Alternative Therapy: If it sounds too good to be true…. guess what?

Several weeks ago I attended a library lecture at which a gentleman was discussing his therapeutic company.  The individual was describing how his intervention can “miraculously improve” learning disabilities, ADHD, and Autism.  I found myself thinking, “Wow, this guys is good.”  And what I mean is that he was good at being a salesman.  Parents all too often are looking for a quick cure- an instant fix for whatever condition their children have.  We as clinicians all too often get mad at these parents for trying alternative therapies instead of what we know to be scientifically sound interventions.  However, who can seriously blame these parents?  They want the best for their children.  These parents desperately want their children to behave and appear like a neurotypical child.  They want quick fixes and lasting change. 

A relatively recent book, Snake Oil Science ,by R. Barker Bausell, explains the fallacy behind many alternative interventions.  In the book he explains how patients and physicians are often sold into the benefits of alternative therapies with no real rhyme or reason as to the proposed mechanisms for improvement.  Bausell’s main arguments against alternative interventions are two-fold: 

1) there is no explanation behind the reason for change and

2) the research behind the therapies is often quite lousy

This is a great read for any clinician who provides recommendations for parents or patients in general. 

Dr. Teri Hull wrote a blog article a few weeks ago describing the limitations of Developmental Vision Therapy as an intervention.  This is a touchy subject for many people, as there are numerous practitioners and patients who have either prescribed or benefited from vision therapy or some other alternative intervention.  I would admit that there are certain people who benefit from such interventions.  However, what we know from sound scientific research is that these studies do not benefit a sample at the population level.

I am curious as to everyone’s thoughts on alternative interventions.

What do you as parents think? 

Therapists who are reading this blog, what are your opinions? 

Do you ever refer parents to such alternative therapies? 

What have your results been?

24 replies
  1. Wendi Cieciwa
    Wendi Cieciwa says:

    By nature, I am the kind of person who is curious as well as skeptical. I will ask, “Where’s the research that supports this?” However, as a parent of an autistic child, I feel myself wanting to try what I can. Here is the thing that frustrates me. I believe I’m not the only parent that feels this way. I by no means consider myself “duped” or “sold into” these alternative therapies. I feel like people are sharing what they think has worked for them. I remain VERY skeptical as to weather these things will help my child. However, I do try some of them. I would also appreciate people not lumping all alternative methods together as all good or all bad. Would I do chelation…NO! I feel it can be dangerous for my child. Would I try a gluten free/casein free diet? Sure. Hyperbaric chambers…NO! Vitamins/probiotics/fish oil? YES!!!! I do recognize that some parents are tricked into thinking this will cure their child. I also realize that there are some people out there trying to make money from this. However, I also believe that people truly think they have seen improvement when implementing these alternative therapies. The day after removing casein from my son’s diet, he spoke a five word sentence while looking me in the eye. A month later though, he showed more dramatic improvement. Prior to that, he would also show dramatic improvements over the course of the day. Was this a coincidence or did the casein removal help? My point is, I am not oblivious that this may not be the reason for his improvement…but maybe it is. He certainly is doing better than before. Two days after starting him on Super Nu-Thera (a vitamin for autistic children) and a strong probiotic, his stools were solid for the FIRST time and he began eating vegetables and rice for the first time and even tried dipping foods which he had NEVER done before. This was a hard one to deny. We will be sticking to this. I feel he would have made improvements without these alternative therapies. Early intervention (OT, Speech, DT) has been wonderful for him and I believe it is so more important than any of these alternative therapies. However, I do believe some of them may have their place and maybe one day some research can back it up. Either way, please don’t think we as parents are all tricked into this. Some of us are just keeping an open, but cautious, mind and giving them a try.

    Reply
  2. maureen evans
    maureen evans says:

    Very Interesting article by Dr. Greg and a very insightful comment by a parent whose personal experience says it all!

    Reply
  3. Matina
    Matina says:

    I agree with Wendi as well. I have a son who is now 17 years old and suffered from chronic ear infections beginning at 1 year of age. He had constant fluid in his ears. His pediatrician just continued to treat him with antibiotics and did not think “out of the box.”
    Learning disabilities became evident by age 2 years old. I went to get a second opinion finally from an MD with a european background that took one look at him at age 4 and said he has severe allergies probably to food. She did a blood test and discovered he had food sensitivities to gluten and casein. His ear infections stopped and his receptive and expressive language started to flourish. He is now functioning academically at grade level in high school. I think its important to get the advice of many expert advisors that may have been exposed to age old wisdom that does not fit into modern conventional medicine. They can detect things in the “blink” of an eye. Matina

    Reply
  4. Dominick M. Maino, OD, MEd, FAAO, FCOVD-A
    Dominick M. Maino, OD, MEd, FAAO, FCOVD-A says:

    The American Optometric Association notes that “Optometric Vision Therapy is a sequence of neurosensory and neuromuscular activities individually prescribed and monitored by the optometrist to develop, rehabilitate and enhance visual skills and processing. The vision therapy program is based on the results of a comprehensive eye examination or consultation, and takes into consideration the results of standardized tests, the needs of the patient, and the patient’s signs and symptoms. The use of lenses, prisms, filters, occluders, specialized instruments, and computer programs is an integral part of vision therapy. The length of the therapy program varies depending on the severity of the diagnosed conditions, typically ranging from several months to longer periods of time. Activities paralleling in-office techniques are typically taught to the patient to be practiced at home, thereby reinforcing the developing visual skills. Research has demonstrated vision therapy can be an effective treatment option for Ocular motility dysfunctions (eye movement disorders), Non-strabismic binocular disorders (inefficient eye teaming), Strabismus (misalignment of the eyes), Amblyopia (poorly developed vision), Accommodative disorders (focusing problems), Visual information processing disorders, including visual-motor integration and integration with other sensory modalities and Visual sequelae of acquired brain injury.

    My ophthalmological colleagues are not educated in optometric vision therapy, do not have clinical experience in doing optometric vision therapy and have not been certificated in this area. Optometrists, on the other hand, are taught about binocular vision problems and optometric vision therapy in all the schools and colleges of optometry, practice optometric vision therapy within their offices and even have certification available via organizations such as the College of Optometrists in Vision Development (http://www.covd.org).

    It is unfortunate that Dr. Stasi has not been able to keep up with the current National Institutes of Health National Eye Institute sponsored research that shows optometric vision therapy to be most successful for binocular vision problems. I would suggest you read:

    A randomized clinical trial of treatments for convergence insufficiency in children. Scheiman M, Mitchell GL, Cotter S, Cooper J, Kulp M, Rouse M, Borsting E, London R, Wensveen J; Convergence Insufficiency Treatment Trial Study Group. Arch Ophthalmol. 2005 Jan;123(1):14-24.

    Long-term effectiveness of treatments for symptomatic convergence insufficiency in children. Convergence Insufficiency Treatment Trial Study Group. Optom Vis Sci. 2009 Sep;86(9):1096-103.

    The efficacy of visual therapy: accommodative disorders and non-strabismic anomalies of binocular vision. Suchoff IB, Petito GT. J Am Optom Assoc. 1986 Feb;57(2):119-25.

    Vision, learning, and dyslexia. A joint organizational policy statement. American Academy of Optometry. American Optometric Association. Optom Vis Sci. 1997 Oct;74(10):868-70.

    The association between vision quality of life and academics as measured by the College of Optometrists in Vision Development Quality of Life questionnaire. Vaughn W, Maples WC, Hoenes R. Optometry. 2006 Mar;77(3):116-23.

    Measuring ADHD behaviors in children with symptomatic accommodative dysfunction or convergence insufficiency: a preliminary study. Borsting E, Rouse M, Chu R. Optometry. 2005 Oct;76(10):588-92.

    Visual factors that significantly impact academic performance. Maples WC. Optometry. 2003 Jan;74(1):35-49.

    There is a great deal more research support for optometric vision therapy but space limitations stops me from suggesting all the articles you could read. Please go to http://www.covd.org for more information.

    Thanks

    Dominick M. Maino, OD, MEd, FAAO, FCOVD-A, Professor of Pediatrics/Binocular Vision Illinois Eye Institute/Illinois College of Optometry dmaino@ico.edu

    See http://www.MainosMemos.blogspot.com for current research info on children’s vision.

    Reply
  5. Greg Stasi
    Greg Stasi says:

    Dr. Maino,

    Thank you for your comments. I appreciate all open and honest discussions for topics that we hold close to our heart. I fully agree with you that the research supports Developmental Vision Therapy for convergence insufficiency.

    Yet, the research from the learning disabilities and neuropsychological community does not support the use of such therapies for learning disabilities. Dyslexia is primarily a phonological processing disorder. The majority of children with a reading disorder exhibit primary deficits with their language functioning as opposed to true visual deficits. Therefore, treating the visual system would not improve the underlying issues at hand. Dr. Hull blogged about Developmental Vision Therapy several weeks ago. In her blog, she discussed the article: Learning Disabilities, Dyslexia, and Vision from Pediatrics in 2009. I cannot do the article justice by loosely producing sources and articles that were cited in the article. I encourage you, and any other practitioner, to read the article and comment on the conclusions that the authors submitted.

    Dr. Maino, what would your primary recommendation be for a child with ADHD? Would it be pharmacological intervention or vision therapy?

    I would like for you to respond so that we can get a discussion going. By no means, am I am trying to discount you or tear apart your practice. I want to engage in a research based discussion about interventions for children with learning issues.

    Sincerely,

    Greg Stasi

    Reply
    • Dana Nadel
      Dana Nadel says:

      There are a number of research articles that demonstrate the relationship between vision and learning (College of Optometrists in Vision Development, n.d.). According to the American Academy of Optometry and the American Optometric Association (1997), children “at risk for learning related vision problems should receive a comprehensive optometric evaluation. This evaluation should be conducted as part of a multidisciplinary approach in which all areas of function are evaluated and managed” (p.284-286). It is important to note the emphasis placed on the multidisciplinary approach required to address vision problems. Children who experience vision deficits that impact their learning may benefit from vision therapy, occupational therapy, speech therapy and other educational supports. It is essential that this multidisciplinary team approach be used to appropriately address all of the child’s needs.

      The American Academy of Optometry and the American Optometric Association (1997) identify that “vision therapy does not directly treat learning disabilities or dyslexia. Vision therapy is a treatment to improve visual efficiency and visual processing, thereby allowing the [child] to be more responsive to educational instruction” (p.284-286). Research supports the use of vision therapy to treat: eye movement disorders, inefficient eye teaming disorders, misalignment of the eyes, poorly developed vision, focusing disorders and visual information processing disorders (Optometry and Vision Science, 1999). If a child is having difficulties with the above, vision therapy can be one of the many treatment approaches that will help him/her be successful in school.

      As an occupational therapist, I work with children who experience visual difficulties that impact their daily functioning at home and at school. Vision difficulties interfere with reading, writing and playing. A child who has difficulty focusing their eyes will have trouble concentrating on small objects or print at a close distance. Children with eye movement disorders will have difficulty with learning and reading, tracking objects if the object or the child is moving, and scanning across the environment when playing games or reading books. Children with visual motor dysfunction may have trouble copying from the board, may demonstrate sloppy writing or drawing, may have difficulty writing numbers in columns for math problems and may demonstrate poor spacing and inability to write on lines. In closing, children with vision issues often have difficulties with learning and other aspects of their daily functioning. Therefore, it is essential that we address their concerns with a multidisciplinary approach in order to best meet their needs.

      Vision therapy. Information for health care and other allied professionals. A Joint Organizational Policy Statement of the American Academy of Optometry and the American Optometric Association (1999).Optometry and Vision Science, 76(11), 739-740.

      Vision, learning, and dyslexia . A joint organizational policy statement. American Academy of Optometry. American Optometric Association (1997). Journal of American Optometric Association, 68 (5), 284-286.

      College of Optometrists in Vision Development (n.d.). A summary of research and clinical studies on vision and learning. Ohio.

      Reply
  6. Raquel Bassuk
    Raquel Bassuk says:

    Excellent blog and great comments. As a parent of a child with neurological issues, I know that we want to try everything. Some of us are able to provide both, traditional and alternative therapies; however, most of us ar not. Most importatly, children need time to be children, to play and do what kids naturally do, less intusion is better, regardless of which therapy we believe in. i personally favor the well reearched and more traditional therpies.

    Reply
    • Greg Stasi
      Greg Stasi says:

      Thank you for your comments Raquel! I agree with you 100%. We have to make sure that the children recieve the therapy that they require but at the same time do not want to over extend children with therapy.

      Reply
      • wendi
        wendi says:

        I certainly would not want to over extend my child with therapy and have always thought about that as we work through many of his difficulties. However, on the flip side, he absolutely loves the traditional therapies (OT, speech, ABA). He has a great time during them and these therapies are what allow him to then enjoy himself more when doing what kids “naturally do”. He is more comfortable around peers and able to communicate more successfully. As far as alternative therapies, honestly, these are more difficult for me than him. He actually enjoys the gluten free-casein free foods as well as the probiotic and I just mix the vitamins into his juice so he doesn’t even know. In fact, since starting the gluten free diet he has tried so many more foods and actually dramatically increased the variety of foods in his diet. He no longer turns vegetables away. He eats more proteins and enjoys rice. These are foods he wouldn’t eat before. He used to just want bread and fruit and sweets. Quality of life is just better for our family (which doesn’t explain why I’m up at midnight blogging). He is happier and communicates better. I guess what I’m saying is if you want to try something, you shouldn’t feel that you cannot. However, I would never push another person to try alternative therapies. It is true they are not researched enough and my son’s positive results again could possibly be coincidental with natural improvement. At this point and with all the dramatic improvements we’ve seen, it is very difficult to believe that. However, I will remain a skeptic throughout this process. There are times I wish we could just forget therapy and diet and just play. But then I realize that’s my wish. He wants his therapy and has no idea he is on a special diet. He just thinks that certain foods “hurt his tummy for now” and pretty much leaves it at that. I will never regret the wonderful hours of therapy and (maybe) the alternative therapies that have brought us to where we are now and continue to help my child enjoy life to the fullest.

        Reply
  7. Dominick Maino
    Dominick Maino says:

    Dear Dr. Stasi…

    Most optometrists who work in this area do not say that learning related vision problems cause learning disabilities…but they are present in many children with learning issues.

    For example:

    Granet DB, Gomi CF, Ventura R, Miller-Scholte A.The relationship between convergence insufficiency and ADHD.Strabismus. 2005 Dec;13(4):163-8. Notes that “an apparent three-fold greater incidence of ADHD among patients with CI when compared with the incidence of ADHD in the general US population (1.8-3.3%). We also note a seeming three-fold greater incidence of CI in the ADHD population.”

    Solan HA, Larson S, Shelley-Tremblay J, Ficarra A, Silverman M.Role of visual attention in cognitive control of oculomotor readiness in students with reading disabilities. J Learn Disabil. 2001 Mar-Apr;34(2):107-18. Concluded that “Eye movement therapy improved eye movements and also resulted in significant gains in reading comprehension.”

    Atzmon D, Nemet P, et al.A randomized prospective masked and matched comparative study of orthoptic treatment versus conventional reading tutoring treatment for
    reading disabilities in 62 children. Binocular Vision & Eye Muscle Surgery Quarterly, 8(2):p. 91-106, 1993. Concluded that ” Orthoptic treatment, to increase convergence amplitudes to 60 D, is as effective as conventional in-school reading tutoring treatment of reading disabilities. An advantage of orthoptic treatment was that subjective reading and asthenopic symptoms (excessive tearing, itching, burning, visual fatigue, and headache) virtually disappeared after orthoptics. We recommend orthoptic treatment as: 1) an effective alternate primary treatment; 2) adjunctive treatment for those who do not respond well to standard treatment; and 3) as primary treatment in any case with asthenopic symptoms of /or convergence inadequacy.”

    I know that we could throw studies at each other to support our views…one of the things I’ve learned over time is that seldom is there one right answer…and that most of the time there are several right answers for our patients…and we should consider to all of them. As to your question…”Dr. Maino, what would your primary recommendation be for a child with ADHD? Would it be pharmacological intervention or vision therapy? “…my response would be these are not exclusive choices…I have recommended all of them.

    Dominick

    Reply
  8. Dominick Maino
    Dominick Maino says:

    Dr. Stasi…..

    We actually have more in common than you might think. I am working with Elizabeth Berry-Kravis, MD, PhD who is also at Rush on research concerning children with Fragile X. I am in the process of setting up an eye clinic at the Easter Seals Therapeutic School for children with autism, and currently work with adults at the Neumann Association who have not only a developmental disability but also a psychiatric illness. (Donati RJ, Maino DM, Bartell H, Kieffer M.Polypharmacy and the lack of oculo-visual complaints from those with mental illness and dual diagnosis.Optometry. 2009 May;80(5):249-54.)

    You know….this discussion just might be the start of a possible joint project of some kind!

    Reply
    • Greg Stasi
      Greg Stasi says:

      Dr. Maino,

      Thank you so much for replying!

      I would love to meet up and have a great discussion with you. I so appreciate your wealth of knowledge and would be very open and anxious to form a working relationship.

      Please send me an email at: GregS@nspt4kids.com if you would be interested in meeting and discussing possible projects.

      Thank you

      Greg

      Reply
  9. Dominick Maino
    Dominick Maino says:

    A colleague of mine just left this comment on my blog:

    “Dr. Maino, your comments on this study are quite insightful, as usual. In actuality, most standardized testing organizations and educational institutions know more about visual demands of education than these optometrists do. (I know, that is sad and unfortunate, but it is true.) That is why they consider such conditions as convergence insufficiency and accommodative disorders as disabling under Section 504 and the ADA.
    David A. Damari, O.D., FCOVD, FAAO Consultant on Visual Disabilities ”

    The article Dr. Damari is talking about (“Visual demands in elementary school.”) can be found at http://mainosmemos.blogspot.com/. Also the researchers were probably MDs and not ODs …. but most docs fail to diagnose these vision related learning problems no matter what the the degree may be! Sad.

    Thanks….

    Reply

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