| Home | Article Database | Fun Stuff | Resources | Tools & Calculators | Search HY
Ask the Mental Health Expert Archives 2001-2004
Expert Home | Archives by Date | Search Expert Archives | For Professionals | For Consumers
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
Disclaimer  Back to Ask the Expert
|
