Elimination diets in autism spectrum disorders: any wheat amidst the chaff?

The use of complementary or alternative treatment approaches in children with autism spectrum disorders (ASDs) is increasing, and the most popular of such approaches are diets that eliminate either gluten or casein, or both. The popularity of these diets indicates a need for more rigorous research into their efficacy. Owing to significant methodological flaws, the currently available data are inadequate to guide treatment recommendations. The purpose of this review is to examine the available trials of gluten/casein diets in children with ASDs regarding the strength of their findings and also concerning points that may be useful in the design of future studies. Seven trials of these diets in ASD are critically reviewed; 6 of these were uncontrolled trials and 1 used a single-blind design. All reported efficacy in reducing some autism symptoms, and 2 groups of investigators also reported improvement in nonverbal cognition. Design flaws in all of the studies weaken the confidence that can be placed in their findings. Careful double-blind, placebo-controlled studies are needed to evaluate whether actual benefit undergirds the diets' popularity and to provide better guidance to clinicians and caregivers. The literature currently available suggests that diets eliminating both gluten and casein (rather than either alone) should be studied first and that outcome measures should include assessments of nonverbal cognition.

Teaching electroconvulsive therapy to medical students: effects of instructional method on knowledge and attitudes.

OBJECTIVE: To compare the effects of learning about electroconvulsive therapy (ECT) via live observation to learning via an instructional videotape. METHOD: During their psychiatry clerkship, 122 medical students were randomized using these two educational methods, and their ECT knowledge and attitudes were assessed during the first and last weeks of the 6-week clerkship. RESULTS: For both the knowledge and attitudes measures, the clerkship (time) effect was statistically significant (i.e., posttest scores were higher than pretest scores). The interaction effect was significant for knowledge only (pretest scores for students in the live group were slightly lower at pretest than those for students in the videotape group and slightly higher at posttest). The effect size was very small, however, suggesting little meaningful educational difference between the two instructional methods. CONCLUSION: Both live demonstration and viewing a videotape appear to be effective methods for teaching medical students about ECT.

Requiring a one-week addiction treatment experience in a six-week psychiatry clerkship: effects on attitudes toward substance-abusing patients.

BACKGROUND: Medical education shapes students' attitudes toward substance-abusing patients, often in negative ways. Curricular interventions to foster more positive attitudes toward such patients and their treatment can have lasting effects on clinical practice. The nature and duration of such interventions, however, requires clarification. PURPOSE: To test the hypothesis that spending 1 week of a 6-week psychiatry clerkship on an addication treatment site would improve attitudes toward substance-abusing patients without reducing the clerkship's benefits on attitudes toward, and knowledge about, psychiatry patients. METHOD: Using the Medical Condition Regard Scale, preclerkship and postclerkship attitudes toward patients with alcoholism, major depression, and emphysema (a control condition) were examined in 3rd-year medical students following the conversion of 1 of the clerkship's weeks to an addiction treatment site assignment. Psychiatric knowledge was assessed by comparing scores on the Psychiatry Subject examination before and after the change. RESULTS: Mean regard scores increased significantly for patients with alcoholism and for patients with major depression but did not change for patients with emphysema. Subject examination scores before and after the curriculum change were not significantly different. CONCLUSIONS: Spending 1 week of a 6-week psychiatry clerkship on an addiction treatment site increased regard for patients with alcoholism without adversely affecting measures of attitudes toward, and knowledge about, psychiatric patients.

The medical condition regard scale: measuring reactions to diagnoses.

PURPOSE: To develop a non-condition-specific scale to capture biases, emotions, and expectations generated by medical condition descriptors. METHOD: An 18-item pilot scale was developed from the literature on physicians' responses to patients they like and dislike, stigma definitions, and discussions with primary care faculty. Exploratory factor analysis was conducted after 440 medical students rated one of 12 diverse conditions. Confirmatory factor analysis was performed after 163 medical students rated two psychiatric conditions. Validity was evaluated by the scale's ability to meaningfully stratify the 12 conditions and identify changes in attitudes toward psychiatric conditions after a psychiatry clerkship. RESULTS: Exploratory factor analysis supported an 11-item unidimensional solution (all factor loadings >.40, coefficient alpha =.87). The final scale, the Medical Condition Regard Scale (MCRS), taps the degree to which medical students find patients with a given medical condition to be enjoyable, treatable, and worthy of medical resources. The unidimensional model also was supported by the confirmatory factor analyses for the two psychiatric conditions (both comparative fit indices =.98). The scale stratified the 12 conditions as expected: straightforward medical conditions rated highest, somatoform conditions rated lowest. Students showed greater regard for patients with major depression after the psychiatry clerkship, and students who rotated through an addiction treatment program showed a greater increase in regard for patients with alcoholism than did students not exposed to addiction treatment. CONCLUSION: MCRS scores are reliable, and the scale appears to be a valid instrument for assessing regard for any medical condition.