The Autism Fad Parade Continues
Another Autism Fad - And Another Autism Disappointment?
Posted May 31, 2009
At long, long last, I have decided to take the plunge and launch the long-delayed Psychology Today blog, “The Skeptical Psychologist.” As is almost always the case, the blame for the inexcusable delay rests entirely with yours truly. I was massively overcommitted with work during the Spring semester, but now that classes are over, my best excuses are over too.
Today and in the weeks to come, The Skeptical Psychologist will examine a broad array of claims on the fringes – and sometimes outside the fringes – of scientific psychology. We’ll do so with an open mind, but with an eye toward insisting on convincing evidence. Our overarching motto will be the Missouri principle, also espoused by Carnegie Mellon University psychologist Robyn Dawes – “Show me.” We’re willing to be persuaded by novel and even unconventional psychological claims, but will first demand clear and compelling data.
My inaugural post concerns a news story that caught my eye this week while out of town at the Association for Psychological Science (APS) meeting in San Francisco. The headline in the LA Times read “Testosterone-related treatment for autism stirs controversy.” The story focuses on the well known father-son team of Mark and David Geier, who claim that the medication Lupron (generic name leuprolide) is a “miracle” (their words) treatment for autism. Lupron is a prostate cancer and endometriosis drug that is sometimes used to “chemically castrate” dangerous sex offenders. According to the Geiers, Lupron ostensibly treats (cures?) the core symptoms of autism because autism ostensibly is associated with precocious puberty and excessive levels of testosterone. This excessive testosterone in turn ostensibly - my use of “ostensibly” on three occasions is intentional - results in a hypermasculinized brain, which British psychologist Simon Baron-Cohen (cousin of comedian Sasha Baron-Cohen of “Borat” fame) believes to be responsible for many or most of the problematic features of autism. Baron-Cohen, however, vehemently disapproves of Lupron treatment for autism, telling the LA Times that the idea of disseminating Lupron treatment “without a careful trial…fills me with horror.”
As I read this new story and another similar story, I experienced an odd and not entirely reassuring sense of déjà vu. After all, as those of us old enough to have gone around the block a few times surely recall, claims regarding new “miracle cures” for autism are almost too numerous to count. As Paul Offit observes in his recent and superb book, “Autism’s False Prophets: Bad Science, Risky Medicine, and the Search for a Cure,” the autism field has witnessed a seemingly never-ending parade of fad treatments – sensory-motor integration treatment, Son-Rise, facilitated communication, chelation, hyperbaric oxygen treatments, secretin, herbal remedies, and on and on (see also Tristam Smith’s excellent, if depressing, review of these and other treatments in a recent issue of the Scientific Review of Mental Health Practice). Although the jury is still out on a handful of these treatments, like sensory-motor integration, the scientific verdict on many others, like facilitated communication and secretin, is clear – and resoundingly negative. And several of these fad autism treatments, like chelation, are potentially dangerous. All of these treatments, including Lupron, share at least one cardinal characteristic – they have been marketed and promoted far and wide in the wholesale absence of replicated controlled studies.
Although I worked with a number of autistic children in the 1980s as a clinical psychology graduate student and have several close friends (at least two of them academic clinical psychologists) with autistic children, I frankly cannot imagine what it would be like to have an autistic child. So I blame no place whatsoever on the parents of autistic children for embracing such treatments; I suspect that if I were in their shoes, I might well be willing to try any treatment that has even a remote chance of working –so long as the apparent risk was minimal (which is not all clear in the case of Lupron, incidentally). But I do place blame squarely on the Geiers and others who advance wildly enthusiastic claims about autism treatments before they’ve been adequately tested. Giving the parents and relatives of autistic individuals hope is wonderful, but only if this hope is justified. In the long run, nothing is crueler than false hope.
All of us should remain open to the possibility that Lupron alleviates at least some the symptoms of autism; let’s all hope that it does. But we should also insist that researchers and practitioners don’t advance claims that outstrip evidence. As Indiana University Dick McFall reminds us, humility should be our guiding principle as clinical scientists.
Why are so many smart people utterly convinced that dubious or even useless treatments for autism – and for most other psychological conditions, for that matter – are effective? Stay tuned for some potential answers in forthcoming columns – as a little teaser, Google the phrase “naïve realism” for starters.