I wasn’t entriely surprised to receive the item above in my inbox this morning. The headline, Pediatricians doubt effectiveness of sensory integration therapy, smacks a bit of yellow journalism when you consider that the Reuters article on which it is based is titled Pediatricians raise caution on sensory-based therapy. The issue here is a Policy Statement published online yesterday in Pediatrics, the official journal of the American Academy of Pediatrics, titled Sensory Integration Therapies for Children With Developmental and Behavioral Disorders.
1. At this time, pediatricians should not use sensory processing disorder as a diagnosis. When these sensory symptoms are present, other developmental disorders – specifically autism, ADHD, developmental coordination disorder, and anxiety disorder – must be considered first, and be thoroughly evaluated by a developmental/behavioral pediatrician, child psychiatrist, or child psychologist.
2. Pediatricians should advice families about the limited data on the use of sensory-based therapies for childhood developmental and behavioral problems.
3. If the pediatrician is managing a child whose therapist is using sensory-based therapies, the pediatrician can play an important role in teaching families how to determine whether a therapy is effective.
4. Pediatricians should inform families that OT is a limited resource, particularly the number of sessions available through school and through insruance coverage.
We are familiar with these kinds of Policy Statements by the AAP, cloaked in a mantle of scientific concern, but usually with a hidden agenda. Developmental and behavioral optometrists have been countering the AAP’s misrepresnetation of vision therapy for decades. This policy statement has all of the same ingredients: OT is covered on a limited basis by third parties (as if the parent doesn’t have an option for paying privately!), it’s research base is questionable, and what it claims to treat is better treated elsewhere. It even casts aspersion by citing a small study (involving four children on the autistic spectrum) cautioning that SI therapy by OTs can do more harm than good! I say that none of this surprises me because I have heard directly from OTs during my seminars that pediatricians have been giving them a tough time. I suspect that in the drive to establish primary care pediatrics as the child’s medical home, pediatricians have become more aggressive in cherry picking cost containment issues. It’s expedient to point fingers at other professions, such as OT, rather than turning the magnifying lens inward. The irrationality of the Policy Statement is evident in just one of its recommendations. If one looks at the body of evidence in support of treatment for developmental coordination disorder (DCD), which the AAP is endorsing, it is clearly not better than sensory processing disorder (SPD) which it is disputing.
I am sure that we’ll be hearing from the AOTA about this. In the interim, I’ll side with colleaguse such as Dr. Fortenbacher who advocate for collaboration between OTs and ODs on sensory integration therapy and vision therapy. We would all do well to take this latest AAP policy statement with the grains of salt it deserves. I know that most parents will.