Chiropractic “research” and autism

Chiropractic spinal adjustment

Leave it to my good buddy Mark Crislip over at the Society for Science-Based Medicine to have my back when I don’t have a lot of time for a detailed post. (Basically, I was being a good university and cancer center citizen last night, going out to dinner with a visiting professor, and I ended up staying out later than I thought. Fortunately, it was a bunch of people that I liked, and it was a very nice restaurant, which made being good enjoyable, particularly when we got to talk a lot of science.) He pointed me to an absolutely horrible study. The modality is perhaps not quite as bad as aversive therapy that I described a week ago, but for autistic children it’s still plenty bad, man. I’m referring to chiropractic for autism.

Yes, you read that right. Chiropractic for autism.

There’s a chiropractor in Fargo, ND named Scott Van Dam who posted an article Hope for Autism on his website, referencing a study on website Chiropractic Research, a site I hadn’t encountered before (I know, I know, it’s hard to believe) and appears to be—shall we say?—a “target-rich” environment to be bookmarked for the future. In any case, the study referenced is from 2006 appeared in the Journal of Vertebral Subluxation Research (JVSR.com, which now turns up an “domain available” placeholder, suggesting that the journal is as nonexistent as chiropractic subluxations, although there is now an Annals of Vertebral Subluxation Research, which is just as bad). That tells you all you should need to know about the journal right there. Of course, as I’ve pointed out, antivaccine views and chiropractic are two quacky tastes that taste quacky together; so, given how many antivaccine activists consider vaccines to be a cause or contributor to the “autism epidemic,” I suppose it shouldn’t be too surprising that chiropractors think they can treat autism by back cracking.

As Mark Crislip points out, the study itself is not exactly what we would call…methodologically sound, if you know what I mean. Of course, you might say, why would we expect it to be methodologically sound? After all, it’s chiropractors who think that they can treat autism by cracking autistic children’s back or necks. Even so, this study goes off the rails right from the very first paragraph:

Since the primary problem in autistic children is neurological, it is prudent to research the efficacy of chiropractic care in these children. Functional MRI in patients with autism showed significant differences from normal people in the activity of cerebellar mesolimbic and temporal lobe cortical regions of the brain when processing facial expressions. 1 These differences are most likely neurodevelopmental in origin. There are several different approaches for treatment of autistic children beyond the scope of this paper 2; some of these will be mentioned later. Diagnosis of this condition is based upon parent’s observations of specific behaviors, and an experienced team of clinicians. This team may include a neurologist, psychologist, pediatrician, speech/language therapist, learning consultant, and other professionals who are knowledgeable about autism.

Yes, because autism has something to do with the brain, then “adjusting” their spines will help the behavioral problems in autism! Basically, these chiropractors took 14 autistic children, administered the Autism Treatment Evaluation Checklist (ATEC) to them. They started chiropractic manipulation and had the parents do monthly ATEC scores on them. Well, actually, first they randomized the children into a group receiving the full spine treatment versus upper cervical adjustment for reasons every bit as fantastical as the rationale for chiropractic and this study itself because they wanted to find out the “recommended chiropractic technique in these cases of autism.” Note how they assume chiropractic will help. So there’s no control group, no blinding of any kind, and the treatment must have been at least somewhat traumatic because one parent dropped out because “the parent refused to continue to handle the difficulties of stabilizing her child during x-ray procedures.” Translation: Holding the kid down during procedures was too difficult for this parent. Indeed, as Mark noted, these children were stressed for no good reason:

  • “A few of the children displayed aggressive behavior such as pushing, falling, flaying arms in the air, and kicking.”
  • “X-ray examination proved to be the most difficult procedure for autistic children. There had to be another doctor, chiropractic assistant, or parent available to help with the process. In most instances, the presence of the parent was an important component to keep the child from moving. A few circumstances required that the patient’s head be stabilized with another’s hand.”
  • “Hypersensitivity to light and sound were also observed. Light from the collimator bulb either scared or fascinated the children. Sound from the adjustment instrument had the same effects.”

As for that third one, no wonder the autistic children were frightening::

The selected method for upper cervical adjustment used in this study was Atlas Orthogonal (AO). This technique utilizes pre-adjustment /post-adjustment supine comparative leg checks, spinal palpation and a percussion adjusting instrument.

And:

The percussion adjustment instrument is used in AO technique. The patient is placed on his side with head support at four inches below the mastoid. A metal stylus is placed between the mastoid and the ramus of the mandible. An adjustment, an impulse imparted to the stylus by a plunger that excites a compressional wave in the stylus, is then delivered to the patient. At the patient-stylus interface, a portion of the wave energy is transmitted to the patient and a portion is reflected back to the plunger.

That’s right. For the cervical group, these chiropractors were taking a plunger, sticking it between the mastoid process right near the ear and the back part of the mandible and hitting it to “impart energy,” all accompanied by unnecessary radiation exposure and trauma of being held down in order to obtain completely unnecessary X-rays of the cervical spine.

The results, as you might imagine, are meaningless. Both groups improved after three times a week chiropractic evaluation and adjustments, but because there was no control group and no blinding and the outcomes were so short term as to tell us very little this study is worthless to tell us anything. There are a bunch of cervical spine X-rays that purport to show elimination of “subluxations” but appear to show nothing of the sort.

One thing Mark Crislip wasn’t familiar with Bernard Rimland and the Autism Research Institute (ARI), the organization from which the ATEC sprang. (Hey, if I’m going to do a “me too” post, at least I have to add something different to it not covered by Mark.) According to the paper, one reason the ATEC was used (besides its not having been copyrighted) is because “It was designed by experts in biomedical research for the care of autistic children.” Well, not exactly.

Let’s just put it this way. The ARI is known for being antivaccine to the core and devoted to “autism biomed” quackery. In the past, it used to maintain a list of the quackiest of quack autism doctors, the “Defeat Autism Now!” (DAN!) doctors. Indeed, ARI even lent its signature to a petition supporting Andrew Wakefield. In addition, the ARI was one of the sponsors of Luc Montagnier’s highly dubious study looking at infectious causes of autism in which he proposed to treat autism with antibiotics, probiotics. It was also one of the financial supporters of Laura Hewitson’s horrible and unethical study examining thimerosal as a cause of autism in monkeys. Surprisingly, even though the source of the ATEC is font of quackery, it’s not a horribly unreasonable tool. It has, however, as far as I’ve been able to tell, largely been supplanted by newer, more well-validated tools.

In any case, this is chiropractic research. Mark Crislip was right to characterize it as “frightening autistic children” for no good purpose. It’s a study about as bad and unethical as can be imagined. I suppose I should be relieved that it didn’t combine other forms of “autism biomed” quackery with chiropractic, such as chelation therapy, to the back cracking of chiropractic. It makes me wonder what institutional review board (IRB) approved this study. Oh, wait. There’s nothing about IRB approval mentioned in the article. Never mind.