Why Autism Therapies Have a serious Evidence Problem

Some fields of medicine are evidently more like quackery than other fields of medicine!

A word of caution: I suspect that ASD as well as ADHD (Attention-deficit/hyperactivity disorder) are significantly overdiagnosed, not least because they are still poorly understood! Treatment is big business.

The use of single case studies is highly suspect!

"... reported in 2020 that few autism interventions used in the clinic are backed by solid evidence. ...
Another 2020 study—the Autism Intervention Meta-Analysis, or Project AIM for short—plus a string of reviews over the past decade also highlight the lack of evidence for most forms of autism therapy. Yet clinical guidelines and funding organizations have continued to emphasize the efficacy of practices such as applied behavior analysis (ABA). And early intervention remains a near-universal recommendation for autistic children at diagnosis. ...

The problems facing autism intervention science date back to the field’s foundation in the 1970s and ’80s. Some initial studies, though groundbreaking at the time, had small sample sizes and statistical shortcomings. Ole Ivar Lovaas’ seminal 1987 ABA study, for example, was ‘quasi-experimental,’ in that participants weren’t assigned to groups randomly. And other studies from this era followed a ‘single-case’ design, in which participants served as their own controls. ...

From the start, some researchers deemed randomized controlled trials neither ethical nor feasible for a condition as complex as autism. And that resistance fed into a culture of accepting a lower standard of evidence within the field ...

“These are legacy ideas, but they persist,” ... and probably keep the field from advancing toward more effective interventions. ...

Less than a third of the studies that test ABA-related interventions are randomized controlled trials ... And single-case designs make up the bulk of studies included in national reports issued to U.S. clinicians. For example, the 2021 National Clearinghouse on Autism Evidence and Practice (NCAEP) report deemed 28 practices evidence-based, including many behavioral interventions, yet 85 percent of the studies reviewed are a single-case design. So too, the 2015 National Standards Report (NSP) identified 14 effective interventions for autistic children, adolescents and young adults but draws on a set of studies of which 73 percent are single-case. ..."

Why Autism Therapies Have an Evidence Problem | The Scientist Magazine® Some experts argue that better trials are needed before putting interventions into practice.