Friday, April 28, 2006

What science tells us about treating autism and ADHD

Alas, not very much.
John Hawks Anthropology Weblog : Evidence-based medicine and education

...At the Cambridge conference, prominent neuroscientists working in areas such as literacy, numeracy, IQ, learning, social cognition and ADHD spoke directly to teachers about the scientific evidence being gathered in scientists' laboratories. The teachers were amazed by how little was known. Although there was enthusiasm for and appreciation of getting first-hand information, this was coupled with frustration at hearing that many of the brain-based programmes currently in schools had no scientific basis. The frustration arose because the neuroscientists were not telling the teachers 'what works instead'. One delegate said that the conference "Left teachers feeling [that] they had lots stripped away from them and nothing put in [its] place".
Years ago I reviewed the ADHD literature, including some state-of-the-art reviews. Bottom line: we knew very little. Things aren't much better.

It's just as bad in autism. We don't even know what we're studying -- the terms "autism" and "ADHD" and the associated DSM-IV criteria may confuse more than they help. It's very hard to study something you can't even properly name.

There's a lot of great science happening now. In twenty years we may have new words, new diagnostic tests, maybe even evidence-based therapy. For now we're walking in very dim light. Recently I had a psychiatrist suggest the benefits of omega fatty acides in autism -- only to admit that the first trial that might give us a hint of a clue is barely starting.

Dim light indeed! Parents and therapists have to work with the data we have, but, for now, we must treat each intervention as an experiment that should be monitored. Continue it it helps, stop if it doesn't, try to measure outcomes objectively.

Most of all, clinicians should be humble. We don't really know what's going on and what helps or hurts.

PS. There are some topics, however, where there is decent evidence of a "dead end". It's really time to put the vaccine preservative and dental mercury stuff way in back of the back burner. There are so many better places to put resources now.

4 comments:

Anonymous said...

There's a new book about some cases of autism being linked to pollution.

http://www.timesonline.co.uk/article/0,,2682-2160195.html

hth

also you might want to google for
paraoxonase autism

John said...

The Times article is a book review of a book that claims a connection between autism and pollution.

I scanned the review. Neither the book nor the review seemed to have any scientific interest.

To be clear, science only tells us a bit about autism, but science tells us far more than mere scholarship. One of my favorite scholarly treatises is a Soviet era book on Atlantology. It's all blather, but it's quite scholarly. There's a lot of that stuff out there.

Science is far more than jargon and citations. Science is about models, predictions, probabilities and testing. When I say science can't tell us all that much about treating autism, I merely mean we have to be realistic about our ignorance. I don't mean there's a useful non-scientific guide to this family of possibly related disorders.

Neurofreak said...

I'm curious... Have you read any of the case studies out there that look at neurofeedback as a serious option for people with ADHD, and even autism?

A good example is here:
http://www.eegspectrum.com/Applications/Autism/AutismCaseStudy1/

I predict neurofeedback will probably see more widespread adoption on a global scale in years to come. It's just a matter of time.

John said...

I'll check up on the neurofeedback article. Curiously, I worked for years with a psychologist in rural Michigan who used neurofeedback fairly extensively, though not particularly with ADHD.

It's been around a long time, but, like hypnosis, it's gone in and out of fashion. Also like hypnosis, it's very expensive to complete a course of therapy. So hard to get it reimbursed. We'd probably need some kind of automated delivery to make it cost-effective.

I also don't know of any good data on efficacy and any harmful side-effects (there are always harmful side-effect, but one would expect them to be small), but since it's unfashionable it's probably not being studied much.

I suspect for high IQ people that cognitive therapy is probably cheaper and more effective, the interesting question is whether automated neurofeedback delivery would help lower IQ children and teens.