At 12:08 PM -0600 11/17/05, DeVolder Carol L wrote:
Colleagues,
I know that I've asked about this before, but I am so frustrated that I am asking again. Do any of you know anything about Sensory Integration Dysfunction? When I look for information, I find many enthusiastic reports on how successful it is in treating autism, and how it is an essential component of occupational therapy. It seems like pseudoscience to me, but I haven't been able to support my position yet. When I go to Quackwatch, I find information about auditory integration, but not sensory integration dysfunction in general. I also don't know how to handle it if it turns out that I am correct (about it being a pseudoscience). My university has an occupational therapy program and they make extensive use of the literature in support of SID. I routinely have students tell me how amazing it is. There are a number of products designed to treat SID (weighted blankets, special toys, workshops, etc.). I know how to deal with it if it turns out I'm wrong, but...
Thanks for any help or insight anyone can offer.
From QuackWatch:
================
Why "Sensory Integration Disorder"
Is a Dubious Diagnosis
Peter L. Heilbroner, MD, PhD
"Sensory integration" refers to the process by which the brain organizes and interprets external stimuli such as touch, movement, body awareness, sight, sound, and gravity. It has been postulated that certain behavioral and emotional problems result from the malfunctioning of this process. The term "sensory integration disorder (SID)" is used to characterize children who exhibit exaggerated sensitivity to sensory stimuli. The term was coined during the 1970s by A. Jean Ayres, PhD, OTR, an occupational therapist and licensed clinical psychologist who operated a private clinic and taught graduate students at the University of Southern California [1]. Ayres died in 1989, but the clinic she founded has been maintained [1].
Parents of children alleged to have SID typically describe an aversion to loud noises, coarse clothing textures, and particular tastes and textures of food. Many of these children are also clumsy and have a history of late attainment of developmental milestones (i.e., were late to learn to walk or talk). Others exhibit coordination and fine motor problems. These children also tend to have behavioral and social problems.
The methods used to treat these children include brushing the skin, using weighted clothing and special shoes, various exercises intended to improve coordination ("vestibular training"), and other techniques claimed to to "desensitize" or fine-tune the patient's nervous system. The therapies typically are expensive, involve months to years of weekly or more-frequent sessions, and imply to parents and children that there is, in fact, a problem that requires treatment.
Few pediatric neurologists believe that SID is a real diagnostic entity. We note that children with a range of neurodevelopmental and behavioral disorders, including attention-deficit/hyperactivity disorder, autism, and anxiety disorders also have "sensory issues" such as oversensitivity to touch. Many neurologists therefore feel that "sensory symptoms" are a nonspecific indicator of neurodevelopmental immaturity, not a sign of a distinct disorder. Yet thousands of children are sent for these therapies by their parents, at no small expense. Aetna considers sensory integration therapy experimental and does not pay for it [2]. However, a few insurance companies do cover it, and some school districts provide it.
Anecdotal evidence from parents is often used to support the existence of SID and the effectiveness of treatment. A review of the literature on sensory integration disorder reveals mostly poorly designed studies and flawed methodology. Studies with tiny sample sizes (as small as one patient!) are common [3-7]. Other studies investigate sensory symptoms in children with a serious underlying disorder such as autism [8-12], or mental retardation [13-16], and are therefore unlikely to be especially relevant to more normal children. Still other research assesses sensory therapies in the treatment of tangentially related conditions, like learning disability [17-23] or neuromotor delays [24-27]. In some cases where treatment appears to benefit, the therapies may simply be a calming influence on a nervous child. However, there are no adequate controlled studies either supporting the existence of SID as a distinct and definable entity, or clearly demonstrating the effectiveness of the therapies used for SID compared to no treatment at all [28-30]. In my experience, children diagnosed with "SID" are simply very anxious and come from a family that includes others who suffer from an anxiety disorder.
Peter L. Heilbroner, MD, PhD
"Sensory integration" refers to the process by which the brain organizes and interprets external stimuli such as touch, movement, body awareness, sight, sound, and gravity. It has been postulated that certain behavioral and emotional problems result from the malfunctioning of this process. The term "sensory integration disorder (SID)" is used to characterize children who exhibit exaggerated sensitivity to sensory stimuli. The term was coined during the 1970s by A. Jean Ayres, PhD, OTR, an occupational therapist and licensed clinical psychologist who operated a private clinic and taught graduate students at the University of Southern California [1]. Ayres died in 1989, but the clinic she founded has been maintained [1].
Parents of children alleged to have SID typically describe an aversion to loud noises, coarse clothing textures, and particular tastes and textures of food. Many of these children are also clumsy and have a history of late attainment of developmental milestones (i.e., were late to learn to walk or talk). Others exhibit coordination and fine motor problems. These children also tend to have behavioral and social problems.
The methods used to treat these children include brushing the skin, using weighted clothing and special shoes, various exercises intended to improve coordination ("vestibular training"), and other techniques claimed to to "desensitize" or fine-tune the patient's nervous system. The therapies typically are expensive, involve months to years of weekly or more-frequent sessions, and imply to parents and children that there is, in fact, a problem that requires treatment.
Few pediatric neurologists believe that SID is a real diagnostic entity. We note that children with a range of neurodevelopmental and behavioral disorders, including attention-deficit/hyperactivity disorder, autism, and anxiety disorders also have "sensory issues" such as oversensitivity to touch. Many neurologists therefore feel that "sensory symptoms" are a nonspecific indicator of neurodevelopmental immaturity, not a sign of a distinct disorder. Yet thousands of children are sent for these therapies by their parents, at no small expense. Aetna considers sensory integration therapy experimental and does not pay for it [2]. However, a few insurance companies do cover it, and some school districts provide it.
Anecdotal evidence from parents is often used to support the existence of SID and the effectiveness of treatment. A review of the literature on sensory integration disorder reveals mostly poorly designed studies and flawed methodology. Studies with tiny sample sizes (as small as one patient!) are common [3-7]. Other studies investigate sensory symptoms in children with a serious underlying disorder such as autism [8-12], or mental retardation [13-16], and are therefore unlikely to be especially relevant to more normal children. Still other research assesses sensory therapies in the treatment of tangentially related conditions, like learning disability [17-23] or neuromotor delays [24-27]. In some cases where treatment appears to benefit, the therapies may simply be a calming influence on a nervous child. However, there are no adequate controlled studies either supporting the existence of SID as a distinct and definable entity, or clearly demonstrating the effectiveness of the therapies used for SID compared to no treatment at all [28-30]. In my experience, children diagnosed with "SID" are simply very anxious and come from a family that includes others who suffer from an anxiety disorder.
It should be remembered that most children develop and improve their behavior spontaneously. Given the fact that few (if any) adult patients have sensory integration disorder, it is reasonable to question whether costly interventions are really necessary for what is a most likely a self-limiting problem of neurodevelopmental immaturity and anxiety. I also believe that children or families whose behavioral or anxiety disorders could benefit treatment would be better off seeking standard treatment than wasting time and money on unproven or irrational approaches.
Well-designed scientific studies are needed to determine whether or not SID is indeed a disorder, and even if so, whether the treatments currently prescribed are effective or necessary. Until studies along these lines are conducted, the diagnosis of SID should prompt a healthy degree of skepticism.
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
Ottenbacher K and others.
Nystagmus duration changes of learning disabled children during
sensory integrative therapy.
Perceptual Motor Skills 48:1159-1164, 1979.
22. White M. A first-grade intervention
program for children at risk for reading failure. Journal of Learning
Disabilities 12:26-32, 1979.
23. Schaffer R.
Sensory integration therapy with learning disabled children: A
critical review. Canadian Journal of Occupational Therapy 51:73-77,
1984.
24. Ayres AJ. Effect of
sensory integrative therapy on the coordination of children with
choreathetoid movements. American
Journal of Occupational Therapy 31:291-293, 1977.
25. Jenkins JR and
others. Comparison of sensory
integrative therapy and motor programming. American Journal of Mental Deficiency 88:221-224,
1983.
26. Burns YR. Sensory
integration or the role of sensation in movement. American Journal on
Mental Retardation 92;412, 1988.
27. American Academy of
Pediatrics Committee on Children with Disabilities. School-aged
children with motor disabilities. Pediatrics 76:648-649, 1985.
28. Hoehn TP, Baumeister AA. A critique of the application of sensory
integration therapy to children with learning
disabilities. Journal of Learning
Disabilities 27:338-350, 1994.
29. Description of sensory integration. Association for Science in Autism Treatment Web
site, accessed April 30, 2005.
30. Dawson G, Watling R. Interventions to facilitate auditory, visual, and
motor integration in autism: a review of the evidence. Journal of Autism and Developmental Disorders
30:415-421, 2000.
General References
* Arendt RE
and others. Critique of sensory
integration theory and its application in mental
retardation. American Journal of
Mental Deficiency, 92:401-429, 1988.
* Clark FA, Pierce
D. Synopsis of pediatric occupational therapy effectiveness: Studies
on sensory integrative procedures, controlled vestibular stimulation,
other sensory stimulation approaches, and perceptual-motor training.
Presentation for the Occupational Therapy for Maternal and Child
Health Conference. Santa Monica, CA, 1986.
* Denhoff E. Current status of infant
stimulation or enrichment programs for children with developmental
disabilities. Pediatrics, 67:32-37, 1981.
* Dunst CJ,
Rheingrover AM. An analysis of the efficacy of infant intervention
programs with handicapped children. Evaluation and Program Planning
4:287-323, 1981.
* Henderson A. Research
in occupational therapy and physical therapy with children: In Camp BW
(Ed.) Advances in Behavioral Pediatrics. Greenwich, CT: Jai Press,
1981.
* Kimball J. The emphasis is on integration, not
sensory. American Journal on Mental Retardation, 92:423- 424,
1988.
* Kinsbourne M, Caplan P.
Children's learning and attention problems. Boston: Little, Brown
and Company, 1979.
* Ottenbacher KJ. Sensory integration:
myth, method, and imperative. American Journal on Mental Retardation
92:425-426, 1988.
* Ottenbacher K. Sensory integration therapy: Affect or
effect. American Journal of
Occupational Therapy 36:571-78, 1982.
* Ottenbacher
K, Short MA. Sensory integrative dysfunction in children: A review of
theory and treatment. Advances in Developmental and Behavioral
Pediatrics 6:287-329, 1985.
* Pearson PH. The results of treatment: the
horns of our dilemma. Developmental Medicine and Child Neurology
2:417-418, 1982.
* Taft L. Are we handicapping the
handicapped? Developmental Medicine and Child Neurology, 14:703-704,
1972.
* Tickle L. Perspectives in the status of sensory integration
theory. American Journal of
Occupational Therapy 42:427-433, 1988.
------------------------------------------------------------------------
Dr. Heilbroner practices pediatric neurology at The Valley Hospital in Ridgewood, New Jersey.
This article was posted on May 1, 2005.
22.
23.
24.
25.
26.
27.
28.
29.
30.
General References
*
*
*
*
*
*
*
*
*
*
*
*
*
------------------------------------------------------------------------
Dr. Heilbroner practices pediatric neurology at The Valley Hospital in Ridgewood, New Jersey.
This article was posted on May 1, 2005.
--
The best argument against Intelligent
Design is that fact that people believe in it.
* PAUL K.
BRANDON
[EMAIL PROTECTED] *
* Psychology Dept Minnesota State University *
* 23 Armstrong Hall, Mankato, MN 56001 ph 507-389-6217 *
* http://www.mnsu.edu/dept/psych/welcome.html *
* Psychology Dept Minnesota State University *
* 23 Armstrong Hall, Mankato, MN 56001 ph 507-389-6217 *
* http://www.mnsu.edu/dept/psych/welcome.html *
---
You are currently subscribed to tips as: [email protected]
To unsubscribe send a blank email to [EMAIL PROTECTED]
