Showing posts with label AAP. Show all posts

Autism Interventions: New York Times, Once Again, Pushes Non Evidence Based Floortime And Ignores Evidence Based ABA

The New York Times is at it again ... pushing Floortime as an autism intervention ... without mentioning the lack of scientific, empirical evidence in support of its effectiveness. In A Child Psychiatrist Talks About Autism the NYT features a column by Dr. Joshua D. Sparrow which promotes Floortime as an intervention for autistic children and encourages parents of autistic children to consider Floortime as an intervention for their children. (And of course, as usual with the NYT there is no mention of the solid base of evidence in support of ABA as an autism intervention):

"One promising treatment for such children is Floortime, a developmental, individualized and relational approach.


After a careful assessment of the child’s unique profile, therapists and parents using the Floortime approach work together to help the child learn to handle sensory stimulation while gradually interacting in more complex and rewarding ways. The goal is to help these children engage in meaningful relationships, expanding their capacity for communication, understanding and complex, abstract thought. One of the keys is to find the child’s motivation, and to use it as fuel for this work. Another is to make the work rewarding by making it fun and pleasurable for child, parent and therapist. But it is hard and time-consuming work, and families of children with autism spectrum disorders deserve all the support we can possibly give them. Experience has shown that children with autism who are given the support they need are able to expand their abilities to relate, to learn and to communicate, especially with their loved ones.


...


For more on autism spectrum disorders and Floortime, see the International Council on Learning and Developmental Disorders Web site.


Among the many helpful and hopeful books on autism spectrum disorders are those by the late child psychiatrist Stanley Greenspan and the psychologist Serena Weider, including “Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate and Think,” and a new one to be published in April by the pediatrician Ricki Robinson, called “Autism Solutions: How to Create a Healthy and Meaningful Life for Your Child.”

The NYT presents this latest Floortime promotional vehicle without mentioning the limited evidence in support of its effectiveness as reviewed by the AAP and the Association for Science in Autism Treatment.



The picture above is from the AAP Publications Retired and Reaffirmed policy page and indicates that in September 2010 the American Academy of Pediatrics Reaffirmed the Clinical Report: Management of Children with Autism Spectrum Disorders. Pediatrics 2007. The 2007 Report described the lack of empirical, scientifc evidence in support of the efficacy of DIR/Floortime as an intervention for autism spectrum disorders:

"The DIR approach focuses on (1) “floor-time” play sessions and other strategies that are purported to enhance relationships and emotional and social interactions to facilitate emotional and cognitive growth and development and (2) therapies to remediate “biologically based processing capacities,” such as auditory processing and language, motor planning and sequencing, sensory modulation, and visual-spatial processing. Published evidence of the efficacy of the DIR model is limited to an unblinded review of case records (with significant methodologic flaws, including inadequate documentation of the intervention, comparison to a suboptimal control group, and lack of documentation of treatment integrity and how outcomes were assessed by informal procedures55 ) and a descriptive follow-up study of a small subset (8%) of the original group of patients.59" 
(page 1165)

The following information is currently found on the ASAT web site and indicates that Floortime is plausible but essentially untested.

Association for Science in Autism Treatment


Developmentally-based Individual-difference Relationship-based intervention (DIR)/Floor Time


...

Research Summary: DIR is widely considered to be a plausible intervention approach (i.e., one that could be effective), but it has not been evaluated in peer-reviewed studies with strong experimental designs (National Research Council, 2001). An uncontrolled study reported favorable outcomes (Solomon et al., 2007).

Recommendations: An important area for future research is to evaluate DIR in studies with strong experimental designs. Professionals should present DIR as untested and encourage families who are considering this intervention to evaluate it carefully.

It isn't clear to me why the NYT pushes Floortime, a non evidence based autism intevention, and ignores ABA,  the most evidence based intervention for autism, as reviewed for several decades by authorities from the US Surgeon General, to state agencies in Maine, New York and California to the Association for Science in Autism Treatment to the American Academy of Pediatrics. I have to assume that the personal biases and prejudices of senior health editors at the New York Times lie behind this persistent attempt to promote non evidence based autism interventions and ignore or put a negative spin on ABA.  I can think of no other reason, rational or not, for the NYT's  misguided autism intervention reporting.

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Autism and the Media: Anti-ABA Activist Michelle Dawson Is Back In The CBC Spotlight Denouncing ABA



To my knowledge no one has ever accused anti-ABA activist Michelle Dawson of shying away from the spotlight  and  Michelle Dawson is back where she has been so often ... in the CBC spotlight. Once again she is peddling, in the name of science, ethics and "autistic people",  her anti-ABA rhetoric.  Ms Dawson repeats previous sermons in which she preaches  that provision of ABA interventions for autistic children lacks scientific support and is unethical. She offers nothing to back up her opinions. The CBC offers little help in that regard beyond pointing out that Ms Dawson is autistic, is a researcher and is, allegedly, an autism"expert". 

Borrowing a page from the heated rhetoric of the vaccine autism wars Ms Dawson asserts that ignorant, ill informed  parents are being duped by lobbyists and ...  in an interesting twist ... governments ... into thinking their autistic children must have ABA.  The CBC article Expert raps Quebec autism treatment makes no direct reference to the numerous reviews, from the US Surgeon General to the American Academy of Pediatrics,  that have examined hundreds of studies over decades of research and concluded that ABA is the most evidence backed effective intervention for helping autistic children overcome many of the deficits associated with autistic disorders:

"Autism expert Michelle Dawson says the Quebec government is wasting its money by funding "Applied Behavioural Analysis", known as ABA — a program she calls ineffective.

ABA is designed to reinforce behaviour through repetition. Dawson, who has autism, says she has evidence that the approach doesn't deliver what it promises.

The program doesn't optimize the overall wellbeing of people with autism, said Dawson, who researches the neurodevelopment disorder at the University of Montreal.

"In ABA you have the problem that these parents have been told by everybody, including by governments, if your child doesn't get this intervention, they're to some degree down the drain," she said.

ABA is one of the few treatments the Quebec government will finance.

"It doesn't have anything to do with science or ethics, or when you look at the well being of autistic people. It's just really effective lobbying by some people, including people who have pretty extensive conflicts of interest, or even they just are true believers, they have very strong beliefs in certain approaches, or very strong beliefs about autistic people that aren't necessarily grounded in science or ethics," Dawson said."

The CBC should  do more homework on the subject before, yet again, giving Michelle Dawson a platform to promote the same tired  anti-ABA beliefs that launched her into national fame in Canada. If it's journalists are too busy to read some of the many reviews, from the US Surgeon General to the MADSEC Autism review  to the American Academy of Pediatrics which have endorsed ABA as the most effective evidence backed intervention for autistic children  they could at least check with some of the actual autism experts and health authorities that she demeans before again giving her the CBC pulpit to promote her beliefs.  

The CBC  might also want to read  Dr. Edward K. Morris's published article about  Dr. Morton Ann Gernsbacher, an occasional co-author with Ms. Dawson and her mentor Dr. Laurent Mottron,  and a  comrade in arms in their struggle to prevent autistic children from receiving the benefits of ABA treatment: A Case Study in the Misrepresentation of Applied Behavior Analysis in Autism: The Gernsbacher Lectures:   

"This article presents a case study in the misrepresentation of applied behavior analysis for autism based on Morton Ann Gernsbacher’s presentation of a lecture titled ‘‘The Science of Autism: Beyond the Myths and Misconceptions.’’ Her misrepresentations involve the characterization of applied behavior analysis, descriptions of practice guidelines, reviews of the treatment literature, presentations of the clinical trials research, and conclusions about those trials (e.g., children’s improvements are due to development, not applied behavior analysis). The article also reviews applied behavior analysis’ professional endorsements and research support, and addresses issues in professional conduct. It ends by noting the deleterious effects that misrepresenting any research on autism (e.g., biological, developmental, behavioral) have on our understanding and treating it in a transdisciplinary context.

Professor Morris pulled no punches in his critique of Dr. Gernsbacher's public misrepresentations of ABA and the effect of those misrepresentations:

Sentiment against applied behavior analysis is not, of course, necessarily anti science. No matter what Gernsbacher’s sentiments may be, her achievements are anything but anti science.What stunned me, then, was how she reached her conclusions: She inaccurately represented research reviews, wrongly characterized applied behavior-analytic interventions, misleadingly appealed to history, inaccurately conveyed research designs, selectively omitted research results, and incorrectly interpreted intervention outcomes. Although misrepresentations often only a minor nuisance in science, they can have harmful consequences, which I believe hers did (and do), both locally and more broadly.

The local consequences included misinforming KU’s community members about ABA-EIBI; hundreds of KU students about a science of behavior and its application; current and prospective ABS majors about course of study at KU (and careers); and KU staff, faculty, and administrators about scholarship in a department renowned for its research in applied behavior analysis. The broader consequences include Gernsbacher’s probable influence on behavioral, social, and cognitive scientists who teach, conduct research, and provide services in autism; funding agencies and foundations who set priorities and allocate resources for autism research and applications; and state and federal agencies that set standards for autism services and funding. She has standing and stature in most, if not all, of these venues: in APS, of course, but also in the American Association for the Advancement of Science (AAAS), where she is a psychology section member at large, and in the National Science Foundation (NSF), where she is on the Advisory Committee for the Social, Behavioral, and Economic Sciences. Although Gernsbacher surely gained these highly respected positions by conducting first-rate science, the hallmarks of her science were largely absent in this section of her lecture.

In the article conclusion Dr. Morris, after a detailed review of the evidence in support of the effectiveness of ABA as an autism intervention, and after a detailed review of Dr. Gernsbacher's representations of ABA, explains why he wrote the article:

"Mainly, though, I wrote it for the families of children with autism and, ultimately, for those children who need and deserve evidence-based treatments, of which ABA-EIBI so far has the best support. Unfortunately, many parents are dissuaded from using it by misinformed, misguided, or misleading advocates of other approaches. As a result, they often use these approaches until they see their children’s poor progress. When they begin using ABA-EIBI to good effect, they speak of their great regret and guilt for not having used it earlier, when their children had the most to gain and the most time to make those gains. The opportunity cost of not using ABA-EIBI, or any equally effective intervention, is that their children will be delayed in achieving their full potential or never achieve it at all. As a result, their children will need more supportive services and institutionalization later into their lives and perhaps for the rest of their lives at significant personal and social costs to them, and financial costs to us all. This is a crime."

I have been unable to find a public reply by Dr. Morton Ann Gernsbacher to the Morris article, published in early 2009.  Dr. Morris had sent a copy of the article to Dr. Gernsbacher in 2008 shortly before she again presented lectures in which Dr. Morris states she continued to misrepresent ABA.  If Dr. Gernsbacher,  Michelle Dawson, or any of their followers, know of any public replies by Dr. Gernsbacher to the Morris criticisms I ask you to forward them to me.  In the meantime, hopefully, someone will bring the article to the attention of the CBC before it, once again, gives Michelle Dawson a platform to spread her anti-ABA ideology.  Until then the CBC may wish to avoid Michelle Dawson's anti-ABA rhetoric and read at least the following excerpt from the American Academy of Pediatrics 2007 publication, Management of Children with Autism Spectrum Disorders:

"The effectiveness of ABA-based intervention in ASDs has been well documented through 5 decades of research by using single-subject methodology21,25,27,28 and in controlled studies of comprehensive early intensive behavioral intervention programs in university and community settings.29–40 Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups.31–4"
    

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