by
Stephen Starin, Ph.D., BCBA

The internet, like any other large repository of information, contains a great deal of conflicting information. However, the internet poses additional problems in that a vast amount of information is available, it is quickly accessible, and anyone can publish information on the internet. Often, this poses no great threat. After all, it matters little to most of us if there is great disagreement as to whether or not Pete Rose should be inducted into the Baseball Hall of Fame. However, the stakes are raised (no pun intended) when the issues concern the care and treatment of our children.

If you look long enough, you will be confronted with a seemingly endless amount of contradictory information regarding the treatment of problem behaviors. Even a brief examination of information on the internet reveals a vast amount of information regarding the treatment of various disorders and problem behaviors. How do you wade through all this information and make an informed decision? Some helpful hints are described below to assist you in this daunting enterprise.

As you look through information on available treatments, you will see some that sound to you like they ought to work and some that sound like they would not work. You may be strongly tempted to choose the ones that seem to you like they ought to work. However, experience tells us that treatments don't always work just because we think they should (or want them to). We have found that the best solution is often not the most obvious one and might even seem wrong to some people.

We unabashedly advocate a scientific approach for evaluating claims about treatment effectiveness. Unfortunately, too few people rely on the proven methods of science and make decisions, instead, based on testimonials, friendly advise, anecdotes, rumors, good salesmanship, and so on. Some might argue that we should try anything that may possibly help, no matter how remote the possibility. Others argue that these "alternative treatments" can't do any harm, even if they do not produce the desired results. Wrong!

It is true that many of the so-called treatments may not harm a person directly. However, diverting attention, even for a brief period of time, away from treatment methods that have been scientifically proven to be effective is a disservice and can have serious consequences. In fact, some researchers have posited that there is a narrow window of opportunity in treating certain disorders, after which even proven methods may fail to produce optimal results. Therefore, every day that passes without a proven effective treatment is a day lost. For most persons with behavioral, and other, disorders time is precious and should not be wasted.

So, what should you look for when evaluating a proposed treatment? Some guidelines are offered below:

• The treatment should be published in peer-reviewed journals and should have been replicated in more that one study. A peer-reviewed journal is a publication that is dedicated to critically examining research in a particular field. Before being published, the research is reviewed by experts in the particular field to ensure that the authors claims are valid. The more descriptions of successful outcomes in peer-reviewed journals, the more likely it is that the treatment is effective. These are usually obtained by subscription or are available in libraries-they are not generally available at newsstands. Examples include the Journal of Applied Behavior Analysis, Research in Developmental Disabilities, and the Analysis of Verbal Behavior. Newsletters and magazines such as Psychology Today, Time, and Scientific American are not peer-reviewed and should not be used to guide treatment decisions. Peer-reviewed articles should adhere to the following guidelines.
• Claims for successful treatment should include specific, unambiguous descriptions of the behavior. Objective definitions allow the claims to be verified by others. Subjective definitions mean different things to different people and therefore make verification of treatment claims nearly impossible. For instance, cursing could be defined as "socially-inappropriate behavior" or as "saying 'hell' or 'damn.'" The former is subjective and would mean different things to different people whereas the latter is precise and objective. There would be no question about whether or not the behavior improved using the second definition.
• Similarly, the methods of measuring treatment outcomes should be described in clear and objective terms. Precise and objective measurement reduces the bias inherent in subjective measurement methods. For example, measuring the number of tantrums that occur each day is far superior to asking significant others to "rate the degree of improvement." The former method minimizes subjectivity and bias whereas the latter may be affected by a wide variety of variables other than the behavior of interest (e.g., having paid for a "treatment" and therefore should have obtained some results, the therapist saying how much improvement has been obtained, becoming "used to" the behavior, other parents saying their child improved using this treatment).
• There should be controls established to minimize the effects of any factors other that the specific treatment on the behavior of interest. Our world constantly changes and many of these changes affect the behavior in which we are interested. For example, a child exhibiting a problem behavior may be given vitamin supplements and the problem may seem to lessen. Is the vitamin supplement responsible for the behavior change? Should we then suggest that vitamin supplements should be used to control behavior? No. There are many other factors that could have caused (together or alone) the change in behavior. The child may have learned new skills at school, her behavior analyst may have taught her some alternative ways of obtaining desired reinforcement, family problems at home may have been resolved, her doctor may have successfully treated her for an allergy, other children may have punished the problem behavior, her siblings may have reinforced appropriate behavior, and so on. Clearly, before claims for treatment success can be made, many other factors need to be ruled out.
• The treatment should be described in clear, specific terms. Vague descriptions of the treatment process do not allow others to precisely replicate the treatment and therefore make verification very difficult. The treatment must be described clearly enough so that others can repeat the treatment to independently determine its effectiveness in other situation and for other persons.
• Outcomes are described in terms of actual behavior change, not testimonials, anecdotes, and the like. Look for specific, objective outcomes of the treatment; if you don't see these-ask. The person who is promoting a supposedly effective treatment should be able to refer you to empirical, published studies, judged by reputable scientists, that impartially address the degree of treatment effectiveness. Otherwise, you may be relying upon something that worked for only one person in one situation.

It is up to you to carefully and critically evaluate all treatment claims. Ask questions and don't be intimated because the therapist is a professional. A true and caring professional will be willing to answer your questions and should be able to provide you with the information you need to make an informed choice. Even after asking questions and receiving the information you requested you still may be unable to judge the quality of the proposed treatment. If the treatment is for a problem behavior, we suggest that you contact a local chapter of the Association for Behavior Analysis (see Behavior Analysis Organizations for a listing) or e-mail us and we will try to put you in contact with someone in your area.

Suggested Reading

Green, G. (1996). Evaluating Claims about Treatments for Autism. In C. Maurice, G. Green, and S.C. Luce (Eds.) Behavioral Intervention for Young Children with Autism (pp. 15-28). Austin, TX: Pro-ed. This is an outstanding chapter providing detailed  information about this topic. A must read for anyone interested in how to make sense out of all the various treatments (applies to populations other than autism as well).