Effects of L-dopa in autism

A study was designed to determine if blood serotonin concentrations could be lowered in autistic children by the administration of L-dopa and, if so, to observe possible clinical or physiological changes. Following a 17-day placebo period, four hospitalized autistic boys (3, 4, 9, and 13 years of age) received L-dopa for 6 months. Results indicated a significant decrease of blood serotonin concentrations in the three youngest patients, a significant increase in platelet counts in the youngest patient, and a similar trend in others. Urinary excretion of 5HIAA decreased significantly in the 4-year-old patient and a similar trend was noted in others. No changes were observed in the clinical course of the disorder, the amount of motility disturbances (hand-flapping), percent of REM sleep time, or in measures of endocrine function (FSH and LH). Possible mechanisms by which L-dopa lowered blood serotonin concentrations, increased platelet counts, and yet failed to produce other changes are discussed.This research was supported by grants from the Veteran's Administration Research Service; Public Health Research Grants HD 01-58 and AM 08775; National Institute of Health Grant RR-3 to the Health Sciences Computer Facility, UCLA; The National Institute of Child Health and Human Development Grant 04612 from the Mental Retardation Center, UCLA; and by the Department of Mental Hygiene, State of California.The authors wish to express their appreciation to Dr. Joseph Beckerman, Miss Ann Catino, Dr. Gunnar Heuser, Dr. Charles Markham, Miss Gwen McAfee, Miss Terry Preston, Dr. J. Raymond, Mr. Martin B. Scharf, and Dr. Tjiauw-Ling Tan for their assistance and participation in this study.     

Examination of circadian rhythmicity of blood serotonin and platelets in autistic and non-autistic children

A study was designed to determine whether circadian rhythmicity existed for blood serotonin concentrations and platelet counts in autistic and non-autistic children. Blood samples were drawn from hospitalized children, outpatients, and normal adults at varying times throughout the day and over prolonged periods. Circadian rhythmicity was not observed. The possibility remains that there existed very brief or prolonged rhythms which were not detectable by the methods used. The implications of these results in relation to previous findings on blood serotonin concentrations and platelet counts in autistic and non-autistic children are discussed.This research was supported by Public Health Service Grant HD 94612 to the UCLA Mental Retardation Center and the California Department of Mental Hygiene. The authors are indebted to Mrs. Rose Weisler, Miss Selma Plotkin, Miss Juli Wasserman and Mr. Joseph DeLee for administrative assistance and to Dr. J. Raymond and Miss Gwen McAfee of the UCLA Clinical Laboratory for help with platelet counts.     

Blood serotonin in psychotic and brain damaged children

In this preliminary study blood scrotonin levels were measured in 11 severely disturbed children (9 boys and 2 girls) and 6 controls, matched for age, sex and verbal IQ. Tendency toward higher serotonin levels in patients was noted. However, the difference between patients and controls was not statistically significant. Low intellectual functioning was the only parameter which seemed to be clearly associated with higher serotonin levels.A part of this study was supported by Public Health Service Grant MH-04665 from the National Institute of Mental Health. The authors wish to thank Dr. Barbara Fish for her advice and guidance, and Miss Patricia Schneider, R.N. and Mrs. Irene Rush, R.N. for their assistance.     

Laboratory predictions of infantile autism based on 5-hydroxytryptamine efflux from blood platelets and their correlation with the rimland E-2 score

Experiments were conducted to determine the possibility of predicting a diagnosis of autism on the basis of an abnormally high release of¹⁴C-5-hydroxy-tryptamine from 5-HT loaded blood platelets of children. Such increased 5-HT release was previously reported by the authors for blood platelets of children diagnosed as autistic according to the Rimland E-2 score. The platelets of 10 psychotic children (including a number of subjects diagnosed as autistic by the E-2 score) were examined without knowledge of the diagnosis, in order to determine whether the biochemical results correlated with the E-2 score. On the basis of experimental data it was possible to predict that six children were autistic and four were nonautistic psychotics. According to the E-2 score, seven children were autistic and three nonautistic psychotics. The authors conclude that there is a correlation between a diagnosis of infantile autism by the E-2 score and enhanced release of radioactive 5-HT from 5-HT-loaded blood plateletsin vitro.This research was supported in part by National Institutes of Health Grant RR 00 284 and National Institute of Mental Health Grant HD 08429.     

Rapid eye movement (REM) activity in normal and autistic children during REM sleep

Thirty normal children (aged 3–68 months) and 16 autistic children (aged 36–62 months) were recorded during nonmedicated sleep and data pertaining to rapid eye movements (REM) were measured during the first three REM periods of the night. When time of night from which data were gathered was held constant, normal children showed a significant relationship between age and the organization of eye movements into discrete bursts. When autistic children were compared to age-matched normal controls, they showed an immaturity in this phenomena, their results being similar to those found in children less than 18 months of age. Such an immaturity could result from dysfunction at a number of diverse levels and sites in the central nervous system.Supported by the Grant Foundation, by U.S. Public Health Service Research Scientist Development Award MH47361 to Dr. Tanguay, and by U.S. Public Health Service Grants MH26047, MH13517, HD04612 and HD05958. Computing assistance was obtained from the Health Sciences Computing Facility, UCLA, sponsored by National Institute of Health Grant RR-3.     

Social class and psychiatric inpatient care: a twenty-five year perspective

Summary The authors present the major inpatient findings of the final survey conducted by the Trends in Mental Health project. This project, initiated by F.C. Redlich in 1975, is a limited follow-up of Hollingshead and Redlich's,Social class and mental illness. In spite of an enormous proliferation in psychiatric services in the survey's study region over the past 25 years, social class remains a major predictor of locus of inpatient care. In general, class II–IV patients have made significant shifts toward receiving private inpatient care. However, certain subgroups of lower-class patients — blacks, women and those with serious psychiatric disorders — still have limited access to private inpatient treatment. In addition, class V patients continued to exclusively utilize the public system. Deinstitutionalization and the shift of class IV and higher patients to private facilities have created a pooling of the most socially disabled patients on the public inpatient units. For example, almost 80% of all public inpatients were chronically unemployed and 60% lived alone when not hospitalized. The public policy implications of limited social access and the increased relative percentage of socially debilitated patients on public inpatient facilities are addressed.This work was partially funded by the Division of Biometry and Epidemiology, National Institute of Mental Health, Grant # MH35405 and the Mental Health Working Group, Center for Health Policy and Management, John F. Kennedy School of Government     

Social initiations by autistic children to adults and other children

Social initiations made by autistic and verbal-matched retarded children were recorded in two naturalistic situations. Frequencies of initiation to adults did not differ between groups, but the retarded children initiated much more frequently to peers. Most interactions for both groups were positive, but the autistic children engaged in more ritualized, and the retarded children more playful, initiations. The autistic children monitored the social environment more when forced into proximity with peers, whereas the retarded children initiated more in the unstructured situation. Autistic initiation to peers was unrelated to severity of autism, but was related to cognitive skills, including vocabulary and comprehension of affect, whereas retarded children's initiations were unrelated to cognitive level. Results are discussed in terms of the differences between adults and children as social stimuli, prerequisite skills for initiation to peers, and the relationship between social cognition and social behavior. It is suggested that autistic and retarded children differ in the quantity of their initiations to peers, and the quality of their initiations to adults, and that initiations to peers may be a particularly useful index of social development in autistic children. Results confirm the need of autistic children for highly structured social environments, and suggest an important role for the remediation of specific cognitive skills such as comprehension of others' affects.This project was supported by National Institute of Mental Health Grant RO 1 40162 to Drs. Fein, Waterhouse, and Feinstein, and by NINDS 20489 to Autism and Language Disorders Collaborative Project Preschool Study Group. We are very grateful to the staff, students, and parents at participating schools.     

A controlled crossover study of triiodothyronine in autistic children

A placebo-controlled crossover study of behavioral effects of triiodothyronine (T₃) was conducted in 30 young clinically euthyroid autistic children. Multiple independent raters and multiple rating scales were used. Except for a few symptoms that were reduced on T₃, the drug did not differ from placebo. Time itself accounted for most of the improvement in the whole sample. As a group, the lower IQ children responded to T₃. The individual children who were responders could not be defined by any parameter.This study was supported in part by Public Health Service Grant No. MH04665 from the National Institute of Mental Health. The authors wish to express their gratitude to Dr. Nancy Branom (Department of Radiology) and Dr. Ralph David (Department of Pediatrics) for their collaboration, to Mrs. Kathleen Nash, R.N., and Mrs. Sara Sol for their efforts in this study, and to Smith, Kline & French Laboratories for the medication supply.     

Class and mobility in schizophrenic outcome

Summary This paper was addressed to the relationships between social class and outcome, and social mobility and outcome, among schizophrenic males. It was found that outcome, as measured by time spent in hospital, was significantly related to both of these variables. In addition, evidence was presented indicating that these relationships were independent of the effects of differing severities of pathology.Although social class and mobility were shown to play a role in the subsequent course of the disorder, reaffirming their possible implication in its development, no additional information on the nature of such an implication could be provided.From the New York State Mental Health Research Unit, Syracuse, N. Y. This study was supported by Grant #MH-09294 from the National Institute of Mental Health (R. Jay Turner, Ph.D., John Cumming, M.D., and Elmer Gardner, M.D., principal investigators). Computer analysis was supported in part by the National Science Foundation under Grant GP-1137.     

Divorce and Children’s Adjustment Problems at Home and School: The Role of Depressive/Withdrawn Parenting

This study examined linkages between divorce, depressive/withdrawn parenting, and child adjustment problems at home and school. Middle class divorced single mother families (n=35) and 2-parent families (n=174) with a child in the fourth grade participated. Mothers and teachers completed yearly questionnaires and children were interviewed when they were in the fourth, fifth, and sixth grades. Structural equation modeling suggested that the association between divorce and child externalizing and internalizing behavior was partially mediated by depressive/withdrawn parenting when the children were in the fourth and fifth gradesThis study was supported by a grant (R29-48595) from the National Institute of Mental Health awarded to Rena Repetti; Jeffrey Wood was supported by a training grant from the National Institute of Mental Health (Biobehavioral Issues in Physical and Mental Health; MH15750) and a UCLA Research Fellowship. We are very grateful to the children, teachers, and school administrators who participated in the study, and to the many research assistants who helped to collect the data.     

Sex differences in pervasive developmental disorders

Assessed differences in sex ratio, severity of associated mental retardation, and various metrics of severity of autism in autistic, PDD-NOS, and developmentally disordered (non-PDD) cases. Males with autism were more frequent than females, particular at higher IQ levels. The three clinical groups differed, in expected ways, in the various measures of severity of autism with the PDD-NOS cases being intermediate between the strictly diagnosed autistic group and the non-PDD developmental disordered group. Sex differences were primarily confined to IQ; sex differences in other metrics of severity of autism were not prominent. Implications for future research are discussed.This study was supported by grant HD-03008 from the National Institute of Child Health and Human Development, by NIMH grants MH-30929 to the Mental Health Clinical Research Center and MH-46961 to F. R. Volkmar. A previous version of this paper was presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry, San Francisco, October, 1991.     

Differentiating pervasive developmental disorder not otherwise specified from autism and language disorders

Features useful in distinguishing choldren with pervasive developmental disorder (PDD) from those with autism or language disorder were developed from a retrospective chart review using groups of children with PDD-NOS and MA-and sex-matched autistic and language-disordered groups. Charts were reviewed using a list of 80 items compiled from various sources. Items that had adequate interrater reliability and significantly discriminated the PDD-NOS cases from the language-disordered or autistic cases were then evaluated using a second set of cases and signal detection methods. Fewer items significantly discriminated cases with autism from those with PDD-NOS as compared to cases with language disorder. Clinical implications are discussed.From the Yale Child Study Center (Mayes, Volkmar, and Hooks) and the Veterans Administration Medical Center, West Haven, Connecticut (Cicchetti). Marla Hooks is currently affiliated with the University of Washington. This study was supported by grant M846961 from the National Institute of Mental Health, by grant HD-03008 from the National Institute of Child Health and Human Development, by NIMH grant MH-30929 to the Mental Health Clinical Research Center, and grant MRIS-1416 to the Veterans Administration. The authors thank Helena Kraemer for her provision of the QROC program.     

Consistent stress profiles in mothers of children with autism

The present study extends the area of research on stress in parents of autistic children. In this study we used the Questionnaire on Resources and Stress (Holroyd, 1987) to compare the stress profiles across mothers (a) who lived in different cultural and geographic environments; (b) who had children of different ages; and (c) who had children with different functioning levels. Results showed a characteristic profile that was highly consistent across each of these subgroups. Major differences from the normative data occurred on scales measuring stress associated with dependency and management, cognitive impairment, limits on family opportunity, and life-span care. Results suggest the importance of developing treatment programs aimed at reducing stress in specific areas in families with autistic children.Orchard Mental Health CenterThis research was supported by U.S. Department of Education, NIDRR Cooperative Agreement No. G0087C0234 (Koegel and Dunlap), by U.S. Public Health Service Research Grants MH28210 (Koegel) and MH39434 (Schreibman) from the National Institute of Mental Health, by Grant No. G008530082 from the U.S. Department of Education, Handicapped Children's Early Education Program (Dunlap), and by Fogarty Senior International Fellowship 1 FOB TWO 1374-01 (Schreibman) from the Fogarty International Center of the National Institutes of Health. The authors acknowledge the contributions of Prof. Dr. med. Hedwig Amorosa, and Dorle Staniczek, Soz. Pad. of the Max Planck Institute for Psychiatry, Munich, West Germany, and express particular appreciation to Prof. Dr. med. D. Ploog, Director of the Institute.     

Motivation for self-administration of LSD

Summary The reason for self-administration of LSD and the resulting subjective changes in 34 patients hospitalized following ingestion of LSD were studied. Only two patients were primarily interested in its reputed beneficial effects. Although 13 patients reported such effects, the authors were unable to document any objective improvement. Seven patients reported that they felt worse after LSD and experienced increased anxiety or depression. Fourteen reported no change.From the Department of Psychiatry, New York University School of Medicine, and the Bellevue Psychiatric Hospital, New York City. This work was supported in part by Public Health Service Grant MH-08618 from the National Institute of Mental Health.     

Implication of sex differences in the familial transmission of infantile autism

There are studies suggesting possible hereditary influence in autism. Data on 102 autistic children, 78 boys and 24 girls, showed that there was a significantly greater proportion of autistic girls than boys with IQs less than 50 and with evidence of brain damage. The autistic girls also had a greater proportion of relatives affected with autism or cognitive-language deficit than did the boys. The implication of sex differences in the possible mode of familial transmission of autism is discussed.This research was supported in part by grants from the Iowa Mental Health Research Fund Grant and by a grant from the Bureau of Education for the Handicapped, No. 30770242.     

Effects of an Asian client-therapist language,ethnicity and gender match on utilization and outcome of therapy

The purpose of this study was to examine the relationship of Asian client-therapist ethnicity, language and gender match on two measures of utilization: number of sessions with primary therapist and dropout from therapy; and one measure of client outcome: admission-discharge difference in Global Assessment Scale (GAS) scores. The sample consisted of 1746 Asian client episodes in Los Angeles County mental health facilities between January 1983 and August 1988. Various types of multiple regression analyses were used to investigate the relationship of language, ethnicity, and gender match to the three dependent variables and to eight sociodemographic variables.Either client-therapist language match or ethnic match significantly increased the number of client sessions with the primary therapist. However, only ethnicity match had a significant effect on dropout rate. Gain in GAS admission-discharge score was not affected by either a client-therapist ethnicity or language match. Gender match had no consistent effect on the dependent variables. Of the covariates examined, only therapist discipline (social worker) had a consistent effect on the dependent variables.It was concluded that both client-therapist language and ethnicity match are important variables affecting the utilization of treatment. Further research will be needed to separate the effects of language and ethnicity on therapy utilization.This study was supported in part by a grant from the National Institute of Mental Health, #MH 44331 and the National Research Center on Asian American Mental Health, UCLA.At the time the study was conducted, Dr.Lui was employed with the National Research Center on Asian American Mental Health, UCLA.     

Plasma growth hormone response to insulin-induced hypoglycemia in infantile autism: A pilot study

Plasma growth hormone responses to insulin-induced hypoglycemia were examined in eight preschool-age autistic children. Six of these children were examined on two separate occasions: during the period of baseline evaluation and after 4 weeks of daily haloperidol administration. On at least one occasion, half of this small sample exhibited persistent elevation of growth hormone levels, with a failure to return to baseline values over the course of a 135-minute period postinsulin infusion. These data are consistent with the occurrence of hypothalamic dysfunction in subgroups of autistic children. Short-term administration of haloperidol did not diminish the ability of the pituitary to secrete growth hormone in response to insulin-induced hypoglycemia.This study was supported in part by Public Health Service Grant MH-32212 from the National Institute of Mental Health.     

Are state mental hospitals dumping aged patients on nursing homes?

Twenty-five patients from a large state hospital selected for placement in nursing homes were compared with a matched group of 25 patients residing on the same or similar wards but not selected for placement. Comparisons for 43 measures of disturbed psychiatric behaviors, self-care activities, physical and mental status at time of selection, 30 days later, and 6 months later were made to determine whether there were any initial differences, any overall differences for the entire period, and any differences for comparative change. The 25 mental patients selected for placement in nursing homes were functioning far better from a psychiatric standpoint at the time of selection and during the entire 6-month period. There were no consistent differences between groups for improvement. These findings controvert the view that state hospitals are indiscriminately sending patients to nursing homes.This research was performed under Grant ME 01624-01 from the National Institute of Mental Health, U.S. Department of Health, Education, and Welfare. Acknowledgement is made to Mrs. Joan Chisolm and to John E. Rhetts for their assistance.     

The rationale for computer-based treatment of language difficulties in nonspeaking autistic children

Some principles are described which underlie a computer-based treatment method for language difficulties in nonspeaking autistic children. These children are assumed to be dissymbolic with a primary difficulty in processing any type of symbols, language being the most important symbolic system used in human communication. The main treatment principle involved the encouragement of exploratory play with a keyboard-controlled audio-visual display on which symbols can be made to appear accompanied by human-voice and other sounds. Adult interference is minimized so a child can self-select and self-direct his own play. It is reported that, thus far, 13 out of 17 nonspeaking autistic children have shown linguistic improvement. The 4 cases of failure to improve were children who refused to play with the display device.This research is supported by Grant PHS MH 06645-12 from the National Institute of Mental Health and in part, by Research Scientist Award (No. 1-K05-K-14,333) from the National Institute of Mental Health. The author expresses his deep indebtedness to co-workers Horace Enea, David Smith, Malcolm Newey, and Maxine Colby, each of whom has put years of effort into this project.     

Children of farm laborers: Utilization of services for mental health problems

Utilization of various types of services for children's mental health problems was examined among 112 agricultural farm worker families. Pairs of mothers and children (aged 8 to 11) were interviewed using the Diagnostic Interview Schedule for Children and the Child and Adolescent Services Assessment. Sixty-four percent of the children met criterion for one or more psychiatric diagnoses. Children with a psychiatric diagnosis were five times more likely to see a health professional for a mental health problem compared to children without a psychiatric diagnosis. However, less than half of the children with a psychiatric diagnosis saw a health professional for their mental health problems. Families also consulted with school professionals, religious leaders, and non-professionals (such as friends) concerning their children's mental health, but families of children who had a psychiatric diagnosis were not significantly more likely to report these types of consultations than were families of children who did not have a psychiatric diagnosis. These findings are discussed in terms of recommendations for improving the mental health service delivery system for rural children.This research was funded by the National Institute of Mental Health Grant #R03 MH 48101, a William T. Grant Faculty Scholar Award and the National Institute of Mental Health Center for Vulnerable Youth Grant No. P20 MH49878 to the second author, and Grant #MCJ-107 from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services to the first author. The authors express their gratitutde to the staff of the Tri-County Community Health Center, the staff of the North Carolina Migrant Education Program, the staff of the participating schools, Ms. Donna McCarraher, Ms. Sarah Carroll, and our project interviewers for their assistance in conducting this project.