Pediatricians raise caution on sensory-based therapy
Occupational therapy for kids who are over- or under-sensitive to sound, touch or other senses could help improve their symptoms - but parents and doctors should be careful not to miss an underlying disorder in those children, pediatricians said today.
So-called sensory integration therapy, in which occupational therapists use brushes, swings, balls, music and other tools to help kids adapt to external stimuli, has been controversial among doctors.
One issue is whether kids who are overly sensitive to noise, for example, actually have problems with pathways in their brains involved in processing and responding to sound - or if that’s just one sign of a developmental disorder, such as autism.
“That’s the concern - sensory processing disorder might just be a symptom of another underlying developmental problem,” said Dr. Michelle Zimmer, from Cincinnati Children’s Hospital Medical Center, who co-wrote new guidelines on sensory integration therapy for the American Academy of Pediatrics.
“It actually could be that working with an occupational therapist is helpful, but the only caution is that we would like to diagnose the other underlying disorders that go along with sensory problems,” she told Reuters Health.
Young kids who have difficulty with sensory processing may cover their ears when a bell rings or they hear loud voices, chew and suck on inedible objects or rock back and forth in their chairs, for example.
Sensory-Based Therapies
Sensory-based approaches to treating Autism Spectrum Disorders (ASDs) concentrate on correcting or improving the body’s abnormal response to external stimuli.
We all experience the world through our senses- sight, smell, touch, taste and sound. We interpret and react to our surroundings based on information the brain receives from our eyes, nose, skin, tongue, and ears. For the entire time we are awake, these varied sensory organs are continuously sending information to the brain. For those of us without an ASD, the brain filters this constant flow of incoming sensory messages and is able to ignore those that are not relevant at the time.
For example, as I sit at my computer and type, I am only aware of the words appearing on the screen and my fingertips stroking the keys on the keyboard. However, if I allow myself to focus on all incoming sensory messages, I can also hear typing sounds from my colleague’s office, a vehicle passing by, and the low hum of the office heater. I can see the stacks of papers piled on my desk and streaks of sunlight coming through the window blinds. I can feel my clothing against my skin, and even taste the last drops of my morning coffee. Fortunately, for most the day, I am completely unaware of these other sources of sensory information. I am able to concentrate just on the work in front of me.
For many individuals with an ASD, however, this necessary filtering of unimportant sensory input doesn’t happen. The streaks of light coming through the window blinds may be mesmerizing, while the low hum of the heater may be unbearably irritating. This inability to block out normal “background” stimuli sometimes produces a state of “sensory overload” in individuals with an ASD, disrupting their ability to focus and concentrate, which are necessary skills for learning and communicating. The difficulty is not with one specific sense, but with how multiple senses are experienced all at once.
There are a variety of therapies that attempt to help individuals with ASDs by addressing not only these sensory issues, but the impact they have on the brain. Two of the most well known of these are Sensory Integration Therapy and Auditory Integration Therapy.
Children with a range of developmental disorders - including attention-deficit/hyperactivity disorder, anxiety and autism spectrum disorders - may have those types of symptoms, according to the recommendations published in Pediatrics.
But sensory-related problems don’t tend to show up on their own as isolated issues, Zimmer said.
“There are no studies out there that really show that there’s such a thing as a stand-alone diagnosis of a sensory processing disorder,” she said.
For that reason, the recommendations aimed at pediatricians include not using sensory processing disorder as its own diagnosis, but instead evaluating kids for underlying developmental problems.
Sensory-based Treatment for Adults With Developmental Disabilities
In recent years there has been increased focus on sensory-based and sensory-integrative treatment with adults with developmental disabilities, similar in theory and practice to that for children. (Pfieffer and Kinnealey, 2005) Specific assessments have been developed with the adult population in mind. (e.g., Hanschu and Reisman, 1992)
Adults with profound mental retardation may have problems with severe self-injurious behavior (SIB). In some cases, sensory-based treatment has been found to be effective in reducing this problem. (Reisman, 1992) In other cases, sensory-based treatment has reduced agitation and promoted relaxation in adult clients with developmental disabilities (DD).
In one facility in Minnesota, the success of a sensory-based treatment approach in reducing problem behaviors led to widespread support of the program by the majority of the staff, not just the therapists. (Hanschu, 1998)
In general, sensory-based treatment is most effective when it is done frequently and consistently. (Reisman, 1992) This suggests that frequent access to sensory equipment or modalities is helpful. It is essential as well that all staff be provided education and understand the nature of sensory-based treatment.
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By Jeanne Shepard
They also call for talking to families about the limited evidence supporting therapy focusing on sensory processing.
Roseann Schaaf, an occupational therapist from Thomas Jefferson University in Philadelphia, said she agrees there shouldn’t be a separate diagnosis for sensory processing disorder, but said sensory-related treatment can still be a useful part of therapy for kids with other underlying issues.
The recommendation paper “does not consider that the intervention is individually tailored to each child’s needs,” Schaaf, who has studied sensory problems and their treatment, told Reuters Health in an email.
“Unfortunately, it is likely that pediatricians will interpret this article to mean that occupational therapy using sensory integration is not helpful - when in fact, the evidence is mounting that it is helpful for many children,” she concluded.
SOURCE: Pediatrics, online May 28, 2012