Every wave of preferred substance use in adolescence serves similar developmental functions. The recent explosion among adolescents of electronic nicotine delivery systems (ENDS), popularly known as vaping, offers an opportunity to revisit models of the role of substance use in adolescent development. Social media's rise alongside that of ENDS distinguishes this recent phenomenon from previous historical waves of substance abuse: Vaping was and remains highly integrated into the digital culture, situating social media as a unique window into the adolescent users' subjective experience. To that end, we employ analyses of vaping manifestations within adolescent social media to complement clinical case material. We position adolescent vaping as an action-oriented facilitation of externalization, individuation, and challenge to authority that can precipitate adolescent-adult enactments. We propose that this use-reinforcing developmental function complements other biological and social properties of ENDS to cement its position within contemporary adolescent culture. We suggest that the evolution of adolescents' preferred devices from pens to USB-like devices to round pastel Elf Bar types and new wave cannabis products is driven by this trend's successive approximation to satisfaction of an adolescent developmental demand. While legal and limit-setting efforts to reduce adolescent vaping have been partially successful, we offer this updated developmental model to complement existing public health efforts in reducing adolescent ENDS use through an understanding and integration of its developmental meanings.

This paper introduces the topic and unique format of the section that follows, on psychoanalytic work with transgender children. We first review the apparent impasse that characterizes our field regarding clinical work with gender diverse kids, as well as the reasons we pursued a live dialog to push thinking forward. Then, we outline the structure of the entire section, in which four contributors offer short essays, followed by a transcribed and edited version of the dialog we facilitated, which uses these essays as a starting point. We conclude with reflections on some of the themes that arise in the dialog, and implications for all of us who work in the arena of gender and young people.

In March 2021, Hannah Wallerstein and Jordan Osserman facilitated a live dialogue over Zoom on the subject of transgender young people, with four psychoanalytic clinicians and thinkers. The conversation draws on short essays submitted in this section of The Psychoanalytic Study of the Child as a springboard for discussion. It has been transcribed and edited for length and clarity, and is reproduced here. Questions explored include the differences surrounding gender identity in childhood versus adulthood, the use of medical interventions for children experiencing gender dysphoria, the tension between psychoanalytic neutrality and affirmation, and the ethical stakes of working in this field.

For children with moderate to severe emotional or behavioral problems, the current approach in child psychiatry is to make an assessment for the use of both psychotherapy and medication. This paper describes integration of antidepressants and stimulants with psychoanalytically oriented techniques.

In the world of education the emotional life of the child has come in and out of focus. Psychoanalytic ideas and principles, including an emphasis on the individual, unconscious motivations, attachments, transferences, disavowed intentions, and feelings defended against, are in full operation within school settings. More recent developments in social-emotional skill promotion in schools and the emphasis on instilling skills such as perseverance and self-control have aims similar to psychoanalytic ideas of healthy ego functioning but use a more direct, didactic approach. We propose that the psychoanalytic school consultant can help bridge the gap between our wish to instill values and skills and some of the obstacles the individual student and school community might face. Through two case examples, one of a latency-age boy who struggled with aggressive impulses, and the other an adolescent caught in a "sexting" scandal, we delineate how the consultant using a psychoanalytic lens can intervene with the students, parents, faculty, and administration to facilitate the type of growth and education desired.

The self begins as a social self and is dependent on the other and the self-other relationship. Furthermore, shortly after birth, the intersubjective self is nurtured and sustained by the reciprocal interactions with the significant other. Recent research suggests that the significant other's reciprocity depends on his or her capacity for mentalization, and this reflective functioning capacity influences not only the child's developing sense of I, other, and we, but also his or her developing attachment pattern. Several studies have demonstrated that parental reflective functioning can be improved with intervention, and enhancing parental reflective functioning can lead to a more secure attachment pattern and better outcomes for the child and parent. Therefore, intervention with toddlers and their families requires us to consider this dynamic two-person psychology. In this paper, we describe an academic parent-child nursery program aimed at enhancing parental reflective functioning. A clinical example from the collaborative treatment of a mother and her two-year-old will demonstrate how reflective functioning can be enhanced in the parent-child dyad and lead to a more secure parent-child relationship. We will also discuss the value of reflective functioning to the interdisciplinary team and how we dealt with countertransference issues that arose during the treatment.

This paper represents and attempts to describe psychoanalytically informed work applied in a school setting with children with special needs. While many therapists at the Parkside School are trained in analytic techniques and principles, these ideas have not traditionally been applied to children with language-based learning difficulties. Over the years, we have found that analytic ideas such as transference, countertransference, projective identification, containment, and attachment are especially salient to our understanding of these very complex children. Despite being in a school--a nontraditional setting for psychoanalysis--children are seen in individual and group therapy, often more than once a week. We believe that therapeutic relationships and play (sometimes bringing a child to a place of being able to play) are especially mutative with children with language-based learning challenges. Play and relationship provide a holding environment that, over time, allows for the reorganization of a child's often immature developmental capacities into a sense of agency that captures more clearly a child's innate potential. This article includes case studies of children with complex language-based learning difficulties, including autism spectrum disorders.

In this paper we describe an intake evaluation process of elementary schoolchildren who have exhibited difficulties in a more traditional school environment. We show how a dynamic understanding of the child's emotional life and the child's emotions affects his or her behavior, cognitive development, and academic performance. We illustrate how to utilize this understanding in planning an approach in the classroom.

In this collection of papers, psychoanalytic principles come to life in a variety of settings: in a therapeutic nursery, in two schools serving children with special needs, in mainstream schools, and in a psychiatric practice. From dyadic work with a two-year-old's tantrums, to play therapy using deep-sea symbolism with a five-year-old; from the interchange with parents and school administrators in a middle school regarding "sexting, " to the in-depth assessment of children upon entry to a special school, these papers illustrate enriching exchanges between psychoanalysts, educators, children, and their communities.

This paper addresses factors other than symbolic capacity that can influence the use of language by children on the autism spectrum. Chief among the issues considered are the influence of bodily experience on the articulation of words and the influence of fantasies concerning bodily relationships on the construction of words and sentences. It is suggested that such considerations may shed light on the behavior of those children on the autism spectrum whose symbolic capacity is greater than might be assumed from their use of language, and also on that of some children with selective mutism.

Observations of videotaped sessions of the analytic treatment of a four-year-old autistic boy offer insights into the meanings and the mechanisms of transference. These observations illustrate the well-known fact that the relationship of transference to symbolization is ambiguous. They also demonstrate that multiple simultaneous meanings exist in a transference field, and many of these meanings emerge from partially or nonsymbolized domains of experience, including and perhaps most important, bodily experience. Whereas many clinicians would agree with these proposals, finding supportive data for them is difficult. One way to explore nonsymbolized phenomena is by analyzing the observable data in videotapes of an autistic child with limited symbolic capacity. Then these data can be put together with the emerging symbolic communications of the child as well as the countertransference reactions of the analyst and some of the biological processes contributing to these meanings. In this study, complex interactions between and among transference reactions of varying degrees of symbolization and in different domains of meaning may provide clues to transference in patients of all ages.

The current paper provides an overview of an evidence-based treatment, Pivotal Response Treatment (PRT), for autism spectrum disorder (ASD). The paper describes PRT principles and then illustrates the approach using two case reports. The children are preschool-aged children with high-functioning ASD. They were participating in a four-month clinical trial of PRT. At the start of treatment, they presented with significant social communication impairments, including a minimal understanding of reciprocity, limited play skills, and repetitive behaviors and speech. The paper outlines how behavioral treatment goals were identified and then how activities were designed, using principles of PRT, to target skill acquisition. Following the treatment course, both children made substantial and meaningful gains in social communication skill development.

Autism is a prevalent and strongly genetic brain-based disorder. Early focus in the field on the relevance of psychogenic factors led to the blaming of parents for the occurrence of the disorder, and as a result mainstream research on psychotherapeutic approaches has until recently been limited. Although psychoanalytic approaches continue to be considered of limited relevance for these individuals, dynamic theory is both informative and informed by conceptual approaches to the understanding of autism. Theory of mind in particular is a prominent model for understanding the core deficits of autism and bears strong resemblance to the concept of mentalization. Although cognitive-behavioral and social skills interventions may form the cornerstone of psychotherapy for individuals with autism, the formation of a treatment alliance remains crucial and may require a particular willingness for flexibility on the part of the therapist.

Contemporary child and adolescent psychoanalytic technique has evolved and changed a great deal in the last thirty years. This paper will describe the analysis of an adolescent girl from early in the author's career to demonstrate the ways in which technique has changed. The clinical material presented highlights six areas in which contemporary child and adolescent analysts practice and/or understand material and the clinical process differently than they did thirty years ago: (1) the contemporary perspective on mutative action, (2) the contemporary emphasis on mental organization, (3) the developmental lag in integrating the structural model, (4) the child analyst's multiple functions, (5) the child analyst's use of countertransference, and (6) the child analyst's work with parents. The author discusses how he would work differently with the patient now using his contemporary perspective. But he also wonders what might have been lost by not working in a more traditional manner, in particular the opportunity to analyze the patient's hypersensitivity to feeling hurt and mistreated so directly in the transference.

The authors apply a two-systems approach to demonstrate improved treatment possibilities and outcomes in this group of children and suggest that psychoanalysis can be defined as a multimodal strengths-based learning experience. Using clinical material from the analysis of an aggressive, "out-of-control" child, they discuss how these behaviors and symptoms are better understood as an actively constructed effort at self-regulation than as a deficiency in capacity or primitive, lagging development. They illustrate how a two-systems framework can allow for an expanded repertoire of techniques and reclaim psychoanalytic concepts that have fallen into disuse.