The issue of public masturbation in kids with autism is probably one of the most uncomfortable topics for parents to discuss with their clinicians or pediatricians. I usually can sense when a parent wants to bring up the topic, and the parents are usually relieved when I address the issue directly. Inappropriate sexual behaviors (public masturbation or nudity, sexually touching of strangers, etc) are actually not that uncommon among children with a variety of developmental disorders, including autism.
Usually clinicians recommend behavioral modification techniques, similar to the techniques used to decrease the rates of any other undesirable behaviors (please note that in this post I am not talking about masturbation as an “undesirable behavior”. I am instead talking about public masturbation or other type of public sexual behaviors that are considered in most societies to be inappropriate). But often, when the behaviors are not responsive to behavioral interventions, many children show improvements from the use of specific medications.

A review of: Coskun, M., Karakoc, S., Kircelli, F., & Mukaddes, N. (2009). Effectiveness of Mirtazapine in the Treatment of Inappropriate Sexual Behaviors in Individuals with Autistic Disorder Journal of Child and Adolescent Psychopharmacology, 19 (2), 203-206 DOI: 10.1089/cap.2008.020

In a study published in the journal of Child and Adolescent Psychopharmacology, a team of researchers from Turkey examined the effectiveness and safety of Mirtazapine (Rameron) for the treatment of inappropriate sexual behaviors in autism. The study included 10 children with a diagnosis of autism (8 boys and 2 girls, ranging in age from 5 to 16). These children had received behavioral and psychoedcucational interventions for their inappropriate sexual behaviors but these interventions did not reduce these problems. The authors described the percentage of the children who engaged in the different concerning behaviors: non-private masturbation (100%), touching people inappropriately (50%), disrobing in public (20%), sexual interest in particular body parts or nonhuman objects (20%), and observing people bathing or undressing (10%). Two of these children had a co-morbid diagnosis of ADHD and two others had a co-morbid diagnosis of depression.

The children were treated with an initial dosage of 7.5-15mg per day and this was increased according to response and side effects to a maximum of 30mg per day.

The results:
Based on the ‘excessive masturbation’ item from the Clinical Global Impressions-Improvement Scale, the authors found that:

50% of the subjects showed “very much improvement”
30% showed “much improvement”
10% showed “moderate improvement”

The researchers then concluded that the study provides support for the effectiveness of Mirtazapine in the treatment of inappropriate sexual behaviors in children with autism.

But why Mirtazapine?

Mirtazapine is relatively old anti-depressant that is still commonly used. In clinical practice Mirtazapine is often used used because (instead of despite of) some of its side effects (in specific cases desirable side effects). For example, Mirtazapine is associated with significant weight gain, thus it is commonly used for the treatment of depression in people with anorexia. Likewise, Mirtazapine is associated with severe drowsiness, thus it is often used for individuals with depression and insomnia. Thus, the selection of Mirtazapine for this study was also related to another side effect. While SSRI antidepressants (such as Prozac) are associated with sexual dysfunction (for example erectile dysfunction), Mirtazapine has been found to reduce libido (reduced sexual desire). Thus, it is sensible to expect that this medication, by reducing libido, would be effective in the treatment of inappropriate sexual behaviors.

However, the authors correctly discussed the most obvious limitation of this study: no control condition. Since there was no control group taking a placebo pill, it is impossible to tell for sure whether the improvements observed were due to the medication or to the placebo effect (e.g., the expectation by the parents that the medication was supposed to work). Thus, although the study provides some preliminary evidence of the potential effectiveness of Mirtazapine for the treatment for excessive non-private masturbation, there is a need for placebo-controlled studies using larger sample sizes.

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8 Responses to Mirtazapine for the treatment of public masturbation and inappropriate sexual behaviors in autism

  1. Brandon says:

    This is dangerous information. You stated that behavioral therapies often do not work but failed to clearly and explicitly warn people that alternative therapies such as behavior modification should be tried first.

    Just another example of the psychiatric field picking on individuals with autism.

  2. Brandon says:

    Thanks for the reply. You’re right, I misread your post.

    My point is you did not explicitly, and a stress the word explicitly, warn that medication should only be used as a last resort.

    If I can misread this post, so can a parent of an autistic child, who then decides to go put their child on medication without trying behavior therapy first.

    If you disagree with my statement that medication should only be used as a last resort, please reply to let people know. After all your the professional psychiatrist with a PhD, I’m not.

  3. Thank you for your post. However, I think you misinterpreted my writing. I stated that:

    “often when the behaviors are not responsive to behavioral interventions, many children show improvements from the use of specific medications”.

    I did not say that “behavioral interventions often didn’t work”. I said that when then the behaviors are non-responsive to behavioral interventions, often they respond to medication.

    I also stated clearly that in this particular study the children had received behavioral treatments but unfortunately for these children such interventions have not worked.

    Thank you again for your post.

  4. Thank you Brandon for your comment.

    You are right in that I did not state explicitly that medication should be used as a last resort. There is a reason for this. I stated that most clinicians recommend behavioral interventions. It is the norm to try behavioral intervention first, and most clinicians would do this in most cases. However, the question of which interventions should be tried first needs to be answered by the family in consultation with their clinician. The answer to that question can depend upon a number of factors that are unique to each case. At I have a policy not to provide explicit clinical recommendations, precisely because I strongly believe that clinical decisions should be made locally, between families and their service providers. To this end, I limit my discussions to explaining the research findings and providing a summary of each study’s strengths and limitations.

    Thank you again for your comments and for visiting this site. Nestor.

  5. Aspie in NYC says:

    I have a problem with approach. It implies that autism means the inability to either learn or self-control … neither of which is completely true.

    The next step might be do use Lupron like some !Dan doctors to chemically castrate autistic kids … makes them more dosile. If you’re going to do that then why not actual castration. After all, people “fix” their pets to cut down on the humping and aggession.

    There is a moral issue here that needs to be looked at. When kids grow up … what are their rights? Sometimes the bell cannot be unrung.

    – Bob S.

  6. anil says:

    just for the correction of a little dysinformation: the study that have been mentioned was not carried out by hungarian researchers. i prefer not to mention the correct one, but i think much care must be given for such references and/or informations.

  7. PM says:

    I need urgent advise regarding my 14 year old daughter! Firstly we have three girls 14 12 and 6. The 12 year old diagnosed with ADHD. The 14 year old displayed symptoms which we have now (too late) recognised as symptoms of Autism. She when very young around 3 4 used to rock her self on arms of chairs and we would often catch her basically playing with herself and tell her off which she began to hide this we thought she would grow out of it. We didnt connect it with Autism. She now has massive sexual desires and goes out with this in her mind, intentions to have sex in public places, unaware that it is not acceptable. How can we firstly have her checked and diagnosed as autistic if indeed she is???

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