Friday, November 21, 2008

Is Our Field Guided by Science?

In my profession, I continually hear that we need to use evidence-based therapies when treating children with certain psychiatric conditions. I also hear my colleagues saying things like, "There is no evidence that dietary changes reduce the symptoms of ADHD. " It is a nice idea that we as professionals try to be guided by empirically validated interventions in our practice. But are we really guided by science? The answer is ,"yes" sometimes, and "no" many other times.

In many situations, we are not guided by science. In fact, professionals in the fields of child clinical psychology and child psychiatry often practice using a "trial and error" approach. This point is clearly portrayed in the recent article by Gardiner Harris in the NY Times, Use of Antipsychotics in Children is Criticized. Mr. Harris reports a finding from a panel of drug experts that a substantial number of children with ADHD are being prescribed a powerful antipsychotic medication (Risperdal). This drug has not been not approved for the treatment of ADHD by the Food and Drug Administration, the side effects can be quite negative, and the efficacy in the treatment of ADHD has not been established empirically. Judi Warner argues in her subsequent NY Times article, Tough Choices for Tough Children, that children with big problems are being given big, bad drugs because no one really knows what to do with them."

Parents need to realize that our field, including the fields of psychiatry and child clinical psychology, still is not an exact science. There are many times when we do not exactly know how to treat a particular condition and thus, we have to try many different strategies. Medication is often seen as one of the first things to try since we tend to perceive the field of medicine as scientific and all-knowing. But, our treatment strategies are often not well researched and thus, we have to keep trying things to see what works.

As noted in my book, Understanding Your Child's Puzzling Behavior: A Guide for Parents of Children with Behavioral, Social, and Learning Challenges, I firmly believe that parents can be active team members when they are confronted with a child demonstrating extremely significant emotional and behavioral challenges. These parents need to learn how to conduct initial assessments on their own, develop personal philosophies regarding what is happening with their child, and learn about the backgrounds of care providers to whom they turn for help. They also need to collaborate as much as possible with friends, natural caregivers in the child's life (e.g., teachers, family practice physicians), and with the specialists they turn to for help. A coordinated collaborative approach often works bests. Empirically supported interventions should be tried first, but when that fails, other alternative interventions should be tried as well. I encourage concerned parents to buy my book, download the worksheets from our website (, complete these worksheets and implement the expected and valuable insights obtained.