Monday, February 04, 2008

Clear conflict of interest in therapy evaluation!

After academic research in theoretical physics, I worked in risk management for an American investment bank. Core principles of any good risk management is independence of the evaluator and avoidance of conflict of interests. Virtually all outcome studies violate these principles. The studies are done by the therapists themselves, which is a very clear conflict of interest. The therapists have a great interest in getting good results, and are not focused on finding loopholes as independent evaluators would do. I have never heard of any therapists that published a study that showed that his or her therapy approach is not or less beneficial.

The most well-known example is of course the Lidcombe approach to treat children. The group around Prof Onslow are heavily promoting Lidcombe and at the same time have evaluated it! But, there is a bit of hope: an independent Dutch study is underway and looks at the Lidcombe approach versus a demand & capacities approach.


Anonymous said...

What about research that comes from universities? Their Speech Language Pathologists would not have direct monetary benefit from a specific type of therapy/ approach. They benefit from the quality of the research standing up to critique.
In the OT world this issue would be sensory integration. Jean Ayres benefited monetarily from her theories, but the AOTA has critical as well as some supportive research articles, but overall it is still not clearly beneficial. (I think because it is being used too broadly).

I also have another question re: ADD and stuttering. Has anyone heard about Sluggish Cognitive Tempo? Could the ADDish symptoms that pop up in research (Preschoolers-WS difficulty monitoring environment and task/ switching attention easily and then refocusing) be at all related to the cognitive processing that needs to monitor language (even if not spoken) as well as whatever else e.g. topic, content etc...
This is an issue because we are trying to nail down accommodations for our son at school and in one and 1/2 years--for college. Now he's at a private school--8 11th grade students, and two hours to work on school work without a class (like study halls, but one is specifically devoted to science) and the extra time to "process" the material has successfully taken the place of ADD medicine.
I'm not sure where else to look for information re: stuttering and ADD (because for our son, getting him to "speed up" deteriorates concentration and speed for the task and his speech fluency.)

Tom Weidig said...

Many researchers at universities also treat people who stutter. I am not even talking about financial benefits. It is more the need to prove to themselves (and the others) that what they do is successful.

There are speculations that stuttering is related to ADD symptoms for some. This might be because their stuttering is due to a neurological incident like a virus infection or head injury often well before onset of stuttering. A less "visual" side effect of a such neurological incidences might be ADD.

L said...

I am currently an 18 year old nursing student. In the middle of my jr year in high school I was diagnoses with ADD. I am also a stutter. No one ever connected the stuttering with the ADD. This summer I am conducting a study on myself using a device called the Fluency Master to determine if it will help with my stuttering. I also plan to try various types of ADD meds to see if one or another helps more with the stuttering. I have had fantastic results using Adderal for my ADD but it hasn't effected my stuttering.

Anonymous said...

How has your research been going? My son is a 10 year old who stutters and we now think he may have ADD as well. I'm wondering if there's a connection, too. He had a traumatic birth, had a huge abrasion on his head from the vacuum and wasn't breathing when he was first born. I'm wondering if ADD and dysfluency stem from the same part of the brain.