The use of psychedelic agents with autistic schizophrenic children

This review (1971) of 7 studies looked at the effect of psychedelics in autistic children (n=91). Psychedelics led to improved speech and mood, better emotional responsiveness, and decreased compulsive behaviour.

Abstract

“Seven independent studies are reviewed involving 91 autistic children given psychedelic drugs for therapeutic and/or experimental purposes. The majority of children were between six and ten years of age and had failed to respond to other forms of treatment. The most consistent effects of psychedelic therapy reported in these studies included: (a) improved speech behavior in otherwise mute patients; (b) greater emotional responsiveness to other children and adults; (c) increased positive mood including frequent laughter; and (d) decreases in compulsive ritualistic behavior. Differences in patient attributes, treatment technique, and other nondrug factors effected the frequency and stability of favorable outcomes. The kinds of improvements found were essentially the same in each study. The collective results argue strongly for more extensive use of psychedelic drugs in the treatment of autistic children.”

Authors: Robert E. Mogar & Robert W. Aldrich

Summary

Seven studies involving 91 autistic children were reviewed. The most consistent effects of psychedelic therapy were improved speech behavior, greater emotional responsiveness to other children and adults, increased positive mood including frequent laughter, and decreased compulsive ritualistic behavior.

In recent years, a number of studies have been reported involving the administration of psychedelic agents to young children suffering from severe forms of psychological disturbance. These studies are extremely fragmentary and suffer gross shortcomings.

Despite their diversity and severe limitations, these seminal explorations in an extremely complex area of research deserve wider reportage and more serious attention than they have hitherto received.

This critique of the use of psychedelic agents with severely disturbed children will examine the similarities and differences among the studies and try to resolve any conflicting findings.

PATIENT CHARACTERISTICS

In recent years, a number of exploratory investigations involving the administration of psychedelic agents to young children suffering from severe forms of psychological disturbance have been reported. These studies are extremely fragmentary and suffer gross shortcomings.

Despite their diversity and severe limitations, these seminal explorations in an extremely complex area of research deserve wider reportage and more serious attention than they have hitherto received.

This critique of the use of psychedelic agents with severely disturbed children will analyze the results of several studies and point out possible reasons for inconsistent findings.

PATIENT CHARACTERISTICS

A total of 91 severely disturbed children were administered psychedelic drugs, with the majority between six and ten years of age. The seven independent studies disclosed little basis for assuming a significant relationship between age and drug response. However, tentative relationships were suggested by both Bender (3) and Fisher and Castile (4), and comparable favorable effects were found irrespective of age differences.

All patients treated in these studies were severely and chronically disturbed, with a primary diagnosis of autism or childhood schizophrenia. The longest illness duration was 7.6 years.

The modal symptoms characterizing the majority of children given psychedelic treatment are preoccupation with and stereotyped manipulation of objects, isolation from animate objects, failure to acquire general social behaviors, and bizarre rhythmic repetitive motor patterns.

Children who have been administered one or more psychedelic agents for experimental and/or therapeutic purposes show comparable favorable effects irrespective of age differences. However, it is unlikely that this symptom picture consistently distinguishes older from younger psychotic children.

All patients treated in these studies had been hospitalized for periods ranging from two to four years, with the exception of one twelve-year-old boy who had been hospitalized for four months.

The symptoms of children given psychedelic treatment were summarized by Simmons and his co-workers (7). They included preoccupation with and stereotyped manipulation of objects, isolation from animate objects, failure to acquire general social behaviors, and bizarre rhythmic repetitive motor patterns.

Despite significant communalities among the seven groups of children studied, there is little indication in the work reviewed here of differential response or benefit as a function of age, diagnosis, duration, or severity of illness.

RATIONALE AND HYPOTHESES

Explicit hypotheses were absent in these exploratory studies, but all investigators agreed that all known forms of treatment had failed, so a potent experimental drug seemed justified.

The purpose of these studies was to explore the therapeutic potential of psychedelic drugs rather than their psychotomimetic properties. Bender’s view was that psychedelic drugs tend to ‘normalize’ behavior rather than subdue or stimulate it.

Bender, Fisher, and Simmons each offer a psychological interpretation of childhood schizophrenia, and psychedelic drugs are viewed as a powerful means of undermining an intractable defense system and thereby making the patient more receptive to contact and communication with others.

Freedman was prompted to use LSD primarily as an experimental device to study psychosis, but was influenced by the success of other studies with autistic children and adult mute catatonic patients.

Rolo’s single patient had a variety of symptoms, including mutism, hallucinations, paranoid delusions, and psychosomatic disturbances.

Despite significant communalities among the seven groups of children studied, there is little indication in the work reviewed here of differential response or benefit as a function of age, diagnosis, duration, or severity of illness.

RATIONALE AND HYPOTHESES

Although there is no definite rationale for administering psychedelic drugs to disturbed children, all investigators agreed that all known forms of treatment had been attempted without success.

All of these studies were exploring the therapeutic potential of psychedelic drugs rather than their psychotomimetic properties. Bender’s study was different in that she hypothesized that psychedelic drugs tend to normalize behavior rather than subdue or stimulate it.

Bender, Fisher, and Simmons each offer a psychological interpretation of childhood schizophrenia, and psychedelic drugs are viewed as a powerful means of undermining an intractable defense system and thereby making the patient more receptive to contact and communication with others.

Although Freedman used LSD primarily to study psychosis, he was influenced by the dramatic improvement in autistic children reported by Peck and Murphy and by the apparent success of Cholden, Kurland, and Savage (9).

DRUG REGIME

LSD-25 has been by far the most frequently employed psychedelic agent in work with psychotic children, but Bender’s second study (3) found no differences between the action or effectiveness of LSD-25 and UML-491.

Fisher and Castile used LSD-25 and Psilocybin at times singly and at times simultaneously, and they optimized the psychedelic experience for a given patient rather than mechanically administering a constant dosage of the same agent to all patients.

Most investigators settled on 100 micrograms as optimal, but Bender used a lower level and gradually increased the amount to as high as 150 wg. Fisher and Castile used multiple agents and employed a wide range of dosage levels, but found that 250-300 ug of LSD was most effective.

Seven studies were conducted on LSD, ranging from single sessions to daily sessions over one year. The optimal therapeutic regime was not determined, but five sessions per patient were given preferably at two week intervals.

Freeman concluded that repeated administrations of LSD would be ineffective with psychotic children, but Bender found little indication of either rapid or sustained tolerance to LSD using her method of continued daily administrations over extended periods.

DRUG REGIME

LSD-25 has been by far the most frequently employed psychedelic agent in work with psychotic children, but Bender’s second study (3) found no differences between the action or effectiveness of LSD-25 and UML-491.

Fisher and Castile used LSD-25 and Psilocybin at times singly and at times simultaneously, and they optimized the psychedelic experience for a given patient rather than mechanically administering a constant dosage of the same agent to all patients.

Most investigators settled on 100 micrograms as optimal, although Bender used a lower dosage and gradually increased the amount to as high as 150 wg. Fisher and Castile used multiple agents and employed a wide range of dosage levels, especially with older schizophrenic children.

Seven studies were conducted on LSD use. The frequency and total number of treatments varied widely, from a single session per patient to daily sessions over periods as long as one year.

Freeman concluded that repeated administrations of LSD would be ineffective with psychotic children, but Bender found little indication of either rapid or sustained tolerance to LSD, and her impressive improvement rates suggest that a high frequency regime of moderately large doses is sufficient.

PHYSICAL AND PSYCHOLOGICAL MILIEU

The findings obtained in these studies are the result of an interrelated set of determinants, and the administration of LSD is inextricably embedded in a larger psychosocial process.

Fisher and Castile created a nonmedical atmo-‘sphere for autistic children that included a high dose, 7-10 hour session, a variety of therapeutically-meaningful or aesthetically-pleasing stimuli, a positive patient-therapist relationship, and active therapist involvement with the patient including role-playing.

In each study, the circumstances under which the session was conducted were consistent with the purpose and expectations of the investigator. The supervision of Freedman’s patients was performed primarily by a familiar psychiatrist, and the intent was clearly therapeutic.

Rolo and Simmons used the double-blind method and presented various playing objects, games, and tasks to the child. The studies were designed to simulate or elicit normal social behavior and emotional responsiveness.

Several probable effects of the physical and psychological milieu are suggested in these studies, including the investigator’s orientation, the degree of active therapist-patient interactions permitted during the drug-induced state, and the congenialness of the setting.

RESULTS

Each of these exploratory studies suffered major shortcomings either as therapeutic or experimental undertakings. The use of pretreatment baselines against which to measure change either during or after psychedelic therapy were generally contradictory results.

Fisher and Castile created a nonmedical atmo-sphere for autistic children that included a high dose, 7-10 hour session, therapeutically-meaningful or aesthetically-pleasing stimuli, a positive patient-therapist relationship, and active therapist involvement with the patient including role-playing.

In each study, the circumstances under which the session was conducted were consistent with the purpose and expectations of the investigator. The supervision of Freedman’s patients was performed primarily by a familiar psychiatrist, and the intent was clearly therapeutic.

Rolo and Simmons employed the double-blind method and presented various playing objects, games, and tasks to the child. These activities were designed to simulate or elicit normal social behavior and emotional responsiveness.

The expectations of a particular research team seem highly related to various aspects of both drug regime and setting, and greater therapeutic benefit seems to occur in congenial settings offering some opportunity to experience meaningful objects and interpersonal activities.

RESULTS

Each of these exploratory studies suffered major shortcomings either as therapeutic or experimental undertakings. Furthermore, follow-up data was not obtained in most cases, and objective evaluation of improvement in severely disturbed children presents unique problems.

Bender and her co-workers (2) found that aggressive, overtly psychotic children improved after treatment by decreasing personalized ideation and increasing accuracy of response to Rorschach, Draw-A-Person, and Bender-Gestalt tests.

Bender reported that several children with autism improved in speech and verbal communication after LSD or UML, and that many were able to communicate their needs. Other positive effects of LSD include an elevated mood, less compulsive ritualistic behavior, and increased interaction with others.

The children were flushed, bright eyed, and unusually interested in the environment. They sought positive contacts with adults, approaching them with face uplifted and bright eyes, and responding to fondling, affection, etc.

Simmons’ patients showed increased social behaviors, smiled more, laughed more, and reduced self-stimulation during LSD sessions compared to non-LSD sessions.

The major findings of Bender, Fisher and Castile, Freedman, and Simmons are remarkably similar. When LSD is effective with autistic children, it is effective in characteristic wars.

Fisher and Castile found that nondrug factors influence treatment outcome, but made conservative estimates of improvement based on the extent and stability of favorable changes after treatment was terminated.

The lack of short-term follow-up data on the majority of children treated with psychedelic drugs has been a major limitation of the work reviewed here.

Therapeutic intervention in severely retarded or regressed children utilizes close physical interaction to which the child must respond. This results in increased attendance to physical and face contact with an attending adult and concomitant reduction of competing self-stimulatory behavior.

The collective work reviewed here supports the main conclusion reached by Simmons and his co-workers that LSD-25 may offer a useful adjunct to psychotherapy.

Greater therapeutic benefit was related to active therapist involvement, meaningful objects and interpersonal activities, and congenial settings.