Pediatrician
Dr. Shapiro completed his undergraduate education at UC San Diego, earning a B.S. in Biochemistry and Cell Biology, and a B.A. in Political Science. He furthered his education at UCLA where he earned a Masters Degree in Public…
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Is Sensory Processing Disorder a Real Diagnosis?
Posted in Sensory Integra... by Dr. Jeremy F. Shapiro on May 31, 2012
When I was pediatric resident a decade ago, I recall spending a rotation with a developmental pediatrician at my hospital and walking away from the experience with something I still find rather remarkable. It was this physician’s opinion that sensory processing disorder (SPD) was not a real diagnosis. So during the first couple of years following residency, as I began my pediatric career, I often felt conflicted trying to explain how a number of children I cared for didn’t have SPD despite having overwhelming sensory issues; whether those issues were related to sight, sound, balance, touch, or even taste. I ultimately rectified the conflict in my mind by making the assumption that my senior did not believe SPD was a stand-alone diagnosis, but in fact, sensory issues were just a component of other “larger” developmental disorders (e.g. ADHD, autism spectrum, anxiety disorder.)

Fast forward through the last 10 years and after caring for thousands of patients, I say without reservation that sensory issues are an overwhelming childhood concern and SPD should be included in the next addition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5.) Yes, autistic children often have sensory issues and I’ve noticed many children with sensory concerns have a greater level of anxiety; but often I will see children, who I believe, only have sensory issues. And when I do refer to developmental pediatricians for clarification, they often agree as they too use the SPD diagnosis and recommend an occupational therapist as part of the treatment plan.

But in the June edition of Pediatrics, a new policy statement from the American Academy of Pediatrics (AAP) recommends that pediatricians not use SPD as an official diagnosis. In fact, there are a total of 4 recommendations in the policy statement (see below) and all of them stem from the concern there is a lack of research in this area.
1. As just mentioned, pediatricians should not use SPD as a diagnosis with the recommendation of trying to determine what underlying other developmental disorder is at play (e.g. anxiety disorder, ADHD, autism spectrum.)

2. Families need to be made aware there is limited evidence on the effectiveness of sensory-based therapies (often performed by an occupational therapist as mentioned above.)

3. If sensory-based therapies are being used, the role of the pediatrician should include teaching the families how to determine if the therapy is helping.

4. Families need to be made aware occupational therapy is a limited resource and prioritizing treatment is key in order to maximize the child’s ability to perform daily functions, whether it be at school, home, or even with friends.
Now if you’ve read my writings these last few years, you know I am a believer of evidence-based medicine. But as I’ve had so many children I care for with sensory issues find such great success in working with occupational therapists, I do hope this new policy statement doesn’t deter pediatricians from continuing their use in the future.

And as always, please feel free to jump in the discussion here.

- Dr. Jeremy

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As a pediatric occupational therapist, I am truthfully also skeptical of SPD as a stand-alone diagnosis. Then again, I'm a new practitioner, so my lack of experience may be a bias. That being said, I also find great success in the sensory-based strategies I use to help these children, regardless of an official SPD "diagnosis".

I also have an opinion about the suggestions made by the AAP. In my mind, helping parents understand how to track progress should be the job of a good therapist who is treating the child for sensory issues on a weekly basis, not the physician who see's the child once in a blue moon. It should be the therapist's job to make objective, measurable goals with the parents and use assessments that can show change over time. Maybe that's the point the AAP is making, and I'm over-thinking the statement :)
By sarahOT  Dec 21, 2013
8
As a pediatric occupational therapist, I am truthfully also skeptical of SPD as a stand-alone diagnosis. Then again, I'm a new practitioner, so my lack of experience may be a bias. That being said, I also find great success in the sensory-based strategies I use to help these children, regardless of an official SPD "diagnosis".

I also have an opinion about the suggestions made by the AAP. In my mind, helping parents understand how to track progress should be the job of a good therapist who is treating the child for sensory issues on a weekly basis, not the physician who see's the child once in a blue moon. It should be the therapist's job to make objective, measurable goals with the parents and use assessments that can show change over time. Maybe that's the point the AAP is making, and I'm over-thinking the statement :)
By sarahOT  Dec 21, 2013
7
Is sequencing(dyslexia)disorder a type of sensory disorder? I have ADHD (diagnosed at UBC & by 2 independent psychiatrists, because I didn't believe in It)and when I had psycho-educational testing done at school, they confirmed sequencing disorder (I knew there was a problem but not what it was)I take dexadrine sometimes combined with wellbutrin(excellent results)
By constructiongramma  Mar 10, 2013
6
As a Special Ed. teacher and a mom of a kid with undiagnosed SPD issues, I wholeheartedly agree. So many of my students with ADHD have hidden sensory issues and would greatly benefit from OT services, so I have learned many OT strategies to use with my students on my own.
By anewdebbie  Oct 21, 2012
5
As a Special Ed. teacher and a mom of a kid with undiagnosed SPD issues, I wholeheartedly agree. So many of my students with ADHD have hidden sensory issues and would greatly benefit from OT services, so I have learned many OT strategies to use with my students on my own.
By anewdebbie  Oct 21, 2012
4
I am a pediatric Occupational therapy assistant. And I am a mom of a child with sensory processing disorder. I was telling my child's pediatrician from the time he was one that something was "off". after 10 years she finally listened to me and we sought out OT. I don't understand why it is that Doctors have such a hard time wrapping their brains around the fact that sensory processing disorder is a stand alone diagnosis that just means that the nervous system is under/over developed in some areas. If it's possible to need glasses to fix a little bit of a sight problem or a lot of a sight problem (which is a sensory organ) why can't you need therapy to fix a touch problem, or a sensitive hearing problem. When it gets to a point where a child is shutting down so they can't cope with sensory input, there needs to be a way to fix it with out labeling them with heavy diagnoses that they don't need!
By equillman  Sep 25, 2012
3
Thanks for this. My daughter has sensory processing disorder despite a negative autism diagnostic and a negative ADHD diagnostic. Her affect recognition is in the 85th percentile, her theory of mind is low average, and her communication is above average with the exception of related central auditory processing problems (figure/ground auditory filtering.) Her cognitive is 94th to 98th percentile on Wechsler tests. Our family is riddled with autism on both sides, and we see our daughter as perhaps having inherited bits and pieces but not the entire 'autism package'. As Temple Grandin has asserted, sensory problems and related anxiety are terribly debilitating. I've had a lifelong anxiety disorder, and so did my father, but I didn't realize it was because of sensory problems until my daughter was diagnosed. For us the sensory issues absolutely cause the anxiety, not the other way around. Just like a learning disability, for example, causes anxiety.
By s12K  Jun 05, 2012
2
Dr J.
Thanks for this blog! At the same time you posted this, I was having Oli evaluated for 3 hour with the OT for sensory concerns that the school OT did not address on his FIE, the 3 year required evals for public education FAPE. Since Oli is Dx as autistic, the issue is the fact that the sensory integration dysfunction causes him issues in school. The OT touched on the topic that you are in that there are many kids who have integration issues, in fact most people do to some extent or another. I remember thinking that the issues lie in the root and the SI maybe just another symptom. Indeed parents need to be told how to get and monitor if the help is correct. Thanks
By Olismom  Jun 03, 2012
1
" The Out-of-Sync Child", and "The Out-of-Sync Child Has Fun" -- both by Carol Stock Kranowitz, are excellent books on information regarding sensory integration issues. The "Out-of-Sync Child Has Fun" is an excellent book that provides tons of fun and easy sensory exercises ( or as we call them -- games ) that you can do at home with your child.
By joeasner  Jun 02, 2012
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