The term “aromatherapy” generally refers to a treatment that relies on plant extracts to promote physiological and psychological healing. The National Center for Complementary and Alternative Medicines (NCCAM) of the U.S. Department of Health and Human Services defines aromatherapy as a treatment “in which the scent of essential oils from flowers, herbs, and trees is inhaled to promote health and well-being” (NCCAM, 2012). However, some practitioners administer essential oil extracts topically or orally (Bradley, Brown, Chu, & Lea, 2009; Herz, 2009). Researchers have yet to agree on a standard definition of aromatherapy, thus creating one of the many problems associated with studying its efficacy.

Many societies and cultural groups have used essential oils for ritual, aromatic, and medicinal purposes for thousands of years. We have no information about how the potential healing power of aromatic plants was discovered, yet ample evidence from Egypt, India, and the Middle East indicates their use in ancient times. Hundreds of references to various oils exist in Judeo-Christian religious texts, and aromatic plants were found within royal tombs of Egypt and China. Aromatherapy is practiced globally, holding particular import in Eastern medicine and traditional native cultures. For example, in the Amazon region, some peoples use linalool, a compound found in many essential oils, to control epileptic seizures.

In the Western world, aromatherapy is regarded as a complementary and alternative medicine (CAM). However, this “nonscientific folk remedy” (Herz, 2009; Takeda, Tsujita, Kaya, Takemura, & Oku, 2008) has become increasingly popular throughout the Western world in recent years. Perry and Perry (2006), a mother and daughter research team from New Zealand who focus extensively on aromatherapy, describe it as the fastest-growing CAM today. In one study on CAM use in children with attention-deficit/hyperactivity disorder (ADHD) (Sinha & Efron, 2005), researchers reported that out of 23 CAM treatments, aromatherapy was the second most frequently used, behind diet modifications.

Review of the extant literature reveals claims that aromatherapy can successfully treat dementia, ADHD, autistic spectrum disorders, schizophrenia, anxiety, depression, and sleep disorders. Some even claim that certain essential oils can promote hippocampal neurogenesis (Perry & Perry, 2006). Thus far results have proved inconclusive. In one study, a combination of aromatherapy and massage reportedly helped to increase shared attention in four preschool-age children with comorbid autism spectrum disorders and severe learning deficits (Solomons, 2005). In another study, 5 minutes of lavender inhalation through an oxygen mask showed a significant effect on perceived pain reduction during needle insertion, lowered the need for anesthesia, and decreased stress (Kim et al., 2011). This decrease in stress may indeed be due to the pharmacological effects of the essential oil lavender. Researchers have found linalool, the sedative component of lavender, is responsible for eliciting a parasympathetic nervous system response. Sayorwan et al. (2012) found linalool to decrease blood pressure, heart rate, respiratory rate, and skin temperature. In this same study on the effects of lavender oil inhalation on emotional states, autonomic nervous system, and brain electrical activity, electroencephalograms showed significant increases in theta and alpha wave activity, both of which are associated with relaxation and inhibition.

Yet when researchers tested whether expectancy bias or the pharmacological effects of lavender were responsible for anti-anxiety effects, they found that expectations of relaxation enhance relaxation prior to a stressful cognitive task (Howard & Hughes, 2008). Additionally, aromatherapy can prove harmful. Researchers diffused bergamot for inhalation to pediatric patients undergoing stem-cell infusion and to their parents. Bergamot is an essential oil thought to reduce anxiety and nausea. The authors of this study report that patient anxiety and nausea increased significantly. Interestingly, parents of the children undergoing stem-cell infusions reported being less anxious after exposure to the essential oil (Ndao et al., 2012).

Most published research literature on aromatherapy is based on anecdotal evidence, case studies, and animal models. Many of the studies conducted on human participants have major methodological problems, such as small sample sizes, ascertainment biases, lack of control groups, and others. Most important, apart from the few studies mentioned here, very little research of any kind has focused on child and adolescent populations.

Use of aromatherapy in the clinical treatment of psychopathology in child or adolescent populations poses risks. No consensus exists on safe dosages. Little research has focused on essential oils and drug interactions. No governmental or regulatory organization ensures high quality of essential oils as the U.S. Food and Drug Administration does for prescription drugs. Another factor contributing to unreliability and invalidity in the literature on aromatherapy involves inconsistency among researchers as to what product to use or in which dose, concentration, or delivery system. In addition, by some estimates up to 70% of those using herbal and aromatic therapies do not report such use to their primary care provider (Cline et al., 2008). The current state of science in aromatherapy as a treatment for childhood ADHD or any other psychological conditions amounts to little more than traditional folkloric medicine.

Boot camps and disciplinary boarding schools, often based in rural areas of the western United States or abroad, have become popular “treatment” alternatives for children and adolescents with conditions such as conduct disorders (CDs) and oppositional defiant disorder (ODD). So-called tough love has some broad intuitive appeal in some families and communities. Removal of the child or adolescent from their homes, peers, and communities along with imposition of rigorous physical activity demands and strict discipline form the key components of such programs, although many former participants in such programs have cited severe abuse or torture (e.g., denial of food or medical care, isolation and confinement, beatings, etc.) as integral to the experience.

The World Wide Association of Specialty Programs and Schools (WWASPS) provides an example of one controversial organization that at one time had a system of 25 such “therapeutic” schools for children ages 12 to 17 years with behavior problems. Today, fewer than 10 WWASPS schools remain open. Abuse allegations and lawsuits filed by former students and deaths of some WWASPS students have led to the majority of school closings (see, e.g., Dobner, 2011, and Janofsky, 2001). Physical and emotional abuse reports are not uncommon in such “therapeutic” boarding schools or residential boot camp facilities.

In thinking about efficacy of interventions for childhood or adolescent CDs, consider the importance of using the least restrictive and most effective treatments for children with externalizing behavior disorders. Consider, for example, the handbooks by Weisz and Kazdin (2010) and Ollendick and King (2004), which provide substantial overviews of highly effective interventions for CDs and ODD. Of course, the treatments most often recommended require considerably more effort and engagement by parents than extracting the child to a remote residential intervention. Also, consider the correlational studies showing a strong positive relationship among parenting problems, childhood abuse, and CDs (Boden, Fergusson, & Horwood, 2010; Fergusson, Boden, & Horwood, 2008; Murray & Farrington, 2010). In this context, it seems highly inappropriate to treat a childhood disorder with abusive and neglectful behaviors when the very etiology of the problem may stem in part from abuse, neglect, or inconsistent parental engagement in treatment. Indeed, Lilienfeld (2007) has particularly called out boot camps and intimidating “Scared Straight” programs as having significant potential to cause harm to child and adolescent participants.

The popularity of heavy-handed disciplinary and military-style residential programs seems particularly outrageous considering the attendant high risks and lack of scientific support. No empirical data in support of such programs has reached the peer-reviewed literature (Lilienfeld, 2007). Ethical concerns make studies on the effectiveness of coercive treatments in reducing antisocial behavior difficult. However, the research that does exist shows that boot camp programs and programs such as “Scared Straight” do more harm than good to youth with behavior problems by exacerbating painful emotions (Lilienfeld, 2007; Petrosino, Turpin-Petrosino, & Buehler, 2005). Literature on behavior disorders such as ODD and other CDs suggests that multifaceted treatments including multisystemic family therapy are far more effective (Children’s Mental Health Ontario, 2011; Lilienfeld, 2007; Olendick & King, 2004; Weisz & Kazdin, 2010).

While not a treatment technique in the usual sense, Drug Abuse Resistance Education, popularly known as D.A.R.E., has wide social support as a program aimed at preventing substance abuse among school-age students by using police officers to educate them on the dangers of drugs and alcohol. According to its official Web site, D.A.R.E. is currently implemented in about 75% of our nation’s schools (D.A.R.E. Web site, 2012). Despite its popularity, there is no scientific evidence to support the claim that it prevents or even decreases subsequent alcohol and drug abuse.

D.A.R.E. was founded in 1983 with the mission of “teaching students good decision making skills to help them lead safe and healthy lives.” This program describes itself as a “police-officer-led series of classroom lessons that teach children from kindergarten through 12th grade how to resist peer pressure and live productive drug and violence-free lives.” The website includes anecdotal articles written by police officers and supporters of the program, yet no scientific empirical data support the program’s ability to decrease or prevent substance use.

D.A.R.E. may not decrease substance use, but participation in the program certainly does not increase substance use either (Thombs, 2000). The high level of satisfaction community members report with the program predominantly accounts for the support it enjoys and its overall reputation in the community (Thombs, 2000). Parents, police, and school authorities all want to reduce substance abuse among children and adolescents. The program has a level of intuitive or face validity. After all, if adult authority figures all tell you that something’s bad for you, you won’t do it, right? Paying police officers to teach in such programs has support within the community policing movement, and what school system will say no to a free (to them) program that enhances positive collaboration with law enforcement while arguing the merits of healthy behavior?

According to Gorman and Huber (2009), the U.S. Department of Education has set very minimal standards for D.A.R.E. to meet to qualify for support, making it easy for program officials to demonstrate that they met these requirements. To qualify for use in the classroom, D.A.R.E. was required to have just one program evaluation that showed an effect on substance use or violence 1 year after the program concluded.

Several studies have shown no significant effects of D.A.R.E on participants’ short-term or long-term substance use (Ennett, Tobler, Ringwalt, & Flewelling, 1994; Gorman & Huber, 2009; Rosenbaum, 1994; Thombs, 2000; Uibel, 2010). These findings should serve “as reminders to researchers and program advocates that positive outcomes are not guaranteed simply because a program is prosocial in nature and widely supported” (Rosenbaum, 1994, p. 27). These findings should also raise a red flag for donations and financial backing that goes into the program. An average of $750 million of federal funds is spent on D.A.R.E. each year (West & O’Neal, 2004). This money could be better spent on “evidence-based programs that have been shown much more promise in prevention trials” (Thombs, 2000, p. 36).

Over the past two decades, researchers have conducted a variety of different studies examining the effectiveness of the program with different methodological approaches. The results remain strikingly similar: Participation in a D.A.R.E. program produces no significant effect on later substance use. A meta-analysis of 11 previously published studies of D.A.R.E. found either no effect of the program or found that the D.A.R.E. program actually proved less effective than the control condition (West & O’Neal, 2004). A retrospective study of undergraduate college students who had earlier participated in D.A.R.E. revealed no difference in substance use when compared to their counterparts who did not participate in D.A.R.E. (Thombs, 2000). In a longitudinal evaluation of D.A.R.E., researchers determined that any initially promising results became undetectable over time (Rosenbaum, 1994). In addition, one study also provided evidence showing that D.A.R.E. participation did not alter participants’ later attitudes toward these substances (Uibel, 2010). Again, the enormous amount of money poured into D.A.R.E. programs annually could be better spent developing programs with demonstrable preventive effects.