Sensory Processing Disorder & Diagnosis – A Call for More EBP in Pediatric Occupational Therapy Practice

Sensory Processing Disorder Featured

EBP = Evidence-based practice

Current SPD Trends

Many OT students, as did I, learned about Sensory Processing Disorder (SPD) in school. It is very much talked about and is very ‘OT’. I see many OT accounts on social media such as IG making content about SPD, selling products related to SPD, or using it as lead-generation for their businesses, e.g. private pediatric OT clinics.

Chris of ABC Therapeutics (who has been doing OT way longer than I have and practices in pediatrics as well as teaches), mentions that there is “no formally recognized clinical designation of ‘sensory processing disorder. It is a term constructed by occupational therapists that has not been formally recognized by the larger medical community.”

SPD was in fact renamed several times and called different terms before.

He further adds,

“I would like to encourage my occupational therapy colleagues to reconsider the way that they talk to families about these matters.  There are pages and pages of Google search results that point parents to a mythological sensory ‘diagnosis’ – and this far outstrips the actual incidence of significant developmental problems that may have sensory modulation difficulties as a feature (e.g. autism).”

Controversy

  1. Occupational therapists don’t diagnose.
  2. Doctors diagnose.
  3. But SPD is not recognized as a medical diagnosis, e.g. DSM.
  4. Then why are children being “diagnosed” with SPD?

Edit: It appears that SPD is described in other manuals besides the DSM.

Adam Lanza, the suspect in the Sandy Hook school shooting may have brought some attention to SPD, particularly because he was believed to have it,

During FRONTLINE’s and The Hartford Courant‘s investigation into the Newtown tragedy, one potentially important clue came in an email from a family member. According to the message, Lanza as a young boy had been diagnosed with sensory integration disorder (SID). The condition — also known as sensory processing disorder or sensory integration dysfunction…”

Lanza was later diagnosed with Asperger’s.

The American Academy of Pediatrics (AAP) advises against using SPD as a diagnosis. “When these sensory symptoms are present, other developmental disorders … must be considered and thoroughly evaluated.”

Dr. Miller of the Sensory Processing Disorder Foundation made these comments,

Dr. Lucy Jane Miller, Ph.D., founder and research director of the Sensory Processing Disorder Foundation, comments on how the reported symptoms by the shooter, Adam Lanza, are a classic indicator of a form of Sensory Processing Disorder (SPD).

“Our hearts go out to the families impacted by the tragedy in Newtown, Connecticut. Reports that Adam Lanza, the shooter, felt no pain indicates he likely experienced Sensory Under-Responsivity, one of the six forms of SPD, found in virtually all children with an autism spectrum disorder. The suggestion that Lanza suffered a rare and exotic condition reflects the widespread unawareness of SPD. In reality, SPD is a common neurological condition that affects at least 1 in 20 children.”

“SPD is not included in the fourth edition of the Diagnostic and Statistical Manual (DSM-IV), published in 1994, which is typically used by health care providers to diagnose and prescribe treatment options. Unless identified in a diagnostic manual, like the DSM, children rarely get the help they need.”

“When diagnosed and treated early, children with SPD are able to function well in society. Typically, treatment for SPD involves occupational therapy with a sensory approach. Unfortunately, lack of a diagnostic code means that treatment is not covered by insurance.”

“Without treatment, children with SPD are at high risk for many emotional, social, and educational problems, including the inability to make friends or be a part of a group, poor self-concept, academic failure, and being labeled clumsy, uncooperative, belligerent, disruptive, or out of control. Anxiety, depression, aggression, or other behavior problems can follow.”

Understandably, this statement upset many parents and families.

Children are Still Being Treated for SPD

In another blog post titled, “Time to throw in the towel on sensory processing assessment”, Chris describes some of the costs that families are paying to “treat” SPD,

“Occupational therapists can’t bill insurance for this therapy and that the costs are $175 per session and are needed for 18 or 30 sessions, depending on who you ask.  Maybe it depends on credit card limits in different geographic localities, I am not sure.  The fact that the cost for this therapy can range from $3000 to $5000 is in itself a red flag that should make most parents squeeze their wallets shut and run for the hills.  The fact is that there is no consensus on frequency of these interventions and there is also no consensus if this ‘intensive sensory’ approach has any merit.”

Moving Forward