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The Persistence of Fad Interventions in the Face of Negative Scientific Evidence: Facilitated Communication for Autism As a Case Example

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The Persistence of Fad Interventions in the Face of Negative Scientific Evidence: Facilitated Communication for Autism As a Case Example Evidence-Based Communication Assessment and Intervention ISSN: 1748-9539 (Print) 1748-9547 (Online) Journal homepage: http://www.tandfonline.com/loi/tebc20 The persistence of fad interventions in the face of negative scientific evidence: Facilitated communication for autism as a case example Scott O. Lilienfeld, Julia Marshall, James T. Todd & Howard C. Shane To cite this article: Scott O. Lilienfeld, Julia Marshall, James T. Todd & Howard C. Shane (2014) The persistence of fad interventions in the face of negative scientific evidence: Facilitated communication for autism as a case example, Evidence-Based Communication Assessment and Intervention, 8:2, 62-101, DOI: 10.1080/17489539.2014.976332 To link to this article: http://dx.doi.org/10.1080/17489539.2014.976332 Published online: 02 Feb 2015. Submit your article to this journal Article views: 5252 View related articles View Crossmark data Citing articles: 1 View citing articles Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=tebc20 Download by: [University of Lethbridge] Date: 05 October 2015, At: 05:52 Evidence-Based Communication Assessment and Intervention, 2014 Vol. 8, No. 2, 62–101, http://dx.doi.org/10.1080/17489539.2014.976332 EBP Advancement Corner The persistence of fad interventions in the face of negative scientific evidence: Facilitated communication for autism as a case example Scott O. Lilienfeld1, Julia Marshall1, James T. Todd2 & Howard C. Shane3 1Department of Psychology, Emory University, Atlanta, GA, USA, 2Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA, 3Boston Children’s Hospital, Boston, MA, USA ................................................................................................................................................. Abstract Communication disorder and mental health professionals may assume that once novel clinical techniques have been refuted by research, they will be promptly abandoned. Using facilitated communication (FC) for autism as a recent case example, we provide evidence to the contrary. Although FC was scientifically dis- credited by the mid-to-late 1990s, data we review demonstrate that it is still frequently administered in clini- cal and educational settings. We examine evidence for FC’s (a) continued use as an intervention for autism, (b) persistence in academic and institutional settings, (c) popularity in online and print sources, (d) promotion in the media, and (e) ongoing risk to caregivers accused of sexual abuse. We analyze the sources of these troubling developments, explore their ethical implications, and offer recommendations for addressing the spread of FC and other fad interventions. Keywords: Fads; Autism; Autism spectrum disorder; Developmental disabilities; Facilitated communi- cation; Treatment; Science–practice gap. INTRODUCTION a trend that has received scant attention— namely, the propensity of certain interven- The past is never dead. In fact, it’s not tions to endure in the practice community even past (Faulkner, 1950). well after researchers have discredited them (see also Kurzban, 2011, on “zombie As Santayana wrote, those who forget the psychology,” or erroneous ideas about the past are doomed to repeat it (see Thomas, mind that will not disappear). In this arti- 2007). The legacies of pseudoscientific and cle, we examine a recent example of this otherwise unsupported practices in com- phenomenon with an eye to better under- munication disorders, psychology, and standing its sources: the persistence and likely resurgence of facilitated communica- Downloaded by [University of Lethbridge] at 05:52 05 October 2015 allied disciplines impart a sobering lesson: Ineffective techniques may persist long tion (FC) for individuals with autism 1 after they have been debunked. Tradition- spectrum disorder (ASD) and other ally, fads are defined as short-lived fash- developmental disabilities. ions that disappear about as abruptly as they emerged (Best, 2006; Paris, 2013; 1 Vyse, 2005). Nevertheless, the fields of The formal term for autism in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition communication disorders, as well as clini- (DSM–5; American Psychiatric Association, cal, counseling, school, and educational 2013) is now autism spectrum disorder. Never- psychology, have often been bedeviled by theless, because most of the literature on FC antedated DSM–5, we use the terms “autism” For correspondence: Scott O. Lilienfeld. E-mail: and “autism spectrum disorder” interchangeably [email protected] in this manuscript. © 2015 Taylor & Francis This article was originally published with errors. This version has been amended. Please see Corrigendum (http://dx.doi.org/ 10.1080/17489539.2014.1026026). EBP ADVANCEMENT CORNER: PERSISTENCE OF FAD INTERVENTIONS 63 Many communication disorders and other being scientific consensus regarding mental health professionals are probably a technique’s ineffectiveness. Indeed, in aware that in the early 1990s, FC became attempting to explain why secretin and immensely popular in educational and vision therapy, two interventions once clinical circles as a means of establishing widely embraced for the treatment of aut- expressive communication among non- ism, had declined markedly in popularity, speaking individuals with autism and other Huang, Seshadri, Matthews, and Ostfeld disorders (Green, 1994; Green & Shane, (2013) conjectured that “these interven- 1994). They probably also know that by tions have been formally studied and the mid- to late-1990s, FC had been con- found to be ineffective” (p. 750). In an vincingly refuted by controlled research overarching analysis, Overholser (2014) and overwhelmingly rejected by the scien- proposed the “modal life cycle” of psycho- tific community (Jacobson, Foxx, & logical fads. According to Overholser, Mulick, 2005; Jacobson, Mulick, & toward the end of this life cycle: Schwartz, 1995; Mostert, 2001, 2010; Probst, 2005; Shane & Kearns, 1994). The fad is evaluated in a more objective Professionals in the fields of communica- manner (Carson et al., 1999). A state of disenchantment ensues. Results tend to tions disorders and mental health may reveal the true mediocre effectiveness and therefore be surprised to learn that FC common limitations of the new approach. remains alive and well in much of the As evidence accumulates, the fad may be mainstream autism and developmental dis- dismissed and quietly discarded, as is the abilities community, and that it seems to fate of many fad innovations. Alterna- tively, some fad ideas (e.g., systematic be staging a broader comeback (Hagen, desensitization, dialectical behavior ther- 2012; Heinzen, Lilienfeld, & Nolan, apy) are found to be effective and they in press; Travers, Tincani, & Lang, in become integrated within modern press). In this article, we examine evidence accepted practices. (p. 53) for the surprising persistence of FC and explore the implications of this phenome- Overholser’s description implies the exis- non for communication disorders, psychol- tence of two principal routes for fad inter- ogy, psychiatry, and allied fields. Before ventions: Such techniques are either (a) doing so, however, we place FC within the scientifically discredited and then promptly broader context of fads in mental health. jettisoned (e.g., Huang et al., 2013)or(b) corroborated by scientific research and then assimilated into the mainstream of Downloaded by [University of Lethbridge] at 05:52 05 October 2015 clinical practice. THE PSYCHOLOGY AND SOCIOLOGY OF FAD In contrast, we posit the existence of a TECHNIQUES third pathway, as exemplified by FC. In Researchers and practitioners may assume this alternative trajectory, the fad method that once a novel technique has been is refuted by scientific evidence. Or, closer demonstrated to be ineffective, it will be examination reveals that the technique rapidly abandoned by its proponents. For was devoid of scientific plausibility. Even example, Shorter (2013) pointed to “scien- so, the fad persists, and sometimes thrives, tific disproof”—that is, “demolishing a in “underground form” in sizeable sectors notion with scientific data” (p. 557)—as of the clinical or educational communities. one of two approaches to putting a halt to The fad may acquire a sufficient cachet of psychiatric and psychological fads, the respectability to be tolerated as a fringe 64 EBP ADVANCEMENT CORNER: PERSISTENCE OF FAD INTERVENTIONS activity within otherwise reputable profes- individuals (Loftus, 1993; McNally, 2003) sional groups and scholarly departments. and that genuine recovered memories Its popularity will often be sustained by unearthed in psychotherapy are exceed- the activities of members of tightly knit, ingly rare and perhaps nonexistent social-media-based support groups. Or, it (Geraerts et al., 2007). Nevertheless, recent may become normalized because the num- survey data point to a sizeable science– ber of researchers concerned about its practice gap in beliefs concerning recov- credibility is extremely low. Although ered memory techniques (Patihis, Ho, these conjectures are plausible, scant Tingen, Lilienfeld, & Loftus, 2014). For attention has been devoted to the theoreti- example, although only 16.1% of clinical cally and pragmatically important question psychology researchers agreed that of why certain fads collapse under their “repressed memories can be retrieved in own weight after being discredited, memory accurately,” this percentage was whereas others
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