Concerned About Unconventional Mental Health Interventions?

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

Monday, April 21, 2014

You Can't Go Home Again, Or Regress to Infancy Either


The idea of psychological regression keeps pushing its way to the front of the discussion, and I suppose I shouldn’t be surprised, because current na├»ve beliefs about psychology almost always assume that someone can go back to early childhood, back to the womb--   even back to previous lives. Still, when this matter comes up again, I feel like taking up the fight on the side of reason.

In a recent blog post, I referred to  Kathy Brous, who says she accidentally regressed herself back to infancy. (I really must get her book and see how she did it, and I do think she should warn us all of the kind of accident that might have this effect.) Then, a few days ago, I received a flyer advertising a class in qigong (the Chinese exercise/meditation routine) for autistic children. The class instructs parents how to do what they call qigong sensory training, which they are then to do with their autistic children every night. What does that have to do with regression, you ask? Well, here’s what the flyer says: “The routine is designed to normalize your child’s difficulties with touch & sensory sensitivities so they can essentially ‘go back’ and begin to reclaim the key developmental milestones that were missed in the first years of life.” In other words, the qigong presenter (who is someone I know and had respected up to this point) claims that the treatment can cause regression to an earlier psychological stage, followed by rapid recapitulation of previously-missed developmental steps.

The idea of regression has become so embedded in American thought that it is hardly even discussable--  it’s an a priori assumption, an agreed-upon given, even one of dear Mr. Rumsfeld’s known knowns. But let’s just think about it for a bit.
The idea of regression came out of the neurological studies of John Hughlings Jackson in the late 19th century. Hughlings Jackson was interested in seizure disorders (his wife had died from one) and other aspects of brain damage, and in the course of his work he concluded that the nervous system was organized in a hierarchical fashion. This meant that higher-level brain areas acted to inhibit the more primitive parts of the brain, but if the higher areas were damaged, primitive movement patterns would reappear, showing that the lower areas were now “in charge”. Hughlings Jackson’s view of regression was of great interest to Sigmund Freud, whose biological view of personality used the metaphor of regression, comparing psychological changes to neurological events. Freud’s second important metaphor, the idea that human motives and needs acted in a hydraulic manner and could be blocked in their normal flow by disturbing events, worked together with the regression idea, suggesting that if a patient could regress to and remember an event that caused emotional blockage, that blockage would disappear.

Freud’s ideas about regression really involved events after the first year of life or so, and in some of the cases he mentioned, patients had been young adults when the problem incident occurred. However, some of Freud’s students and colleagues, like Otto Rank, suggested that emotional difficulties required regression to the time of birth, and some later authors moved the problem period to prenatal life--  or even, as Scientologists claim, to conception.

So, how do we examine these ideas? It’s certainly true that sometimes people act childish, and if they are children they may show problem behaviors characteristic of earlier ages, things we thought they had “outgrown”. Under hypnosis or other forms of suggestion, people may act as if they are babies, or at least act the way they think babies act. Have any of these people really regressed? The first issue, that of showing less mature behavior, is easily explained as a reaction to stress; it’s not necessary to posit regression in order to explain it. For the second, it’s important to realize that with suggestion people can also act as if they are much older than they are, or at least they can act the way they think a much older person acts. If we are going to accept regression on the grounds of a person being able to act like a baby under hypnosis, it seems that we should also accept “progression” to a later stage of life--  and I can’t believe that even the most devout regressionist would be willing to do that.

It seems, then, that we don’t have evidence that people do regress in the common sense of the term. And according to the usual rules of logic, the burden of proof is on those who claim regression happens, as it is not possible to prove that something never occurs.

Obviously, the most important question about regression has to do with whether there is evidence to support its occurrence. But in the absence of such evidence we can also proceed to consider the plausibility of regression. An important concept that argues against psychological regression is epigenesis. This term refers to the fact that in the course of development, innate biological factors interact with experiences to shape the individual. At every stage of development, new experiences act on a person who has already moved along a developmental pathway determined by biological characteristics added to previous experiences. Thus, the individual who has had Experience A at an early stage may respond very differently to an event than the way someone who has had Experience B responds to the identical event. In the course of development, people really change, and the results of past events may or may not be able to be undone later—but in any case are not undone by repeating early experiences.

To take a biological example, a child who has been badly malnourished may be brought back onto a normal developmental path if given an improved diet at age 18 months, but if the better diet does not appear until age 5, stunting of growth and of brain development will not be corrected no matter how good the food is---  and incidentally, to improve the five-year-old’s diet does not mean to give him 6 months of milk alone and then start him on pureed foods, which would be the appropriate analogy to many psychological regression methods. Similarly, a person who has lost speech due to a stroke is not treated by exposure to infant-directed talk of the kind he originally needed for good speech development.

Erik Erikson’ psychosocial theory of development made good use of the idea of epigenesis. Erikson saw the individual as working through a series of challenges in which he or she needed to find a balance between two aspects of the self and of the world. At each stage, the person brought to the new challenge characteristics that came from previous development, which helped to determine how a balance might be found.  Regression was not an option--  but did that mean that a problem from the past could never be resolved? No, in Erikson’s view, every problem of personality development (like a balance of trust and mistrust) was to some extent re-worked at every developmental stage, in the context of new events and new abilities. Each stage had a focal problem, but other issues were also malleable, so, for example, a person who had in early life had reason to be distrustful could during childhood, adolescence, or later, have new experiences with people that would enable a more positive balance of trust and mistrust.


The idea of epigenesis is that people are influenced by experiences but that they keep on developing and become different persons over time. The idea of regression is that some aspect of an individual remains identical in spite of maturation and experience, but carries with it “buckets” of experiences that can be dumped and replenished with better contents through a regression procedure. This seems to suggest that according to the regressionist view, the personality is somehow independent of the usual rules of time, space, and developmental change.

But, you say, let’s go back to the qigong. What if the regression claim is irrelevant? Isn’t the important thing whether it works? And it turns out that there are claims that it works, but it’s all a bit sticky. For example, in one study (Silva, L., Schalock, M., & Gabrielsen,K. (2011). Early intervention for autism with a parent-delivered qigong massage program: A randomized controlled trial. American Journal of Occupational Therapy), the authors concluded that qigong was effective. Having invited parents to join the trial, and presumably explained that some would receive treatment and others be wait-listed, they compared a group of children whose parents were given 3 hours of training , plus 30 minutes a week for 7 weeks of coaching while the parents performed the procedure in the presence of a trainer, to another group who were not described as receiving any attention except for being told they were wait-listed. So, as so often happens, we have people who are told they’re getting a good treatment, get a lot of attention from enthusiastic trainers, get together with the trainer and the child periodically, and spend more time in direct interaction with the child than usual, and they’re compared to people who don’t get any of that. Not surprisingly, it turns out that families with kids with handicapping conditions do better when they get supportive attention, and the kids then do better too; we don’t have to turn to Chinese medicine for an explanation here. The authors of that study should have had a comparison group with sham qigong  using different movements than the real thing, and they did not have that, so I’m afraid they don’t get to conclude that the treatment is effective.  

  



Monday, April 14, 2014

Disorderly Thinking About Developmental Trauma Disorders


Sunday Koffron Taylor [sorry, I gave the wrong name before] kindly posted for a Facebook group the following piece: http://attachmentdisorderhealing.com/developmental-trauma, the work of one Kathy Brous, who is said to be a technical writer and advertises her own book with the statement that she accidentally regressed herself back to infancy. (How’d she get back again? That’s what I want to know.)

I was floored by Brous’s statements about the posited Developmental Trauma Disorder, proposed by Bessel van der Kolk to the editors of  DSM-5 and rejected by them on the grounds that there have been no published accounts of cases that are appropriate for this diagnosis and not for other existing diagnoses. Brous appears to quote van der Kolk and Allan Schore correctly, however, so I don’t think the whole problem can be blamed on her.

Let me offer a few quotations from Brous’s article, with rejoinders to each.

First, I note that Brous refers to Allan Schore as the “father of attachment theory in the U.S.” This is an absurd statement and indicates that Brous is in fact ignorant of the actual history of attachment theory as understood by psychologists, rather than by journalists. If one had to choose “fathers” for attachment theory in the U.S., Alan Sroufe and Everett Waters come to mind as the major candidates. Schore’s contribution, if such it can be called, is something he calls “regulation theory” or “modern attachment theory”. As I was preparing an article about attachment theory for the journal Theory and Psychology several years ago, a reviewer asked me to include Schore’s ideas, which I did, looking especially at his attempts to bring material about brain injuries and about behaviors of other species into the discussion. Here is part of what I said: “.. A.N. Schore’s speculation about right-brain functioning is on shaky ground. Passing over the well-known fact of the holistic functioning of an intact brain, we can note that a careful parsing of Schore’s sources (J.R. Schore & A,N, Schore, 2008) suggests a lack of due attention to some important points. In addition to a number of references to Schore’s own publications as evidence for specialized right-hemisphere attachment functioning, Schore and Schore cited about 10 sources as indicating empirical evidence for the postulated connection. Of these, two… involved work on rodents, which was presented as supporting evidence without any textual reference to the use of data from non-humans. One paper… described hemispheric differences in processing upper and lower parts of a facial display, and concluded that lower facial displays are preferentially processed by the left hemisphere and upper facial displays by the right hemisphere; Schore and Schore mentioned only the right-hemisphere data. A fourth paper… discussed facial processing deficits in persons  for whom a cataract in early infancy had prevented stimulation of the right visual cortex; Schore and Schore cited this paper as evidence for the right-brain hypothesis without noting that the teratogenic or genetic event that caused the cataract might also have caused atypical brain development…” (Mercer,J. [2011]. Attachment theory and its vicissitudes: Toward an updated theory. Theory & Psychology, 21, 25-45). Et cetera, et cetera, all to the point that Schore’s “modern” theory is based on a stroll through the cherry orchard. Read the background material, and you see at once that Schore’s part of this belief system is largely notional.

All right, let’s soldier on to more of Brous’s remarks. How about this one? “Developmental trauma starts in utero when there’s not much more than a brain stem and goes on during the pre-conscious years… until 36 months, when the thinking brain… comes on line. It’s 45 months [apparently beginning at conception, to make the numbers right. JM] ranging from general anxiety to non-stop terror.”

Where to begin? How about psychological trauma in utero? What events are emotionally disturbing to a fetus? Are we talking about emotion-related hormonal changes in the mother, which could certainly shape aspects of brain development but would have to be related to intense and continued distress in order to do so?  Is this a theory that actually could apply only to children of mothers held in concentration camps or caught in civil wars, or is there some attempt to think about more typical developmental events? My guess is that Brous, at least, is not talking about any of these things, but instead is committed to the idea of trauma at the time of conception, a la Scientology. My crystal ball suggests that behind Brous’s references lies a belief in “cellular consciousness”-- posited learning that does not require a nervous system--  and that this is also concealed in van der Kolk’s claims about the body keeping score.

All right, and when are these “preconscious years”? Is Brous claiming that children of almost three years are not thinking in the usual meaning of the term? Are these the same children who are known as toddlers to be able to figure out whether to believe a person who has acted “nice” rather than one who has not? Are they the same ones who tell and listen to stories and express intense likes and dislikes, or who reason about their own behavior (I’ll quote one two-year –old of my acquaintance: “I like chickens, but I never kiss them, because they have beaks and no lips.”) If Brous wants to say that cognitive development is very much in progress during the first three years, or even that most people have few or no memories from that period, that’s fine--  but to say young children are “preconscious” is inaccurate and without purpose except to allow for an extravagant emphasis on their experiences of fear, even constant terror.

Let’s jump ahead a bit. Now we see that van der Kolk calls “insecure attachment and attachment disorders” the causes of the posited Developmental Trauma Disorder. But, hold the phone a moment. It’s well known that infant-parent attachment does not develop until at least 6 months after birth. Methods for measuring insecure attachment are directed at children of 12 months or older, so there’s no way anyone could reliably identify this in a child between 6 and 12 months, much less in earlier life. As for “attachment disorders”, these are not the same thing as insecure attachment (see previous post for more about this). How can it be that attachment “problems” cause DTD, but DTD is caused by events as early as conception--  as much as 15 months before attachment even begins? Like a problematic form of attachment behavior, this reasoning is disorganized/disoriented.

Just one more bit here, as I’m sure we’re all getting tired (goodness knows I am; reading this stuff is wearing). Van der Kolk has a treatment for the disorder he proposes. It’s somatosensory healing, which turns out to mean doing theater, yoga, and martial arts in order to “get them inter-personally attuned.” Folks, it’s as easy as that! These children have lived in terror from conception and had their brains skewed as a result, but children’s theater will fix it! Their bodies will change that scoreboard to say “game on”. The National Endowment for the Humanities will take over from NIMH, and the Santa Barbara Graduate Institute will be accredited by acclaim, and Alice Miller will be canonized, and I will become a hermit.






Saturday, April 12, 2014

Insecurity Is Not Pathology (cf. Linus and Woody Allen)

 For a very long time, before attachment became a religion, Americans have been worried about “insecurity”. People who value independence and individualism can get nervous about insecurity, with its suggestions of emotional dependence and social engagement. I remember overhearing a conversation years ago, about a child who had a “security blanket”. “How come he carries that blanket around all the time?” “I guess he’s insecure.” “Oh. Well, I guess then we’d better take it away from him.” (Here we have not only the belief that everyone must at least behave as if they are independent, but a common error of logic--  if A causes B, then removing B must also remove A!) Like many other somewhat frightening things, insecurity has been a topic of humor from Linus right on to Woody Allen.

Today, we see the concern with insecurity reflected in journalism and discussions that equate  insecure attachment, as measured by methods like the Strange Situation, with “attachment disorders”. Insecure attachment, originally defined as a pattern or quality of attachment, may now be touted as an emotional disorder (e.g., www.helpguide.org/mental/patenting_bonding_reactive_attachment_disorder.htm).
According to a number of studies, among children with normal family experiences, about 65% are evaluated as securely attached. About 30% are insecurely attached in one or another of the possible categories, and a small percentage are assessed as disorganized in their attachment behavior. Disorganized attachment is associated with early maltreatment and also with later externalizing problems (e.g., aggressive behavior). Insecure attachment is not ideal, but on the other hand is not particularly associated with serious psychopathology.

If insecure attachment does not cause serious problems, how did it come about that people are so concerned with it--  indeed, that they are concerned about it at all? How did “security” come into the study of attachment? There is a history here.

It’s easy to assume that secure and insecure attachment behaviors are so different that they jumped right out at Mary Salter Ainsworth as she observed young children. Actually, though, Ainsworth went looking for them and developed the Strange Situation as an instrument that would differentiate them. She has told part of the story herself (www.psychology.sunysb.edu/attachment/online/ainsworth_security_and_attachment.pdf).

Ainsworth was a student of William Blatz of the University of Toronto in the 1930s. Blatz developed a “security theory” that was a welcome alternative to Freudian theory in an anti-psychoanalytic intellectual environment. Blatz did not publish widely or sponsor a great deal of research on security theory, and Ainsworth’s recollections and comments are probably the most accessible source of his ideas. As Ainsworth noted about Blatz, “He was a brilliant hypothesizer, but I believe he did not think of research so much as a way of testing hypotheses as a way of reformulating old hypotheses and discovering new ones. He did not attempt to spin a theory to encompass all of personality and its development. He did, however, think that the concept of security could guide the exploration of this rich and confusing field.”

What was security, from Blatz’s viewpoint? According to Ainsworth, it was “feeling confident or effective, even though one’s feeling of efficacy might stem from reliance on something or someone other than oneself.”
Blatz felt that people want to be comfortable and secure, but they were also motivated by an “appetite for change”, which in itself can create insecurity. When very young, they experienced an “immature dependent security”, in which they needed to be able to retreat to a protective parent when frightened by the consequences of their exploration. Subsequently, as children became more knowledgeable, they could achieve an “independent security” that allowed them to explore without constantly checking back with adults. In fact, Ainsworth noted, Blatz thought that by the time they reached maturity, “they should be fully emancipated from parents and not dependent on them any more… any substantial continuation of ‘immature dependent security’ was to be viewed as undesirable”--   a far cry from the current preoccupation with maintaining early attachment behavior through the teens! Having achieved independence, however, the individual was now ready to enter into a partnership of “mature independent security”, in which each partner provided support and protection for the other as needed.

If steps in the development of security did not progress properly, Blatz considered, a variety of processes like intolerance of disagreement and blaming of others might come into the picture as ways to achieve a sense of comfort and effectiveness. However, as Ainsworth pointed out, “Blatz arrived at his list [of processes] in a purely ad hoc fashion in the course of his clinical experience, and never claimed it was complete.”
Ainsworth’s early research involved attempts to evaluate the security of adults. In pursuing this work, and in her later efforts to assess children’s attachment, she followed an important concept contributed by Blatz. As she wrote, “Blatz’s theory does not hold with a simplistic dichotomy between secure and insecure. The degree to which children are secure can be assessed through an examination of their confidence in others, especially parents, to provide comfort, reassurance, and protection when needed, and [my italics—JM] their confidence in being able to cope with the world on the basis of their own skills and knowledge… One cannot arrive at a single security/insecurity score, but should instead consider the patterning in a comprehensive assessment.” Such patterns, of course, are what Ainsworth and her colleagues attempted to assess by means of the Strange Situation, and that much-valued measurement seems unfortunately to have encouraged not only a dichotomy of secure vs. insecure, but an overvaluing of the former and a pathologizing of the latter. (Not all students of attachment agree with the typology of secure and insecure attachment, and some authors have proposed that attachment security actually lies on a continuum.)

As you can see, Blatz’s view of security seems to have been a major factor causing Ainsworth to look for “secure” and insecure” patterns in young children’s attachment behavior. She did not first look for patterns, and then label them as secure or insecure. (Disorganized/disoriented attachment behavior, on the other hand, was first noticed as a pattern and later named.) Ainsworth continued, very appropriately, to focus on patterns of attachment behavior, but unfortunately popular and journalistic views have come to identify secure attachment as a good category and all other types of attachment behavior--  insecure patterns, disorganized/disoriented attachment, even Reactive Attachment Disorder--  as belonging to an equally bad category. This is comparable to assuming that there is only one acceptable pattern of early language development or of pubescence, and that all others --  not just the truly problematic---are to be deplored or subjected to treatment.

It is a curious pursuit, the examination of the journalistic theory of attachment. In some cases, like the one just discussed, the media have re-worked earlier views in order to achieve a simple way of defining the good and the bad, and in order to abandon the complicating idea of developmental change in attachment.  In other cases, some of Bowlby’s old tenets, now long abandoned, are maintained. For example, the statement that “you don’t attach in a group home” (http://miami.cbslocal.com/2014/04/10/senate-group-home-proposal-spurs/debate/) may well be a result of assuming that Bowlby’s original monotropy theory (attachment to a single caregiver only) still holds, although in fact this idea was abandoned long ago, and it is clear that a young child may be attached to several adults, not all necessarily with equal security.










Wednesday, April 2, 2014

Autism Awareness versus Autism Anxiety


Today, April 2, has been designated as Autism Awareness Day, and I think this is a wonderful idea--  provided that what people are made aware of involves accurate information about autism. To be anxious about autism—an increasingly frequent condition of parents--  is not the same thing as actually being aware of the facts. Here are some of the factual issues that can create a lot of anxiety if not understood.

  1. Diagnosing autism
I receive almost daily inquiries from young parents who are terrified that their infants of a few weeks old are autistic, because the babies don’t gaze into their eyes, or sometimes because the babies are rather placid. These very worried people are not aware that babies do not become very socially interactive until they are three or four months old. In fact, in the old days before autistic disorders had been described, this normal stage was often referred to as “autistic” or self-absorbed.  The anthropologist Ashley Montagu spoke of human beings as having a period of “exterogestation” in which babies developed for a few months as if they were still in the womb, and it’s during the months of  “exterogestation” that autistic self-involvement and inattentiveness to stimulation are evident.

Someone asked me yesterday how babies acted at two months of age when they were going to be diagnosed as autistic later on. This is an excellent question (as we all say when we don’t have an answer), but think what would have to be done in order to know this. We would have to have careful descriptions of the behavior of thousands of two-month-olds, follow them until age 2 or 3 years, and find out which ones were diagnosed as autistic--  then look to see whether there had been differences at two months between those who were later said to be autistic, and those who were not. This research has never been done, and given our current fiscal austerity, I don’t suppose such expensive work will be done in my lifetime, although perhaps it will eventually take place.

The bottom line is that it is not possible to tell babies who will be autistic apart from those who will not, when they are very young. I know this is disturbing in light of the constant emphasis on early intervention, but it’s a fact nevertheless. It’s also a fact that when babies are diagnosed as being autistic during the first year or so of life, there are many false positives--  children who are categorized as autistic, but who then proceed along a typical developmental trajectory. Even  toddlers and preschoolers may be incorrectly diagnosed. One of the problems is that some behaviors often associated with autism, like toe-walking and hand-flapping, are also often seen in younger typically-developing children.

  1. That epidemic
One concern that naturally makes parents anxious about autism is the constant reference to an epidemic of autism, with numbers of diagnosed children increasing so rapidly that if we keep on at this rate everyone will be autistic and the concern will be about those unfortunate neurotypical kids, growing up in a world they don’t understand!

Is there really an epidemic of autism? Or do these increasing numbers have something to do with the way we diagnose and count cases of autism? There’s no question that criteria for the autism diagnosis have changed over the years, and of course there will be more or fewer diagnosed cases if we broaden or narrow the standards for making the diagnosis. The anthropologist Roy Grinker (grandson of the famous name, if anyone remembers him) has looked at editions of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM) back to the first edition in 1952. Autism was originally conceived of as a type of schizophrenia, later as possibly a cause of mental retardation, still later thought to be related to attachment, and in the most recent edition is connected with communicative disorders and includes the problems that used to be called Asperger’s syndrome. There are likely to be big differences between numbers of children diagnosed as autistic when the criteria are those for a form of schizophrenia, and the numbers diagnosed when an “autistic spectrum” includes mild social disabilities. This is not to say that there is or is not an actual increase in cases of autism, but the facts warn us to be careful about conclusions that may be based on apples only, apples and oranges together, or all the fruit in the produce aisle.

A relevant piece of information is that state autism rates are correlated with the average adult educational level of the state. That is, in states where adults tend to be highly educated, there are high rates of autism diagnoses. Does this mean that we’re back to the old idea of the over-intellectual refrigerator mother who causes autism? No, what it probably means is that when parents are well-educated and know that autism is a possibility, they are more likely to seek that diagnosis and the treatment that can go with it. Less educated parents may assume that their possibly-autistic child is “just peculiar” or perhaps mentally retarded, and never seek diagnosis or treatment. (And by the way, if they happened to choose homeschooling, who else would there be to suggest a diagnosis?)

  1. What causes autism?
At the risk of repeating myself and many other people, I want to say that It Is Not About Vaccines, with or without thimerosal, or whether on the recommended schedule or some other schedule. Andrew Wakefield’s study pointing to vaccination as a cause of autism was fraudulent, and this has been known for quite a while.
An excellent article by Sam Wang, “How to think about the risk of autism”, appeared in the Review section of the New York Times on March 30. A graphic showed a list of possible causes of autism and the risks associated with each one. (For those who are worried about the effect of older fathers [over 60], fewer than 3% of the children of such fathers are expected to develop autism.) The effect if being premature by 9 or more weeks is much greater, but still, fewer than 3% are later diagnosed as autistic.

The huge cause of autism is a genetic one; when one identical twin is autistic, the chances are between 36% and 95% that the co-twin will also receive this diagnosis.(However, because there seem to be many genes and gene interactions at work in autism, there is no genetic test available.) For fraternal twins, who are not genetically identical, the chances are up to about 30% that if one twin is diagnosed as autistic, the other will also be diagnosed. The other leading cause of autism, a non-genetic factor, is damage to the cerebellum at the time of birth, which is rarely mentioned by the mass media.

  1. Are there good treatments for autism?
I wish I could answer this question more positively than I can. The best established treatment for autism, Applied Behavior Analysis (ABA), was originally reported to be highly effective and to enable a large proportion of autistic children to attend mainstream classes without any special help. But a more recent randomized controlled trial suggests that the size of the effect of ABA is not nearly as large as had been thought. ABA is often recommended by school child study teams and is often paid for by health insurance.

Another treatment that has been put forward as useful for autistic children is DIR/Floortime ™, a procedure that encourages the development of communication at levels from the simplest to the most complex. Unfortunately, there has been little research giving supportive evidence for the effectiveness of DIR. A randomized controlled trial has been said to be ongoing, but I have not been able to find that it has been published.

Both ABA and DIR are plausible in terms of established information about child development and learning.

I am sorry to say, however, that there is a list of implausible, non-evidence-based psychological treatments that are sold to concerned parents and that make unreasonable claims both about causes of autism and about their own effectiveness.  (These are in addition to physical treatments like chelation or diet restriction.) I will describe a few of these.

Holding Therapies, methods that involve physical restraint of children accompanied by demands for emotional expression, were suggested for treatment of autism in the 1960s. These treatments are painful and frightening for children and have largely been rejected in the United States, in spite of the support given to them some years ago by Temple Grandin and Bernard Rimland.  They continue to be used in Germany and in the Czech Republic, in spite of  the protests of psychologists in those countries. There is no evidence that Holding Therapies are effective in treating autism. Jirina Prekopova, the leading Czech proponent of the treatments, has in fact shifted her claims to a religious/spiritual benefit and re-named her method a “lifestyle”.

A treatment that shares some concepts with Holding Therapies is le packing. This French method combines restraint through wrapping in cold, wet sheets with a psychoanalytic approach, and is based on the belief that autism results from a poor mother-child relationship. It has been stated that a randomized controlled trial of le packing is underway, but I have found no published report.

Son Rise ® is a method advertised in the United States. It proposes that  autism is caused by a lack of bonding. Treatment involves adult efforts to encourage eye contact by wearing big glasses and holding interesting objects near their eyes to attract the child’s attention; adults also practices “joining” (a method derived from dance and movement therapy) by imitating the child’s self-stimulating movements. There is no acceptable evidence supporting Son Rise®, but it seems to be attractive to parents desperate for help.

HANDLE (Holistic Approach to NeuroDevelopmental and Learning Efficiency) is a method which assumes that autism is an extreme anxiety disorder, although it is not clear how HANDLE techniques would impact anxiety. HANDLE uses a variety of exercises such as the wearing of red and blue “3D” glasses and sucking on “crazy straws”; these are said to increase eye coordination and stimulate the cranial nerves by causing rhythmic stimulation of the brain hemispheres. HANDLE therapists also practice face-tapping by tapping with their fingers along the lines of the trigeminal nerve, to the rhythm of “Twinkle, twinkle, little star.” The CAM practice of Reflexology is referenced as the rationale for the tapping. Needless to say, there is no systematic evidence that HANDLE is effective as a treatment for autism.


I hope that some real awareness about autism, the facts about the “epidemic” and the actual causes of the disorder, can reduce a bit of the anxiety about autism that is tormenting many parents. I also hope that some understanding of the implausible treatment methods on offer will help guide parents of autistic children to ABA and DIR, the methods that are plausible, even though their evidence basis may not be what we would like to see.