Archive for the ‘Oxytocin’ Category

Significant Autism Events of 2017

Thursday, December 28th, 2017

In the face of the exploding incidence of childhood developmental abnormalities, scientific knowledge is sorely lacking. These are my top picks for this year’s most useful human research and events that address our understanding about the cause(s) and treatment(s) of these conditions.

January
Disrupted prediction errors index social deficits in autism spectrum disorder
This BRAIN study which locates “… coding discrepancies between the predicted and actual outcome of another’s decisions…” provides, “a novel insight into the neural substrates underlying autism spectrum disorder social symptom severity… could provide more targeted therapies to help ameliorate social deficits in autism spectrum disorder.”

February
Microbiota Transfer Therapy alters gut ecosystem and improves gastrointestinal and autism symptoms: an open-label study
“This exploratory, extended-duration treatment protocol thus appears to be a promising approach to alter the gut microbiome and virome and improve GI and behavioral symptoms of ASD. Improvements in GI symptoms, ASD symptoms, and the microbiome all persisted for at least 8 weeks after treatment ended, suggesting a long-term impact.”

March
WORLD’S LARGEST AUTISM GENOME DATABASE SHINES NEW LIGHT ON MANY ‘AUTISMS’
There were several studies, this year, that implicated the genetic susceptibility of ASD. This one is from Autism Speaks’ MSSNG project. “The omitted letters… (pronounced “missing”) represent the missing information about autism that the research program seeks to deliver.”

April – Autism Awareness month
The Pesticide Action Network and the Natural Resources Defense Council filed a complaint against the EPA, led by Trump appointee Scott Pruitt, asking a federal court to make the agency follow through on an Obama-era recommendation to ban chlorpyrifos, a pesticide linked to brain damage in children. The Trump administration reversed that recommendation last week — even though the EPA concluded in November that the pesticide is associated with autism, lowered intelligence, developmental delays, and attention deficit disorders.

Injury Mortality in Individuals With Autism
Conclusions were that, “Individuals with autism appear to be at substantially heightened risk for death from injury.”

From the FDA, this warning – Autism: Beware of Potentially Dangerous Therapies and Products

May
Autologous Cord Blood Infusions Are Safe and Feasible in Young Children with Autism Spectrum Disorder: Results of a Single-Center Phase I Open-Label Trial
Not the most rigorous study design, and safety does not imply efficacy. Nevertheless, by utilizing the infant’s own stored umbilical cord blood, “Behavioral improvements were observed during the first 6 months after infusion and were greater in children with higher baseline nonverbal intelligence quotients.”

June
Intranasal oxytocin treatment for social deficits and biomarkers of response in children with autism
The Child Development Center has been finding this treatment somewhat helpful for eye contact and socialization.

Functional neuroimaging of high-risk 6-month-old infants predicts a diagnosis of autism at 24 months of age
Functional, not merely structural connectivity was tested at a very early age. Only in the research phase, “These findings have clinical implications for early risk assessment and the feasibility of developing early preventative interventions for ASD.”

July
Low-dose suramin in autism spectrum disorder: a small, phase I/II, randomized clinical trial
Dr. Naviaux reported the use of a 100 year-old medicine for African Sleeping Sickness on a small group of ASD patients. His unified theory of central nervous system dysfunction involves the ‘Cell Danger Response’ – a proposed common pathway leading to autism. This could represent the most promising research of the year.

August
Increased Extra-axial Cerebrospinal Fluid in High-Risk Infants Who Later Develop Autism
The MRI test may assist in identifying autism risk in susceptible infants and younger siblings of affected children. However, accuracy was not optimal. Additional studies will be required to suggest whether it is worth risking exposure to anesthesia for testing.

September
Some good publicity for Planet Autism. The Good Doctor, a TV show about an autistic professional appeared on ABC. Compared to Rain Man, it represents a quantum leap in the public perception of autism. Also, Julia, a muppet with autism, joined the cast of the popular PBS children’s show ‘Sesame Street’. Plus, debuting this year was Netflix’ new comedy about an autistic teen, Atypical. Finally, you may want to check out these two offerings: Keep the Change, a love story which challenges popular misconceptions about ASD, and the more serious Deejinclusion shouldn’t be a lottery.

Combined Prenatal Pesticide Exposure and Folic Acid Intake in Relation to Autism Spectrum Disorder
Folic acid is a vitamin given to pregnant mothers to prevent spina bifida. When taken in higher doses during the first trimester, “… associations between pesticide exposures and ASD were attenuated…” Should all younger women be taking vitamin B9, or could it be too much of a good thing?

October
Accurate Autism Screening at the 18-Month Well-Child Visit Requires Different Strategies than at 24 Months.
Comparison of Autism Screening in Younger and Older Toddlers.
Accuracy of Modified Checklist for Autism in Toddlers (M-CHAT) in Detecting Autism and Other Developmental Disorders in Community Clinics.
These three studies evaluated a popular screening tool for autism, and found that is more accurate in children at 24 months of age than at 18 months. Pediatricians and other specialists need a superior tool to test children younger than 20 months. At The Child Development Center, we have found that the Autism Evaluation Checklist, careful observation, and a detailed history will yield a more accurate diagnosis.

November`
Association of White Matter Structure With Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder
By utilizing a specialized MRI technique researchers were able to discover, “ASD traits and inattention and indexes of white matter organization, particularly in the…” tissue that connects the two halves of our brain. This technology might also identify ‘Processing’ and ‘Executive functioning’ disorders.

Subcortical Brain and Behavior Phenotypes Differentiate Infants With Autism Versus Language Delay
By combining MRI information plus behavioral assessments, scientists might be able to predict which children are only experiencing ‘benign’ speech delay.

December
Tools and techniques to improve the oral health of children with autism
By offering these suggestions, there is recognition of the need for improved mouth care in children with sensory and oral-motor issues. It’s one of the most obvious places to reduce the body’s inflammatory load.

Differences in fecal microbial metabolites and microbiota of children with autism spectrum disorders
Confirming the stool testing that functional medicine doctors utilize, “… data in this study support that children with ASD have altered metabolite profiles in feces when compared with neurotypical children and warrant further investigation of metabolites in larger cohorts.” Evidence-based medicine.

Advances on the research of the environmental risk factors of children autism
Amid all of the recent genetic research is this reminder that documents, “risks of autism in children may increase following in prenatal exposure to air pollutants, heavy metal and pesticides.”

Conclusions
Another year of more questions than answers. Why does it seem to be taking so much time for useful human studies to appear? Dollars for basic research depend on funding agencies’ understanding of this enigmatic condition. Plus, it takes more than a billion dollars to develop any new medication, so ASD is a very risky proposition.

Then, there is the Bettleheim effect (he popularized the ‘refrigerator mom’ theory), the Wakefield effect (any new idea about autism becomes suspect), the vaccine effect (just talking about ASD leads to this controversy), and the continued debate about whether there even really IS an epidemic.

However, practically everyone, nowadays, knows some family that is touched by this developmental disorder. We must continue to hope that progress will accelerate in response to the reality of a condition that affects so many of our children

Medical Academy of Pediatric Special Needs – Fall 2016

Sunday, September 11th, 2016

This week, the Medical Academy of Pediatric Special Needs held its semiannual conference in downtown Atlanta, GA. This is ‘Ground 0’ for practitioners, researchers and professors from all over the world to meet, learn, explore and discuss a myriad of relevant topics.

Members who have been returning for 100’s of lecture hours generally choose the advanced courses. For some, the conference has become a group of ~50 experienced and knowledgeable practitioners who meet to discuss ‘workups’, basic science, relevant research and treatment protocols for those who are most affected with ASD.

Notes and Observations
Day 1 – Tough Cases
I really enjoyed our lectures by the plain-speaking Dr. John Green, of Portland, OR. Dr. Green not only reviewed those who improved because of his medical expertise, but those who got better in spite of him, those who haven’t gotten better, those who got better but he can’t figure out why, and the most frustrating – patients who improve only to suffer frequent relapses.

Dr. Sid Baker, a pioneer of the biomedical movement, described his early medical experiences in Africa that morphed into his lifelong dedication to treating patients with ASD. He expressed his disappointment that so many conventional colleagues disagree with our practice.

Dr. Baker elucidated how he initiates care with new patients. He discussed increasingly resistant cases, covering topics from severe speech apraxia to the approach to children with injurious behaviors.

The first day was filled with the most frustrating and difficult cases you can imagine. Eminent practitioners Drs. James Neuenshwander, Michael Elice, and Julie Buckley challenged our diagnostic and therapeutic knowledge, attempting to navigate the complicated courses of those who improved and those who didn’t.

Day 2
Dr. Daniel Amen‘s morning lecture was entitled “3D Brain SPECT Imaging”. The takeaway message was that SPECT scans – technology – could/should/will become a mainstay for a multitude of CNS disorders. His manner and stories of research, technical evaluation, and clinical practice, were positively spellbinding and inspirational.

Dr. Theoharides presented his research and extensive knowledge about the important role of allergy in ASD. Dr. Theo continues to publish a mountain of monumental works, not only on the topics of autism and the role of mast cells, but treatments, as well.

Toxins were the subject of the afternoon’s lectures. We learned about the identification of substances in the environment that are dangerous, how they are measured, how damage is done, and the means to control and treat. For the skeptical reader, there was a plethora of supporting scientific evidence of the relationships to autism (and many other modern conditions).

As has become customary, Dr. Dan Rossignol rounded up the day with a roundup of all of the latest scientific research. Rapidly.

Day 3 – Advanced Clinical Cases
Severe behaviors and speech apraxia. For patients who are most resistant to conventional and alternative treatments, essential oils, acupuncture, and even worms were explored as possible solutions.

Throughout the afternoon, cases got even tougher! Lyme, Persistent Lyme, Non-Lyme Lyme, PANDAS, PANS, parasites… an increasing number of reasons to have signs and symptoms that are called autism. Such information extends our knowledge and leads to better diagnoses for our patients, and possibilities for treatment.

Dr. Green discussed biomarkers. Though these ‘labs’ are not specific to ASD, per se, this will become a necessary next step to document level of involvement and response to treatments.

A brand new treatment, repetitive Transcranial Magnetic Stimulation was presented by Dr. Arun Mukherjee. The jury is still out on this expensive intervention.

Conclusions
One important reason that I return to this meeting, is simply that I feel at home among like-thinking practitioners. Members don’t agree on every subject, but we are respectful and actually enjoy our practices.

In traditional medicine, conferences are basically show-and-tell affairs, where researchers report their data, previously published in medical journals. When doctors think outside the box, practitioners with diverse skills, who are scattered over the globe, discover improved results by networking in this fashion.

Patients, parents, and families can feel confident that progress is being made (slowly), as serious, dedicated doctors continue to try to unravel this modern mystery.

Finally, I am proud to report that, at this meeting, I was awarded Fellowship status in the Medical Academy of Pediatric Special Needs.

Oxytocin for Autism – Again

Saturday, October 31st, 2015

For the past couple of decades, oxytocin – ‘the love hormone’ – has been postulated as a possible remedy to the social deficits associated with ASD. TheAutismDoctor has previously reviewed the use of this peptide, released by the pituitary gland, which is located in the center of our brain. Animal models to determine value have shown promise, however, the experience in human subjects has met with mixed results.

This Newest Study, published in Molecular Psychiatry, claims to be “the first clinical trial to support the potential of oxytocin as an early intervention for young children with autism to help improve social interaction deficits.”

10/2015 The effect of oxytocin nasal spray on social interaction deficits observed in young children with autism: a randomized clinical crossover trial
Thirty-one children with autism received …oxytocin and placebo nasal spray morning and night… for 5 weeks, with a 4-week washout period between each treatment. Compared with placebo, oxytocin led to significant improvements on the primary outcome of caregiver-rated social responsiveness. Overall, nasal spray was well tolerated, and the most common reported adverse events were thirst, urination and constipation. 

Other selected recent (human) literature:
04/2010 Intranasal Oxytocin Improves Emotion Recognition for Youth with Autism Spectrum Disorders
This study provides the first evidence that oxytocin nasal spray improves emotion recognition in young people diagnosed with autism spectrum disorders.

01/2014 Oxytocin but Not Testosterone Modulates Behavioral Patterns in Autism Spectrum Disorders
8 children with ASD were recruited and underwent psychological profiling… Higher oxytocin levels were connected with more severe adaptive behavior in ASD patients. Increased oxytocin levels in children with more severe phenotype could be a result of compensatory mechanism of impaired oxytocin signaling. Oxytocin seems to employ distinct mechanisms in regulating social behavior in autism and healthy population.

03/2014 Nasal Oxytocin for Social Deficits in Childhood Autism: A Randomized Controlled Trial
Compared to placebo, intranasal oxytocin did not significantly improve emotion recognition, social interaction skills, or general behavioral adjustment in male youths with autism spectrum disorders.

08/2014 Plasma oxytocin concentrations and OXTR polymorphisms predict social impairments in children with and without autism spectrum disorder
These findings indicate that <<oxytocin>> biology is not uniquely associated with ASD

04/2015  ncbi.nlm.nih.gov/pmc/articles/PMC4404976/" target="_blank" rel="noopener">Salivary Oxytocin Concentrations in Seven Boys with Autism Spectrum Disorder Received Massage from Their Mothers: A Pilot Study
Seven male children with autism spectrum disorder (ASD), aged 8–12 years… were assigned to receive touch therapy During the period of massage therapy, the children and mothers exhibited higher oxytocin concentrations compared to those during the non-massage period. 

12/2015 Oxytocin enhances attentional bias for neutral and positive expression faces in individuals with higher autistic traits
This effect of oxytocin is strongest in healthy individuals with higher autistic trait scores, thereby providing further support for its potential therapeutic use in autism spectrum disorder.

12/2015 (in progress) Oxytocin enhances orienting to social information in a selective group of high-functioning male adults with autism spectrum disorder
Individual differences in stress-related avoidance tendencies should be taken into account when considering OXT as a treatment of social deficiencies in autism.

Experience at The Child Development Center of America
lovedrugThis peptide hormone can be rapidly digested in the gut, so intranasal spray is felt to be more reliable and likely to act directly on the brain. Any parent of a sensory child is aware of the difficulty administering a nasal spray. The kids run for the hills! So, a sublingual preparation, available by prescription from a specialized pharmacy, has been a mainstay.

♥ Of the scores of patients who have tried the product, only 3 parents continue to administer the substance. Those few report improved eye contact and focus, and give it once per day, in the morning.

♥ The most common reaction is, “It didn’t make any difference,” or that any improvement wasn’t worth $80-$160 per month.

♥ A few parents have reported transient agitation or worsening of aggression, and discontinued treatment.

♥ One male, teenage patient had a negative psychological reaction that lasted for months, according to the mother. It was very disturbing that we weren’t able to predict this extreme reaction, nor the extended time to recovery.

Conclusions
More clinical experience will lead to improved knowledge about efficacy and safety. Hopefully, doctors will better identify those candidates who are most prone to exhibit positive responses.

Oxytocin therapy may be worth a try in selected patients. The practitioner should be knowledgable and experienced about biomedical intervention. A thorough explanation of the risks and the benefits should be presented and documented. Due to the lack of solid evidence, close follow-up is warranted.

Addendum:
Blood-oxytocin levels in normal range in children with autism, study finds

Low levels of hormone linked to social deficit in autism

Intranasal oxytocin treatment for social deficits and biomarkers of response in children with autism

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Brian D. Udell MD
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