then the developmental delays and the children will make sense.

From this perspective, the child has not had the benefit of a completed attachment.  As all infants, he is born unconscious and ready to be brought out in relationship to the caregiver, but this does not happen.  The child is left in a waiting state.  He is waiting for a completed attachment.  Thus the behaviors that one sees in the child with autism are the result of not having had a completed attachment.  The behaviors are what can be called coping and state of existence behaviors.  Each child will cope differently to the circumstance and thus will have different behaviors as compared to another child.  A key point to mention is that because of the incomplete attachment the child is left without the ability to use himself both in body (lacks self-agency) and mind (lacks theory of mind).  The ability to use one's self will vary from child to child.  Some children will be more conscious of him/herself and thus have more access to use themselves in relationship to others.  Thus we have a continuum of ability, which is typically known as the functioning level of the individual on the spectrum (low functioning, high functioning and Asperger's).

To explain it in a little more depth, the behaviors one sees in individuals with autism are unconscious behaviors that have been dissociated or separated within the child.  It is like the child is of two minds, the conscious mind and the unconscious mind.  This is true of all human beings.  Within the child with autism he is more dissociated and split from his emotions than others who appear to develop typically. Dissociation does not give us the complete picture.  From a broader perspective, one can say that the child on the autism continuum has a lack of a completed attachment, has a dissociated sense of self, has developed coping mechanisms to manage the situation, is unable to use himself in relationship to others, seems to lack the knowledge of his own emotions and is unable to access those dissociated emotions and finally uses indirect mechanisms to grow in relationship to others.  The treatments that seem to help this population are actually helping the child to become more conscious and integrated as a human being.

About the Author

Karen Savlov is a licensed Marriage and Family Therapist and psychoanalyst practicing in West Los Angeles. She is affiliated with the Institute of Contemporary Psychoanalysis. She specializes in autism spectrum disorders, depression, anger management, assertion training, communication, anxiety, relationships and work related issues. She has worked for many years with children, adolescents and adults including those on the autism spectrum continuum. She has also provided trainings and support groups for parents of children with autism. She is now running groups for college age students with developmental disabilities. She has made presentations on this subject at numerous conferences and meetings.

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