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I have spent the first part of my career in pediatrics convincing parents, teachers, and other therapists that sensory processing is important for development, and that sensory processing disorders are a real “thing”. I am spending the latter part of my career trying to explain to the same groups that using a sensory-based activity does not constitute sensory treatment.
Why?
Results. You will not get good results to any treatment if the underlying principles aren’t understood and used correctly. This requires more than a therapy ball and a brush. A local school district uses general sensory activities for the whole class, rather than sensory-based treatment for kids with sensory processing disorders. I get a lot of private practice referrals from this neighborhood. The district’s refusal to address children’s needs in the classroom, while telling parents that they are “sensory-aware”, is frustrating to everyone, including the therapists in the district. They don’t seem to stick around…..
Therapy for sensory processing disorders requires an evaluation. Assessing the problem and identifying a rationale for the related behaviors or functional deficits is essential. Tossing out a sensory-based activity because it is fun, easy, or has worked for another child is the hallmark of a well-meaning provider that wants to help a child but doesn’t have the training of a licensed therapist.
A good example would be to offer teething toys to a child that chews their shirt. Sounds like a solid plan: oral seeking equals oral stimulation. But wait! What if the child is using oral seeking to address severe sound sensitivity? Isn’t it better to deal with the cause of the problem rather than the end-point behavior? You would need an evaluation to know that their greater problem is poor modulation and sensitivity.
Treatment techniques follow a pattern that is based on the brain’s neurological response to sensory input. I didn’t take courses in neuroscience because I liked looking at brain sections. I took those courses so that I could understand the structure and function of the brain!
The right intervention (movement, pressure, etc.) uses intensity, duration, specificity of sensory input, location of contact/input, frequency, and timing to achieve results. This sounds like a lot to consider, and….it is! The way OTs create a sensory diet isn’t by looking at what worked for another child. We look at what we observe, what we assess, and what the child’s performance demands are. Only then can we identify what should be used, how and when it should be used, and how to determine our next steps in treatment.
What about the child selecting the activity that they “sense” they need?
Well, if that were therapy, we would all simply set up equipment and let the child play. We are THERAPISTS, and we know that seeking input isn’t the same as treating dysregulation, aversion, or poor postural activation. Of course, we want and need kids to have a say in their sessions. But the idea that a child’s nervous system knows what it needs? That is like saying that since I like Doritos, then my body is telling me that I need more fat, processed carbs, and salt. Not.
A great treatment that isn’t used at the correct level of frequency or used when it is most needed is going to fail. So will the right frequency of treatment used vigorously rather than with skilled observation. Non-therapists can be taught a treatment intervention, but it takes training and experience to create a treatment program. This is no different from any other type of therapy. Psychotherapists aren’t just talking to you. Speech therapists aren’t simply teaching you how to pronounce the “r” sound. If it was that easy, we wouldn’t need licensure, or even a degree.
It would be a lot more fun. We make it look easy, and that is the art of OT.
I have just explained (some of) the science.
