Allergy-related autism, communication and NAET

For quite a while now I have been catching the odd mention of something called NAET with regards to lots of different conditions. NAET stands for the Nambudripad Allergy Elimination Technique coincidentally named after its discoverer Dr Devi S. Nambudripad.

Looking more closely at the description of NAET, my brow becomes slightly furrowed as words like 'selective energy balancing' are used to describe part of a process to desensitise a person from their allergies. I don't want to seem unfair or exclusionary to such concepts, and please no hate comments from any NAET supporters, but in my ignorance I do find it slightly difficult to picture such energy and how or what relationship it might have to the body. Certainly it is not something that my doctor ever shared with me about my childhood cat allergy and I would have probably had a hard time bringing it into any consultation with them. Having said that I can't [normally] see magnetism or gravity either but don't give them such a hard time; assuming that is, that they don't start to claim to affect things like allergy or autism without the appropriate research evidence as back up.

I would therefore not normally be paying too much attention to NAET. When however the results of a randomised-controlled trial are published, I tend to become a little more attentive. So it is that thanks to Research Autism, I stumbled upon this paper by Teitelbaum and colleagues* (full-text) looking at the use of NAET with a group of children with autism. The study was also registered with the NIH ClinicalTrials.gov site (here) although no raw results have been posted following the last review in June 2008.

So what did this paper say?

• Sixty children with a diagnosis of autism and a history 'suggestive' of food sensitivity (bowel, skin and/or other issues) were randomly allocated to a treatment (n=30) or control group (n=30). The randomisation method was an interesting one in that a 5-year old child picked names on papers from a bowl. What a great introduction to the scientific method for him!
• Treatment consisted of acupressure along the spine, hands and feet while the participant was holding particular allergens followed by something called neuromuscular sensitivity testing (NST), a procedure described as being similar to muscle response testing to assess effectiveness of treatment. Fifty allergens were treated consisting of 100 treatment occasions (twice a week); the study ran for a year. Controls received no NAET treatment during that time.
• Parents or primary caregivers completed the ATEC and a couple of other measures grading outcome.
• Results: 23 children in the NAET treatment group were described as improving to such an extent that "..they were able to function in regular school classes instead of special education classes". By contrast, none of the control group improved or "..were able to function in regular school classes". 
• There were also statistically significant group improvements on all of the subscales of the ATEC and total score when comparing treatment vs. control groups. The results also include a case study of a young boy with autism who was reported to improve considerably during the study period.

At first glance and without knowing what NAET was, I think most people would be impressed with these results. Twenty-three out of 30 participants using NAET went from an SEN to mainstream classes because of their improvement and none from the control group. Indeed this should really be 23 out of 26 children bearing in mind the participants who dropped out of the treatment group and I assume a protocol not including intention-to-treat. All of the ATEC subscales showed significant group improvements for the treatment group compared to controls and as far as I can see, no significant adverse effects were reported. Not bad at all.

But here's the thing. If I were to compare these [preliminary] results with any other intervention experimentally looked at for autism, these findings would probably indicate that NAET ranks up near the top of the table of autism interventions even if only for those allergy-related cases. My question therefore is why has this paper not created more excitement and a thirst for more research in this area?

The answer lies perhaps with a few 'issues' with this study and techniques described. As per the authors' comments, applied kinesiology is rather on the periphery when it comes to modern medicine and indeed its failings when appropriately tested. My attention is immediately drawn to a recent study by O'Reilly and colleagues** examining the professional view of alternative medicine with autism in mind which highlights some of the main issues. I would imagine that applied kinesiology is probably not central to the traditional medical model. That and the continuing attention raised with other complementary techniques such as the recent Singh/British Chiropractic Association saga and an even more recent post detailing a checklist for intervention therapies. At this point I might add that I offer no opinion on whether things like applied kinesiology work or not; merely that its principles and rather subjective methods have not (yet) produced unequivocal data on reliability or response.

One could also highlight that some of the methodology of this study as being a potential source of bias. So, for example, this was not a double-blind study and as far as I can see no placebo condition was applied. The question of how this type of method could be double-blinded and placebo-controlled is the counter argument which would require some sideways thinking in any future study design. As for the placebo effect, one should never underestimate how powerful an action this can exert on a person when specific elements are in place e.g. administered by a doctor in a white coat with lots of encouragement about positive effects, bearing in mind also who was rating participants on outcome.

I am also interested in the medical treatment as usual instructions provided to parents of participants in both groups. "In both groups, parents were instructed to continue any medical treatments the child was receiving prior to enrolment in the study". Unfortunately I can't see anywhere in the article information about what these treatments were, how they changed over the experimental period and importantly, whether any other interventions were introduced during the long study duration. Is it indeed likely that 30 children with autism would not adjust/undertake educational, behavioural or other intervention for a whole year?

I don't want to be overly critical or anything about this paper just because it details techniques which I don't understand or don't fit with the current way of thinking. Indeed the dietary trial I was involved with has similar methodological failings in terms of lacking double-blindedness and final analysis based on a per protocol decision. Having said that there is a difference between changing a persons diet and asking them to hold a carrot or a jar containing a carrot or other carrot essence whilst someone manipulates their back (as per the story of the discovery of NAET).

I know quite a few people would probably like to draw a line under this study and put it down to a fluke finding with methodological issues. Personally, if there is any possibility that NAET, for whatever reason including a placebo effect, might be able to clinically impact so positively on a persons functioning and quality of life as to move them from SEN to mainstream school, I would like to see a more methodologically-sound, independent study undertaken on it. Bearing in mind also the potential power of touch and massage as per this previous post, it is not beyond the realms of possibility that independent of the allergy-perspective, there may not have been some effect from the acupressure side of things, which itself needs a little bit more investigation particularly from a safety perspective.

To finish a treat for my oldest offspring with a catchy tune from recent Brit winners One Direction (God, did I actually link to this ..?)

* Teitelbaum J. et al. Improving communication skills in children with allergy-related autism using Nambudripad's Allergy Elimination Techniques: a pilot study. Integrative Medicine. 2011:10; 36-43

** O'Reilly M. et al. Complementary or controversial care? The opinions of professionals on complementary and alternative interventions for Autistic Spectrum Disorder. Clinical Child Psychology & Psychiatry. February 2012.