Special Education Perspectives, Volume 13, Number 1, pp. 66-74, 2004
A TEACHER'S GUIDE TO
CONTROVERSIAL PRACTICES
Jennifer Stephenson
University of Technology, Sydney
ABSTRACT
Correspondence: Dr Jennifer Stephenson, Faculty of Education, University of Technology, Sydney, PO Box
222, Lindfi eld, NSW, 2070. Ph: (02) 9514 5354. Email: Jennifer.Stephenson@uts.edu.au
Information promoting controversial and
unsupported interventions and therapies for
students with special education needs seems
to abound on the Internet. However, there
are many sites that appear to offer a more
balanced, evidence-based assessment of the
effi cacy of interventions and treatments. This
article provides a guide to such sites in regard
to a number of controversial treatments in order
to assist teachers and families make informed
decisions about the practices they adopt.
Any teacher in search of information about
teaching students with special education needs
who visits the Internet will immediately be
confronted with a plethora of programs and
therapies that are claimed to be effective.
Similarly, families of these students, who are
searching for help with the education and
treatment of their child, are likely to locate the
same range of programs and therapies. Families
may then approach teachers and schools and
request that particular strategies be used with
their child. How do teachers and families make
informed decisions about which practices to
pursue and which to ignore?
The use of ineffective
therapies may not only cause harm, but may mean
that children do not receive interventions that are
known to be effective. This article will review
some of the controversial practices advocated
on Internet sites (and elsewhere), and provide
Internet sites that publish more sober advice on
these practices.
Several authors (Herbert, Sharp, & Gaudino,
2002; McWilliam, 1999; Park, 2003;
Scheuermann & Evans, 1997; Simpson, 1995;
Worrall, 1990), concerned with the uptake and
use of interventions and therapies that may be
regarded as frauds or fads, have developed a set
of indicators that may serve as warning signs that
a practice has not been shown to be effective:
• The practice is supported by anecdotes and
testimonies, not by the results of scientifi c
studies reported in refereed journals.
• The practice is reported directly to the mass
media and does not appear in professional,
refereed journals.
• The treatment recommended does not have
a logical connection to the presumed cause
of the diffi culty.
• The practice is not supported by established,
related bodies of knowledge.
• Proponents claim they are conspired against
by the “establishment”.
• Proponents make exaggerated claims
about effectiveness and may claim to cure
a condition.
• Proponents may have a fi nancial stake in the
treatment.
• Those completing the assessment to
determine if the treatment is suitable, are
the same people who will gain fi nancially
by selling the treatment.
• Practice can only be implemented by
specially trained people.
• May require the interventionist to have
“faith” in the treatment.
• Proponents claim the practice cannot
be properly evaluated using scientific
methods.
• Marketing is based on strong emotional
appeals.
• The practice should be used exclusively.
• The treatment is very intense.
• Legal action has been taken over the
treatment.
There are several useful Internet sites that guide
you through a set of questions, which should
reveal if any of these warning signs apply to the
therapy in question. These include the Autism
Association of South Australia (2003) and
Vanderbilt Children’s Hospital (2003).
Writers who have used these criteria have
identified a number of educational and
therapeutic practices as controversial and
unsupported by scientific research. The
following list is drawn from a number of refereed
publications: conductive education, facilitated
communication, sensory integration, Doman-
Delacato patterning, auditory integration
therapies, Irlen lenses and coloured overlays,
and multisensory environments (MSEs) or
snoezelen approaches (Arendt, MacLean, &
Baumeister 1988; Dawson & Watling, 2000;
Herbart et al., 2002; Hogg, Cavet, Lambe, &
Smeddle, 2001; Jacobson, Mulick, & Schwatz,
1995; McWilliam, 1999; New York State Health
Department, 1999; Shaw, 2002; Simpson,
1995; Stephenson, 2002; Worrall, 2001).
Thisknowledge base contained in the research
literature is, however, largely inaccessible to
families and practitioners who may have neither
the skills nor the time and interest to search,
read and understand this literature.
Fortunately however, just as the Internet has brought
increased access to information promoting
controversial and unproved practices, it has also
provided access to more balanced evaluations of
these practices. The next section of this paper will
briefl y review some controversial therapies and
include sources such as position papers, policies
and fact sheets from professional organisations,
special interest organisations and individuals
that are readily available on the Internet. The
URLs are provided in the reference list.
Auditory Integration Therapies (AIT)
This label covers strategies such as the Berard
method, Samonas Sound Therapy, and the
Tomatis method. The American Academy
of Paediatrics Committee on Children with
Disabilities (1998, Recommendations, para.
12) reviewed auditory integration training as a
therapy for children with autism and concluded
that although AIT “may help some children
with autism, as yet there are no good controlled
studies to support its use.”
More recently, The American Speech-Language Hearing
Association (2004) produced both a technical
report and a position paper which found that
Auditory Integration training is “experimental
in nature and has not yet met scientifi c standards
as a mainstream treatment” (p.1). The American
Academy of Audiology (n.d.) position statement
on Auditory Integration Training states that
the technique should be regarded as “purely
investigational” because of the lack of published
research showing its effectiveness, and that
consumers should understand this before they
begin treatment.
The Educational Audiology Association (n.d.)
supports the position taken
by the American Academy of Audiology and
the American Speech-Language-Hearing
Association that “Auditory Integration Therapy
has not been proven to be a viable treatment for
any disability”.
Vision therapies
These include the use of eye exercises, fi lters,
and coloured lenses which purport to improve
a child’s reading. The American Academy
of Paediatrics, the American Association for
Pediatric Ophthalmology and Strabismus and
the American Academy of Ophthalmology
(1998) produced a joint policy statement on
these approaches in relation to students with
learning disabilities, especially those who have
diffi culty learning to read. The policy states,
“Visual problems are rarely responsible for
learning difficulties. No scientific evidence
exists for the effi cacy of eye exercises (“vision
therapy”), or the use of special tinted lenses in
the remediation of these complex paediatric
neurologic conditions” (Policy, para. 2). They
note that studies of these practices, which
claim improvements, have usually included
educational remedial techniques, and these
most likely explain reported benefi ts. The use of
tinted lenses for reading diffi culties purportedly
caused by Scotopic Sensitivity Syndrome named
by Irlen (American Optometric Association,
2003) has been assessed by the American
Optometric Association (2003) who found
that “there is currently no scientifi c research
to support the ‘scotopic sensitivity’ syndrome
hypothesis”, and that the use of coloured lenses
requires further investigation.
Sensory Integration Therapy
Sensory Integration Therapy (SIT) was
developed by Jean Ayres in the 60s and 70s,
with the aim of improving the way “the brain
processes and organises sensations” (Ayres,
1979 cited in Arendt et al., 1988, p.402.). The
therapy involves providing sensory stimulation
in various ways, such as by providing deep
pressure sensations, vestibular stimulation,
having students wear weighted vests, and/or
use scooter boards (Arendt et al., 1988; Shaw,
2002). Arendt et al. (1988) reviewed its use
with people with intellectual disability and
concluded “until the therapeutic effectiveness
of sensory integration therapy with mentally
retarded persons is demonstrated, there exists
no convincing empirical or theoretical support
for the continued use of this therapy with that
population outside of a research context” (p.
409). Hoehn and Baumeister (1994) critiqued
the theory and practice of SIT with children with
learning disabilities and supported the fi ndings
of Arendt et al. (1988), concluding (p.348) that
“the current fund of research findings may
well be suffi cient to declare SI therapy not
only merely an unproven, but a demonstrably
ineffective, primary or adjunctive remedial
treatment for learning disabilities and other
disorders.” More recent reviews continue to
support this conclusion.
Pollock (2000) concluded that its use is contentious,
and Shaw (2002) concluded that there is no evidence of its
effectiveness with students with autism, learning
diffi culties or other developmental disabilities.
In a response to Shaw’s critique, Miller (2003),
although supporting sensory integration therapy
within a broader framework of occupational
therapy, conceded that the approach remains
unproven from a scientifi c perspective.
Doman-Delacato Patterning Treatment
This technique involves a demanding regimen
of daily exercises (often carried out with a
team of volunteers) that is claimed to improve
neurological organisation. The Institutes for the
Achievement of Human Potential who offer the
program state because of the intensive nature
of the program “there is no time for the child
to engage in other programs or school while
enrolled in the Intensive Treatment Program”
(Brain Injury and Early Childhood Education
Resources: IAHP, n.d., Content, para. 8).
Cummins (1988) offers a review and critique
of this treatment. More recently, the American
Academy of Pediatrics Committee on Children
with Disabilities (1999) has issued a position
paper that concluded that the efficacy is
unproven and the demands on families may be
harmful. This position paper was endorsed by the
National Down Syndrome Congress (n.d.).
Facilitated Communication (FC)
FC is a method whereby a person is assisted
to type or to use a communication device by
a facilitator who may provide full support to
the hand, wrist or arm, or who may provide
emotional support. It has been shown that for the
vast majority of users with autism or intellectual
disability, the content of the communication
comes from the facilitator (Jacobson et
al., 1995). The American Speech-Hearing
Association (1994) has produced a lengthy and
thorough review that concluded that “neither
the reliability nor the validity of techniques
associated with facilitated communication
have been demonstrated satisfactorily at this
time” (p. 127). This position is supported by the
American Psychological Association (1994) and
the American Academy of Child and Adolescent
Psychiatry (1997).
Conductive Education (CE)
CE aims to teach children with cerebral palsy or
other movement disorders to achieve personal
goals, increase their independence and exercise
choice (Ludwig, Leggett, & Harstall, 2000).
Ludwig et al. (2000) carried out a comprehensive
review and concluded that the effectiveness of
CE is not established for children with cerebral
palsy. They note that there are many local
adaptations of conductive education, which
have moved away from the full-time, intensive
residential approach originally developed in
Hungary, and that these adapted approaches
also need rigorous evaluation. United Cerebral
Palsy National (1995, 1997), in two fact sheets,
similarly call for more research to demonstrate
the superior effi cacy of conductive education
over more traditional approaches.
Multisensory Environments (MSEs) or
Snoezelen
These approaches were originally designed
as a leisure option for people with severe and
multiple disabilities. Current proponents have
gone beyond their use as a potentially enjoyable
leisure option, and make a wide range of claims
for the benefits of sensory stimulation as
delivered by these environments (Stephenson,
2002). Unfortunately, review articles, or
materials based on them, which suggest these
claims are unfounded, have yet to reach Internet
sites. However, two review articles (Hogg et al.,
2001 and Stephenson, 2002) which, between
them, located only fi ve studies on children with
intellectual disabilities and none on children
with autism, suggest that the use of MSEs to
achieve educational or therapeutic goals with
school aged children is currently without a fi rm
research base.
With the increasing demand for evidence based
practices in medicine and in the therapies allied
with special education, practitioners have a
responsibility to make careful decisions about
the interventions they use or endorse (Bennett
& Bennett, 2000). The URLs provided above
are easily accessible and provide information
that assists balanced decision making. In
addition to these sites, there are other sites
that provide more general advice or lead into
more specifi c sites. A very useful bibliography
of controversial practices that includes both
published and Internet sources is available from
Lakehead University (n.d.). A more general site,
which also contains user-friendly information,
along with references to the professional
literature, is Stephen Barrett’s Quackwatch
site that is directed at quackery in general, but
includes information of relevance to therapists and
educators. The National Council Against Health
Fraud has a newsletter, which is available online
and which provides brief articles on relevant topics
such as quackery in autism treatments (2001).
It is fair to acknowledge, of course, that
any intervention starts as an unsubstantiated
treatment before it is researched and its effi cacy
tested. It is also true that even a strategy with a
fi rm research base may not work for all students
in all contexts. This is one of the reasons why
accepted best practice in special education
involves the setting of clear outcomes and careful
monitoring of student responses to interventions
(Westling & Fox, 2000). The advice provided by
Pollock (2000) in relation to sensory integration
provides sensible guidelines for those wishing
to trial unsupported therapies. She suggests that
“clear, measurable, functional outcomes should
be established”, and then the treatment should be
assessed against those outcomes after an eight
to ten week trial. Similar guidance is provided
by the American Speech-Language Association
(1994) in relation to facilitated communication,
and they also suggest informed consent should
be obtained before implementing unsupported
practices.
Teachers have a responsibility to select
interventions that are likely to be effective,
and to monitor the impact of the interventions
they do select to ensure that their students are
learning. This is especially so for children with
special education needs who, because they have
diffi culty learning, have less time to be wasted
on poor interventions. Teachers can make better
decisions if they are fully informed about the
nature of the interventions they choose. They
can also help families make fully informed
decisions if they are aware of easily accessible
information based on sound research. This
article has attempted to provide a brief overview
of more common controversial therapies, and
inform readers about accessible Internet sites
that counteract the claims made by promotional
Internet sites.
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