Problem Kid or Label? A Look at Sensory Integration
Some Say Sensory Integration Dysfunction Is a Legitimate Diagnosis. Others Call It a New Name for a Familiar Behavior.
[By Stacey Colino in The Washington Post.]
http://www.washingtonpost.com/wp-dyn/articles/A935-2002Feb25.html
As a baby and toddler, Donna Kacin’s son seemed fussier and more frequently out of sorts than other kids his age. Loose-fitting socks or tags in the backs of his shirts would bother him no end. Any sudden noise would cause him to clap his hands over his ears. The only foods he would eat were white — bagels, noodles, bananas and cheese. Certain odors, such as those from pizza or hot dogs, would send him running from the room. And everyday transitions, such as leaving the playground, would induce meltdowns.
“Everything seemed to be a little harder for him,” recalled Kacin, a mother of two who lives in the District. “He protested a lot of things that other children seemed to take in stride.”
Such behavior often leaves doctors — and parents — scratching their heads. Many wonder if the baffling behavior is due to food allergies, an anxiety order, attention-deficit hyperactivity disorder (ADHD) or some other problem. Often they have the child tested for these conditions.
But now some of these parents, including Kacin, are being told their children may have a condition called sensory integration dysfunction, orDSI.
The term sensory integration dysfunction was coined in the 1960s by A. Jean Ayres, an occupational therapist in California who was interested in how sensory processing difficulties could interfere with the ability tolearn.
Occupational therapists (OTs) and other professionals consider DSI a neurologically based disorder that makes it difficult to carry out everyday tasks. This can mean children have a hard time playing, eating, dressing, going to school and getting along with peers — some of the most crucial early developmental challenges they face.
DSI is essentially “a problem of organizing and interpreting the sensory information once it comes in so that you can do something meaningful with it,” explains Lynn A. Balzer-Martin, a pediatric occupational therapist in Chevy Chase who specializes in diagnosing children suspected of having DSI.
But not all experts in child development and psychology are aware of the condition, and others are deeply skeptical about it. Despite its acceptance as a diagnosis among occupational therapists and some parents, DSI is not acknowledged by the leading publications in psychology and child development. It is not listed in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the bible of psychiatric disorders, or in the International Classification of Diseases (ICD-9), published by the World Health Organization.
If you search for the words “sensory integration dysfunction” in the National Library of Medicine’s database, which incorporates thousands of authoritative medical publications, not a single hit comes back. Use “sensory integration disorder” and it comes back with just one reference, to sensory problems related to autism.
“It’s not a part of my vocabulary,” said Karin Nelson, a pediatric neurologist and chief of the neuroepidemiology branch of the National Institute of Neurological Disorders and Stroke, which is part of the National Institutes of Health. The condition is not indexed in child neurology textbooks, Nelson said. “I don’t think it’s a neurologically acknowledged disorder.”
“It is not a distinct entity,” said Paul Lipkin, an assistant
professor of pediatrics at the Kennedy Krieger Institute and the Johns Hopkins School of Medicine in Baltimore and a member of the American Academy of Pediatrics’s Section on Children with Disabilities. “There is no standard, universally recognized diagnosis of sensory integration disorder. In the array of human qualities, there’s always a degree of variation. In the medical field, we always have to have a cutoff for what’s abnormal.”
Other practitioners believe that the cluster of symptoms is real and deserving of treatment, even though it is not yet scientifically validated as a distinct illness.
“It’s still a relatively new area for clinicians,” noted David Fassler, a child and adolescent psychiatrist in Burlington, Vt., who is chairman of the American Psychiatric Association’s Council on Children, Adolescents and Their Families. “My sense is that there are kids who have this kind of problem, and we’re still doing the research that’s necessary to define the parameters of the disorder. It seems that some intervention programs do have some positive effects for children. If it helps for a particular child — even if it’s early in the course of understanding why it helps — I think it’s something we need to look at seriously.”
In an answer in a Web-based forum for parents of children with DSI, occupational therapist Barbara Hanft explains why professionals may see the same symptoms in different ways — and as different conditions.
“Part of the problem … arises out of disciplinary perspectives,” she wrote. “For any individual child with learning and behavior problems, the MD may diagnose ADD or ADHD, the psychologist a mood disorder, the OT sensory integration, the speech pathologist … an auditory processing disorder, the teacher a specific learning disability, and so on. Each discipline has a narrow focus and defines brain function by what they have been trained to see.”
Acceptance of the legitimacy of DSI may depend partly on geography. “I find that most pediatricians in the greater Washington area accept the concept of sensory integration,” said Larry B. Silver, professor of psychiatry at Georgetown University Medical Center and author of “The Misunderstood Child: Understanding and Coping with Your Child’s Learning Disabilities” (Three Rivers Press, 1998). “If you were to go to Minneapolis, you may not see this. It depends on where pediatricians are trained.”
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http://www.washingtonpost.com/wp-dyn/articles/A935-2002Feb25.html
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