Research on sensory integration therapy

Sometimes when an idea is very new, research evidence cannot be available. Research takes time and people for subjects, which you can’t get until you start. If you are in the first testing group for the research, by the way, you should at least get a discount, in fact if a university is running the program you may even get paid for some things.

When things are new and not yet in the mainstream then all you can get is anecdotal evidence, so you have to use judgement.

Actually, I’m willing to listen to anecdotal evidence, but like all anecdotal reports everywhere in life, it has to be taken with a large grain of salt and very careful use of your sense of smell. Be extra alert for anything fishy with anecdotes.

As, for example, do they all have the same tone and vocabulary and appear as if all written by the same person? Do they all claim miracles? Do they all put down other approaches and epecially put down scientific research? Do they make claims that are contrary to proven medical fact? Do they claim wonderful new discoveries that are secrets owned only by the director? Do they claim that things are instant and effort-free? Once you smell one of these fish, that *still* does not prove anyone is wrong — some real researchers are cranks too — but it should make you tread very very cautiously, and be especially careful about large amounts of money with no refund available.

One problem with theories that aren’t in the mainstream is that it is hard to get the scientific backup and you do sound like a crank. Trying to preach the need for phonics in reading instruction thirty years ago put me well on the wrong side of the fence. So don’t ban a program because it’s experimental, but do be cautious with safety and money.

Sensory integration can be the cause of inattentive behaviors. If it is, then SI therapy could work. On the other hand, ADHD type behaviors can have many causes and without evidence of SI, it certainly wouldn’t be what I’d try first.

A safer bet would be to do Interactive Metronome. It works on integration and there are clinical studies that have shown improvements in ADHD diagnosesd individuals. My own son did IM with great success—he still have some attention issues but the teachers thought he was a new child.

Beth

This is for Guest but also for Beth, whom I never got back to!! I’m so glad there is a forum devoted to this.

I’m part of a group of moms (w/education, business, medical, psychological professions) who are exploring this topic now and are considering some independent research of our own. We have literally thousands of documents to read through at the moment; I’ll get back to you soon if I find anything concrete.

Here’s more anecdotal info. My son is 4 1/2, mild to moderate issues, and is both sensory-seeking and sensory defensive. He’s [u]not [/u]on the autism spectrum (several therapists and psychologists have worked with him and said emphatically he is not), although some of his behaviors do kind of look like it sometimes, though these are decreasing. We saw some immediate results from brushing therapy (when you use a small, plastic-bristled surgical brush on the skin several times a day, combined with joint compressions). My son had frequently pulled on one of his nipples (ouch!!), so much so that it is enlarged. When we started brushing, he really stopped doing it after about a month. Unfortunately, brushing is very hard to keep up with and we sort of slacked off, and, no surprise, he resumed the old habit. We also bought a bear-hug vest for him that sometimes calms him and makes him less unfocused.

He receives o/t twice a week, and what it may have done is made him much less rigid (play, temperament, diet). He is also better at coping with overwhelming situations—loud noises, chaotic classrooms, parties; he still struggles a bit when things don’t go exactly his way, but he’s getting better. At o/t they do a lot of deep pressure and vestibular stimulating (spinning) activities for him. His fine-motor skills have improved tremendously; they’re working on his gross motor planning and visual-spatial stuff now, and are doing listening therapy to help him focus, although I have to say he really has no trouble in this area most of the time. He still gets tired very easily and he does have some very subtle boundary issues with other kids, but he’s very social and has fun with kids in general. I have to say that part of me feels as though some of the improvements I’ve seen are purely due to his maturing, but I also have to agree that the therapies are helping in some way.

FYI, Guest, another mom (a psychologist, too) whose SID (and other stuff) child is 11 has noticed a sharp decrese in her daughter’s SID symptoms when the girl began taking an SSRI (Paxil). The mom, who has sensory issues herself, also noticed a decrease in her symptoms as well.

Now for another question; did anyone’s child experience difficulties during pregnancy or childbirth? At 19 weeks my son was at the 75th percentile for size; he was born just five days early but small (5 lbs, 11 oz). My labor was long and he experienced heart decelerations, but wasn’t blue or anything, even though the cord was wrapped around his neck twice. Just curious! Early signs—wanted to be held all the time and never wanted to sleep alone; still pops in our bed in the middle of the night. He also always sleeps touching either me or my husband. Gets a bit tricky now that he has some power in his legs. Thanks for reading all this!

Another point of view:

http://www.nasponline.org/publications/cq312si.html

mmm214, I hope you encourage the other mom’s you know to come to this site. The more informed parents here the better.

http://www.schwablearning.org/pdfs/2200_7-barktran.pdf

Russel Barkley is considerered an authority on ADHD and has been doing research on it for years. This transcript of a presentation is quite long but you should be able to skim through it to find where he talks about sensory integration therapy.

Thank you Rover! That is a very helpful document. I can see now why my doctor is suspicious of sensory integration theories.

ADHD can be confused with DSI. Are you sure of the diagnosis?

It has been my unfortunate experience that many pediatricians do not address developmental issues. I am a nurse and have heard so many stories. Then I experienced it myself. I had to take my son to a developmental pediatrician on the advice of my daughter’s PT. They both have dyspraxia, but he has DSI also. Once I had the evals and suggestion sent to my pediatrician, I no longer had a problem getting what I needed. No I am fighting with school districts. I always knew I had to advocate for my own health care etc…, but I never dreamed it would be so hard (or scary) to have to advocate for my children too. You would think that people would feel inclined to help children (in general), but that is naive - unless it is in their own backyard, they don’t care enough.

I think that it is important to understand that anything that would cost $ to treat in a society where there are financial incentives not to treat (within the reimbursement structure of health insurance plans and within school district budgets) will cause opposition on many fronts. It is a politically and economically charged issue. Especially something not well understood and not easily or quickly treated as is the case with DSI. I have heard that some teachers refer to DSI as the “new ADHD” meaning that it is not popular to say ADHD, but rather DSI.

Some would say that “DSI” is just another name for ADHD. It tends to be more palatable to parents who are not comfortable hearing another diagnosis. Not much evidence out there that DSI is actually a separate disorder vs. a set of symptoms that tend to show up where there is a neurological problem. Autistic kids, ADHD kids, kids with LD, kids with dyspraxia tend to have problems with sensory integration. So do people with traumatic brain injury. its probably a sign of neurological impairment. The symptoms are real enough, but the existence of a separate disorder is open to question.

I just had my son evaluated by an OT at his LD school. One eval, he had to hold two different positions as long as possible. One he held for 11 seconds and one for 18 seconds. A 6-year-old should be able to hold each position for 30 seconds. My son is 9. The muscles used to hold these positions are the same muscles needed to sit at a desk for extended periods of time. So he doesn’t have the muscle development to sit in a desk and so he fidgets and slouches and squirms in his seat.

The OT is going to work with him on that.

Also he has fine motor issues, bad handwriting, and a bad pencil grasp and the OT will work on that.

He didn’t meet the criteria for SI and I didn’t expect to. He does have some areas of need and the OT will work on it an hour a week.

The moms I have talked to say OT was the best thing for their child, over anything else they tried.

[quote=”Anonymous”]
The moms I have talked to say OT was the best thing for their child, over anything else they tried.[/quote]

Just FYI, OT does not necessarily mean sensory integration therapy. There are plenty of OTs out there who work with kids with motor issues by using more traditional approaches. The Jean Ayres SID approach is of relatively recent vintage. OT can really help kids with things like handwriting, zipping, buttoning, tying shoes. The research has not established, however, that is it useful for LD or ADHD or that it reduces symptoms of sensory defensiveness, etc. My kid had 7 years of OT and I think it helped. His private OT (first 3 years) used a combination of approaches, including some SI stuff. School based OT was more practical and, frankly, ended up being more useful, although it may have been a function of him maturing. For those parents out there who think their child “just” has SID, I’m sugggesting that you might want to consider the possibility that there is more going on than that because SID may be something of a euphemistic diagnosis.

[quote=”Anonymous”]Can anyone point me in the direction of some research on the effectiveness of sensory integration therapy? An OT examined my child and recommended this therapy but my pediatrician says there is no proof it works for ADHD. It sounds like something that might help, but I don’t want to waste money if it really won’t be useful.

I am an occupational therapist assistant and firmly believe that sensory intergration therapy would benefit your child. I use these techniques in my practices for early intervention up to high school students. Before peforming any activities that require sitting at a table such as at school. I have the child perform sensory activities to improve ogranization of the the nervous system to decrease “nervous energy” to calm the student. This will improve focus and attention span and you will see your child improve.]

I have a seven year old son who recently received a private OT eval. Some of his weaknesses were with his motor skills, some with sensory integration, all over body awareness, and so on. I have three pages of recommended activites to do at home with him to help him improve these areas. If anyone is interested in these lists, please send me a PM and I’ll be glad to share.

While I understand that following strict scientific controls is a problem that many successful studies have had which undercut their degree of conficdence, making blanket statements discrediting findings is not necessarily the best response.

I also have a problem with people who dismiss out of hand the experiences of literally hundreds of people under the heading “anecdotal”, as though they were talking about oral traditions passed down from the ages and not the firsthand experiences of credible people.

Also, I find it interesting that certain groups of professionals will dismiss one set of studies for strict scientific adherance flaws, but will embrace other studies which jive more with their personal opinions which have the same type of flaws.

Speaking specifically about SI and the placebo effect…

My boy benefitted from SI (brushing and deep pressure) in quantifiable ways. It reduced his aversions to certain textures and sounds, increased his ability to focus and his receptive language skills, and also reduced his hyperactivity.

My specific quetion is, how do we achieve placebo effect in a non-verbal 5 yo with full-blown autism who would refuse to comply with 100% of requests made of him, and yet demonstrated improvements in behavior using industry-accepted measuring devices (CARS and GARS) conducted by independant and experienced evaluators who had zero stake in the therapy employed?

[quote=”Dad”]

Speaking specifically about SI and the placebo effect…

My boy benefitted from SI (brushing and deep pressure) in quantifiable ways. It reduced his aversions to certain textures and sounds, increased his ability to focus and his receptive language skills, and also reduced his hyperactivity.

My specific quetion is, how do we achieve placebo effect in a non-verbal 5 yo with full-blown autism who would refuse to comply with 100% of requests made of him, and yet demonstrated improvements in behavior using industry-accepted measuring devices (CARS and GARS) conducted by independant and experienced evaluators who had zero stake in the therapy employed?[/quote]

Dad,

The problem with “observations” by parents about positive effects from particular treatments, is that parents themselves are susceptible to the placebo effect. It is a basic human tendency to credit those occurences which fit their belief and to ignore those occurrences that don’t fit. Our minds are wired to reject cognitive dissonance. Humans are not computers; we aren’t objective. The more a parent believes that a treatment is effective, the more likely it is that the parent will observe what they interpret as positive results, even if those results cannot be objectively established. (And vice versa, for that matter. If the parent is leery of the treatment, he or she will be more likely to “observe” negative results) The problem with anecdotal reports is that it is impossible to fully weed out or account for the personal belief of the individual offering the report. That is why good studies are conducted using a double blind method — researchers are human too and when they know whether someone is getting the real deal vs. a sugar pill, their observations will be colored just like everyone else in the world. It is important to understand that the subjectivity that colors our observations is not deliberate — its just the way humans are. Sometimes what we observe can be verified and quantified. Sometimes what we observe is a product of our minds rejecting facts that don’t fit into our particular beliefs. That is why rigorously conducted research is so important.

Darn! Forgot to add my final point: your boy showed improvement as measured by objective scales, but really good research would have made sure that the observer filling out those scales did not know about the treatment received. Then, if those results were replicated across a large enough number of children with the same issues/diagnosis as your son and under the same rigorous protocols, we would have basis for saying this is a treatment likely to help most children who have the same diagnosis and symptoms.

And that was my point. The person who rated my boy had no knowledge of what (if anything at all) that we were doing. She is a diagnostic specialist trained to use the best tools available for evaluation of autism (CARS and GARS). The placebo effect that is suggested may occur in myself as a parent does not hold water in my case, because we have had 3 other interventions, two of which were failures and neither myself nor the other adults involved with my child saw any change in my boy when we tried them.

I do not dispute that placebo occurs; to the contrary, I know that in many cases it does. I just have a very difficult time with sweeping statements made about a particular intervention that I know from firsthand experience does what some would say it does not.

I have seen the APA make other statements of null-effect concerning non-psychologist generated treatments that have later panned out. I think that that also plays a part in what they have said about SI.

I have only recently heard the term sensory integration and have not done very much research (other than asking the slp about it at school). This is a pretty new idea and was not around when I was in school. However, much of what I have learned rings true with me. I have ADHD and have very sensitive skin. I love the trend of low rise jeans because I cannot have anything around my waistline ( and even wore mens jeans in college to avoid women’s style wastebands). I am also very picky about the texture of the clothes I wear. My mom thinks that part of why I was so cranky as a baby was that I was so sensitive to textures. I get sensory overload in noisy social situations and places like the mall and airports. It makes me very irritable and I just want to lie down and go to sleep. I am also very weird about personal space. In large crowds I panic (and get very irritable) if people are pushing up against me, or I feel like I don’t have enough “elbow room”. As an adult I don’t see myself seeking any treatment for these, but thought it might give some insight for those with small children who have similar symptoms.

Good book on this subject “The Out of Sync Child”, there is also a more recent follow up book.

My ADHD son canot have tags in his underwear (excuse me he wears BOXERS because he cannot stand the elastic in briefs), and cannot wear sneakers that lace through the leather instead of having loops, cannot eat foods with any strong odor or texture, and wears his pants like he belongs singing rap with Eminem since he cannot stand the feel of pants on his waist. He sleeps in August (all year round) with a Down comforter because he needs to feel the weight on him or he cannot sleep!

This must be common since tagless underwear is all the rage, most sneakers are made with loops, and hipster jeans are all you can find for girls (I need them to make them for boys now too).

The company Southpaw Enterprises sells weighted blankets, vests, hats, and lots of other products tailored for kids who have SPD (sensory processing disorder; what it’s being officially called now). My 4-year-old loves blankets and also pillows—anything for the squished feeling! Temple Grandin, the famous autistic author and professor, actually invented a device that you can get into and receive deep pressure.

[quote=”mmm214”] SPD (sensory processing disorder; what it’s being officially called now). [/quote]

Who exactly is it that has decided on the “official” name for a group of symptoms that has yet to be solidly defined as a freestanding disorder? Whatever you call it, there is NO evidence that a person “just” has SID or SPD. Instead, although the difficulties are absolutely real, they are a sign of an underlying, brain-based problem. That is why we see sensory defensiveness, etc., with autism, ADHD, LD, CP, and traumatic brain injury. Temple Grandin, for example, is well known to be autistic.

Lucy Miller, who is doing the most research on this right now, calls it SPD. When you start doing searches on this stuff, you find that it goes by a lot of different names/acronyms: SIDS, DSI, etc. Maybe SPD is used by her to distinguish it more from other conditions. I’m part of a group that is studying this, and we’re going by what she says.

I believe it’s worth recognizing as a singular disorder, even if it is typically part of a larger package. It can be a devastating condition in itself, without all the other problems. (My son has no other diagnosis, and his symptoms are mild—maybe something will come up later, but at least I understand how to help him right now. I mean beyond the o/t stuff.) Trying to understand the etiology of the thing can’t hurt, and might shed some light on its connection to LD, autism, etc., and maybe even help with new therapies for these disorders.

I was just wanting some imput on DSI. My grandson was just diagnosed with this and I know very little…just what I have read on the computer. So if anyone out there has information on this subject please reply.Thanks for any help.