Sensory Integration

It was long overdue and for my tastes a bit watered down, but I must say that the American Academy of Pediatrics’ recent policy statement on sensory integration therapies (Pediatrics 2012;129:1186-89) is a nice piece of work. It stops short of saying that sensory integration therapies have little or no value. But, I guess I can defend their cautious approach. While there don’t seem to be any good studies to support those therapies, there is always a small chance that they might help the rare child with developmental and/or emotional problems. Over the last 30-plus years, I haven’t observed any situations in which therapies such as brushing or textured diets have helped. But then I may have nodded off once or twice.

The policy statement includes some broad recommendations on how pediatricians might wean families off therapeutic regimens that aren’t working. It mentions education and setting time limits after which pediatricians and parents should revisit the decision to continue the therapy and ask if it has been meeting stated goals.

I think it would have been helpful to include in the statement some sample language and talking points to assist in the process. Not all of us, myself certainly included, can always come up with the best words in situations like this. I fear that on a bad day I might say something like, "That stuff is bunk!" and figure that the issue was dead. Of course most parents will understandably recoil at such insensitivity, and I will have lost any chance I might have had in getting the ship going in a better direction.

The unfortunate irony hidden in the whole sensory integration rat’s nest is that while the therapies probably have little value, the label of "disorder" can be reassuring to many parents. For years they may have struggled to figure out how to help their child who has seemed different. When an occupational therapist describes to a parent the features of a typical child with a "sensory integration disorder," it may be the first time anyone has said or implied, "You aren’t alone. There are other children who behave this way. In fact we have a name for it."

The problem comes when the therapist takes the next step and says, "And there are some therapies that we can do to help it." The problem is that the evidence doesn’t support that leap from label to therapy. What we need is a new set of labels that avoid words like "disorder" or "syndrome," which might suggest that some therapy or intervention is necessary.

Most, if not all, of the children I have seen whose primary diagnosis is a sensory integration disorder are normal. They may be extremely sensitive to sounds or textures or tastes or smells or being touched or all of the above. But they are normal and with time will lose some and maybe all of that hypersensitivity. What they need is to be understood. They will benefit from having their environment adjusted to accommodate their peculiarities (not abnormalities). Until they mature. Parents, teachers, relatives, and caregivers must be coached to change their expectations.

The hypersensitive child may not do well in the relative chaos that his older brother has thrived in. He may not accept textures that his omnivorous sister devoured. He may require more space than his classmates. Maybe his behavior is a manifestation of anxiety ... probably the greatest mimic in the cast of emotional actors.

Unfortunately, it is often difficult for all of us to ignore or abandon an active (but ineffective) intervention and accept a strategy that includes patience, altering expectations, and adjusting lifestyles. One could argue, "What damage is done by continuing a therapy that may not have been proved effective, but seems to be harmless?" My answer would be that these therapies are probably diverting parental attention, and siphoning time and resources away from activities that will be more beneficial to the child and his family.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him at [email protected].

It was long overdue and for my tastes a bit watered down, but I must say that the American Academy of Pediatrics’ recent policy statement on sensory integration therapies (Pediatrics 2012;129:1186-89) is a nice piece of work. It stops short of saying that sensory integration therapies have little or no value. But, I guess I can defend their cautious approach. While there don’t seem to be any good studies to support those therapies, there is always a small chance that they might help the rare child with developmental and/or emotional problems. Over the last 30-plus years, I haven’t observed any situations in which therapies such as brushing or textured diets have helped. But then I may have nodded off once or twice.

The policy statement includes some broad recommendations on how pediatricians might wean families off therapeutic regimens that aren’t working. It mentions education and setting time limits after which pediatricians and parents should revisit the decision to continue the therapy and ask if it has been meeting stated goals.

I think it would have been helpful to include in the statement some sample language and talking points to assist in the process. Not all of us, myself certainly included, can always come up with the best words in situations like this. I fear that on a bad day I might say something like, "That stuff is bunk!" and figure that the issue was dead. Of course most parents will understandably recoil at such insensitivity, and I will have lost any chance I might have had in getting the ship going in a better direction.

The unfortunate irony hidden in the whole sensory integration rat’s nest is that while the therapies probably have little value, the label of "disorder" can be reassuring to many parents. For years they may have struggled to figure out how to help their child who has seemed different. When an occupational therapist describes to a parent the features of a typical child with a "sensory integration disorder," it may be the first time anyone has said or implied, "You aren’t alone. There are other children who behave this way. In fact we have a name for it."

The problem comes when the therapist takes the next step and says, "And there are some therapies that we can do to help it." The problem is that the evidence doesn’t support that leap from label to therapy. What we need is a new set of labels that avoid words like "disorder" or "syndrome," which might suggest that some therapy or intervention is necessary.

Most, if not all, of the children I have seen whose primary diagnosis is a sensory integration disorder are normal. They may be extremely sensitive to sounds or textures or tastes or smells or being touched or all of the above. But they are normal and with time will lose some and maybe all of that hypersensitivity. What they need is to be understood. They will benefit from having their environment adjusted to accommodate their peculiarities (not abnormalities). Until they mature. Parents, teachers, relatives, and caregivers must be coached to change their expectations.

The hypersensitive child may not do well in the relative chaos that his older brother has thrived in. He may not accept textures that his omnivorous sister devoured. He may require more space than his classmates. Maybe his behavior is a manifestation of anxiety ... probably the greatest mimic in the cast of emotional actors.

Unfortunately, it is often difficult for all of us to ignore or abandon an active (but ineffective) intervention and accept a strategy that includes patience, altering expectations, and adjusting lifestyles. One could argue, "What damage is done by continuing a therapy that may not have been proved effective, but seems to be harmless?" My answer would be that these therapies are probably diverting parental attention, and siphoning time and resources away from activities that will be more beneficial to the child and his family.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him at [email protected].

It was long overdue and for my tastes a bit watered down, but I must say that the American Academy of Pediatrics’ recent policy statement on sensory integration therapies (Pediatrics 2012;129:1186-89) is a nice piece of work. It stops short of saying that sensory integration therapies have little or no value. But, I guess I can defend their cautious approach. While there don’t seem to be any good studies to support those therapies, there is always a small chance that they might help the rare child with developmental and/or emotional problems. Over the last 30-plus years, I haven’t observed any situations in which therapies such as brushing or textured diets have helped. But then I may have nodded off once or twice.

The policy statement includes some broad recommendations on how pediatricians might wean families off therapeutic regimens that aren’t working. It mentions education and setting time limits after which pediatricians and parents should revisit the decision to continue the therapy and ask if it has been meeting stated goals.

I think it would have been helpful to include in the statement some sample language and talking points to assist in the process. Not all of us, myself certainly included, can always come up with the best words in situations like this. I fear that on a bad day I might say something like, "That stuff is bunk!" and figure that the issue was dead. Of course most parents will understandably recoil at such insensitivity, and I will have lost any chance I might have had in getting the ship going in a better direction.

The unfortunate irony hidden in the whole sensory integration rat’s nest is that while the therapies probably have little value, the label of "disorder" can be reassuring to many parents. For years they may have struggled to figure out how to help their child who has seemed different. When an occupational therapist describes to a parent the features of a typical child with a "sensory integration disorder," it may be the first time anyone has said or implied, "You aren’t alone. There are other children who behave this way. In fact we have a name for it."

The problem comes when the therapist takes the next step and says, "And there are some therapies that we can do to help it." The problem is that the evidence doesn’t support that leap from label to therapy. What we need is a new set of labels that avoid words like "disorder" or "syndrome," which might suggest that some therapy or intervention is necessary.

Most, if not all, of the children I have seen whose primary diagnosis is a sensory integration disorder are normal. They may be extremely sensitive to sounds or textures or tastes or smells or being touched or all of the above. But they are normal and with time will lose some and maybe all of that hypersensitivity. What they need is to be understood. They will benefit from having their environment adjusted to accommodate their peculiarities (not abnormalities). Until they mature. Parents, teachers, relatives, and caregivers must be coached to change their expectations.

The hypersensitive child may not do well in the relative chaos that his older brother has thrived in. He may not accept textures that his omnivorous sister devoured. He may require more space than his classmates. Maybe his behavior is a manifestation of anxiety ... probably the greatest mimic in the cast of emotional actors.

Unfortunately, it is often difficult for all of us to ignore or abandon an active (but ineffective) intervention and accept a strategy that includes patience, altering expectations, and adjusting lifestyles. One could argue, "What damage is done by continuing a therapy that may not have been proved effective, but seems to be harmless?" My answer would be that these therapies are probably diverting parental attention, and siphoning time and resources away from activities that will be more beneficial to the child and his family.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him at [email protected].