I think a milestone just happened.
The American Academy of Pediatrics (AAP) published a new policy statement this month regarding sensory integration therapies for children with developmental and behavioral disorders. The fact that this statement exists is HUGE!!! While I think overall, the statement leaves the reader with a negative and skeptical impression of sensory-based interventions, the information within the statement is accurate. One needs to read with the intention of critically appraising and with the filter of remembering it is a document intended to guide pediatricians in making clinical decisions. The statement does support an outcomes based approach to using sensory interventions, which is the way any OT interventions should be offered, AND the statement acknowledges the potential benefit of sensory interventions for some children!!! Did you read that?! THE AAP ACKNOWLEDGES THE POTENTIAL BENEFIT OF SENSORY INTERVENTIONS FOR SOME CHILDREN!!! The fact that the AAP acknowledges ANY potential benefit AND that they wrote a policy statement on it, are significant signs of progress in the field of Occupational Therapy, in my opinion. Hat’s off to the lead clinicians and researchers in my field! The statement reads:
“Despite the challenges of defining and studying the effectiveness of sensory integration therapy, it is possible that the treatment of sensory processing difficulties is helpful to children who have problems identified in sensory processing measures.”
What this says to me is that while the research may not be sufficient enough to validate sensory integration as a standard treatment protocol, there are some children being identified with sensory processing problems and some of those children may benefit from treatment to address those challenges. Additionally, the measures being used to identify these children, may also have some validity. The statement also suggests that pediatricians support families in advocating for a “trial” period of intervention when using sensory based therapies, which inherently means that the AAP considers that a trial of sensory integration therapy may be worth considering for some children. I for one am thrilled that the AAP has come to this conclusion.
However, not everyone agrees with my positive take on this AAP statement (surprise, surprise). There are some OT’s and many parents who are very upset by the negative criticisms found within the article and while I agree that the article puts Pediatricians at the helm of the treatment process, despite not being the experts in identifying and treating sensory processing challenges, and it does suggest pediatricians not “diagnose” sensory processing disorder, which sounds like the AAP does not validate the existence of sensory processing challenges . What the article states is: “Because there is no universally accepted framework for diagnosis, sensory processing disorder generally, should not be diagnosed.” What is doesn’t explicitly clarify is that currently there is no such medical “diagnosis” of sensory processing disorder in the diagnostic manual, making it impossible for doctors to give the “diagnosis” in the first place, and that the process of attempting to get the diagnosis included in the manual as its own entity is still underway. It also does NOT encourage pediatricians to use the diagnoses that DO exist for infants and young children in the O-3 classification, which does include “Regulation Disorders of Sensory Processing”. It should also be noted that the AAP statement is somewhat hypocritical in that it criticizes the existing sensory integration research yet cites ONE study against sensory interventions with a sample size of 4 (I’m not a qualified researcher but even I know that’s not a gold standard study due to lack of a representative sample). I am unhappy because the AAP recommends that pediatricians “educate” families about the limitations of Occupational Therapy, which could leave the reader feeling skeptical about my services and may over-ride the initial acknowledgements made early on in the paper. That said, as big as my ego may be sometimes when it comes to my clinical skills, even I try to articulate the potential limitations of my services, so that families can make informed decisions about the treatment choices for their children. That said, the medical profession is limited as well and I wish that the article instead of encouraging increased awareness of the limitations of occupational therapy, would emphasize the potential benefits of occupational therapy but state NO ONE DISCIPLINE can be effective for ALL types of challenges and often children with sensory processing challenges need multiple types of providers and interventions, over the course of their treatment. Further research is still needed to fully discern the treatment protocols most indicated for effectively managing sensory processing challenges. I am chalking it up to the “process” of the medical establishment and the medical model around which our health system is structured and hope the mere fact this statement now exists, will open doors to discussion and opportunity for education and research at a global AND individual level. I for one, will be forwarding to multiple pediatricians I know, with the POSITIVES highlighted! I recognize that pediatricians are often the first place a struggling parent with a struggling child, might turn. Thus pediatricians need guidelines. This new policy statement is a guideline and I believe it is one strong step in the evolution toward greater understanding and mainstream acceptance of how to effectively treat sensory processing challenges. It will happen. It is just a matter of time and I was pleased to find Dr. Gold (a physician by the way) who agrees. She goes even further, to suggest that sensory processing may actually be at the root of many already “diagnosable” conditions, including anxiety, AD/HD, depression and autism. Yesterday in her article, “Could Sensory Integration Disorder be the Primary Problem”, she wonders out loud:
“…I wonder, as we learn more about the genetics and neuroscience of mental illness, we will find that the sensory processing issue is primary, and we simply organize the range of symptoms that may result from this problem into categories, in the form of diagnoses such as autism, OCD, anxiety and depression. These may in fact all be regulatory sensory processing disorders.”
Wouldn’t that be a turn-around?! For those of you unfamiliar with the challenges faced by myself and many OT’s, parents and other professionals, in trying to advocate for services to people who are uninformed and unconvinced of the effectiveness of the services we provide, or even the validity of the existence of the problem in the first place, imagine my delight in not only encountering a physician who suggests that sensory processing may not just be associated with other diagnoses, but may actually be CAUSING them?! To find the national organization of pediatricians acknowledging there may be some validity to both the existence of sensory processing challenges AND treatment to address these challenges is a milestone event in my career and despite the lingering concerns I’ve raised above, I am using my “glass half-full philosophy” to consider the new policy statement an endorsement of my services and revel in the potential that exists by way of having this new AAP document, however it’s written.