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Ask the Mental Health Expert Archives 2001-2004

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SIB Medicine

Q. I have a 9-year-old son who has severe autism. I came across a study on Trexan (by Jaak Panksep of Bolling Green University, Ohio) for self injurious behavior (SIB). I was grateful it worked for the SIB at a low dose. Since he has grown, should Trexan be increased to accommodate his growth or will a higher dose defeat the help it has already given?

The dose is 1/3 of a 50 mg tablet I crush up and administer once a day. Since my son has grown and his testosterone has increased, I spoke to our family physician who suggested Casodex. The new medicine was added to his regimen and has helped to keep him from putting holes in my wall with his head and he no longer tears up the recliner.

A. I am happy that naltrexone seems to have been helpful with your son. As I'm sure you know, there are no medications approved by the U.S. Food & Drug Administration (FDA) specifically for use in Autism, nor is Trexan (naltrexone) approved for this use. Nevertheless, some clinicians and researchers have found naltrexone to be helpful in reducing self-injurious behavior (SIB) in various patient populations, including some with autism.

Not all the research has borne this out, however. The study you may have in mind is by J. Panksepp and P. Lensing, Department of Psychology, Bowling Green State University, Ohio 43403. It is published in J Autism Dev Disord 1991 Jun;21(2):243-9.

With respect to dosing, several of the controlled studies have used a dose of 1 mg/kg naltrexone. Thus, in a double-blind placebo-controlled crossover trial, 23 autistic children, aged 3-7 years, were treated with a mean daily dosage of 1 mg/kg naltrexone for 4 weeks. Drug effects were monitored with behavior checklists rated by parents and teachers, and ethological playroom observations. On average, parents' checklists and playroom data did not show a difference between naltrexone treatment and placebo ("sugar pill") treatment; however, teachers significantly favored naltrexone treatment. They reported a decrease in hyperactivity and irritability.

No effects of naltrexone on social and stereotypic behavior could be demonstrated (see Willemsen-Swinkels et al, Biol Psychiatry 1996 Jun 15;39(12):1023-31). Using this study as a guideline, one might choose to increase the naltrexone dose as the patient got older and heavier--however, that doesn't necessarily mean that your son should be on a larger dose of naltrexone. That is really the call of his physician, and may depend on a variety of factors; e.g., how the naltrexone may interact with your son's other medications, whether any paradoxical responses to naltrexone have been seen in your son's case (i.e., worsening of SIB, which has occasionally been reported), and other factors.

Still, I do think it would be important to raise this issue with your son's doctor. I hope that your son's condition improves. If not, you may want to consider getting a second opinion from an expert in managing autistic behaviors.

July 2003

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