Research about the benefits of intranasal oxytocin therapy for autism

Will just a snort make kids sociable?

Since the 1990s, advocates of providing oxytocin to children with autism have discussed articles (e.g., Modahl et al., 1992; Panksepp, 1992) that have reported the possibility that a drug mimicking a naturally occurring hormone makes individuals with autism affiliative and socially connected. Some folks have called the drug, oxytocin, "the love drug." That topic is the focus of this post, but first, it's important to understand a little more about the drug, oxytocin.

Please understand that oxytocin is sometimes called "Pitocin" because that is a trade name for one company's version of the drug. Pitocin may not be equivalent to all oxytocins, but it's a pretty good bet that they are similar!

Oxytocin affects pituitary hormones by influencing neural functions associated with the regulation of behavior. One well-documented use of oxytocin is in child birth, because it helps induce labor; readers should understand that there is a substantial research literature about its use in child birth but I'm not going that direction. Please see Mayo Clinic (2021) for an overview of uses of oxytocin during labor, including proper use and side effects.

Oxytocin with children with autism in the news

One can find a lot of blog posts and such about oxytocin. They sometimes use the tradename, "Pitocin." In what follows, I focus on uses of oxytocin as a therapy for autism, regardless of what name people assign to it. My interest was piqued by a paper from October 2014 by Sikich et al.

The Love Hormone

As noted previously, some experts have discussed the potential benefits of oxytocin for children with autism. Does the love hormone improve affiliative behaviors of children with autism?

What an exciting prospect! A drug that helps kids with autism be more sensitive to other people in their worlds!

What's not to like?

As readers might guess, the potential therapy is all over the Internet. Check this news story about a study from Stanford University

Also, there are other Internet sources available that tout benefits of oxytocin based on research. For example, see the Vimeo video of Professor Adam Guatella, of Children's Health Queensland, describing research from his group (navigate to vimeo.com and find resource 426891799; something between Vimeo and Substack thwarts me from embedding the video).

Does it really work?

So, that brings us to this update. We need to think about this therapy carefully. There are two related questions: (a) does it work and (b) are there downsides?

Of course, we want to know if it "works," but will it do harm? No one I know wants to employ a therapy that does harm!

Cai et al. assessed harmful outcomes. In the studies that Cai et al. (2017) examined, there were some adverse reactions:

Nasal discomfort (14.3%), tiredness (7.2%), irritability (9.0%), diarrhea (4.5%), and skin irritation (4.5%) were the most common adverse events.

Are those outcomes enough to make parents or teachers pause when considering oxytocin therapy? Now, maybe I could stand a little tiredness, but I don't like experiencing some of those outcomes (diarrhea!). If the benefits are great enough, I might be willing to subject myself (or my child) to some of the adverse reactions.

So, there may be side effects. Ugh. But what about the benefits? I started down this path because I saw a new study in the prestigious New England Journal of Medicine (more about it in following notes).

Well, there is additional evidence about oxytocin working, but it is mixed. Here is a sampling of meta-analyses I found:

  • Ooi et al. (2017) reviewed trials. They concluded that "Previous evidence revealed mixed findings about the effects of oxytocin on ASD. Given the limited number of RCTs, our summary of findings on the effectiveness of oxytocin on ASD should still be considered tentative" (abstract).

  • Wang et al. (2019) concluded that "oxytocin had a small and non-significant effect on core symptoms in ASD population."

  • Huang and colleagues (2020) reported that their "findings suggest that oxytocin...can be regarded as an effective treatment for some core aspects of ASD, especially in the domain of social functioning" (abstract).

There are plenty of other summaries of the research. And, as one can tell from reading just these three snippets, there is not a clear consensus. In scientific research, it is often the case that consensus is lacking. (Why? Because variations in scientific methods produce different outcomes. It’s why one must not make a decision based on any one study, but examine the preponderance of evidence after a shipload of evidence has been collected.)

Indeed, the article I mentioned that was from the New England Journal of Medicine (Sikich, et al., 2021) presented results from a scientifically strong study, results that should not be encouraging for advocates of this therapy. We’ll need to see how those results hold up in replication and how they compare to other studies using strong methods. Wait and see!

Conclusion

I'm not convinced that oxytocin is effective or safe. If it was my child, I'd be very leery of having her or him snort it.

Sources

Cai, Q., Feng, L, & Yap, K. Z. (2017). Systematic review and meta-analysis of reported adverse events of long-term intranasal oxytocin treatment for autism spectrum disorder. Psychiatry and Clinical Neurosciences, 72(3), 140-151. https://doi.org/10.1111/pcn.12627

Deolinda, A. R. B. (2021). Oxytocin and autism: Exploring the ‘Love Drug.’ Autism Parenting Magazine. https://www.autismparentingmagazine.com/oxytocin-autism/

Huang, Y., Huang, X., Ebstein, R. P., & Rongjun, Y. (2020). Intranasal oxytocin in the treatment of autism spectrum disorders: A multilevel meta-analysis. Neuroscinece & BioBehavioral Reviews, 122(1), 18-27. https://doi.org/10.1016/j.neubiorev.2020.12.028

Mayo Clinic. (2021). Oxytocin (intravenous route, intramuscular route). Mayo Clinic Web site. https://www.mayoclinic.org/drugs-supplements/oxytocin-intravenous-route-intramuscular-route/description/drg-20065254

Modahl, C., Fein, D., Waterhouse, L., & Newton, N. (1992). Does oxytocin deficiency mediate social deficits in autism. Journal of Autism and Developmental Disorders, 22, 449–451.

Ooi, Y. P., Weng, S. J., Kossowsky, J., Gerger, H., & Sung, M. (2017). Oxytocin and autism spectrum disorders: A systematic review and meta-analysis of randomized controlled trials. Pharmacopsychiatry, 50(01), 5-13. https://doi.org/10.1055/s-0042-109400

Panksepp, J. (1992). Oxytocin effects on emotional processes: Separation distress, social bonding, and relationships to psychiatric disorders. Annals of the New York Academy of Sciences, 652, 243–252.

Sikich, L., Kolevzon, A., King, B. H., McDougle, C. J., Sanders, K. B., Kim, S. J., Spanos, M., Chandrasekhar, T., Trelles, P., Rockhill, C. M., Palumbo, M. L., & Cundiff, A. W., Montgomery, A., Siper, P., Minjarez, M., Nowinski, L. A., Marler, S., Shuffrey, L. C., Alderman, C., Weisman...Vensta-VanderWeel, J. (2021). Intranasal oxytocin in children and adolescents with autism spectrum disorder. New England Journal of Medicine, 385(16), 1462-1473. https://doi.org/10.1056/NEJMoa2103583

Wang, Y., Wang, M-J., Rong, Y., He, H-Z, & Yang, C-J. (2019). Oxytocin therapy for core symptoms in autism spectrum disorder: An updated meta-analysis of randomized controlled trials. Research in Autism Spectrum Disorders, 64(x), 63-75. https://doi.org/10.1016/j.rasd.2019.03.007

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