Etiological pathways toward autism and diversities of treatments: from unimodal to multidimensional approaches. Commentary on “An integrative model of autism spectrum disorder: ASD as a neurobiological disorder of experienced environmental deprivation, early life stress, and allostatic overload” by William M. Singletary, M.D.

The diversity of factors that may contribute to autism is enormous. Some lead to therapeutic ideas, most do not. Our own early work focused on possible endogenous opioid excesses in the brain, which lead to the use of low doses of naltrexone (LDN, 0.25 mg/kg, every other day, orally administered). The history of such an intervention is summarized. This strategy, even at much lower doses (such as ∼0.5 mg per day orally), has now been claimed to have benefits for a large variety of bodily problems, including diverse pains, multiple sclerosis, and a variety of other problems. Here I focus on our early experiences in treating autism with LDN, and wonder how it relates to Singletary's fascinating, wide-ranging therapeutic experiences. His interventions, which likely facilitated neuroplasticity (as suggested by the work Singletary reviews by Molly Helt and others), promoted remarkable improvements in seven-year-old Larry, a high-functioning Asperger's child. As Larry progressed from self-centered social aloneness toward the capacity to love with multimodal neuroplasticity-inspired treatments, I wonder if LDN might speed the journey with children like him.