Behavior Assessment of the Syndrome of Autism: Behavior Observation System

Behavior Assessment of the Syndrome of Autism: Behavior Observation System B. J. FREEMAN, PH.D., E. R. RITVO, M.D.,

AND

P. C. SCHROTH, M.A.

In this paper the final form of the behavior observation system for autism (BOS) is described and data on 137 children presented. The results indicated that there is a great deal of overlap between lowfunctioning autistic and mentally retarded children and between high functioning autistic and normal children. In addition, different behaviors differentiated each group from its control. Relation to Examiner behaviors best differentiated the lowautistic group while Solitary Stereotypic and Language behaviors best described the highautistic group. These results are discussed in terms of the methodological problems encountered when attempting to establish objective diagnostic data. Journal of the American Academy of Child Psychiatry, 23, 5:588-594, 1984.

In spite of the vast research that has been conducted over the last 30 years on the syndrome of autism, an objective method for describing the children and for establishing the diagnosis has not been developed (Freeman and Ritvo, 1982). Several methodological problems have limited the development of such an objective system. First is the necessity of utilizing appropriate comparison groups to account for the overlap among behaviors exhibited by children with the syndromes of autism and mental retardation as well as normal subjects (Freeman et al., 1978; 1979). Second, since the syndrome of autism is defined by sets of heterogeneous symptoms, many behaviors must be rated simultaneously and on large numbers of chil-

dren, 2) identify subgroups of autistic children, and 3) develop an objective means of describing subjects in behavioral and biological research. In order to accomplish these goals, the techniques of behavioral assessment were applied to the clinical problem of differential diagnosis of children with the syndrome of autism. In an earlier paper (Freeman and Schroth, 1983), we described the initial version of the scale and its measurement properties, i.e., the stability, reliability and discriminability of each of the original 67 behaviors. As a result of these analyses, 24 behaviors which could be accurately measured were selected to comprise the revised BOS. The purpose of the present paper is to describe the completed revised BOS. In

dren to develop valid data (Ornitz and Ritvo, 1976).

addition, data on the application of the BOS to 137

Such heterogeneity of symptoms has complicated the development of a direct observational scale since subgroups of autistic children may show different sets of symptoms. For example, Bartak and Rutter (1976) and Freeman et a1. (1981) both reported that autistic children with testable IQs above 70 showed different patterns of symptoms than did those with testable IQs below 70. Since 1976, we have been conducting a large research project designed to develop an objective behavior observation system (BOS) which will: 1) differentiate autistic from normal and mentally retarded chil-

children will be presented. Method Subjects

The subjects for this study were 1) 63 children initially screened who met the National Society for Autistic Children's (Ritvo and Freeman, 1977) and DSM-III diagnostic criteria for the syndrome of autism; 2) 34 children with a diagnosis of mental retardation (Grossman, 1973)matched to the autistic group on mental age obtained on the Merrill-Palmer Preschool Performance Test (Stutsman, 1931); and, 3) 40 normal children matched to the other two groups by chronological age. Table 1 shows the mean chronological ages (CA) and the mean mental ages (MA) in months obtained on the Merrill-Palmer Preschool Performance Test. The autistic children were divided into two groups: high-autistic (21), those with IQs above 70 and lowautistic (42) those with IQs below 70. There were no differences between the CAs of the low-autistic and the mentally retarded group. However, the low-autis-

This research was supported in part by MH29248 awarded to the first author; HD 47-12 awarded to E. Ritvo, M.D., and the Max and Lottie Dresher Fund; MH 30897 awarded to Peter Tanguay, M.D., for the Clinical Research Center for the Study of Childhood Psychosis; Maternal and Child Health Project No. 927 awarded to J. Q. Simmons III, M.D.; Computing ReSOW1:es Group, all of the Division of Mental Retardation and Child Psychiatry, University of California, Los Angeles. Reprints may be requested from B. J. Freeman, Ph.D., 760 Westwood Plaza, Los Angeles, CA 90024. 0002-7138/84/2305-0588 $02.00/0 © 1984 by the American Academy of Child Psychiatry. 588

589

BEHAVIOR OBSERVATION SYSTEM TABLE 1

Mean Chronological Age (CA) and Mean Mental Age (MA) in Months on the Merrill-Palmer Preschool Performance Test for each Diagnostic Group Diagnostic Group Low-autism (N = 42) Mentally retarded (N= 34) High-autism (N= 21) Normal (N= 40)

CA

MA

51.6

27.3"

56.1

32.3

54.9"

46.2

45.8

50.2

'»> 0.01.

tic group did have significantly lower MA. On the other hand, the high-autistic group and the normal group were well matched on MA but the high-autistic group was older than the normal group. In addition to cognitive testing, each patient was examined by two Board Certified Child Psychiatrists who determined the clinical diagnoses. Developmental histories and medical examinations were obtained. Procedures

The BOS contains 24 objectively defined behaviors as listed in Appendix A. Behaviors are divided into four groups: Solitary, Relation to Objects, Relation to People, and Language. In addition, within each group, repetitive and nonrepetitive behaviors are coded separately. Each child was videotaped through a one-way mirror in a playroom setting. The room contained ageappropriate toys, a child's table and chair, and one adult chair. The child was brought into the room by the examiner who told the child to do anything he/ she wanted to. If the child was initially crying, observations did not begin until the child was quiet. Each child was observed on 3 days, 1 week apart. The experimenter in the room and the observers were blind to the diagnosis of the child. Undergraduate Psychology students were trained to code the videotapes. These observers participated in approximately 2 months of training prior to data collection. The training process involved three stages: 1) memorization of the coding system, 2) familiarization with the procedures used for recording the behaviors, and 3) practice in using the coding system by rating preliminary videotapes of pilot subjects similar to those included in the study. The pilot subjects were exposed to the same experimental procedures used in the study. Data collection was begun followingadequate observer training, which was determined by an average agreement percentage of 80% or better on each behavior.

The Behavior Observation System There are three elements to the BOS: recording, recognition, and measurement of behavior. Recording of behavior is achieved through videotape recording of the session. Recognition is accomplished by observer review of the videotape and the coding of the occurrence of specific behaviors on a data form. Measurement is effected by computer evaluation of the recognition data. Behaviors which are deemed of interest are rigidly defined, and assigned a one- or two-character mnemonic code. If a behavior is observed during the defined 10-second time interval, the code is entered on the data form; if not, the observer need do nothing but continue viewing the tape. The codes are entered on the form continuously, separated by a comma or space, while the videotape is viewed. Only defined behaviors which are observed are recorded, but the number of behaviors which can be recorded is not limited. Thus, this element of the system is concerned only with human observation and recognition of specifically defined behaviors, and the recording of this recognition. Complete recording of behavior during the session is achieved by the videorecording. With the counting or scoring being done by computer, the observer is able to focus on observation and recognition of behaviors. The time interval for this study is a 10-second interval. An audio clock indicating minute and interval of the session is superimposed on the videotape. The beginning of each interval is marked by the observer as "/" or "-", indicating whether or not the child was facing the examiner. This then has a dual purpose-indication of interval and information on duration of time facing the examiner. At the beginning of each minute, the observer starts a new line on the data form. An example of this data form is shown in Figure 1. The computer checks identification data for completeness and then proceeds to scan the data. Undefined behavior codes and minutes with more or less than six intervals are flagged for correction. The number of intervals in which a given behavior was noted are counted, and the percent of time spent facing the examiner calculated. Behaviors can be weighted and combined expirically for scoring subscales. For the purposes of the current data analysis, a mean score for each child over observers and sessions was computed for each behavior. Results Frequency Analyses

Table 2 shows the mean frequency of behaviors, the percentage of children in each group who exhibited

590

FREEMAN ET AL.

Subject·s Name ROBERT 10No. Term Session Dale of Taping Observer ReviewDale

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FIG. 1. Sample data sheet for revised Behavior Observation System.

the behaviors, and the interobserver agreement coefficients for each behavior. In all cases, the low-autistic group was compared to the mentally retarded group and the high-autistic to the normal group. Table 2A show the mean frequency of occurrence of each behavior in each diagnostic group. T-Tests were used to compare the low-autistic to the mentally retarded children and the high-autistic to the normal children. There was a great deal of overlap between both autistic groups and their controls. Only four behaviors differentiated both autistic groups from their control (Purposeful Use of Objects, Nonpurposeful Use of Objects, Talks to Examiner, and Repetitive Vocalizations). Both autistic groups exhibited less purposeful and more nonpurposeful play than either comparison group. In addition, both autistic groups talked less to the examiner and engaged in more repetitive vocalizations than their controls. When the low-autistic and mentally retarded comparison is examined, three additional behaviors (Locomotion, Looks toward Examiner, and Nonstimulusrelated Talking) differentiated the groups. The lowautistics were more active, looked at the examiner less

and engaged in less nonstimulus-related talking than did the mentally retarded children. When the high-autistic-normal comparison is examined, the groups differed on an additional eight behaviors (Hand-flapping, Finger-wiggling, Mouthing Objects, Sniffing Objects, Stereotypic Manipulation of Objects, Vocalizations, Echolalia, and Stimulusrelated Talking). Thus, the autistics engaged in significantly more of all these behaviors, with the exception of Stimulus-related Talking, than did the normal subjects. Table 2B shows the percentage of children in each group who actually exhibited the behaviors. This is an important measure as many of the behaviors occur with a very low frequency and the fact that they occur at all may be of diagnostic importance. Chi-squares were used to compare the groups oil this measure. The high- and low-autistic groups differed from their controls on different behaviors in each category. Two patterns can be seen if Table 2B is examined in detail. For some behaviors, e.g., Repetitive Jumping, Talks to Examiner, the percentage of children in the highand low-autistic groups were different but the behavior differentiated both groups from its control. For other behaviors, e.g., Finger-wiggling, Changing Toys, approximately the same percentage of children exhibited the behavior in both autistic groups, but-only one of these groups differed from its control. These two patterns indicate that the occurrence of some of the behaviors is at least partially a developmental phenomenon, i.e., dependent on mental age. When the frequency analysis (Table 2A) and the percentage of children analyses (Table 2B) are examined in combination, it becomes apparent that different categories of behaviors differentiate the high- and low-autistic children from their controls. In thecategory of Repetitive Solitary Behaviors, more children in both autistic groups exhibit the behaviors. However, the behaviors are clearly of more diagnostic importance in the high-autistic group. The same is true of Specific' Sensory Use of Objects. On the other hand, while all children engage in the behaviors, both autistic groups exhibited less Purposeful Use of Objects and more Nonpurposeful Use of Objects than did their controls. The Relation to Examiner behaviors appear to be of more importance in the low-autistic groups while the Language behaviors are more important for the high-autistic group. Table 2C shows in the interobserver coefficients for each behavior. This is an important measurement as it indicates how accurately the behaviors were recorded. Correlation coefficients among observers were greater than 0.70 on all but eight of the behaviors. Six of those behaviors (Whirling, Finger-wiggling, Visual

591

BEHAVIOR OBSERVATION SYSTEM TABLE 2

Mean Frequency of Behaviors, Percentage of Children Who Exhibited the Behaviors, and Interobserver Agreement B. Percent of Children Who ExhibA. Mean frequency Behaviors

Behaviors

Low autism

Mentally retarded

12.09

11.62

Normal

Low autism

Mentally retarded

High autism

Normal

C. Interobserver Agreement Correlation Coefficients

6.48

5.31

100

100

100

98

0.85

High autism

ited Behaviors

SolitaryBehavior A. Manipulation of Body B. Stereotypic Solitary Behaviors 1. Repetitive Jumping 2. Hand-flapping 3. Gesticulation 4. Whirling 5. Finger-wiggling 6. Locomotion

0.57

0.039

0.04

0.00

21

6

5

2

1.00

1.54 2.91 0.76 1.00 6.52

0.33 0.61

0.06 0.22 0.00 0.050.63

45 43 12 43 71

29 26

0.74 1.59-

0.65 0.30 0.04 0.43 0.48

35 50-

33 48 5 38 33

936 5 930

0.81 0.89 0.63 0.38 0.86

0.57 1.24

0.32 0.84

0.27 0.48

0.11 0.45

47 62

35 44

33 38

14 43

0.84 0.23

3.50 6.22 0.88 0.96 12.06

0.80 3.88 0.31 0.03 12.09

0.79 3.85 0.33 0.24 9.14

0.38 0.850.040.15 5.85

64 74 38 19 98

53 74 32 2100

43 52 24 33 100

50 41 9 20 98

0.88 0.91 0.84 0.92 0.63

18.94

34.68-

47.12

67.48-

98

91

100

100

0.88

46.62

34.46

32.08

20.69

100

100

100

100

0.80

5.89

7.54

9.66

8.96

100

88

100

100

0.72

0.08

0.06

0.20

12

12

5

0

0.49

14.05

23.69

11.55

10.35

100

100

100

100

0.82

0.69

2.51

5

32

52

61

0.84

0-

Relation to Object/Toys A. Specific Sensory Use of Objects 1. Cover Ears/Eyes 2. Visual Detail Scrutiny 3. Rubbing Surfaces 4. Mouthing Objects 5. Sniffing Objects 6. Finger-flicking B. Stereotypic, Ritualistic Manipulation of Objects C. Purposeful Use of Objects D. Nonpurposeful Use of Objects E. Changing Toys

Relation to Examiner A. Leads Adult by the Hand B. Looks toward Examiner C. Talks to Examiner

0.009

0.82-

Language A. Vocalization (Noncommunicative) B. Repetitive Vocalization C. Echolalia D. Talks to Self 1. Stimulus-related 2. Nonstimulus-Related

32.72

23.62

34.44

12.35-

98

100

100

95

0.83

8.83

2.25

4.07

1.59

88

68

76

66

0.40

0.04

0.00-

2.89 3.59

4.05 0.79

0.22 0.11

2.04 0.92-

10 14

2924

10

0-

62 67

73 41-

0.55 0.29

-p < 0.01.

Detail Scrutiny, Leads Adult by Hand, Stimulus-related Talking and Nonstimulus-related Talking) occurred with a very low frequency, making accurate measurement difficult. The two remaining low coefficint behaviors (Stereotypic Object Use and Repetitive Vocalizations) reflect problems in definitions. The observers reported difficulty discriminating these be-

haviors from Nonpurposeful Object Use and Vocalizations. Discriminate Analysis Table 3 shows the results of the stepwise discriminate analysis (Dixon and Brown, 1979). When the low-autistics are compared to the mentally retarded

592

FREEMAN ET AL. TABLE 3

Results of Discriminate Analysis A. Low-Autistic-Mentally Retarded Group Comparison" No. classified in each group Diagnostic group

Percent correct

Low-autism Mentally retarded Total

Lowauti sm

Mentally retarded

Total

69 82.4

29 6

13 18

42 24

75

35

31

66

B. High-Autism-Normal Group Comparison" Diagnostic group High-autism Normal Total

Percent correct 71.4 95.5 87.7

No. classified in each group Highautism

Normal

Total

15 2 17

6 42 48

21 44 65

"Behaviors: Repetitive Vocalizations; Talks to Examiner. b Behaviors: Manipulation; Purposeful Use of Objects; Talks to Examiner; Nonstimulus-related Talking; Vocalizations.

children, two behaviors (Repetitive Vocalizations and Talking) yielded a mean 75% correct classification (69% for the autistics and 82.4% for the mentally retarded). These results confirm the frequency data which indicated a great deal of overlap between these groups. However, it should be noted that the interobserver agreement for Repetitive Vocalizations was low (0.40). This might have contributed to the overlap and would indicate that, while the behavior may be diagnostically important, it would need to be better defined to be useful. On the other hand, five behaviors (Manipulation of Body, Purposeful Toy Play, Communicative Speech, Nonstimulus-related Talking and Vocalizations) yielded a 95.5% correct classification of the normal subjects but only a 71.4% correct classification of the high-autistics, indicating ojVerlap between these two groups as well. The results of these discriminate analyses, while confirming the importance of the Language variable in differentiating the groups, also indicate that behaviors and IQ alone may not be adequate to differentiate autistic from normal and mentally retarded children.

Discussion The results of this study indicate that the techniques of behavioral assessment can be applied to the complex clinical problem of describing the behavior of autistic children. Furthermore, these data confirm the generally accepted notion that autism is not a single entity but rather a syndrome. The fact that different behaviors differentiated each of the autistic-subgroups

from its control further supports the hypothesis that there are subgroups of autistic children. While there is overlap among groups and objective behavioral measures alone may not be adequate to describe the children objectively, this technique will be extremely useful in determining further subgroups of children and in measuring changes in the behavior of children who serve as subjects in behavioral and biological research. Why is quantitative behavior alone not adequate for diagnosis? One possible explanation is that qualitative aspects of the child's social behavior may be important in diagnosis. In this study, interaction of the child with the examiner was not measured directly. Rather only the frequency of discrete behaviors such as looking and talking to the examiner were measured. Since the quality of the social interaction is considered to be one.of the primary symptoms of autism (Kanner, 1943), it may be necessary to develop behavioral scales which can measure this qualitative aspect of behavior before differential diagnosis can be made with 100% accuracy. Future research needs to focus on the appli cation of behavioral assessment techniques to this complex but intriguing problem.

Appendix A: Revised Behavior Observation System for the Syndrome of Autism: Abbreviated Definitions (Code Used Shown in Parentheses) I. Solitary Behaviors A. Manipulation of Body (M)

Childmanipulates any part of his/her body. B. Stereotypic, Solitary Behaviors

These specific behaviors are coded individually and include repetitive bouts (at least 2 times within a 10second interval) of the following behaviors: 1. Repetitive Jumping (J): Childstands in oneplace and jumps up and down. 2. Hand-flapping (H): Child oscillates hand(s) up and down, back and forth, bending and/or not bendingat the wrists. 3. Gesticulation/Grimace (G): Child executes any complex, idiosyncratic, bizarrebody movement. 4. Whirling (W): Child turns body in at least one complete circular rotation within one 10~second interval. 5. Finger-wiggling (FW): Child oscillates finger(s) back and forth. 6. Locomotion (LO): Includes the following behaviors: a. Toe-walking b. Pacing c. Body -rocking/tapping d. Head-banging II. Relation to Objects/Toys

The term "object" includes toys, examiner, walls, floor, and anything in..the room excluding the child and his/

593

BEHAVIOR OBSERVATION SYSTEM

her clothing. The toys selected for this study are scattered on the floor in the room and include the following: 1. Baby Potato Head 2. Bristle Blocks 3. Puzzle Blocks 4. Top 5. Train and Tracks 6. Stacking Rings on a Stick The child's relation to objects is classified into the behavioral categories listed below in this section . Use only one of the following codes to describe each action or contact the child has with the objects in the room. A. Specific Sensory Use of Objects Include: 1. Covers Ears/Eyes (CE): Child places object(s) over ear(s) or eye(s). Can also include banging object(s) over ear(s) or eye(s). 2. Visual Detail Scrutiny (VD): Child holds object(s) in front of eyes and examines visually. 3. Rubbing Surfaces (RS): Child uses hands, fingers or any body part to feel surface areas of toys, wall, floor or any object present in the room. Include scratching surfaces here. 4. Mouthing Objects (MO): Child places object up to or in mouth. May include licking, sucking, kissing, or biting the object. 5. Sniffing Objects (S) : Child performs an object to nose behavior by bringing object to nose. 6. Finger-flicking (F) : Child uses tops or tips of · finger(s) in a brushing-away or flicking motion on object surfaces . B. Stereotypic, Ritualistic Manipulation of Objects (R) Within one lO-second interval, child engages with an object and repeats the same bodily action(s) at least twice so that the said engaged object is manipulated in the same manner. C. Purposeful Use of Objects (P) Child uses toys as manufacturer intended. Only exception is the puzzle blocks, where a child may create/attempt to create the designs printed on the blocks or may use as building blocks to construct towers, etc. Also included in this category are attempts, though not necessarily successful, to play purposefully. (For example, child tries to put train tracks together, but cannot.) D. Nonpurposeful Use of Objects (N) Child uses toys in a manner not intended, such as throwing, kicking or stomping on toys. When a child is merely holding or carrying a toy, judgment and assignment of a code should be held until the end of the interval. If the child continues to hold/carry the toy throughout a complete lO-second interval, "N" is coded. But if the child should begin a specific act (e.g., CE , VD, RS, MO , S , F, P , R) before the interval ends, that specific act is coded. For example, child holds two bristle blocks and prior to the interval end, he/she stacks them. Code "P." Momentary holding/carrying of toys is not coded. E. Changing Toys (C): Child diverts attention to a different toy set.

III. Relation to Examiner The following behaviors are coded individually: A. Leads Adult by Hand (LA): Child pulls examiner's hand or arm. This behavior may be accompanied by direct verbal requests. B. Looks Toward Examiner (L): Child's head, and/or eyes, if viewing position allows for the eyes to be seen, is directed on to any part of the examiner's body, including not only the examiner's head and facial area , but also legs, feet, arms, and the like. C. Talks to Examiner (T) : Child talks to examiner, makes requests, may use words, phrases, gestures, telegraphic speech or echolalia. Child must be looking at the examiner while talking and/or must directly address the examiner (e.g., "hey you," saying the examiner's name, and the like). IV. Language

A. Vocalization-Noncommunicative Speech (V) This category includes the following: 1. Vocalizations-child makes single sounds such as consonants (e.g., "mmmmmm") or vowels (e.g., "aaaaa"). 2. Babbles-child makes sequences of a consonantvowel pattern (e.g., ba da rna bo). Usually involves a variety of sounds. B. Repetitive Vocalization (RV): Child repeats the same noises or sounds at least twice (e.g., "ba-ba"). C. Echolalia (E) Included in this category are the following: 1. Immediate echolalia : Child repeats exactly what was said immediately after it was said. 2. Delayed echolalia: Child repeats what was said but after a period of time has elapsed, e.g., will repeat something he heard the day before. Only code if child repeats what examiner said earlier. 3. Negative echolalia: Child repeats what he has heard, but adds negative affect to it. May either be immediate or delayed echolalia. Specify child's comment separately. D. Talks to Self: Child talks aloud, but speech not directed at examiner. Includes the following circumstances: 1. Talks in a Stimulus-related Manner (TS): Child's speech describes the toys or objects in the room. 2. Talks in a Nonstimulus-related Manner (TN) : Child's speech does not appear to be related to the stimulus situation. (Singing is included here if the subject of the song is in no way related to the present environment.)

References BARTAK, L. & RUTIER, M. (1976), Differences between mentally retarded and normally intelligent children. J. Aut. Childh. Schizo; 6:109-120. DIXON, W. & BROWN, M. (1979), Biomedical Computer Programs, Pi-Series, Berkeley: University of California Press. FREEMAN, B. J. & RITVO, E. (1982), The syndrome of autism: a critical review of diagnostic systems and follow-up studies and the theoretical background of the Behavior Observation Scale.

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In: Advances in Child Behavior Analysis and Therapy, ed. P. Karoly, Toronto: D. C. Heath. & SCHROTH, P. (1983), The development of the behavior Observation System. Behav. Assess. 6:177-187. - - RITVO, E., GUTHRIE, D., SCHROTH, P. & BALL, J. (1978), The Behavior Observation Scale for autism. This Journal, 17:576-588. GUTHRIE, D., RITVO, E., SCHROTH, P., GLASS, R. & FRANKEL, F. (1979), Behavior Observation Scale: preliminary analysis of the similarities and differences between autistic and mentally retarded children. Psychol. Rep., 44:519-524. RITVO, E., SCHROTH, P., GUTHRIE, D., TONICK, I. & WAKE, L. (1981), Behavioral characteristics of high and low IQ autistic children. Amer. J. Psychiai., 3:254-258.

GROSSMAN, H. J. (ed.) (1973), Manual on Terminology and Classification in Mental Retardation. Baltimore: Garamond/Pridemark Press. ' KANNER, L. (1943), Autistic disturbances of affective contact. Nerv. ' Child, 2:217-250. ORNITZ, E. & RITVO, E. (1976), The medical diagnosis, In: Autism: Diagnosis, Current Research and Management, ed. E. Ritvo, B. J. Feeeman, E. Ornitz & P. Tanguay. New York: Spectrum. RITVO, E. & FREEMAN, B. J. (1977), National Society for Autistic Children definition of the syndrome of autism. J. Pediat. Psychol., 4:146-148. ' , STUTSMAN, R. (1931), Guide/or Administering the Merrill-Plllmer Scale of Mental Test. New York: Harcourt, Brace, & World. .

ANNOUNCEMENT The Margaret S. Mahler Literature Prize for' 1983 was awarded to Annemarie P. Weil, M.D. This $500 prize was awarded in recognition of her paper "Thoughts About Early Pathology." It was delivered at the 14th Annual Margaret S. Mahler Symposium held in Philadelphia in May 1983. The .announcement. was made by the Literature Prize Committee at the Mahler Symposium in May 1984. Papers for this $500 prize for 1984 are now being accepted. Papers should deal with clinical, theoretical, or research issues related to Dr. Mahler's concepts of separation-individuation in Child Development. Please send six copies by Decem- ' ber 31, 1984 to: Marjorie Harley, Ph.D. Literature Prize Committee 201 St. Martins Road Baltimore, MD 21218