How to choose mental health treatment for my child
Before you Spend Time and Money on Intervention or Treatment, READ THIS!
We have so much information at our fingertips and can find a “solution” to almost anything with a google search. It’s necessary to be resourceful and to seek knowledge as a parent. However, it’s challenging to critically evaluate the evidence behind what you’re reading. Maybe you’ve googled things like this…
“How to improve my child’s attention…”
“How to help my teen with anxiety…”
“How to help my child’s reading problems…”
It’s not uncommon for parents to bring questions about a treatment or intervention because they’ve done their own research before they arrive at an appointment. They wonder if they should invest for their own child. In some cases, parents have already tried interventions without much success. They are discouraged because they have lost both time and money and didn’t see results.
As clinical scientists, many psychologists receive training during their doctoral studies to critically evaluate research. We want to teach you some strategies that you can try on your own. Then we will try a couple examples together.
Try These Strategies to Evaluate Research Studies:
First, you need to find the original scientific study (hopefully more than one!) that supports the effectiveness of an intervention or treatment you want to learn about.
- Go to the website for the treatment. Somewhere on the website you should find a link to the “Studies” or “Research” that provides evidence that it works. If you cannot find the research studies behind the treatment, it’s a RED FLAG.
Once you find one, look for the title of the study, full citation or reference. Sometimes they will post a summary of the study but this may not be entirely accurate. You want to form your own opinion and summary of this study. So copy and paste the title of the study into a new google search page.
Look at the search results. Click on any links related to the study title to try to find the full “article” or at least the published summary of the study called the “Abstract”. The Abstract is always available online (if the study was actually published).
Once you find the article or Abstract for the treatment, read about who participated in the study. Look for the section about the “Sample” or “Participants”, which should describe the children in the study.
- Are the participants similar to your child based on age, gender, race, ethnicity, language, country of origin, medical or developmental diagnosis, or other important factors? The more similar to your child, the more likely the results will be relevant.
- How big is the participant sample size? The higher the costs or risks of the treatment, the larger the sample needs to be. Pay attention to how the sample size changes over the course of the study. For example, sometimes they start with a big sample, but over time the participants drop out and don’t complete the study. The final sample size that completed the study is important. Consider why so many dropped out.
Did they include a comparison group for the treatment? Look in the Methods section (or Results).
- High quality science about treatment effectiveness needs a comparison group alongside the group that actually participated in the treatment. This might be called a control group (also called wait list control or treatment as usual group). The control group does not receive the treatment or they might be placed on a waiting list to receive the treatment later.
Alternatively, they might have a treatment comparison group. The treatment being compared is one that is known to be helpful or effective. The scientists want to show that their new treatment is just as effective or more effective than the known treatment.
If there is no control group or the new treatment is not compared to a known treatment, it’s a RED FLAG.
Read the Results or Conclusions. Do they make sense? Do they clearly report how the treatment helps?
- Sometimes the Title of the study is misleading. The authors want to get your attention with the Title. But it may not accurately reflect the actual study results. (This trick is used even in good research! You need to read the actual Results or Conclusions. Sometimes the authors studied a small piece of the bigger problem, but they make a giant leap in their Title. They generalize the results beyond where they should.
- What do the Conclusions say? Did the study participant group actually do better than the control or comparison group? By how much? The results should also explain things like how long the treatment is required to see improvements. And how long the improvements lasted after stopping the intervention.
- Towards the end of the Conclusions, you’ll find the study limitations. It is always expected that scientists report the study limitations that can be improved upon. This helps direct other scientists. It also makes the study transparent so that you know its flaws. If there are no study limitations reported, this is a RED FLAG.
About the authors who published the study (the scientists)
- Under the study title you will find the author names. Under their names, you should see their “affiliations” or the institutions with which they belong. Typically they are part of a university or medical center. Try also searching their name at the affiliation to see what they study. Is their expertise related to the treatment?
- We also want to know if the authors benefit in some way from the intervention they are publishing about. Do they belong to the same institution that sells the treatment? In other words, are the scientists who published the study also getting paid when customers buy the treatment? This is considered a conflict of interest. It is a huge RED FLAG to have a conflict of interest or to be biased in favor of producing a specific result in science. Search for statements in the published study about conflicts of interest.
Let’s try two examples together:
I googled the key words “vitamins for attention problems in children”.
I found On Task Naturally vitamins at www.ontasknaturally.com. I clicked on the menu tab called “Studies”. As I click on each study, I see details that are RED FLAGS:
- The studies reported are not specifically about the On Task Naturally vitamins, but instead about specific ingredients in the vitamins themselves. A few studies seem like they could be credible, but they study very specific questions (e.g., Zinc in ADHD; or Zinc in mental health) and again, I don’t see studies that look at On Task Naturally vitamins specifically.
- I also discover that almost all the scientists who published the studies are from outside the US (click on affiliations), and most are published in another language or a journal from outside the US. I wonder why…. They market that these are “Made in the USA”.
- At this point, I’m left wondering if anybody has actually studied On Task Naturally vitamins. Luckily, they make no promises about the outcome of taking these vitamins. But the name of the vitamins implies that they keep the child “On Task”, right? They want you to conclude that because vitamins and minerals deficiencies are reportedly linked to attention problems and other behavioral concerns in the studies the post. And their vitamin supplements are treating these deficiencies. But this is a leap.
Next I googled the key words “brain exercises for kids”.
I found the program called Brain Balance: www.brainbalancecenters.com This program makes very strong claims about its effectiveness. It states that the program will “enhance cognitive and emotional wellbeing”, and “build brain connectivity” to “unleash their untapped potential”.
WOW! If this is really true, I’m left wondering why every child isn’t using it?! I clicked on the website menu tab called “Research”.
- The first study posted is by Dr. Rebecca Jackson and Josh Jordan, PhD. When you following the links to the original article, you learn about the authors. Dr. Rebecca Jackson actually works for Brain Balance. Uh Oh! Remember, that leaves us with concerns about bias and conflict of interest. Josh Jordan, PhD was at the Dominican University of California when this was published. After searching his name, I learn that he was involved in cancer reasearch. Hmmmm. Is he a qualified expert in the area of attention problems? Not sure.
- There is another study published by Cambridge Brain Sciences, again with Dr. Rebecca Jackson of the Brain Balance Achievement Centers. Study title is called: “Effect of the Brain Balance Program on Cognitive Performance in Children and Adolescents with Developmental and Attentional Issues. The second author is Conor Wild at the Brain and Mind Institute in London. I have not heard of this so I go to this website to learn more. But I cannot find Conor Wild under the Investigators tab. Maybe he’s not an investigator? Hmmmm. Not sure about this study either.
- Another study is widely advertised on their website. Here is the original study title: “Final White Paper: Effects of Brain Balance Exercises and Interactive Metronome on Children with Attention Deficit Hyperactivity Disorder are Similar to the Effects of Stimulant Medication”. It includes an author from Harvard University, Dr. Martin Teicher. His affiliation definitely leads one to believe he is an expert.
As I read the study conclusions, I see this statement “Based on the preliminary findings, follow-up studies are warranted with a larger sample size to confirm the initial findings. Additional studies can help to confirm the hypothesis that Brain Balance may work….” The language they use is critical. They say a larger sample is “warranted” and the study “may work”. This is cautionary, and it seems to come from an expert.
- So far, I’m skeptical about the research behind Brain Balance. But if I was interested in this intervention for my child, I would definitely keep reading the research because this is not a low cost investment. It looks like the initial payments are for an “assessment”, which can be hundreds of dollars. After this, the intervention program begins, but there are no prices listed (that I could find) for this intervention.
It does take time and patience to understand the science behind an intervention. But this time is well worth it to protect your resources, and most importantly your child. Although some treatments or interventions may be very low risk, if an intervention is frustrating or confusing for your child (e.g., attention or reading intervention), you risk the emotional wellbeing of your child. Do as much research as you can to ensure you made a choice that feels right at the time, or consult an expert to ask questions.
The truth is that it can sometimes be difficult to find the right treatment or intervention for a child. This is the case even when we know the research supported interventions.
It’s absolutely critical that you clearly understand the problem you are trying to treat before you begin an intervention for your child. If you question your child’s diagnosis or you are unsure what should actually be targeted for intervention, your child may need a thorough evaluation.
Reach out to us to schedule an initial caregiver intake. We want to learn about your concerns and make recommendations for next steps! Contact us here: https://pedneurocenter.com/contact/
