Yatawara, C. J., Einfeld, S. L., Hickie, I. B., Davenport, T. A., & Guastella, A. J. (2015). The effect of oxytocin nasal spray on social interaction deficits observed in young children with autism: A randomized clinical crossover trial. Molecular Psychiatry, 21(9), 1225-1231.
Catherine Kishel
Rutgers University,
Graduate School of Education
Why research this topic?
Social interaction deficits are considered a core symptom of autism spectrum disorder (ASD), but effective treatments for these deficits are limited. Some medications may improve behavior problems that are sometimes associated with ASD (e.g., aggression or over-activity), but there is little evidence for medications effective in treating the core social symptoms of ASD. Behavioral interventions offer significant improvements, but are often time consuming and costly. The hormone oxytocin is associated with social understanding and behavior in typically functioning adults, leading to the possibility that it may be an effective treatment for social symptoms experienced by children with ASD. Initial studies found that oxytocin administered via nasal spray to adults and youth with ASD (aged 12-19) improved emotion recognition. The current study sought to determine the effects of oxytocin nasal spray on social interaction in children ages 3-8 with ASD, since prior research indicates that interventions provided early in childhood offer the best chances for long-term improvement.
What did the researcher do?
The researchers recruited 31 children with ASD ages 3-8 years and randomly assigned them to one of two treatment conditions: 1) oxytocin nasal spray for the first phase of the experiment followed by 2) placebo in the second phase (A-B, 15 participants) or the reverse (B-A, 16 participants). Each phase lasted five weeks, with a four-week period between phases to prevent carryover effects. Neither the participants, their parents, nor the experimenters knew which children were receiving which nasal spray at any time during the experiment; this was done to control for potential bias in the results. All families completed pre-test screening assessments, including the ADOS (Autism Diagnostic Observation Schedule), SRS (Social Responsiveness Scale), DBC (Developmental Behavior Checklist), RBS-R (Repetitive Behavior Scale – Revised), and CSQ (Caregiver Strain Questionnaire) to obtain baseline measures of symptom severity and family burden before phase 1 and again before phase 2. The researchers then looked for a change in these measures, as well as clinician global improvement ratings, after the children experienced both phases of the experiment.
What did the researchers find?
The researchers found that, on average, children improved significantly more in parent-rated social responsiveness (SRS) and clinician global improvement ratings after receiving oxytocin than after receiving placebo. There were no significant differences between oxytocin and placebo for severity of ASD symptoms (ADOS), behavior problems (DBC), or repetitive behavior (RBS-R-P), or for family burden (CSQ). Interestingly, 90% of participants improved on the SRS between pre- and post-test results after receiving oxytocin, while 77% of participants demonstrated improvement between pre- and posttest results after receiving the placebo spray. Conversely, no participant worsened following oxytocin administration, but 10% did so after receiving placebo. No significant differences were found between oxytocin and placebo on adverse reactions experienced by children (adverse reactions included thirst, increased urination/constipation, and hyperactivity and aggression).
What are the strengths and limitations of the study?
A strength of the study is that it is the first doubleblind, randomized, placebo-controlled, crossover clinical trial investigating the effects of oxytocin nasal spray on the social behavior of young children diagnosed with ASD. Oxytocin was found to be well tolerated by the children and easy to administer. Limitations include the small sample size (31 children), the inclusion of children who were taking other psychotropic medications during the experiment, and reliance on parent report as an outcome measure. In addition, many children were excluded because they did not accept nasal spray administration, limiting the generalizability of the results and potential application of this intervention.
What do the results mean?
This study suggests that oxytocin nasal spray may improve social symptoms in young children with ASD. However, these results need to be confirmed in larger studies that include a representative sample of young children with ASD. Nasal administration of oxytocin is an example of the potential for development of a medical treatment for social impairments in children diagnosed with ASD.
Citation for this article:
Hawkins, A. (2018). Research review: The effect of oxytocin nasal spray on social interaction deficits observed in young children with autism: Science in Autism Treatment, 15(2), 19-20.
