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This issue opens with four commentaries on an extensive and rich Target Article on autism spectrum disorder (ASD) by Singletary (2015), which appeared in our previous issue. In that Target, entitled “An integrative model of autism spectrum disorder: ASD as a neurobiological disorder of experienced environmental deprivation, early life stress and allostatic overload,” Singletary surveyed a wide range of neurobiological data about ASD, integrated within a developmental framework. That survey provided a context for his model of allostatic overload as a central driver in the disorder. He suggests that this model offers the potential for integrated, multi-disciplinary understanding and treatment. Somewhat rare in the literature about autism, he includes psychoanalytic theories that take seriously the inner mental experience of the autistic child.
Singletary presented a model in which the child has some inborn vulnerabilities in circuits that mediate interpersonal processes; these interfere with receiving parental nurturance, regardless of how healthy and attuned it might be. This leads to a vicious cycle, causing increasing stress and anxiety in the child, and possibly discouragement in the parent. His Target explores some of the different outcomes from this dysfunctional beginning. The author then movingly describes his treatment of Larry, beginning at age 4, and enriches the account by showing the evolution of Larry’s drawings, through which Larry expressed his feelings throughout the long therapy – and which strikingly demonstrate the significant progress he made.
The commentators, internationally known experts in their fields, cast additional light on the topic in this issue, and raise some provocative questions. Anne Alvarez expands on Singletary’s discussion of the types of defensive processes he sees developing in the overly stressed autistic child, through an elaboration of her observations to two types of states: the avoidant, aloof and withdrawn state compared to