._er.J. Psvchiat.                       ]22       _0"   _o
                                                                                                    L-i_II (].966).
                                                                                              , =....                                       LBO 7L75

                       _i:i     May                  THE AMERICAN JOURNAL OF PSYCHIATRY                                                             1966
                       _:                                                                                                         SPECIAL       SECTION

                                                                                     Seven        Papers    Related   to

                           _'                                         CHILDREN AND ADOLESCENTS

                                               MODIFICATION                          OF       AUTISTIC        BEHAVIOR        WITH     LSD-25

                                                     JAMES Q. SIMMONS III, M.D., STANLEY J. LEIKEN, M.D.,
                                                       O. IVAR LOVAAS, ProD., BENSON SCHAEFFER, M.A.
                                                                   AND BERNARD PERLOFF

                                  Effective modification    of autistic be-                                 various    psyehotherapeutie     approaches(3,
                                havior presents the clinician with a for-                                   4, 5, 7) and approaches      based on learning
                                midable challenge as evidenced by reports                                   theory using both positive and negative
                                of treatment results and long-term follow-                                  reinforcement(13,     15, 17). In many in-
                                up in early infantile autism(7, 8) and in                                   stances successful treatment has been large-
                                the more inclusive      area of childhood                                   ly absent or limited to isolated behavioral
                                schizophrenia(3,  4). Characteristically,   the                             changes.
                                more regressed and retarded        the autistic                                In reference to drugs, considerable recent

                                child, the more energetic and prolonged
                                tile effort required to modify the behavior,is                                         has focused    in the
                                                                                                            interest LSD-25(6), even on severe therapeutic
                                                                                                            use of                               childhood    :[ "':
                                and in extreme eases treatment efforts have
                                   The symptom picture in this more re-
                                                                                                            disturbances. Bender(2)     reported favorable
                                                                                                            results in a group of 14 schizophrenic chil-
                                                                                                            dren, ages six to ten, treated with LSD. In       1
 )T, T                          1) preoccupation           and
                                                    with centersstereotyped
                                tarded group generally               around:                                showed report sherelated     that spontaneous
                                                                                                            this first mood elevations, more the children
                                manipulation of objects (toys, etc. ) ; 2)                                  play with adults and other children, more
                                isolation of the self from contact with                                     positive contacts with adults, greater re-
                                animate objects (including      minimal eye                                 sponsiveness to fondling and affection and,
                                contact) ; 3) failure to acquire general                                    finally, a reduction in rhythmic and whirl-
                                social behaviors (including    speech) ; and                                ing behavior. These responses followed by
                                4) bizarre rhythmic repetitive    motor pat-                                30 to 40 minutes the ingestion of 100/_g. of
                                terns(10, 11).                                                              LSD-25 and lasted for two to three hours.
                                   A wide range of approaches       has been                                The drug was given one to three times per
                                taken in an effort to alter the symptom                                     week through a six-week period of time.

  d                             picture of this disorder. The efforts have                                  In Bender's second study(l) the number
                                included insulin subcoma, drugs (stimu-                                     of patients and the duration of the study
c patients. Psychomaltr         lants and tranquilizers),                   electric         shock(2),      were increased. Results generally were the
                                                                                                            same as reported in the initial study.
                                  Dr.      Simmons     is Assistant      Professor      of    Psychiatry       These findings are quite thought-provok-
f hypertensive or               in residence at the University of California at Los                         ing since they represent     major modifica-
"s.                             Angeles      and   Chief,      Children's        Inpatient       Service,   tions of the somewhat intractable behavior
                                U.C.L.A.       Neuropsychiatric           Institute.       Dr.    Leiken
 million patients, it is        was formerly Senior Fellow in Child Psychiatry,                             generally labeled the autistic barrier. How-
)bserved. Drowsiness,           U.C.L.A., and is presently with the Air Force                               ever, it is diflqcult to assess the reliability
 galactorrhea,                  Medical Corps. Dr. Lovaas is Associate Professor,                           or replieability  of Bender's findings, since
r pseudoparkinsonism            Department of Psychology, U'.C.L.A. Benson                                  her methodology       and data are not pre-
s,                              dents in and Bernard
                                           the Departments of Psychologystu-
                                                      Perloff aro graduate
                                                                               at                           sented.

                                U.C.L.A. and Stanford University, respectively.                                It appears logical that a first step in the
        1202                                CHILDREN    AND   ADOLESCENTS                                [ May      1966

        assessment of LSD would involve some                  following characteristics:   no response to            and
        attempt      to more clearly delineate      the       people, no appropriate play behavior, no               were
        nature and uniqueness         of the behavior         speech and considerable    rocking behavior,           corm,
        changes of autistic children subjected       to       Both had unique repetitive motor patterns,             recor
        the drug. Freedman(9),       studying a group         $1 showed     a rhythmic,   well-coordinated           ed a
        of 12 schizophrenic    patients, ages 6 to 12,        finger movement when touching objects or               bcha
        made some effort to more rigorously define            his own body. Sm demonstrated       repetitive         amo_
        the nature of the behavioral change in an             inappropriate play consisting of spinning              was
        acute     single trial study. However,     like       objects and flapping his arms at shoulder            . duril
        Bender's studies, the data and technique of           level while extending his face and gazing              scl:i p
        measurement       are not presented   and no          toward the object. Temper outbursts and                been
        effort was made to replicate the study. In            crying episodes were frequent in S_ lint not               Ei
        addition,     both Freedman's     and Bender's        often seen in $I.                                       Soci_
        studies   involved    heterogeneous   groups,            Procedure and apparatus. Study 1 was               in
        making intragroup comparisons difficult,              carried out in six daily sessions distributed         cont;
           This study was designed to investigate             over two weeks. Days 1 and 6 were control             beh_
        in a single set of subjects, presenting       a       sessions while days 2, 3, 4 and 5 com-                quir4
        reasonably homogeneous symptom picture,               prised the experimental sessions. On days             or c
        the characteristics of LSD-induced  changes,          of the experimental sessions, Ss were either           E's
        Methodologically    we adhered to an intra-           given an inert placebo or 50 pg. LSD-25               etc. )
        subject replication design, where LSD                 in pill form. Neither the adult interacting            (roc
        was repeatedly presented interspersed    with         with the patient    nor the recorder       was         mov
        control and placebo observations.     At the          informed of the drug schedule. The inter-              ing
         same time an attempt was made to ob-                 val between LSD doses varied from three                stari
        jectively   record behavior,                          to four days. The medication was given by              bch_
                                                              the same nurse 55 minutes prior to the                 or s_
        METHOD                                                first observation period. The total observa-              1)
           Subjects. This experiment,     comprised of        tion period consisted       of two successive          folk
        two studies, was conducted at the Neuro-              20-minute test periods; the first was des-             voc_
        psychiatric Institute, U.C.L.A. Center for            ignated Socialization Test and the second              ster_
        the Health Sciences, and involved a pair of           was Social Isolation Test. Three hours after           touc
        identical male twins. At the time of Study            the drug (or placebo)        administration,   50      han,
        1 the Ss were aged four years nine months,            mg. of chlorpromazine         (Thorazine)     was      do_
        and at the time of Study 2 they were                  given orally to terminate the LSD effects,             arm
        aged five years two months. Both Ss (S_                  The Socialization Test consisted of four            objc
        and $2) were physically          well-developed       five-minute subtests : 1) the S sitting alone          lau_
        boys described       as having shown difficul-        in the experimental     room; 2) the experi-               S
        ties within the first year of life. The initial       menter being present (sitting still) and               obs,
        problems centered        around failure of eye        not attending     the S; 3) the experimenter           two
        contact with the parents, failure to make             talking to the S (calling his name, etc.),             tion
        use of objects appropriately and subse-               reaching his arms out to him and every                 sior
        quent failure to develop speech.                      30 seconds picking up the S and placing                sior
           S_'s difficulties    appeared    earlier    and    him on his lap (the S left the lap if he               day
In,     were more obvious to the parents              than    desired);    and 4) replication of subtest 1.          on
emst_   those of S_. In both boys the second and                 The Social Isolation Test consisted of a            dru
_in_    third years were characterized         by failure     period of 20 minutes during which the S                day
bol     to develop the usual social behaviors of              was alone in the experimental          room but        obs
w,      children that age and by the persistence of           was provided        with four toys : a ball,               [
_y,C°   rhythmic repetitive motor patterns. Exten-            bucket, doll and sink stopper,                          mir
Pr,     sive physical and laboratory        examination          During     each session behavioral        mea-       the
sid     failed to reveal any physiological          abnor-    surements were taken by a recorder in an                giv.
i_      malities,                                             adjoining observation      room connected       to      juk
           Behaviorally, both Ss demonstrated           the   the experimental room by one-way screens                ses,,

             [ May    _   l.t___!        J" SIMMONS,    S. LEIKEN,   O. LOVAAS, B. SCHAEFFER AND B. PERLOFF                      1203
 no response     to   !   and sound equipment.           The recordings         the drug was administered             immediately
ty behavior, no            were made using a push-button            console     following the control session. One hour
_king behavior,           conm'cted to a 12-pen Esterline            Angus      later the Ss were observed for the effect of
 motor patterns,          ro_'order. When activated, the pen record-            the drug. Again the LSD experiences were
veil-coordinated          t'd appearance and duration of a given                terminated with chlorpromazine 50 mg. by
:hing objects or          Iwhavior. An adequate level of reliability            mouth. *
rated repetitive          among various recorders'          measurements            Data were collected in the same manner
ng of spinning            was assessed in sessions conducted before,            described above. However, only three be-
'ms at shoulder            during and after the study. Further de-              haviors were recorded:         movement toward
ace and gazing             _cription of the recording      technique      has   the E, movement          away from the E and
  outbursts and           bct.n made by Lovaas(12).                             eye-to-face contact. Each session lasted for
nt in S_ but not              Eight behaviors    were recorded       in the     20 minutes       and was divided          into five
                          Socialization Test:      1) arranging      objects    four-minute     tests. During these five tests
:. Study 1 was             in a stereotyped      manner;      2) physical       the Ss were presented         with the following
ions distributed          contact with the E; 3) social nonverbal               situations, designed to simulate the types
  6 were control          Iwhavior (behavior        of child which re-          of interactions which are part of the usual
4 and 5 corn-             quired cues from the adult for initiation             relationships     between     adults    and small
sions. On days            or completion, such as playing with the               children.
  Ss were either          E's hand, coming to the E when called,                    Test 1-Peek-a-boo.      A four-minute period
50 /zg. LSD-25            _.tc.); 4) vocalizations;    5) self-stimulation      in which the E sat facing the S, who was
]ult interacting           (rocking, flapping arms, stereotyped        finger   also seated in a chair. The E kept the S
   recorder   was         movement, mouthing objects, hand touch-               between his knees. The E placed his face
ule. The inter-           ing body repetitively, snout movement and             directly    in front of the S after moving
ied from three            staring at lights); 6) social nonverbal               from behind a hand-held screen, at the
a was given by            behavior initiated by the S ; 7) destructive          same time saying, "peek-a-boo." The face
    prior to the          or screaming behavior;and 8)laughter.                 was presented for ten seconds and then
   total observa-            During the Social Isolation          Test the      covered by the screen for five seconds. The
:wo successive            following behaviors       were recorded:         1)   procedure      was repeated        four times a
   first was des-         vocalizations ; 2) snout movements ; 3)                minute for four minutes.
 nd the second            stereotyped    finger movement;         4) hand           Test 2-Pat-a-cake.       The E and the S
 ree hours after          touching body; 5) spinning objects with                were sitting in the same position as out-
finistration, 50          hands; 6) rocking;        7) jumping up and            lined above for Test 1. The E presented
aorazine) was             down ; 8) mouthing objects ; 9) flapping               the rhyme "pat-a-cake ....          " with appro-
LSDeffects.               arms; 10)staring      at lights; 11)arranging          priate gestures, for eight seconds while
asisted of four           objects in stereotyped       manner;     and 12)       looking directly at the S. When the rhyme
 S sitting alone          laughter and smiles,                                   was terminated,       the E then averted        his
2) the experi-               Study 2 consisted of a series of nine               face for a period of seven seconds. This
 ng still) and            observation    sessions carried      out over a        cycle was repeated        four times a minute
 'experimenter            two-month period. The first five observa-              for four minutes.
    name, etc.),          tion sessions consisted of three drug ses-                Test 3-Face-to-face.      Again sitting as in
 im and every             sions interspersed     with two control ses-           Test 1, the E leaned forward and attempted
     and placing          sions. They were carried out on different              to press his cheek to the S's, as in a hug,
  the lap if he           days. The last four observations were made             for a period of ten seconds, then E sat
    of subtest 1.         on two different days with a control and a             back in the chair with his gaze averted for
 consisted of a           drug session occurring on each of the two              five seconds.
    which the S           days. Only the data from the last four                    Test 4-Hand-holding.         The E brought
 ttal room but            observations in Study 2 were plotted,                  the S into a three-foot          diameter    circle
  oys: a ball,               During Study 2, 50/zg. of LSD was ad-               every 15 seconds. S's hands were held
                          ministered  by mouth 60 minutes before                  _ On the second and third days of Study 2
 tavioral    mea-         the observation   sessions. The LSD was               both the Ss began having episodes of pallor,
 ecorder    in an         given in liquid form and administered in              profuse diaphoresis and hypotension after chlor-
                                                                                promazine.   As a consequence   chlorpromazine    was
 connected   to           iuice or milk. When the control and drug              discontinued and the LSD episode was allowed
 _-way screens            sessions were carried out on the same day,            to terminate without medication.
                                 .............................     -"   ...........            .................................................        ,,,,.I,,.,i _._,_

          1204                                              CmLVRF__AND ADOLESCENTS                                                                 [    May                    196(

          lightly with no effort to impede the S's                                  In Study 2 the period of time between
          withdrawal from the circle. This was re-                               LSD doses varied from four to seven days.
          peated four times a minute for ten rain-                               The five tests were presented   in an un-                                                           I_
          utes.                                                                  systematic order over the various sessions
              Test 5-Following.      The E knelt in one                          in the two studies.
      !   of three three-foot diameter circles, called                            RESULTS
          the S by name and held his arms out-
          stretched   toward the S. The E remained                                   Study 1. Briefly, the Ss showed consistent
          in the circle for 15 seconds, then rotated to                           changes of certain behavioral areas in both
          one of the two remaining            circles. The                        tests. In the Socialization     Test the social
          procedure     was repeated       four times a                           behavior     of "looking at the face" was
          minute for four minutes,                                                almost uniformly increased by LSD over
              Other than as noted in the description                              the control levels. On the Social Isolation
          of the tests, no attempt          was made to                           Test the predominant       modes of repetitive                                            i
          restrict the S's behavior,                                              motor behavior were consistently depressed                                                ,
              The following     recordings     were made                          during the LSD sessions. Laughing              be-                                            ,_
          during the Pat-a-cake and Peek-a-boo                                    havior was essentially absent during con-
          Tests:    1) movement       toward the E, de-                           trol sessions but markedly increased in all
          fined as the S moving his hands or body                                 LSD sessions. The other behaviors            inca-
          across the knees of and toward the E; 2)                                sured in this study showed no consistent
          movement away from E, defined as the S                                  alteration in one direction or another.
          moving his body out of the chair or turning                                The data recorded       during the various
          his back to the E; 3) eye-to-face contact,                              tests were analyzed       separately    for each
          recorded when the S looked at the face of                               test in both studies. The various behaviors
          the E; and 4) stimulus presentation;           in                       are presented    as the percent of total time
           Pat-a-cake the stimulus was recorded when                              they occurred during each test. Only those
           the E began the rhyme and in Peek-a-boo                                behaviors which showed consistent modi-
           when the E peeked from behind the screen,                              fication under LSD have been plotted.
              During    the Face-to-face       Test, these                           "Eye-to-face contact" (from the Sociali-
          events     were    recorded:     1)    movement                         zation Test) showed the most consistent
           toward the E, defined by the S main-                                   change in both Ss. In all but one instance
           taining face contact or reestablishing it                              in 12 trials the percent time that the Ss
           when it was broken, but prior to the next                               looked at the E's face was increased during                                                         2)
           stimulus presentation;     2) movement away                             LSD as compared        to non-LSD       sessions,                                                   ap
           from the E, as in the first two tests; 3)                               Since the eye-to-face contact was the same                                                          of
           fondling, the S touching face of the E                                 whether the adult interacted         or was only                                                     sa
           with his hands; and 4) stimulus presenta-                              present, the average of the two situations                                                           la_
           tion, when the E initiated face contact                                 has been plotted in Figure 1.                                                                       tic
           with the S.                                                                Evaluation   of the Social Isolation Test                                                         fo
             During Hand-holding     the following were                               in Study 1 revealed a uniform reduction
          recorded:     1) movement      toward   the E                               in self-stimulatory    behavior    in the LSD                                                       at
          when the S maintained hand-holding or                                       sessions over all six trials (Figure 2). The                                                        h_
          reestablished it before the next stimulus                                   percentages     plotted for self-stimulation                                                        ty
In,       presentation;   2) inside circle, the S being                               represent   the average of the two maior                                                            fi_
          inside the three-foot circle in which the E                                 modes observed. In $1 it is the average of                                                           th
st_       stood; and 3) stimulus presentation, when                                   rocking and a characteristic hand-to-body                                                            al
ai_       the E initiated hand-holding,                                               pattern (behaviors 6 and 4). In S_ it is the                                                         e.
pr_          During the Following       Test, recordings                              average of rocking and preoccupation      with                                                       ol
          were : 1) eye-to-face, as in other tests. ' 2)                              spinning objects (behaviors 6 and 5).                                                                C
m,        inside circle, the S in same circle as the                                     A second phenomenon was found con-                                                                r_
_r        E; and 3) stimulus presentation, when the                                   sistently throughout     all trials during the                                                       b
in        E moved into a new circle and called the                                    test of Social Isolation : a marked elevation
w_        S's name.                                                                   of laughing         and smiling behaviors                    (Figure                                 c
                    [_May            1966    ]       j.   SIMMONS,       S. I.EIKEN,   O.   LOVAAS,   B.   SCHAEFFER   AND   B.   PF__LOFF           1205

_riod of time between                                                                      1
                                                                                      FIGURE                                                                '
)m four to seven days.                                                     Contact s Measured the Socialization est
                                                                  Eye-to-Face    a          by                T
 presented   in an un-                  I00
r the various sessions                                                                                                  t

• Ss showed consistent                      80
                                                     SI                                                           Sz
havioral areas in both
ation Test the social                       70
   at the face" was
teased by LSD over              =           60
  the Social Isolation
 modes of repetitive            _           50
_onsistently depressed          ._
dons. Laughing   be-            "_          40
 absent during con-
edly increased in all
her behaviors mea-                          30
rowed no consistent
on or another.                              20
during the various
;eparately for each                         10
le various behaviors
ercent of total time
ach test. Only those        i                        J        I      I          I      I         I                 I     I        I          I   I   I
;d consistent modi-
_'been  plotted.                                     I        2      5         4   5            6                  ]    2         _   4          5   6
  (from the Sociali-        :                        C        PL     LSD       LSD PL           C                  C    at        LSD PL         LSD C
he most consistent
 11 but one instance                                                                                       Day
 L time that the Ss
 as increased during                 2). This type of behavior generally did not                      vations by one hour, the results were quite
 non-LSD       sessions,             appear on control days but rose to a high                        consistent. First, the eye-to-face measure-
 _tact was the same                  of 80 percent during LSD sessions. This                          ments in the Peek-a-boo,         Pat-a-cake    and
 acted or was only                   same change       (increase     in smiling and                   Face-to-face      Tests revealed     that in all
 the two situations                  laughter) was observed in the Soeializa-                         instances under LSD the percent time ap-
 e 1.                                tion Test but was not plotted since data                         pearance of the eye-to-face beha, dor ex-
 ',ial Isolation Test                for one LSD session in $I were lost.                             ceeded that of the control observations
 aniform reduction                      Study 2. This study was designed in an                         (Figure 3).
 vior in the LSD                     attempt    to obtain data on the Ss' be-                             In examining       very limited aspects of
  : (Figure 2). The                  havior when presented         with some specific                 interactional     behavior vis-a-vis the E, the
  " self-stimulation                 type of human interaction. During the first                      data showed that in $1 there was consider-
  f the two major                    five observations    of Study 2, it was found                    able movement away from the E in control
   is the average of                 that certain extraneous intercurrent vari-                       sessions which was uniformly reduced in
  _tic hand-to-body                  ables affected responsiveness to the drug,                       the LSD sessions. Movement toward the E
  4). In $2 it is the                e.g., respiratory    disorders;     therefore, the                showed no systematic       relationship    for S_
  eoccupation with                   observations were repeated and both the                           (Figure 4).
  s 6 and 5).                        control and the LSD sessions were re-                                S_ showed a slightly different pattern in
    was found con-                   corded on the same day in an attempt to                           that movement away from the E was not
                                     reduce day-to-day        variations     in the Ss'               reliably    related    to LSD but movement
  rials during the                   behaviors,                                                       toward the E was increased in all six LSD
  aaarked elevation                      In those experimental sessions in which                       observations wtien compared to the six
  _haviors (Figure                   control observations preceded drug obser-                         control observations (Figure 5).

             1206                                          CHILDREN AND ADOLESCENTS                                                [May     1966
                                                                     FIGURE 2
                                                           Results the SocialIsolationTest
               I0 0           X- - - -X         Self-Stimulation            Behavior)
                                                Laughter (Affect)
                        r     _.            :                                                                                                 c

                90            Sl                                                               S2

                                                                                                                                            _ i
             "_ 50             ""                                                                                                           _-

                 20                                                                                                                ×
                                        /'                 /                                          r',,
                               I       I
                                                 I     I                I
                                                                                           /      -      I          I       I      I
                               I       2        5      4       5      6                    I     2       5          4      5       6
                              C        PL       LSD LSD PL             C                   C     PL      LSD PL           LSD C

_               in all the tests in Study 2 there was no                     activity level. The effect usually  persisted                    o
             evidence of a reduction under LSD in the                        for three hours and was at its peak between                      a.
             number        of times      the   Ss responded         to       one and two hours.                                                1_
             stimuli     presented     by the E. In addition,                                                                                  i_
             there was no noticeable          change     in the time         mscussloN                                                         a
             characteristics       of the      Ss'   responses      to          This     study     has    been     undertaken    to            a
             stimuli presented       by the E.                               determine       what    value,    if any, LSD may                  (
                In reviewing       all the data from the sys-                have     as an adjunct          to the therapy      of
             tematic observations         where control, placebo             autistic   children.     It was felt that in order                   t
             and experimental sessions were varied, it                       to accomplish         this an effort should be                       !
             did not appear        that any simple adaptation                made to control         as nearly     as possible the
             existed to explain the changes obtained,                        circumstances        under which the drug was
    clf_        General      observations      made     in addition          given and to clearly          define the dependent                   ,
    .,ta     to the systematic recordings on each of the                     variables     measured.      On the basis of the
    di_'_:   LSD days revealed    the characteristic                 onset   results     obtained  in        this     study   it   seems
    bo:      of a response    approximately        30              to 45     likely,   at least in the       type     of subject    used,
    p_,      minutes after drug administration.                       The    that LSD could be profitably used as a
    syl      physical       symptoms        included       dilation     of   therapeutic       adjunct    to    the     various    inter-
    Pr       pupils and flushing of the face. Blood                          actional therapies currently in vogue.
    a_.      pressure and pulse measurements showed                             The changes in behavior which suggest
    in       no remarkable variation. Behaviorally there                     this are: 1) an increase in social be-
    wc       was an increase in laughter and general                         haviors manifested by increased eye-to-face
                                                                                                                                              _t         #

             [ _V_ay    l____]]       J.    SIMMONS,         S.       LEIKEN,   O.   LOVAAS,    B.   SC_EFFER        AND   B.   PEHLOFF                       ]_f

                                                                                  FIGURE 3
                                                                               Contact Replication
                                                                      Eye-to-Face      (         Study)
                          [0 0 -                                                                                                X- --X             Control
                                                                                                                                M                  LSD
                             90                                                                                                     ,'

                             80       S_                                                                        S2                                                      ,

                       _ so
                       "_ 50

                       _ 40

                       =" 30

                             20                                                                                                                              ,X
                                           ,_/'//_                                                                                  ,IX'-...X.,./
       zx                     I0      e" "°,X_                    t        "X"""
                                                                      .X--..   -X                               X" " -X-- -XI
                                      X"               "_X"
_l       ,                            I        2         I              2       I       2                       I    2          I         2              I    2
5       6                             Peekaboo                                  Following                       Peekaboo                              Following
.SO     C                                               Pat-A-Cake                                                              Fat-A-Cake
ly persisted           contact and increased          responsiveness   to                      tendance to physical and face contact with
_akbetween             adults ; 2) an increase in smiling and                                  an attending adult and concomitant reduc-
                       laughing behavior, generally considered an                              tion of competing self-stimulatory      behavior.
                       indication of a pleasurable affective state;                               Additionally, the general response char-
                       and 3) a decrease in one form of non-                                   acteristics    of the Ss during        the LSD
ertaken      to        adaptive behavior demonstrated            by a re-                      experience were the same as during the
  LSD may              duction in self-stimulation,                                            control period, i.e., the number and latency
therapy of                Therapeutic intervention in severely re-                             of the responses to externally presented
at in order            tarded or regressed children utilizes to a                              stimuli. With these factors operating con-
 should be             great extent close physical interaction         to                       currently, it is possible to conclude from a
 ossible the           which the child must respond. In the usual                              behavioral point of view that the Ss were
  drug was              state it is often difficult to intrude upon the                        aware of and increasingly attendant          upon
 dependent             child because of a general lack of respon-                               external events, particularly as they related
tsis of the            siveness coupled with the random character                              to the E. Thus, two possible criteria for a
   it seems            of responses when they are obtained. The                                 successful intervention in autistic children
bject used,            barrier to external stimuli is further         in-                       are met:a     diminution of competing events
used as a              creased by self-stimulatory behavior with a                              (self-stimulation)     and increased contact
ious inter-            high percent time appearance both in the                                 with the attending adult (object).
,_ue.                  resting state and when stimuli are presented                                A third item which must be considered
_h suggest              from the external environment. The results of                           is the increase     in .smiling and laughing
social be-             our experiments clearly demonstrate changes                              behavior, which can be viewed from two
.'ye-to-face            in exactly these areas with increased         at-                       perspectives-first,    the significance   of the
                     l_0s                                                   ^_OL_C_s
                                                                   c_o._N AND                                                                      [Ma_                      ....
                                                                                  FIGURE 4
                                         Subject l's InteractionalBehaviorwith the Experimenter           Study)                                                             _OC
                                                                                                                  ,                                                                 9(:
                              9 0           _              &          towardE
                              8 0           X------X                  a
                                                               Movement wayfrom E

                              70            SI                                                                                                                                       7r,.
                                                                                                                                                                           _. 6C
                     _. 50
                     cl_                                                                                                                                                    ._-

                     ,..._                                     _                                                                                                            _ 4C
                        40                                     _
                     #.                                            _                                                                                                                   5(

                                                                                                                                     x                                                 2(
                               I0               x\                                                                       \                                                             I(
                                                                                                                          \                                                             (
                              30                                   _
                               O-                                          x            x          x""'x                     _(
    '                               --      I          I       I            I     I    __I         L_      I       I           I      I             I                _
_:' :                                       C LSD C                        LSD C       LSD C            LSD C             LSD C               LSD
                                            Peekaboo                   r        Face-To-Face       Peekaboo              1           Face-:to-Face
                                                                Pat-A-Cake                                            Pat-A.Cake

                                    Day !                                                          Day2
                     behavior in terms of internal events in the                        limited response hierarchy available to him.                                                more o
                     S and second, in terms of the response of                          The behavioral        changes obtained         in the                                       picture
                     the E to the subject's   behavior.   It is pos-                    subjects    of our studies      are consistent   with                                          Thel
                     sible that  the laughing    and    smiling  be-                    those    considered     desirable    and necessary                                          applic_
                     havior is representative  of a mood change                         in child-adult      interactions     in order that                                           genera
                     in the individual where external and in-                           adults receive some gratification for their                                                  becau,'
                     ternal    stimuli   are    perceived       as pleasurable,         efforts,   These       changes        have   been        related                             ments

                     If this be so, another criterion
                     may      is achieved      in that     for treatment
                                                           the    external                                 in the
                                                                                        to an alteration attending behavioral which
                                                                                        istics of the                  adult              has                                        U.C.L
                                                                                                                                                                                     of 18
                     events    manipulated      by the E (the treat-                    been noted aneedotally       in the nonmeasured                                               the
                     ment) would be associated with or super-                           part of our experiments         and in previous                                               variel
        effc         imposed upon a pleasurable                state and                pilot studies on the use oE LSD with this                                                     child;
        s_,_         attending     adults may acquire properties                        type of child. The interaction            is more                                              expel
        ,li_         symbolic of gratification,                                         intense    except when controlled by the                                                       respc
         bol            Also, one must            consider the rein-                    experimental design,                                                                           tardt
         p_,         forcement     provided    the E on the basis of                        The results   of this study are consistent                                                  denc
         ,,y.        changes     in the S. Characteristically          it is            with    those    of Bender       and   Freedman.                                                tion.
          °,c        very difficult      to respond      to the autistic                However,      our findings    have been      limited                                                TI
          ski        schizophrenic       child   because    of the very                 to a small sample        with similar    relatively                                              mea
               Vi:                                                                                                                          ......................              '
                  i -,i _   .......                              .4

                                      1966    ]        J.    SIMIVIONS,       S.   LEIKEN,       O.   LOVAAS,       B.   SCHAEFFER      AND   B.   PEBLOFF        1209

                                                                                                        FIGURE 5
_plicatiantudy/                              JC)O _         Subject Interactional
                                                                 2's                 withtheExperimenter
                                                                               Behavior                        Study)

                            i                 90            ¢             &              toward
                                                                                   Movement   E
                                                            X----X                       away
                                                                                   Movement fromE
                                              70            Sz


                                              40            ,/                                         /                       /
              x                               I0
    \                                         30
                                               0   -        X----X                 /
                                                                                   X_--X               X---X                    X---X              X---X     /
        X                                                   I         ,I ,         I         I          I       I               L        I    __J__.l         I      ]

      '  _
   - LSD C          _
                   LSD -                                C I_SD "C rI_SD C -_ LSD'
                                                         --, '         ''-                                                    _ C -, LSD, _C f LSD ,C TL.SO,
    C  e _                                                   Peekaboo                                  Face.To-Face                  Peekaboo                 Face.To.Face
          Face.To-Face                                                                 Pat-A-Cake                                                   Pat-A-Cake
                                                   Day1                                                                          Day2
                                      unchanging behavior patterns representing                                 sequently the drug may have to be used
    hy available to him.              more or less a pure culture of the disease                                on a schedule similar to that utilized by
    _s obtained in the                picture.                                                                  Bender(I, 2) in her long-termexperiments.
    are consistent with                  There are some reservations to the                                     Here again, however, studies will have to
     ble and necessary                application of these findings to the more                                 be undertaken         to compare        behavioral
     )ns in order that                general population    of psychotic     children                           changes occasioned by the drug to clearly
     tification for their             because of the restricted      sample. Experi-                            established baseline behaviors in the same
     _ave been related                ments are currently being carried out at                                  subject.
     aavioral character-              U.C.L.A. with a heterogeneous        population                              Since psychotherapy       can be considered
      adult which has                 of 18 psychotic children(16).       Analysis of                           a learning experience, experiments          should
       the nonmeasured                the data available    shows a much wider                                  be attempted       to determine     if there is a
        and in previous               variety of responses, with a tendency for                                 transfer   in learned     behavior     from LSD
      )f LSD with this                children   similar to the subjects of this                                days to non-LSD days and vice versa. In
       faction  is more               experiment (severely retarded patients)to                                 terms of this consideration,         pilot studies
       ntrolled  by the               respond in a like manner, while less re-                                  already    carried out by the authors(15)
                                      tarded schizophrenic    children showed evi-                              demonstrated      that LSD abolished behavior
        y are consistent              dence of social withdrawal and disorganiza-                               maintained by weak symbolic rewards and
        and Freedman.                 tion.                                                                     had no effect on behavior          reinforced    by
        ¢e been limited                  The effects of LSD on the behaviors                                    strong symbolic punishment.
         milar relatively             measured in this study are transient. Con-                                   Finally, one must question whether or
              1210                                    CmLt)REN AND ADOLESCENTS                               [   May    1966

              not LSD is merely replacing self-induced     Neuropsychiatric Institute and Mr. Bruce                     14. I.
              stimuli  with pharmacologically-produced     Rubenstein,   graduate student, Department                       J
              stimuli which will tend to block interaction of Psychology, U.C.L.A.                                      15. 1_
              with the environment.   The data presented                                                                    J,
              here do not supportthat contention.                          REFERENCES                                       S
                                                             1. Bender, L., Faretra, F., and Cobrinik, L. :                 L
              SUMMARY   AND CONCLUSIONS                         LSD and UML Treatment of Hospitalized                       sc
                1. LSD-25      appears   to     offer    a   useful      Disturbed Children, Recent Advances
                                                                         Biol. Psychiat. 5:84-92, 1963.
              adjunct   to the psychotherapy    of autistic           2. Bender, L., Goldschmidt, L., and Siva
              children because of its positive effect in                 Sankar, D. V. : Treatment of Autistic
              areas which are closely related        to the              Schizophrenic Children with LSD-25 and
              process of psychotherapy.                                  UML-491, Recent Advances Biol. Psy-
                 2. A pair of identical male autistic twins              chiat. 4:170-177, 1962.
              was periodically    administered  50 /zg. of            3. Brown, J. L. : Prognosis from Presenting
              LSD-25 and observed for behavior changes.                  Symptoms of Pre-School Children with              l'ai
                 3. Control and drug observations      were              Atypical Development, Amer. J. Ortho-          crisis
                                                                         psychiat. 30:382-390, 1960.
              made while the Ss were placed in a series               4. Brown, J. L. : Follow-Up of Children           as wc
              of standard     test situations referred to as             with Atypical Development        (Infantile    for th
              the Socialization Test, Social Isolation Test,             Psychosis), Amer. J. Orthopsychiat.      33:   under
              Peek-a-boo, Pat-a-cake, Face-to-face, Hand-                855-861, 1963.                                 tween
              holding and Following Tests.                            5. Call, J. D. : Prevention of Autism in a        schoo
                 4. Diverse behaviors       were recorded in             Young Infant in a Well Child Conference,       five t(
              the areas of self-stimulatory behavior, social             J. Child Psychiat. 2:451-459, 1963.             is a
              interaction and affect.                                 6. Cohen, S. : Notes on the Hallucinogenic        with s
                 5. Recordings were made using an Ester-                 State, International Record of Medicine            In
              line Angus Multiple pen recorder. All                                      1
                                                                          173:380-387, 960.                              learnt1
              behaviors were measured in total time up-               7. Eisenberg, L. : The Autistic Child in           h'arni_
              pearance and plotted as percent time in                    Adolescence, Amer. J. Psychiat. 112:607-        ing (_
                                                                         612, 1956.                                      tardat
              appearance.                                             8. Eisenberg,L., and Kanner,L. : Early In-
                 6. Consistent    behavioral   changes   re-             fantile Autism 1943-1955, Amer. J. Ortho-      difflcu
              suited after LSD in that the Ss demon-                     psychiat. 26:556-566, 1956.                    the al
              strated an increase in eye-to-face contact              9. Freedman,      A. M., Ebin, E. V., and         discipl
              with the E, an increase in laughter       and              Wilson, E. A. : Autistic Schizophrenic         psych(
              smiling behavior       and decrease   in self-             Children: An Experiment in the Use of          an oul
              stimulatory    behavior.  There was an in-                 d-Lysergic Acid Diethylamide (LSD-25),         to the_
              crease in S_ in movement toward the E                      Arch. Gen. Psychiat. 6:203-213, 1962.          ress r(

      _                                                                  Affective Contact, Nervous Child 2:217-         liminal
      :'_     from the E.                                                 250, 1943.                                     previo
      i          7. Further    experiments      are     needed   on   11. Kanner, L. : Problems of Nosology and

l        t    the a decrease in Sj in drug more
                             LSD,               a dosage away
              and effects ofvarying utilizing movement diverse
              population,             the                  and        10. Psychodynamics Autistic 19:410-426,Autism,
                                                                          Kanner, L. : of Early Disturbances 1949.
                                                                          Amer. J. Orthopsychiat.                 of     volvin 1
              observation times and analyzing the trans-              12. Lovaas, O. I., Freitag, G., Gold, V.J.,        can Ps'
              fer of learning      from drug to nondrug                   and Kassorla, I. C. :A Recording Appara-       .May 3-i
    In,       situations,                                                 tus and Procedurefor Observations f     o           Dr. 1
    eft,                                                                                                                  Psychial
    su_                                                                   Behaviors of Normal Children in Free            Mcdicin
    dis                       ACKNOWLEDGMENTS                             Play Settings, J. Exp. Child Psychol. 2:        Orleans
    no                                                                    108-120,  1965.                                 llis add
    hO_,r,       This study was supported in part by a                13. Lovaas, O. I., Freitag, G., Kinder, M.I.,       l)r. Net
    c_        grant from the Sandoz Company, Hanover,                     Rubenstein, B. D., Schaeffer, B., and          Tulane_
    _y,,_,_   N.J. The LSD was supplied by the same                       Simmons, J. Q. : Experimental Studies in        tendent,
     pr       company, courtesy of Harry Althouse.                        Childhood Schizophrenia : Establishment         merly    ][
     s_          The authors gratefully acknowledge   the                 of Social Reinforcers, read at the Western       Mental 1
     ,,i      valuable efforts of Lorraine Freitas, R.N.,                 Psychological Association, Portland, Ore-        Service
              Head Nurse of the Children's Ward of the                    gon, 1964.                                       of Ment

         [ May              1_o6]                     ^nTn_a     P. BURDONAND JANIES H. NEELY                                 1211
nd Mr. Bruce                14. Lowms, O. I., Schaeffer, B., and    Simmons,        16. Simmons, J. Q., Lovaas, O. I., Benor, D.,
_t, Department                  j.Q. : unpublished data, 1964.                          and Daniels, D. : unpublished data, 1964.
                            15. Lovaas, O. I., Schaeffer, B., and    Simmons,       17. Wolf, M. M., Risley, R., and Mees, H. :
                                j. Q. : Experimental Studies in     Childhood           Application of Operant Conditioning Pro-
                    ,           Schizophrenia: Building Social       Behaviors          cedures to the Behavior Problems of an
d Cobrinik, L. :                Using Electric Shock, J. Exp.       Stud. Per-          Autistic Child, Behav. Res. Ther. 1:305-
                    ,           sonality           1
                                         1:99-109, 965.                                 312, 1964.
 of Hospitalized
_ent Advances
63.                 _
  L., and Siva
_nt of Autistic     i                CHRONIC         SCHOOL          FAILURE IN BOYS:              A SHORT-TERM
th LSD-25 and                          GROUP         THERAPY          AND EDUCATIONAL                APPROACH
ces Biol. Psy-
                                           ARTHUR P. BURDON, M.D. AND JAMES H. NEELY, ED.D.                                            i
rom Presenting
 Children with                 Failure in primary school is a family                                      ]FOR
                                                                                    SELECTIONOF ]FA/M[ILIES                            i
mer. J. Ortho-              crisis; repeated or chronic school failure,             INCLUSIONIN ]PROGRAM
p of Children               as wc choose to call it, is a major dilemma                Specifically excluded    from the study
lent (Infantile             for tile whole family(3).     Considering   that        were children with discernible       neurologi-
wpsychiat. 33:              underachieving      children    represent    be-        cal deficit as determined   by psychological
                            tween about 15 and 30 percent of all                    tests as well as physical examination and
f Autism in a               school children of normal intelligence, and             children with obvious specific reading dis-
ild Conference,             five to seven percent fail repeatedly, there            ability or dyslexia. Evaluation     procedures,
I, 1963.                    is a truly awesome number           of children         including pediatric, neurological,     psychiat-
 Hallucinogenic             with serious problems at school,                        ric and psychological      testing,    preceded
:1 of Medicine                 In the literature     the terms secondary            the admission of the family to the treat-
                            learning impotence(13),       primary neurotic           ment program.
 istic Child   in       _    h,arning inhibition(4)     and neurotic read-             Criteria for admission were established
 chiat. 112:607-            ing disability or secondary reading re-                  as follows: 1) the presence of repeated
   L.: Early In-            tardation(12)     have been applied      to the          school failure in a physically healthy boy,
 liner. J. Ortho-           difficulties these children face. Since 1960             aged seven to 12 years; 2) the absence of
                            the authors, representing    respectively   the          gross or minimal     brain damage     in the
 , E. V., and           i   disciplines of psychiatry and educational                child., 3) the presence of a reliable in-
   Schizophrenic            psychology, have collaborated    to organize             telligence  quotient  of at least average
  in the Use of         _   an ontpatient clinic-school as an approach               range; 4) the absence of frank or subclin-
 ide (LSD-25),              to these problems. This is a five-year prog-             ical psychosis in the child or his parents ;
 213, 1962.                 ross report on our treatment program in-                 and 5) the presence of real concern and
 isturbances of             volving 55 boys and their families. A pre-               interest on the part of the parents, and a
   Child 2:217-             liminary report      has   been    published             willingness and ability to participate in
  Nosologyand               previously(i),                                           mandatory group therapy.
 fantileAutism,                                                                        The therapeuticprogram was of limited
 410-426, 1949.                Read at the 121st annual meeting of the Ameri-        duration (3.5 to 5 months) with intensive
 , Gold, V.J.,              ,an l'sychiatric Association, New York, N. Y.,           involvement of each member:child,   moth-
 )rding Appara-             May3-7, 1965.
 bservations of                Dr. Burdon is Clinical Associate Professor of         er and father. Group psychotherapy     ses-
                            Psychiatry,  Louisiana State University School of        sions were held once a week for 90 min-
  Idren in Free             Medicine and formerly Medical Director, New              utes, separately  for the mothers and for
  ld Psychol. 2:            Orleans Mental tlealth Center, New Orleans, La.          the fathers. Participation of both parents
                            ltis address is 372(} Prytania Street, New Orleans.
  Kinder, M.I.,             Dr. Neely is Lecturer, Department      of Psychiatry,     was a requirement  for admission and con-
  ;ffer, B., and            Tulane University School of Medicine and Superin-         tinuation of the family in the program.
  atal Studies in            tendent, Belle Chasse State School. He was for-          Each child attended his regular public or
   Establishment             merly Executive Director of the New Orleans              parochial school during the morning and
                             Mental ltealth Center.
  It the Western               This work was supported by Public Health               the clinic-school in the afternoon.
  Portland, Ore-             Service grant OM-351 from the National Institute            Each child was assessed with regard to
                            of MentalHealth.                                          his specific educational defects and was

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