By Nestor Lopez-Duran PhD
This week I will be writing a series of micro reviews of recent treatment studies. Some of these articles are controversial for different reasons, for example below I discuss issues with single-case reports and later this week I will discuss issues regarding conflict of interest in the publication process.
The Journal of Autism and Developmental Disorders just published a case report on the effectiveness of pressure vests in engagement behaviors during a preschool class in a 57-month-old boy with a diagnosis of developmental delay. The authors used an A-B-A design, in which the researchers observed behavior changes during a baseline (A) after the initiation of treatment (B), and after the termination of treatment (A). The authors did not find any improvements in engagement behaviors with the use of the vest. Does this mean that pressure vests are not effective? NO. The data simply showed that the pressure vest did not help this particular child. Thus, we can not generalize these findings to anyone else.
There is very little more I can say about this study, except to pose the question: why are we still publishing single case studies? The methodology was sound (for a single-case study) and the article well written, and I further appreciate the authors efforts in emphasizing the limitations of the single-case nature of their study. So Im not questioning the authors. My question is to JADD I can not think of a single reason as to why this type of single case reports should continue be published. Autism is not an extremely rare condition, and pressure vests are not an extremely rare or individualized intervention, both of which could potentially justify a single case report. Thus, the utility of publishing case studies on common conditions/treatments eludes me.
What is the problem with a single case reports? That regardless of the outcome of the study, we simply can not reach any conclusion about the effectiveness of the treatment thus we learn very little from it. In medicine, case reports are useful to communicate to other physicians/researchers examples of diagnostic and treatment issues of extremely rare conditions or situations (so rare that conducting more externally valid studies would be impossible). In contrast, the utility of case reports of common treatments in very common conditions is more questionable, and it raises a number of ethical issues given the increased access to these type of findings by the general public.
Reichow, B., Barton, E., Good, L., Wolery, M. (2009). Brief Report: Effects of Pressure Vest Usage on Engagement and Problem Behaviors of a Young Child with Developmental Delays Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-009-0726-3