Showing posts with label Placebo. Show all posts
Showing posts with label Placebo. Show all posts

Saturday, 5 October 2013

Parental Placebo Effect in Autism

I have not met that many parents of kids with ASD; from those that I have met it, is clear that often the therapies applied are limited by the more skeptical parent.  There really are no therapies that everyone agrees on.

So it is no surprise that sometimes my wife doubts the value of the therapies I am sharing in this blog.  She would far rather have a homeopathic wonder cure, than use drugs or ABA.  I saw today as an opportunity.  Monty, aged 10 with ASD, had been up half of the night with a virus and his Mum said "don't give him any of your medicines"; "OK" I replied.

By 2pm Monty was in an increasingly bad mood, frustrated,  exhibiting obsessive repetitive behaviours and showing warning signs of mild self injury.

So I mixed him up a Peter cocktail (1.2g NAC, 10 mg atorvastatin and 1mg of bumetanide) in orange juice.  Within 10 minutes things started to change.  Facial expression switched from anger to contented and, most telling of all, he sat at the piano and started to play.  I could not have hoped for a better result. 

After an hour I asked Mum, if she noticed the transformation.  Yes she had and agreed it was remarkable.

Placebo Effect

It is clear that the more involved the parent becomes, the greater is the risk of seeing what you want to see, rather than what is there.  This why nobody generally listens to parents and indeed why doctors are not supposed to treat their children.

It is always good to have a reality check.

I can now move forward to my serotonin and acetylcholine interventions, in the knowledge that previous interventions have past their critical test.

Wednesday, 3 April 2013

Placebo Effect in Autism

Placebo effect in autism - Parent/Child Matrix      

A big problem in autism research is the placebo effect.  It could be because the child found the therapy fun and liked all the attention and so showed improved behaviors; or it could be that the parents so desperately wanted to see an improvement, that they imagined it.

In good research, half of the kids receives the trial drug and the other half receive a placebo.  But what happens when both groups show an improvement?  Well if both groups show equal improvement then the therapy has no value.  In almost all the research I have seen, the placebo group shows an improvement.  In one study the placebo group improved 70% on the behaviour rating scale.

We need to conclude several things:-
  • Good studies rely on assessment by clinicians, not parents
  • If the therapy was fun and included lots of 1:1 attention, then the kid's behavior will improve, regardless of the medical value of the therapy.
  • Do not reject a study because the placebo group improve moderately
  • Always focus on the relative improvement of the group on the trial therapy vs the control group on the placebo.

Behavioural rating scales

In autism there are many different behavioural rating scales, including :-
Researchers can pick and choose which scale to use and which scale to emphasize.  All these scales are highly subjective.  Different people assessing the same child will get a slightly different answer.  The same person assessing the same child a week later will also get a slightly different answer. 

Tiny Studies and Not so Objective Researchers

Many studies in autism have a tiny number of subjects, sometimes fewer than ten. Often researchers have a vested interest in the research, this is not always a bad thing. As a result it is best to focus on research that has been frequently cited by other researchers, this should mean that they buy into it.

Example - Secretin Research

In a 2003 study of the hormone secretin, 62 children participated. At that time there were stories that secretin was a "wonder cure" for autism. Half received a one-off injection of secretin, the other half received a placebo. The clinicians' tests showed that there was no behavioral improvement in either group; the parents however saw things differently. The parents of 48 children saw an improvement. When asked to guess whether their child had received the placebo or the secretin, 27 guessed correctly and 27 guessed wrong. Six families would not guess and two families dropped out.