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November 4, 2011

Nicotine Therapy Shows Promise for Autistic Adult

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Nicotine Treatment Shows Promise for Self-Injurious Behavior in Autism.

                            By: Kim Oakley

Self-Injurious behavior (SIB) is one of the most devastating and difficult to treat behaviors in autistic individuals. As the population of Autistic Spectrum Disorder (ASD) swells, researchers sense the urgency to find new and better treatments. Sadly, this urgency has not extended to self-injurious behaviors in autism. Depending on which study read, about 10-30% of autistics suffer from SIB. That said, let’s pause and recognize the difference between autistics who episodically and mildly self-abuse and those who chronically and savagely self-abuse. For example, an autistic who mildly slaps his leg every few months is a world apart from an autistic that slams his fists into his head or bite pieces of flesh from his arm everyday.

Thus, when I write about SIB, I refer to serious case. Cases like my son’s. I’m not the only parent of an autistic child with SIB. There are thousands of other self-injurious autistics around the world. I can only imagine the pain of parents living in a third world country with an autistic child with SIB. Have we even identified where they are?

For decades, academics, behaviorists, psychologists and others have sought to discover reasons and remedies for SIB. Few research studies have held promise. One reason is the standard of care for treating SIB doesn’t include diagnosing brain function. Autistics held captive to years of SIB require a serious examination of brain function. Why the brain?

Autistic brains are unlike other brains. One study showed autistic patients had lower perfusion in right temporal, occipital lobe, thalami, and left basal ganglia (Journal of Neuropsychiatry, 2000). Another showed brain dysfunction in temporal and parietal lobes with left cerebral hemisphere showing greater abnormality than left side (Journal of Nuclear Medicine, Vol 36, No. 7, 1995).

After revolving inside the world of autism and SIB for over 20 years, I believe a major fueling mechanism involved in SIB is neurotransmitter dysfunction. This would explain fluctuating antecedents. And baffling mood swings.

Research shows disruptions of acetylcholine in brains of autistic adults. Interestingly, last year, a functional magnetic resonance image (fMRI) of my son’s brain showed “blunted choline.” I discovered this by persistent inquiry, after repeatedly told test “showed nothing significant.”

Blunted choline in the autistic brain is far from insignificant. It was the first hopeful clue I’d heard in years. Immediately, I began researching ways to elevate choline in brain. That’s how I came across nicotine research. Not that studies show direct connections to nicotine helping autistics with SIB, but nicotine stood out to me as a unique therapy to target and tweak not only acetylcholine, but other neurotransmitters likely involved in fueling my son’s SIB.

Case in point— researchers found, along with serotonin and dopamine, deficits in the neurotransmitter acetylcholine may be associated with autism (Gillberg C. Steffenburg, et al., 1989). Stimulation of cholinergic neurons releases dopamine in brain. One study suggested dysregulation in dopamine within basal ganglia as a causative factor of SIB (Canales et al., 2000).

So we see neurotransmitter dysfunction in autism. The challenge is identifying which neurotransmitters are involved in lowering an autistic individual’s SIB threshold. It’s scary to think I would’ve never known my son’s brain was deficient in a neurotransmitter, had I not pushed for an fMRI and later discovered “blunted choline.” I’m not saying every parent of an autistic child should demand brain imaging. But in cases of autism with intractable SIB, it should be the standard of care.

Back to nicotine elevating choline in the brain: Nicotine activates cholinergic neurons in many areas of brain, improving memory, focus and concentration. A foggy brain with impaired concentration increases anxiety. Anxiety is one of many antecedents that trigger my son’s SIB. Because multiple antecedents fuel SIB, it’s prudent to rule out and detect if we ever hope to discover more effective treatments for SIB.  

Not all physicians are receptive to novel, emerging treatments. And even fewer respect a parent’s research and recommendations for therapy. Thankfully, my son’s general practitioner, neurologist and psychiatrist (all females I might add) are amazingly kind and receptive to research and suggestions I’ve presented. They’re open-minded doctors. They want to help my son. I couldn’t ask for a better team of doctors. Surely, this has helped renew hope in what was becoming a hopeless situation.

Conclusion: My autistic son began nicotine patch therapy to help treat his chronic, episodic, brutal SIB in July of this year, 2011. He began with 14 mg patch, placed on shoulder, 1x daily, removed at night, and replaced with a fresh patch, in a different location on upper body, in morning. Within a few days, we saw a reduction in SIB and increased focus and concentration.

Three weeks later, we lowered the dose. He began wearing the 7mg patch. We saw a slight increase in SIB, but it may have been sparked by constipation or what appeared as a slight cold, which he recuperated from rather quickly (that was odd).

As of today, November 4, 2011, he’s still on 7mg Nicotine Patch daily, with 14 mg patches used PRN (as needed) for days SIB escalates. Using higher dose patch PRN has helped calm him on days he exhibits a sharp increase in slapping or punching his body.

We have not seen an increase in seizure activity while on Nicotine Patch. Not even on 14 mg dose. We have seen slight decrease in appetite, on 14 mg patch, however.

We have also seen significant increase in laughter, focus and self-control. He’s not so “stuck” or “scattered” in his own world. Also, fine and gross motor skills appear better. Not dragging his feet as much. All in all, while not a cure, using Nicotine Patch therapy to help treat my son’s devastating SIB continues to show promising results.

Written by Kim Oakley, mother of a handsome autistic boy with SIB


Amy said...

That is AMAZING Kim!!! I am soooo happy that this helped your son :) I have passed your blog on to another parent whose son has devastating SIB and nothing they have tried has worked. I hope you don't mind!

ALso want to let you know that you and your son ARE helping others by blogging. I know Nick's SIB is nothing like your sons, but it is one of the most horrible things to witness your child hurt themselves. It is because of your first post about choline that I started buying the vitamins with choline added. Thank you! Who would have ever thought of something as simple as a nicotine patch?? I am glad your handsome boy is doing wonderful!

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