Autism spectrum disorder, as delineated in current psychiatric terminology, is presented as a treatment challenge in the case of a nonverbal, poorly related toddler who entered into successive foster care homes. The history of the disorder, from its earliest identification in the psychiatric literature, through select psychoanalytic understandings over time is reviewed. It is suggested that autistic conditions feature a relative lack of differentiation between self and other which otherwise would be reflected across representational modalities. The authors bring together theoretical questions concerning encoding of experience, dyadic engagement of the parenting figure, and brief therapy techniques in illustrating and reporting on stages of treatment in the case, centered upon the significance of early language and play in ego development.