The Debate Over DSI
As I read The Out-of-Sync Child and worked my way through checklists of symptoms, I was surprised that some of my son's behaviors were, literally, out of the textbook. But I also felt twinges of skepticism. Sure, my son hated being wrapped in a bath towel, but how meaningful was his aversion to terry cloth? My less volatile daughter objects to strong odors that don't seem to bother other people, and I simply chalk it up to an acute sense of smell. And many kids have tantrums or shut down when they're overstimulated.
In fact, most people have some sensory quirks. "But just because I go nuts when my hands are goopy doesn't mean I have DSI. I just stay away from kneading bread. You compensate," explains Kranowitz. Alarms should go off, though, when your child's behavioral tics begin to interfere with daily life. "Sensory integration functioning occurs along a spectrum," explains Dr. Miller. "It's not a disorder or disability until the daily routines of childhood are disrupted. If your child is able to sleep, play with other children, attend school, and be successful, he may have sensory sensitivity, but it's not DSI."
In fact, some doctors question whether DSI can exist in otherwise appropriately developing children. About 10% to 12% of these kids and 30% of kids with developmental disabilities like autism and ADHD have sensory processing problems. Adrian Sandler, M.D., a developmental-behavioral pediatrician in Asheville, NC, who chairs the American Academy of Pediatrics' committee on children with disabilities, agrees that just because a child is overly sensitive or undersensitive does not mean she has DSI: "She is simply unusually bothered by sights, sounds, touch, and so on." And in the absence of another diagnosis like, say, autism, he further argues that sensory processing problems are developmental. "They are likely to improve with time and may not require interventions," he says. In other words, DSI should not be considered a disorder but a behavioral pattern that normally developing children will often outgrow.
This skepticism is in part due to the condition's humble scientific pedigree. A. Jean Ayres, who first described the condition and coined the term, was an OT with a Ph.D. -- not an M.D. Her followers, occupational therapists, began having children swing on swingsets and touch textured objects to help them adjust and cope. They didn't ground their work in the kind of rigorous research that is the bedrock of science. "A lot of research needs to be done to investigate the validity of the approach," says Dr. Miller, who hopes that her work, which receives funding from the National Institutes of Health, will help give DSI the credibility it needs to gain broader acceptance -- and entry into the manuals that doctors refer to when treating a problem.
But in the absence of a formal diagnostic category, a growing number of doctors are recognizing DSI."Sometimes you have to take a leap of faith," says Chris Johnson, M.D., a professor of pediatrics at the University of Texas Health Sciences Center in San Antonio. She often directs her patients to OTs and says their parents usually report an improvement in their child's focus and motor skills.
Linda Paul (not her real name), a mother in New York City whose son, now 4, was so underresponsive to sensation that, as a baby, he would laugh after getting a shot, puts it more bluntly. "Some medical professionals pooh-pooh this diagnosis," she says. "But they don't spend every day with your child and see the treatment play out."