Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Thursday, August 5, 2010

Book Reviews: Alternative Therapies for Children

Two books published by Jessica Kingsley Publishers will be of interest to students of complementary and alternative treatments for disorders of childhood mental health or educational progress. Dyslexia and alternative therapies, by Maria Chivers (London: Jessica Kingsley, 2006) focuses on treatments for reading problems, but includes a variety of CAM approaches covering a spectrum of methods from physical manipulation to stress reduction. Understanding controversial therapies for children with autism, Attention Deficit Disorder, and other learning disabilities, by Lisa A. Kurtz (London: Jessica Kingsley, 2008) reviews a much broader range of problems and treatments, as its title suggests.
The Chivers book is notable for its completely uncritical consideration of an extensive list of dyslexia treatments. The author concedes that “tried and tested teaching methods should not be replaced, and… alternative approaches should be treated as complementary”. She asks readers to judge for themselves but notes that “it will pay dividends to keep an open mind”. She applies this approach even to “distant healing” methods, about which she remarks that “some people are skeptical about therapists who state they can cure them without touching or even seeing the clients themselves. But as with many therapies in this book they may be worth trying.” About one method, Chivers says, “This definitely works for me.” She advises that “it is healthy to maintain a critical faculty and to question what you are told, but equally make sure this does not prevent you from being open to some of the valuable treatments that are out there.” Clearly, Chivers is not one to concern herself with the evidence basis for a practice.
Chivers provides no discussion whatever of issues concerning research design or the concept of evidence-based practice, but simply presents a list of CAM treatments and summarizes the claims made by their proponents. She includes a bibliography with a small number of articles from peer-reviewed journals, a very few of which report randomized controlled trials; most of the resources listed are non-technical or even speculative in nature. The book also features a list of organizations whose websites offer either general information or advocacy for specific methods such as chiropractic treatment.
Chivers’ book is not a resource for those who are interested in evidence-based practice, but it does provide a lengthy and sometimes surprising list of CAM methods that have been put forward as potential treatments for reading disabilities. These include acupuncture, hypnotherapy, and nutritional supplements as well as “visual” treatments like the use of colored overlays. The suggested treatments resemble each other, not only in the absence of empirical support for their usefulness, but in their complete lack of plausibility. Curiously, the one highly plausible, although little-supported, method of treating dyslexia, FastForWord, is omitted from the list.
The Kurtz book makes a somewhat better effort to deal with the issue of evidentiary foundations for CAM therapies. One reason for this may be the fact that Kurtz is looking at treatments for psychiatrically-diagnosed conditions as well as for educational problems. The higher cost and insurance-related decisions of the former suggest the need to focus on efficacy, whereas the effectiveness of educational methods is less frequently subjected to serious evaluation. Kurtz presents reference lists for treatments, including outcome research in some cases, but providing only occasional and cursory guidance about conclusions to be drawn; much more space is devoted to methods for training practitioners than to the evidence bases of these treatments. As was the case for the Chivers title, plausibility is not mentioned as a concern, and the completely implausible “Bach flower remedies” receive the same attention as the quite plausible but weakly supported FastForWord.
Kurtz’s discussion of several methods involves notable omissions. The reference list for the Doman-Delacato “patterning” technique includes a reference to the 1999 policy statement of the American Academy of Pediatrics on this method, but the text does not note that this statement was the second of two by this group, both rejecting the use of “patterning”. The discussion of Facilitated Communication refers in passing to the possible influence of the practitioner on this method, but does not discuss some of the serious accusations families have suffered as a result of the assumption that the technique yields accurate information about a child’s intention.
Kurtz’s discussion of Holding Therapy is problematic in that it describes only one of the several approaches that would be categorized under that label. In addition, the description fails to explain the length or frequency of sessions, a point that would do much to communicate the intense experiences characteristic of the specific treatment described (the Welch method). Kurtz does not mention that Holding Therapy has been classed as a potentially harmful treatment.
It was a surprise to this reader to see DIR/Floortime listed as a CAM treatment by Kurtz. DIR (Developmental, Individual-difference, Relationship-based therapy ) is indeed lacking in an established evidentiary foundation, and it uses some of the problematic methods associated with Sensory Integration. However, DIR has a highly plausible theoretical basis and there is ongoing work aimed at outcome evaluation, so DIR would seem to stand in considerable contrast to other methods discussed by Kurtz.
Like some other Jessica Kingsley publications, the Chivers and Kurtz books give the reader a certain sense of incompleteness, as if no reviewer or copy editor had acted to jog the authors’ memories and remind them to include or elaborate on various points. As simple lists of treatments, or as compilations of resources for further study, however, they provide well-organized though unevaluated information for the interested researcher.

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