Psicose e autismo na infância: uma abordagem psicanalítica do diagnóstico diferencial a partir do corpo e da linguagem

Abstract

The psychoanalyst inserted in the context of child mental health is faced with clinical conditions that constitute real challenges regarding the formulation of the diagnosis and the direction of the treatment. This fact is particularly relevant when it comes to childhood psychoses and autism, given their very early origin and the lability of psychic structuring in childhood. In the current psychiatric clinic, the term ASD (Autism Spectrum Disorder) condenses the two clinical types under this nomenclature, placing autism as what was previously called childhood psychosis. As for psychoanalysis, there is no such equivalence between the two frameworks. he discussion about the defense mechanism involved in autism and the debate about its inclusion or not in a fourth structure remains in the psychoanalytic movement. In childhood, childhood psychoses present themselves in a multifaceted way, with varied symptoms, similar to those of autism, which produces a real diagnostic confusion, especially if its formulation is based on the phenomena. The symptoms associated with these conditions range from developmental delay, learning difficulties, to psychomotor agitation, stereotypies, language disorders, aggression and hallucinations. A scenario that leads to some questions, such as: what exactly is psychotic in children? What is it about when we talk about autism (or ASD) today? How can we better specify these cases considered atypical that do not present themselves as classic autism, but are not always configured as psychosis? How to situate a diagnosis based on structural differences, as proposed by psychoanalysis, emphasizing an approach to the body and language? Psychoanalysis, which does not define the diagnosis by symptoms, but by structural traits and transference, can contribute to this discussion, and this is the research proposal, that is, to situate the psychosis/autism differentiation, from a clinical understanding that considers the psychic structuring of the subject and the implications for the body and language. It is also important to highlight the Lacanian theoretical contribution, above all, his considerations about a clinic oriented to the real and in which the body acquires primacy. Body and language constitute, therefore, two central axes of the research, since they compose the substrate on which the psychoanalytic treatment with children is carried out. The investigation's method is bibliographic research and the study of clinical cases attended by the researcher, which illustrate the impasses related to the diagnostic definition. It is intended to understand the specificities of the two conditions beyond the symptoms presented by the children. It is hoped that this research will contribute to the more adequate identification of the two diagnoses, enabling better interventions, in addition to problematizing the supposed increase in cases diagnosed as autism today to the detriment of childhood psychosis, especially schizophrenia.