This PDF from Discover Chiropractic is headed “Chiropractic and Autism: Studies Give Hope”.
The evidence on Pubmed
Having read the headline, I searched for autism and chiropractic on Pubmed. Here’s what Pubmed says:
No items found.
You get the same result if you search for autism and spinal manipulation.
Discover Chiropractic’s Evidence
I thought I’d take a look at what the papers cited by Discover Chiropractic actually said. The second paper is this one: link to abstract [saved as PDF here]. The first paper cited (published in Clinical Chiropractic) costs $31.50 to purchase and the abstract has scant detail:
This article describes the diagnostic criteria, etiology, prevalence and optimal management strategies available for children with autism, based on a review of the literature.
It is not clear from the abstract whether the review of the literature was systematic. I would guess that this paper is more likely to be a comment piece on autism in children rather than a systematic review of the literature on chiropractic and autism.
Onto paper number two. The Journal of Vertebral Subluxation Research (JVSR) paper referred to a small study, with just 14 participants.
Of these 14, seven subjects were allocated to a chiropractic group receiving “full spine adjustment” and the remaining seven were allocated to a chiropractic group receiving “Atlas Orthogonal upper cervical adjustment”. So the two groups were both “chiropractic treatment” of one sort or another, and there was no placebo arm in this study.
It is unclear why the authors compare two forms of chiropractic treatment rather than comparing one or more forms of chiropractic with a sham procedure.
To evaluate the clinical effects, the authors used ATEC (Autism Treatment Evaluation Checklist). This is a one-page form consisting of 4 subtests: “The ATEC is designed to assist parents, physicians and researchers to evaluate various treatments for autism.”
Digression: the checklist was apparently developed by Bernard Rimland, who was “the founder of the Autism Research Institute, which now promotes chelation and unproven nutritional therapies for autism, and supports Dr Andrew Wakefield”. Rimland was apparently a “high-profile supporter of the discredited idea that the mercury preservative thimerosal in vaccines caused autism”. [I quote from a piece by Dr Aust that refers to Rimland having authored papers in the Journal of Orthomolecular Medicine. We will return to CAM journals later.]
I cannot tell from the abstract what the authors’ hypothesis was. This page on “how to write a research paper” seems to be quite clear on this point:
Summarize the study, including the following elements in any abstract. Try to keep the first two items to no more than one sentence each.
- Purpose of the study – hypothesis, overall question, objective
- Model organism or system and brief description of the experiment
- Results, including specific data – if the results are quantitative in nature, report quantitative data; results of any statistical analysis shoud be reported
- Important conclusions or questions that follow from the experiment(s) [My emphasis.]
See also page two of Trish Greenhalgh’s How To Read A Paper, which states that:
Unless it has already been covered in the introduction, the hypothesis which the authors have decided to test should be clearly stated in the methods section of the paper. [My emphasis]
We are told that the authors compared two forms of chiropractic and evaluated children using ATEC, but we are not told what the authors expected to find.
We see percentages for improvement on ATEC scores in the two groups, and are told that there are five of seven children in the full spine adjustment group who improve and six of seven in the upper-cervical group who improve.
We are not told whether such improvements are typical in children with autism over the period of time that covered the trial. There is no information on how likely it is that these results would be seen purely by chance. As we are looking at developmental delay, we might expect to see improvement with or without treatment.
The authors conclude that “In this study, the clinical outcome of chiropractic care showed higher efficacy with upper cervical adjustment when compared to full spine adjustment in autistic children. Further studies are recommended.”
All they have shown is that when you compare chiropractic treatments in two groups, one group seems to improve more than another. We don’t know from this study whether chiropractic is effective, as we do not know how a control group might have fared.
Further studies are recommended by the authors. I have one or two ideas as to the nature of further studies.
Perhaps there should be some consideration of comparison of chiropractic spinal manipulation therapy and sham SMT. A larger number of subjects might participate in future trials – certainly more than fourteen, one would hope.
Hopefully, the authors will include a hypothesis when writing their abstract.
Comment from the authors on the reliability and validity of ATEC would also be welcome. As would discussion of the random assignment of subjects – i.e. how subjects were allocated.
A note on Alt Med Journals
I am far from the first commenter to pick up on problems with alternative journals. AP Gaylard highlighted some suggestions made by R Barker Bausell in his book “Snake Oil Science – The Truth About Complementary and Alternative Medicine“. One of these recommendations was to:
Give more credence to trials published in well known medical journal and give no credence at all to those published in CAM journals.
Dr Aust has also been quite outspoken on the trouble with CAM journals: here, and in a follow-up post. The follow-up post contains a summary of what Dr Aust perceives as being the modus operandi of the alternative journals.
I am wary of papers published in alternative journals and on one occasion found that a paper cited by the author of an article in an alternative journal was actually misrepresented by the author.
The article was published in Alt Med Review (Alternative Medicine Review) and the title was “Hot Flashes – A Review of the Literature on Alternative and Complementary Treatment Approaches”. The paper that was misrepresented was looking at evening primrose oil versus placebo for treatment of hot flashes, and was authored by R Chenoy et al.
There is an erratum for the paper published in JVSR:
The original publication of this paper was from a draft that contained errors in described data. This was corrected and the revised version published. Please refer to the Letters to the Editor related to this paper for more detail.
Discover Chiropractic is also the name of a website run by sceptic blogger Zeno. This website should not be confused with the Discover Chiropractic who issue newsletters claiming that chiropractic may give hope to children with autism and their families.