In Disconnected Kids Robert Melillo presents a thesis encompassing a wide spectrum of neurobehavioral disorders of childhood and proposes a therapeutic intervention that can treat them all. This review will examine Dr. Melillo's main thesis, his proposed intervention, and the evidence upon which both thesis and intervention rely.
According to Dr. Melillo, the cause of neurobehavioral disorders of childhood such as ADHD, Autism, Dyslexia, etc., is a brain imbalance. As a result, he proposes that all these disorders fall under the category of 'Functional Disconnection Syndrome'. The specific nature of the alleged brain imbalance is rather global, involving the anatomy and physiology of the two hemispheres. Namely, Dr. Melillo argues that if the development of the two hemispheres is uneven, their functioning may not be synchronized. Reduced synchronized activity between the two hemispheres is then said to materialize into one of the disorders of the 'Functional Disconnection Syndrome'.
Dr. Melillo's thesis appears problematic for several reasons. First, one may ask how functional imbalance (i.e., lack of synchronized activity between the two hemispheres) can bring about such a variety of disorders. Second, one may question the exact nature and parameters of the alleged 'reduced synchronized activity between the two hemispheres'. Anatomic and functional asymmetries are not an uncommon feature of the human brain. Lateralization of functions, such as the processing of language and spatial information, each preferentially performed by one hemisphere, is a common feature of the brain, not a feature associated with impaired performance. How and when do asymmetries become the expression of desynchronized activity and thus problematic? Regretfully, the alleged causes of delayed brain development are as diverse (e.g., prenatal maternal stress, birth trauma, illness, injury and zenobiotic/toxic exposure) as the patterns of behavioral symptoms that result from anatomic and functional asymmetries.
The author makes an attempt to clarify the notion of anatomic and functional asymmetries (see also Melillo, R., & Leisman, G., 2009), but the evidence provided is meager, mostly correlational, and rather selective. For instance, reduction in the white matter of the corpus callosum, the array of fibers that connect the two hemispheres, is claimed to be one of the main culprits of the Autistic Spectrum Disorders (Melillo, R., & Leisman, G., 2009). Yet the evidence cited refers to diffusion tensor imaging, which illustrates white matter reduction in several brain areas, including the corpus callosum, of autistic children (Barnea-Goraly, Kwon, Menon, Eliez, Lotspeich, & Reiss, 2004). Evidence of reduced white matter in the corpus callosum is then used to imply that 'the most common type of functional disconnection seen in these children is one that involves the two hemispheres' (Melillo, & Leisman, 2009, p. 6). It is unclear, however, how evidence of reduced white matter in other brain areas relates to the autistic syndrome, and how all evidence directly relates to the functional and behavioral patterns that appear to be disturbed in such a syndrome.
The author's undeveloped narrative relating anatomical evidence, functional evidence and behavioral deficiencies merely reflects his 'big picture' approach to neurobehavioral disorders of childhood, which influences not only his thesis but also his proposed intervention. This is not surprising. The critical issue of Dr. Melillo's thesis is the reduced synchronized activity between the two hemispheres, which he assumes to be at the core of a variety of neurobehavioral disorders of childhood. Dr. Melillo uses this thesis to suggest that the best therapeutic approach is to embrace a combination of interventions, including somatosensory, cognitive, behavioral, and biochemical approaches. The overarching goal of the approach would be to increase the activity of the developmentally delayed hemisphere so that the two hemispheres can become synchronized. How each of these qualitatively diverse interventions can all target the same problem is unclear. There is also very little scientific evidence that each of the proposed interventions has long-term beneficial effects either alone or in combination with the others. Therapeutic practices, irrespective of their behavioral, cognitive, or biochemical focus, must be subjected to rigorous scientific testing before claims are made regarding their effectiveness (see Baker, McFall, & Shoham, 2008).
A critical examination of Dr. Melillo's work must also encompass the claim that diagnoses of neurobehavioral disorders of childhood, including ADHD, Asperger's syndrome, Autism and Dyslexia, have increased substantially in the past ten years. The first issue that this claim raises is whether the observed statistical increment results primarily from the frequency with which diagnoses of such disorders are generated, from the actual incidence of such syndromes, or from both. Increased use of a diagnostic category could be symptomatic of a more widespread screening and/or of improved detection accuracy of screening devices, all desirable outcomes in clinical practice. However, it could also be the result of a Type 1 error (i.e., false positive), an undesirable outcome. If the criteria for attributing a disorder to clients/patients are relaxed or even misapplied, the resulting outcome may be a 'fake' increase in the frequency of occurrence of the disorder.
Of course, debates regarding the statistical frequency of neurobehavioral disorders of childhood, including ADHD, Asperger's syndrome, and Autism, are hollow when we consider research evidence attesting to their existence and reminding us of the pain and suffering that these disorders bring along. Thus it is important to examine critically (i.e., put to the scientific test) all proposals regarding the cause(s) of these neurobehavioral disorders and suggested interventions.
It is undeniable that Dr. Melillo's thesis and proposed intervention give hope to all affected parties (children, parents and clinicians) that neurobehavioral disorders of childhood can be eradicated one day in the near future by relying primarily on behavioral and cognitive treatments. Right now, however, more evidence has to be collected before these disorders are fully understood and this future can become reality.
© 2010 Maura Pilotti
Maura Pilotti, Ph.D., Department of Psychology, Hunter College, New York