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.
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.''
Earlier exploratory work examined administering psychedelic agents to young children with severe psychological disturbance, but the reports are fragmentary, heterogeneous, and often unpublished. Mogar and colleagues note wide diversity across those early studies in the drug used, dose and dosing schedule, therapist experience and expectations, and the physical and psychological setting of administration. Patient samples also varied in age and symptom profile, and most investigations suffered from small sizes, subjective outcome criteria, and poor follow-up, factors that together have limited the field’s uptake and produced polarized controversy that curtailed publicly sanctioned research. This paper reviews and integrates seven independent studies in which psychedelic drugs were given to children diagnosed with autism or childhood schizophrenia. The stated aim is heuristic rather than conclusive: to summarise commonalities and differences across studies, identify likely determinants of inconsistent findings, and indicate directions for more definitive future research into the therapeutic potential of psychedelics in childhood disorders.
Papers in Blossom that reference this study
Sabé, M., Sulstarova, A., Glangetas, A. et al. · Molecular Psychiatry (2024)
Danforth, A. L., Struble, C., Yazar-Klosinski, B. et al. · Progress in Neuro-Psychopharmacology and Biological Psychiatry (2016)
Johnson, M. W., Richards, W. A., Griffiths, R. R. · Journal of Psychopharmacology (2008)
Sessa, B. · Journal of Psychopharmacology (2008)
Mogar and colleagues conducted a literature review of seven clinical and research reports that collectively involved 91 children treated with psychedelic agents for therapeutic or experimental purposes. The extracted text indicates a ‘‘fairly exhaustive’’ search but does not detail databases, search dates, or formal inclusion criteria. The reviewed reports span varied designs and methods rather than a single standardised protocol. The pooled sample ranged from five to fifteen years of age, with most children between six and ten. All patients were described as severely and chronically disturbed, with primary diagnoses of autism or childhood schizophrenia; many had been hospitalised for two to four years and a majority were long-standing mute prior to treatment. Individual study designs varied widely: some investigators (Rolo, Simmons) used double-blind procedures to introduce experimental control, while others (Bender, Fisher and Castile) employed open therapeutic approaches. Dosage practices differed considerably. Most investigators reportedly considered 100 micrograms (μg) of LSD as typical; Bender started at 50 μg and titrated up to 150 μg, whereas Fisher and Castile used a broad LSD range of 50–400 μg and sometimes combined agents (LSD and psilocybin, occasionally simultaneously). Fisher and Castile also described a regime including pre-medication with 10 mg Librium, 10–15 mg psilocybin given about 30 minutes later, and then 250–300 μg LSD, with possible session “boosters” of 25–100 μg. Investigators differed in the therapeutic milieu and therapist role. Fisher and Castile attempted a deliberately non-medical, extended-session approach modelled on contemporary techniques (7–10 hour sessions, music, meaningful objects, a male and female therapist experienced with psychedelics, active role-playing). By contrast, Freedman’s orientation was primarily psychotomimetic observation with limited therapist engagement, and Bender often administered LSD as a routine daily medication without special preparatory conditions. Rolo and Simmons standardised sessions with play tasks or structured games to elicit social behaviours. Outcome assessment was mainly observational during acute drug effects; formal pre–post baselines and systematic follow-up were generally lacking, with the exception of Bender who administered the Vineland Maturity Scale at baseline and at a three-month follow-up in one study. The extracted text does not report statistical analysis methods or meta-analytic techniques, consistent with a narrative synthesis rather than quantitative pooling.
Across the seven reports covering 91 children, the most consistently reported effects were: improved speech behaviour in previously mute patients, increased emotional responsiveness toward peers and adults, elevated positive mood (including frequent laughter), and reductions in compulsive, ritualistic behaviours. These patterns appear repeatedly in the case descriptions despite methodological heterogeneity. Patient characteristics described in the reports included a predominance of severe, chronic disturbance with long-standing mutism in nearly all 91 children. Illness duration varied; most had been hospitalised for two to four years, while Fisher and Castile’s subgroup (N = 12) averaged 7.6 years of illness. The investigators did not find clear evidence that age, diagnosis (autism versus childhood schizophrenia), or illness duration consistently predicted response, although some authors (Fisher and Castile, Bender) suggested tentative relationships in their more detailed assessments. Drug regimens produced varied exposures: psilocybin and LSD were used singly and together; typical LSD dosing centred on 100 μg but ranged up to 400 μg in some protocols, with reported strategies including titration, pre-medication, and intra-session boosters. Only a minority of studies attempted experimental controls: Rolo and Simmons used double-blind methods with standardised tasks, while Freedman’s study involved single-session observation and Bender reported repeated daily dosing over extended periods (up to a year in some accounts). Objective measurement was scarce. Most data were observational during acute drug reactions and pretreatment baselines and systematic follow-up were generally absent. One exception was Bender’s use of the Vineland Maturity Scale, where follow-up ratings at three months were described as qualitatively higher for all children assessed. The extracted text does not provide aggregate numerical effect sizes, confidence intervals, p-values, or systematic adverse-event counts. Authors repeatedly attribute variability in outcomes to differences in drug regime, therapist expectations and experience, and the physical/psychological milieu in which sessions occurred.
Mogar and colleagues interpret the collective literature cautiously, emphasising that the psychedelic experience is embedded within a broader psychosocial process and that drug effects cannot be meaningfully separated from therapist–patient interactions, setting, and investigator expectations. They argue that more favourable therapeutic outcomes were associated with active therapist involvement, congenial non-medical settings offering meaningful sensory and interpersonal stimuli, and flexible approaches that allowed spontaneous behaviour. Conversely, sterile medical or laboratory environments and mechanically administered procedures appeared to be counter-therapeutic in these reports. The authors underscore substantive limitations in the evidence base: small and heterogeneous samples, largely observational outcome reporting, vague or subjective improvement criteria, variable and sometimes extreme dosing strategies, infrequent use of blinding or controls, and inadequate follow-up. They also note the lack of explicit theoretical rationale in many studies, though several investigators hypothesised that psychedelics might disrupt defensive structures in childhood psychosis and thereby facilitate contact and communication. Mogar and colleagues present the reviewed work as heuristic: despite its shortcomings, the consistency of certain clinical observations (speech gains, emotional responsiveness, mood elevation, reduction of ritualistic behaviour) across disparate reports warrants more rigorous replication. They recommend more definitive studies that control for non-drug determinants of outcome, standardise dosing and therapeutic milieu, employ objective pre–post measurement and longer follow-up, and use appropriate experimental controls. The extracted text emphasises that broader social controversy over psychedelics has restricted public research funding and dissemination, a context that has contributed to the fragmentary nature of the literature.
tributes, treatment technique, and other nondrugfactors effected the frequency and stability offavorable outcomes. The kinds of improvement found were essentially the same in each study. The collective results argue strongly for more extensive useofpsychedelic drugs in the treatmentof autistic children. In recent years, a number of exploratory investigations have been reported involving the administration of psychedelic agents to young children suffering from severe forms of psychological disturbance (7-7). Either as therapeutic or experimental undertakings, these studies are extremely fragmentary and suffer gross shortcomings. As a case in point, wide diversity along major dimensions known to influence drug response and treatment effectiveness characterize this work. These include the agent employed, dosage level, number and frequency of administrations, therapist expectations and previous experience with psychedelic drugs, and finally the setting and circumstances surrounding the drug-induced state. With regard to patient characteristics, the children treated were demographically varied and covered a broad age range. More importantly, the samples were markedly heterogeneous with respect to the nature, severity, and duration of modal symptoms. The major experimental shortcomings included small samples, subjective and vague criteria of drug effects and improvement, and grossly inadequate follow-up. Despite their diversity and severe limitations, these seminal explorations in an extremely complex area 'San Francisco StateColle ge. y of research seem worthy of wider reportage and more serious attention than they have hitherto received. Almost without exception, these reports have. appeared in obscure publications or remain unpublished. A more significant reason for their relative neglect has been the polarized controversy surrounding psychedelic agents which has all but completely * curtailed publicly-sanctioned research. In this critique of the use of psychedelic agents with severely disturbed children, the various studies conducted thus far will be comprehensively reviewed and integrated. Particular attention will be given to their similarities and differences along known relevant dimensions in order to detect communalities and possible reasons for inconsistent findings. While some attempt will be made to resolve seemingly contradictory results, the heuristic value of this work will be emphasized rather than its conclusiveness. Hopefully, the tentative conclusions derived from these initial efforts will point the way for more definitive studies into the therapeutic efficacy of psychedelic agents with childhood disorders.
A fairly exhaustive search of clinical and research reports revealed a total of 91 severely disturbed chil-dren who have been administered one or more psychedelic agents for experimental and/or therapeutic purposes. As detailed in Table, this collective group of patients ranged from five to fifteen years of age, with the large majority between six and ten years of age. Careful examination of the seven independent studies disclosed little basis for assuming a significant relationship between age and drug response. However, tentative relationships were sug-_gested by bothand Fisher and Castile (4). Bender noted that in contrast to pre-adolescents, younger 'children manifest consistently different reactions to a variety of medical and pharmacological treatments. For this reason, she hypothesized that her older patient group (12-15, N = 8) would not show the dramatic positive changes obtained with the younger children. Contrary to expectations, comparable favorable effects were found irrespective of age differences. Fisher and Castile, on the other hand, concluded that older children were better candidates for psychedelic therapy because verbal communication was possible and also because they tended to be less withdrawn, more schizophrenic than autistic, and displayed more blatant symptomology. While these patient features were obvious advantages for the particular therapy technique employed by Fisher and Castile, it is unlikely that this symptom picture consistently distinguishes older from younger psychotic children. Thus, on the basis of the avail-able evidence concerning the immediate and subsequent effects of psychedelic drugs on children, age per se appears to be an inconsequential variable. All patients treated in these studies were described as severely and chronically disturbed with a primary diagnosis of autism or childhood schizophrenia. With regard to duration of illness, most had been hospitalized for periods ranging from two to four years. Many were afflicted since birth. An apparent exception was the single patient studied by Rolo and his co-workers (6). This twelve-year-old boy had been hospitalized for four months. No estimate of the duration of his illness was reported. At the opposite extreme, the twelve children treated by Fisher and Castile were probably the most severely disturbed with an average illness duration of 7.6 years. The modal symptoms characterizing the majority of children given psychedelic treatment were well With this second sample, one-half were given LSD and one-half were given UML. Based upon estimates of patient resistance, a wide variety of dosage level-during combinations were used both within-and between-subjects. Psilocybin and LSD were employed at times singly and at times simultaneously. didates for psychedelic therapy because verbal communication was possible and also because they tended to be less withdrawn, more schizophrenic than autistic, and displayed more blatant symptomology. While these patient features were obvious advantages for the particular therapy technique employed by Fisher and Castile, it is unlikely that this symptom picture consistently distinguishes older from younger psychotic children. Thus, on the basis of the avail-able evidence concerning the immediate and subsequent effects of psychedelic drugs on children, age per se appears to be an inconsequential variable. All patients treated in these studies were described as severely and chronically disturbed with a primary diagnosis of autism or childhood schizophrenia. With regard to duration of illness, most had been hospitalized for periods ranging from two to four years. Many were afflicted since birth. An apparent exception was the single patient studied by Rolo and his co-workers (6). This twelve-year-old boy had been hospitalized for four months. No estimate of the duration of his illness was reported. At the opposite extreme, the twelve children treated by Fisher and Castile were probably the most severely disturbed with an average illness duration of 7.6 years. The modal symptoms characterizing the majority of children given psychedelic treatment were well With this second sample, one-half were given LSD and one-half were given UML. Based upon estimates of patient resistance, a wide variety of dosage level-during combinations were used both within-and between-subjects. Psilocybin and LSD were employed at times singly and at times simultaneously. fantile autism. This was also true of Rolo's single patient. Although autism was invariably present, the "schizophrenic" children were less withdrawn and manifested a greater variety of symptoms including overt aggression, hallucinations, paranoid delusions, and psychosomatic disturbances. Almost without exception, long-standing mutism was characteristic of 'all 91 patients prior to psychedelic treatment. Despite these significant communalities among the seven groups of children studied, individual dilferences in patient characteristics extended over a fairly broad range. Without discounting the possible importance of individual differences, 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. As will become apparent in subsequent sections of this paper, the failure to detect such relationships seems partly due to fragmentary patient data and the crude estimates available of drug response and subsequent changes in behavior. Consistent with this hypothesis, the differential findings reported by Fisher and Castile appear to reflect their more detailed assessment of personal history information and individual differences in both pre-and post-treatment symptomology. They also applied more stringent criteria of improvement than the other investigators.
Explicit hypotheses or theoretical bases for administering psychedelic drugs to disturbed children are almost completely absent in these exploratory studies. The lack of a definite rationale is hardly surprising when one considers the enigma surrounding both schizophrenic behavior in children and response to psychedelic drugs. Despite great diversity in expectations and technique, there was one point of departure shared by all investigators, namely, that all known forms of treatment had been attempted without success. Thus, the use of a potent experimental drug with the particular chronic patients selected seemed justified. With regard to the purpose of these studies, all were to some extent exploring the therapeutic potential of psychedelic drugs rather than their psychotomimetic properties. This was least true of Freedman and his co-workers (5) who viewed .LSD primarily as a means of studying the schizophrenic pro- Consistent with their explicit therapeutic intent, Bender, Fisher, and Simmons each offer essentially the same hypothesis based on a psychological interpretation of childhood schizophrenia: ""The working hypothesis of this study is that the psychosis is a massive defensive structure in the service of protecting and defending the patient against his feelings and affectual states'? (4). Psychedelic drugs were viewed as a powerful means of undermining an intractable defense system and thereby making the patient more receptive to contact and communication with others. In attempting to explain the predominantly positive results in this area of research (Table), it is worth emphasizing that the collective work A final secondary objective worth mentioning is that the more recent studies (6,7) were influenced by Bender's earlier reports of successful LSD treatment. These studies were attempts to replicate Bender's findings using various contro] measures and other methodological refinements. Despite these significant communalities among the seven groups of children studied, individual dilferences in patient characteristics extended over a fairly broad range. Without discounting the possible importance of individual differences, 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. As will become apparent in subsequent sections of this paper, the failure to detect such relationships seems partly due to fragmentary patient data and the crude estimates available of drug response and subsequent changes in behavior. Consistent with this hypothesis, the differential findings reported by Fisher and Castile appear to reflect their more detailed assessment of personal history information and individual differences in both pre-and post-treatment symptomology. They also applied more stringent criteria of improvement than the other investigators.
Explicit hypotheses or theoretical bases for administering psychedelic drugs to disturbed children are almost completely absent in these exploratory studies. The lack of a definite rationale is hardly surprising when one considers the enigma surrounding both schizophrenic behavior in children and response to psychedelic drugs. Despite great diversity in expectations and technique, there was one point of departure shared by all investigators, namely, that all known forms of treatment had been attempted without success. Thus, the use of a potent experimental drug with the particular chronic patients selected seemed justified. With regard to the purpose of these studies, all were to some extent exploring the therapeutic potential of psychedelic drugs rather than their psychotomimetic properties. This was least true of Freedman and his co-workers (5) who viewed .LSD primarily as a means of studying the schizophrenic process by "intensifying pre-existing symptomology." A final secondary objective worth mentioning is that the more recent studies (6,7) were influenced by Bender's earlier reports of successful LSD treatment. These studies were attempts to replicate Bender's findings using various contro] measures and other methodological refinements. Fisher and Castile employed LSD-25 and Psilocybin at times singly and at times simultaneously. These investigators were unique in using a variety of dosage level-drug combinations both with the same patient on different occasions and with different patients on the same occasion. The specific drug regime adopted for a given session was determined by clinical criteria of the patient's particular defense structure and his expected resistance to psychedelic drugs. Stated differently, Fisher and Castile were the only investigators who attempted to optimize the psychedelic experience for a given patient rather than mechanically administering a constant dosage of the same agent to all patients. This feature of their method was consistent with the greater attention paid to individual patient differences and their general orientation to psychedelic therapy as a psychopharmacological process. Concerning dosage level, most investigators settled on 100 micrograms as optimal. Although this was the average dosage used by Bender, she differed from the others by starting treatment at a relatively low level (50 ug) and gradually increasing the amount to as high as 150 wg. As suggested earlier, Fisher and Castile usually administered multiple agents and employed a wide range of dosage levels (with LSD, 50-400 wg). As their work progressed, they developed a definite preference for the prolonged high dose psychedelic experience, especially with older schizophrenic children. Their most effective results were obtained with pre-treatment medication of 10 mg Librium, 10-15 mg of Psilocybin given approximately one-half hour later, followed by 250-300 ug of LSD administered twenty minutes later. In addition, Fisher and Castile often gave "boosters" during the session itself ranging from 25 to 100 ug of LSD. Freedman's single session per patient to Bender's daily sessions over periods as long as one year. Al-
It should be emphasized that the findings obtained in these studies are the result of an interrelated set of determinants, only one of which is the ingestion of a Based on a variety of biochemical indices and observations of differential behavior changes, Bender reported no apparent differences between the action or effectiveness of the two drugs. Fisher and Castile employed LSD-25 and Psilocybin at times singly and at times simultaneously. These investigators were unique in using a variety of dosage level-drug combinations both with the same patient on different occasions and with different patients on the same occasion. The specific drug regime adopted for a given session was determined by clinical criteria of the patient's particular defense structure and his expected resistance to psychedelic drugs. Stated differently, Fisher and Castile were the only investigators who attempted to optimize the psychedelic experience for a given patient rather than mechanically administering a constant dosage of the same agent to all patients. This feature of their method was consistent with the greater attention paid to individual patient differences and their general orientation to psychedelic therapy as a psychopharmacological process. Concerning dosage level, most investigators settled on 100 micrograms as optimal. Although this was the average dosage used by Bender, she differed from the others by starting treatment at a relatively low level (50 ug) and gradually increasing the amount to as high as 150 wg. As suggested earlier, Fisher and Castile usually administered multiple agents and employed a wide range of dosage levels (with LSD, 50-400 wg). As their work progressed, they developed a definite preference for the prolonged high dose psychedelic experience, especially with older schizophrenic children. Their most effective results were obtained with pre-treatment medication of 10 mg Librium, 10-15 mg of Psilocybin given approximately one-half hour later, followed by 250-300 ug of LSD administered twenty minutes later. In addition, Fisher and Castile often gave "boosters" during the session itself ranging from 25 to 100 ug of LSD. Boosting was considered beneficial ''(a) when the pa-
It should be emphasized that the findings obtained in these studies are the result of an interrelated set of determinants, only one of which is the ingestion of a particular chemical agent. The significance of seem-ingly contradictory results has often been obscured by the persistent search for static, '"'drug-specific" reactions to LSD. Inconsistent findings become more understandable if the psychedelic experience is viewed as a dynamic configuration of intimate patient-therapist-milieu transactions. In short, the administration of LSD is inextricably embedded in a larger psychosocial process which should be optimized in accordance with particular treatment goals. Even a cursory examination of the work with autistic children clearly reveals that at least some important aspects of the physical and psychological milieu were considerably less than optimal. In the seven studies reviewed here, only Fisher and Castile attempted to create a specifically nonmedical atmo-'sphere that was minimally threatening to the patient. Modeled after the widely-adopted Saskatchewan technique (70,77), the procedure developed by Fisher and Castile included the following key features: (1) a high dose, 7-10 hour session; (2) the use of a variety of therapeutically-meaningful or aesthetically-pleasing stimuli (music, flowers, pictures, food, etc.); (3) a positive patient-therapist relationship formed prior to the session itself; (4) the presence of both a male and female therapist who ''had thorough acquaintance with the phenomena of the drug through personal experience'; and (5) active therapist involvement with the patient including roleplaying (e.g., father, mother). Importantly, these conditions have repeatedly been found to significantly enhance the personal value of psychedelic experiences. In each study, the circumstances under which the session was conducted were consistent with the purpose and expectations of the investigator. Consistent with his psychotomimetic orientation, Freedman's patients were supervised by a familiar psychiatrist primarily for the purpose of careful observation and note-taking. No attempts to relate to the children or personal experience with the drug were reported. The same applies to Bender's group although the intent in this case was clearly therapeutic. She apparently administered LSD as a conventional daily medication that did not require any special conditions or preparation, therapist involvement, or setting. However, her reports are replete with descriptions of spontaneous interactions between staff and children. the sessions conducted by both Rolo and Simmons were also ward attendants. The primary purpose of the studies reported by Rolo and Simmons was explicitly methodological. Both research projects employed the double-blind method and attempted to follow a predetermined, uniform procedure during each experimental and control session. As a means of standardizing the sequence of events and increasing objectivity, both investigators systematically presented various playing objects, games, and tasks to the child. Rolo's single patient was encouraged to engage in quite simple, familiar activities such as throwing a baseball or playing cards. Simmons, on the other hand, created a far more elaborate series of game-like situations that were novel and intrinsically interesting, requiring sustained patient-adult interactions, and importantly were specifically designed to simulate or elicit normal social behavior and emotional responsiveness. A number of probable effects of the physical and psychological milieu are suggested in these studies that bear a significant relationship to the investigator's orientation, on the one hand, and differences in benefit or outcome, on the other. As indicated earlier, the expectations of a particular research team seem highly related to various aspects of both drug regime and setting. With regard to differential improvement rates, a major determinant seems to be the degree of active therapist-patient interactions permitted during the drug-induced state. Secondly, greater therapeutic benefit seems to occur in congenial settings offering some opportunity to experience meaningful objects and interpersonal activities. Finally, psycedelic therapy with psychotic children seems most effective in natural, flexible settings that are reasonably free of artificiality, experimental restrictions on spontaneous behavior, and mechanically administered procedures. Conversely, barren medical . or laboratory environments seem clearly antitherapeutic.
As emphasized previously, each of these exploratory studies suffered major shortcomings either as therapeutic or experimental undertakings. Almost without exception, the findings reported consist mainly of observational data obtained during the acute phase of drug reactivity. The use of pretreatment baselines against which to measure change either during or after psychedelic therapy were gen-BEHAVIORAL NEUROPSYCHIATRY ingly contradictory results has often been obscured by the persistent search for static, '"'drug-specific" reactions to LSD. Inconsistent findings become more understandable if the psychedelic experience is viewed as a dynamic configuration of intimate patient-therapist-milieu transactions. In short, the administration of LSD is inextricably embedded in a larger psychosocial process which should be optimized in accordance with particular treatment goals. Even a cursory examination of the work with autistic children clearly reveals that at least some important aspects of the physical and psychological milieu were considerably less than optimal. In the seven studies reviewed here, only Fisher and Castile attempted to create a specifically nonmedical atmo-'sphere that was minimally threatening to the patient. Modeled after the widely-adopted Saskatchewan technique (70,77), the procedure developed by Fisher and Castile included the following key features: (1) a high dose, 7-10 hour session; (2) the use of a variety of therapeutically-meaningful or aesthetically-pleasing stimuli (music, flowers, pictures, food, etc.); (3) a positive patient-therapist relationship formed prior to the session itself; (4) the presence of both a male and female therapist who ''had thorough acquaintance with the phenomena of the drug through personal experience'; and (5) active therapist involvement with the patient including roleplaying (e.g., father, mother). Importantly, these conditions have repeatedly been found to significantly enhance the personal value of psychedelic experiences. In each study, the circumstances under which the session was conducted were consistent with the purpose and expectations of the investigator. Consistent with his psychotomimetic orientation, Freedman's patients were supervised by a familiar psychiatrist primarily for the purpose of careful observation and note-taking. No attempts to relate to the children or personal experience with the drug were reported. The same applies to Bender's group although the intent in this case was clearly therapeutic. She apparently administered LSD as a conventional daily medication that did not require any special conditions or preparation, therapist involvement, or setting. However, her reports are replete with descriptions of spontaneous interactions between staff and children. the sessions conducted by both Rolo and Simmons were also ward attendants. The primary purpose of the studies reported by Rolo and Simmons was explicitly methodological. Both research projects employed the double-blind method and attempted to follow a predetermined, uniform procedure during each experimental and control session. As a means of standardizing the sequence of events and increasing objectivity, both investigators systematically presented various playing objects, games, and tasks to the child. Rolo's single patient was encouraged to engage in quite simple, familiar activities such as throwing a baseball or playing cards. Simmons, on the other hand, created a far more elaborate series of game-like situations that were novel and intrinsically interesting, requiring sustained patient-adult interactions, and importantly were specifically designed to simulate or elicit normal social behavior and emotional responsiveness. A number of probable effects of the physical and psychological milieu are suggested in these studies that bear a significant relationship to the investigator's orientation, on the one hand, and differences in benefit or outcome, on the other. As indicated earlier, the expectations of a particular research team seem highly related to various aspects of both drug regime and setting. With regard to differential improvement rates, a major determinant seems to be the degree of active therapist-patient interactions permitted during the drug-induced state. Secondly, greater therapeutic benefit seems to occur in congenial settings offering some opportunity to experience meaningful objects and interpersonal activities. Finally, psycedelic therapy with psychotic children seems most effective in natural, flexible settings that are reasonably free of artificiality, experimental restrictions on spontaneous behavior, and mechanically administered procedures. Conversely, barren medical . or laboratory environments seem clearly antitherapeutic.
As emphasized previously, each of these exploratory studies suffered major shortcomings either as therapeutic or experimental undertakings. Almost without exception, the findings reported consist mainly of observational data obtained during the acute phase of drug reactivity. The use of pretreatment baselines against which to measure change either during or after psychedelic therapy were gen-erally absent. In most cases, follow-up data was not obtained. Although caution in interpreting results is certainly indicated, it should be pointed out that these limitations are shared by the bulk of research on drug-and psycho-therapies. Furthermore, objective evaluation of improvement in severely disturbed children presents unique problems due to the nature of autistic symptoms, especially the ubiquity of mutism. Even the few cases not suffering from a complete absence of speech were untestable by standard psychological assessment methods. In their initial study, Bender and her co-workers (2) administered the Vineland Maturity Scale at the beginning of treatment and again three months later. At the follow-up testing, ratings were qualitatively higher for all children. In the second study (3), the 2. The large majority of children treated in these studies were between six and ten years of age and were completely refractory to all other forms of treatment. 8. Although each of these studies contained serious therapeutic and experimental flaws, it was concluded that the collective findings argue strongly for more extensive applications of psychedelic drugs in the treatment of autistic children.
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