Monday, October 30, 2006

DSM and SPD: Are we ready?

October 25-31 is National Sensory Awareness Week and The Knowledge in Development (KID) Foundation is working to obtain inclusion of Sensory Processing Disorder in the DSM (Diagnostic and Statistical Manual). DSM classification would presumably raise awareness of the disorder and contribute to appropriate diagnosis and recognition. The press information from the KID foundation also states that the addition of SPD in the DSM will help reimbursement for treatment.

I fundamentally agree with this effort but I really wonder if we have enough information about sensory processing disorders to present a cogent argument for inclusion. According to the American Psychiatric Association "each disorder included in the manual is accompanied by a set of diagnostic criteria and text containing information about the disorder, such as associated features, prevalence, familial patterns, age-, culture- and gender-specific features, and differential diagnosis. No information about treatment or presumed etiology is included."

Although we have made some excellent progress toward developing tools to identify sensory processing disorders (i.e. The Sensory Profiles) I am not sure that we have completed the research to gather prevalence, familial patterns, or other features. There is some preliminary evidence that we have done about linking measured neurophysiological differences to Sensory Profile scores - which provides some good scientific validation, but I don't know that we have done enough yet.

Finally, we should not rely on a DSM-IV or DSM-V inclusion to support reimbursement. If children who have SPD also have significant impairments in functional performance then short term occupational therapy intervention would be presumably be covered under a related diagnosis code. We really don't know if SPD is a diagnosis unto itself or if it is a clinical feature that is sometimes associated with other conditions. Again, more research is necessary to make this distinction.

In the meantime I strongly recommend that we continue our research efforts to focus on validating neurophysiological markers associated with atypical Sensory Profiles as well as use of tools such as the Children's Assessment of Participation and Enjoyment or the School Function Assessment to measure any performance/function related difficulties of children who presumably have a sensory processing disorder. Gathering additional data related to prevalence, familial patterns, etc. would also be helpful.



References:

American Psychiatric Association (n.d.) FAQs about DSM. Retrieved 10/30/06 from http://www.dsmivtr.org/2-1faqs.cfm

Brown, C., Tollefson, N., Dunn, W., Cromwell, R., & Filion, D. (2001). The Adult Sensory Profile: Measuring patterns of sensory processing. American Journal of Occupational Therapy, 55, 75-82.

Miller, L., McIntosh, D., McGrath, J., Shyu, V., Lampe, M., Taylor, A., Tassone, F., Neitzel, K., Stackhouse, T., & Hagerman, R. (1999). Electrodermal responses to sensory stimuli in individuals with fragile X syndrome: A preliminary project. American Journal of Medical Genetics, 83(4), 268-279.

The KID Foundation (2006, October 12). Advocacy. Retrieved 10/30/06 from http://www.kidfoundation.org/advocacy/

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