Chiropractic Treatment of Behavior Problems: When Is Evidence Not Evidence?

Today on my ADHD blog I posted information about the use of chiropratic with children who have behaviour problems. I'd like to repeat the information here because I think it applies to autism as well.

An excellent article/blog at Psychology Today.

Jean Mercer, PhD, blogs today on Psychology Today about a recent article claiming to prove that chiropractic treatment of children for behaviour problems works. Here is the actual article: (Alcantara, J., & Davis, J., The chiropractic care of children with Attention Deficit/Hyperactivity Disorder: A retrospective series) was published in 2010 in Explore: The Journal of Science and Healing (pp. 173-182).

The authors examined 4 cases from their records in which children and adolescents had received spinal manipulations and advice about dietary supplements from chiropractors over several months. (Note, these are not randomly chosen cases, just four cases picked out that worked out. ) They used a 15-item checklist of ADHD symptoms showed that the symptoms improved from the pre-treatment to the post-treatment period. From this very small amount evidence Alcantara and Davis concluded that the treatment was an effective way to alleviate ADHD. They attempt to prove something remarkable with just a hint of support.

There are some serious problems with not only the amount of this evidence, but with it's nature. First, to just pick four cases and make any assumption out of that data is, well, dangerous. You wouldn't use this method to prove any drug therapy worked! But with chiropractic, it's seems OK. (I mean, who will get hurt, besides your wallet?) This "evidence" is so prone to being affected by chance to use it is silly at best, and misleading at worse. Scientifically, before making these kinds of claims we need a large number of cases. Especially when there are so many different things that could affect the outcome. Mercer explains this really nicely with an analogy about picking four black socks out of a hugh pile of socks. The larger the pile, the less likely the first four are really telling you much about the pile. The next four in a row might be white, green or yellow! Probability studies tell any scientist NOT to do this.

Alcantara's study is also basically a "before and after" study. You follow someone who gets a certain treatment and compare how they were doing before the treatment and after the treatment. On it's face this sounds logical, but it's not. There are so many things that could have an effect. Age, time, parent's expectation, getting attention from the study itself, teachers and parents being relieved that after years of problems their child or student is now in a study and professionals are helping them! This is one of the dangers of this type of study, and one of the reasons you need a large sample of subjects to make sure these influences are't confounding your data. Four is not a large number, it's a number that increases the possibility for this kind of mistake.

There is no control group to compare these kids to. What if we took just four other students and did nothing, or had them take part in a sham study where the treatment might be made up? Would the results be any different? This is one way we avoid the problems of expectations and time and all the other things that can mislead us. But there is none of that, none. And this "study" is about a medical intervention for a serious life long disability!

There are also other problems with this study, it was not blinded properly, so people taking part knew what outcome was expected (scientific research has so clearly shown that not blinding these sorts of research studies causes problems with validity). And we don't know what other treatment interventions these children were involved with that might have had an effect on the outcome.

The problem here is that this study will be used by "holistic" treatment providers who will make claims to the public that there is a "published" and "peer reviewed" study that shows chiropractic manipulation is a helpful treatment for behavioural problems and ADHD in children.

THERE IS NO SUCH STUDY.

A much more in-depth analysis of the use of Chiropractic treatment on children can be found at Science Based Medicine. This article clearly shows that the use of chiropractic treatments is simply scientifically indefensible.

I suggest any parent thinking about using alternative medicine for behavioural problems read this article ....twice!

This week, in my practice, two more parents showed up who had been using "alternative medicine" with their children. Here in BC children below the age of 6 get nearly $20,000 to use for the treatment of their choice ...to a limit. Both had used all their monies on chiropractic, homeopathic and "auditory retraining" programs. None was left for basic interventions by a behavioural or speech specialist to teach communications skills or parenting techniques. These were sad situation. But when searching the internet for tretments what they found was a list of these "wholistic" practitioners offering everything from massage, diets, sound therapy to chelation therapy. None of which are supported by science. Again this week I went on line and found a local Naturopathic Physician (NP sometimes is referred to as "Not a Physician") offering" homeopathic vaccinations."

These parents were mislead by what they thought was legitimate research they found on the web. Research like the research above. One way to prevent this from happening to you is to use your medical doctor for advice, not a practitioner of holistic medicine! Look to web pages like Science-Based Medicine (which has a nice list of similar pages and resources) and I often send people to look up treatments on a very good skeptical site: Quackwatch.

When considering any treatment you can also simply try typing in the treatments name and words such as "skeptic."

Finally, because so many individuals are taking their children to homeopaths for unproven or disproven treatments, I'd like to suggest watching Richard Dawkin's video on homeopathy found here. It's an excellent place to start. And if you have a sense of humour (and watching people spend their money on these treatments you need a sense of humour, you could watch this funny video from Mitchell and Web.

For more information about scientifically validated interventions for children and adolescents with behaviour problems, ADHD, autism, Aspergers and related disorders please visit my web page at www.relatedminds.com or www.socialcognitivetherapy.com I have offices in Burnaby (serving New Westminster, Coquitlam, Port Moody and Maple Ridge) as well as offices in downtown Vancouver. I am a registered psychologist and registered marriage and family therapist, and would be more than happy to speak with you about possible treatments and interventions.