Oxytocin and the autism anti-treatment movement

Unless you were not paying attention last month (or possibly in a comma), you were sure to notice the new study involving oxytocin and autism. In this small study, researchers demonstrated that an inhaled form of oxytocin could improve social behaviors in adults with high functioning autism. The result is very tentative but, assuming that the results can be replicated in future studies, oxytocin has the potential to be a powerful treatment for people with autism.

This is not the first study to show a link between autism in oxytocin. Prior research has shown oxytocin also can help improve other aspects of social behavior, such as emotion recognition, in young adults with autism. People with autism are known to have genetic defects on genes associated with oxytocin while others have epigentic disregulation of said genes. It has also been shown that children and adults with autism have lower levels of oxytocin in their blood.

Or in simpler terms, we have a known genetic and environmental issue, a method of detecting the problem, and a potential way to address it. And, if the current study is any indication, addressing the deficiency has the potential to improve functioning in one of the core deficits of autism, at least in some people with autism.

If you remember what I wrote a few weeks back, there is some evidence that the first deficits of autism to emerge in infants are social ones and that some of delay in acquiring other skills, such as speech, might be due to problems with social learning. What would happen if we were able to detect these problems in very young children when they are first developing and correct them? I am thinking that it would be possible to prevent other problems from developing and help the infant progress at a normal pace.

The above is complete speculation on my part and a substantial amount of work still needs to be done before any treatments involving oxytocin are even possible. But the potential is there for this to become of the first treatments to target the core problems with autism.

Who could possibly be against that?

Well, Michelle Dawson for one. As I have written about before, Ms Dawson is one of the people who feel that it is somehow unethical to try to treat autism. Try as I might, I simply cannot understand why she opposes helping children or adults with autism. But I can easily point out the absurdity of her arguments against the current study.

As I said above, the current study demonstrated that oxytocin can improve social functioning and it is the way that it demonstrated this improvement that is the core of what Ms Dawson is objecting to.

This study was not an extended study of the effectiveness of oxytocin but rather a relatively simple test of whether there was any significant effect. The researchers were giving a nasal form of oxytocin and the effects of the dose were very short lived. As a result, the test used had to be a simple yet an effective measure of social functioning.

The researchers chose a simulated ball game that was played on a computer with three other players - A, B, and C. The study participants were under the impression that the other players were real people but, in reality, they were simulated by a computer program. The way the game was played was that once a player received the ball, they had to chose another player to pass it to. That player would then in turn pick one of the other players and pass the ball to them. And so on and so forth. Each game lasted a good number of rounds (passes).

The games always started off "fairly" and the three computer players (A, B, and C) would pick another participant at random to pass the ball to. But after a few rounds, the three computer players changed how they decided who to pass the ball to.

Player A (the "good" player) would choose to pass the ball more often to the study participant while Player C (the "bad" player) would choose not to pass the ball to the study participant very often. Player B would remain neutral.

To further stack the deck, the researchers told the participants that each time a player received the ball, they would earn 2 euro. So when the participant received the ball and earned money, they then had the option of returning the favor to person who passed them the ball or of passing the ball to another player. Thus, the game was a really a test of reciprocity. As most knowledgeable people would tell you, reciprocity is one of those social skills that can be disrupted in people with autism.

The study participants were divided into three groups - a "normal" group, a treatment group, and a placebo group. The treatment group and placebo groups both contained people with autism but the treatment group received a dose of oxytocin while the placebo group received a placebo.

As would be expected, once the bias of the other players became clear, the "normal" participants strongly favored passing the ball to player A (the "good" player), presumably because A was much more likely to pass it back to them, and much less likely to pass the ball to player C (the "bad" player), presumably because C was not as likely to return the favor.

The participants in the placebo group, unlike the "normal" participants, did not show a preference for passing the ball to any other player but seemed to pass it to the other players almost equally.

However, the participants in the oxytocin group more closely resembled the "normal" group and showed a preference for passing the ball to player A (the "good" player) while excluding player C (the "bad" player).

To confirm these findings, the researchers staged a second trial with a modified game using another group of adults with autism. The participants were once again divided into placebo and treatment groups but the game was modified to remove all mention of monetary rewards. The results were again the same, with the placebo group not showing any preference while the treatment group showed a preference for player A while excluding player C.

Based mostly on this finding (and several other secondary findings), the researchers concluded that oxytocin might help restore "normal" social functioning in people with autism.

To perfectly honest, this test is somewhat simplistic and not very indicative of what oxytocin would do for social skills in general. Based on the results of this one study, we cannot generalize the finding and say that oxytocin would be a good treatment for autism.  But for what it is, this study was well done and the results are pretty solid.

Now that I have explained the game, lets return to Michelle Dawson and her opinions of the study. Ms Dawson apparently feels that the reason the placebo group passed the ball randomly in the face of biased behavior is that -

The autistic [placebo group] in contrast displayed no such selfish and discriminatory behaviour. They continued to throw the ball to the other players in equal proportion, ignoring their self-interest in favour of keeping all players equally included.

Further, subjective ratings of the other players revealed that the autistic [placebo group] did not have the kinds of biases that are routinely called hypocrisy. They did not judge C, who shared the most with B, as worse or less trustworthy than A, who shared the most with themselves.

According to Andari et al. (in press), autistics "cannot understand or engage in social situations," as evidenced by autistics' outstandingly altruistic performance in this game. It is this profound social deficit, this altruistic autistic behaviour, that was targeted for treatment.

Basically, Ms Dawson feels that the placebo group was able to understand the social situation and made a conscious choice not to "judge" or engage in "hypocrisy". These "austicis" took the feelings of the other players into account and decided to act in an altruistic manner so that no other player felt left out. Taking this argument to the logic conclusion, the treatment group had to have lost the ability to act in an altruistic manner and decided to be hypocritical and purposely exclude the other players from the game.

Since these statements are contrary to everything that we know about autism as well as the very definition of what the medical condition of autism is, I would respectfully suggest a simpler explanation to fit the facts. The reason that the placebo group acted the way they did because was because they simply failed to react to the social situation.

If you look at the results of the game in the initial rounds before the other players started showing their biases, the "normal" group was sending the ball to the other players equally. It is only once the bias become obvious that the "normal" and treatment groups started changing their actions. This is a typical - and desirable - social trait. We are more likely to respond favorably to people who respond favorably to us and less likely to act favorably to those who discriminate against us.

But Ms. Dawson would have you believe that people with autism someone have a superior grasp of social situations and consciously chose to be altruistic.

Which of these sounds like autism to you?


References

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Andari E, Duhamel JR, Zalla T, Herbrecht E, Leboyer M, Sirigu A. Promoting social behavior with oxytocin in high-functioning autism spectrum disorders. Proc Natl Acad Sci U S A. 2010 Mar 2;107(9):4389-94. Epub 2010 Feb 16. PubMed PMID: 20160081.

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