Questioning the evidence behind evidence-based approaches

Some of the most ineffective and sometimes most harmful treatments are considered “evidence-based.” The phrase in isolation is meaningless without understanding the quality of the evidence AND whether the evidence supports the purpose for which the treatment is being used. Additionally, practices that were at one time considered evidence-based can be found (through additional research and time) to no longer be considered evidence based, yet many only remembers that this practice is “evidence-based”, completely missing the new information.

For example, behaviorism (rewards and consequences) has been used in schools for over 20 years as the foundation of the Positive Behavior Interventions and Support approach. Individual research projects show some positive changes in some schools over a few years for some children. Given the number of years, this practice has been in place, and the amount of funding provided to the National Technical Assistance agencies, the amount of outcome-related research is small. The research doesn’t address which students do well with this approach and which students do not. A frequently heard message from families of children with disabilities is that this approach is harmful; children with disabilities are being punished for non-volitional stress responses. Many families are removing their children with disabilities to homeschool them according to participants in online support and/or advocacy parent groups. The national discipline data (restraints, seclusion, suspension, and restraints) is not showing reductions of these exclusionary practices which one would expect for an approach that has been promoted for over 20 years. 

Another issue is whether the goal of the evidenced-based treatment is in alignment with the other program goals. The goal of PBIS is compliance, a goal that does not align with the goals of the educational system.

Another example is ABA (applied behavioral analysis). This was considered “the gold standard” for the treatment of autistic children. However, in recent years, several things have occurred:

Yet, many people still believe ABA is the best treatment for autistic children. However, if we listen to the experiences of autistic people that have been through ABA we hear evidence of the damage this approach can cause. In fact, most autistic self-advocates agree that autism does not need to be cured. Groups like the Autistic Self Advocacy Network suggest that rather than focusing on treatment, we should focus on supporting autistic people to live good lives. One might wonder how an approach can be can consider evidence-based if we are not considering the experiences of those that have direct experience with the practice.

In summary, just listing “evidence-based” as a criterion doesn’t assure that:

  • The research used to determine the practice is evidence-based are in alignment with the goals for which the treatment is being considered
  • The evidence includes long term data and results
  • Unintended consequences of the evidence-based practice are recognized
  • New research has indicated that this practice should no longer be considered evidence-based.

On the other hand, an approach based on neuroscience will take into account how the brain works. As new information is learned about brain functioning approaches will be updated to stay consistent with neuroscience.

Behaviorism still practiced throughout the United States and still considered “evidence-based” completely misses the difference between behaviors that are willful and behaviors that are automatic (stress behaviors). It misses the fact that human behavior changes depending on whether the brain’s “threat detection system” is triggered, setting off flight/fight or freeze behaviors. Understanding and applying the neuroscience allows adults to respond to children experiencing stress with compassion and support rather than punishment.

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