In a Different Key: The Story of Autism (30 page)

Besides, more rigorous reviewers were looking back at studies published in the first half of the decade, and were questioning the claims that LSD had
done anything good at all for children with autism.

—

O
NE BLUNT TRUTH
was cited again and again in the 1960s by researchers who resorted to outlandish measures in the effort to help kids with autism. It was the simple fact that nothing else had been found to do any good. This excuse was used to justify the LSD experiments, and it was
used again by a UCLA psychologist named O. Ivar Lovaas who, in 1965, began using a battery-powered cattle prod to give electric shocks to children. The result would be as momentous as it was controversial.

Norwegian-born, Lovaas came to the United States in 1950
on a music scholarship to Iowa’s Luther College, before discovering psychology, which led him into graduate studies at the University of
Washington. In the early 1960s, he had been part of a team at UCLA that had tested LSD as a treatment for autism
and had been disappointed.

By that time, Lovaas had long been disillusioned with the Freudian theories he had been taught during his early days at the University of Washington. His philosophical break with those theories began when he worked for a time at Seattle’s Pinel Foundation Hospital. This was a twenty-bed residence, serving primarily well-connected families, where most of the patients were diagnosed with schizophrenia and were treated with psychoanalysis. Lovaas’s main role at Pinel consisted of taking the patients on walks around the grounds to calm them when they became agitated. These walks gave him an opportunity to get to know the patients, and he quickly came to the conclusion that psychoanalysis, though well-intentioned, wasn’t doing them any good. One summer, two patients, on different days, committed suicide by diving headfirst from an upstairs window. As Lovaas would tell an interviewer years later, in his usual blunt way: “I knew them, and they weren’t that crazy.”

Lovaas was disappointed in the absence of data or testing that demonstrated the efficacy of psychoanalytic treatment, and even more so by its almost complete failure to help people with more severe forms of mental illness. He began gravitating toward a radically different approach, which led him to start in with the electricity experiments—giving shocks to disabled kids.

Lovaas’s first set of what he called “punishment studies” did not employ the cattle prod. Instead,
his initial experiments, which took place in 1964 at the Neuropsychiatric Institute at UCLA, involved an electrified floor. The study subjects were two boys,
Mike and Marty, five-year-old twins, both of whom had autism. They did not speak or respond to speech, and 70 to 80 percent of their time awake involved behaviors that Lovaas wanted to see if he could stop: rocking, fondling themselves, or flapping their hands or arms repetitively. Lovaas also wanted to try to make them come when their names were called. He intended to produce both of these outcomes through the calculated use of pain.

To do this, he placed the boys, one at a time, in a room with two
adults, who stood on opposite sides of the child. The grown-ups wore shoes, but the child was barefoot, the soles of his feet exposed to a grid of metal tapes stuck to the floor, which were hooked up to a battery. When a switch was thrown, an electric current raced through the metal tapes, dealing a shock to anyone who touched it, which Lovaas described as “definitely painful and frightening.”

The experiment started with the electricity already switched on and jolting the barefoot five-year-old. Simultaneously, one of the two adults began calling out, “Come here,” with arms spread. If the boy moved toward the open arms, even just by some random impulse, the electricity was immediately turned off, stopping the pain. If he did not move, after three seconds, the boy would get a little shove toward the beckoning grown-up. That too stopped the pain. Each boy went through this fifty times in the first session alone (there were three sessions over three days). The electricity went back on anytime either boy lapsed into his usual rocking or flapping. When this happened, the adults shouted a sharp “No!” at the child. The electricity, meanwhile, stayed on until the unwanted behavior ceased.

Lovaas was pleased with the results, as each boy quickly adapted his behavior to move toward the open-armed adult when invited, and each became obedient to the shouted “no.” In Lovaas’s view, both boys became “more alert, affectionate, and…surprisingly, during successful shock avoidance, they appeared happy.”

But the effect was not permanent. In the absence of continual “shock-training,” as Lovaas called it, both boys, within a matter of months, reverted to their previous patterns of behavior. Still, Lovaas believed he had shown that “punishment can be a very useful tool for effecting behavior change.”

It was after these experiments that Lovaas procured a “Hot-Shot,” which was the brand name given to a range of “electric livestock prods,” manufactured in several sizes and colors by a firm located in the middle of dairy-cow country, in Savage, Minnesota. The one that Lovaas acquired was twelve inches long and
delivered 1,400 volts. It had been designed for use on 2,000-pound animals. Used on humans, it caused real pain, to which he could attest because he had
tried it on himself, as had a couple of his assistants. Although the pain lasted
only a few seconds, they said that it was like having a tooth drilled by a dentist who had run out of Novocain.

This new round of punishment studies was carried out on three institutionalized children temporarily transferred to Lovaas’s custody for research purposes—Linda and John, both age eight, and Gregg, age eleven. Lovaas described all three children as “retarded,” but it is clear from his descriptions that they had severe autism, as well as other disabilities. They were entirely unable to take care of themselves and given to a variety of disturbing behaviors. John, for example, had been known to drink from the toilet and to eat his feces. Linda was functionally blind, and Gregg was unable to walk. Whenever they hit Gregg with the “Hot-Shot,” they had to prop him up in a wheelchair first.

The shocks were an attempt to control the single most horrifying behavior shared by the children: physically attacking themselves. All three ferociously pummeled their own faces, especially their ears, with their fists, or slammed their heads into whatever sharp, hard edge was nearby. During one ninety-minute period, John had been observed striking himself 2,750 times. The faces and heads of all three children were a road map of scars. On the day Linda was brought in to UCLA, she had blood leaking from one ear. None of the children could talk; the violence they turned on themselves was the only message they seemed capable of sending to the outside world.

Lovaas later explained that he had intentionally chosen the most severely self-destructive children he could find. He had approached two Southern California institutions, Camarillo and Pacific State Hospital, and asked the staff to point out the children most given to harming themselves. Immediately, they singled out John, Linda, and Gregg. All three had started hurting themselves as toddlers and had since been subjected to the same last-resort method of control: physical restraints, twenty-four hours a day. Linda’s wrists were kept bound to her thighs, with only a little bit of slack, to prevent her from reaching her head with her hands. She lay on her stomach, facedown in a bed all day, sunrise to sunset, awake and flopping one leg up and down. Gregg, on the other hand, was pinioned face-up, looking at the ceiling, his wrists and ankles tied to the corners of the bed. He had spent the previous two
years that way. Inactivity had caused his Achilles tendon to shorten, which is why he could no longer walk.

Lovaas wanted to see whether he could stop the children’s self-destructive behavior by punishing them the instant it appeared. It would be pain for the purpose of preventing pain—a paradox that, to many of Lovaas’s critics, was perverse, and that he would never explain to their satisfaction.

John went first. For five minutes, he was freed of his hand and foot restraints and made to sit on the lap of an attending nurse. Lovaas sat facing them, the Hot-Shot ready. Right away, John hit himself. Lovaas reached over, touched the boy’s leg with the Hot-Shot, and squeezed its trigger. The one-second-long shock surprised the eight-year-old. In instantaneous pain, John flinched and a little shudder went through his body. But this also interrupted the self-battering, at least momentarily. After a pause, John started in again, his fists flailing into his own face. Lovaas shocked his leg again. This was followed by another, longer interruption in his self-battering. The data is not entirely clear, but it seems that John and Lovaas repeated this pattern a third time, and possibly a fourth, before the five minutes were over. One result, however, was indisputable: the shock slowed the pace of John’s hitting dramatically. During this one session, he went from striking himself about fifty times per minute at the beginning of the session, to almost zero strikes per minute after being shocked.

For the following two rounds, on two subsequent days, John was spared the cattle prod. Two associates of Lovaas were working with him that day, with instructions to let his behavior slide so that Lovaas could see how John responded to their leniency. Indeed, his self-injuring returned immediately and worsened from session two to session three. Interestingly, however, it was still lower overall than at the start of the experiment. During non-testing times, John was also generally less violent whenever he was in or even near the experimentation room than when he was in other parts of the institute. On the fourth day, the original discipline returned. Lovaas was back in the seat. John, placed in the nurse’s lap, brought his fists up and slammed them into his own face. Lovaas shocked him, and once again, the pounding plummeted.

There were weeks of this yet to go, but one of the most dramatic
revelations about John occurred not during sessions with the cattle prod. Rather, it was something that happened between sessions. On the morning of the very first day, after being shocked three or four times in a five-minute period, John was returned to his room. It was decided to leave him, for a time, without the restraints he always wore, and the door to his room was left open.

At first, John huddled, motionless, beneath the sink in a corner of the room. It was not until twenty minutes had passed that he ventured out from under the sink and walked over to a cupboard near a different corner of the room. He peeked inside briefly, then scurried back to the sink. Fifteen minutes later, he did the same thing—out and back.

At last he stood up and, with small, tentative steps, made his way to the open door and into the hallway. Following the wall, he found the room next door and entered it. A moment later, he was back in the hallway again.

Something was triggered in him at that point, because John began to run. It did not look like fear. It looked more like he was actually having fun. It was only a corridor and a couple of laboratory rooms, but it was more space than he had been able to explore at will since he had been institutionalized years earlier. As if he couldn’t get enough of the feeling, he ran back and forth, over and over. From behind mirrors and through doorways, Lovaas and his team watched a little boy tasting a certain kind of childhood freedom for the first time.

Then John made a delicious discovery, which brought the frantic running to a sudden stop. He could scratch himself. Before this, his hands had always been tied behind his back. Now his hands could reach almost every inch of his body. Given the chance, he took it, and sank into the primal pleasure of it, scratching himself all over for a full hour.

A little while later, he got a bath—something that had always been impossible because of his beating arms. But in this brief hiatus from self-injury, he let Lovaas’s staff plunk him into a tub of warm water. He screamed with happiness when he felt it and immediately scooted lower till he had submerged himself head to toe. Still under the water, he opened his eyes and stared with wonder at the team in white lab
coats gathered around the tub, who were staring back at him in a wonder of their own.

—

L
OVAAS ACHIEVED SIMILAR
mastery of the self-destructiveness of the other two children, Linda and Gregg. In their cases, however, it took only four sessions to suppress the unwanted behavior. With Linda, he added something new to the experiment: he and the other experimenters began to shout “No!” directly into her face when they were giving her a shock. Within three sessions, just the word was enough to get her to stop beating herself.

When he went back to working with John again, Lovaas expanded the experiment to see if he could crush John’s self-injurious behavior not only in the lab but in a wider variety of settings. He took him to other parts of the institute, and even outside, and gave him shocks there. After that, Lovaas wrote,
“John was effectively freed from self-destructive behavior outside the laboratory.”

It is unknown how long the positive results lasted after the experiments ended. The children were not at UCLA for the purposes of treatment. They were laboratory specimens, chosen for research and returned at the end of the experiments to the institutions where Lovaas had found them. But he knew, and sometimes lamented, that all three resumed the self-injurious behaviors he had suppressed, and that each of them would end up once again tied down to their beds. But Lovaas was not a caregiver. His personal responsibility to the children ended when he handed them back. For him, the priority was research, which was going to mean more experiments, with more children, and perhaps, if he was smart and tenacious enough, discoveries that would lead to ways to help all of them.

—

L
OVAAS WAS A
magnet for attention, who attracted both ardent fans and harsh critics. Over the ensuing decades, he would become—at least within the academic world—a star performer, a hot bright light, a noisy combatant, an athlete. As a professor, he knew how to play to the crowd, lacing his lectures with jokes and tales from his Norwegian
childhood, like the one about how he kept his feet warm in his boots on frigid mornings in the 1940s when he had to go milk the cows. “I let the cows piss on them,” he’d say.