Sunday, March 15, 2009

Treating autism is not a science

One of the reoccurring themes in the autism world is that only treatments that have been proven to work should be used.  This is what evidence-based medicine is all about.  In general I think this is a good idea - you want to be confident that what you are doing will actually correct the problem that you are targeting.  The assumption is that most of the medical world operates this way and that autism treatments should too.

Sounds good, right?

According to a recent entry at Brain Blogger entitled How Strong is Your Evidence? this might not be the case :
[A] recent study published in the Journal of the American Medical Association (JAMA) found that, at least with regards to cardiovascular problems, the vast majority of the medical evidence supporting current recommendations is weak. Researchers examined the current recommendations of the American Heart Association and the American College of Cardiology on 22 different cardiovascular topics. They graded the strength of the evidence supporting these recommendations from A to C, with A being the best evidence, and C being very little or weak evidence. Only 12% of the recommendations were in the A category. A staggering 45% earned a C.
So even when treating cardiovascular problems evidenced based is only the goal not the rule.  So what does that mean when it comes to listening to your doctor?
So should you ignore the majority of what your doctor says for lack of strong evidence? Not necessarily. Most doctors are simply working with the best information they have, even if the data supporting it is weak.
Sounds reasonable to me.  In the absence of strong evidence proving that treatments work you go with the best information that you have.  I imagine that it helps if the person interpreting the information has a background in the area.

So what does this mean when it comes to autism treatments?  The evidence is lacking for almost every treatment out there. The only treatment that I am aware of that has any sort strong evidence behind it is ABA.  So what about all of the other alternative treatments?

If you look organizations that attempt to track what treatments are used you will find a wide variety of thing that people will try, everything from vitamins to diet to therapies to drugs.  

So not only is evidence lacking, there is no lack of options.  So what do to.
I think the answer is simple.  You go with the best information that you have.  You start with the treatments with the most evidence and branch out from there.  You keep in mind that not every treatment will help every child and keep going.  If there is something that you want to try but there is no evidence at all that supports it then stay away from it until there is some level of evidence.  If you can find a medical professional who specializes in the field who you can work with so much the better.

Treating autism is not a science as of yet, it is still of an art. 

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