Is “Sensory Processing Disorder” a real condition?
I recently saw a young patient and her parents for a second opinion regarding the diagnosis of “Sensory Processing Disorder” (also called “Sensory Integration Disorder"). They wanted to know more about it and more importantly how to treat it.
Sensory processing or integration refers to the process by which the brain organizes and interprets external stimuli such as touch, movement, body awareness, sight, sound, and gravity. The diagnosis of SPD is typically made by occupational therapists and is generally not recognized by mainstream medicine. Children diagnosed with SPD tend to exhibit unusual or exaggerated sensitivity to various sensory stimuli. They complain about textures of food or clothing. They may be oversensitive to loud noises. They may also have behavioral issues or delays in motor skills.
It is clear that children with sensory issues do exist, but the more important question is whether SPD is a distinct medical syndrome and whether the treatment typically given has any effect on the child’s short or long term functioning.
SPD was first described by A. Jean Ayres, PhD in 1968. She was both a psychologist and occupational therapist. She sold her clinic in 1984, but stayed on at the successor practice as a consultant. However, that practice was sued at least 15 times, for issues relating to its business practices, and in 2007 the California Superior Court issued an injunction that shut down the practice.
Proponents of SPD believe that it is a developmental disorder amenable to therapy and that treatment can improve developmental outcomes. However, the prevailing medical opinion is that SPD does NOT meet the usual standards required to qualify as a diagnosis. It is interesting to note that SPD is not included in the universally recognized Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), despite campaigning by occupational therapists to have it included.
Certainly many children who go on to be later diagnosed with Autism Spectrum Disorder (ASD) have a history of sensory issues. Similar issues can be seen in children with Attention Deficit Hyperactivity Disorder and anxiety disorders.
Therapy for SPD recommended and provided by occupational therapists includes brushing the skin, using weighted clothing, special shoes, and various excercises to improvive coordination ("vesitubular training”). These techniques are claimed to desensitize the patient’s nervous system. These therapy sessions are expensive and involve months to years of weekly or more frequent sessions.
In 2005, experts at the University of Rochester concluded that there had been no adequate controlled studies either supporting the existence of SPD or demonstrating that that its treatment is more effective than no treatment at all. In 2012, the American Academy of Pediatrics issued a policy statement that stated that SPD should not be diagnosed, and that “parents should be informed that the amount of research regarding the effectiveness of sensory integration therapy is limited and inconclusive.”
The bottom line is that most children with sensory issues improve their behavior spontaneously. It is reasonable to question whether costly interventions are really necessary for what are most likely self-limiting problems of neurodevelopmental immaturity and anxiety.
Please feel free to contact with me any questions you may have.