The Appeal of Unvalidated Treatments By Caitlin LaBarbera ABA 553 Assessing Autism Interventions

Introduction With the rise of autism and other developmental disabilities there is a new claim for a cure around every corner. Whether it is McCarty proclaiming how she saved her son, changing diets, or natural healing, there are new treatments popping up everyday.

Introduction With all these new “fad” treatments, we as professionals need to be able to identify interventions that are both validated and plausible. We need to ask our self the question, Are they scientific and data driven treatments or are they fads that promise false hope?

Validated Treatments Scientifically Valid Treatments Involve Increasing skills in specific areas Improving functioning in every day situations Contain controlled studies Consistent with previous knowledge Treatments with solid scientific support: Applied Behavior Analysis Psychotropic Medication These are both considered validated and plausible in the scientific community Skill areas include communication/self care With Objective measures of behaviors relevant to every day functioning

Unvalidated Treatments Pseudoscientific Treatments Interventions that are considered to have little to no scientific basis Appealing because they are advertised as Cures Fast and Easy “Deeper” Benefits Natural In reality these interventions provide false hope and can sometimes cause more problems

How can you determine if a treatment is both validated and plausible, or if it is just another fad? Evaluating treatments is complicated by the huge variety of interventions offered. There are megavitamins, diets, medications, sensorimotor therapies, relationships therapies, computer softer ware programs, and many more up and coming interventions.

Red Flags . Tristram Smith gives us several key pointers on picking out Scientifically Valid Treatments while weeding out Pseudoscientific Interventions.

Cure Healing Miracle Breakthrough Revolution Remedy HOW many times have you turned on the tv or picked up a paper and see one of these words in relation to autism. I’m sure all of us hope that this will one day be true but what these word should tell you is to be cautious and look for the science. These are Eye catching, attention grabbing words for service providers and families. As appealing as these words are History has shown us that the causes and cure of a disability having suddenly been discovered are almost certain to be false. Revolution Remedy

We found a cure… Facilitated Communication Popular interventions that “found a cure” included: Facilitated Communication Auditory Integration Training Gentle Teaching All were found to be infective and some proved to create problems instead of eliminating them. Since the 90’s there have been a number of treatments that have professed a “cure”

Important Sounding but Vague Benefits Enhanced Learning A Better Sense of Self Increased Focus Improved Body Awareness These benefits are cited more often by family's as a reason for trying an Unvalidated treatment than the promise fore a cure. The problem with this is.. A Greater Well-Being Reduced Tactile Defensiveness

Important Sounding but Vague Benefits Lack scientific evaluations Lack controlled studies Benefits are so vague that testing them would be difficult if not impossible. How do you test a better sense of self, or a greater well being?

http://www.youtube.com/watch?v=8JdDU0Ql8EI Important Sounding but Vague Benefits This type of healing treatment is a good example of important sounding, but vague benefits. There is not scientific data behind her hear massaging

Controlled vs. Uncontrolled Studies ABA and Psychotropic Medication – Scientifically rigorous and controlled studies Unvalidated treatments – Make no distinction between rigorous and nonrigorous studies Uncontrolled Lack objective measures Megavitamin Therapies These studies have controls to ensure that individuals who receive the treatment improve to a greater extent than they would have with out the treatment Megavitamin therapies - case studies, Testimonies from parents, and surveys that supported the treatments but that does not necessary meant that they meet the standards for scientifically valid treatment. When the case studies and surveys were put through controlled studies they did not stand up to the evidence stated

Technology Technology has extraordinary uses in science but having technology in a treatment does not mean that the treatment is ligament. Is the technology used reliable and does it support the study? Or is technology thrown in to make the treatment appear validated Pseudoscientific treatments often incorporate sophisticated medical or educational equipment, such as computer software specialized laboratory tests of urine or blood and bio feedback on brainwaves. They do this to make you think that the treatment is scientifically valid

Criticisms of Validated Treatments Criticism may be used to justify implementing their own interventions Using criticism to hide one of their own faults “Criticisms of one treatment or its practitioners do not constitute evidence for the effectiveness of another treatment (Smith 2005) .” Criticisms of validated treatments often come from pseudoscientific interventions Example: Medication causes negative side effects so you should try… our natural way!! But does that mean that the “natural” way works?

Subjective Evidence Testimonies from parents Case studies Surveys Unvalidated interventions tend to rely on Testimonies from parents Case studies Surveys Popularity Longevity These things cannot be substitute for a controlled study You need to be careful when looking at scientific evidence It has been shown that many treatments that have received favorable survey ratings have not held up in controlled studies. So you need to look cautiously on where your scientific evidence is coming from

http://www.youtube.com/watch?v=3qR6aDkVjYY An example of subjective evidence is that lot wheat and dairy free diets rely on parent testimonies, and individual case studies

Example: Diets – Eliminating Dairy and Wheat. Is it really the diet? Parents desire to see gains Protein deficiency Spending more time with child Deprivation – Motivation Other environmental changes Due to the parents need to spend more time regulating what the child eats

Core Deficits Once the deficit is corrected there will be global improvements in functioning Two believed deficits include: The lack of ability to form reciprocal relationships Problem in processing or sensory input Proposing that changes in one behavior will by itself lead to changes in other behaviors goes against a large body of research on humans and other organisms in both clinical and laboratory settings (Detterman&Sternberg,1995). This is where a treatment revolves around the idea that there is one major thing missing or out of sorts with the child Examples – play therapies, gentle teaching, holding therapies. It simplifies treatment – Fix one thing, and everything else will fall inline. Treatments based on core deficits are incompatible with other knowledge about human behavior.

Natural Therapies “Natural Therapies” Special diets to eliminate food additives Cut out wheat a dairy Chelation therapy Antifungal medications Shunning vaccinations “Natural” does not mean safe or effective. Chelation therapy – take medication to remove heavy metals and purify Anti fungal medications – taken for alleged yeast infections attributed a history of antibiotic use

Treatment Combinations Treatments are often combined in hopes to accelerate and maximize treatment Some treatments encourage combinations Megavitamins Reality - combining treatments have no effect and can even reduce effectiveness of treatments. Megavitamins - state that it is inappropriate to use as a stand alone treatment, but are important additions to behavioral interventions. Investigators believe that the impact of therapies like megavitamins should be able to be tested and proven effective in isolation. And that claiming that it has little impact alone should serve as warning that the treatment could be ineffective.

Experimenting Implementing a new treatment First, make only one treatment change at a time Second, Identify specific target behaviors Use objective measures to obtain a baseline Finally, monitor changes in the target behavior on an on going basis with objective measures obtained by raters who are blind to treatment. Hyman and Levy (2000) Now that you know about all the red flag and everything to look out for

http://www.youtube.com/watch?v=qbhkX2oBmJY What would be appealing? How many red flags can you pick out?

Evaluating Treatments Treatments that are both validated and plausible Treatments that are Unvalidated and implausible Should be Widely Used Should be Avoided

Reference Jacobson, J. W., Foxx, R. M., & Mulick, J. A. (2005). Controversial therapies for developmental disabilities, fad, fashion, and science in professional practice. Lawrence Erlbaum.

http://www.youtube.com/watch?v=s6Svp81lPhQ Weed Watch a short clip on a family that tried a new intervention