The lead had us hooked. We kept reading for the evidence, but we couldn’t find any. There was no quantification of the benefits. No mention of potential harms. No discussion of costs. No analysis of the size of the study or its limitations. In nearly every one of our criteria, the story fell short.
This was a very disappointing article. There is the assertion that the intervention works (and some evidence given for effects on brain function via changes in EEG) but not enough information to know what was done, how many patients, how long they were treated, the effects on behavior, etc.
As the study itself notes, there have been no clinical trials to date to show that early behavioral therapy in children with autism can have a positive effect on brain development. Instead, parents with autistic children are left without any proven options for helping their children. The rising number of children being diagnosed with autism has created a significant demand for a therapy that will work, and journalists owe it to readers to carefully vet studies of experimental approaches like this.
The story does not discuss costs. And we can only assume that two years of therapy would be quite expensive for families and, as yet unproven in multiple trials, likely would not be covered by insurance.
The story makes a bold claim in the lead: “Early, intensive autism treatment improves children’s brain development, a new study shows.” It does not go on to quantify the benefits found in the study. How many of the kids showed brain improvement? And how was that improvement measured? The story provided only the qualitative description “The [brains of] children who received the ESDM looked virtually identical to typical 4-year-olds,” Dawson says. “The children that received the interventions normal in their communities continued to show the reversed pattern.”
In addition, we don’t know the clinical significance of a change in EEG.
There is no mention of any potential harms in this story. It is very possible that the therapy itself does not have any actual side effects, but we always think the risk profile of a therapy is worth a mention.
This study was in 48 children. Given all of the unknowns around autism and the complexities of autism spectrum disorders, it is important for readers to understand that this study captured a very small group of kids and that its results may not be cause for widespread optimism about altering autism’s course. There is nothing in the story that triggers us to understand the quality of the evidence. We can infer that it is a comparative study – but beyond that no real information is given.
The story receives kudos on this count. There are very few stories about autism that do not spend time trying to alarm parents about the rising number of cases. There is more fear and mistrust around autism than most childhood disorders, in part because of the constant drumbeat that the numbers are on the rise and that your child could be next. More reporters should take the straight forward approach that WebMD has taken here.
We thought the story spent too much time with the lead author of the study, but we appreciated the comments from Arthur L. Beaudet, MD, professor of molecular and human genetics, pediatrics, and molecular and cellular biology at Baylor College of Medicine, Houston. He said, “To the extent early intervention helps brain development, it is more likely to help by letting the brain compensate and get around the problems rather than reverse them. …We do know if you damage the brain of a young child, like in an accident, the infant brain has a tremendous ability to recover and get around the problem.” More voices like this would have helped readers understand the importance of the findings and the likelihood that they would have a broad application for children with autism.
It is a low bar to get one outside source but at least this was done.
We’re giving the story a pass here because the reporter and Dawson acknowledged that there are other therapies available. “Although she and her colleagues developed the ESDM treatment, Dawson is quick to point out that it’s not the only effective autism treatment. The key, she says, isn’t the treatment — it’s the timing.”
It is not clear from the story whether this therapy is being used anywhere or whether it is something that only Dawson and her colleagues are testing out in small settings.
Although the study itself makes the claim that “This was the first trial to demonstrate that early behavioral intervention is associated with normalized patterns of brain activity,” the story does not address that stated claim of novelty.
Basically, this is a reasonably novel treatment with a novel outcome (EEG activity – although one of uncertain importance).
In the nature of news, what’s really new should be pointed out and if it’s not new, that should be pointed out as well.
The story does not appear to rely on a news release.