Sensory Therapies and Autism: Some Concerns

There are a lot of IEP's filled with interventions for which there is little if any scientific evidence of efficacy. HealthNews has an excellent report this week on some serious doubts about the use of many sensory interventions for children with autism spectrum disorder and Aspergers Disorder that calls many of them into question. Sensory therapies using brushes, swings and other play equipment are increasingly used by occupational therapists to treat children with developmental issues such as autism, but a large pediatricians organization says there isn't much evidence that such therapies actually work. And how often are children taken from the classroom to a "sensory room" for interventions such as brushing and swinging when there is so little evidence this makes sense?What is important is that before parents spend the time and money on taking children to sensory therapy, they should know that as of now many of these techniques are largely unproven. "It's OK for parents to try these types of therapies, but there is little research backing up the effectiveness of these therapies and whether or not they improve long-term outcomes for kids with developmental disabilities," said Dr. Michelle Zimmer, an assistant professor of pediatrics at Cincinnati Children's Hospital Medical Center. Zimmer is the co-author of a new American Academy of Pediatrics policy statement on what is often referred to as "sensory integration therapy." The policy statement appears online May 28 and in the June print issue of Pediatrics. According to the pediatrician group, "sensory processing disorder" should not be used as a "standalone diagnosis." No one disputes that children with conditions such as autism can have abnormalities in their responses to sensory stimuli, including sight, taste, touch and sound. For example, autistic children may have aversions to loud noises, to certain food textures or to being touched unexpectedly, Zimmer said. But that doesn't necessarily mean the problem is with their brain pathways for processing sensory information, as the term "sensory processing disorder" implies. Instead, some other issue could underlie their reactions to stimuli, such as a behavioral issue, said Dr. Susan Hyman, chair of the American Academy of Pediatrics subcommittee on autism and an associate professor of pediatrics at University of Rochester Medical Center, in Rochester, N.Y. Instead of chalking up various aversions or compulsions to sensory processing disorder, health care providers need to consider what other developmental issues may be going on with the child, such as autism, attention-deficit hyperactivity disorder (ADHD) and so on, Zimmer said. A full and comprehensive diagnosis needs to take place, along with a Functional Behavioural Analysis to determine the cause of the unwanted and harmful behaviours before employing unproven techniques, especially when they are often offered IN PLACE OF interventions that are known to work. "There has never been a study that has shown that a child can have just sensory processing disorder, isolated from another developmental disabilities, such as autism or ADHD," Zimmer said. In sensory integration therapy, occupational therapists put children on a "sensory diet," exposing them to different sights, smells, sounds and sensations, to improve the brain's ability to process the information. "For now, however, whether it works remains a theory," Dr. Zimmer said. In the absence of controlled clinical trials testing whether sensory therapies work, parents have to try to be objective, ask themselves tough questions about whether the treatment is really working, set specific goals and determine if the child is moving toward the target. "Is it improving the child's ability to function? That's where more research needs to happen," Zimmer said. Hyman, who studies sensory differences in children with autism, agreed. "The scientific testing of this intervention has not demonstrated that it is effective for all children as a standalone treatment," she said. "However, for individual children, it may be an important part of a total therapy package." "You don't want to spend a lot of time money and energy on a treatment if it's not right for them. They have to be prudent," Hyman said. "In the absence of data, parents have to utilize the information that's available to them in making choices." One serious problem is that children are removed from classrooms in order to effect this "sensory diet." Limited time, staff and funding is used to implement these unproven treatments, and there is little left to implement treatments that are known to work. It is far easier to get an aide to take a child to a sensory room to swing, or to brush them on the arm during class, that to get a staff member adequately trained in behavioural interventions. Often staff training and availability leads to certain interventions. When a child with moderate to severe behavioural issues is receiving a sensory diet, brushing, "social stories" and "walks" throughout the day rather than having a professionally trained behavioural specialist complete an FBA (Functional Behavioural Assessment) and implement a behavioural program, parents should wonder if this is due to an assessment based on science, or staffing availability and limitations. OTs (Occupational Therapists) and PTs (Physical Therapists) are highly trained and critically important members of any school intervention team. They can offer critical help and insight into working with children with autism spectrum disorder, ADHD and other similar conditions. But today there is an over emphasis on simple, easy and unproven interventions because schools simply don't have enough professionals trained to implement the most basic behavioural interventions ranging from token systems (positive behavioural reinforcement systems) to desensitization programs. These well tried, scientifically proven and studied techniques require trained staff members, something we seem to have fewer and fewer of with all the funding cuts our educational system has undergone. 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