As a pediatric occupational therapist for 30 years, reading the American Academy of Pediatrics policy statement on sensory integration therapies for children with developmental and behavioral disorders (American Academy of Pediatrics, 2012) impacted me deeply. My reaction is bests summarized by the movie title The Good, the Bad, and the Ugly.
The Good is the best practice directive for implementing sensory integration interventions strategies (also called sensory processing, sensory-motor, and sensory strategies) for developmental and behavioral disorders. I agree with the policy that best practice is the use of sensory integration intervention to achieve sensory related functional goals as one component of a comprehensive treatment strategy. I also agree with the pediatrician statement that in certain specific situations behavioral strategies can be more affective than sensory integration for children with severe Autism who do not respond to people. It is helpful to be reminded of these best practice guidelines.
The Bad of the pediatrician’s policy are several deceptive omissions that may harm children and confuse parents. First, while the policy mentions that sensory integration is used by occupational therapists, they do not mention that it is one of several approaches that occupational therapists comprehensively use with children who have developmental and behavioral challenges. My occupational therapy interventions for children with developmental and behavioral challenges often includes sensory integration in purposeful play activities but equally utilizes the behavioral, cognitive behavioral, mindfulness, massage, and developmental frames of reference. Second, the policy statement omits that OT uses sensory integration interventions because there is evidence they provide effective activities (Smith et al., 2005) and environmental modifications (Dunn et al., 2012). Sensory activities can frequently initially be the only intrinsically motivating interactions with children who have developmental and behavioral challenges (Parham et al., 2011; Pfeiffer et al., 2011), and can be clinically effective in reducing the need for or amounts of medications with potential side effects prescribed to manage behaviors.
Given the recent seated academic emphasis beginning in pre-school, sensory strategies provide a needed active multiple intelligence approach to learning that involves bodily-kinesthetic and visual-spatial experiences enabling learning in students with developmental and behavioral challenges (Brand, 2006). In my work over the past 30 years treating children with severe developmental and behavioral challenges I’ve found sensory strategies are an important frame of reference that integrates extremely well with the behavioral (Pivotal Response Training) and developmental models. I obtained a Master’s Degree in Special Education and a Ph.D. in Marriage & Family Studies but chose not to pursue certification as a special education teacher or Marriage & Family Therapist. While I team extensively with and greatly respect Special Education teachers and Marriage & Family Therapists, I stayed only an OT because I‘ve found great value in occupational therapy including use of a sensory integration intervention model.
The ugly is the confusion the omissions mentioned above in the American Academy of Pediatrics policy statement on sensory integration therapies for children with developmental and behavioral disorders bring to parents and medical doctors and the lack of respect they convey to the occupational therapy profession. Which leads me to the reason that while I hate conflict with doctors, I wrote this response to the American Academy of Pediatrics policy statement on sensory integration therapies for children with developmental and behavioral disorders.
Many years ago I worked with a child who had severe developmental and behavioral problems and was being expelled from preschool. His mother had me work with the preschool using a combined sensory integration and behavioral frame of reference. The teachers implemented my consultation suggestions and were pleased with his behavioral improvement, when suddenly the mother stopped the OT at the urging of her pediatrician who said “I hate the OT sensory stuff”. The child’s behavior deteriorated and he was eventually heavily medicated for his behavior so he would not be expelled.
I work extensively with pediatricians (mostly developmental pediatricians) and continue to respect pediatricians. While I appreciate their best practice reminders I worry that the American Academy of Pediatrics policy statement on sensory integration therapies for children with developmental and behavioral disorders will prejudice pediatricians against occupational therapists, and hurt pediatrician’s relationships with parents who appreciate what we do to help their children.
References:
American Academy of Pediatrics. (2012). Policy Statement: Sensory Integration therapies for children with developmental and behavioral disorders. Pediatrics, 129; 1186-1189.
Brand, S.T. (2006). Facilitating emergent literacy skills: A literature-based, multiple intelligence approach. Journal of Research in Childhood Education, 21(2), 133-148.
Dunn, W., Cox, J., Foster, L., Mische-Lawson, L. & Tanquary, J. (2012). Impact of a contextual intervention on child participation and parent competence among children with autism spectrum disorders: A pretest-posttest repeated-measure design. American Journal of Occupational Therapy, 66, 520-528.
Smith, S.A., Press, B., Koenig, K.P., Kinnealey, M. (2005). Effects of sensory integration intervention on self-stimulating and self-injurious behaviours. American Journal of Occupational Therapy, 59, 418-425.