Part I: Neurodevelopmental Issues
Psychotherapy for young people is full of questionable ideas. This article, the first in a three-part series, addresses neurodevelopmental issues, including craniosacral therapy for intellectual disabilities, dolphin-assisted therapy for those on the autism spectrum, brain balancing for inattention, teaching based on learning styles, and dental devices for tics.
There are hundreds of different types of psychotherapy practices used with children and adolescents. Many have been shown to be ineffective, and some of them even have harmful effects. Still others have never been tested but are based on implausible assumptions.
In the book Pseudoscience in Child and Adolescent Psychotherapy (edited by Stephen Hupp, Cambridge University Press, 2019), scholars from psychology and related fields detail some of the most common examples of pseudoscience and dubious claims made related to psychotherapy with youth. Each chapter of the book also includes a sidebar written by skeptics and science communicators, representing a variety of different disciplines.
Most of the sidebars in the book have been pulled together in this three-article series. For this first installment dedicated to neurodevelopmental issues for youth, contributors include three neuroscientists, a behavior analyst, a clinical psychologist, a dentist, a pediatrician, and a high school student. Topics covered in six sections include symptoms related to intellectual disabilities, the autism spectrum, attention-deficit/hyperactivity disorder, specific learning disorder, and tics. Finally, the issue of whether children should be taught about pseudoscience is addressed.
Intellectual and Adaptive Functioning: Does Craniosacral Therapy Improve Cognitive Functioning?
Intellectual disabilities are very often the product of an individual’s genetic endowment or injury to the brain, such as hypoxia during birth or toxic exposure to lead during childhood (Shapiro and Batshaw 2011). Educational methods typically are the most effective means of improving functioning and quality of life. Craniosacral therapy (CST) has been claimed to be a useful alternative medical treatment for treating an array of health problems and disabling conditions, including intellectual disability.
CST is also called craniopathy, cranial osteopathy, cranial therapy, sacro-occipital technique, and bio-cranial therapy. The method typically is used by practitioners with dubious credentials (e.g., chiropractors) but also by seemingly credible individuals such as physical therapists, massage therapists, osteopaths, and dentists. CST is based on the unsubstantiated notion that a craniosacral system is associated with the “primary respiratory mechanism” of cerebrospinal fluid that influences blood flow throughout the body. CST proponents claim they can detect a “craniosacral rhythm” in their clients and that applying pressure to the skull can influence the regulation of cerebrospinal fluid. They further claim that balancing cerebrospinal fluid is critical for good health and brain function, and this is an outcome of their treatment. CST practitioners believe they can use light touch to detect the flow of cerebrospinal fluid and therapeutically manipulate cranial bones. Manipulations are claimed to regulate cerebrospinal fluid, thereby improving cognitive functioning.
There exists no underlying scientific justification or reliable scientific evidence for CST (Hartman and Norton 2002). Several studies have found that CST practitioners are unable to reliably detect the craniosacral rhythm they claim informs their treatment (Hanten et al. 1998; Rogers et al. 1998; Wirth-Pattullo and Hayes 1994). At least two deaths associated with CST have been documented (Barret 2012). CST is not a medical treatment and does not improve intellectual disability. CST has been described as wholly pseudoscientific, and its practice is often characterized as quackery.
Autism Spectrum: Does Dolphin-Assisted Therapy Have Healing Effects?
Lori Marino and Scott O. Lilienfeld
Dolphin-assisted therapy (DAT) is a popular treatment for a host of mental disorders and developmental disabilities. In particular, DAT is widely used around much of the world for autism spectrum disorder and other developmental disabilities in children, adolescents, youth, and adults. DAT typically involves swimming or interacting with captive dolphins with the expectation that contact with them generates powerful therapeutic effects. DAT was introduced in the 1970s and has become a highly lucrative business in several countries, including the United States. Most captive dolphin parks offer some version of a DAT experience for visitors, and many advance nonspecific and often expansive claims about its effectiveness. In doing so, they may appeal to a range of explanations, including increased concentration abilities, reward, changes in brain waves, and the purported “healing effects” of echolocation (the sonar that dolphins use to locate and identify living and nonliving objects). DAT facilities typically charge visitors exorbitant fees for “treatments” that can last anywhere from one session to several sessions over a week, and no professional accreditation is required.
DAT’s popularity notwithstanding, several methodological reviews of published studies have revealed that there is no credible scientific evidence for its long-term effectiveness for autism spectrum disorder or any other condition (Humphries 2003; Marino and Lilienfeld 1998; Marino and Lilienfeld 2007a; Marino and Lilienfeld 2007b). Virtually all published studies alleging the effectiveness of DAT are seriously methodologically flawed and lack both internal validity (experimental rigor) and external validity (generalizability). For example, few if any studies adequately account for the nonspecific effects of hope and support from mental health professionals, so any apparent benefits of DAT may merely be due to what psychologists term a placebo effect—improvement resulting from the mere expectation of improvement. In addition, there is no compelling evidence that the seeming effects of DAT reflect anything more than the short-term boost in mood resulting from interacting with a highly charismatic and intelligent animal. In short, there remains no credible peer-reviewed evidence that DAT is scientifically legitimate.
Most DAT facilities rely largely or entirely on testimonials from customers to tout their business. Nevertheless, testimonial evidence alone is insufficient to conclude that a treatment works. For example, customers who have something positive to say are often unrepresentative of all customers. Moreover, parents may notice naturally occurring improvements in their children’s behavior and mistakenly attribute them to DAT.
Aside from being scientifically unsupported, DAT is ethically problematic for several other reasons. First, DAT centers inform vulnerable and at times even desperate individuals that an unsupported technique is highly effective. Moreover, some children and adults have been injured, in a few cases seriously, while swimming with captive dolphins. In addition, the dolphins used in DAT facilities are forced to participate in these activities in confined, often unhealthy, settings. Therefore, DAT is a physically risky, expensive, and ethically problematic intervention that is premised on unsubstantiated scientific assertions.
Inattention and Hyperactivity: Does Brain Balancing Improve Attention?
Some treatment providers for attention-deficit/hyperactivity disorder (ADHD) claim the root cause of ADHD is diminished right-hemisphere brain function, which is fixed by their “sensory-motor” exercises. Unfortunately, this account of ADHD is a gross oversimplification. No honest expert knows what the correct or equal balance between the brain hemispheres ought to be, especially because the relative involvement of each hemisphere will vary according to task demands. While it is true that many studies point to abnormal lateralization of function in ADHD—unusual activation of one hemisphere or the other, compared with controls—findings in this area are incredibly messy, and there is certainly no consensus that these activation patterns represent the root cause of the condition.
For instance, while there is some evidence for reduced right-hemisphere function in people with ADHD compared to controls, other studies have actually documented enhanced right-hemisphere function (Hale et al. 2005). Another study found enhanced transfer of information across the hemispheres in teens with ADHD, contradicting the central “brain balancing” idea that ADHD is caused by disconnection between the hemispheres (Brown and Vickers 2004).
Despite claims of ground-breaking research to support the brain balancing approach, only one published pilot study (Leisman et al. 2013) supports the use of brain balancing exercises for the treatment of ADHD, and it lacked any control group (Leisman et al. 2010). Curiously, what appear to be the exact same participants and data return in a second paper presented as new research three years later, now with a control group bolted on. There was obviously no randomization to this control group, and they engaged in no comparison treatment. What’s more, the children who completed the brain balancing exercises and the controls were all taking stimulant medication during the study. In short, there are not any well-done studies to show that “brain balancing” improves attention.
Learning: Should Children Be Taught Based on Their Preferred Learning Style?
Every first-time parent is surprised at how quickly their child’s character appears: whether they’re spirited or compliant, shy or outgoing, every child is unique. And the emphasis on developmental milestones online and in the pediatrician’s office has parents and teachers mentally checking boxes every month and comparing their children’s behavior and abilities with his or her peers. Well-meaning parents and teachers often reinforce activities in which the child shows precociousness while limiting time in tasks that expose weaknesses—exactly the opposite of what is needed. Research has shown that conditions that make learning seem more difficult are actually more effective for long-term retention (Bjork 1994). For example, spending an hour a day over the course of several weeks reviewing material for an exam is a better way of ensuring you’ll remember it a year later than waiting until the night before and cramming for eight hours. Distributing versus massing practice is just one “desirable difficulty” that slows down the rate of learning in the short term but provides long-term benefits. Even though it feels harder, it ultimately leads to better learning outcomes, if the goal is to retain information for the long term. What’s more, when tasks feel easy, we intuitively believe that we are learning. But while we make large gains in learning a new skill at first, with repeated practice, we experience diminishing returns (Heathcote et al. 2000). Once it feels easy, we’ve stopped learning. By the same token, teaching students using a variety of styles is much more effective than sticking to one mode of instruction. Students might differ in their preferences, or in what feels easy to them, but the evidence shows that teaching students only in their preferred learning style is not effective (Pashler et al. 2008). Different material might benefit from different modalities, but students should be exposed to a diverse array of teaching styles, and those that feel most difficult might end up yielding the best results.
Tics: Can a Dental Device Decrease Tics?
Grant Ritchey and Clay Jones
Whenever gaps in the scientific understanding of a challenging medical condition exist, you can be confident that there will be a long line of people attempting to fill those gaps with unscientific diagnostic and treatment recommendations. Tic disorders, in particular Tourette’s syndrome, are no exception to this rule. In fact, because of its unique and fascinating clinical presentation, patients with Tourette’s are especially vulnerable to all manner of blatant snake-oil salesmen and well-meaning believers in implausible and unsupported remedies.
One mode of unconventional therapy being marketed is the fabrication of a dental appliance to manage tics. The hypothesis behind this approach is that many of the habitual movements of people with Tourette’s are due to reflexive tics of muscles innervated by the trigeminal nerve, or Cranial Nerve V (which also innervates the mandible, or lower jaw). This observation is then extrapolated to infer that the symptoms of Tourette’s and other movement disorders are a function of an “overstimulation” of the neural impulses carried by the trigeminal nerve to the brain due to dysfunction within the temporomandibular (jaw) joint. Realigning the mandible, therefore, will ostensibly reduce this “neural noise,” resulting in a reduction or elimination of tics.
While this might have a small amount of biological plausibility, there is very little good research to support this approach. A handful of case reports can be found in the literature, but they demonstrate very little evidence. Tics are found in all muscle groups, not just those innervated by the trigeminal nerve. Moreover, it cannot explain the other features of Tourette’s not correlated with jaw position (e.g., brain chemistry changes, familial and genetic patterns).
More studies are needed, but as of now, this treatment cannot be recommended or endorsed. We go into greater detail on dental appliances and tics on the Science-Based Medicine blog (Ritchey and Jones 2016; Ritchey and Jones 2018).
Should Children Be Taught about Pseudoscience?
The importance of pseudoscience has fallen between the cracks for many educators in American schools. If more teachers incorporated critical thinking about pseudoscience into lectures and discussions, students would be able to better prepare themselves for a future of differentiating what is truth and what is fiction. In his address to congressional representatives about quackery, James Randi (1999) explained, “A properly educated and informed public would know about this, and protective laws would not be required. Again, education is the key.” In this quote from his speech, Randi was speaking about how the government needs to intervene on pseudoscientific practices plaguing the United States. More education about pseudoscience would help people be able to defend themselves from misinformation.
To fully educate the American people, the schooling system is one critical place students can learn about skepticism at an early age so they can continue to use critical thinking throughout adulthood. What people learn at an early age can shape what one believes as an adult. The main takeaway is that what youth learn matters, and everyone deserves the opportunity to be taught critical thinking about pseudoscience at school. For more about teaching skepticism to youth, see Lilienfeld (2017).
The authors are listed in the order that their work appears in the book. Authors were only involved in their own entries and were not involved in writing or editing the other sidebars.
- Barrett, S. 2012. Why cranial therapy is silly. Available online at https://www.quackwatch.org/01QuackeryRelatedTopics/cranial.html.
- Bjork, R.A. 1994. Memory and metamemory considerations in the training of human beings. In J. Metcalfe and A. Shimamura (eds.), Metacognition: Knowing about Knowing. Cambridge, MA: MIT Press, 185–205.
- Brown, L.N., and J.N. Vickers. 2004. Temporal judgments, hemispheric equivalence, and interhemispheric transfer in adolescents with attention deficit hyperactivity disorder. Experimental Brain Research 154(1): 76–84.
- Hale, T.S., J.T. McCracken, J.J. McGough, et al. 2005. Impaired linguistic processing and atypical brain laterality in adults with ADHD. Clinical Neuroscience Research 5(5–6): 255–263.
- Hanten, W.P., D.D. Dawson, M. Iwata, et al. 1998. Craniosacral rhythm: Reliability and relationships with cardiac and respiratory rates. Journal of Orthopaedic & Sports Physical Therapy 27: 213–218.
- Hartman, S.E., and J.M. Norton. 2002. Craniosacral therapy is not medicine. Physical Therapy 82: 1146–1147.
- Heathcote, A., S. Brown, and D.J.K. Mewhort. 2000. The power law repealed: The case for an exponential law of practice. Psychonomic Bulletin & Review 7(2): 185–207.
- Humphries, T.L. 2003. Effectiveness of dolphin-assisted therapy as a behavioral intervention for young children with disabilities. Bridges: Practice-Based Research Synthesis 1: 1–19.
- Leisman, G., R. Melillo, S. Thum, et al. 2010. The effect of hemisphere specific remediation strategies on the academic performance outcome of children with ADD/ADHD. International Journal of Adolescent Medicine and Health 22(2): 275–284.
- Leisman, G., R.Z. Mualem, and C. Machado. 2013. The integration of the neurosciences, child public health, and education practice: Hemisphere-specific remediation strategies as a discipline partnered rehabilitation tool in ADD/ADHD. Frontiers in Public Health 1: 22.
- Lilienfeld, S.O. 2017. Teaching skepticism: How early can we begin? Skeptical Inquirer 41(5): 30–31.
- Marino, L., and S.O. Lilienfeld. 1998. Dolphin-assisted therapy: Flawed data, flawed conclusions. Anthrozoos 11: 194–199.
- ———. 2007a. Dolphin assisted therapy: More flawed data, more flawed conclusions. Anthrozoos 20: 239–269.
- ———. 2007b. Dolphin assisted therapy for autism and other developmental disorders: A dangerous fad. Psychology in Intellectual and Developmental Disabilities (Division 33), American Psychological Association 33(2): 2–3.
- Pashler, H., M. McDaniel, D. Rohrer, et al. 2008. Learning styles: Concepts and evidence. Psychological Science in the Public Interest 9(3): 105–119.
- Randi, J. 1999. James Randi on quackery and the need for science education. Available online at www.skeptic.com.
- Ritchey, G., and C. Jones. 2016. Use of dental appliances in the management of Tourette syndrome. Available online at https://sciencebasedmedicine.org.
- ———. 2018. Tic’d off. Available online at https://sciencebasedmedicine.org.
- Rogers, J.S., P.L. Witt, M.T. Gross, et al. 1998. Simultaneous palpation of the craniosacral rate at the head and feet: Intrarater and interrater reliability and rate comparisons. Physical Therapy 78: 1175–1185.
- Shapiro, B.K., and M.L. Batshaw. 2011. Intellectual Disability. Nelson Textbook of Pediatrics, 19th ed. Philadelphia, PA: Saunders Elsevier, 216–222.
- Wirth-Pattullo, V., and K.W. Hayes. 1994. Interrater reliability of craniosacral rate measurements and their relationship with subjects’ and examiners’ heart and respiratory rate measurements. Physical Therapy 74: 908–916.