ABSTRACT
Hallucinatory delusions may accompany children on the autistic continuum which becomes ego-syntonic, becoming integral to the child's thinking and feeling states. For children with developed self-awareness, they may also be kept a guarded secret lest others find that they are 'harbouring' bizarre delusions. One young teen, A. J., finally confided, after four years of art therapy, that he was often accompanied by what he referred to as the 'presence'. He described it initially as a hazy, transparent figure, a being from another world, which hovered over his shoulder, whispering to him. After almost a year of art therapy, A. J. finally gave graphic form to the 'presence'. Such is the power of the primary process on the autistic continuum; it can exert its id-derived pressures with tremendous longevity, like a recurring, sometimes lifelong, nightmare. Fantasy worlds may operate in parallel to relatively normal functioning—it happens all the time, as one may fantasize during the long workday, in transit or during downtime.
