"Lack of Benefit of a Single Dose of Synthetic Human Secretin in the Treatment of Autism and Pervasive Developmental Disorder," A.D. Sandler, et al, New England Journal of Medicine, vol. 341, pp. 1801-6 (editorial pp. 1842-1844) December 9, 1999.

I include a review of this article even though the disorder is autism, not ADHD because it highlights the pitfalls of rushing to a new unproven treatment after the media grabs hold of a single anecdotal experience.

 

A three year old autistic child (autism like ADHD is also a very multicausal heterogeneous problem of language, communication and relatedness often accompanied by some degree of retardation) was being evaluated for diarrhea and was given the gastrointestinal hormone, secretin, as part of a diagnostic test. Within a week his mother reported and subsequently publicized a dramatic improvement in his ability to relate to his family and others. The case was reported several times and many had the impression that several children had responded to the hormone while it was actually this single child that copied over and over again in the media.

When the Wall Street Journal reported on the case a veritable flood of requests for the hormone led to a temporary shortage (there are several hundred thousand children with autism in the U.S.). Virtually every expert in the field was dubious. We have seen many other "treatments" reach fad state only to fade when they were shown to be of no value in controlled settings (where families and doctors were given placebo or "treatment" and were "blinded" (didnít know which) they had received). Here 56 children were either given a single dose of secretin intravenously or sham placebo treatment. There were no differences noted between the two groups in followup (interestingly both groups improved somewhat though equally to the well known placebo effect).

While I can understand the allure of such treatment for the rather gloomy prognosis of autism nevertheless I personally experienced the effects on the treatment of a very difficult non-compliant four year old autistic child. I was working with the parents doing very unpleasant time consuming behavioral approaches (focusing on developing an effective time out and having him respond to some of his parentsí verbal injunctions). The couple was struggling and the moment they heard about the secretin "treatment" they left therapy to seek out a physician who could give their son the hormone. They never returned to a therapy program that has a much more clear value albeit more long term and difficult to achieve. I hope this example elucidates similar problems for ADHD which also has its share of "alternative" unproven treatments.