AAAP Today

Can oxytocin, the “love hormone” treat a core symptom of Autism?

By Lirio Sobrevinas-Covey, Ph.D.

Social skills deficits – in communication, ability to interact with others, and lack of empathy, mark one of the two defining criteria of Autism Spectrum Disorders (ASD). (The other is repetitive and restrictive behaviors).

This background underlies the measured excitement among autism researchers in the possibility that oxytocin, found to play a positive role in the neuroanatomy of bonding and intimacy relationships, might be effective in ameliorating one of the two core symptoms of ASD. No drug has been found to treat the debilitating social skills deficit of persons with ASD.

In animal and human studies, oxytocin, a natural peptide found in the hypothalamus, has demonstrated promise for enhancing response to social stimuli and improving social interactions and communication. Oxytocin has been dubbed – “the love hormone”, “the cuddle hormone”, or “the bonding hormone”.

In human studies, oxytocin was administered intra-nasally. Observed outcomes included improvements in social cognition, empathy, and reciprocity. Adverse effects were not reported.

Not all studies yielded positive outcomes, however. These early studies also suggested that intermittent rather than chronic oxytocin treatment is prefferrable.

It remains unclear if oxytocin treatment effects are moderated by differences in dosage, duration of use, the patient’s age, and environmental influences. Combining oxycotin with behavioral treatments has been considered as a possibly desirable approach.

Oxytocin and Asperger’s Disorder? In my view, results of research studies on the "love hormone" offer special promise for persons with Asperger’s Disorder (AD), one of the conditions that fall under the rubric of Pervasive Development Mental Disorder, along with Autism, in the DSM-IV. Children and adults with AD have characteristics that meet the core symptoms of ASD, notably, impairment in effective social interaction and communication; but, differently from the other ASD subgroups, they are not typically impaired in cognitive functioning, language ability, or academic skills. Thus, Asperger’s adults are often characterized by achievement in the educational area; however, the social skills deficits handicap them in gaining employment commensurate to their academic training and occupational skills. The job interview, for instance, where social impact on the potential employer is important, can function as a formidable barrier.

Investigations into the potential therapeutic application of oxytocin are still in early stages. Available data are insufficient for physicians to prescribe oxytocin. Still, in the face of a lack of treatment for the core symptoms of ASD, oxytocin is an exciting potential treatment.

Reference:

Larry J. Young an Catherine E. Barrett. Can oxytocin treat autism? Science. 2015 February 20; 347(6224): 825–826.

Diagnosis of Asperger’s Disorder

By Lirio Sobrevinas Covey, Ph.D.

In DSM-IV (American Psychiatric Association, 1994), Asperger’s Disorder was one of four syndromes classed under the overall rubric of Pervasive Development Disorder (the others were Autistic Disorder, Rett’s Disorder, and Childhood Disintegrative Disorder).

In the recently published DSM-V (2013), autism symptoms are classed into two groups – social/communication group and the restrictive and repetitive group, all under a single overall classification labelled as Autism Spectrum Disorders (ASD). This new classification is intended to reflect the range in severity of autism symptoms, rather than to reflect a qualitative difference. Persons previously classified as AD in DSM-IV are likely to still fall under the rubric of ASD and regarded as high functioning autisms.

Asperger’s Disorder is characterized by abnormal social functioning and repetitive behaviors but not with reduced cognitive functioning, intelligence, or language ability. There is ongoing controversy regarding the validity of AD as separate from autism, in particular, “high functioning autism’’. Notably, in ICD-10 (the diagnostic classification associated with the World Health Organization), Asperger’s Disorder is classified as a subgroup of ASD.

Questionnaires specific for assessing Asperger’s Disorder have been developed. More work is required according to a review of five third-party AD rating scales that described the existing measurements as – promising but demonstrating significant weaknesses (Campbell JM, J Autism and Developmental Disorders, Volume 35, Feb, 2005). One of the five, the Krug Asperger’s Disorder Index (KADI) is considered the most sound and reliable. These instruments, although not defining of Asperger’s Disorder by themselves, can provide the diagnostic team with basic information for pursuing a more complete and intensive inquiry. Arriving at a correct diagnosis is so imperative for helping the ASD-affected individual receive appropriate clinical assistance and reach a positive life outcome.

Following are excerpts on diagnosing Asperger’s Disorder from a recent review article by FL Tarazi et colleagues from the Department of Psychiatry and Neuroscience Program, Harvard Medical School, published in Expert Reviews, 2015.

“The diagnosis of Asperger’s syndrome is complicated by the lack of a standardized diagnostic test. Asperger’s, and other ASD, are usually diagnosed as part of a two-stage process.

The first stage begins with developmental screening during physical checkups with a family doctor or physician. Interview of the child should include open-ended questions, awkward pauses, inquiring about special interests, relationship with friends and family, insight into other people’s intentions and beliefs and understanding of figurative language.

The interview should be conducted without the support of the parent. Direct observation, ideally starting in the clinic’s reception area, is essential to assess the child’s social interactions.

If any AD or ASD related symptoms are noted, the child is referred for comprehensive evaluation by a team of specialists that typically includes a psychologist, neurologist, psychiatrist, speech therapist, and additional professionals who have expertise in diagnosing children with AS and other ASD.”

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Abi C. Dango

Miriam College

Bridging to the Norm through AAAP

December 2014, our Public Relations class met two groups that had the same advocacy – to help raise awareness regarding people with special needs. The first one to present was Best Buddies, an organization that focuses and caters to children who are diagnosed with autism. They showed videos in class and presented their different activities that promote a buddy system. Some could go to different activities, have bonding activities, and mostly attend events that are created by this organization and other groups which have the same plea. What touched me the most, while the Best Buddies were presenting, was when a speaker said that their goal is to soon be not needed in Philippine society, and eventually, the whole world. At first, I got confused because how can an organization have a mission to soon not be around? Each company should have an ambition to stay for a very long time. However, when the speaker explained why, I got shocked. She said that in the future, they envision a world wherein, an organization like this would not be needed anymore just for people to be around children with special needs. It may be just from my perspective, but I saw the pain in her eyes when she said this. Her plea was real and sincere. And that’s when I realized that I want to lend a hand to people with special needs.

Having experienced this and while going through the Public Relations class at the same time, the main application that I have realized is that in each event that we have to create, our main goal is always to get to the other side, how to reach the other end of the road. In every step that we make, we have to keep in mind that everything that we do shall always benefit the audience or the target market. In that way we will be able to achieve our advocacy, and at the same time have more people on our side.

After going through all the tasks for AAAP, the second advocacy group, I have realized a lot of things, learned many important lessons, and I got to meet a lot of people with very pure hearts and passionate souls. But the one that I will treasure the most is how I understood why these kinds of organizations exist. It is for us to bridge out to the norm. For us to realize that in this world, differences will always be present and will be seen on each and every one of us, and that’s nothing to be ashamed of. We have to build bridges to develop a society wherein we will be comfortable of our variations. ­Unity among diversity, that’s the goal.