is there such thing as sensory processing disorder?

Published March 31, 2009 by Nancy

Quackwatch has an article on sensory processing disorder (SPD) entitled “Why ‘Sensory Processing Disorder’ is a Dubious Diagnosis.”

The authors says there is no such thing.

I read the article. Although grammatically well written, my editor pen was twitching.

Here are my editorial concerns for the author.

1. Define entity.

This is important. For the author (a pediatric neurologist, according to Google), a medical issue is a entity when it has been tested and proven to be a thing.

How? The author doesn’t say. He just says SPD studies are flawed, but then he doesn’t go into detail. What is lacking in these studies is your and my guess.

He says he found the studies too small, with too much observation and anecdote. Fine. But what do these studies need instead? That information is missing.

And are learning disabilities, ADHD, and Asperger Syndrome entities according to his definition? The author mentions them as if they are entities. Yet many specialists have doubts about LD, ADHD, and ASD as entities. There are too many different kinds of each. Some respond to one kind of treatment, others don’t. Some improve with age, others don’t. In some respect, these disorders are just groups of symptoms lumped together and given a name.

The author doesn’t seem to have the same entity concerns with LD, ADHD, and ASD as he does with SPD. See #2.

2. Define distinct disorder.

The author says that most of the SPD research has been on ASD, LD, and ADHD kids (instead of on “normal” kids). He says these kids are known to have “sensory issues” so they shouldn’t be considered to have SPD. Instead, “sensory issues” should be considered part of the underlying condition they have.

Then why does such a diverse group of developmental disorders all have “sensory issues” as a component? If “sensory issues” were distinct, relevant to only one disorder, then it could be considered an effect of that particular disorder. But when it appears in several groups, then it is more than just an effect of an underlying disorder.

How important is distinctness? It’s not a criteria for the acceptance of many disorders.  ASD, LD, and ADHD aren’t very distinct among themselves. Many kids have more than one of these diagnoses.

I can’t figure out why distinctness is such an important idea for this author.

3. Define sensory issues.

What does it mean to say that ASD, LD, and ADHD kids have “sensory issues” but they don’t have SPD? Is SPD not the same as “sensory issues”? Are we not splitting hairs here?

4. Define chicken vs. egg

Certainly it’s true that if you have ASD, LD, or ADHD you are more likely than other people to have “sensory issues.” But it is equally true that if you have “sensory issues” you are more likely than other people to have ASD, LD, or ADHD.

Which comes first: the sensory processing disorder, or the learning/developmental disorder?

The author holds that the learning/developmental disorders come first.

I find it far more reasonable to hold that the sensory issues come first. After all, a broad group of disorders all share sensory processing difficulties. What do you think — are LD, ASD, and ADHD types of sensory processing disorders? See #5.

5. Define anxiety

The author believes (and includes “most” other pediatric neurologists with him) that anxiety causes “sensory issues.” He adds ( as an extra snub at the parents of kids who pay for SPD therapy) that kids with anxiety often come from families with anxiety disorders.

Certainly anxiety and sensory processing difficulties are linked. But correlation is not causation.

The anxiety/sensory argument is another chicken and egg question. See #4. Does anxiety cause sensory problems? Or do sensory problems cause anxiety? Or is there are snowball effect? And if so, what comes first?

My guess is that the sensory problems come first. Think about it. You have to be anxious about something. The CNS doesn’t just wake up one morning and decide, “Hey, I think I’m going to be anxious!” Bewildering senses in a child dependent on the senses for accurate information is certainly a reasonable cause for elevated anxiety! From there, it snowballs.

No, I can’t prove it. See #2.

6. Define standard

The author maintains that there isn’t proof that SPD therapies work. Most studies are observational. The gold standard of a double-blind study has not been applied. Therefore, nothing has been proven to work.

The medical establishment’s obsession with the “gold standard” drives me right round the bend sometimes!

Listen up. You can only do a double-blind study on treatments where the clinician doesn’t know what he or she is administering. So, drugs, supplements, and lotions - that’s it. For everything else, the clinician knows what he/she is doing. Moreover, so do the kid and the parent.

Translation: It is impossible to do an SPD study that meets the gold standard.

Another translation: The medical establishment’s standards are skewed in favor of pharmaceutical treatments.

The author advises families with anxiety issues to seek out standard therapies for these problems. Translation: drugs.

Quel surprise.

7. Define spontaneous improvements

First, the author holds that there are no adults out there with SPD.

I beg to differ. I am married to a fellow with significant sensory issues.  Because he was not diagnosed as a child does not mean he doesn’t have it. It just means that there are no stats on it. One should not confuse the absence of statistics or complaints with the absence of the issue.

Second, the author also holds that SPD kids improve with age. Since they improve with age, that means SPD is simply neurological immaturity.

Certainly these kids do improve with age. But is that true only because their neurological systems age? Or is it also because day-to-day movements, sensory exposure, exercise, and trial and error teach the kid’s senses over time to work better?

The brain is not a piece of hardware. It is more like software. It programs itself. It changes and develops.

Neurological development doesn’t just happen because the calendar date changes. It happens because of the body’s work.

Many ADHD kids seem to “outgrow” their issues in their mid-teens too. Does this mean that there is no such thing as ADHD? Or does it mean that ADHD and SPD belong in the same category?

Either you accept both as neurological disorders that improve with age, or you reject both as neurological disorders entirely. But not just one and not the other.

****

The article is a good example of the medical establishment’s very well-meaning circular arguments. It starts with a set of assumptions and accepts them without proof, then holds to an impossible standard of truth the concepts it is arguing against.

My opinion.

ADHD vs. sensory processing disorder

Published March 30, 2009 by Nancy

How easy is it to tell the difference between ADHD and sensory processing disorder (SPD)?

Not.

Both make kids bouncy and inattentive. Both can cause learning disabilities. Up to 50 conditions mimic ADHD, and SPD is one of them. Time magazine is calling SPD “the new ADHD” — missing the point that maybe it’s the old ADHD!

The problem with ADHD is that it is diagnosed by observation, not by tests. So it’s all in the interpretation.

A neuro-different kid with a grab-bag of behaviour and attentional issues is more likely to get an ADHD diagnosis than anything else. The diagnosing practitioner is usually very, very insistent.

Will a trial of stimulants to “prove” whether or not it’s ADHD?

Unlikely. Stimulants work for everyone. Ritalin is a more popular drug than opioids on college campuses–because it helps with all-nighters and long reports.

For anybody.

So ritalin isn’t “proof” of anything.

Also, stimulants have significant side effects, some of them long-term. Kids with SPD have heightened sensory responses and anxiety, so they can end up developing tic disorders and paranoia.

My opinion — meds are not a route to take unless you know the kid has ADHD and nothing else has worked.

So what’s the difference between ADHD and sensory processing disorder?

There is no short answer. But here are some points to consider:

  1. SPD is still controversial. I don’t know why, but it is. Many psychs don’t “believe” in it. But most psychs believe in ADHD. Hence the high rate of ADHD diagnosis.
  2. Occupational therapists who specialize in sensory problems are best at diagnosing SPD. In fact, they’re the only ones who really know what it is. So see the psych, then see the OT, then decide who’s right.
  3. Just to make it more complicated, a kid can have both ADHD and SPD. Or SPD and LD (learning disabilities), which can look like ADHD. So having one doesn’t cross out the other.
  4. Was your kid grouchy as a baby? Did the colic never end? This suggests a possible sensory problem.
  5. Is your kid left-handed or no-handed? Big clue. SPD kids often have handedness issues.
  6. If the kid does not have a learning disability, then lean toward SPD. ADHD is a learning disability condition. It’s probably not ADHD if school grades are good and attention for things he/she likes is fine, even if he/she has the behaviour of a gibbon and a mind perched in a different galaxy.
  7. Consider sensory integration programming, regardless.It’s extremely helpful to ADHD kids, even if they aren’t classic SPD.

heart-rate variability

Published March 30, 2009 by Nancy

We saw the doctor at the neurofeedback clinic over (Canadian) Thanksgiving.

He said good work etc., but we need to shift the focus onto heart-rate variability.

HRV involves using a breathing belt around the waist and a pulse monitor on the finger, instead of electrodes attached to the head. The computer presents two graphs: one for breathing, one for heartrate. The object is to get the rise and fall of these two graphs to match.

To do this, the child has to find the optimal breathing speed, which is usually slower than normal. When the heart-rate functions in response to the breathing, instead of independently, then the sympathetic and autonomous nervous systems are working in synch.

The child will feel calmer.

With a little practice every day, the child learns to feel this in-synch rhythm and feels more in control. In a very short time, staying in synch becomes natural. Stress and anxiety go down, and the child is calmer.

rethinking school

Published March 30, 2009 by Nancy

schoolSchool and Sensory ProcessingI’m starting to wonder if the whole concept of school is a bit like a rotary dial telephones.

Public schooling was developed in the mid 1800s to early 1900s to give reading, writing, and ‘rithmetic to the masses. Most people were farmers, hence the summers off.

It was a system where teachers hit kids who didn’t cooperate and labelled unsuccessful kids “dunces” and humiliated them. There were no learning disabilities, no disadvantaged parents, no social skills training, no autism spectrum. There wasn’t even much kindness.

All kids faced the front because they had to watch and listen to the teacher, who was the main source of information. They could also look at books, the alternative source. They sat at desks because the point of education was to write. They were supposed to sit still, not run around, even if that’s what their bodies were screaming at them to do.

And here we are today, past year 2000, still with more or less the same model.

Despite what we know about differences in child development

And neurodiversity.

And the problems with age groupings.

Despite the internet.

Despite changes in the family structure, parenting, parent education levels, and the urban work schedule.

Sure, some people have experimented with alternative schools and home schools.But the majority of kids still go to schools.

Where learning is painfully slow if you are bright, and painfully fast if you are learning disabled.

Where extroversion is rewarded and introversion denigrated.

And where ASD kids have suffered for decades.

The problem with school is something called Normal.

Normal doesn’t exist, yet it’s the thing school revolves around. And if you’re not in or near this Normal, school ends up making you feel like a freak. It takes years to shake it off.

I don’t know what the alternatives are. Sometimes I picture a hybrid learn/work program, where kids shadow adults part of the time, learning work-based skills, and then learn from school and the internet at other times. Or maybe all kids belong with their parents at work, in separate classroom areas, where they do lessons by internet based on their own interests, and work the rest of the time by their parents side. When kids don’t want to do school and learning, they do something else.

But maybe that’s too organic for our culture.

I know my kid would be happier.

the museum meltdown 2

Published March 3, 2009 by Nancy

Well, weren’t we the model family at the science museum last week!

No meltdowns, no yelling, no frustration.

Sure, we had to spend an inordinate amount of time at the visual game-maker exhibit. But heck, we were there early, and there was nobody in line. We did all the other stuff too.

What was remarkable was that there was no fuss. Just cooperation and enthusiasm.

A miracle, maybe. But I’m attributing it to six intensive months of neurofeedback.