Writing in the Chicago (IL, US) Tribune under the headline “Autism treatments: Risky alternative therapies have little basis in science” Trine Tsouderos and Patricia Callahan reported about the background and myriad problems with many treatments used as therapy for children with Autism. They expose the lack of evidentiary support for therapies ranging from mega-doses of vitamins to chelation and show the relationships between practitioners of these therapies and a couple of organizations well-known among those who follow Autism.
The Tribune found children undergoing daylong infusions of a blood product that carries the risk of kidney failure and anaphylactic shock. Researchers in the field emphatically warn that the therapy should not be used to treat autism.
Children are repeatedly encased in pressurized oxygen chambers normally used after scuba diving accidents, at a cost of thousands of dollars. This unproven therapy is meant to reduce inflammation that experts say is little understood and may even be beneficial.
Children undergo rounds of chelation therapy to leach heavy metals from the body, though most toxicologists say the test commonly used to measure the metals is meaningless and the treatment potentially harmful.
Reporters Tsouderos and Callahan conducted interviews with an impressive array of advocates for the therapies (including representatives of Autism One, Autism Research Institute, and Defeat Autism Now) and doubters (mostly serious scientists). They combed through the weak and barely related research that many of the advocates use as well as the evidence showing limited or no benefits of the therapies.
All in all, these reporters deserve kudos for the unflinching thoroughness of their reporting. I encourage readers to read, reread, and disseminate the article. Here’s a link to “Autism treatments: Risky alternative therapies have little basis in science.” Flash of the electrons to Liz Ditz, whose Twitter post about this article alerted me to it.
Children and youths who were treated with “atypical antipsychotic medications” (aripiprazole, olanzapine, quetiapine, or risperidone) gained substantial weight and had changes in their metabolism in a study reported by Christoph Correll and colleagues in the Journal of the American Medical Association. The drugs, which are used to treat childhood schizophrenia, bipolar disorder, and (sometimes) Autism, also caused changes in blood lipids.
Drug
Brand Name
clozapine
Clozaril
risperidone
Risperdal
quetiapine
Seroquel
olanzapine
Zyprexa
The medications, which are also known as second generation antipsychotics, are marketed under the names shown in the table at the right.
On average, the children’s weight gains differed across the different medications, ranging from 8.5 kg with olanzapine to 4.4 kg with aripiprazole. For better than half of the children, the gains amounted to more than 7% of their body weight. Changes in the children’s metabolism varied by drug, too; olanzapine caused the largest problems and aripiprazole caused no changes in metabolism (e.g., cholesterol).
The National Autism Center released the report of its National Standards Project. The project was designed to identify interventions that are or are not beneficial for individuals with Autism or Autism Spectrum Disorder and it presents known therapies in three categories: established, emerging, unestablished (including a subsection on “ineffective/harmful treatments”).
In summary, the National Standards Project, a primary initiative of the National Autism Center, seeks to:
describe the age, diagnosis, and skills/behaviors targeted for improvement associated with treatment options
identify the limitations of the current body of research on autism treatment
offer recommendations for engaging in evidence-based practice for ASD
Under the headline, “Hyperbaric chamber: healthy or hype?” in multiple news sources, Chris Woolston reported about various uses of hyperbaric oxygen therapy (HBOT). He has quotes from an advocate and, hooray, from people who know better.
Although I have followed the promotion of secretin as a treatment for Autism pretty much since the first reports about it, I hadn’t checked on it lately. My initial foray into the topic in 1998 resulted in some skepticism with hedges. As the research evolved, it became clear that the skepticism was warranted.
However, I was surprised that Stephen Edelson, writing in a 2008 article entitled The secretin story: Still a promising treatment for autism,” considered “the studies investigating the efficacy of secretin have been very positive.” Coupled with some vaguely remembered notion that fewer than 50% of physicians discouraged use of secretin, the article gave me pause. I thought, “Hmmm. Maybe you’re earlier analysis was hasty, John.” Continue reading ‘Secretin reminder’
Writing under the headline “Pros and cons of screening teens for depression,” Brendan Borrell examined some of the issues that sometimes roar around surveying youths to identify those who are depressed or at risk for depression. Mr. Borrell’s article, which is one in a series of articles about depression appearing in the Los Angeles Times, addressed concerns such as parental reservations about testing of their children without permission, false positive identification of a high percentage of students, and the absence of adequate treatment for many who need help.
Mr. Borrell established the importance of the issue in his lead:
By the time a teenager graduates high school, about one out of nine of his or her peers has attempted suicide. Suicide is the third leading cause of death among young people, behind car accidents and homicide, and 10% to 12% of teens ponder suicide every day.
Arne Duncan, US Secretary of Education, wrote to the chief officers of education for each of the states in the US on 31 July 2009 regarding the use of seclusion and restraint in schools. He expressed concern about the testimony heard recently by the Education and Labor Committee of the US House of Representatives, and recommended that states adopt Positive Behavioral Interventions and Support.
My home State of Illinois has what I believe to be one good approach, including both a strong focus upon Positive Behavior Intervention and Supports (PBIS) as well as State regulations that limit the use of seclusion and restraint under most circumstances….
Several other States have also adopted effective seclusion and/or restraint policies, but there are many jurisdictions that have not, leaving students and teachers vulnerable. Continue reading ‘A. Duncan promotes PBIS’
Citalopram, one of the class of drugs known as selective serotonin reuptake inhibitors (SSRIs) which are usually used to address depression, did not yield beneficial results in a recent study of whether the use of the drug with children and youth with Autism reduced repetitive behaviors. The study, reported by Bryan King and colleagues, included 149 individuals ages 5 through 17 with moderate or severe Autism who were recruited from various parts of the US. Not only did the treated group appear no better than the placebo group, but the children in the Citalopram group were more likely to have adverse outcomes.
Lack of Efficacy of Citalopram in Children With Autism Spectrum Disorders and High Levels of Repetitive Behavior Citalopram Ineffective in Children With Autism Continue reading ‘Citalopram’s non-effects’
Tom Jackman’s article about Danny Watt to which I referred a few days ago (see this post) is generating a lot of discussion on the Post’s Web site. The comments on Mr. Jackman’s story are informative. For example, at least a half dozen mention having a family member with mental illness. Link to the comments.
The parents of Daniel Watt, a youth who had multiple problems, told the story of their son’s life and suicide. Tom Jackman of the Washington Post reported the story of Danny and his parents, helping explain some of the problems of addressing the needs of children with multiple diagnoses—co-morbid schizoaffective disorder and substance abuse, in Danny’s case.
Danny Watt once leapt from a moving train. He hurtled through the windshield of a rolling car. Got pummeled by drug dealers. Overdosed. Swallowed rat poison. Tried to hang himself.
In his tumultuous 21 years, Danny Watt danced with death in the most amazing, horrible ways. In the end, two college students spotted him facedown in the cold, murky water of the C&O Canal one afternoon in April 2008. The medical examiner said Danny had drowned.
Parade Magazine, the insert into millions of Sunday newspapers in the US, carried a brief piece about seclusion and restraint in the versions to be delivered 26 July 2009 (available on line 25 Jul 2009). The piece doesn’t present anything new, but we can hope that it helps to sustain concern about providing appropriate treatment for individuals with disabilities.
“Hold Me Tight, Let Me Go,” a movie about a UK school for children with Emotional and Behavioral Disorders, will air on US television 28 July 2009 on P.O.V. The film, made by Kim Longinotto (pictured at right), features the children and staff at Mulberry Bush School in the Oxfordshire village of Standlake. P.O.V. (Point of View) provides “documentaries with a point of view.”
Variety describes it as a film “mixing ferocity with tenderness, delicacy with tenacity”–exactly like the unusual school it explores. In Hold Me Tight, Let Me Go, one of Britain’s leading documentary filmmakers takes a verité look at Oxford’s Mulberry Bush School for emotionally disturbed children. Mulberry’s heroically forbearing staff greets extreme, sometimes violent behavior with only consolation and gentle restraint. Kim Longinotto’s unblinking camera captures an arduous process and a nearly unhinged environment, but it also records the daily dramas of troubled kids trying to survive and the moments of hope they achieve with Mulberry’s clear-eyed staff.
Link to the US PBS site, where one can learn when the entire film will be available in different areas. Visit the Mulberry Bush organization’s Web site. See the UK’s Office for Standards in Education, Children’s Services and Skills (Ofsted) listing for the Mulberry Bush School. Link to an extended piece, “Inside the home for angry infants: It costs £123,000 a year to send a child to this special school — because nobody else will have them,” by Caroline Scott in the Times Online (11 May 2009). Learn about other P.O.V. shows.
EBD Blog provides news and commentary about Emotional and Behavioral Disorders in children and youths. These problems have sometimes been called "emotional disturbance" or even "serious emotional disturbance." Whatever they are called, these problems are real, painful, and important. They often affect other people as well as having deleterious effects on school, social relations, and other aspects of the individuals' lives.
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