Science, Pseudoscience and Antiscience Theories In Autism

Finding effective treatments for their children with autism is one of the most difficult challenges parents face. In this month’s ASAT feature, Gina Green, PhD, BCBA-D and Lora Perry, MS, BCBA share insights about the many pseudoscience and antiscience theories and claims that are made about treatments for autism, and suggest some questions parents can ask to help them decide which treatments are most likely to help. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!

Science, Pseudoscience and Antiscience Theories in Autism:
Gina Green, PhD, BCBA-D and Lora Perry, MS, BCBA

The Importance of Informed Treatment Decisions
“Your child has autism.” With those words, a parent’s world comes crashing down. What to do? Choosing a treatment is one of the most important decisions the parents of a person with autism will ever have to make. How do parents find truly effective treatment for their child? In an ideal world, the person who dropped the autism diagnosis on a family would provide the answer. But the unfortunate fact is that many who make this diagnosis are not well informed about the wide array of autism treatments, and the degree to which these treatments have proven effective (or not). So until the day comes when parents can count on data based professional guidance, they will need to become very discerning about the various treatments, therapies, and programs that are claimed to be effective for autism. The same applies to those who are concerned with helping families get effective services. There is a need to do a lot of homework, and to do it quickly. Why the urgency? Because the stakes are high, and every moment is precious.

Pseudoscience and antiscience theories in autism

Children and adults with autism can learn, and there are effective methods for helping them develop useful skills and lead happy, productive lives. At the same time, research has shown that many currently available interventions for autism are ineffective, even harmful, while others have simply not been tested adequately. Every moment spent on one of those therapies instead of effective intervention is a moment lost forever. Besides, common sense suggests that it is wise for parents and professionals alike to invest in interventions that can be reasonably calculated to produce lasting, meaningful benefits for people with autism—that is, interventions that have withstood scientific testing.
As parents and professionals seek information about autism treatments, they discover a long and perplexing list of “options,” many of them promoted by sincere, well-meaning, persuasive people. Everyone claims that their favorite treatment works, and parents and practitioners are often encouraged to try a little bit of everything. This can be very appealing to people who are seeking anything that might help. How does one choose wisely? To quote the late Carl Sagan, “The issue comes down to the quality of the evidence.” So the first step is to find out exactly what evidence is available to support claims about autism treatments. But all evidence is not created equal. How does one sort pure hype from solid proof, wishful thinking from rigorous testing?
Science, Pseudoscience, and Antiscience in Autism
Approaches to answering fundamental questions about how the world works can be grouped into three broad categories: science, pseudoscience, and antiscience. Science uses specific, time-honored tools to put hunches or hypotheses to logical and empirical tests. Some of those tools include operational definitions of the phenomena of interest; direct, accurate, reliable, and objective measurement; controlled experiments; reliance on objective data for drawing conclusions and making predictions; and independent verification of effects.
Science does not take assertions or observations at face value, but seeks proof. Good scientists differentiate opinions, beliefs, and speculations from demonstrated facts; they don’t make claims without supporting objective data.

In contrast, pseudoscience tries to lend credibility to beliefs, speculations, and untested assumptions by making them appear scientific — for example, by using scientific jargon, endorsements from individuals with “scientific” credentials, perhaps even some numbers or graphs. But instead of objective measurements from well-controlled experiments, pseudoscientists offer testimonials, anecdotes, and unverified personal reports to back up their claims. Antiscience is the outright rejection of the time-tested methods of science as a means of producing valid and useful knowledge. The extreme antiscientific view is that there are no objective facts; all knowledge is made up of personal interpretations of phenomena.
Pseudoscientific and antiscientific treatments and approaches for various conditions, including autism, abound. They are promoted enthusiastically, not in peer-reviewed scientific journals, but in materials published by their promoters, such as newsletters, videotapes, books, advertisements, and the Internet. These treatments have several distinguishing features (see side-bar). Some may seem benign at first glance, but that can be misleading. Over the years, many such treatments have proven to have very harmful physical and emotional side effects. They also exact a great societal toll by diverting precious resources from effective treatments and sound research, raising false hopes, and perpetuating illusions (for some examples, see the books Controversial Therapies for Autism and Intellectual Disabilities and Crazy Therapies, listed below).
Smart Questions
Parents and professionals can protect people with autism from the harms of bogus and ineffective treatments by exercising healthy skepticism, and asking several questions of everyone who claims to have an effective intervention for autism: What is the intervention, precisely? Exactly what is it supposed to do? Have its effects been tested in controlled experiments using direct, objective measures? If so, were those studies published in peer- reviewed scientific journals? What did studies show about positive effects and negative side effects? Did the effects carry over beyond the immediate treatment setting? Is there another scientifically validated treatment that is similarly effective but has fewer negative side effects? Who will administer this treatment, and how can I be sure they are qualified to do so? How will its effects on this individual be evaluated, and by whom? What will happen if we do nothing? Listen to the answers, but don’t take them at face value. Seek out published research on the treatment, and, if necessary, someone with expertise in scientific research methodology to help you evaluate it. Also take note when no answers—and no solid supporting studies — are provided. What is not known or said matters, too.

When families seek treatment for a child diagnosed with cancer or diabetes, they aren’t simply given a long list of interventions that someone somewhere believes to be effective, and told to choose from that list on their own; they can usually expect to be informed about treatments that are based on sound scientific research. Why settle for anything less when the diagnosis is autism?

PSEUDOSCIENTIFIC THERAPIES: Some Warning Signs
(adapted from the American Arthritis Foundation)

  1. High “success” rates are claimed.
  2. Rapid effects are promised.
  3. The therapy is said to be effective for many symptoms or disorders.
  4. The “theory” behind the therapy contradicts objective knowledge (and sometimes, common sense).
  5. The therapy is said to be easy to administer, requiring little training or expertise.
  6. Other, proven treatments are said to be unnecessary, inferior, or harmful.
  7. Promoters of the therapy are working outside their area of expertise.
  8. Promoters benefit financially or otherwise from adoption of the therapy.
  9. Testimonials, anecdotes, or personal accounts are offered in support of claims about the therapy’s effectiveness, but little or no objective evidence is provided.
  10. Catchy, emotionally appealing slogans are used in marketing the therapy.
  11. Belief and faith are said to be necessary for the therapy to “work.”
  12. Skepticism and critical evaluation are said to make the therapy’s effects evaporate.
  13. Promoters resist objective evaluation and scrutiny of the therapy by others.
  14. Negative findings from scientific studies are ignored or dismissed.
  15. Critics and scientific investigators are often met with hostility, and are accused of persecuting the promoters, being “close-minded,” or having some ulterior motive for “debunking” the therapy.

References

Barrett, S., London, W., Kroger, M., Hall, H., & Baratz, R.S. (2012). Consumer health: A guide to intelligent decisions (9th ed). New York, NY: McGraw Hill.

Foxx, R.M. & Mulick, J.M. (2015). Controversial therapies for autism and intellectual disabilities: Fad, fashion, and science in professional practice (2nd ed.). New York, NY: Routledge.

Green, G. (1996). Evaluating claims about treatments for autism In C. Maurice, G. Green, & S.C. Luce, (Eds.), Behavioral intervention for young children with autism: A manual for parents and professionals (pp. 15–28). Austin, TX: Pro-Ed.

Green, G. (2015). Fads, follies, and frauds. In J.M. Johnston & D.H. Reid (Eds.), The promise of behavioral services for people with intellectual disabilities (pp. 79 – 91). Cornwall-on-Hudson, NY: Sloan Publishing.

Lilienfeld, S.O., Lynn, S.J., & Lohr, J.M. (2003). Science and pseudoscience in clinical psychology. New York, NY: The Guilford Press.

Park, R.L. (2000). Voodoo science: The road from foolishness to fraud. New York, NY: Oxford University Press.

Randi, J. (1982). Flim – flam! New York, NY: Prometheus Books.

Sagan, C. (1995). The demon-haunted world: Science as a candle in the dark. New York, NY: Random House.

Schick, T. & Vaughn, L. (2010). How to think about weird things: Critical thinking for a new age (3rd ed). Boston, MA: McGraw Hill.

Shermer, M. & Gould, S. J. (2002). Why people believe weird things: Pseudoscience, superstition, and other confusions of our time. New York, NY: W. H. Freeman.

Singer, M.T. & Lalich, J. (1996). “Crazy” therapies. What are they? Do they work? San Francisco, CA: Jossey-Bass Publishers.

Vyse, S. (2013). Believing in magic: The psychology of superstition. New York, NY: Oxford University Press.

www.quackwatch.org – Your Guide to Quackery, Health Fraud, and Intelligent Decisions, operated by Stephen Barrett, MD

ABOUT GINA GREEN, PHD, BCBA-D

Executive Director, Association of Professional Behavior Analysts

Gina Green received a PhD in psychology (Analysis of Behavior) from Utah State University in 1986 following undergraduate and master’s-degree studies at Michigan State University. Dr. Green has authored numerous publications on behavioral treatment of individuals with disabilities and the experimental and applied analysis of behavior. She serves or has served on the editorial boards of several professional journals in behavior analysis, developmental disabilities, and psychology. Dr. Green co-edited the books Behavioral Intervention for Young Children with Autism and Making a Difference: Behavioral Intervention for Autism. She has served the Association for Behavior Analysis International and the California Association for Behavior Analysis in several roles each, including President. She was on the Board of Directors of the Behavior Analyst Certification Board from 2002-08, also serving as Chair of the Continuing Education Committee, and on the Board of Trustees of the Cambridge Center for Behavioral Studies for 15 years.

Currently Dr. Green sits on the professional advisory boards of several autism programs and organizations. She is a Fellow of the American Psychological Association and the Association for Behavior Analysis International. Other recognitions and awards include Psychology Today’s Mental Health Professional of the Year (2000); honorary Doctor of Science degree from The Queen’s University of Belfast, Northern Ireland (2005); California Association for Behavior Analysis Award for Outstanding Contributions to Behavior Analysis (2013); New York State Association for Behavior Analysis John W. Jacobson Award for Contributions to Behavior Analysis (2013); Berkshire Association for Behavior Analysis & Therapy Sidman Award for Enduring Contributions to Applied Behavior Analysis (2014); Friend of the Kendall Centers, Modesto, CA (2014); and Autism Speaks Provider of the Year (2014). Dr. Green lectures and consults widely on autism and related disorders, behavioral research, effective interventions for people with disabilities, and public policies affecting the practice of applied behavior analysis.

ABOUT LORA PERRY, MS, BCBA

Board Certified Behavior Analyst

Lperry@BCBA4Hire.com
www.transition2adulthood.com

Lora Perry has been a Board Certified Behavior Analyst since 2004. She has developed and led organizations focused on serving children with autism, intellectual disabilities and emotional/behavioral disabilities, combining both her knowledge of clinical programming and her business management skills. Prior to entering private practice, Ms. Perry was an executive with Providence Service Corporation, a global human services organization headquartered in Tucson, Arizona. Ms. Perry served as the National Director of Autism Services for Providence, focused on data-driven treatment planning, progress monitoring, resource utilization, and outcome monitoring.

As the parent of twin sons with autism, Ms. Perry started the Merrymeeting Center for Child Development in 2000, a school and treatment center for children with autism. Merrymeeting was eventually subsumed into Providence, where Ms. Perry served as Executive Director for ABA Services at Providence of Maine. In this role, she utilized applied behavior analysis to serve children, families, communities and agencies overcoming autism spectrum disorders, and emotional/behavioral disabilities.

Ms. Perry attended New Hampshire College, where she earned her Master of Science degree in Business Education. Today Perry works not only with children, but also with teams transitioning children with special needs to adulthood, and with businesses seeking to leverage the power of behavior analysis to improve organizational management.