Although this is not the way that Occupational Therapists world wide would like to spread the word about Sensory Processing Disorder, it is a small step depicting that although little is known in the medical world, SPD is on the radar and beginning to make an impact on the medical community. Now is the time for OTs, PTs, SLPs, teachers, parents, caregivers and friends to show the medical community how real Sensory Processing Disorder really is and how sensory integrative therapies can help!!!!
This is the article printed in the May 2012 issue of PEDIATRICS. The official journal of the AAP-
Sensory Integration Therapies for Children With Developmental and Behavioral
http://pediatrics.aappublications.org/content/early/2012/05/23/peds.2012-0876
located on the World Wide Web at:
The online version of this article, along with updated information and services, is
Sensory Integration Therapies for Children With
Developmental and Behavioral Disorders
abstract
Sensory-based therapies are increasingly used by occupational thera-
pists and sometimes by other types of therapists in treatment of children
with developmental and behavioral disorders. Sensory-based therapies
involve activities that are believed to organize the sensory system
by providing vestibular, proprioceptive, auditory, and tactile inputs.
Brushes, swings, balls, and other specially designed therapeutic or rec-
reational equipment are used to provide these inputs. However, it is un-
clear whether children who present with sensory-based problems have
an actual “disorder” of the sensory pathways of the brain or whether
these deficits are characteristics associated with other developmental
and behavioral disorders. Because there is no universally accepted
framework for diagnosis, sensory processing disorder generally should
not be diagnosed. Other developmental and behavioral disorders must
always be considered, and a thorough evaluation should be completed.
Difficulty tolerating or processing sensory information is a characteristic
that may be seen in many developmental behavioral disorders, includ-
ing autism spectrum disorders, attention-deficit/hyperactivity disorder,
developmental coordination disorders, and childhood anxiety disorders.
Occupational therapy with the use of sensory-based therapies may be
acceptable as one of the components of a comprehensive treatment plan.
However, parents should be informed that the amount of research regard-
ing the effectiveness of sensory integration therapy is limited and incon-
clusive. Important roles for pediatricians and other clinicians may include
discussing these limitations with parents, talking with families about a tri-
al period of sensory integration therapy, and teaching families how to
evaluate the effectiveness of a therapy. Pediatrics 2012;129:1186–1189
BACKGROUND: DEVELOPMENT OF THE SENSORY SYSTEM
Sensory integration is a framework first described by occupational
therapist A. Jean Ayres, PhD, in the 1970s. It refers to the body ’s way
of handling and processing sensory inputs from the environment.1
Ayres felt that the sensory system develops over time, much like
other aspects of development (language, motor, etc), and that deficits
can occur in the process of developing a well-organized sensory sys-
tem. A well-organized sensory system can integrate input from multiple
sources (visual, auditory, proprioceptive, or vestibular). Ayres postu-
lated that sensory integration dysfunction occurs when sensory neu-
rons are not signaling or functioning efficiently, leading to deficits
in development, learning, and/or emotional regulation.
SECTION ON COMPLEMENTARY AND INTEGRATIVE MEDICINE
and COUNCIL ON CHILDREN WITH DISABILITIES
KEY WORDS
sensory integration, sensory processing, sensory integration
therapy
This document is copyrighted and is property of the American
Academy of Pediatrics and its Board of Directors. All authors
have filed conflict of interest statements with the American
Academy of Pediatrics. Any conflicts have been resolved through
a process approved by the Board of Directors. The American
Academy of Pediatrics has neither solicited nor accepted any
commercial involvement in the development of the content of
this publication.
All policy statements from the American Academy of Pediatrics
automatically expire 5 years after publication unless reaffirmed,
revised, or retired at or before that time.
www.pediatrics.org/cgi/doi/10.1542/peds.2012-0876
doi:10.1542/peds.2012-0876
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2012 by the American Academy of Pediatrics
1186 FROM THE AMERICAN ACADEMY OF PEDIATRICS
Organizational Principles to Guide and Define the Child
Health Care System and/or Improve the Health of all Children
by guest on June 13, 2012
pediatrics.aappublications.org
Downloaded from
The ability of the brain to process
sensory information from the environ-
ment has been an expanding area of
basic neuroscience research. Hubel and
Wiesel were among the first to docu-
ment the important effects of early
experience (eg, deprivation) on the way
visual sensory input is processed in the
brain.2–5 Animal and human research is
beginning to explore how other senses
are processed and integrated6–10 and
how those processes are disrupted
in specific syndromes (eg, autism,11,12
schizophrenia13,14) and by specific ex-
periences (eg, institutionalization, inter-
national adoption15,16).
STATEMENT OF THE PROBLEM
Since Ayres1 descri bed sensory i n-
t egrat i on dy s f unc t i on i n t he 19 7 0s ,
s ens or y - bas e d t herapi es hav e be en
used increasingly, mainly by occupa-
tional therapists (but sometimes other
health professionals) to treat a range of
symptoms seen in children presenting
from across a variety of settings, in-
cluding the home, community organ-
izations, clinics, and schools. Sensory
integration, sensory “diets,” and other
sensory-based therapies typically are
based on cl assi c sensory i ntegra-
ti on theory but of ten do not use al l
of the ori gi nal l y descri bed sensory
integration protocols. Sensory-based
therapies involve activities that are
believed to organize the sensory sys-
tem, by providing vestibular, proprio-
ceptive, auditory, and tactile inputs, by
using brushes, swings, balls, and other
specially designed equipment to pro-
vide these inputs. Occupational thera-
pists and other health professionals
may also use a sensory processing ap-
proach when identifying and modifying
barriers that limit the individual’s ability
to par ti ci pate in everyday acti vi ti es
or occupati ons.
Proponent s of sensory i nt egrat i on
t heory bel i eve t hat i nappropri at e
or defici ent sensory processi ng i s
a developmental disorder amenable
to therapy and that treatment can
improve developmental outcomes. 17
A definition of sensory processing
disorder has been proposed but has
not been universally accepted.18 Stand-
ardized measures, such as the Sen-
sory Profile,19 have been developed to
classify a child’s sensory deficits. The
Sensory Profile provides a standard
method for professionals to measure
a child’s sensory processing abilities
and to provide a profile of the effect
of sensory processing on functional
performance in the daily life of a child.20
Such standardized measures are com-
monly used by occupational therapists
to quantify how much these devel-
opmental and behavioral differences
affect the child’s functional performance
of t he dai l y act i v i t i es of chi l dhood.
The possible diagnosis of sensory pro-
cessing disorders remains a challenging
clinical issue. In the sensory processing
disorder classification system proposed
by Miller et al,18 sensory processing
disorders are subdivided into 3 specific
patterns: sensory modulation disorder,
sensory discrimination disorder, and
sensory-based motor disability. These
patterns are then categorized into sub-
types. Sensory modulation disorder is
subdivided into overresponsive, under-
responsive, and sensory seeking/craving
subtypes. Sensory discrimination dis-
order has no subtypes. Sensory-based
motor disability is subdivided into pos-
tural disorder and dyspraxia.
Sensory processing disorder or a
similar diagnosis has been included in
Zero to Three’s Diagnostic Classifica-
tion of Mental Health and Develop-
mental Disorders of Infancy and Early
Childhood Revised21 and the Diag-
nostic Manual for I nfancy and Early
Chi l dho o d o f t he I nt e rdi s c i pl i nar y
Council on Developmental and Learning
Disorders,22 where “regulatory-sensory
processing disorder ” in infants has
also been classified as a developmental
di f f erence f or t hi s group. For ol der
children and adolescents, no com-
monly accepted definition of sensory
processi ng di sorder exi st s. Some
experts have proposed that the defi-
nition of autism spectrum disorders
in the forthcoming Diagnostic and
Statistical Manual of Mental Dis-
orders, Fifth Edition be expanded to
include definitions of associated sen-
sory issues, such as under- and over-
responsiveness; however, the committee
that is preparing the textbook has re-
quested that more studies be per-
formed before sensory processing
disorder can be officially recognized.23
It remains unclear whether children
who present with findings described
as sensory processing difficulties have
an actual “disorder” of the sensory
pathways of the brain or whether these
deficits represent di ff erences asso-
ciated with other developmental and
behavioral disorders. Specifically, the
behavioral differences seen in chil-
dren with autism spectrum disorders,24
attention-deficit/hyperactivity disorder,25
and developmental coordination dis-
orders26 overlap symptoms described
in children with sensory processing
disorders. Studies to date have not
demonstrated that sensory integration
dysfunction exists as a separate disorder
distinct from these other developmental
disabilities. Fur thermore, numerous
chal l enges exi st for eval uati ng the
effectiveness of sensory integration
therapy, including the wide spectrum
of symptom severity and presentation,
lack of consistent outcome measures,
and family factors, which make re-
sponse to therapy variable.27–29
Despite the challenges of defining and
studying the effectiveness of sensory
integration therapy, it is possible that
the treatment of sensory processing
difficulties is helpful to children who
have problems identified in sensory
processing measures. Some published
case series and observational studies
PEDIATRICS Volume 129, Number 6, June 2012 1187
FROM THE AMERICAN ACADEMY OF PEDIATRICS
by guest on June 13, 2012
pediatrics.aappublications.org
Downloaded from
have reported positive outcomes of
sensory integration therapy for chil-
dren with sensory processing dis-
orders.27,29 Older meta-analyses30,31 and
at least 2 more recent reviews32, 33
have been published that suggested a
positive trend in meeting occupational
goals with the use of sensory integra-
tion therapy. However, the authors of
the 1999 meta-analysis cautioned
that most studies in the field were
of insufficient scientific rigor to be
included in a meta-analysis, studies
varied in the use of outcome meas-
ures, and the ability to draw con-
clusions and detect a treatment effect
was limited.31 Many of the more recent
studies, unfortunately, share some of
these traits.
One recent small study cautions health
care practitioners about the possible
negative behavioral effects of sensory
integration therapy in certain pop-
ulations. Devlin et al34 reported on the
comparative effects of sensory inte-
gration therapy and behavioral inter-
ventions on rates of challenging or
self-injurious behavior in 4 children
in whom autism spectrum disorder
was diagnosed. A functional assess-
ment was conducted to identify the
variables maintaining the challenging
behaviors. The sensory integration
therapy was designed by an occupa-
tional therapist who was trained in
sensory integration therapy. The sen-
sory integration therapy and a behav-
ioral intervention were compared
within an alternating treatments de-
sign. Results from this study clearly
demonstrated that the behavioral inter-
vention was more effective in reducing
challenging behavior and self-injurious
behavi or t han was t he sensory in-
tegration therapy. Finally, in t he best
treatment phase, onl y t he behavioral
i nterventi on was i mpl emented, and
further reduction was observed in the
frequency of challenging behavior and
self-injurious behavior.
RECOMMENDATIONS
1. At this time, pediatricians should not
use sensory processing disorder as
a di agnosi s. When t hese sensory
symptoms are present, other devel-
opmental di sorders—speci fical l y,
autism spectrum disorders, attention-
deficit/hyperactivity disorder, deve-
lopmental coordination disorder,
and anxi ety di sorder—must be
considered and thoroughly evaluated,
usually by appropriate referral(s)
to a developmental and behavioral
pediatrician, child psychiatrist, or
child psychologist. The American
Academy of Pediatrics clinical re-
port on the management of children
with autism spectrum disorders is
a useful resource to help with these
referrals.35
2. Pediatricians should recognize and
communi cat e wi t h f ami l i es about
t he l i mi t e d dat a on t he us e of
sensory-based therapies for child-
hood developmental and behav-
ioral problems.
3. If the pediatrician is managing a
chi l d whose therapi st i s usi ng
sensory-based therapies, the pedia-
trician can play an important role in
teaching families how to determine
whether a therapy is effective.
a. Help families design simple
ways t o moni t or ef f ect s of
t reat ment ( eg, behavi or di a-
ri es, pre-post behavior rating
scales). Help the family be
specific and create explicit
treatment goals, designed at
the onset of therapy, focused
on improving the individual’s
ability to engage and par tici-
pate in everyday activities
(eg, ability to focus, tolerate
foods, and be in a room with
loud noises).
b. Set a time limit for seeing the
family back to discuss whether
t he t herapy i s worki ng t o
achi eve t he st at ed goal s.
4. Pediatricians should inform fami-
lies that occupational therapy is
a limited resource, particularly the-
number of sessions available through
schools and through insurance cov-
erage. The family, pediatrician, and
other clinicians should work together
to prioritize treatment on the basis of
the effects the sensory problems
have on a child’s ability to perform
daily functions of childhood.
With input from the following committees/
councils: COCWD, ASC, SOAI, COPACFH, SOAH,
SODBP, SON, SOEH, and COCHF.
LEAD AUTHORS
Michelle Zimmer, MD
Larry Desch, MD
SECTION ON COMPLEMENTARY AND
INTEGRATIVE MEDICINE EXECUTIVE
COMMITTEE, 2011–2012
Lawrence D. Rosen, MD, Chairperson
Michelle L. Bailey, MD
David Becker, MD
Timothy P. Culber t, MD
Hilary McClafferty, MD
Olle Jane Z. Sahler, MD
Sunita Vohra, MD
LIAISON
Lt Col Della Livesay Howell, MD – Section on
Young Physicians
STAFF
Teri Salus, MPA, CPC
COUNCIL ON CHILDREN WITH
DISABILITIES EXECUTIVE COMMITTEE,
2011–2012
†Gregory S. Liptak, MD, MPH, Chairperson
Nancy A. Murphy, MD, Interim Chairperson
Richard C. Adams, MD
Robert T. Burke, MD, MPH
Sandra L. Friedman, MD
Amy J. Houtrow, MD, MPH
Miriam A. Kalichman, MD
Dennis Z. Kuo, MD, MHS
Susan Ellen Levy, MD
Kenneth W. Norwood Jr, MD
Renee M. Turchi, MD, MPH
Susan E. Wiley, MD
LIAISONS
Carolyn Bridgemohan, MD – Section on De-
velopmental and Behavioral Pediatrics
1188 FROM THE AMERICAN ACADEMY OF PEDIATRICS
by guest on June 13, 2012
pediatrics.aappublications.org
Downloaded from
Georgina Peacock, MD, MPH – Centers for
Disease Control and Prevention
Bonnie Strickland, PhD – Maternal and Child
Health Bureau
Nora Wells, MSEd – Family Voices
Max Wiznitzer, MD – Section on Neurology STAFF
Stephanie Mucha Skipper, MPH
† Deceased.
REFERENCES
1. Ayres AJ. Sensory Integration and the
Child. Los Angeles, CA: Western Psycholog-
ical Services; 1979
2. Hubel DH, Wiesel TN. Anatomical demon-
stration of columns in the monkey striate
cortex. Nature. 1969;221(5182):747–750
3. Hubel DH, Wiesel TN. The period of sus-
ceptibility to the physiological effects of
unilateral eye closure in kittens. J Physiol.
1970;206(2):419–436
4. Wiesel TN, Hubel DH. Effects of visual dep-
rivation on morphology and physiology of
cells in the cats lateral geniculate body.
J Neurophysiol. 1963;26:978–993
5. Wiesel TN, Hubel DH. Extent of recovery from
the effects of visual deprivation in kittens.
J Neurophysiol. 1965;28(6):1060–1072
6. Hackett TA, Barkat TR, O’Brien BM, Hensch
TK, Pol l ey DB. Li nki ng t opography t o
tonotopy in the mouse auditory thalamo-
cortical circuit. J Neurosci. 2011;31(8):
2983–2995
7. Polley DB, Hillock AR, Spankovich C,
Popescu MV, Royal DW, Wallace MT. De-
velopment and plasticity of intra- and in-
tersensory information processing. J Am
Acad Audiol. 2008;19(10):780–798
8. Popescu MV, Polley DB. Monaural depriva-
tion disrupts development of binaural se-
lectivity in auditory midbrain and cortex.
Neuron. 2010;65(5):718–731
9. Störmer VS, McDonald JJ, Hillyard SA.
Cross-modal cueing of attention alters ap-
pearance and early cortical processing of
visual stimuli. Proc Natl Acad Sci USA. 2009;
106(52):22456–22461
10. Batterson VG, Rose SA, Yonas A, Grant KS,
Sackett GP. The effect of experience on the
development of tactual-visual transfer in
pigtailed macaque monkeys. Dev Psycho-
biol. 2008;50(1):88–96
11. Hardan AY, Minshew NJ, Melhem NM, et al.
An MRI and proton spectroscopy study of
the thalamus in children with autism. Psy-
chiatry Res. 2008;163(2):97–105
12. Gepner B, Féron F. Autism: a world chang-
ing too fast for a mis-wired brain? Neurosci
Biobehav Rev. 2009;33(8):1227–1242
13. Martínez A, Hillyard SA, Dias EC, et al. Mag-
nocellular pathway impairment in schizo-
phrenia: evidence from functional magnetic
resonance imaging. J Neurosci. 2008;28(30):
7492–7500
14. Sehatpour P, Dias EC, Butler PD, et al. I m-
paired visual object processing across
an occipital-frontal-hippocampal brain net-
work in schizophrenia: an integrated neu-
roimaging study. Arch Gen Psychiatry. 2010;
67(8):772–782
15. Jacobs E, Miller LC, Tirella LG. Devel-
opmental and behavioral performance of
internationally adopted preschoolers: a pi-
lot study. Child Psychiatry Hum Dev. 2010;41
(1):15–29
16. Wilbarger J, Gunnar M, Schneider M, Pollak
S. Sensory processing in internationally
adopted, post-institutionalized children.
J Child Psychol Psychiatry. 2010;51(10):
1105–1114
17. Ayres AJ. Sensory Integration and Learning
Disorders. Los Angeles, CA: Western Psy-
chological Services; 1972
18. Miller LJ, Anzalone ME, Lane SJ, Cermak SA,
Osten ET. Concept evolution in sensory
i nt egrat i on: a proposed nosol ogy f or di -
agnosi s. Am J Occup Ther. 2007; 61(2) :
135–140
19. Ermer J, Dunn W. The sensory profile:
a discriminant analysis of children with
and without disabilities. Am J Occup Ther.
1998;52(4):283–290
20. Dunn W. Sensory Profile. San Antonio, TX:
Psychological Corporation; 1999
21. Zero to Three. Early childhood mental
health. Available at: http://www.zerotothree.
or g/ c hi l d- dev el opment / ear l y - c hi l dho od -
me nt al - he al t h/ . A c c e s s e d J ul y 3 0 , 20 11
22. Greenspan SI , Wi eder S. The i nt erdi sci -
pl i nar y counci l on devel opment al and
learning disorders diagnostic manual for
infants and young children - an overview.
J Can Acad Child Adolesc Psychiatry. 2008;
17(2):76–89
23. American Psychiatric Association. DSM-5
development. Conditions proposed by out-
side sources. Available at: http://www.dsm5.
org/proposedrevision/Pages/Conditions-Pro-
posed-by-Outside-Sources.aspx. Accessed July
27, 2011
24. Cheung PP, Siu AM. A comparison of pat-
terns of sensory processing in children with
and without developmental disabilities. Res
Dev Disabil. 2009;30(6):1468–1480
25. Hender K. Effectiveness of sensory inte-
gration therapy for attention deficit hyper-
activity disorder (ADHD). Evidence Centre
Critical Appraisal. Series 2001: Intervention.
Clayton, Victoria, Australia: Centre for Clinical
Effectiveness, Monash Medical Centre; March
21, 2001
26. White BP, Mulligan S, Merrill K, Wright J. An
examination of the relationships between
motor and process skills and scores on the
sensory profile. Am J Occup Ther. 2007;61
(2):154–160
27. Tochel C. Sensory or auditory integration
therapy for children with autistic spectrum
disorders. STEER. 2003;3(17). London, UK:
Wessex Institute for Health Research and
Development, University of Southampton
28. Lane SJ, Schaaf RC. Examining the neuro-
science evidence for sensory-driven neu-
roplasticity: implications for sensory-based
occupational therapy for children and
adolescents. Am J Occup Ther. 2010;64(3):
375–390
29. Miller LJ, Coll JR, Schoen SA. A randomized
controlled pilot study of the effectiveness
of occupational therapy for children with
sensory modulation disorder. Am J Occup
Ther. 2007;61(2):228–238
30. Ottenbacher K. Sensory integration therapy:
affect or effect? Am J Occup Ther. 1982;36
(9):571–578
31. Vargas S, Camilli G. A meta-analysis of re-
search on sensory integration treatment.
Am J Occup Ther. 1999;53(2):189–198
32. Baranek GT. Efficacy of sensory and motor
interventions for children with autism.
J Autism Dev Disord. 2002;32(5):397–422
33. May-Benson TA, Koomar JA. Systematic re-
view of the research evidence examining
the effectiveness of interventions using a
sensory integrative approach for children.
Am J Occup Ther. 2010;64(3):403–414
34. Devlin S, Healy O, Leader G, Hughes BM.
Comparison of behavioral intervention and
sensory-integration therapy in the treat-
ment of challenging behavior. J Autism Dev
Disord. 2011;41(10):1303–1320
35. Myers SM, Johnson CP; American Academy
of Pediatrics Council on Children With Dis-
abilities. Management of children with au-
tism spectrum disorders. Pediatrics. 2007;
120(5):1162–1182
PEDIATRICS Volume 129, Number 6, June 2012 1189
FROM THE AMERICAN ACADEMY OF PEDIATRICS
by guest on June 13, 2012
pediatrics.aappublications.org
Downloaded from
DOI: 10.1542/peds.2012-0876
; originally published online May 28, 2012;
Pediatrics
COUNCIL ON CHILDREN WITH DISABILITIES
SECTION ON COMPLEMENTARY AND INTEGRATIVE MEDICINE and
Disorders
Sensory Integration Therapies for Children With Developmental and Behavioral
Services
Updated Information &
/peds.2012-0876
http://pediatrics.aappublications.org/content/early/2012/05/23
including high resolution figures, can be found at:
Rs)
3
Peer Reviews (P
Post-Publication
76v1
http://pediatrics.aappublications.org/cgi/eletters/peds.2012-08
R has been posted to this article:
3
One P
Subspecialty Collections
cs_and_toxicology
http://pediatrics.aappublications.org/cgi/collection/therapeuti
Therapeutics & Toxicology
the following collection(s):
This article, along with others on similar topics, appears in
Permissions & Licensing
tml
http://pediatrics.aappublications.org/site/misc/Permissions.xh
tables) or in its entirety can be found online at:
Information about reproducing this article in parts (figures,
Reprints
http://pediatrics.aappublications.org/site/misc/reprints.xhtml
Information about ordering reprints can be found online:
rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
Grove Village, Illinois, 60007. Copyright © 2012 by the American Academy of Pediatrics. All
and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk
publication, it has been published continuously since 1948. PEDIATRICS is owned, published,
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly
by guest on June 13, 2012
pediatrics.aappublications.org
Downloaded from
No comments:
Post a Comment