Lonely evidence, it is difficult to save children with autism

Parents of many autistic children have spent great efforts. For many years, they insist on intervention for their children and improve their children's mental conditions. Some people have good effects, some people are effective, everything seems to be the arrangement of fate. They don't know that all these therapies have not received strict clinical evidence.

Compilation | Xiaoye

Twenty years ago, Andrew Whitehouse was a speech therapist. He didn't remember how many special small patients had been diagnosed, but they had a common name -the child of the stars. Because the diseases that these children suffer from the development of the brain are related to the development of the brain, they do not understand social networking, it is difficult to communicate, as if they are trapped in lonely planets. After years of scientific popularization, most people have heard of this disease called "autism", which is professional called autism spectrum disorder. According to the World Health Organization statistics, about every 100 children around the world have autistic patients [1].

Whitehouse found that many worried parents did not hesitate to try various therapies, and some of them had not even received scientific verification. Some families shrink their clothing, only to allow children to use machines that claim to "connect the brain again" [2]. But in fact, the so -called machine does not have a real effect except for beeping.

Today, Whitehouse, who has rich experience in diagnosis and treatment, is a professor of autism research at the University of Western Australis, and is also the director of the Lelethon Kids Institute. Over the years, Whitehouse has led the team to conduct random control clinical trials, in which the patients and family members, scientific research, medical practice and other aspects are deeply rooted in autism. In the field of research, scientists, doctors, and medical practice system makers have been accepted and even anticipated by clinical evidence standards. And this issue involves a wide range of risks, not only the family's risk of patient life safety, but also more emotional problems, economic risks, and opportunities costs [2].

To this end, he led the team to start with the previous academic literature, examine the study of popular autism intervention in clinical practice, and examine the reliability of scientific evidence. In November 2020, the team published the "Intervention of Children's Spectrum Spectrum: Interventions for Children on the Autism SPECTRUM: A Synthesis of Research Evidence" report [3], conclusion shows that the autism intervention used in clinical use was used There are rarely support for solid scientific evidence. This negative conclusion instantly detonated the academic community. A large number of clinicians, therapeutic suppliers, and professional institutions took action within a few weeks, or threatened to prosecute Whitehouse or complained to their employers. , Threaten their personal safety. Whitehouse never expected that a scientific research report would cause himself, family and colleagues to fall into danger.

However, not only the Whitehouse team analyzes such a conclusion. In 2020, Psychology Bulletin published an analysis of intervention therapy for children 0-8 years old (AIM project), from the University of Texas University in the United States, Special Education Assistant Professor Micheal Sandbank led the team to track 7 most popular and effective early intervention therapy for early intervention therapy. The results found that if you do not consider research quality indicators, only 3 therapies (behavioral intervention, development intervention and spontaneous issue Development behavior intervention (NDBI) shows a significant positive effect. However, if the research standards are strictly considered -whether it is a random control test, the research results are defined bias -then all therapies are ineffective (statistical effect is not significant). However, Sandbank himself pointed out that although the analysis results are not ideal, this does not mean that we want to give up all these intervention methods [5].

In fact, both reports can be attributed to the same key issue: why is the high -quality evidence of autism intervention research so scarce?

Research method dispute: Case research VS random control test

The development of autism intervention can be traced back to the 1970s and 1980s. At that time, some breakthrough clinical research sample scale was small, and there were also loopholes in statistics. Here, the pioneer of behavior analysis and intervention in the field of autism: Ole Ivar Lvaas, a Norwegian American psychologist.

Since the mid -1960s, LvaaS has tried to use application behavior analysis (Applied Behavior Analysis (ABA) to establish intervention therapy, through one -to -one professor's language of autism, breaking other core barriers to autism, developing play and self -rescue ability [6]. In 1987, LVAAS published a breakthrough study entitled "Behavioral Treatment and Normal Intellectual Functioning in Young Children with Autism" entitled "The Behavioral Treatment and Normal Intellectual Function" [7]. ABA intervention treatment, 47%of the test children (N = 19) successfully resumed normal intelligence and educational functions, which is no different from healthy peers. In the control group as a control group (N = 40), only 2%of people returned to normal levels. Since then, people have begun to believe that they can finally live and study independently by teaching autistic children. Lvaas is also known as the "father of ABA". He actively spreads ABA therapy and encourages many students and colleagues to participate in autism intervention research. Later, many new therapies appeared on the basis of ABA intervention. It can be said that the ABA research of LvaaS has the innovation of "quasi -test", but there are certain limitations, one is the small sample scale; in addition, during the research process, the test children are not randomly grouped. His approach is the background of the time at that time: psychological research in the same era as LvaaS mainly follows the design principles of "Single-Case", that is, the lack of formal control groups in case research. The group is also in the control group.

In fact, by the 1980s, medical clinical studies have widely accepted the current gold experiment standards -Randomized Controlled TRIAL, but the research on psychology and medicine intervention is still quite laborious to keep up with other disciplines. Essence Jonathan Green, a professor of psychiatry at the University of Manchester, proposed that from the beginning, some researchers believed that RCT was neither ethical nor feasible in the face of such complex autism. This mentality has promoted the default attitude of everyone in the field of low standard research. [8].

In the AIM project hosted by Sandbank above, less than one -third of the ABA intervention therapy research by researchers using statistical analysis of ABA intervention therapy has adopted random control design, let alone mention most of the reports read by clinicians in the United States are all reports. Case research. In 2021, a report from the National Solitus Evidence and Practice Exchange Center (NCAEP) stated that [9], after analyzing 972 articles, 28 medical practice was based on evidence. 85%of the research is a case study. In addition, in 2015, the National Standard Report (NSP) confirmed the effective intervention therapy for autistic children, teenagers and young people [10]. Similarly, 73%of the research was a case research.

It is true that in the development of modern psychology, the research method of individual cases helps to observe and study a certain or small group of trial objects, so as to find the causes of certain behaviors, diseases and psychological phenomena, observe its clinical development and Change to help researchers establish theory. However, in clinical treatment, the disadvantages of case research are quite obvious. First of all, due to the too few cases, the research results must be cautious when they are promoted to a more common general conclusion. Secondly, case research does not necessarily reveal causality. Finally, case research is not suitable for tracking long -term development and changes, and this is precisely the focus of dense intervention therapy. The so -called dense intervention therapy is a traditional treatment method for autism children aged 0 to 9. It takes 25 hours to 40 hours a week. The process persists for two to three years. Despite the huge manpower and time cost, the rehabilitation effect is not immediate, and long -term tracking is required. The lack of high -quality research in the academic community has proved its true effect. Sandbank pointed out that although case research can help researchers test the changes in specific treatment methods (such as conventional classroom learning in schools), "We cannot provide general treatment suggestions based on case studies." [8]

As we all know, the therapy without sufficient verification may cause serious substantial harm, so the clinical trials of modern medicine emphasize whether the verification method is reliable [11]. Whitehouse believes that maintaining the status quo of low quality evidence will push the development of autism intervention therapy into the dangerous edge of danger, which is also the original intention of actively promoting random control research in the field.

Conflict in interest

In addition to the conflict of research theory and methods, the conflict of interest in each other is also a hidden crisis in the field of autism intervention. It is this powerful force that is stubbornly suppressing the data standards.

In the United States, the treatment system for autism has established a billions of dollars in industries, which is largely due to national insurance authorization and funding ABA intervention suppliers. The commercialization of autism has increased medical care, but it may also damage the important position of high -quality research evidence. After all, private enterprises are pursuing profits, and in the game of profit and good medical practice, profits are always winning. [8] In addition to the problems brought by commercialization, researchers participating in research evidence evaluation may have multiple jobs, and the relevant scientific research institutions behind them cannot be ignored. Competing Interest may obstruct the fairness of assessment. For example, the "Journal of Applied Behavior Analysis" published by ABA research. Most members of their editorial board are analysts certified by the committee. They have received ABA qualification training, so they naturally tend to support ABA intervention in ABA intervention. The assessment of papers may have deviations.

In addition, many ABA analysts have also participated in the writing of national standard reports, which logically included ABA therapy into the standard "established intervention therapy" list. At the same time, May Institute, a non -profit institution in the United States that provides ABA intervention therapy services, is also one of the fund sponsor of the national standard report. Although the contributions of analysts and research institutes are displayed in the report, the hidden conflicts of interest have not been mentioned. After all, in the appraisal agenda of that era, the conflict of interest was strictly inquired and operated unconventional. Although it is not to say that the practice of ABA analysts must be excluded, it shows that the conflict of interests can make others look more fairly to examine research evidence.

In addition, the conflict of interest also involves the dual role of the researchers. People who review the study of autism intervention may also be the founder of a certain therapy. In public research, this identity is rarely mentioned. Connie Kasari, a professor of human development and psychology at the University of California of California, said: "Researchers often have no motivation to get out of their" islands', and they are unwilling to verify independently or cooperate with others to verify intervention therapy. The problem of money. "[8]

The future development trend of autism therapy

The development in the field of autism is still less than a century, but it is currently necessary to surpass the concepts and methods left over from history. Many scientists are committed to promoting this field to develop in more dimensions, and everyone is still optimistic about the future.

First of all, regarding test methodology, autism research has a trend of turning to random control. According to statistics, the number of random control research has risen from 2 items in 2000 to 48 in 2018. Most of them appeared after 2010, and only 12.5%of research had risks of bias and low risks. [12]

Secondly, the study of autism intervention needs to surpass the operation of only a single intervention therapy in the control group, and compares multiple intervention therapy. The ultimate goal is to allow doctors to list the advantages and disadvantages of different therapies to the patient's family, so as to make a wise choice for patients. For example, a study published in 2021 in Journal of the American Academy of Child & Adolescent Psychiatry compared the effect of ABA intervention therapy and an early Denver Model (ESDM). Those who are mainly aimed at the comprehensive intervention system of children aged 4 to 5 to 5 to 3 years old. They use games as the intervention framework, focusing on emotional interaction and social motivation, emphasizing the teaching and family intervention model in natural situations [14 ]. It was found that the efficacy of the two was comparable. In fact, if more studies can occur, you can help professionals understand which intervention therapies can achieve the best effect at the least time and economic costs. But currently there are too few such research.

In addition to the efficacy of multiple therapies, the application of different intervention therapies is also worth exploring. Connie Kasari, a professor of human development and psychology at the University of California, Los Angeles (UCLA), led the team to develop a game -based natural intervention therapy Jasper. She compared the effects of applying Jasper before and after ABA intervention. The effect of the structured ABA intervention method will be better first, and other situations will be the opposite. Such a serial multiple distribution random test will help develop personalized treatment strategies for individuals.

For researchers, Sandbank suggested that he has the courage to break through the traditional model of intervention therapy through case verification. The previous article has also stated that it can be designed from multiple angles to design experimental solutions to give priority to independent reproduction intervention effects. Although such a research results may not be as ideal as original research, "we must not be afraid of any discoveries." [8] At the same time, researchers should never forget that they are obliged to launch high -quality scientific research, rather than shirk responsibility to shirk to the responsibility to shirk to the responsibility to the other aspects.

Finally, in order to effectively promote the study of autism, scientific supervision also needs to change from top to bottom. Many autism journals need to tighten the standards published by their papers, and more fund sponsorship is also required to motivate scientific researchers to launch higher costs and more complicated designs. For example Essence The two reports mentioned at the beginning of this article (from the Whitehouse and Sandbank team) have exposed the potential problems of autism science to the public's sight. It has just begun to get high -quality data "[8], but only what we do can we save more" stars ".

references

[1] https://www.who.int/zh/news-load/fact-detail/autism-disorders

[2] https://www.spectrumnews.org/opinion/beyond-dhe-a-confrsation-with-ndrew-whitehouse/

[3] https://www.autismcrc.com.au/interventions-EVIDENCE

[4] https://doi.apa.org/doilanding?doi=10.1037%2FBUL0000215

[5] https://www.spectrumnews.org/news/studies-Find- Thin- Evidence-For-Early- AutiSM- Therapies/

[6] http://thelovaascenter.com/about-s/dr-edar-lovaas/

[7] https://doi.apa.org/doilanding?doi=10.1037%2F0022-006x.55.1.3

[8] https://www.the-scientist.com/news-opinion/why- autism-hve-n-n-problem-69916

[9] https://link.springer.com/article/10.1007/s10803-020-04844-2

[10] https://nationalautismCenter.org/national-tandards-project/Phase- 2/significant-findings/

[11] https://blog.scienceNet.cn/blog-279293-1254793.html

[12] https://acamh.onlinelibrary.wiley.com/doi/10.111/jcpp.12828

[13] https://linkinghub.elsevier.com/retrieve/pii/s0890856720313502

[14] https://ww.ncbi.nlm.nih.nih.gov/pmc/articleS/pmc7390010/ #::text=P 85%A5%E4%B8%B9%E4%BD%E6%A8%A1%E5%BC%EF%EF%BC%88early,%E5%84%BF%E7%AB%A5%E7%9a 9a %84%e7%BB%BC%E5%90%88%E5%B9%B2%E9%84%E4%BD%E7%B3%BB%E3%80%82

Source: Return to Park Popular Science China-Creative Cultivation Plan

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