La position psychotique répond à un ensemble de mécanismes défensifs s'organisant autour de l'expression psychopathologique associant un accès possible mais fluctuant au champ et la construction de représentations et la possibilité d'exprimer des vécus affectifs et émotionnels dans le cadre de la relation interpersonnelle. Les angoisses prévalentes apparaissent de l'ordre d'angoisses de type « crainte de » perte de l'intégrité de soi et d'angoisses de persécution. Le mode de relation à l'Objet s'organise dans le registre de la tridimensionnalité: ce mode de relation se manifeste sur le plan de la spatialité par un accès possible, mais fluctuant à la différenciation soi/non-soi et sur le plan de la temporalité par une appréhension possible, mais fluctuante de la succession des événements vécus. Par ailleurs, les modalités d'identification prévalentes apparaissent de l'ordre de l'identification projective pathologique. La position psychotique s'inscrit dans le recours aux mécanismes psychiques de clivage et de projection.

Si nous proposons l'hypothèse d'articuler la position autistique avec les particularités de fonctionnement des enfants présentant un TED autistique et la position psychotique avec les particularités de fonctionnement psychiques des enfants présentant un TED non autistique, il s'agit ici de modalités de fonctionnement prévalentes et non exclusives. Elles peuvent constituer un ensemble de mécanismes défensifs potentiellement mobilisable par chacun en dehors d'un cadre et du repérage d'émergence symptomatique pathologique. Si l'ensemble des auteurs considérés dans ce travail décrivent les deux modalités de fonctionnement comme différenciées, les positions autistiques et psychotiques s'organisent dans le même temps autour d'un axe de liaison possible en appui et en référence au processus développemental.

Cet abord compréhensif porté par une perspective psychanalytique a pour objet de pouvoir ajuster au plus près les projets thérapeutiques et d'accompagnement à destination des enfants, adolescents et adultes porteurs d'autisme.

La prise en compte des particularités de fonctionnement articulées avec le diagnostic de TED de type autistique nous enjoint à insister particulièrement sur l'importance du caractère plurifocal de la prise en charge. En effet, la question des difficultés pour les enfants présentant un TED autistique de pouvoir prendre en compte les aspects affectifs et émotionnels de leur environnement soutient l'importance accordée aux différentes propositions relationnelles dans leur versant affectif et émotionnel dans le cadre de médiations sensorielles, corporelles et langagières.

Par ailleurs, la grande sensibilité aux aspects émotionnels et aux ressentis affectifs des enfants présentant un TED de type non-autistique justifie toute l'importance portée aux articulations des différents axes du projet thérapeutique et d'accompagnement.

Ainsi, l'approche psychopathologique réactualisée des autismes des enfants, adolescents et adulte, dans le cadre d'une démarche compréhensive des symptômes exprimés représente un pont d'appui possible à la mise en place d'un projet thérapeutique le plus ajusté possible aux besoins des personnes.

The nosographic group of Pervasive Developmental Disorders as described in the International Classification of Diseases in its 10th revision is the medical diagnosis that can now be used to characterise people with autism.

In the context of current psychiatric practice, this large nosographic group is divided into two distinct entities: autistic type PDD and non-autistic type PDD. Autistic type PDDs combine the two diagnoses identified as the most specific autistic syndromes: F84.0 infantile autism and F84.5 Asperger's syndrome of ICD-10. Non-autistic type pervasive developmental disorders include children with so-called mild or incomplete forms of PDD and include F84.1 - atypical Autism - and F84.8 - Other PDD diagnoses.

In this work, our goal is to define as closely as possible the psychopathological peculiarities of the psychic functioning of people with autism as they were approached by the English psychoanalytical school and more specifically by post-Kleinians in connection with current nosographic references.

From Melanie Klein's original study of the young child Dick, the comprehensive psychopathological and psychoanalytic perspective of the autistic experience continued through the works of Meltzer and his colleagues, Frances Tustin, Geneviève Haag, Didier Houzel, Daniel Marcelli and Pierre Delion. They were able to contribute and transmit elements of understanding of the psychic functioning of people who now meet the requirements for the diagnosis of a PDD.

From a review of the current literature of these authors of the Kleinian and post-Kleinian psychoanalytic field, the aim of this work is to propose a hypothesis of differential PDD psychopathological functioning according to whether the person is diagnosed with autistic PDD or a non-autistic PDD.

The autistic position would characterise the psychopathological functioning of children with an autistic PDD; the psychotic position would be correlated with the psychopathological functioning of children with a non-autistic PDD.

The autistic position responds to a set of defensive mechanisms organised around the expression of peculiarities associating difficulties in investing and accessing the process of symbolic representation, difficulty expressing affective experiences, and apprehension in interpersonal relationships. The emotional experience is marked by long-established anxieties expressed in the sensory or corporal memory. These anxieties can be of various levels: they may be anxiety of annihilation or ‘states of’ discontent, such as endless fragmentation, running on or falling anxieties. The mode of relation to the Object is organised in the two-dimensional memory: this mode of prevalent relation is manifested on the spatial level by self/non-self indifference, and on the temporal level by difficulties in apprehending the succession of experienced events. In addition, the prevailing identification methods appear in the order of adhesive identification. The autistic position is part of the recourse to psychic mechanisms of dismantling.

The psychotic position responds to a set of defensive mechanisms organised around the psychopathological expression that associates possible but fluctuating access to the field and the construction of representations and the possibility of expressing affective and emotional experiences in the context of the interpersonal relationships. The prevailing anxieties appear in the level of anxieties of the ‘fear of’ type, loss of self-integrity and persecution anxieties. The mode of relation to the Object is organised in the three-dimensional memory: this mode of relation is manifested in the plane of spatiality by a possible access, but fluctuating with the differentiation between self and not-self and on the plane of temporality by a possible but fluctuating apprehension of the succession of events experienced. In addition, the prevailing identification methods appear in the order of pathological projective identification. The psychotic position is part of the recourse to the psychic mechanisms of splitting and projection.

If we propose the hypothesis of articulating the autistic position with the psychics peculiarities of children with an autistic PDD and the psychotic position with psychics peculiarities of children presenting a non-autistic PDD, we are dealing here with prevalent and non-exclusive modes of operation. They can constitute a set of defensive mechanisms, potentially mobilised by each, outside a framework and the identification of symptomatic pathological emergence. While all the authors considered in this work describe the two modalities of functioning as differentiated, the autistic and psychotic positions are organised at the same time around a possible link axis in support and with reference to the developmental process.

This comprehensive approach, supported by a psychoanalytic perspective, aims to make it possible to adjust therapeutic and support projects as closely as possible for children, adolescents and adults with autism.

Taking into account the peculiarities of functioning articulated with the diagnosis of autistic type PDD requires us to insist particularly on the importance of the plurifocal character of the management. Indeed, the issue of difficulties for children with autistic PDD to be able to take into account the affective and emotional aspects of their environment supports the importance given to different relational proposals in their emotional and affective aspects in the context of sensory mediations, both bodily and linguistic.

In addition, the high sensitivity to the emotional aspects and feelings of children with a non-autistic type PDD justifies the importance given to the articulations of the different axes of therapeutic and accompanying projects.

In this way, the updated psychopathological approach of autism in children, adolescents and adults, as part of a comprehensive approach to the symptoms expressed, represents a possible bridge of support for setting up a therapeutic project that is as well-adjusted as possible to people's needs.