Tuesday, June 05, 2012Dear Dr. Gold,
In your May 30 piece ("Could sensory integration disorder be the primary problem?" Boston.com), you suggest that a root cause of developmental and mental health disorders, including autism, OCD, anxiety and depression, may be sensory integration (SI) disorder. As anecdotal evidence, you point to the reported sensory discomforts of some individuals with these diagnoses. You then go on to recommend that these sensory deficits be treated in the context of relationship-centered interventions, such as Greenspan's DIR* Floortime model for intervention in autism.
While one would not question that at least some individuals with autism may experience differences in sensory perception, it is important to note that despite several decades of application, there is scant scientific evidence that sensory integrative therapies are beneficial. Also, many of the types of problems that persons with autism may have (e.g., hypo- or hyper-reactivity to sensory stimuli, difficulty combining multiple sources of input) are different than many of the problems that SI practitioners purport to treat. Techniques such as wearing weighted vests, brushing, sensory diets, and joint compression are, at best, experimental, and, at worst, pseudoscientific.
There is a real cost to the individual with autism for participation in sensory integration activities, as well as for his or her family. For example, consider that a child who spends 15 minutes per school day engaged in ineffective sensory therapies will lose 50 hours per year or more of school time that could be spent on programming related to the promotion of independence, such as communication and daily living skills instruction. In the deliberations of educational teams, presumed "sensory disintegration" may be a "red herring" that draws attention away from the difficult topics of legitimate educational and therapeutic programming. Savvy marketers hawk so-called sensory therapeutic devices (e.g., special lights, weighted belts), separating families from their hard-earned dollars for products that too often promise the moon but collect dust in closets.
Thankfully, the scientific method offers reasonably straightforward ways of evaluating the hypothesized benefits of sensory integrative techniques when adopted as interventions. Specifically, single-subject design methodology that includes objectively defining the purported benefit beforehand and comparing "baseline" data with "treatment" data helps families and educational teams, rises above the limitations of conjecture and day-to-day variability in behavior. This scientific approach is consistent with the recommendation of the American Academy of Pediatrics for "teaching families how to evaluate the effectiveness of a therapy" and should be applied by sensory integration practitioners when they ply their craft.
One last note: Your recommendation that sensory integration techniques be used in the context of Greenspan's DIR Floortime model should be met with skepticism. Effectiveness of the DIR approach as a treatment for autism has little empirical support. Families investigating treatment options are encouraged to investigate options with trusted clinicians and consult independent reports that review the "state-of-the-science" for autism interventions (e.g., http://www.nationalautismcenter.org/affiliates/reports.php).
* Developmental, Individual Difference, Relationship-based
Daniel W. Mruzek, Ph.D., BCBA-D
Board Member, Association for Science in Autism Treatment
Anya K. Silver, MA, BCBA
Media Review Committee, Association for Science in Autism Treatment