Research, Therapy, and Special Education

child wearing EEG cap for brain study

child wearing EEG cap for brain study

What is sensory processing disorder? What causes it? Can it be cured? What are the best treatment protocols? These questions pertain to the actual condition.

There is another set of questions whose answers depend on the answers to the first set of questions above.  If my child needs special education, therapy and/or medical treatment for Sensory Processing Disorder, how do I get them from within the educational and medical system? Who decides which treatments and education are appropriate? Who will pay for this expensive special treatment?

Background

Sensory Processing Disorder and its underlying Sensory Integration Theory were born out of A. Jean Ayres work in the 1970’s.  Her program utilizes a therapeutic protocol that has been used for many years by occupational therapists providing improved occupational performance in children. She described sensory integration therapy as an approach used to help the brain’s ability to organize sensory input for use in functional behaviors. This therapeutic framework (also applied at home and school through training of other caregivers) provides the child with experiences rich in appropriate sensory input, in a guided manner, to produce an adaptive response (i.e., functional behavior) deemed more effective than previously observed behaviors. In a nutshell, Sensory Integration therapy produces results.

Enter the Psychologists (the world of Psychiatry)

Since behavior is the defining measure of results from sensory integration therapy, the psychologists have legitimate domain over the process of diagnosis and treatment. Many developmental disorders appear first as behavior problems to parents, and psychologists are consulted to correct them.  Autism, Down Syndrome, PDD-NOS, and other mental disorders, (along with Sensory Integration Dysfunction) become diagnosed by psychologists and psychiatrists through their diagnostic bible, DSM-5 Diagnostic and Statistical Manual of Mental Disorders

In 2013 DSM-version 5 was published and, for the first time it lumped behaviors seen as sensory integrative issues under the diagnosis of Autism, while excluding Sensory Processing Disorder per se. This produced a flurry of reactions and has clouded the once clear order of diagnosis, treatment, and special education for children experiencing Sensory Integration Disorders. Insurance companies have begun to react to this diagnostic transition and do not consistently pay for claims they once routinely acknowledged. School systems rely somewhat on the diagnosis to apply their required fulfillment of IDEA mandates on a child-by-child basis. A backlash has been felt by parents, teachers, and healthcare professionals of children who suffer these conditions.

Enter the Researchers

Child in MRI lab

Child in MRI lab

It is a well known fact that research concerning Sensory Integration and other brain functions lags far behind research in other areas of medicine. This is partly due to the complexity of the brain and central nervous system, partly to the mixed domain between brain medicine and psychiatry, and partly due to the available technology for performing these studies. Additionally, most people knowledgeable in A. Jean Ayres model of Sensory Integration are therapists in clinical practice and, “would rather be barefoot and playing with kids in a clinic than be stuck in a lab doing research.” according to Patricia Oetter, MA, OTR/L, FAOTA in a radio interview on  September 16.

Research has become the ‘Holy Grail’ of the Sensory Integration model.  Its findings promise to provide a biological foundation for diagnosis and treatment of Sensory Processing Disorders.  This new approach to diagnosis eliminates behavioral considerations and returns to the physicians control over diagnosis, treatment (and thus special education).

In the past few years there has been a glimmer of hope.  Patricia L. Davies and others published results in 2007 of a small study using EEG brain mapping which validates the diagnosis of Sensory Processing Disorders.  In a groundbreaking new study(published Jul 6 2013) from UC San Francisco, researchers have found that children affected with SPD have quantifiable differences in brain structure, for the first time showing a biological basis for the disease that sets it apart from other neurodevelopmental disorders.

It is interesting to note that therapeutic definitions and categories used in distinguishing (and selecting) patients/subjects for research come from clinicians who evaluate and treat these clients–Occupational Therapists.

Tracing of flower used as the task for fMRI

Tracing of flower used as the task for fMRI

Additional findings are showing up in research conducted using Functional Magnetic Resonance Imaging of the brain.  In other words, brain scans are performed on selected patients/subjects while performing specific and repeatable tasks.  Similarities are showing up in the test population and differences in the control population.

Conclusion

Sensory Integration Research (mostly brain scanning) is beginning to catch up with Therapy and Special Education.  Diagnoses applied by therapists and Special ED psychologists help select the populations for research and also help correlate research findings. Until research claims victory, some Special Education and Therapy continues without benefit of DSM-5 and some therapy continues without benefit of insurance.

References:

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About Emily Lauren

Jenny Clark, OTR/L, BCP (AOTA Board Certification in Pediatrics), is a licensed pediatric occupational therapist with over 22 years experience working as a school-based occupational therapist, independent contractor for early intervention services, private practitioner, speaker, consultant, author, and inventor. Jenny currently owns a pediatric therapy private practice, Jenny’s Kids, Inc. Jenny Clark Jenny is the author of the best-selling book on sensory processing entitled Learn to Move, Move to Learn: Sensorimotor Early Childhood Activity Themes(AAPC 2004), (Starter Kit available) More recently Ms Clark has written a sequel Learn to Move, Moving Up! Sensorimotor Elementary School Activity Themes (AAPC 2009). In addition, she has published two DVD’s Learn to Move: Dinosaurs (AAPC 2005), a companion to her first book, and Sensory Processing Disorder Kit: Simulations and Solutions for Parents, Teachers, and Therapists (AAPC 2006), which won the 2007 media in excellence video award from Autism Society of America. Jenny’s newest publication is a music CD, Sing, Move, Learn (AAPC 2010), which accompanies the songs in her first book. Ms. Clark is a contributing author for the book Autism Spectrum Disorders: A Handbook for Parents and Professionals (Greenwood Publishing Group 2007), as well as a chapter author for Autism Spectrum Disorders: Foundations, Characteristics, and Effective Strategies. (Pearson Publishing 2011 by Boutot & Myles). Jenny is the inventor of the Patent-Pending “Weigh” Cool Bracelet. Jenny has spoken both nationally and internationally on a variety of topics, including sensory integration/processing. She received her bachelor’s degree in Occupational Therapy and graduated with distinction from the University of Kansas.
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