Developmental Sensory Disorder: Contributions From A Clinical PerspectiveEdward Goldson, M.D.
The Childrens Hospital Parents, teachers and other child care providers refer children to the pediatrician or family care practitioner seeking help in the diagnosis and care of children presenting with the signs and symptoms of what is being labeled a sensory processing disorder. These children are disorganized, angry, on occasion aggressive, frustrated, frightened, have explosive behavior, are unable to process the information that comes to them from their internal and external environments and frequently have major difficulties learning. These are very complex behaviors and probably do not reflect a unitary disturbance in neurodevelopmental functioning. Instead, these behaviors may reflect a final common pathway for a number of disorders among which are problems with processing sensory information. How to tease apart these various etiologies is indeed a challenge for the child care provider, the parent, the educational system and the researcher. Furthermore, how we intervene should be directed by our understanding, if possible, of the underlying disturbance(s). If one considers the various levels that need to be considered, there is the clinical presentation which is influenced by the neurophysiologic process which in turn is directed both by genetic characteristics and environmental experiences. A number of assessment tools have been utilized in research to describe and characterize children presenting with the clinical picture of Sensory Processing Disorders (SPD). Among the questions that need to addressed is the taxonomy of this disorder which in turn can direct investigation into the nature of the disorder and then inform intervention and efficacy of intervention. How do we conceptualize this clinical picture? Moreover, how can we and should we use the research assessments in the clinical setting? What do we do with this information? Parents, clinicians and children are asking for help. Linked to strategies of intervention are behavioral and pharmacologic treatments. We are currently very pharmacologically focused. Medications are frequently used indiscriminately yet in some circumstances can be helpful. We need to think broadly and characterize as rigorously as possible what clinicians are observing, what the research tells us and how we should intervene. We need to providers with a broader perspective about these children and avoid medications when possible, yet recognize when they need to be used. Linked with this issue is the fact that we need to convince clinicians that SPD is a real entity or entities. We need to have the research and clinical observations that demonstrate that these disorders do exist, have negative effects on children and are treatable either as free standing problems or as contributing to other neurodevelopmental disorders such as autism, learning disability, ADHD, etc.
SPD, at least as a clinical entity, is real. It is recognized that children do have these difficulties and we are beginning to understand some of the physiological underpinnings for these problems. Our challenge is to integrate our information and be able to respond to the clinical demands presented to clinicians on a daily basis.