Chapter 3: Controversial Therapies for

Children

Gerald P. KoocherMadeline McMann

Annika Stout

Controversial Treatment

To examine efficacy of treatments, should rely on criteria used as standards of evidence used for expert testimony in courts of law

Daubert: testing, peer review, error rates, acceptability in the relevant scientific community

Kumho: One could prove causality by the absence of significant findingsThese criteria have helped select controversial discredited treatments, still advocated by some practitioners

Controversial Therapies Covered

AromatherapyBoot-Camp/Disciplinary Boarding School

Interventions (e.g., Scared Straight)Drug Abuse Resistance Education (D.A.R.E.)“Energy” Psychology and Emotional Freedom

TechniqueRebirthingReparative or Sexual Preference Conversion

Therapies

Aromatherapy

Defined: treatment that relies on plant extracts to promote physiological and psychological healing

U.S. Department of Health and Human Services’ National Center for Complementary and Alternative Medicines (NCCAM) defines aromatherapy as a treatment: “in which the scent of essential oils from flowers, herbs,

and trees is inhaled to promote health and well-being” (NCCAM, 2012)

Aromatherapy

Some practitioners administer essential oil extracts topically or orally (Bradley et al., 2009)

Difficult to study due to lack of consensus on definition

Is practiced globally, particularly in Eastern medicine and traditional native culturesE.g., Amazon regions: linalool, a compound found in many oils,

is used to control epileptic seizures

Used more frequently in Western cultureE.g., Children with ADHD (Sinha & Efron, 2005)

Aromatherapy Findings

Results inconclusive

Some literature claims that aromatherapy can successfully treat: dementia, ADHD, ASD, schizophrenia, anxiety, depression, and sleep disorders

Some oils may be able to promote hippocampal neurogenesis (Perry & Perry, 2006)

Combination of aromatherapy and message helped to improve attention of preschool-aged children with ASD and severe learning deficits (Solomons, 2005)

Aromatherapy Findings

Can prove harmful

E.g., Bergamot (oil thought to reduce anxiety and nausea)Diffused bergamot for inhalation to pediatric patients

undergoing stem-cell infusion and their parents; results indicate that patient anxiety and nausea increased significantly (Ndao et al., 2012)

Most published research based on anecdotal evidence

Aromatherapy Risks

No consensus on safe dosages

Little research on essential oils and drug interactions

No governmental or regulatory organization ensures high quality of essential oils (e.g., like the FDA does for prescription drugs)

Inconsistency among researchers on what products to use, dosage, concentration, or delivery system

Boot-Camp Interventions and Disciplinary Boarding Schools

Often based in rural areas of the Western U.S. or abroad

Popular for children and adolescents with conduct disorder or oppositional defiant disorder

E.g., World Wide Association of Specialty Programs and Schools (WWASPS)Controversial organizationAt one time, had 25 “therapeutic” schoolsAbuse allegations and lawsuits filed by former students; deaths of

some WWASPS studentsLed to majority of school closings (Dober, 2011)

Efficacy of Boarding Schools

Most efficacious treatments include more effort and engagement by the parents than placing a child in a remote residential intervention

Strong positive relationship between parenting problems, childhood abuse, and conduct disorder (Fergusson et al., 2008)

Lilienfeld (2007): boot camps and Scared Straight programs have significant potential to cause harm to child/adolescent participantsNo empirical support for these programs; instead indicate that these

problems exacerbate painful emotions

Multifaceted treatments (e.g., multisystemic family therapy) much more effective (Weisz & Kazdin, 2010)

D.A.R.E.

Drug Abuse Resistance Education

Program aimed at preventing substance abuse among school-aged students by using police officers to educate them on the dangers of drugs and alcoholImplemented in 75% of U.S. schools (D.A.R.E. website, 2012)

No scientific evidence to support claim that it prevents or decreases subsequent alcohol and drug abuse

D.A.R.E.

Participation does not increase or decrease substance abuse (Thombs, 2000)

Community members report high levels of satisfaction (Thombs, 2000)

Several studies have shown no significant effects of D.A.R.E. on participants’ short-term or long-term substance use (e.g., Uiblel, 2010; Gorman & Huber, 2009)

Despite lack of evidence, three-quarters of a billion dollars of federal funds are spent on D.A.R.E. each year (West & O’Neal, 2004)

“Energy” Psychology and Emotional Freedom Technique

Emotional Freedom Technique (EFT)Ordained minister, Gary Craig, developed EFT in the mid-

1990s

Practitioners believe that an imbalance in the body’s energy system causes all negative emotionsTapping at particular points on the body alters brain activity to

produce calming effects (Feinstein, 2008)Practitioners believe that it can cure insomnia, anxiety, PTSD,

depression, grief, and ADHD

Is considered a brief treatment with results between 1 and 10 sessions (Wells et al., 2003; Church et al., 2012)

EFT

Founder Gary Craig indicates that treatment can be used with an individual of any age, including children and preverbal infants

Only anecdotal evidence, no studies found children

Some recognize EFT as a “probably efficacious treatment” for specific phobias Based on Wells et al. (2003): compared effectiveness of

EFT to diaphragmatic breathing in reducing phobia to small animals; EFT found more effective• Diaphragmatic breathing, however, also not considered an

empirically supported treatment

EFT: Possible Mechanisms

Descriptive or anecdotal research shows positive results but why it works remains unclear

Literature suggests that placebo effects, distraction from the issue at hand, imaginal exposure, or other cognitive processes may be responsible for the effectiveness of EFT

Rebirthing Therapy

Proponents argue that human birth is a traumatic event (Lieberman & Rank, 1993)Rebirthing breath work is thought to cure a variety of problems

that started with birth trauma

For children, primarily associated with treating attachment disorders and related behavioral issues (Hanson & Spratt, 2001)

Although most psychological professionals indicate that the technique is ineffective and potentially harmful, the therapy is still practiced by both licensed and unlicensed therapists

Rebirthing Techniques

Several different techniques appear in the literature

Most common version: “the child being held down by several adults, rolled up in blankets, and being instructed to fight his/her way free” (Chaffin et al., 2006)Techniques can be traced back to 1974 and to Leonard Orr,

who would submerge his friends in a hot tub with nose plugs until they “began to get in touch with certain of their own destructive behavioral patterns” (Singer & Lalich, 1996)

Harmfulness of Rebirthing

Substantial body of research demonstrating harmfulness (e.g., London, 2001; Chaffin et al., 2006)

Candace Newmaker: 10 years old, received rebirthing therapy

Diagnosis: reactive detachment disorderPreparation of rebirthing: had her head shaken, screamed at inches

from her face, face licked, forced to make eye contact, chunks of hair cutoff, forced to kick her legs to the point of exhaustion and to sit motionless (Sarner, 2001)

Wrapped tightly in blanket restrained by therapists for 90 minutesUnconscious following treatment, died the next day Colorado passed “Candace’s Law”: illegal for licensed

psychotherapist to practice rebirthing in Colorado

Reparative/Conversion Therapy

Reparative therapy: based on the assumption that homosexuality is a mental disorder or based upon the a priori assumption that a patient can change his/her sexual orientation (Samakow, 2012)

World Health Organization rejects reparative therapy“It is a serious threat to the health and well-being–even the

lives–of affected people” (O’Connor, 2012)

California legislation effective January 1, 2013, prohibits licensed psychotherapists from practicing reparative/conversion therapy with minors

Reparative Therapy

Includes variety of cognitive, behavioral, and spiritual tacticsMajority include significant aversive condition componentE.g., tying blocks of ice to male participant’s hands or heated

coals while simultaneously showing him pictures of men holding hands

Shidlo and Schroeder (2002): 3% of participants reported “successful heterosexual shift”; 88% remained homosexual Missing 9% successfully committed suicide or dropped out of

treatment 17% attempted suicide

Reparative Therapy: APA

American Psychological AssociationCode of ethics forbids psychologists from making false or

misleading statements about the scientific or clinical basis of their services

Some individuals may lead their clients to believe that homosexuality is a disease, although it has been long since removed as pathological by both psychology and psychiatry (Smith, 2012)

Patients presenting for treatment regarding sexual preference should be treated in a manner consistent with professional guidelines that do not stigmatize them for same-sex attraction

Selecting Ethical and Effective Treatment

Need sound evidentiary basis combined with individual, cultural, and family preferences that assure the most effective outcome

Professional ethics require practitioners to make truthful statements about the efficacy of treatments and demonstrate competence in treating these individuals

When individuals carry out unethical treatments, well-trained professionals have the ethical obligation to speak out to the public