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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