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

2. 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.

3. 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?

4. 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

5. 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

6. 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.

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

8. 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

9. 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”

10. 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

11. 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?

12.
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

13. 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

14. 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

15. 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?

16. 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

17.
An example of subjective evidence is that lot wheat and dairy free diets rely on parent testimonies, and individual case studies

18. 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

19. 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.

20. 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

21. 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.

22. 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

23.
What would be appealing?
How many red flags can you pick out?

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

25. 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.

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