Friday, July 8, 2011

Autism, temporal binding... and chiropractic

I'm famous. Well, sort of. Earlier this week, one of my colleagues sent me a link to a YouTube video in which chiropractic doctor David Sullivan discusses one of my papers on autism and how it influences his "evidence based practice". 

It's a classic of its genre. The video starts off with a spinning brain and funky science-o-mercial music. And Sullivan somehow manages to equate autism with a dodgy dial-up internet connection whilst weaving our  hypothesis in with Einstein and the space-time continuum. I'm flattered, but also more than a little baffled.



Our paper was called "The temporal binding deficit hypothesis of autism" and came out in the journal Development and Psychopathology nine years ago (now there's a scary thought). In it we suggested that autism might be caused, at least in part, by a reduced interaction between different brain regions. Based on the idea that communication within the brain involves synchronization (or 'temporal binding') of oscillatory neural activity, we predicted that there would be reduced synchronization of brain oscillations in autism.

I'm always pleased when people read and share my papers, especially when they greet it with this degree of enthusiasm. Sullivan gets a lot of things wrong but, as someone who likewise blogs on papers I find interesting but maybe don't completely understand, I can't be too critical [1].

But there are a number of things that it's important to clarify.

First and most importantly, our paper does not endorse chiropractic as a treatment for autism. We don't even mention it. To be fair,  Sullivan doesn't say that we do, but if you were distracted by the spinning brain, the white coat, and the fancy neuro-terminology then you might come away with that impression.

Second, while I'm prepared to admit that I know very little about chiropractic, I really can't see how people with autism might benefit from someone fiddling about with their spines. Last time I checked, autism wasn't considered to be a form of back problem. Sullivan doesn't provide any evidence that chiropractic is a suitable treatment. He doesn't explain how it might be beneficial, even in theory. More to the point, he doesn't elaborate on how the insights gained from our paper are at all relevant to his practice.

Digging around on his website, we do however get this mission statement:
"Therapeutically, the goal is to restore optimal synchronization and inter-communication between all brain areas. As this process evolves, the brain becomes more cohesive in its function, and the child is able to perform at a more age-appropriate and higher functional level."
But there still nothing as to how his chiropractic treatments would actually achieve this goal.

Third, our paper presented a hypothesis. We didn't show anything; there was no evidence, no data; we had an idea and ran with it. As it happens, there have since been a number of studies suggesting that autistic brains on the whole are less well-connected than your average brain. But, it's not nearly as simple or straightforward as we initially hypothesized. Different studies find that different neural pathways are disconnected. Some studies even suggest heightened connectivity. And while there's lots of evidence for abnormal brain oscillations, look more closely and the actual pattern of abnormality isn't very consistent. Another big problem is that evidence for abnormal brain connectivity has been found for umpteen other disorders that are quite different to autism. And there's a fairly compelling counter-argument that anomalous brain connections might be a consequence of autism rather than its cause.

As in so many other fields of autism research, progress is being made, but each new finding generates as many questions as it does answers. We're still a long way from understanding the neurobiological basis of autism in its various manifestations. Changes in brain connectivity and neural oscillations are, I believe, part of the story. But it's going to be a very complicated story.

Sullivan claims to have "a thorough understanding of the science and neurology behind ASD". If he does, he's in a minority of one.

Footnote:

[1] I do make a point of emailing the authors of the paper I'm blogging and giving them the opportunity to comment and make corrections. And if there's something I'm not sure about, I run it past them before posting.

Reference:

ResearchBlogging.orgBrock J, Brown CC, Boucher J, & Rippon G (2002). The temporal binding deficit hypothesis of autism. Development and psychopathology, 14 (2), 209-24 PMID: 12030688 Download PDF

Update 15/7/11:

Kylie Gray (Monash Uni) has passed me a chapter on autism that she wrote for a chiropractic textbook with a view to educating chiropractic students about autism. She did a comprehensive literature search and found no evidence of efficacy.

Here are the relevant paragraphs:
"There is no evidence [the editor added the words "at this point"] of the efficacy of chiropractic in the treatment of autism. A few cases studies, not published in peer reviewed journals, have claimed that successful outcomes were achieved through the use of chiropractic with children with autism (Gleberzon 2006). Case reports and anecdotal reports do not provide evidence for the efficacy of a treatment; randomized clinical trials are needed to investigate the effects of any treatment.

"It has been noted that primary management of the treatment of a child with autism by a chiropractor is neither in keeping with knowledge of current best practice nor in the best interests of the child (Ferrance 2003, Gleberzon 2006). It is essential that professionals working with the families of children with autism are knowledgeable about the demonstrated efficacy, or lack thereof, of treatments that are available. It is important for professionals to be able to explain these issues to families and provide them with informed advice about their treatment options."
Gray, K.M., Brereton, A.V., & Tonge, B.J. (in press) Autism. In N Davies (Ed.) Chiropractic Paediatrics. Edinburgh: Harcourt Brace & Company.

Update 20/08/11:

A number of commenters have pointed out that Dr (of Chiropractic) Sullivan is employing "Brain Balance" techniques which may or not involve chiropractic treatment of autistic kids after all. I've contacted him to find out but haven't had a response. Anyway, if you've come across Brain Balance and think that it sounds vaguely plausible, I'd urge you to read this and this on the Science Based Medicine website.


Further reading:

51 comments:

  1. Chiropractors make silly claims like this all the time. They claim they can cure a whole host of diseases and medical conditions with a little spine cracking. http://www.badscience.net/2009/07/we-are-more-possible-than-you-can-powerfully-imagine/
    It makes me sad to think that MQU was the first university in the world to offer a professional chiropractic degree... that's not something to be proud of! And frankly, given the low quality of the students going through the chiro program an MQU, it's no wonder chiropractors are so dodgy! (side note: I used to be a prac supervisor at MQU for the chiro students as they needed to do a first year physics unit. So I do have first hand knowledge here!)

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    1. Small minds with misinformed opinions make me sad...

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  2. Last time I checked, autism was *not* considered to be a form of back problem.

    -- The infamous "leave out the not" error has struck I suspect ;-) Been there, done that one myself!

    I love the caption you’re added to the photograph, by the way.

    (From another science blogger who has written about chiropractics…)

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  3. Cheers Grant, fixed that one up!!!

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  4. Third, our paper presented a hypothesis. We didn't show anything; there was no evidence, no data; we had an idea and ran with it

    how did you manage to get that published? (I'm actually being serious)

    A.L.

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  5. AL - if there was a prize for best moniker...

    To answer your question, it's not that unusual for papers to present a hypothesis without new data. Our hypothesis was based on existing evidence - it didn't come out of thin air. But it involved making a few connections between research literatures that up until then hadn't been linked.

    The important point, however, is that while our hypothesis provided a potential explanation for findings in the autism literature, you can't take those existing findings as evidence supporting our hypothesis. You need to make predictions (that other existing theories wouldn't make) and then go out and test them.

    What I was objecting to was our paper, which was pure speculation, being presented as hard evidence.

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  6. 1) It must be strange to find your paper picked up in such an odd way.

    2) Anyone trying to deal with autism on a daily basis is living with a hellish problem that can't be appreciated from just a clinical standpoint, and therefore they are entitled to seek out any sort of help they deem useful. Realistically, his patients may have musculoskeletal problems that respond to chiropractic therapies, and he may well provide them some relief. No doubt that also is a great help to the parents of his patients, too. And who knows, perhaps the manipulations provide increased bloodflow on a temporary basis. With that:

    3) (And the reason I am driven to post in the first place:) There is a guy at UCLA who is testing autistic patients and finding major and consistent abnormalities on SPECT scans in his autistic patient, which measure perfusion in tissue. He postulates that the perfusion abnormalities are due to chronic viral infection, because they all have greatly increased serum viral titers. He also believes that this problem goes past autism and may even explain some ADD, ADHD, and Chronic Fatigue Syndrome (CFIDS, or myalgic encephalitis in Great Britain)in adults. It's a fascinating concept. Your hypothesis would actually fit in with his, I suspect.

    If you'd like to know more about him, let me know.

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  7. Wow. Always love it when the Comments are as fascinating as the piece they're commenting on. (Please pardon ending in a preposition; couldn't figure out how else to say it.)

    I have a friend whose older child is high-functioning autistic, which is why I quickly went to this blog when I saw it RTed on Twitter. I do not pretend to know anything useful about autism. Nor do I profess to have any knowledge or expertise in chiropractic, beyond being a patient/client who has tried to educate herself somewhat about chiropractic out of interest once she and her husband have been helped so much by our chiropractor, and not merely our backs!

    And that's really all I want to touch on. I can't say much about the claims of David Sullivan, because of my lack of training and expertise. I didn't even see the video, because in my browser I got some kind of "crashed" message where I suspect the video is supposed to be for us to view. I can only go on what Jon Brock said, and the mere remark that David Sullivan does not in any way explain just how he is proposing that chiropractic would have the outcome he's professing, raises red flags for me.

    I just wanted to point out, purely FYI: So true that autism is not a back problem. Nor is chiropractic only about backs. I had always had a feeling that Chiropractic as a whole is not necessarily the quackery that so many people think it is, yet at the same time I always wondered why I would hear from people that chiropractic alleviated or lessened some problem or pain that had nothing to do with the back or even joints. But now I've got a glimmer of how that works:

    True, Chiropractic deals with the spine, which is for the most part located in the back. Chiropractic deals with what's IN the spine: simply put*, the nervous system. (*It has to be simply put, since I'm not trained; I can't get technical or complicated! ::smiles & winks:: ) And the Nervous System reaches to EVERY part of the body.

    The point of chiropractic adjustments is to correct---now here's a word I had a hard time getting my tongue around---"subluxations". (Wish I knew of another word for it!) A subluxation is when the nervous system coming out of a particular vertebra or series of vertebrae is interrupted in some way. Perhaps an injury mis-aligned some vertebrae. Perhaps an activity over long-term has pushed things out of proper alignment. Perhaps a pulled, strained, or torn muscle in turn pulled something out of place. I can't get any more precise or technical than that.

    If the nervous pathway is interrupted, whether partially or fully blocked, then the nerves can't transmit what they're supposed to to whatever part of the body they're supposed to govern, including the brain. Over the long-term, yes, I can see that that could cause problems. If the blockage has to do with nerves that are supposed to be talking to various parts of the brain, then sure: I could see all sorts of conditions resulting from the subluxation.

    Thus, "in theory" ----(I want to move to Theory. Everything works in Theory. But I haven't yet found any openings in Theory. Nor: On The Other Side, where the grass is always greener!)---- I could see that some sort of subluxation-related problem could indeed be contributory to the presence of what is termed autism. In theory.

    And if the doctor cannot even say something to the effect of, "I propose that chiropractic adjustments would have the impact I've professed because the adjustments would lead to this, which would in turn lead to that, which could then result in thus-and-such . . .", well then, I'm as skeptical, or at least as cautious as Jon about this particular citation of his hypothesis!

    I mostly just wanted to address the chiropracic = nothing but backs matter. And my chiropractor never claims to cure anything. He believes the body will heal more than he ever could. All he does is clear the way, by clearing subluxations, for the body to do it's thing.

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  8. [::sighs:: I'm such a wordy person. Had too many characters to post the entire response by the time I was done. So, for what it's worth (decidedly less than 2 cents, I'm sure ::grins:: ), here the rest of what I wrote:

    He [my chiropractor] is the first to say that traditional medicine has its place---I've heard through entirely other circles that in this country we excel at Crisis Care but not at Wellness Care, & to my mind, that sounds like my chiropractor's view, too. If anyone reading this is the least bit curious, try to find & read a copy of the "poem":

    "My Chiropractic Message" by Victor N. Naumov.

    (I took down that info from the poster of the poem hanging at my chiropractor's practice.) Perhaps the remarks about looking to the spine for the causes of Dis-ease and the body's ability to heal itself and "I am scientifically educated but, Yet never claim to be smarter than the body" and "I can influence all diseases with use of my hands Yet never claim to treat any specifically" and so on, will help put things in perspective.

    At any rate, I very much enjoyed this blog entry, Jon. I very much understand how a paper could get published without presenting new data. Indeed, I should think the field of scientific and medical inquiry advances every bit as much on minds looking at existing findings and seeing new connections and sharing those new connections, as on the work that produces the findings in the first place. Isn't that how research comes to move in new directions and allows us to discover new things?

    I may well follow your blog more regularly now that I've been introduced to it. Thank you for the good read!

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  9. [[{{argh! Pesky apostrophe! That should be "its", not "it's = it is" in: "for the body to do its thing".!!

    And I should've added D.C. to the poet's name, thus: Victor N. Naumov, DC. }}]]

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  10. David Sullivan is a "functional neurologist" or a "chiropractic neurologist", so to speak trained at the Carrick Institute. He's mouthing the doctrine of "functional disconnection syndrome", a made-up syndrome created by Robert Melillo DC that's the basis for the marketing of the Brain Balance Centers (a franchise operation in the US, usually operated by chiropractors).

    What is a chiropractic neurologist

    As in other medical professions, we have individual specialists within the chiropractic profession. Through education, training and board certification, we choose to limit practice to a certain specialty to assist other physicians in the diagnosis and treatment of a variety of conditions. Typically, a chiropractic neurologist serves in the same consulting manner as a medical neurologist. The difference is that the therapies or applications of a chiropractic neurologist do not include drugs or surgery. As a result, certain conditions are more customarily amenable to treatment by a chiropractic neurologist as opposed to a medical neurologist, and vice versa. ....

    It is my opinion that the individual chiropractors, such Sullivan, are true believers and are not cynically providing hope to distressed parents in order to profit. As to Carrick, Melillo, and the rest, I have a different opinion.

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  11. It's interesting how one's pre-conceived notions and judgments stop one from looking beneath the veneer and checking out what people are saying. Such is the case with the people you speak of - Sullivan, Melillo, Carrick. Having owned a Brain Balance Center in Southern California for four years, I've seen the results with autistic children that can be achieved by utilizing the functional neurology principles. And that doesn't necessarily include "cracking their back" as more than one person mentioned. I've seen autistic children return to what appears normal function by both subjective and objective findings. "Connectivity" is a new endeavor in neuroscience, and I presume you know the expression "neurons fire together, wire together". We know that there is massive dys-connectivity in autism, and we also know that if you stimulate various sensory and motor nerves it will increase neuroplasticity. This if what the principles of functional neurology are based on. If you knew that Harvard and Standford were working on some of the same principles as Carrick et al, you'd applaud it. And, they are. Just don't condemn a process because it's delivered by a chiropractor.

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  12. Anonymous (the most recent one): Two questions:

    First, many kids with autism show improvement over time. Your anecdotes in themselves do not show that the treatment caused their improvement. Obviously, you realise this. But presumably, if the interventions are as remarkably successful as you suggest, there are large scale studies published in reputable journals, showing meaningful and statistically reliable effects compared to untreated controls as assessed by independent measures that are blind to treatment group. Maybe I'm looking in the wrong places but I haven't found these papers. Perhaps you could supply a reference or two.

    Second, could you perhaps explain how your treatment targets the specific connections that need rewiring? I'm familiar with the argument that each patient is an individual and so there's no generic treatment to explain. So I'll make it easy. Could you provide one specific example of one individual patient, how you diagnosed which connections were miswired, how you determined the requisite treatment, and how you determined that those connections had been 'fixed'?

    I'm a scientist. It's my job to be skeptical :)

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  13. I've emailed David Sullivan:

    Hi David

    I've recently been alerted to your YouTube video about our paper on "The temporal binding deficit hypothesis of autism". While I'm glad that you found our paper interesting, I'm concerned that you are promoting our paper as evidence for your therapies.

    I've posted a full response on my blog here:

    http://crackingtheenigma.blogspot.com/2011/07/autism-temporal-binding-and.html

    You're welcome to comment, particularly if you can clarify what exactly it is you do to these kids and what evidence there is that this does or even could work.

    Cheers

    Jon

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  14. "I've seen autistic children return to what appears normal function by both subjective and objective findings.

    Was that just because the treatment lasted years, and they grew up? Kanner's original 1943 paper noted that as autistic childen age, many of the symptoms often become milder.

    ""Connectivity" is a new endeavor in neuroscience, and I presume you know the expression "neurons fire together, wire together".

    That old adage is a statement of Hebb's Rule proposed by Donald Hebb in 1949. So it's not a new endeavor.

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  15. Still no links or references from Anonymous? Imagine my surprise.

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  16. Jon, as ever your thoughtfulness and consideration of the issues is top notch. I've had a bit of a think, and as you know the whole Hebbian thing was what fired me off in the first place with the paper, and whilst Sullivan doesn't appear to be offering any evidence, I can perhaps see a potential mechanism by which re-alignment of neural pathways in the spinal tracts might serve towards the creation of different excitatory and inhibitory patterns throughout the whole central nervous system.

    As you know, one of the main findings in our following paper (Brown, Gruber, Boucher, Rippon & Brock 2005) where we asked youngsters with autistic spectrum disorder and youngsters matched for verbal and non-verbal performance scores to view simple visual illusions and measured the patterns of high frequency electrical signal in the brain showed that those in the autistic spectrum group showed far higher levels of such activity. We concluded that it may therefore be a lack of inhibition of neural activity that is being shown in autism. The reasons that might underlie such a lack of inhibition are many and various; there appears to be a different arrangement of neurons (many more, much smaller and more tightly packed (Casanova et al 2002); some neurons act in a way that lessens the likelihood of following neurons responding (inhibitory) - and in the main these are in deeper levels of the cortex. In a system where there is a different arrangement of columns, this might reduce the connectivity of inhibitory neural pathways, but of course this is speculation, as currently there is no safe, ethical way of finding this out. I am pretty excited about diffusion tensor imaging on this one though.

    Now, how might changing the activity at a lower level of the central nervous system act on such a system? Bearing in mind this is speculation, I would like to suggest that potentially in a "whole" system as dynamic as that of the brain (and the spinal cord IS part of the brain, it is a collection of highly extended neurons grouped together and protected by a series of bones), it does seem likely that allowing or enabling free flow where there has been blockage *might* enable re-balancing between inhibitory and exitatory circuits.

    I have often wondered if this might be something that underlies the (apparently) effective chinese practice of acupuncture.

    Whilst I do not in any way wish to open this up to every one of the often vituperous blogs regarding alternative health practices, I would very strongly be interested in testing this hypothesis out in a properly controlled, and well considered set of experiments. Either using chiropractic or using acupuncture (not both at the same time as that would be confounding), whilst measuring patterns of high frequency activity across the scalp. In this manner, I would like to examine whether overall and specific patterns of high amplitude / low amplitude high frequency brain activity change in response to treatment.

    And in answer to one of the posts - how did we get the first paper published, I seem to remember that Jon and I argued for at least an hour for every half hours writing we did because we came at the hypothesis from two different perspectives. It was marvellous, thanks Jon.

    Brown, C., T. Gruber, Boucher, J, Rippon, G and Brock, J. (2005. Gamma abnormalities during perception of illusory figures in autism
    Cortex 3 (Special Issue: Developmental Neurobiology) (2005) p 264-376.,


    Casanova, M. F., Buxhoeveden, D. P., & Brown, C. (2002). Clinical and macroscopic correlates of minicolumnar pathology in autism.
    Journal of Child Neurology, 17(9), (2002) p692-695,

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  17. Hmm. Caroline, I'm a bit surprised you think this has even a remote degree of plausibility. My concerns are that:

    a. We don't actually know what they do, so it's impossible to work out what effects whatever it is they do do has on the spinal chord let alone any indirect knock-on effect that could ever have on the brain. There's the Neuroscience 101 stuff about Hebbian learning in there to give it some face plausibility, but that's as far as it goes in terms of actually cashing this out in terms of neurobiological mechanisms. Without that, we're deep in the realms of woo.

    b. While we should always be open to the possibility that sometimes things work and we don't quite know why, as far as I can tell, there is no actual evidence that it does work.

    c. Whereas you're saying, OK, let's test this procedure (once we've worked out what it is we're testing) and see if and how it works, these people are already saying with a completely straight face that their intervention is proven and evidence based. They're making money out of desperate parents (and who knows, putting kids at risk of serious spinal injury) by dressing up as neuroscientists. To paraphrase Steve Novella (linked above), they're bypassing the science and going straight to the franchise.

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  18. At what point does Dr. Sullivan say that he is treating his Autistic patients with spinal manipulation or, as the author of this blog ignorantly puts it, "fiddling about with their spines?" He doesn't say that he is. You have inferred that on your own.

    The therapies that he is likely using are very standard treatments used by physical therapists, occupational therapists and other health professionals. The difference, however, is how they are being applied. As he mentioned in his video, therapies are directed hemispherically, not globally as would be done in the aforementioned professions.

    Please remember this as well. This video appears to be directed at the general public, not as a dissertation on his theories about neuroscience to a group of professionals.

    For those of you skeptics, please read "Neurobehavior Disorders of Childhood, an Evolutionary Perspective," by Melillo and Leisman. It is very well referenced and, in fact, is used as a text at UCLA.

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  19. Ah, good. An expert.

    thevreelandclinic: Perhaps you would be so kind as to answer my questions to Anonymous (July 10)

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  20. My understanding is there is a schizm within the chiropractic community. THose who stick to the treatment of spines and profess no further benefit, and those who claim all manner of cures from ASD to a replacement for vaccination. The latter group have never been able to have their claims verified by independent controlled research to my knowledge, and those in the first group of chiros are often the first to point that out. There was an interesting piece in The Australian newspaper about this the weekend before last (apologies for no link).
    My understanding of Autism to date would suggest that no amount of spinal manipulation or conversely 'energy' blockage would either relieve or impede Autism symptoms.
    The vreelandclinic, it is precisely because of the pseudo science being disseminated to the public by the above chiropractor that these conversations need to be had. Hopefully any parent who stumbles across that youtube video will also find this blog. It seems clear to me the gentleman really does not understand what he is talking about and is doing both himself and his profession a disservice consequently.

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  21. Just did a PubMed search for "Autism + Chiropractic". You can see the results here:

    http://www.ncbi.nlm.nih.gov/pubmed?term=autism%20chiropractic

    Nothing. Not one single paper.

    Basically, this means that there aren't any studies published in reputable medical / scientific journals. Worth bearing in mind next time a chiropractor tells you that their autism treatment is "evidence based".

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  22. My son had chronic ear infections, and concomitant treatment with anti-biotics. They were getting ready for tubes. Our doctor was a brilliant Ped, and nationally recognized.

    We were told Randy the Chiropractor had treated other kids with ear infections. Seems we had been giving Ben a bottle at night and the milk leaked into his ears and caused the infection.

    Within a week, his infections cleared up. (He started walking, too.)

    Only time I've ever had any contact with a chiropractor.

    Jus' sayin...not sure what, but jus sayin.

    Common people love chiro's. I'm not sure why...because they are cheaper than doctors but still wear white coats?

    Guess I'll allow someone else to actually add to the discussion.

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  23. Hello all,

    I'd like to add to this discussion but I'll share a little about myself first. I am a chiropractor in the US and have been for 5 years. I am also continuing to further my professional education as a learner and student through the Carrick Institute of Graduate Studies. At this point in my studies, I would not profess to be an expert is ASD, neurology or to have sufficient answers to many of the questions that have been raised in this dialogue.

    I would like to clear up a few things that seem to be misunderstood.

    1) There is a difference between being a chiropractor and being a functional neurologist. Dr. Sullivan seems to be speaking from his functional neurology education and not merely as a chiropractor that is laying patients down on an adjusting table, delivering a spinal adjustment and claiming to have improved the function of a person with autism.

    2) Simply typing chiropractic and autism into pubmed will not reveal the research you are looking for, again this is not the work of traditional chiropractors.

    3) "they're bypassing the science and going straight to the franchise" This is not the whole story, certainly some in the chiropractic profession have missed the boat when it comes to working through the scientific process and peer review. This is not the case with the best of us, much research and publication has occurred over the last several years within the functional neurology community. Including projects specific to ASD.

    Here is a link to the FR Carrick Research Institute page with a list of their current and past projects.
    http://www.frcarrickresearchinstitute.org/projects

    Here is a link for a pubmed search using more specific search criteria:
    http://www.ncbi.nlm.nih.gov/pubmed?term=functional%20disconnection%20syndrome%20autism

    This research is still uncovering the basis for a more thorough understanding of exactly how functional neurologists can serve people with autism. With that said, we do have very skilled clinicians that are actively changing lives with their understanding of how to serve this special population.

    Thanks for allowing this discussion, I look forward to contributing more if I am able.

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  24. Hi Ryan

    Thanks for the constructive comments. I'll read the paper that you linked to on PubMed. It'll be good to get a better insight of what is actually involved.

    In the meantime, it's worth pointing out that, even using your new criteria, there is only ONE paper that comes up and this is not providing evidence that "Functional Neurology" approaches work.

    Like our 2002 paper, Melillo and Leisman are proposing a hypothesis that autism might be some kind of disconnectiomy kind of problem, but also saying "Hey we reckon we can treat it".

    I've only been able to read the abstract so far, but I'm pretty sure if there was actual evidence that they could "fix" autism, that would have made it to the abstract.

    Also, the research at the Carrick Institute is all listed as "ongoing". The poster presentations are all for studies measuring EEG oscillations in autism, not actually evaluating treatments of autism. The research itself sounds pretty interesting, but again there is no evidence that these treatments work.

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  25. usethebrainsgodgiveyou, I hear many of these stories too. My response is that correlation does not equal causation. We can't know if your childs ear infection would have cleared up without the intervention. As ear infections can.
    IF claimed results cant be replicated in a controlled environment then we have a problem.

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  26. I can't help but notice that in these posts more than one person has inferred that chiropractors are adjusting their ASD patients and that is the only therapy being applied. Others have made the leap that somehow chiropractors believe autism is a problem of the back and nerves and can be treated accordingly.

    Jon, your background as a researcher is impressive but you are not being very objective. You said yourself you know very little about chiropractic but you've made repeated claims about it as if you do. Isn't your job as a scientist to suspend your own beliefs and bias to look at the facts and come to a rational conclusion?

    So far you have concluded that chiropractors are adjusting their autistic patients, claiming them cured and offering no evidence as to how they've done it. This simply is not the case with all chiropractors.

    As Sharon mentioned above, there is a divide in chiropractic. There are those that believe that adjusting someone's spine is the key to all things healthy. While I see it as a valuable tool, I don't believe it cures disease. I can only speak for the US because I do not know what chiropractic is like outside of it, but chiropractors in the US are licensed as primary care doctors and treat much more than backs. Those with sub-specialties, like neurology, have degrees that are accredited by the same credentialing bodies that accredit many medical sub-specialties here in the US and Canada. Those chiropractors have very different practices that the ones you are envisioning in your head.

    I agree wholeheartedly with you about providing more research as to how functional neurology works. Those projects are in the works as you have noted.

    The therapies that these chiropractic neurologists are applying include light and sound therapy, tactile therapy, balance work, nutritional counseling, behavior modification and many other therapies that have proven to be helpful for ASD patients. They are not simply adjusting them.

    I would ask that you have your facts correct before you make generalized conclusions about an entire profession. As a scientist, I am sure you know that generalizations are rarely correct.

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  27. thevreelandclinic

    When Sullivan says effectively "I'm a chiropractic doctor. I know how to treat autism", I think I can be forgiven for assuming that he is using chiropractic techniques to "treat" autism. He may be doing other things instead of or as well as adjustments. He doesn't specify. I've asked him for clarification and he hasn't responded.

    30 seconds on Google shows that, regardless of what this particular chiropractor is doing, there are plenty of chiropractors out there who claim to cure all manner of disorders and diseases via adjustments (see the article in the Australian linked above for one example). So while I may have jumped to conclusions about what exactly it is that Sullivan is doing, please do spare me the righteous indignation.

    The bottom line, however, is that whether we're talking about chiropractic adjustments or "functional neurology", there does not appear to be any evidence of efficacy. It's not me being biased. In the absence of evidence I have nothing to be biased about.

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  28. I wonder if it is a litigenous action, viability of chiropracty set aside?

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  29. Chiropractic is the detection and correction of vertebral subluxation. A subluxation simply put is something out of alignment in your spine. The result of this can be limitations to the nervous system which runs through the spine. A chiropractor does not 'fix' your spine, a chiropractor just allows your body to function to it's optimal potential, free of subluxation. If this optimal potential means that a person with autism is able to live a better quality of life then why wouldn't you?

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  30. Anonymous this is not a question of better quality of life, and that's an incredibly subjective term anyway. The issue is that many Chiropractors claim, no matter what treatment they are applying, they can treat ASD and it's symptoms. I am waiting to see the clear evidence of this. What I see is families paying money for non evidence based treatments when those same dollars could be going towards therapies that are shown to have good effect.

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  31. Traditionally, autistic patients relied solely on medication to relieve symptoms, such as aggression, in an attempt to cope with the disease. Chiropractic care, on the other hand, is a drug-free, holistic approach to treatment that focuses on improving the patient's overall quality of life. In the case of autism, this is especially relevant, since the symptoms often present considerable distress to not only the patient but their family also.

    Chiropractor Adelaide

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  32. G Wilson it may be drug free, but it is not cost free. Parents and their ASD children, would be better off spending hard earned money on evidence based treatments. Chiro is not one of those. Personally it looks to me like Chiropractors are just one more profession profiteering off Autism, while offering no clear benefit.

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  33. I'm not suggesting that traditional chiropractic is delivered reproducible results or brings a clear benefit, conversly I've seen the work of functional neurologists first hand with multiple cases. Let's presume for a moment that functional neurologists (chiro background or otherwise) have an answer for 70% of ASD. But due to the cost and lack of funding you don't have research to "prove" it yet. Imagine being a clinician and seeing the changes you are able to influence in these kids, would you stop everything for months (maybe years) until it is proven in the literature or would you continue to serve those in need while research is in the works.

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  34. Hi Anonymous.

    Thanks for commenting. The problem is that subjective impressions are extremely unreliable, particularly if they come from people with an investment in the treatment, be they parents or practitioners. That's why proper research is needed.

    I've found no evidence of proper research being carried out and, as you admit, there is certainly none published. And yet chiropractors / functional "neurologists" are claiming that their approach is evidence based. There are many words for this behaviour but chiropractors have a habit of suing if you use them.

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  35. Fascinating posts - most of which got my blood boiling. While research is of incredible importance, how many long-term studies do we have on any other ASD therapy? Not many studies show long-term efficacy in the traditional treatments. Why would people spend their well-earned money on the pharmaceutical companies? People have been spending billions on medical treatments for their children and are finding that there is no real improvement in symptoms, or, worse, that new symptoms arise. It's the proverbial "dog chasing his tail" and people are tired of the circles and side-effects. Chiropractic is an incredibly beneficial tool that many, many people find not only relief from but also improvement in overall health. While the majority of chiropractors "crack backs" (which is an incredibly ignorant description), many also utilize well-studied practices, as well. Chiropractic has a much more grass-roots approach to health and as a consumer, I very much appreciate that aspect - I trust word-of-mouth at this point far more than I trust the medical community in bed with the pharmaceutical companies. Anyone with a general knowledge of anatomy and physiology understands that nerves, which control EVERY bodily function, run up and down and through the spine. Ignoring the spine in terms of any sort of neurological dysfunction is like ignoring a car accident that has knocked out the power in a city - you would never just continue trying to flip the switch, would you? What are you so afraid of? Do your homework - you of all people, being a researcher, must know how to do proper digging. Find a reputable, respected chiropractor in your area and ask a million questions. I bet you'd be very surprised at what you uncover.

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  36. Dr.Rachel.

    Thanks for the comment. While I agree that there is a need for more research into conventional interventions, you haven't actually provided anything resembling a coherent argument, or addressing the pertinent question of what it is that chiropractic practitioners are doing to/with autistic kids if they're not practicing chiropractic on them.

    Your claim is that chiropractic is beneficial for autism because nerves control bodily function. It sounds convincing in a kind of hand-wavy kind of way (like so many wacky and often dangerous autism treatments). But in truth it's no more valid than claiming that leeches will cure autism because all bodily functions require blood.

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  37. This comment has been removed by a blog administrator.

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  38. Why was this comment removed by administrator?

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  39. Where do you go if you have autism AND a bad back? Last time I checked people with autism CAN get back pain - just like mine! (sat propped up with 6 pillows and still not comfortable - arrrgh!). It's possible that being freed from back pain (and some ordinary folk say that Chiro can achieve this) might just make a persons autism less significant and troublesome. It also occurred to me that deep pressure seems to work for some people with ASC, Temple Grandin etc and perhaps Chiro might borrow from some of this effect. Who knows. Arrrgh, my backs gone again.
    Chris

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  40. Full body rehabilitation of the kinetic chain must be evaluated to find imbalances, which must be corrected through specific Chiropractic Adjustments. Nerves travel through both muscles and joints

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  41. I am an ESL chiropractor trained in functional neurology from Carrick Institute. I don't crack back but I do manipulate joints in hands and feet. I only work with autistic children in my practice. Typically I only see them for 3 months. There were only a couple cases from well over 100 kids that I could not help because the kids were so big, heavily medicated, and overweight. Typically I only can help autistic kids when they are physically small and lean. The younger the better. From my experience, I say kids between 2 & 3 year old will start to talk within 3 months of my treatment, kids between 3 & 4 year old will take 6 to 12 motnhs to start to talk (I mean real talk, not talk like perrot). For example, there was an 8-yo kid that could not hear or talk and doctors decided to perform ear surgery on him. Within 6 months of my treatment, the boy could talk and hear. The surgery was canceled. He later was transferred from special school to regular school. For successful cases, the credits belong to superparents. Only superparents can take instructions from functional neurologists to help their kid become normal. It is my opinion that no treatment will work when parents do nothing. There are many factors that interfere the outcomes when trying to help autistic kids to become normal. I don't think we can study about the effectiveness of autistic treatment because there are so many variables. Autistic kids with different muscle tones, food allergies, family backgrounds, environmental triggers, etc. will respond differently to functional neurology or any other type of treatments. Beside neurological deficits, autistic kids have a lot of metabolic deficiencies. We cannnot help them if we allow their blood sugar fluctuate all day long.. this is happening with ABA's food rewarding system. I am not here to judge anyone or system. These kids only have a few early years of their life to get the most benefits from treatment. I do trade my energy and sweats to achieve good results. I don't think good treatment results will come when doctors and/or parents are not sweating. Expect a lot of physical and mental work if you want to help these kids... There is no easy way around in my opinion. Peace!

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    1. So, in short, when kids improve it's down to your miracle treatment. But when they don't, it's because their parents aren't super enough.

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  42. You made some decent points there. I looked on the net for your problem and located most people goes together with along with your internet site.

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  43. In my experience, many practitioners who make these global claims of curing a variety of things and use hand-wavy neuroscience are sincere, and are constantly fine-tuning their procedure with patients. However, they don't understand science and they're assuming their audience doesn't, either, and will be so impressed by phrases like "rewiring the brain" that they don't ask "in what way?" (And don't even get me started on the frustrations of asking "In what way?" and getting a response that's clearly intended to answer the question, but which really doesn't). In short, it's great to point out all the holes and lack of support, but I'm not sure it's right to suggest all these practitioners are profiteers.

    The problem many parents face, as an earlier commenter pointed out, is that even the "best-supported" interventions don't have a lot of high quality studies supporting them, and many promising ones haven't yet been investigated at all. In the absence of studies it's hard to tell apart pseudoscience from "proto-science"--something that will eventually be borne out, but hasn't been tested yet. It seems to me all you can really do once you've ruled out the obvious doozies is to try something that seems targeted to a skill you'd like your child to learn and watch like a hawk to see if there's any concrete, specific, large improvement--even knowing you can't be certain how much is the intervention and how much is just the person growing and learning, you can at least rule out what *isn't* helping.

    Personally, I'd love to see some of the sensory treatments one of the chiropractors alluded to properly tested. I'd particularly like to see developmental optometrists' tinted lenses and certain listening programs tested to see whether they can help kids with SPD (autistic, ADHD, or otherwise). We desperately need more interventions targeted at sensory and motor problems. It frustrates me that qualified scientists are focusing mostly on social and language-based interventions and are leaving sensory and motor to the chiropractors, developmental optometrists, OTs, and so on, when we know so much about how the various sensory systems work and integrate information already.

    I actually really like Positive About Autism's idea about deep pressure. If anyone ever does a proper double-blind study with a control group, maybe a comparison treatment could be regular deep-pressure massage. Sorry about the novel!

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  45. Great post! Been reading a lot about back health lately. Thanks for the info here!

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