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Sensory-Integration Disorders

When I first started my clinical practice at a Children’s Hospital, I got referrals left and right to assess children for “Sensory Integration” disorders. The classic referral was from parents who were concerned that their 2 year old was clumsy (aren’t they all kind of clumsy?) or didn’t like tags touching them (who does?). I thought maybe I missed that day in graduate school, because at the time, I had never heard of such a disorder. Sure, I had heard of children with Autism and ADHD who had sensory issues, but not a “Sensory Integration Disorder,” per se. All I knew was that when I brought it up to other professionals, it was met with an eye roll 9 chances out of 10. Over the years, I have heard the term less and less, but for those wondering what the heck it is, and if it’s even a real disorder, check out this posting on Quack Watch. I’d love to hear what others think on this issue.

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Comments on Sensory-Integration Disorders

  1. Anonymous says:

    Hi. I love your blog and even with your tales of office sharing and lack of heat am still considering going into your profession. πŸ™‚

    I’m guessing from the reference to professionals and the eye rolls and the referral to quack watch you have your mind just about made up. πŸ™‚ My child is diagnosed on the spectrum so I am familiar with watching children with sensory issues(playgroups can be fun!) The things the kids go through can be a nightmare. I usually explain to people by asking them to imagine their worse PMS ever and then being developmentally immature and trying to handle it, or imagine sitting on sandpaper, having a light shining in your face, loud music playing and someone trying to talk to you at the same time.
    But does that make it a separate issue? Well I guess my question is, since all of these disorders including ASDs and ADHD are diagnosed using DSM checklists,,, Isn’t one of the areas(I’m not sure, you would know)concerning response to stimulus? Since each kid diagnosed is a bit different, isn’t SID just that they don’t show symptoms in other areas but do in this one?

    As a parent who had to go through a loong expensive diagnostic process(my small early concerns when Id never even heard of this “alphabet stuff” πŸ™‚ were met with near eye rolls and dismissiveness until things became more clear) I bristle when I hear parents boiled down to being concerned about a kid not liking tags. In our case it was a small sign of a bigger issue.
    Thanks for sharing your world.

  2. @Anon: Thanks for reading and commenting. I agree that sensory issues can be a red flag for other disorders, and I feel your pain in having to go through such a lengthy and painful process of finding out how to help your child. I am often on the other side of the table, giving that difficult diagnosis, undiagnosing other professional’s diagnoses, and sifting through all the data to make sure the intervention matches the symptom. It’s confusing and frustrating for parent, to say the least.

    Remarkably, there is no mention of SID symptoms in the DSM-IV criteria for either Autism or ADHD. That being said, I have issues with the DSM-IV in general, for two reasons. 1) People who lack the experience in diagnosing complex disorders throw out inappropriate diagnoses, and 2) I think it’s not helpful to make categorial distinctions (e.g. ADHD, not-ADHD) to give kids help. The kid who is one symptom shy of the criteria for ADHD needs help too.

    What I think this post is getting at is that unfortunately, many of the symptoms of childhood disorders are not specific enough. Many things can cause one symptom. Because of this, sometimes parents and professionals pathologize normal development. We must all be careful that we address the needs of the kids so they can thrive to the best of their abilities, but not over-prescribe disabilities without the research and clinical judgement to do it properly.

    Okay, that is my Sunday morning sermon on the DSM-IV, hope you liked it. πŸ™‚

  3. Anonymous says:

    So you are saying we shouldn’t buy “DSM-IV The Home Game” for the holidays? πŸ™‚
    One of the things I am fascinated by in your line of work is how you are able to help children get the support they need with any of these symptoms.
    For parents, It seems we need a diagnosis to be taken seriously(I fought labeling so hard at first and it was a professional like you who gently broke it down for me), but at the same time I have found that my sons diagnosis has offered nothing in the way of practicality, meaning it doesn’t tell you what to do next or offer a 1,2,3 step for anyone who works with your child to follow.
    I agree we shouldn’t be pathologizing everything. I remember having a teacher once ask me if a certain behavior was due to his label. I told him it was more likely he was just 7 πŸ™‚

  4. Chris says:

    Hi Rebecca,

    Here is some information for you from my blog – I am an OT and I believe that I have a fairly balanced perspective on ‘sensory integration’ issues. Feel free to browse these posts and I hope they are helpful to you

  5. Stray says:

    Hi Rebecca,

    Just browsing through your blog as our 14 year old son has just been (finally) diagnosed with whole ton of stuff. He has dyspraxia (fine motor skills below second centile), low muscle tone, hypermobility, and his visual motor integration is so poor it's unregistered on the curve for his age.

    However, despite all of this, the biggest challenge he faces is his Sensory Integration Disorder. He can hear every frequency they can test at the quietest level they test it at. He can't keep his balance or touch his nose with his eyes closed. Visually busy environments make him lose his sense of 3D space. He is both under and over responsive to physical stimuli. You can imagine how much he enjoys the supermarket!

    In the UK, where we live, Sensory Integration is usually diagnosed alongside Aspergers. We have often wondered if he was Aspie (mum is a psychotherapist who works with people with ASD). In the end his paed has placed him with the Aspie team to work with the sensory stuff.

    As we don't really know how autistic spectrum disorders develop, we're wondering whether he perhaps would have developed a more expanded Aspie profile had he had a different upbringing. He has great attachments, but withdraws when over stimulated. All his family were very careful not to push him socially as a child, though not with any particular intention other than that it felt wrong. He also has a cleft palate, which bought him a lot of peace and quiet as a child as he was unable to speak fluently til very late.

    My suspicion is that there are plenty of adults with Sensory Integration disorders, though fewer who had the right environment not to withdraw completely and get a broader diagnosis such as aspergers.

    I was cynical when I first read about Sensory Integration problems, but I am now convinced. You can't fake the tests my son took.

    The line I really took issue with in the Quack Watch article is this one: 'In my experience, children diagnosed with "SID" are simply very anxious and come from a family that includes others who suffer from an anxiety disorder.'

    My partner (the psychotherapist) is quite anxious in highly stimulating environments. Since our son was diagnosed we've discovered that she has an abnormal hearing profile as well. Could it not be that the parents have anxiety as a result of an undiagnosed SID? It seems that they'd concluded the opposite without even asking the question.

    On the whole I've found everything I've read here to be helpful – particularly the stuff on VMI problems. So I was disappointed to see you putting up the quackwatch article without critiquing it.

  6. Anonymous says:

    I am also a school psychologist, and very frustrated with the "SID" diagnosis flood I am seeing. Whether or not other want to accept this, SID is not based on research and I believe many parents are being taken for a ride with paying for treatments to ease symptoms of SID (which appear to be just as effective as simple maturation).

  7. Unknown says:

    This is such an interesting topic to me. I am a PsyD and work in a clinical outpatient setting. A little while back I read the book "Sensational Kids". Before reading the book, I felt as though SID was totally made up. After reading the book I completely believe in the concept. I also recognize that there is very little training on the topic for mental health professionals or even for OTs (whom I understand to be the most qualified to make such diagnoses) and even less research on the subject. Yes, it may be just a constillation of symptoms but so are half the other diagnoses in the DSM at this point. I am just suggesting that we not rule out the concept, because for some kids I do think it is a very real thing. Just thinking about how each of the different senses (including vestibular and proprioceptive) effect children with other kinds of difficulties can help guide treatment. Ya know the ADHD who is constantly crashing into things? Yes it is impulsivity but it is also a proprioceptive issue (otherwise he would be that other highly impulsive kid who does not crash into things or the fantastic soccer player, etc.)

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