Autism Case Report: Cause and Treatment of “High Opioid Tone” Autism

Abstract

Introduction: Neurobiological systems engineering models are useful for treating patients. We show a model of “high opioid tone” autism and present a hypothesis about how autism is caused by administration of opioids during childbirth.Main Symptoms: Clinical diagnosis of autism in a 25 year old man was confirmed by a Social Responsiveness Scale (SRS) self-rating of 79, severe, and a Social Communications Questionnaire (SCQ-2) by the patient's father scoring 27. Cold pressor time (CPT) was 190 seconds—unusually long, consonant with the high pain tolerance of autism.Therapeutic Intervention and Outcomes: At naltrexone 50 mg/day SRS fell to 54 and SCQ-−2–9; both non-significant. CPT fell to 28, repeat 39 s. Improved relatedness was experienced ambivalently, understood as feelings never before experienced—causing pain. Non-compliance with naltrexone was followed by cutting open his palm and drinking alcoholically. Transference focused psychotherapy has helped him remain naltrexone—compliant while he works on issues of identity and relatedness.Conclusion: The model suggests studies that could be conducted to both prevent and treat this form of autism.

Reduced Child-Oriented Face Mirroring Brain Responses in Mothers With Opioid Use Disorder: An Exploratory Study

“…Although allied research in humans has suggested that opioids like buprenorphine might reduce separation distress and offer treatment for some forms of depression (Panksepp and Yovell, 2014;Yovell et al, 2016), there have also been concerns that opioids may usurp healthy parent-infant separation distress and reward circuits that may be critical to mother-infant bonding (Swain et al, 2005). Indeed, "high opioid tone" has been recently discussed as a concern in the development of autism spectrum disorder (Anugu et al, 2021), which is arguably one of several developmental disorders showing impaired intersubjective function (Trevarthen and Aitken, 2001). Thus, although BT is highly effective for reducing withdrawal, intersubjectivity-dependent face mirroring may be adversely influenced.…”

Role of Brain Modulators in Neurodevelopment: Focus on Autism Spectrum Disorder and Associated Comorbidities

“…There is an interesting hypothesis reported early in the literature that assumed opioid excess in the brain is a cause or a factor of autistic features. A recent case report hypothesized a “high opioid tone” group of autistic patients [ 170 , 171 , 172 ]. However, the use of opioid receptor antagonist naltrexone to overcome such excess resulted in a significant reduction in hyperactivity without any improvement in the core symptoms of ASD [ 173 ].…”

Affective Neuroscience Contributions to the Treatment of Addiction: The Role of Social Instincts, Pleasure and SEEKING

“…In terms of the social instincts, the person exposed to the extreme or ambivalent separation-distress trauma will experience difficulties in their relationships with others. Johnson (65)(66)(67)(68) has extensively worked on an opioid-tone model that hypothesizes a correlation between opioid tone and proximity to others. If a person feels lonely, their opioid tone is low and can be modulated by the company of others.…”

“…The second category entails the modulation of the need for proximity to others ( 66 ). High opioid tone contributes to the subjective feeling that the person does not need to relate to others as can be seen in Autism Spectrum Disorder (ASD) ( 65 ). This feeling may cause the pleasurable idea of self-sufficiency, which would apparently solve the problem of failed trust derived from early childhood separation-distress trauma.…”