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Monday, January 14, 2013

Treatments Without Evidence

In Research on Autism Spectrum Disorders, Johnny Matson and colleagues ask: "Why are there so many unsubstantiated treatments in autism?"  The abstract:
The number of interventions used in the field of autism is astronomical. Unfortunately, while there are effective and well-researched methods, many of the techniques that parents use have no empirical support. These interventions are expensive, take up valuable time, and in some cases are dangerous. How bad is this problem, how did the field get here, and what are potential solutions? This review covers this important but infrequently discussed topic.
► Large numbers of treatments in widespread use have little or no research support.
► There are a number of factors that appear to be driving this very disturbing trend.
► The gap between the evidence base and the use of unsubstantiated treatments appears to be growing.
► More emphasis on establishing guidelines, enforcing professional standards, and disseminating information is needed.
What are some unsubstantiated treatments?
 Parents gain information from many sources. Testimonials, parent groups and acquaintances, and especially the Internet are rich sources of misinformation. Often an impetus to seek these alternative methods is the lack of satisfaction and/or ineffectiveness of treatment. One common method is complementary and alternative medicines such as special diets, special vitamins, animal therapy (e.g., petting dogs, riding horses, etc.), chelation therapy, craniosacral therapy, music therapy, and  secretin. Estimates are that 32–92% of parents use one or more of these methods for their children with ASD. Additionally, it has been reported that 62% of parents shared their use of one or more of these methods with their child’s primary care doctor (Wong & Smith, 2006). These treatments are expensive, require a great deal of time and effort, are often dangerous, and they have not been proven to be effective. Davis and colleagues (2013) reviewed the available research on chelation therapy, for example, and concluded that the evidence supporting its effectiveness is extremely weak. Likewise, Lang and colleagues (2012) reviewed the studies published on sensory integration therapy and concluded that agencies that use research or scientific methods should not use this treatment. Similarly disappointing results have been noted for gluten-free and casein free diets (Mulloy et al., 2010).