John Hawks Anthropology Weblog : Evidence-based medicine and educationYears ago I reviewed the ADHD literature, including some state-of-the-art reviews. Bottom line: we knew very little. Things aren't much better.
...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".
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.