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.
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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.
I’m starting to wonder if the whole concept of school is a bit like a rotary dial telephones.