Sensory Processing Disorder, or SPD, is quite the hot topic in the pediatric world these days. Since occupational therapists are the ones that these children are referred to for therapy, I often get a lot of questions on the subject. Here are just a few of the questions I receive on a frequent basis:
1. What is Sensory Processing Disorder?
In the simplest of explanations – a person has difficulty processing and interpreting sensory information (i.e.: smell, hearing, vision, taste, touch, and movement). This in turn impacts how they respond to sensory input.
For example: Imagine your body has trouble processing touch input. A light brush on the arm feels like a million needles. Could you ignore that? Of course not, it would drive you crazy! Not to mention the fact that you would begin to feel anxious as to when the next touch experience would come. Locked in a “fight or flight” response to sensory input, life would most likely be a constant struggle for you.
That’s just one example of Sensory Processing Disorder. One person might be over-responsive to sensory input, while another might be under-responsive. Everyone is different. If you dive deeper into the diagnosis you can also get into sensory modulation disorders, difficulty with praxis, and all of that good stuff. But for now let’s just speak of sensory processing in the most basic of terms.
I like to tell people that we all have some sort of sensory “quirks”. Some people can’t stand wool sweaters or touching something slimy in the kitchen sink. Someone might require complete silence to study, and another might need to jog every morning in order to stay focused at work.
So what’s the difference between a sensory preference and SPD? With SPD, the sensory issues impact your ability to function or participate in daily activities. If your shirt bothers you so much that you can’t even get dressed in the morning, you’re going to have a hard time keeping that office job of yours.
2. Is Sensory Processing Disorder Real?
That depends on how you phrase the question. Is SPD a real condition? YES!! A thousand times YES! If you ever want to disagree with me on this then come on over to my clinic and I’ll introduce you to some of my friends.
However, is SPD an actual diagnosis? Eh, not definitively…many professionals still refute it. Some groups are pushing to get SPD an official spot in the DSM-V, (The Diagnostic and Statistical Manual- the manual used for diagnosis of mental disorders) but as of now it’s not looking so good.
3. What is the controversy over Sensory Processing Disorder?
This is a cop-out to say, but the phrase “we need more research” gets thrown out a lot. Apparently people feel as if the evidence is too anecdotal, and more intense clinical research needs to be done. See question 4 for more on this.
The diagnosis is also considered “vague.” Since it encompasses so many symptoms, people feel as if it’s just another label thrown at a kid.
As I said before, it’s not actually in the DSM. Therefore, those who know nothing about the diagnosis (and aren’t willing to learn anything about it, either) might automatically dismiss what people try to tell them. This includes the following important groups:
There are some doctors that refuse to acknowledge SPD, and make their stance on this known to anyone that will listen. They don’t see the medical validity to the diagnosis and often say to a parent “they’ll grow out of it.” (This phrase drives me up the wall, by the way.) I’ve even heard of a doctor reprimanding a therapist colleague for bringing the subject up at a meeting.
Some OT’s don’t even believe SPD is a real diagnosis. They criticize sensory integration theory and look down on those that practice it. Sad to say, but we are often looked at as the “fluff” of occupational therapy.
Some insurance companies specifically exclude coverage for sensory integration therapy, claiming it is “unfounded in research” and “experimental therapy”. That last one makes it sound like OT’s are mad scientists, doing some crazy experiments on kids. It also makes it very challenging for a parent to receive services for their child.
4. Why is there no research to back it up?
Well, there is research out there if you look for it. The problem is that a lot of it is based on “case studies”, meaning a research paper on one person’s progress.
In the medical world, in order to have a quality, well-respected clinical trial, you have to have a large sample and a control group. This means gathering a lot of people with the exact same symptoms and comparing their progress against a control group of people with typical sensory systems.
How in the world are you going to do that with this diagnosis? It’s darn near impossible. Every person presents differently, and there are often other diagnoses that coincide with the diagnosis of SPD, muddying up the entire research process.
Another problem is that the majority of the data collection and screening process for SPD is based on parent report. Parents’ opinions of their children are subjective, to a fault at times. I’ve had a client that I knew was a huge sensory mess, but when I got the paperwork back from the parent, everything they marked on the form scored in the “typical” ranges. It was maddening.
Also, there are not a lot of universal “interventions” to track. Therapists don’t all practice sensory integration in the same way, so how to do know what is working or not? (Refer to my explanation of therapist preferences HERE for more insight on this.)
Don’t forget, we OT’s also look like crazy hippies with our brushes, swings, and squishing people with weighted things. (This is another awesome quote from a parent about OT, and I kind of love it.)
5. What do I think about SPD?
So glad you asked. I happen to be one of the most skeptical people ever. Sometimes I find it hard to believe that I am in a profession that many people like to refute or say is nonsense. But yes, I know SPD is a real condition. I also know that therapy helps improve not only the child’s life, but their family’s as well.
On the flip side, I do feel that the word “sensory” is thrown around with a bit too much laxity. Some people refuse to believe that behaviors are not “sensory” related. Others ignore a true ADHD diagnosis in lieu of purely “sensory” intervention.
All in all, I think we need better screening and education regarding the topic of SPD. And while I work on that, could someone get to work on those amazing clinical trials that will shut everyone else up? Thanks