Tuesday, January 19, 2010

Folk taxonomies and sensory processing disorders

At least once or twice a week I get email or comments on the blog from people asking me if I think they or their children have a sensory processing disorder. The range of concerns most commonly includes one or more of the following: difficulty with attention, difficulty tolerating clothing textures, dislike of certain tastes or smells, or social anxiety.

The problem with diagnosis of these symptoms is that the field of learning disabilities or psychology or even psychiatry has a very poor record of diagnostic stability over time. Diagnosis tends to take on the flavor of 'current thinking' - so for example if you had these problems in Freud's time you would likely come away with a very different diagnosis than what you might receive today. That doesn't instill confidence in a person like me who is looking for a more universal and longstanding point of accuracy about these matters. A compelling example of this is the diagnosis of pediatric bipolar disorder, effectively described in this blog post.

Another example of this diagnostic problem is an article written a couple years ago by Ben-Sasson, et. al. (2007). The article described the diagnostic/labeling differences employed by occupational therapists and psychologists when considering toddlers who had sensory over-responsivity (from the OT perspective) or anxiety (from the psychological perspective). This article effectively demonstrates how professional training and item wording can strongly impact the way that different diagnosticians interpret common behavioral attributes.

When people think that a disorder is present I believe that it is most important to begin with actually determining if there is a functional behavioral problem that is interfering with ability to carry out everyday tasks. That can help us avoid falling into the trap of labeling every nuanced form of trait or characteristic difference that people may express. Humans are natural 'meaning-makers' and we don't advance the cause of understanding our patient's concerns unless we improve our ability to become armchair anthropologists about our own professional culture.

It might be interesting to write a blog post and call it "The Elementary Forms of Sensory Processing Disorder" and see how many occupational therapy researchers get the joke.



References:

Ben-Sasson, A., Cermak, S. A., Orsmond, G. I., Carter, A. S., & Fogg, L. (2007). Can we differentiate sensory over-responsivity from anxiety in toddlers? Perspectives of occupational therapists and psychologists. Infant Mental Health Journal, 28(5), 536-558.

Neuroskeptic (January 14, 2010). A brief history of bipolar kids. Retrieved from http://neuroskeptic.blogspot.com/2010/01/brief-history-of-bipolar-kids.html

2 comments:

Karen said...

Chris,

I was going through old filing cabinets here in Georgia and I found a printout from 2000 from hemikids on SI. It was written by Chris Alterio and I was like I bet that's my ABC dude...and I was right! You're like, everywhere. :) Good for you.

Chris said...

Ah, that was a long time ago! It was an excellent site and I think that Nancy Attwood has renamed the site Children's Hemiplegia and Stroke Association http://www.chasa.org/(but keeps the old name around for archived listserv messages).

I got a big chuckle about being identified as your ABC dude; it was an excellent comment and really made my day - thanks!