Autism spectrum disorder therapies: why the controversy?

Why do I get conflicting advice about an intervention?

You might expect to get the same advice about an ASD intervention no matter who you ask. But this isn’t always the case. Parents often find they’re given contradictory advice. This happens for several reasons:

• Advice, reliable and otherwise, comes from all kinds of sources – for example, doctors, researchers, other parents, naturopaths. These people might not agree with each other.
• Professionals often disagree about interventions and so their ideas about what you should do will be different from each other.
• Different people use different definitions of ‘evidence’. For example, some people rely on results gained from scientific studies for evidence. Other people feel that personal testimony or anecdotes are good evidence.
• There might not be enough reliable evidence about an intervention to give you a clear message.
• Even if the evidence about an intervention is reliable, people can interpret the evidence differently.
• Evidence aside, people have their own philosophies and opinions. They often add their own perspectives to the advice they are ‘passing on’.
• Someone might be trying to sell or promote an intervention. The information you get might be biased as a result.

Why do professionals have different opinions about treatments?

Sometimes health professionals, therapists, service providers or institutions will disagree on the effectiveness of therapies.

This is because they:

• have different definitions of ‘effective’ or ‘successful’, based on the different approaches they take. For example, a speech pathologist might define success as ‘some language improvement’. A psychologist looks for improvements in different areas, including behaviour.
• disagree on the theory behind a treatment, regardless of its track record
• use different research tools (chosen methods or techniques) to reach their conclusions
• use different terms to describe an ASD condition
• use different terms to describe what an intervention does. The advice they give you might sound different but mean the same thing
• have different ideas about how a treatment should be tested or evaluated – they don’t use the same yard stick.

Why can’t RCN just list the interventions that work?

We can usually say which interventions for ASD are better supported by research. But in most cases, more research is needed to say whether an intervention really ‘works’.

This is partly because the term ‘ASD’ covers a huge range of conditions and characteristics. This means that an intervention that ‘works’ for one child with ASD might not work for another.

Also, what’s meant by ‘it works’ can differ for different approaches. This makes it difficult to compare interventions. For example, one intervention might claim that ‘it works’, meaning that it ‘improves communication’. Another might make the same claim and mean that it ‘cures autism’.

How scientific studies can help you find answers
Scientific studies are carried out to answer questions about what therapies are effective.

Such studies help you find out whether an intervention has been classified as:

• strongly supported by research
• moderately supported by research (perhaps with mixed results)
• supported by limited or no research
• not supported by research – that is, it has no effect or shows evidence of negative outcomes.

The ‘research rating’ for an intervention isn’t all you need to know. When you’re choosing a therapy, your decision will also be based on other factors – for example, costs, availability and what suits your family.

Why is it hard to prove something works?

When people test an intervention, the testing has to meet a range of scientific standards. It’s a bit like the quality standards used for food – if the standards are met, you can feel confident that the testing has been done carefully, and that the evidence is reliable.

Obstacles for people testing interventions

• Quality evaluations cost time and money, and often proper testing has to wait until someone funds the research. Still, it can be useful to know if the ‘jury is out’ on an intervention.
• Evaluations can’t always meet the criteria for a convincing test. For example, the best testing usually involves designs based on randomised controlled trials, or a number of single-subject design trials, but there are various reasons why this might be difficult. For example, using a controlled trial might be hard because of the way an intervention is set up, or how participants feel about being in a control group. Still, having an idea about how an evaluation meets the criteria can help you make informed decisions.
• Comparing different evaluations can be difficult. They might measure outcomes in different ways, or even have different ways of describing the same ASD condition.

Obstacles aside, new evaluations are being carried out all the time, so it’s always worth asking professionals more about what the evidence says.

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