I received an email today regarding a parent who was interested in finding training on how to implement a 'brushing' program on their five year old child. The child's therapist allegedly encouraged the parents to research it themselves - which seemed a little odd to me. This got me thinking: perhaps there is a population of therapists who just can't find resources on the Wilbarger Approach.
I can understand the frustration. There has been very little published in the literature about this approach - perhaps the two most-cited references of the authors themselves are Wilbarger and Wilbarger (1991) and Wilbarger and Wilbarger (2002). These are not research studies; they are just descriptions and theoretical ideas about the concept of sensory defensiveness. There are studies that have been published by others but they have been single subject designs or they have been published in newsletters. The Sensory Defensiveness website (allegedly sponsored by Patricia Wilbarger) has promised answers to frequently asked questions since sometime in the mid to late 1990s. I think it is an abandoned site.
For many years (going back to the early 1990s) I recall that the Wilbarger Protocol was a hot topic in the occupational therapy continuing education world. How many OTs attended those training sessions? Is it possible that 3,500 therapists paid for this training? At a hypothetical cost of $300 for a conference, is it possible that over $1 million dollars has been spent on learning about this intervention? That is an interesting question.
I was hard pressed to find a training session for the Wilbarger Protocol today. You can order a VHS tape for $30 at Professional Development Products. Is there no more demand in the OT market for the product that it has been relegated to the discount bin in the continuing education world?
Well for an intervention that was virtually ignored by researchers the Wilbarger Protocol certainly had some legs. It still does, if you use Google as any indicator of popular interest in a topic.
Lucy Miller made an extremely cogent argument about the need to "promote research that leads to better diagnoses and effective interventions" as opposed to making "unequivocal and emotional statements." I agree with her argument completely, but as the title of this entry implies - how long are we supposed to wait for this research to be done? The approach was developed and many people were trained. There were promises made that 'research is coming soon,' but I haven't seen it.
While surfing around tonight I think I found a potential source of very useful information - and I think we might be able to thank Ruth Segal. I believe that I met her a couple years ago at an SSO conference, and I wish I knew then that she was interested in this topic. Anyway, an old web page from NYU states that one of her research projects was on "The perspectives of children, caregivers, and therapists of the brushing and compression program for sensory defensiveness." I haven't been able to find out if this has been published, so if anyone knows I would be interested. The point here is that she thought this research might help us to "understand the phenomenon of embracing or rejecting new interventions." In my opinion, this really represents the 'bottom line' on this entire discussion. Why do OTs embrace these interventions - and why do OTs hold on to them in the absence of supporting research?
Most importantly, have we served the public interest by creating a 'demand' for a service that we have never supported with research and that we no longer even train therapists in?
Miller, L.J. (2003). Empirical evidence related to therapies for sensory processing impairments. Communique’, 31(5), 34-37. Response to: Shaw, S.R. (2002). A school psychologist investigates sensory integration therapies: Promise, possibility, and the art of placebo. Communique’, 31(2), 5-6.
Wilbarger, P., & Wilbarger, J. L. (1991). Sensory defensiveness in children aged 2 - 12. Santa Barbara, CA: Avanti Educational Programs.
Wilbarger, J.L. & Wilbarger, P.L. (2002). Wilbarger approach to treating sensory defensiveness and Clinical Application of the Sensory Diet. Sections in Alternative and Complementary Programs for Intervention, Chapter 14. In Bundy, A.C., Murray, E.A., & Lane, S. (Eds.). Sensory Integration: Theory and Practice, 2nd Ed. F.A. Davis, Philadelphia, PA.