Dear Mr. Hannaford:
Thank you for taking the time to weigh the evidence!
In your article, “Autism Inc.: The Discredited Science, Shady Treatments and Rising Profits behind Alternative Autism Treatments” (January 30, 2013), you consider information gathered from various primary sources on all sorts of treatments, acknowledge that autism treatments have become a very profitable enterprise for many providers, and come to a well-founded conclusion: applied behavior analysis (ABA) is “the gold standard of treatment” for individuals with autism. For that, we applaud you.
You describe the journey of several duped parents — once amazed by the gamut of so-called “miracle cures,” such as chelation therapy, dietary supplements and other alternative remedies — now informed, and able to draw the line between quackery and science. Refreshingly, your work captures the experiences of parents who would rather be chastised for taking away other peoples’ hope than support unorthodox biomedical interventions. In contrast to most testimonials, your article provides the complete picture.
Not convinced by the misleading opinions of medical professionals — even those with celebrity endorsement — you question why certain controversial autism treatments have not been published in peer-reviewed journals, even if touted as effective after performing “proper” studies. We commend your keen attention to this red flag of pseudoscience which, along with others, is highlighted in the “Making Sense of Autism Treatments: Weighing the Evidence” section of the Association for Science in Autism Treatment (ASAT) website (https://www.asatonline.org/treatment/makingsense).
To complement your informative news piece, we would like to offer readers some basic guidelines about interpreting evidence and spotting quackery. In an article by Chambless and Hollon (1998), several fundamental questions are taken into consideration when defining empirically supported therapies. We will highlight a few, with brief explanations:
1. Does the treatment actually work? This question is addressed if, in two or more well-designed studies conducted by independent research teams, the treatment proves beneficial when compared to another treatment (comparison) or no treatment (waitlist or placebo);
2. What about conflicting results? This question is addressed if the well-designed studies point in one direction and the poorly designed studies point in another. When there is comparable methodological rigor, be conservative! Do not include the treatment as evidence-based until differential results can be identified; and
3. For whom is the treatment beneficial? This question is addressed best if you straddle the line between efficacious and effective research. For instance, participants in efficacious research such as Randomized Clinical Trials (RCTs) are vigorously screened to yield pure samples. However, some studies demonstrate treatment utility or effectiveness (the treatment can be shown to work across populations in actual clinical settings).
Again, thank you for your careful approach. You give the greatest weight to treatments grounded in the best available scientific evidence, and caution parents who may be lured by under-researched treatments – well done! Fortunately, evidence-based treatments such as ABA do exist, and are increasingly available to families.
Leanne Tull, MADS, BCBA, and Scott M. Myers, MD, FAAP
Association for Science in Autism Treatment
Chambless, D. L., & Hollon, S. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66, 7-18.