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Sensory Pretend Disorder

I really wish I’d thought up the title of this article myself – I must confess I didn’t. It comes from an American psychologist, Travis Thompson. But it’s so good, I had to use it. I’m sure Mr Thompson will forgive me.

Some time ago, I wrote in this very publication about the dangers of exposing children to “therapies” that have no evidence behind them either to confirm their benefit, or assure parents of their safety. The focus of that article was the chiropractic industry, and a recent report of a child with a vertebral fracture following a “manipulation” says it all.

For some time now, I’ve been observing early intervention services for children with a range of learning, developmental, and other concerns. I read therapists’ reports, hear feedback from parents, and directly engage with early intervention providers on a regular basis. The more I observe, the more worried I become.

As you read this, consider the question…”What is a Sensory Processing Disorder (SPD)?”. I’m guessing already that many of you as parents could give me an answer because your child sees an OT for treatment of a SPD. So does your friend’s child. So does your nephew. Your school employs an OT. Your next door neighbour feels left out as her daughter DOESN’T have a SPD…yet. Where has this trend come from? And what does an OT do for these kids?

I can tell you, that if you asked a room full of doctors “what does an OT do?”, many wouldn’t have any idea. Especially when it comes to occupational therapy for children. A quick internet search through OT websites though will tell you what OT’s say…

 

“…sensory integration disorders…”

“…sensory processing, including attention and regulation…”

“…specialised sensory techniques…”

“…SPD..is based in science”

 

I could go on…and on…and on. To be fair, I’ve cherry-picked the sensory stuff. OT’s talk about helping motor delays, handwriting, low tone, planning, organisation, etc. It’s the sensory side of things I want to focus on.

What is a Sensory Processing Disorder? Well, according to the woman who came up with the idea in 1972, Jean Ayres, sensory processing (or sensory integration as it was then known) is “the neurological process that organizes sensation from one’s own body and from the environment and makes it possible to use the body effectively within the environment”. So, if you have a problem with that “neurological process”, you have a sensory integration disorder, or SPD these days.

Sounds good so far. Seems to make some sort of sense. We’re all a product of our environment aren’t we? Let’s go with that Jean.

But wait a sec…we probably should show parents out there that 40 years later, there is good evidence that sensory integration has a neurological basis in science shouldn’t we? Here are some articles one could read…

  1. N/A
  2. N/A
  3. N/A
  4. N/A
  5. N/A
  6. Etc, etc

You mean there is no evidence? Nup, nope, no, nil, absolutely nothing. Surely Jean there is some evidence? Apparently not…

OK, so we’ll forgive Jean that slight hole in the story. Moving on. According to many OT’s, sensory processing difficulties are a Disorder. So SPD should be listed in the “big book of disorders” shouldn’t it? That would be the Diagnostic and Statistical Manual of Disorders (DSM). After all, since Jean’s great sensory integration revelation of 1972, there have been versions II (revised), III, III (revised), IV, IV (revised), and in 2013 DSM-5, where SPDs would be listed wouldn’t they?

Looking…

Looking…

Looking…

Nothing.

Despite extensive lobbying by those who advocate for SPDs, the DSM-5 committee chose not to include SPD in the latest version. Not only that, SPD wasn’t even given acknowledgment that it was a recognised area that needed further research.

Maybe third time lucky. What does the peak paediatric body in the US, the American Academy of Pediatrics say?

“The AAP recommends that pediatricians not use sensory processing disorder as an independent diagnosis”.

So where does that leave us?

No evidence.

No inclusion in DSM.

No recognition by peak medical or psychological bodies.

Yet, parents are told it exists. Parents are told that it can explain their child’s developmental and/or behavioural issues. Parents pay a lot of money to have “therapy” to treat a SPD (often for long periods). Kids are following “sensory diets”. Parents and schools are constructing “Sensory Rooms”. It’s hard to fathom.

Furthermore, just because an autistic child presents with well-accepted over-responsiveness to environmental stimuli, does not imply a separate Disorder. And so-called Sensory Integration Therapy will not “cure” that child of their autism.

Don’t get me wrong. There are fantastic OT’s out there who practice within an evidence base, who make remarkable differences to childrens’ and families’ lives, and who very importantly discharge children from their care when set goals are achieved. But their colleagues who peddle ideas from the 1970’s that have no basis in evidence, do the good OT’s a grave disservice. Not to mention the children they are treating.

Sensory Processing Disorder? Nothing but Pretend…

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