Autism Spectrum Disorders: There Remains a Place for Psychodynamic Psychiatry through Neuroplasticity, Emotion Regulation, Caring Connections, and Hope

There remains a role for psychodynamic psychiatry in the care of individuals with autism spectrum disorders (ASDs). Contemporary psychodynamic models are uniquely positioned to integrate today's neurobiological understandings of ASD with the subjective experience of those with ASD. Historical psychodynamic formulations of ASD struggled to appreciate the interrelatedness of biological, psychological, and social complexities in individuals with this disorder. Emotionally experienced or "illusory" environmental deprivation, early life stress, and allostatic overload, along with biological factors, current stress, and neuroplasticity, drive maladaptive coping and lead to difficulties with relationships. Fears of caring emotional connections are related to self-protective isolation and other maladaptive efforts to regulate emotions, shutting out what the child needs most-parents' love and help. In a nonlinear way, maladaptive emotion regulation further interferes with the development of the social brain. Thus, a psychodynamic defense-oriented focus upon adaptive emotion regulation provides a therapeutic avenue. Helping build the child's capacity for adaptive emotion regulation, which includes letting others help, can lead to a sense of safety and promote caring connections, a positive outcome. The authors offer guidance in the treatment of individuals with ASD in accordance with contemporary understandings of the disorder and care.