Saturday, December 07, 2013
I recently stumbled across your article regarding the study published in the Journal of Autism and Developmental Disorders by Schaaf et al. Whether one of your writers penned this, or it was picked up “off the wire” from Thomas Jefferson University’s public relations department, I applaud your dissemination of scientific research in autism treatment. We need more of this!
As a science consumer, I am always interested in studies which purport new findings that overturn the status quo, and positive outcomes from sensory-integration therapy definitely fit that bill. As a Board member of the Association for Science in Autism Treatment, I constantly comb through article after article in an attempt to separate the wheat from chaff, providing guidance to parents of children with autism who may not possess adequate expertise and who certainly do not find themselves with excess time.
The news copy on your website describes this new study as one of the first randomized control trials and indicated that it yielded better outcomes than “standard care.” This is good news, if it continues to be demonstrated, because it would lead to another science-based tool for families impacted by autism. However, I caution the reader of your article to be careful, and implore that your science writers be equally cautious about statements that imply that this new discovery can replace behavioral training. In fact, the study does not compare a manualized Sensory Integration intervention with behavioral treatment, but rather compares it and spotty behavioral treatment against nothing.
Let me clarify why I use “spotty” to describe the behavioral treatment. Firstly, it is unclear in the manuscript exactly how many hours the students received. It appears that the experimental group received an average of 9 hours total [across 10 weeks?] but could also be interpreted as 9 hours/week. The control group received a reported 23 hours [again, weekly or total?], but did indicate one participant reported 240 hours of support in the school. With this amount excluded, the control group either received a total of 7.8 hours [total] or 7.8 hours weekly. The recommended amount of behavioral treatment to address symptoms of autism tends to be between 20-40 hours a week. Neither group received that level of behavioral treatment. This, in and of itself, is not a problem. Generally, treatments are tested against their absence, rather than compared to a well-established treatment. Only after it has been demonstrated and replicated that an approach does provide improvement would a research team then begin comparative evaluations.
Unfortunately, the way your web article was written, it sounds as if the study compared OT-SI package to standard care [which is later defined in your article as 25-40 hours/week of behavioral services]. This could lead a casual reader to believe that the study demonstrated that OT-SI provides improvements beyond what is gained by 25-40 hours of behavioral treatment. Not only is this inaccurate, it may result in parents opting for a sensory integration approach instead of behavioral treatment, a choice with no science supporting it. It is especially worrisome given the inaccurate statement that behavioral treatment requires two years before any gains are observable. This is patently false as there are a myriad of studies that show socially significant improvement (on the order of months) from a behavior analytic approach.
As a scientist, I am always excited to see new studies examine treatment for autism with scientific rigor. It is very important that the results of each are conveyed in a manner that tempers the hope for a breakthrough with the reality of each study’s limitations. In a world in which everything is valued for convenience and immediacy, I understand that people want results now; but rushed science is generally botched science and we are likely going to find solid science-based treatment through a very systematic, methodical approach. While it may feel like advances move at glacial speeds, the benefit this approach will bring is incredible. Families affected by a diagnosis of autism deserve no less.
Joshua K. Pritchard, PhD, BCBA
Board Member, Association for Science in Autism Treatment