An Observationally and Psychoanalytically Informed Parent-Toddler Intervention for Young Children at Risk of ASD: An Audited Case Series and Convergences with Organicist Approaches

In this paper we describe, with illustrative vignettes, an observationally and psychoanalytically informed parent-toddler intervention for young children at risk of ASD. The intervention was offered to children between 18 and 24 months who fell in the High Risk category of the Checklist for Autism in Toddlers (CHAT), which carries an 83% chance of a diagnosis at the age of 3 ½. In the absence of pathways for children under 2, this preliminary case series comprised 8 children from a heterogeneous clinical population. A significantly lower proportion of treated children were later diagnosed than the CHAT would predict (p = 0.03, Fisher’s Exact Test), suggesting that this intervention merits further investigation with larger numbers of children and additional instruments. Scores on two routine outcome monitoring measures (the Goal Based Measure and the PIR-GAS) improved both in children who were later diagnosed and in those who were not. We consider these findings in relation to recent non-psychoanalytic research papers (including an RCT on a parent-mediated intervention) that demonstrate the prime importance of parent-toddler interactions, and we suggest that supporting parental confidence is essential to improvement. We discuss emerging convergences between psychoanalytic and organicist approaches, and the possible place of this intervention in conjunction with others.