Are there verbal hallucinations in autism? Review from a historical and transparadigmatic perspective

Abstract

The differential diagnosis between autism and schizophrenia in childhood has been the subject of numerous controversies. Because verbal hallucinations could be one of the main clinical phenomena when establishing a differential diagnosis, the objective was to investigate the presence or absence of verbal hallucinations in autism. For this, a selective and unsystematic review of the current scientific evidence was carried out. Added to this, the phenomenon of hallucination, and mainly verbal hallucination, was conceptualized from a historical perspective; the relevance given to hallucinations in the delimitation of the mentioned nosographic constructs was broached; and verbal hallucinations in autism were analyzed comparing different paradigms, including contributions from psychoanalysis. We observe that from the side of scientific evidence it is not possible to state strong conclusions regarding the presence or absence of verbal hallucinations in autism. In turn, the historical review of the concept of verbal hallucination from classical psychiatry together with contributions from psychoanalysis, invite us to think that one of the differential characteristics between autism and psychosis is the absence of verbal hallucinations in the first diagnosis, and that if there were hallucinations in autism, these would present different qualities from those of psychosis. We consider it highly relevant to be able to establish this differentiation in the hallucinatory phenomenon in autism, not only in order to establish a differential diagnosis between the two conditions, but also because of the implications that this could have in pharmacotherapy.