Sensory Therapies For Autism: How Much Sense Do They Make?

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ASPartOfMe
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28 May 2017, 12:25 am

Forbes Magazine

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In other words, the evidence base for these therapies is fragile or nonexistent, at least according to a systematic review just published in Pediatrics, covering the findings of 24 studies. The review, by Vanderbilt researcher Amy S. Wietlauf and colleagues, focused on massage, sensory integration approaches, environmental enrichment, and auditory enrichment, tossing in the available few studies of music therapy and weighted blankets for good measure. That list likely sounds familiar to parents of autistic children.

According to the authors, the available evidence for the effectiveness of any of these interventions is limited, and even for those that seem to have an effect, how long the effect lasts is simply unknown. The longest term they could drum up was 6 months.

Therapies based on sensory integration, environmental enrichment, and massage may yield some positive outcomes for both sensory and motor systems, but the evidence is less than overwhelming. Whether or not they do anything negative--besides draining a pocketbook--is not known because only one of the studies the authors found even looked at the question.

In general, these authors found small, lightweight studies generally lacking rigor, involving a broad mix of autistic participants with heterogeneous demographics. Yet for years, children have been receiving these therapies--wearing headphones for auditory integration, receiving various kinds of massage, rolling around on things or having things rolled on them, experiencing targeted exposures to various stimuli, lying under weighted blankets--all in the name of helping them streamline their sensory inputs, yet no one even knows if they're effective. No one knows if they are even necessary.

The studies that Weitlauf and her colleagues did find were mostly teeny, many of them with fewer than 20 participants in a group (the median sample size was 34). Many of them had a high or moderate risk of bias, which means a possible skew one way or the other in the results.

The thing is, these conclusions aren't especially novel. As the authors themselves note, a half dozen previous reviews stretching back to 2011 have yielded similar results: limited support for most of these approaches.

This systematic review is one of a pair published in Pediatrics; its partner paper showed even less effect with the various supplements and other purported nutritional remedies peddled to parents of autistic children. In an editorial accompanying the duo, Duke University professor Geraldine Dawson laments the lack of definitive findings or clear efficacy of the myriad options laid out in front of autistic parents, all of them involving expense of time and money. But there's a plot twist.

Dawson observes that a huge contribution to improvement in many trails of therapies in autistic populations comes from a placebo effect. Almost a third of participants in these trials may respond to placebo, she writes, and outcomes depend to a great extent on who's doing the rating, where the trial is located, and what other therapies are ongoing in addition to the placebo. With almost half of improvements even in the treatment group being attributable to placebo, studies require larger populations for any genuine effects of treatment to be clear.

The response to these findings, from both Dawson and the authors of the systematic review, is to call for better, more rigorous studies. Part of that rigor would, Dawson writes, require understanding better the biology of autistic people and using better measures of treatment outcomes.

Perhaps. But given the power of placebo that has been established, perhaps a look at the factors driving that effect would also be useful. Perhaps the issue isn't small studies or placebo effects or lack of rigor but a lack of attention to what autistic children respond to best.


The lack of minimal scientific rigor is common in the autism research. Despertion combined with profits to be made and this is what you get.


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“My autism is not a superpower. It also isn’t some kind of god-forsaken, endless fountain of suffering inflicted on my family. It’s just part of who I am as a person”. - Sara Luterman


Redxk
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28 May 2017, 8:38 pm

I don't care if studies find it's making me worse; I won't give up my weighted blanket!