Crap detecting for beginners

[The following is an edited version of a speech I gave at the launch of this book* in May 2017.]

A recent Four Corners program featured the results from a ‘shadow shop’ of 240 pharmacies conducted by Choice. Pharmacists were asked to recommend something for these actors posing as shoppers who claimed that they had been “feeling really stressed lately”. 26% of pharmacists recommended Bach Flower remedies, a product for which there is absolutely no scientific evidence for efficacy. Another 3% recommended homeopathic products.

Non-evidenced based fads like this predilection for so-called ‘natural’ remedies are widespread. Just look at Gwynneth Paltrow’s GOOP website, for example.  I had no idea just what you could do with a jade egg! But it is in educational interventions and therapies for children with developmental disorders that we see some of the loopier manifestations of this generic, worldwide, anti-scientific trend.

And this is not even a recent phenomenon. I have now been working in the field of educational psychology and special education for over 45 years. After graduating in Psychology from the University of Manchester in 1970, I started work immediately as Professor Peter Mittler’s research associate at the ‘Hester Adrian Research Centre for the study of learning processes in the mentally handicapped’, as children with intellectual disabilities were then known. In those days, such children did not attend school, special or otherwise, they attended Junior Training Centres (or JTCs). They were regarded as ineducable and could only be ‘trained’.

It was on one of my first visits to JTCs that I encountered Dolman Delacato Psychomotor Pattterning. I was quite unprepared for what I saw being practised which looked for all the world to me like witchcraft. The little girl with a severe disability lay on a table while two adults moved her limbs in patterns resembling crawling movements, all the while chanting child specific rhymes.

It was seriously weird and extraordinarily time-consuming. (Those interested in this now discredited and largely discarded practice might be interested to read the critique provided by Quackwatch. (https://www.quackwatch.org/01QuackeryRelatedTopics/patterning.html .)

This was my first encounter with educational/therapeutic snake oil, at least as an adult, but it was by no means my last. Interestingly, I was advised, at the time, to be cautious about criticising the method because its proponents were notoriously litigious; again this was the first, but not the last, time I was to encounter this tactic for silencing dissenting voices critical of non-evidence based practices and procedures.

In recent years, my esteemed colleagues, Max Coltheart and Linda Siegel, among others, have been threatened with legal action after offering critical commentary on dubious educational and therapeutic practices. Linda received a threatening letter from the lawyers representing the Arrowsmith program but they did not follow through. Legal representatives for the Dore program soon gave up hassling Max when Macquarie University made clear that they were right behind him and challenged Dore to a public debate. It was not long after this that the Dore organisation in Australia, at least, was forced to close down completely. But, as I like to say, when one Dore closes, another one opens! There is always another bogus program lying in wait for the uninformed and desperate.

My academic colleagues and I at Macquarie University Special Education Centre (MUSEC), which I had the honour of directing for over twenty years, shared a passion for evidence-based practice long before it became flavour of the month in educational circles. We were united in our loathing of the plethora of bogus claims for dodgy programs, with which the history of special education was littered, and for which there was no evidence for efficacy. It was my colleague Dr Jennifer Stephenson who, in 2005, urged us as a group to launch the MUSEC Briefings, single page, factual summaries on relevant topics of interest, many of which examined the evidence for popular interventions. Our aim was to highlight programs and practices for which there was good scientific evidence for efficacy and those for which there was not. The MUSEC Briefings became very popular and were, indeed still are, widely distributed. It is sad, then, to report that the future of the Briefings is in doubt, following the recent closure of MUSEC by the University. (But see the following repository: https://figshare.com/articles/MUSEC_Briefings_Archive/5096455 )

The demise of the Briefings is a source of sadness but now we have a new, even more all-encompassing, reference resource which is destined to become a classic, I’m sure, and the first of many editions. Caroline Bowen and Pamela Snow’s witty, informative and, indeed, exhaustive, new text will be our future ‘go to guide’ when we are confronted with an intervention for children with developmental disorders that we have not previously encountered. May I take this opportunity to express my admiration for their painstaking efforts in tracking down so many useless interventions.

Their new text, ‘Making Sense of Interventions for Children with Developmental Disorders: A guide for parents and professionals’, is destined to become the field guide for amateur and professional crap detectors everywhere. As I have already mentioned it is remarkably inclusive. As an enthusiastic crap detector myself, I came across coverage of many interventions that I knew little about or had not heard of before at all. Take FODMAPS for example. It was only a month or two ago that I first heard this term, from my haematologist. I did not know then, but I do now, that low FODMAPS diets are being promoted as a treatment for children with autism spectrum disorders (or ASD).

What is or are FODMAPS? FODMAPS are, wait for it, ‘fermentable, oligo-, di-, monosaccharides and polyols’. And some people say the MultiLit acronym is contrived! FODMAPS refers to fermentable, poorly absorbed, short-chain, carbohydrates but I prefer Caroline and Pamela’s no-nonsense description: “FODMAPS are in disreputable farty-foods like beans, onion and broccoli, and also in milk, apples, wheat, high-fructose corn syrup, and more”. They go on to comment, and I quote:

“The casein-free (CF), GF (gluten free), and GFFC (gluten free and casein free) diets have a new competitor for consumer moolah in the ASD food fad field: the low-FODMAP diet. For years, ASD advocacy groups, families and clinicians have fallen for sharp advertising of the GFCF diet, with scientific-sounding phrases: ‘evolving paradigm’, ‘promising research trend’, ‘new understandings’, ‘latest discoveries’ – but soon, the Low FODMAP diet may become the new black, despite no demonstrable link as yet, between FODMAPS and ASD.”

I have quoted this passage at length to give you a flavour of the engaging style in which this book is presented. It is lively and opinionated, in the very best sense, and is clearly written by human beings rather than by academic Daleks, the preferred speech style preferred by so many wannabe authorities. Moreover, as the comedian Eric Morcombe used to say of comedy partner Ernie Wise’s supposed toupée: “you can’t see the join”. Seriously, you can’t tell where one author stops and the other picks up. This continuity of voice is a remarkable achievement.

Coming in at nearly 400 pages including appendices, it is a hefty tome but its coverage is encyclopaedic and never dull. In their epilogue, they provide two extensive lists of programs and procedures. The first (shorter) list is headed ‘Could try harder’ and puts on notice the developers of these interventions that might show some promise but which are in sore need of sufficient quality evidence for efficacy. Here we find, for example: controlled crying, Lindamood Bell, the Orton-Gillingham/Multi-Sensory Structured Language Program, Positive Behaviour Support and Triple-P Positive Parenting, to name but five.

In the second, far longer list, headed bluntly and unequivocally ‘No convincing evidence’, we find, for example, many old friends such as: BrainGym, Fast ForWord, the Arrowsmith Program, behavioural optometry and, last but not least, Reading Recovery.

I could go on. There is so much to delight and intrigue in this book. So much crap to detect and so little time. Let me finish by saying this: “Buy this book.” In fact, buy two copies and give one to a friend. They’ll thank you for it.

*‘Making Sense of Interventions for Children with Developmental Disorders: A guide for parents and professionals’ by Caroline Bowen and Pamela Snow, published by J & R Press Ltd.