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What is sensory integration? Sensory Processing Disorder (SPD)?

Is there proof that SPD is real?

What is the purpose of a SPD assessment?

What is the significance of "soft neurological" signs?

What is occupational therapy? What does an occupational therapist do?

What evidence is there that occupational therapy is an effective intervention for SPD?

Answers provided by Edward Goldson, MD. Dr. Goldson is a professor of pediatrics at the University of Colorado Health Sciences Center in Denver, Colorado, and has been on the staff of The Children's Hospital in Denver, since 1976.

Q: What is sensory integration? What is a Sensory Processing Disorder (SPD)?

A: All human beings receive information from their internal and external environments through the senses: vision, hearing, touch (somatosensory), taste (gustatory), smell (olfactory), vestibular, and proprioceptive. We respond to these stimuli automatically.

The term sensory integration refers to the process by which 1) we receive this information, 2) the central nervous system directs the information to the appropriate parts of the brain, and 3) the information is "integrated" or synthesized, so that we can respond to the stimuli in an adaptive manner.

When there is a disturbance in this capacity to automatically integrate sensation and respond adaptively, the individual has Sensory Processing Disorder (SPD). These disorders can have a negative impact on a child's capacity to learn, to function in socially appropriate ways, and to perform the daily tasks of living.

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Q: Is there proof that SPD is real?

A: Following a hiatus after Dr. Ayres died in 1988, research into SPD has recently entered a massive growth phase. The sensory processing abilities of hundreds of children are being tested in multiple laboratories, providing the replicate data that are the cornerstone of scientific credibility. Research scientists from numerous, diverse disciplines are conducting primate studies, rat studies, anatomic studies, electroencephalographic, and other psychophysiological studies, plus studies of twins, other familial studies, and many more. Results are being reported in refereed professional journals where research must meet exacting standards to be published.

Research completed or currently underway or in press includes studies investigating:
  • What are the underlying physiological, neurological, and biochemical mechanisms implicated in SPD?
  • What is the concurrent and divergent evidence that SPD is a valid separate syndrome and not just a set of correlated symptoms within ADHD, Autism, fragile X syndrome, or another disorder?)
  • What is the behavioral phenotype of SPD?
  • What empirical evidence documents the effectiveness of occupational therapy in ameliorating SPD as well as in changing self-regulation, self-esteem, and social participation in children with the disorder?
  • What is the prevalence of SPD in the typically developing population and in populations that have disabilities?
  • What is the etiology of SPD?
  • Is there a familial component to SPD?

Click Ten Fundamental Facts about SPD to see a list of some findings.

Abstracts and clinical reports may be found in Our Library.

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Q: What is the purpose of a Sensory Processing Disorder assessment?

A: The capacity to process information has an effect on an individual's learning, social participation, self-regulation, and ultimately his or her self-confidence and self-esteem. When there are disturbances in sensory processing, these functional domains can be adversely affected. Examples of sensory disorders include problems with tactile discrimination, touch localization, graphesthesia, imitating postures, perception of body position in space, and bilateral motor coordination, in the absence of any frank peripheral or central nervous system damage. 

There are a variety of scales and clinical observations that can be used to identify and assess the degree of disturbance. Such an assessment, performed by a highly trained occupational therapist, is necessary prior to determining the appropriate intervention to assist in remediation of, or compensation for, the SPD difficulties. The focus of the assessment and the intervention is to identify the underlying sensory disturbance(s) that may be adversely influencing the child's ability to function adaptively in his or her environment and to provide occupational therapy to enhance the child's functional abilities.

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Q: What is the significance of "soft neurological" signs?

A: In and of themselves or from a purely functional perspective, soft neurological signs have no significance. However, from a diagnostic view the signs may be significant, suggesting neurological immaturity and/or the presence of a Sensory Processing Disorder.

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Q: What is occupational therapy? What does an occupational therapist do?

A: Occupational therapy (OT) is a developmental intervention that seeks to enhance an individual's ability to function successfully in the community.

The occupational therapist starts with an evaluation of the child's capabilities that influence performance of tasks (called "occupations") necessary to function in his natural environment. The occupational therapist then assesses the child's specific strengths and weaknesses with respect to self-care, play/leisure skills, academic abilities, and sensory-motor capabilities. When therapeutic intervention is recommended, it is used to enhance the child's capabilities and includes aspects such as accommodations in positioning, adaptive equipment, modification of the environment, and functional enhancement of sensory perception, motor responses, and functional mobility and manipulation to accomplish the daily tasks ("occupations") of living. Whenever possible, natural environments are the venue for intervention, although clinics and inpatient settings are also employed. There are carefully delineated techniques for helping children with sensory processing disorders.

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Q: What evidence is there that occupational therapy is an effective intervention for SPD?

A: The American Journal of Occupational Therapy in March-April 2007 published the first research study ever to evaluate the outcome of occupational therapy with a sensory integration approach (OT-SI) that met all four criteria of a randomized control trial (RCT). This study was the culmination of 10 years of research by the SPD Foundation and addressed the limitations of the estimated 80 previous studies of treatment effectiveness by (1) using a homogeneous sample, (2) manualizing treatment, (3) including outcome measures that were shown previously to be sensitive to change from OT-SI, and (4) using randomized treatment groups and blinded evaluators.

All p values are p. The findings were that children in the OT-SI group made gains that were significantly greater than the children in the other two groups (No Treatment and Activity Protocol, a placebo treatment) on Goal Attainment Scaling (p < 0.001). The OT-SI group also increased significantly more than the other groups on Attention (p = .03 compared to No Treatment; p = .07) and on the Cognitive/Social Composite of the Leiter-R (p = .02 compared to Activity Protocol). On both the Short Sensory Profile Total Score and the Child Behavior Checklist Internalizing Composite, change scores were greater for the OT-SI group, but not statistically significant. Physiologically, even with a very small sample, the OT-SI group showed greater reduction in amplitudes of EDR compared to the Activity Protocol and No Treatment groups.

The children in the Activity Protocol group, made greater but non-significant gains compared to the other two groups on Socialization (Vineland). Children in Group C (No Treatment) made greater but non-significant gains on the CBCL Externalizing Composite.

The findings suggest that OT-SI appears to be effective in ameliorating difficulties of children with SPD who have Sensory Over-Responsive subtype.  Children in the OT-SI group made significant changes compared to the Alternate Treatment and the No Treatment groups on several key measures. In addition, trends occurred toward greater improvement in the OT-SI group on Internalizing (CBCL) and the SSP Total Score.  The small sample size and lack of statistical power mandate caution in interpretation of results.

Source
  • Miller L, Schoen SA, James K, Schaaf RC (2007). Lessons Learned: A pilot study of occupational therapy effectiveness for children with Sensory Modulation Disorder. American Journal of Occupational Therapy, 61(2), 161.

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