Autism Interventions: New York Times, Once Again, Pushes Non Evidence Based Floortime And Ignores Evidence Based ABA

The New York Times is at it again ... pushing Floortime as an autism intervention ... without mentioning the lack of scientific, empirical evidence in support of its effectiveness. In A Child Psychiatrist Talks About Autism the NYT features a column by Dr. Joshua D. Sparrow which promotes Floortime as an intervention for autistic children and encourages parents of autistic children to consider Floortime as an intervention for their children. (And of course, as usual with the NYT there is no mention of the solid base of evidence in support of ABA as an autism intervention):

"One promising treatment for such children is Floortime, a developmental, individualized and relational approach.

After a careful assessment of the child’s unique profile, therapists and parents using the Floortime approach work together to help the child learn to handle sensory stimulation while gradually interacting in more complex and rewarding ways. The goal is to help these children engage in meaningful relationships, expanding their capacity for communication, understanding and complex, abstract thought. One of the keys is to find the child’s motivation, and to use it as fuel for this work. Another is to make the work rewarding by making it fun and pleasurable for child, parent and therapist. But it is hard and time-consuming work, and families of children with autism spectrum disorders deserve all the support we can possibly give them. Experience has shown that children with autism who are given the support they need are able to expand their abilities to relate, to learn and to communicate, especially with their loved ones.

...


For more on autism spectrum disorders and Floortime, see the International Council on Learning and Developmental Disorders Web site.


Among the many helpful and hopeful books on autism spectrum disorders are those by the late child psychiatrist Stanley Greenspan and the psychologist Serena Weider, including “Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate and Think,” and a new one to be published in April by the pediatrician Ricki Robinson, called “Autism Solutions: How to Create a Healthy and Meaningful Life for Your Child.”

The NYT presents this latest Floortime promotional vehicle without mentioning the limited evidence in support of its effectiveness as reviewed by the AAP and the Association for Science in Autism Treatment.

The picture above is from the AAP Publications Retired and Reaffirmed policy page and indicates that in September 2010 the American Academy of Pediatrics Reaffirmed the Clinical Report: Management of Children with Autism Spectrum Disorders. Pediatrics 2007. The 2007 Report described the lack of empirical, scientifc evidence in support of the efficacy of DIR/Floortime as an intervention for autism spectrum disorders:

"The DIR approach focuses on (1) “floor-time” play sessions and other strategies that are purported to enhance relationships and emotional and social interactions to facilitate emotional and cognitive growth and development and (2) therapies to remediate “biologically based processing capacities,” such as auditory processing and language, motor planning and sequencing, sensory modulation, and visual-spatial processing. Published evidence of the efficacy of the DIR model is limited to an unblinded review of case records (with significant methodologic flaws, including inadequate documentation of the intervention, comparison to a suboptimal control group, and lack of documentation of treatment integrity and how outcomes were assessed by informal procedures55 ) and a descriptive follow-up study of a small subset (8%) of the original group of patients.59" 

(page 1165)

The following information is currently found on the ASAT web site and indicates that Floortime is plausible but essentially untested.

Association for Science in Autism Treatment


Developmentally-based Individual-difference Relationship-based intervention (DIR)/Floor Time


...

Research Summary: DIR is widely considered to be a plausible intervention approach (i.e., one that could be effective), but it has not been evaluated in peer-reviewed studies with strong experimental designs (National Research Council, 2001). An uncontrolled study reported favorable outcomes (Solomon et al., 2007).

Recommendations: An important area for future research is to evaluate DIR in studies with strong experimental designs. Professionals should present DIR as untested and encourage families who are considering this intervention to evaluate it carefully.

It isn't clear to me why the NYT pushes Floortime, a non evidence based autism intevention, and ignores ABA,  the most evidence based intervention for autism, as reviewed for several decades by authorities from the US Surgeon General, to state agencies in Maine, New York and California to the Association for Science in Autism Treatment to the American Academy of Pediatrics. I have to assume that the personal biases and prejudices of senior health editors at the New York Times lie behind this persistent attempt to promote non evidence based autism interventions and ignore or put a negative spin on ABA.  I can think of no other reason, rational or not, for the NYT's  misguided autism intervention reporting.

Stephen Harper's Hand Picked Autism "Stakeholder Representatives"

The Stephen Harper government has a pathetically feeble national autism strategy. Essentially it consists of a mediocre Autism Web Page and a Postponed Autism "Stakeholders' Symposium". The "Stakeholders' Symposium" was postponed at the last minute; purportedly because the Government of Canada couldn't find a big room in which to hold the event. In reality it was cancelled because too many outspoken autism advocates, including me, were being nominated by autism organizations to attend the symposium.

Now the government, and CIHR Institute of Neurosciences, Mental Health and Addiction are sending out invitations to a rescheduled Autism Symposium to be held November 8th-9th, 2007, at the Four Points Sheraton Hotel, Toronto Airport . Prior to sending out the invitations the government, and CIHR, solicited names from various professionals and other individuals from the various regions of Canada to attend. They did not ask the provincial autism societies for names, even though as stated by CIHR Institute of Neurosciences, Mental Health and Addiction Scientific Director Rémi Quirion, PhD and Assistant Director Barbara Beckett, PhD:

"Above all, the symposium is being organized as an opportunity for
knowledge exchange, networking, and community-building."

It is a funny exercise in community building when the government officials and bureaucrats pick who will attend as representatives of community organizations. The decision as to who will represent a community or organization is one that should be made by that community or organization not by other parties. Undoubtedly the delegates chosen will be people who will not rock the Harper Conservative government boat. The PR releases coming from the symposium will also undoubtedly reflect the Harper position, or non-position, on autism generally.

The "Autism Symposium" may turn out to be many things but it will not be an exercise in "community building". It will be just one more page from Stephen Harper's Book of Dirty Tricks - the Autism Edition.

Autism Symposium Cancelled - Harper's Book of Dirty Tricks Page 2

The Harper Conservative government strategy to address the Autism health crisis in Canada is beyond pathetic; it is wretched. It is nothing more than a ploy from the now infamous Conservative Party Book of Dirty Tricks.

The Harper Conservatives' autism strategy was announced in November 2006 by Health Minister Tony Clement and consisted of a web page and a stakeholder symposium to be held in 2007. Yes there were other elements - sort of. A research chair was mentioned - sort of. The Harper conservatives pledged to begin exploring the establishment of a research chair focusing on effective treatment and intervention for ASD. They also pledged to launch a consultation process on the feasibility of developing an ASD surveillance program through the Public Health Agency of Canada (PHAC) to help shape appropriate ASD programming and research. I wonder which generation of Canadians will be around to see whether an ASD surveillance program, whatever that is, is determined to be feasible?

Of course there is the pledge to address Canada's autism health crisis by designating a bureaucracy within a bureacracy, the pledge to designate the Health Policy Branch of Health Canada as the ASD lead for actions related to ASD at the Federal Health Portfolio level. Health Canada itself of course is the federal government Department charged with responsibility over health matters which the Harper Conservatives tell us [ignoring the development over decades of cooperative federalism] is a matter entirely within provincial constitutional jurisdiction. Gee, the policy branch of the federal department responsible for a matter which the Conservatives claim is entirely within provincial jurisdiction will be designated as the lead branch of that department for actions related to ASD at the federal level. WOW!!

Then there is the autism web site promised by Health Minister Clement. Personally I believe it to be the least informative autism site on the internet. But that may be a bit harsh. There may be autism web sites that are still "under construction" and actually say nothing at all. Judge for yourself:

http://www.hc-sc.gc.ca/dc-ma/autism/index_e.html

Then there is the "stakeholders" symposium promised to be held in 2007. As one who has been an autism activist for the last 8 years in New Brunswick I recoil at the use of the word "stakeholder". It sounds like a property interest in a commercial transaction. I am an autism activist because of my profoundly autistic son. He, with his brother, are the joys of our life but they are not "stakes" in a poker game. And government typically defines the stakeholder concept broadly to include any group that might be useful in pushing the government's own agenda. Careful selection of a few stakeholder groups for government funding and support invariably results in useful tools for creating division and weakness in the disability community whose issues are being addressed, allowing government to divide, delay and deny provision of necessary services.

I was asked by the Autism Society New Brunswick to participate as the ASNB representative at the autism stakeholders symposium which was scheduled to take place mid-June 2007 in Ottawa. I contacted the Canadian Institute for Health Research to register for the event and was told that the federal government wanted the Autism Society Canada, the federal organization of which ANSB is a member, to forward the names of participants for the autism symposium. Thus the provincial body, the ASNB, could not forward names directly of representatives for a national symposium to address an issue which, according to Stephen Harper, Tony Clement and Edmonton area MP Mike "Bigfoot" Lake [Conservative Party autism spokesman and Autism Dad]is entirely within provincial jurisdiction. The Autism Society Canada put my name forward at the request of ASNB and I waited to receive my invitation. I had been told the invitations would be sent out two weeks ago. When I followed up last week I was informed by CIHR that the symposium was being discussed at a more senior level and that so many names were put forward that it was necessary to arrange a new larger location. In the meantime I had become aware that prominent, no nonsense autism activists like Andrew Kavchak in Ottawa and the FEAT-BC folks had also been put forward as participants in the national autism stakeholders symposium. Last week it was formally announced that the symposium was "postponed" to an unspecified date in the fall.

I do not believe the excuse that the Government of Canada could not find a large enough room to accommodate a national symposium of autism representatives by mid-June. The federal government is THE consumer of services for such activities in the National Capital Region and has a lot of purchasing/bargaining power. There is a substantial industry in the region which thrives on hosting such events and the capacity has been developed for these purposes. The federal government itself owns a good chunk of the national capital real estate and surely has the facility to itself host a symposium.

The Harper Conservative government became increasingly aware that activists such as yours truly, Andrew Kavchak, some FEAT-BC reps, and some of the family members involved in the Auton and Deskin-Wynberg autism cases were coming to Ottawa to participate in the national autism symposium and they wanted no part of it. That is the more plausible explanation for the postponement/cancellation of the symposium. The whole national autism "strategy" could have been lifted from page 1 of the Harper Book of Dirty Tricks recently exposed and which directs Conservative MP's to to obstruct the progress of parliamentary committees, including stacking such commitee proceedings with witnesses who would support the Harper Conservatives' agenda. The page was turned to page 2 when the only pledge of any merit, the national autism stakeholders symposium was "postponed" until the fall of 2007. IF the symposium does proceed in the fall you can be sure that every effort will be made by the party of Harper and Clement to ensure that the voices of serious autism activists will not be present and will not be heard. As dictated in Harper's Book of Dirty Tricks only sponsored, docile autism representatives supportive of the Conservative Party agenda will be invited. ... Continued on Page 3, Harper's Book of Dirty Tricks.