Keith J. Hyatt, EdD, Western Washington University Ken Howell ...

Keith J. Hyatt, EdD, Western Washington University 

Ken Howell, PhD, Western Washington University 

2010 Pacific Rim Conference

Purposes of Presentation 

• Discuss the importance of selecting research-based 

practices 

• Review and critique selected “controversial” practices 

• Investigate reasons for seemingly uncritical adoption 

of “controversial” practices 

• Provide basic guidelines for selecting research-based 

practices 

• It is our hope that knowledge will lead to increased use 

of evidence based practices and improved outcomes 

for individuals with disabilities 

Hyatt, Filler, & Krasch; TASH 2009 

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Importance of Research-based 

Interventions 

• Individuals with disabilities deserve to receive effective 

interventions 

• Many allied health and human services professionals 

receive training that does not emphasize scientific 

training (Jacobson, Foxx, & Mulick. 2005a) 

• Lack of research time and expertise can lead many well 

intentioned professionals to recommend interventions 

based on familiarity 


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• Legal Requirements 

Interventions 

• “promoting schoolwide reform and ensuring access of 

children to effective, scientifically based instructional 

strategies and challenging academic content” (NCLB) 

• “to ensure that those personnel have the necessary skills 

and knowledge, derived from practices that have been 

determined, through scientifically based research to be 

successful in serving those children.” (IDEA) 


4


Interventions 

• Past practices in special education that have been 

refuted continue to re-appear and/or maintain some 

following. 

• Process training has always made the phoenix look like 

a bedraggled sparrow. You cannot kill it. It simply 

bides its time in exile after being dislodged by one of 

history’s periodic attacks upon it and then returns, 

wearing disguises or carrying new noms de plume, as it 

were, but consisting of the same old ideas, doing 

business much in the same old way. (Mann, 1979) 


5

Possible Dangers of Using Nonscientifically 

supported practices 

• Some may actually cause harm 

• Take time away from effective interventions 

• May provide false hopes 

• May provide unrealistic expectations of individuals 

• Many are quite expensive 

• Can cause guild feelings among family members 


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Why do controversial practices 

continue? 

• Lack of training in use of effective practices 

• Effective practices too difficult to implement 

• Positive effects of validated practices aren’t readily 

apparent 

• Workshops and trainings that promote ineffective 

practices 

• Convincing testimonials 

• Pseudoscientific fads frequently use “scientific 

sounding” terminology 


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Interventions 

• Recent survey of parents 

of children with autism 

• Reported current or past 

use of 108 different 

treatments 

• Used 7 different 

treatments on average 

( Green, Pituch, Itchon, 

Choi, O’Reilly, Sigafoos, 

2005) 

Rank Treatment Now 

(%) 

Past 

(%) 

1 Speech Therapy 70 23.2 

2 Visual Schedule 43.2 18.6 

3 Sensory Integration 38.2 33.2 

4 ABA 36.4 22.7 

30 Facilitated Com 9.8 10.2 

33 Chelation 7.4 10.2 

62 Irlen Lenses 1.6 1.6 

82 Doman-Delacato .6 1.6 

103 Dolphin Therapy 0 1.2 

Hyatt, Filler, & Krasch; TASH 2009 8


Interventions 

• Doman-Delacato Repatterning 

• Ontogeny recapitulates Phylogeny 

• Crawling, creeping, crude walking, mature walking 

• Reproduce evolutionary patterns of amphibian to reptilian to 

human 

• Clearly discredited by numerous research studies, yet the 

practice continues: Institutes for Advancement of Human 

Potential and National Association for Child Development 

• American Academy of Pediatrics (1984 and 1999) 

recommended alerting new physicians to program to avoid 

errors of past and noted absolute lack of scientific research 

supporting repatterning. 


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• Sensory Integration Therapy 

Interventions 

• Based on theory developed by Jean Ayres (1972) 

• Recapitulationist theory 

• Originally used with children with learning disabilities 

• Not promoted as a substitute to academic intervention, rather 

to integrate sensory perception in CNS and get individual 

ready for learning 

• Theory correctly notes the role of cortex in incorporating 

sensory information but no reliable evidence that integration 

of sensory information is necessary for higher level 

functioning (Smith, et al., Ch 20 2005) 


10


Interventions 

• Sensory Integration Therapy (continued) 

• Practices thought to impact vestibular, proprioceptive, 

and tactile systems 

• Traditional practice included swinging, scooter boards, 

smooshing 

• Current practice may include brushing, deep massage, and 

weighted vests 

• Treatment often costly and may last more than 1 year 


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Interventions 

• Sensory Integration Therapy (continued) 

• Numerous studies and reviews have failed to support the 

efficacy of sensory integration therapy 

• Poor research design of numerous studies with earliest 

studies tending to provide some support while later, 

better developed studies failed to support (Vargas & 

Camilli, 1999) 

• Baranek (2002) noted studies of children with autism 

were fraught with methodological problems and threats 

to validity. 


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Interventions 

• Sensory Integration Theory (cont.) 

• Lack of consistent research support for efficacy and is 

based on an older neurological theory that has failed 

empirical investigation. (Baranek, 2002) 

• Reviews b y Hoehn & Baumeister, 1994; Polatajko et al., 

1992; Arendt et al., 1988, Hyatt, Stephenson, & Carter, 

2009, Leong & Carter, 2008; Shaw, 2002 failed to support 

efficacy of Sensory Integration Therapy. 

• Some (eg. Baranek) who noted significant problems 

with SI research advocated for additional research. 


13


Interventions 

• Sensory Integration Therapy 

• Dawson and Watling (2000) noted little research on individuals 

with autism. 

• “In the case of sensory integration therapy . . . There exist so few 

studies that conclusions cannot be drawn.” 

• Arentd, MacLean, & Baumeister (1988) “ To base a treatment on a 

theory that cannot be tested is pesudoscience. To conduct 

interventions based on opinion without critically evaluating the 

evidence is paternalism, not professionalism.” 

• Considered an nonreimbursable medical expense by 

major insurance companies due to lack of supportive 

research 


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• Miller (2003) 

Interventions 

• “ Rigorous research evaluating the effectiveness of 

sensory integration therapy is crucial and must continue 

over the upcoming decades. However, these children 

and families cannot wait for definitive research 

evidence.” A statement similar to this would indicate 

bias in a research study. 

• “The knowledge base from research in this field is in its 

infancy and substantial work is needed before enough 

rigorous empirical data are available to proffer valid 

conclusions about the effectiveness of this intervention 

approach.” The field is over 30 years old, how long with 

this infancy last? 


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Interventions 

• Facilitated Communication 

• Originated in Australia and was initially used with 

individuals with CP 

• Fundamental premise is that some people have 

“undisclosed literacy” and simply experience difficulty 

with expression not a cognitive limitation (Jacobson, 

Foxx, Mulick, 2005b; Kavale and Mostert, 2004) 

• Research has repeatedly failed to support FC 

• Jacobson et al. (2005b) Reviewed 9 studies since 1992 that 

supported FC but found major methodological errors 

• Virtually every appropriately designed study failed to support 

communicator authorship 


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Interventions 

• Facilitated Communication (continued) 

• Mostert (2001) reviewed 29 studies 

• 19 provided one or more control procedures refuted FC 

• 6 provided one or more control procedures supported FC 

• 4 with no controls supported FC 

• Review confirms prior research with high quality research 

failing to support FC & those supporting FC were so 

methodologically poor that results can’t be accepted 

• Experimental rigor required if there is any hope of 

demonstrating efficacy of FC 

• Noted findings consistent with prior reviews (e.g., Cummins & 

Prior, 1992; Green, 1992, 1994; Hudson, 1995) 


17


Interventions 


• Emerson, Grayson, Griffiths (2001) found that 

quantitative data in their study failed to support FC but 

qualitative supported 

• They did not even discuss the methodology in the paper 

• Biklen (1990) 

• Research should not include testing the person 

• Fundamental belief in FC by facilitator is required 

• Wolfensberger (1992) “the mother of all crazes, the 

cold fusion of human services” 


18


Interventions 


• American Psychological Association (1994): 

• facilitated communication is a controversial and unproved 

communicative procedure with no scientifically demonstrated 

support for its efficacy. 

• Association for Behavior Analysis International (1995): 

• It is the position of the Association for Behavior Analysis that 

FC is a discredited technique. Because of the absence of 

ample, objective, scientific evidence that FC is beneficial and 

that identifies the specific conditions under which it may be 

used with benefit, its use is unwarranted and unethical. 


19


Interventions 


• TASH (2000) 

• Recognized the controversy, yet supported use of FC and 

encouraged additional research. 

• encourages its membership to become informed about the 

complexities of facilitated communication training and 

practice and to stay informed of new research and practice 

throughout the facilitated communication training process. 

• American Academy of Child & Adolescent Psychiatry 

(2008) 

• Studies have repeatedly demonstrated that FC is not a 

scientifically valid technique for individuals with autism or 

mental retardation. Hyatt, Filler, & Krasch; TASH 2009 

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Interventions 

• Brain Gym (educational kinesiology) 

• Commercial program that claims simple exercised get 

the brain organized and ready to learn (Dennison & 

Dennison, ) 

• Good for riding in plane, train, auto, sales, surfing, 

reading, attention, organization, writer’s block, senior 

moments, ADHD, reading comprehension, spelling, 

hand writing, golf . . . 

• Few research reports available in blind peer-reviewed 

journals 

• Hyatt (2007) found no empirical studies supporting 

efficacy of program 

Hyatt, Filler, & Krasch; 

and 

TASH 

not 

2009valid 

theoretical support 

21


Interventions 

• Considerations for selecting evidence-based practices 

• Avoid practices initially promoted through the media 

• Do not rely on persuasive testimonials 

• Be wary of research conducted by one organization or 

person with financial interest in the practice 

• Demand a body of research before choosing practice 

• Ensure that quality research is basis for decision 

• Look for experimental or quasi-experimental research 

• Review position statements of reputable organizations 

• Don’t rely on one study or one organization 

• Contact local university 


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Interventions 

American Academy of Child and Adolescent Psychiatry. (2008). Facilitated communication. Retrieved, 

October 1, 2009, from http://www.aacap.org/cs/root/policy_statements/facilitated_communication 

American Academy of Pediatrics. (1999). The treatment of neurologically impaired children using 

patterning [Electronic version]. Pediatrics, 104, 1149-1151. 

American Psychological Association. (1994). Council Policy Manual: M scientific affairs: Facilitated 

communication. Retrieved October 1. 2009, from 

http://www.apa.org/about/division/cpmscientific.html#5 

Arendt, R. E., MacLean,W. E., & Baumeister, A. A. (1988). Sensory integration theory and practice: An 

uncertain connection. American Journal on Mental Retardation, 92, 427-429. 

Association for Behavior Analysis International. (1995). Statement on Facilitated Communication. 

Retrieved October 1, 2009, from http://www.abainternational.org/ABA/statements/FC.asp 

Ayres, J. (1972). Sensory integration and learning disorders. Los Angeles, CA: Western Psychologycial 

Services. 

Baranek, G. T. (2002). Efficacy of sensory and motor interventions for children with autism. Journal of 

Autism and Developmental Disorders, 32, 397-422. 

Biklen, D. (1990). Communication unbound: Autism and praxis. Harvard Educational Review, 60, 3, 

Dawson, G. D., & Watling, R. (2000). Interventions to facilitate auditory, visual, and motor integration in 

autism: A review of the evidence. Journal of Autism and Developmental Disorders, 30, 415-421. 


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Interventions 

Emerson, A., Grayson, A., & Griffiths, A. (2001). Can’t or won’t? Evidence relating to authorship in 

facilitated communication. International Journal of Language & Communication Disorders, 36 (Supp), 

98-103. 

Green, V. A., Pituch, K. A., Itchon, J., Choi, A., O’Reilly, M., & Sigafoos, J. (2006). Internet survey of 

treatments used by parents of children with autism. Research in Developmental Disabilities, 27, 70-84. 

Hohen, T., P., & Baumeister. A. A. (1994). A critique of the application of sensory integration therapy to 

children with learning disabilities. Journal of Learning Disabilities, 27, 338-350. 

Hyatt, K. J. (2007). Brain Gym: Building Stronger Brains or Wishful Thinking? Remedial and Special 

Education, 28, 117-124. 

Hyatt, K. J., Stephenson, J., & Carter, M. (2009). A review of three controversial practices: Perceptual 

motor programs, sensory integration, and tinted lenses. Education and Treatment of Children, 32, 

313-342. 

Individuals with Disabilities Education Improvement Act of 2004, 20 U.S.C. § 1400 et seq. (2004). 

Jacobson, J. W., Foxx, R. M., Mulick, J. A. (2005a). Fad, dubious, controversial, pseudoscientific, and 

politically correct treatments in developmental disabilities services. In J. W. Jacobson, R. M. Foxx, 

and J. A. Mulick (Eds.), Controversial therapies for developmental disabilities: Fads, fashions, and 

science in the professional practice (pp. xi-xvii). Mahwah, NJ: Lawrence Erlbaum. 


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Interventions 

Jacobsen, J. W., Foxx, R. M., & Mulick, J. A. (2005b). Facilitated communication: The ultimate fad 

treatment. In J. W. Jacobson, R. M. Foxx, and J. A Mulick (Eds.), Controversial therapies for 

developmental disabilities: Fads, fashions, and science in the professional practice (pp. 363-383). 

Mahwah, NJ: Lawrence Erlbaum. 

Kavale, K. A., & Mostert, M. P. (2004). Treating autism: manipulators, mystics, and monsters. The positive 

side of special education: Minimizing its fads, fancies, and follies. Lanaham, MD: Scarercrow 

Education. 

Leong, H. M, & Carter, M. (2008). Research on the efficacy of sensory integration therapy: Past, present, 

and future. Australasian Journal of Special Education, 32, 83-99. 

Mann, L. (1979). On the trail of process. New York: Grune & Stratton. 

Miller, L. J. (2003). Empirical evidence related to therapies for sensory processing impairments. NASP 

Communiqué, 31 (5). Retrieved August 9, 2006, from 

http://www.nasponline.org/publications/cq315sensory.html. 

Mostert, M. P. (2001). Facilitated communication since 1995: A review of published studies. Journal of 

Autism and Developmental Disorders, 26, 19-42. 

No Child Left Behind Act of 2001, 20 U.S.C. 70 § 6301 et seq. (2002). 

Shaw, S. R. (2002). A school psychologist investigates sensory integration therapies: Promise, possibility, 

and the art of placebo. NASP Communique, 31(2). Retrieved August 9, 2006, from 

http://www.nasponline.org/publications/cq312si.html. 


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Interventions 

Smith, T., Mruzek, D. W., & Mozingo, D. (2005). Sensory integrative theraspy. In J. W. Jacobson, R. M. Foxx, and J. A Mulick 

(Eds.), Controversial therapies for developmental disabilities: Fads, fashions, and science in the professional practice 

(pp. 341-350). Mahwah, NJ: Lawrence Erlbaum. 

TASH. (2000). Resolution on facilitated communication. Retrieved October 1, 2009, from 

http://www.tash.org/IRR/resolutions/res02faccom.htm 

Vargas, S., & Camilli, G. (1999). A meta-analysis of research on sensory integration treatment. American Journal of 

Occupational Therapy, 53, 189-198. 

Wolfensberger, W. (1992). The “facilitated communication” craze as an instance of pathological science: The cold fusion of 

human services. In H.C. Shane (Ed.), Facilitated communication: The clinical and social phenomenon (pp. 57-122). San 

Diego, CA: Singular Publishing Group, Inc. 


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Keith J. Hyatt, EdD, Western Washington University Ken Howell ...

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